Dr Simon Duffy explores the future of the welfare state. He argues that only a welfare state rooted in a commitment to citizenship is economically and politically sustainable.

1. Reforming the Welfare State for Real
Staff College: Future Directors Programme

2. • The reality of Austerity
• Creativity amidst injustice - heading upstream
• Advancing citizenship
• Strengthening families
• Growing community
• Democratic and constitutional change

3. 1. Austerity

4. • Austerity is the policy of making the poorest &
weakest pay for the mistakes of the rich & powerful.
• The welfare state is totally affordable, but it has
become politically unsustainable.
• Past assumption about how to ‘manage’ the welfare
state from the centre are now collapsing.

9. In total, across England as a
whole, the WCA disability
reassessment process during
this period was associated with
an additional 590 suicides
(95% CI 220 to 950), 279,000
additional cases of self-
reported mental health
problems (95% CI
57,000 to 500,000) and the
prescribing of an additional
725,000 antidepressant items
(95% CI 406 000 to 1 045 000).
Barr B, et al. J Epidemiol
Community Health 2015;0:1–7.
doi:10.1136/jech-2015-206209

10. The Committee is seriously concerned about the
disproportionate adverse impact that austerity measures,
introduced since 2010, are having on the enjoyment of
economic, social and cultural rights by disadvantaged and
marginalised individuals and groups. The Committee is
concerned that the State party has not undertaken a
comprehensive assessment of the cumulative impact of such
measures on the realisation of economic, social and cultural
rights, in a way that is recognised by civil society and national
independent monitoring mechanisms (art. 2, para. 1).
UN Committee on Economic, Social and Cultural Rights:
Concluding observations on the sixth periodic report of
the United Kingdom of Great Britain and Northern Ireland
24 June 2016
UN declares UK Government fails to respect human rights

11. …there is reliable evidence that the threshold of grave or
systematic violations of the rights of persons with
disabilities has been met in the State party… The core
elements of the rights to independent living and being
included in the community, an adequate standard of living and
social protection and their right to employment have been
affected… freedom of choice and control over their daily
activities restricted, the extra cost of disability has been set
aside and income protection has been curtailed as a result of
benefit cuts, while the expected policy goal of achieving
decent and stable employment is far from being attained
UN Committee on the Rights of Persons with Disabilities:
Inquiry concerning the United Kingdom of Great Britain and
Northern Ireland carried out by the Committee under article 6 of
the Optional Protocol to the Convention
6th October 2016
UN declares UK Government fails to respect disability rights

17. 2. Upstream

18. • The welfare state is necessary for the sustainability
of a 21st century democratic society.
• But the welfare state has often been designed
using 19th century assumptions about power.
• We are applying instrumental, rather than
ecological thinking to the welfare state.

25. 3. Citizenship

26. • Post 1945 the welfare state focused on sustaining
people as workers and service users.
• Progressive attempts to convert people into
consumers have further undermined citizenship.
• Only a welfare state that supports citizenship will
itself get the support it needs to be sustained.

28. Citizenship is practical and inclusive

35. Location N Change
England - 6 Sites Phase I Report 60 -18.0%
England - 17 Sites Phase II Report 128 -9.0%
England - 13 Sites IBSEN Report 203 -6.0%
England - Northamptonshire 17 -18.7%
England - City of London 10 -30.0%
England - Worcestershire 73 -17.0%
England - Southwark 85 -29.8%
Scotland - Glasgow 12 -44.0%
USA - Denver - Disabled Children - -34.0%
USA - Florida - Disabled Children - -30.0%

36. 4. Family

37. • Families are the bedrock of all societies, and they
need supporting as families.
• Policy and practice tends to isolate individuals and
ignores issues of gender.
• A decent welfare state would start by supporting
families and show greater sensitivity to gender.

39. The women with the most complex needs don’t fit in services

40. Managing a serious health condition 64%
Finding a safer place to live 27%
Living with childhood abuse 51%
Didn’t finish their education 76%
Recent experience of domestic violence 85%
Fractured family (for those with young families) 66%
Children experienced abuse (for those with children) 55%
Living with a severe level of mental illness 55%
Living with some mental illness 91%
History of drug or alcohol misuse 52%
Victim of crime 41%
Perpetrator of crimes 39%
Worried by debt or lack of money 65%

42. A partnership between women - improving mental health

43. Service label n Urgent problem n Real need n
Victim of
domestic violence
55 Debt 50
Better self-
esteem
64
Mentally ill 39 Housing 48
To overcome
past trauma
54
Criminal 35 Benefits 46
To manage
current trauma
51
Poor mother 33 Health 37
To stop being
bullied
50
Misuses alcohol 24 Rent 32 Guidance 50
Uses drugs 22
Criminal justice
Advocate
24
Relationship
skills
45
Violent 19 Dentistry 8 Mothering skills 26
Chronic health
condition
16 Others 3 Others 1

44. 5. Community

45. • UK welfare state is not only centralised, it is blind to
the richness and diversity of its communities.
• Communities create capacity through relationships
and shared values.
• The welfare state needs to respect, support and
challenge communities.

46. Peers with mental health problems leading community change

48. £0
£500,000
£1,000,000
£1,500,000
£2,000,000
£2,500,000
£3,000,000
MH NursingHome CareMinimum WageCost of PFG
The average cost of PFG over the last 2 years has been £79,000. However the value of PFG
is much greater. If its support and work had all been paid at the minimum wage it would cost
over £0.5 million. If it had been commissioned as home care it would have cost over
£1 million. If it had been provided by a mental health nurse it would have cost £2.75 million.

49. • Postnatal depression reduced by 77%
• Unemployment dropped by 71%
• Reduced fear of crime
• Childhood accident rate dropped by 50%
Community led programme of neighbourhood renewal

53. 6. Reform

54. • The current ‘reforms’ are actually unsustainable
attacks on social justice.
• But the welfare state does need reform, a reform
rooted in a better understanding of justice.
• And a welfare state based on citizenship requires
constitutional change, not policy change.

55. Aristotle explains
that a community
is not made out
of equals, but on
the contrary of
people who are
different and
unequal. The
community
comes into being
through
equalising,
'isathenai.' [Nich.
Ethics 1133 a
14] [Arendt]

56. Could we not see part of
our role as preparing our
children for citizenship?
“Every educational system
has a moral goal that it
tries to attain and that
informs its curriculum. It
wants to produce a certain
kind of human being.”
[Allan Bloom]

61. DISCUSSION

62. www.cforwr.org
@citizen_network
@CforWR
@simonjduffy
fb.me/centreforwelfarereform
fb.me/citizennetwork
e simon@centreforwelfarereform.org
www.citizen-network.org