Tuesday, 5 April 2011

Localism, health and rights

Walking to the tube after a recent meeting on localism and austerity, I found that some of the observations that had been made by the policy experts and practitioners in the group were running around in my head. There was the civil servant who commented wryly that ‘localism’ and ‘austerity’ sort of went together, because Government would be rather less keen to devolve decisions to local authorities in a period of prosperity. A strategic manager from a Drug Action Team observed that drug services had benefited from having a ‘big friend’ from central Government to look out for them in the Bear Pit of local politics, and were afraid that in the ‘new term’ they would ‘get duffed up by the big kids in the playground’. Perhaps most striking of all, a senior civil servant suggested that the critical question in an age of localism was ‘how comfortable we are with failure?’

It seems that even the Secretary of State for Communities and Local Government, Eric Pickles, is finding it a bit of challenge to get ‘comfortable’ with some of localism’s possible consequences. He has recently declared that he is prepared to legislate to stop councils imposing ‘disproportionate’ and ‘unreasonable’ cuts on charities. This was paraphrased by one colleague as ‘localism will deliver the Big Society even if central Government has to compel it to do so’.

It is questionable, of course, how much responsibility local decision makers have for the impact of these cuts. Undoubtedly, individual councils will make better or worse decisions in allocating the resources available to them (and some times ‘political’ decisions), but the constraints within which they are having to make those decisions are tight. As David Brindle, the Guardian’s Public Affairs Editor, has observed, localism is potentially ‘a convenient get out for ministers on some of the most glaringly unfair spending cuts’. In a nutshell, passing the buck (literally) spells passing the buck (metaphorically).

It’s not all about money, of course – important as this is. The provision of local services in the future will depend on how well different local areas adapt to a changing environment, implement and develop new structures and approaches and respond to the challenge of more austere times innovatively. It’s also important to recognise the potential benefits of greater local control and accountability. It was remarked at the localism and austerity meeting that if you speak to local councillors and officials in some of the highest performing areas of the country as judged against the national drug treatment indicators, they often do not have a sense that they are dealing effectively with the drug and alcohol issues that are most visible in their communities and are the priorities for local people.

Ultimately, however, we need to hold on to the awareness that ‘failure’ – wherever the responsibility lies – can have a devastating impact on highly vulnerable individuals, families and neighbourhoods. That is the nub of the moral argument for stepping in to prevent it. There may be many positives to localism, but it is bound to mean that provision for drug and alcohol treatment is much better in some parts of the country than in others (and it could be very bad indeed in some). When he published On Liberty in 1859, the political philosopher John Stuart Mill considered the risks of democratic decision making – particularly to unpopular groups and causes – and concluded that individual rights provided a critical counterbalance to democracy. This observation seems pertinent in the age of localism. No one should ever get at all ‘comfortable’ with service provision (or non-provision) that drops below the same standards of acceptability that would apply to other people experiencing health or mental health problems. We will need to give even more weight and emphasis to notions of right and entitlement to support and treatment, such as those found in the NHS Constitution. Paradoxically, at a time where ‘recovery’ is rightly identified as a key aspiration for drug policy, this means continuing to insist that drug dependency remains a health issue too.

By Dr Marcus Roberts, Director of Policy and Membership

This article first appeared in the DrugScope Members' Briefing. Find out about DrugScope membership here