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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Inside Big Ben: why the world’s most famous clock will soon lose its bong

Every now and then, even the most famous of clocks need a bit of care.

London is soon going to lose one of its most familiar sounds when the world-famous Big Ben falls silent for repairs. The “bonging” chimes that have marked the passing of time for Londoners since 1859 will fall silent for months beginning in 2017 as part of a three-year £29m conservation project.

Of course, “Big Ben” is the nickname of the Great Bell and the bell itself is not in bad shape – even though it does have a huge crack in it.

The bell weighs nearly 14 tonnes and it cracked in 1859 when it was first bonged with a hammer that was way too heavy.

The crack was never repaired. Instead the bell was rotated one eighth of a turn and a lighter (200kg) hammer was installed. The cracked bell has a characteristic sound which we have all grown to love.

Big Ben strikes. UK Parliament.

Instead, it is the Elizabeth Tower (1859) and the clock mechanism (1854), designed by Denison and Airy, that need attention.

Any building or machine needs regular maintenance – we paint our doors and windows when they need it and we repair or replace our cars quite routinely. It is convenient to choose a day when we’re out of the house to paint the doors, or when we don’t need the car to repair the brakes. But a clock just doesn’t stop – especially not a clock as iconic as the Great Clock at the Palace of Westminster.

Repairs to the tower are long overdue. There is corrosion damage to the cast iron roof and to the belfry structure which keeps the bells in place. There is water damage to the masonry and condensation problems will be addressed, too. There are plumbing and electrical works to be done for a lift to be installed in one of the ventilation shafts, toilet facilities and the fitting of low-energy lighting.

Marvel of engineering

The clock mechanism itself is remarkable. In its 162-year history it has only had one major breakdown. In 1976 the speed regulator for the chimes broke and the mechanism sped up to destruction. The resulting damage took months to repair.

The weights that drive the clock are, like the bells and hammers, unimaginably huge. The “drive train” that keeps the pendulum swinging and that turns the hands is driven by a weight of about 100kg. Two other weights that ring the bells are each over a tonne. If any of these weights falls out of control (as in the 1976 incident), they could do a lot of damage.

The pendulum suspension spring is especially critical because it holds up the huge pendulum bob which weighs 321kg. The swinging pendulum releases the “escapement” every two seconds which then turns the hands on the clock’s four faces. If you look very closely, you will see that the minute hand doesn’t move smoothly but it sits still most of the time, only moving on each tick by 1.5cm.

The pendulum swings back and forth 21,600 times a day. That’s nearly 8m times a year, bending the pendulum spring. Like any metal, it has the potential to suffer from fatigue. The pendulum needs to be lifted out of the clock so that the spring can be closely inspected.

The clock derives its remarkable accuracy in part from the temperature compensation which is built into the construction of the pendulum. This was yet another of John Harrison’s genius ideas (you probably know him from longitude fame). He came up with the solution of using metals of differing temperature expansion coefficient so that the pendulum doesn’t change in length as the temperature changes with the seasons.

In the Westminster clock, the pendulum shaft is made of concentric tubes of steel and zinc. A similar construction is described for the clock in Trinity College Cambridge and near perfect temperature compensation can be achieved. But zinc is a ductile metal and the tube deforms with time under the heavy load of the 321kg pendulum bob. This “creeping” will cause the temperature compensation to jam up and become less effective.

So stopping the clock will also be a good opportunity to dismantle the pendulum completely and to check that the zinc tube is sliding freely. This in itself is a few days' work.

What makes it tick

But the truly clever bit of this clock is the escapement. All clocks have one - it’s what makes the clock tick, quite literally. Denison developed his new gravity escapement especially for the Westminster clock. It decouples the driving force of the falling weight from the periodic force that maintains the motion of the pendulum. To this day, the best tower clocks in England use the gravity escapement leading to remarkable accuracy – better even than that of your quartz crystal wrist watch.

In Denison’s gravity escapement, the “tick” is the impact of the “legs” of the escapement colliding with hardened steel seats. Each collision causes microscopic damage which, accumulated over millions of collisions per year, causes wear and tear affecting the accuracy of the clock. It is impossible to inspect the escapement without stopping the clock. Part of the maintenance proposed during this stoppage is a thorough overhaul of the escapement and the other workings of the clock.

The Westminster clock is a remarkable icon for London and for England. For more than 150 years it has reminded us of each hour, tirelessly. That’s what I love about clocks – they seem to carry on without a fuss. But every now and then even the most famous of clocks need a bit of care. After this period of pampering, “Big Ben” ought to be set for another 100 or so years of trouble-free running.

The Conversation

Hugh Hunt is a Reader in Engineering Dynamics and Vibration at the University of Cambridge.

This article was originally published on The Conversation. Read the original article.