Friday, 15 February 2019

If at first you don’t succeed, try, try, try and try again…

Posted by Suzanne Moffatt, Reader in Social Gerontology, Institute of Health & Society, Newcastle University

Ways to Wellness Link Workers provide support to people with
 long-term health conditions who are referred by their GP
Publishing a study protocol is always gratifying (even though it counts for nothing in the Research Excellence Framework!). Publication of this particular protocol evaluating the impact of social prescribing on health and wellbeing caused me to reflect on the 58 months that had elapsed between that initial invitation to develop an evaluation and getting the study protocol into print. Why on earth had it taken so long and what had we done in those months? Well, we weren’t twiddling our research thumbs, but we did get quite a few knock backs in our efforts to secure “the big grant”, and I thought it worth sharing with the research community as multiple failures before success is often untold.

We started with an outline bid to the National Institute of Health Research (NIHR) Public Health Research Programme in 2015 which was shortlisted, but not successful at the full proposal stage. Fortunately an application to the Cabinet Office was successful that same year, which enabled us to complete a qualitative study exploring the impact of social prescribing for service users and perspectives of ‘link workers’ delivering the intervention (work currently accepted for publication). In 2015 (busy year!) applications to the School for Public Health Research (SPHR) Public Health Practice Evaluation Scheme (PHPES) and School for Primary Care were both unsuccessful. But in 2016 we achieved success with a ‘cut down’ version of our SPHR PHPES application (capitalising on end of year finances, I believe) that allowed us to pilot questionnaire data collection (paper rejected and currently being prepared for re-submission). 2017 also saw us obtain a relatively small grant from Newcastle University’s Institutes for Ageing and Social Renewal, allowing us to follow up 24 out of our original qualitative sample of 30 service users, findings of which have recently been published.

Ukulele group, Throckley Community Centre, Newcastle upon Tyne
Despite our lack of success so far in obtaining the “big” grant, we had contributed a valuable body of work on the impact of social prescribing and into the bargain employed some excellent researchers – Mel Steer, Kirsty Laing and Jo Wildman. Yet, in spite of the apparently unstoppable popularity of social prescribing as a way of addressing long term health problems and tackling inequalities, a systematic review demonstrated that a robust evidence base about impact and cost effectiveness is lacking. When the 2017 NIHR Public Health Programme call for research on Community Groups and Health Promotion[1] (16/122) hit my inbox, it dawned on me that another application (our seventh in case you had lost count) fitted the bill. I felt a mixture of dread and exhilaration. Definitely the last chance saloon.

So, why was this bid successful? In essence, because it was more clearly focused on a specific condition (type 2 diabetes), our substantial body of underpinning research, the mixing of quasi-experimental and ethnographic methods and a really excellent team of researchers. So now all we have to do is deliver. But remember, if at first you don’t succeed, sometimes persistence pays off.

For more information about our evaluation of Ways to Wellness Social Prescribing, visit the project website.

Applications to the SPHR Public Health Practice Evaluation Scheme (PHPES) are now being accepted with funded projects expected to start from January 2020.



Reference:
  1. This work is funded by the National Institute of Health Research, Public Health Research Programme, Community Groups and Health Promotion (grant no. 16/122/33). The research was informed by a NIHR School for Public Health Research (SPHR) funded project (project reference: SPHR-FUS-PES-WTW).

The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Friday, 1 February 2019

Universal Credit and the perspectives of ex-Jobcentre Plus staff

In last week's blog post, Mandy Cheetham wrote about the impact that Universal Credit is having on health and wellbeing in Gateshead.  In today's guest post, Kayleigh Garthwaite, Jo Ingold, and Mark Monaghan present their findings from preliminary research with former personnel from Jobcentre Plus.


Universal Credit has attracted considerable criticism from experts and politicians. Yet could it be that it has also caused civil servants associated with the policy to leave their jobs?

Throughout 2018, Universal Credit (UC) has been a prominent feature of political discussion, second only to Brexit. UC is an attempt to simplify the benefits system through the introduction of one single working age benefit and to improve incentives to work through the radical restructuring of the benefits and Tax Credits systems. The design and implementation of UC have been defined by austerity and large-scale expenditure cuts to central government departments and drives for greater efficiency following the (2007-8) financial crash. Consequently, the roll out of the policy has been beset with difficulties, magnified by a turbulent political environment (two General Elections, the Brexit Referendum and changes in Ministerial Portfolios).

Since the introduction of UC, which has consolidated both conditionality and punitive benefit sanctioning, there has been an accruing evidence base highlighting the detrimental impact of UC and social security reform more broadly, particularly for those living on low incomes and in poverty. Unfortunately, there is no clear sign of this research being incorporated into policy and so far, no sign that UC will be amended or abandoned.

Between us we have spent the last few years looking at various aspects and impacts of changes to social security policy in the UK, ranging from accounts of the social consequences of austerity, exacerbated by UC, which has led to rising levels of foodbank use; the role of evidence in the policy discussions within the Department for Work and Pensions (DWP) at the time of UC design; and the role of employers in active labour market policies. It became apparent that little work had been conducted with practitioners responsible for the rollout of the policy. This seems a significant gap bearing in mind the amount of negative publicity that has accompanied the rollout of UC, which sat alongside public statements that despite the difficulties, staff morale within the DWP remains the highest in Whitehall.

Despite a slight increase from 2017 to 2018, from around 2010 there has been a significant reduction in the number of civil servants which coincides with the design and development of UC. Little is known of the reasons for staff departures and whether the demands of working on a controversial policy such as UC played a role. Over the summer of 2018 we conducted preliminary research in the form of in-depth interviews (n=8) with former personnel from Jobcentre Plus in the North of England. We initially hypothesised that reasons for departure would include: financial packages on offer; timing; age; ill health; other opportunities in the labour market or career change; dissatisfaction with current role or manager; and a lack of opportunities in the Department or wider civil service. We were particularly interested in whether objections to policy were also part of the equation.

Amongst our respondents, dissatisfaction with their current role was perhaps the clearest theme to emerge as to why they departed the DWP. This wasn’t always linked to UC per se, but was part of the broader austerity landscape in which UC emerged and was linked to longer term ideological developments within both social policy and public administration, which coalesced around increasing use of managerialist forms of governance and austerity. As has been documented, the movements towards activation in welfare policies foregrounded as a means of reducing the deficit has required specific forms of governance to the extent that welfare-to-work organisations find themselves in almost permanent processes of reorganisation. For our respondents, it was this experience that produced the most consternation.

In terms of top down management targets, our respondents told us of the impact of initiatives within the DWP and how targets and objectives were impossible to hit as meetings with clients had become so truncated, but also because of inconsistency in targets:

… they changed the goalposts all the time. One Monday when I went in it would be all about getting so many people into work experience that week. The next Monday morning it would be getting so many people into sector based work academies.

This impacted most of the vulnerable who would fall through the system when the initiatives didn’t match their needs. This frequently ended in a sanction, leaving the staff feeling bereft and stressed from the predicament of their clients, but also their own working environment:

I just thought “this is awful”. I went home and I was really stressed, my jaw was stressed. And I just thought, “oh my god”. I just felt terrible. And I was annoyed with myself for letting her get to me like that. But it was just an unnatural situation really.

These issues were confounded by a key development in DWP: ‘digital by default’ service delivery. The target culture not only fed into individual appraisal where managers would closely, physically monitor the working practices of front-line staff; staff performance was also measured through digital monitoring. This contributed to staff feelings of dehumanisation. Our respondents reported that the move towards a fully digitized service not only led to feelings of de-skilling and autonomy, but also took away the public service motivation and ethos that drew our respondents into working in the civil service in the first instance. Staff described being permanently on the ‘back foot’, in that digital services were rolled out without staff being given the relevant training. There was also a profound shift in their own views of the public service ethos, which had changed to such an extent that staff reported to us that it was now ‘embarrassing’ to be associated with Jobcentre Plus and that their actions were making ‘vulnerable people more vulnerable’.

I wanted to do a good job, but at the same time my heart wasn’t in it, I was part of something that didn’t sit very comfortably with me. It was becoming embarrassing to say where I worked.

We are not suggesting that UC was solely or directly responsible for the findings we report here. Many of these issues reported to us predated the rollout of UC. But what we found seems to be a product of the direction of policy travel, as well as continuous reorganisation of the delivery of social security and public employment services are in the UK. What was apparent from our discussions with ex-Jobcentre Plus personnel is that under UC these factors were only getting worse. Time will tell whether this continues to be the case.

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About the authors:

Kayleigh Garthwaite is a Birmingham Fellow in the Department of Social Policy, Sociology and Criminology at the University of Birmingham.

Jo Ingold is Associate Professor of Human Resource Management and Public Policy at the University of Leeds.

Mark Monaghan is Lecturer in Criminology and Sociology at the University of Birmingham. 

With thanks to LSE British Politics and Policy, and the London School of Economics and Political Science.

All articles posted on this blog give the views of the author(s), and not the position of Fuse, the Centre for Translational Research in Public Health; the five North East Universites in the Fuse collaboration, or funders.

Featured image: J J Ellison [CC BY-SA 3.0], from Wikimedia Commons