Bluster and belief: Blue-tinged policy in health and housing

Today brought us two contrasting news stories which give further insight into the approach to policy making under the Coalition government. Today’s Guardian contains an interesting piece by Ben Goldacre on the reform of the NHS (available here), while the BBC have been carrying an item – triggered by a statement from the CIEH – about the problem of poor standards in the private rented sector in England, where it is estimated that 1 million properties are dangerous to live in.

What is interesting about these two policy areas is the way in which “evidence” features in the policy process and what leverage it has over the direction of policy. The contrast is sharp. Andrew Lansley is very fond of referring to his approach to the reform of the NHS as being guided by the evidence. But, as Ben Goldacre points out, the evidence that speaks unambiguously in favour of his proposed approach is meagre. There is little robust evidence from the GP fundholding era of the 1990s, in part because the experiment was suspended before it was fully embedded. Where data on the impact of competition in health care has been collected it suggests that the precise type of competition allowed is important in determining whether it improves services. The approach Lansley is taking does not find strong support (as I discussed in more detail in Magical markets and medical muppets).

The Secretary of State also stands charged with a very simple – no, I’ll say it, simplistic – reading of the evidence on cross-national health outcomes to justify the need for change. He resolutely refuses to look at the statistics longitudinally; instead focusing on the cross-sectional data. Why? Because in cross-section recent data places the UK in a relatively poor position, but if you look at the data longitudinally the UK performance has been improving. The cross-sectional case helps him shore up his arguments for reform. The longitudinal data might be read as suggesting that Labour’s initiatives in health were delivering. And, of course, that leaves aside the fact that these health outcomes are influenced by many things other than formal health care provision – such as the UK population’s relative unwillingness to seek preventative or early interventions.

Throughout the Labour era there was an emphasis – in the policy narrative, if not always in practice – on “evidence-based policy”. The effective use of evidence was seen as key to modernising policy making. “Evidence-based” is an honorific. It is no doubt intended to appeal to those science types who inhabit the medical world. So we have a lot of bluster about policy being led by the evidence. Even when there is little evidence to invoke.

Like some sort of character from Lewis Carroll, there is a belief that repeating it often enough will make it so.

In contrast, in the field of private renting we have plenty of evidence that things are seriously amiss. The government’s own figures show that housing standards in the sector are poor relative to other tenures. The arrival of more buy-to-let properties over the last decade has increased average property quality, but that still leaves a significant minority of privately rented properties failing the government’s own Decent Homes standard. And a good chunk of the properties fail because of problems identified through the housing health and safety rating system.

The CIEH was pointing out that the difficulties in accessing home ownership, the problems in the labour market leading to more unemployment, and the Government’s own restrictions on the level of the Local Housing Allowance are going to generate significant demand from people with limited resources. This will exacerbate what was described thirty years ago as the ‘central dilemma’ of private renting – that tenants do not have the money to pay the sort of rents that landlords are seeking. The likelihood therefore is that housing standards, which are already poor across much of the sector, will deteriorate.

One part of the solution here has typically been seen, by most of those who work in or analyze the sector, as some form of landlord registration or licensing scheme. As I discussed a while ago in the Coalition and private renting, in 2008 there were several reports from different sources advocating some form of increased regulation. Labour were going to implement a national registration scheme. One of the first acts of the Coalition’s housing minister was to deem this unnecessary. Similarly, today the CIEH called for clear, workable legislation. The Law Commission spent most of the 2000s developing proposals to deliver greater clarity. However, these proposals have been shelved.

The BBC cites a spokesperson from Communities and Local Government as saying:

ministers believed the current system struck “the right balance between the rights and responsibilities of tenants and landlords”. “Tying the whole sector down in red tape will harm tenants’ interests by pushing up rents and reducing the choice of properties to rent. “Councils have a wide range of powers at their disposal to tackle the minority of rogue landlords who fail in their responsibilities. “We are working with them, to ensure that any barriers to their using those powers, are lifted,” they added.

The argument about red tape misses the point entirely. It is not about “more red tape” it is about recognising that current regulatory provisions are not actually effective. Simplifying and clarifying would increase the chances that they would impact upon what happens in the sector on the ground.

Equally there is plenty of evidence that a system that relies upon local authority enforcement action will never be adequate. That is for two principal reasons. First, it relies heavily on tenants drawing problems to the local authority’s attention. Tenants often don’t. Second, it relies on local authorities having the money to support the activity. For many years it has been evident that they don’ t have sufficient resources to tackle the problems in private renting comprehensively. And that is before the current swingeing cuts are implemented.

But the most telling part of this statement is its opening: “ministers believed …”. We are not in territory where the evidence has a lot of bearing on the matter. Ministers believe that things are acceptable as they are. Arguments about the scale and depth of the problem, its source, and likely intensification cut no ice when we are dealing with policy driven by belief.

I am reminded – almost constantly at the moment – of the propositions that Flyvbjerg identifies at the end of his brilliant book Rationality and Power. It is a book anyone interested in politics, knowledge, evidence and power should read if they get the chance. Proposition 4 is “The greater the power, the less the rationality”.  The argument is relatively simple. Rationality is the tool of the weak. Only if you perceive yourself to be in a weak bargaining position do you need to resort to logical arguments and appeals to evidence to try to convince others of your viewpoint. If you have are relatively powerful then you do not have to bother. Those with great power can act capriciously with impunity.

Contrary to expectation the Coalition has not delivered a weak government paralyzed into inaction. It has delivered strong government taking radical, right wing action in the face of weak opposition. It can act capriciously. But I sincerely hope that it is not doing so with impunity: that in due course it will pay the electoral price.

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2 Responses to Bluster and belief: Blue-tinged policy in health and housing

  1. dave says:

    An excellent post, Alex – there sounds like there might be a book in there about the regulation of the PRS or its governance?
    If you have a copy of the Rationality and Power book, I’d be interested to see it.

  2. shodanalexm says:

    A book on regulating private renting? Now there’s an idea! I sure I’ve come across it before somewhere. The world would certainly be a better place if it existed.

    I do have a copy of Rationality and Power. I might be persuaded to let it out of my sight. Certainly it would be interesting to a part-time Foucauldian like yourself 😉

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