Two NHS staff walk with an elderly patient outside St Thomas' Hospital in London. Photograph: Getty Images.
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We need a revolution in public services to tackle multiple needs and exclusions

By focusing on prevention, prioritising relationships and driving down power to the lowest level possible, we can provide the support the most vulnerable in our society really need.

Across the country there is a small group of people who face multiple problems like homelessness, substance misuse, mental health problems and offending. They slip between the cracks of mainstream public services and they fall out of a political debate that is unrelentingly focused on majoritarian concerns.

And right now, the tricky politics of multiple needs and exclusions is even harder than ever. All contemporary policymaking operates within a brutal fiscal environment (on current forecasts, UK government spending will fall from 44.7 per cent of GDP in 2012 to 39.4 per cent in 2017) and whilst strict adherence to the present austerity trajectory should not be seen as a political inevitability, whoever forms the next government will not simply be able to open the spending sluices again. But tight public finances needn’t be a block on innovation. Large chunks of cash were spent on the problem under the last government and still resulted in insufficient progress. Now there isn’t any money anyway, it’s perhaps time to rip up the old models and start again. 

By coupling centrally-mandated targets and structures with substantial investment, New Labour achieved some notable successes in raising the standard of living for the poorest and most vulnerable in society, particularly children and pensioners. Yet critics on the right and left have described Labour’s approach as "poverty plus a pound", overly focused on income transfers to meet statistical definitions of poverty, rather than addressing its broader, structural causes. What’s more, the preponderance of an overly technocratic and managerial statecraft was ultimately too unresponsive to complex human needs.

The answer, perhaps, lies in the "relational state", an idea to which increasing attention is being paid. Rather than doing things to and for people, a state that works with people; that’s more strategic and less controlling; that prioritises the strength of human relationships over outcomes. It’s an approach that is particularly relevant for the issue of multiple needs and exclusions, with all the evidence of the last 15 years pointing towards the relational approach as being the best way of reaching a hugely problematic and expensive group of a defined size. As Lisa Nandy argues in the new Fabian pamphlet Within Reach, we are all unique individuals with our own lives, contexts and distinct solutions: we need a richer, more complex approach to public services that works with the "whole person" to find structural answers to deep-rooted problems.

This will require designing services around people and driving down power to the lowest level possible, rather than catch-all systems. As Julian Corner has written, people who face multiple needs and exclusions "are effectively where all the faultlines in the existing systems converge". He argues they should therefore be a "litmus test for the effectiveness of services used by a much wider group of people". Rather than trickle down, effective service design should geyser up.

People’s problems rarely sit comfortably within one government department, and this is especially the case for those living chaotic lives. Politicians are finally looking seriously at the opportunities of greater service co-ordination, which can drive the cost-effective improvements in standards that neither the market nor the central state alone can deliver. This is coupled with renewed interest in localism in policy circles, in part due to the diminishing returns achieved from the centre over 13 years of Labour government, and in part due to a growing recognition of the democratic empowerment potential of central government "letting go". This doesn't mean abandoning the central state’s role, but changing it, so that it is acting more as a hands-off convenor, setting a series of questions which local authorities are then empowered to answer.

Politicians from all parties can agree there is both a fiscal, social and moral case for providing extra support for severely disadvantaged groups, though they have different emphases and goals – both the Centre for Social Justice's Christian Guy and Nick Clegg’s former adviser Richard Reeves suggest that a commitment to this case is shared across the political spectrum. By focusing on prevention, getting the relationships right, and seeing the whole person, we can provide the kind of support the most vulnerable in our society really need. By taking a long-term approach, with better policy co-ordination across Whitehall and service co-ordination at a local level, we can save money and strengthen communities at the same time.  

‘Within Reach: The new politics of multiple needs and exclusions’ can be found on the Fabian Society’s website here

Ed Wallis is the editor of Fabian Review

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Sooner or later, a British university is going to go bankrupt

Theresa May's anti-immigration policies will have a big impact - and no-one is talking about it. 

The most effective way to regenerate somewhere? Build a university there. Of all the bits of the public sector, they have the most beneficial local effects – they create, near-instantly, a constellation of jobs, both directly and indirectly.

Don’t forget that the housing crisis in England’s great cities is the jobs crisis everywhere else: universities not only attract students but create graduate employment, both through directly working for the university or servicing its students and staff.

In the United Kingdom, when you look at the renaissance of England’s cities from the 1990s to the present day, universities are often unnoticed and uncelebrated but they are always at the heart of the picture.

And crucial to their funding: the high fees of overseas students. Thanks to the dominance of Oxford and Cambridge in television and film, the wide spread of English around the world, and the soft power of the BBC, particularly the World Service,  an education at a British university is highly prized around of the world. Add to that the fact that higher education is something that Britain does well and the conditions for financially secure development of regional centres of growth and jobs – supposedly the tentpole of Theresa May’s agenda – are all in place.

But at the Home Office, May did more to stop the flow of foreign students into higher education in Britain than any other minister since the Second World War. Under May, that department did its utmost to reduce the number of overseas students, despite opposition both from BIS, then responsible for higher education, and the Treasury, then supremely powerful under the leadership of George Osborne.

That’s the hidden story in today’s Office of National Statistics figures showing a drop in the number of international students. Even small falls in the number of international students has big repercussions for student funding. Take the University of Hull – one in six students are international students. But remove their contribution in fees and the University’s finances would instantly go from surplus into deficit. At Imperial, international students make up a third of the student population – but contribute 56 per cent of student fee income.

Bluntly – if May continues to reduce student numbers, the end result is going to be a university going bust, with massive knock-on effects, not only for research enterprise but for the local economies of the surrounding area.

And that’s the trajectory under David Cameron, when the Home Office’s instincts faced strong countervailing pressure from a powerful Treasury and a department for Business, Innovation and Skills that for most of his premiership hosted a vocal Liberal Democrat who needed to be mollified. There’s every reason to believe that the Cameron-era trajectory will accelerate, rather than decline, now that May is at the Treasury, the new department of Business, Energy and Industrial Strategy doesn’t even have responsibility for higher education anymore. (That’s back at the Department for Education, where the Secretary of State, Justine Greening, is a May loyalist.)

We talk about the pressures in the NHS or in care, and those, too, are warning lights in the British state. But watch out too, for a university that needs to be bailed out before long. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.