Capitalism, the state and health care in the age of austerity:A Marxist analysis

The capacity to provide satisfactory nursing care is being increasingly compromised by current trajectories of healthcare funding and governance. The purpose of this paper is to examine how well Marxist theories of the state and its relationship with capital can explain these trajectories in this period of ever-increasing austerity. Following a brief history of the current crisis, it examines empirically the effects of the crisis, and of the current trajectory of capitalism in general, upon the funding and organization of the UK and US healthcare systems. The deleterious effect of growing income inequalities to the health of the population are also addressed. Marx’s writings on the state and its relation to the capitalist class were fragmentary, and historically and geographically specific. From them, we can extract three theoretical variants: the instrumentalist theory of the state, where the state has no autonomy from capital; the abdication theory, whereby capital abstains from direct political power and relies on the state to serve its interests; and the class-balance theory of the state, whereby the struggle between two opposed classes allows the state to assert itself. Discussion of modern Marxist interpretations include Poulantzas’s structuralist abdication theory and Miliband’s instrumentalist theory. It is concluded that, despite the pluralism of electoral democracies, the bourgeoisie do have an overweening influence upon the state. The bourgeoisie’s ownership of the means of production provides the foundation for its influence because the state is obliged to rely on it to manage the supply of goods and services and the creation of wealth. That power is further reinforced by the infiltration of the bourgeoisie into the organs of state. The level of influence has accelerated rapidly over recent decades. One of the consequences of this has been that healthcare systems have become rich pickings for the evermore confident bourgeoisie.

Social work education and political conflict: preparing students to address the needs of victims and survivors of the Troubles in Northern Ireland

This paper reports on the evaluation of a European PEACE III sponsored teaching and learning project that was designed to enable social work students to better understand the needs of victims and survivors of the conflict in Northern Ireland. The paper begins with an introduction to policy, practice and educational contexts before reviewing the literature on social work, conflict and trauma. It also summarises key, innovative pedagogical approaches used in the teaching, including the use of ground rules, teaching teams consisting of lecturer and service user dyads, learning exercises and case studies. The paper then explains the evaluation methodology. This involved two surveys which returned 144 student and 34 practice teacher questionnaires. The findings revealed that
students were generally committed to this form of teaching and engagement with victims and survivors of the conflict, although some students reported that their attitudes towards this subject had were not changed. Some students also discussed how the conflict had affected their lives and the lives of families and friends; it is argued that such biographical details are crucial in developing new pedagogical approaches in this area.
Practice teachers who supervised some of these students on placement reported general levels of satisfaction with preparedness to work with conflict related situations but were less convinced that organisations were so committed. The paper concludes with a discussion of the study limitations and a recommendation for more robust methods of teaching and evaluation in this area of social work education and practice.

Enabling Social Work Students to Deal with the Consequences of Political Conflict: Engaging with Victim/Survivor Service Users and a ‘Pedagogy of Discomfort’

This paper describes the evaluation of an educational project, delivered in a Bachelor in Social Work degree (BSW) program in Northern Ireland. The project aimed to equip social work students to be more culturally competent in this divided society, with a central focus on including victim/survivor service users in social work training. A number of pedagogical approaches are noted, with particular consideration of Boler's ‘pedagogy of discomfort’ as a model that includes the multidimensional nature of the learning process when topics carry a high emotional tariff. The evaluation of the students' experience indicated that: there was strong support among students for the project; the unique contribution of service users was affirmed; and the project appeared to increase students' awareness and capacity to practice in a divided society. The evaluation of the trainers' experience highlighted key processes in the delivery of collaborative training. The authors argue that the lessons learned are broadly applicable to other forms of service user and carer involvement in social work training and in other societies in which health and social care professionals have to deal with the legacies of political conflict.

Developing a social work curriculum on political conflict – Findings from an IASSW funded project

This paper presents the findings from an innovative project funded by the
International Association of Schools of Social Work (IASSW) and undertaken by
an international team of academics investigating the development of a global
curriculum for social work in the context of political conflict. Coupled alongside
the emerging research and literature on the subject, our small-scale survey
findings indicate support for the need for social work educators to address
political conflict more systematically within social work curricula at both
undergraduate and post-qualifying levels of social work education. The paper
illuminates the opportunities for creative pedagogy whilst also examining the
threats and challenges permeating the realisation of such initiatives. In this way,
the implementation of a proposed curriculum for political conflict is given meaning within the context of IASSW’s Global Standards for social work education. Given the exploratory nature of this project, the authors do conclude that further research is warranted in regard to potential curriculum development and suggest using a comparative case study approach with more in-depth qualitative methods as a way to address this.

Autonomy and Control of State Agencies:Comparing States and Agencies

Do public organizations with similar tasks or structures differ across states with respect to their autonomy and control? If so, why? By comparing the autonomy, control and internal management of state agencies, this book shows how New Public Management doctrines actually work in three small European states with different politico-administrative regimes. Using a unique set of similar survey data on 226 state agencies in Norway, Ireland and Flanders, this study explains differences in agency autonomy, control and management by referring to international isomorphic pressures, state-specific politico-administrative regimes and characteristics of agencies. Therefore, organization theory and neo-institutional schools are used to formulate four competing theoretical perspectives and hypotheses are tested through simple and advanced statistical techniques. By comparing practices between states and between types of agencies, this study substantially enhances scientific knowledge about why public organizations are granted autonomy, why they are controlled in specific ways, and how autonomy affects internal management.

Managing state-owned enterprises in an age of crisis:An analysis of irish experience

As with all aspects of public management, the control, financing, and regulation of state-owned enterprises (SOEs) are matters subject to changing international trends and domestic political imperatives. The effects of the global financial crisis (GFC) on the ownership, financing, and role of SOEs are still unfolding, but undoubtedly will be heavily influenced by a new era of public sector reforms principally designed to reassert central political controls, as well as by fiscal pressures to balance state budgets. In this regard, the Irish experience is instructive, with the findings from two datasets being used here to examine various modes of state enterprise control and their corresponding autonomy. Significantly, there has been considerable variety within and across the SOE sector, demonstrating the need for more detailed understanding of how SOEs are managed. © 2011 Taylor & Francis.

Autonomy and regulation of state agencies:Reinforcement, indifference or compensation?

This paper analyses the relationships between the autonomy and regulation of state agencies in Norway, Ireland and Flanders (Belgium). The empirical basis is provided by broad surveys of public sector organizations carried out in 2002-2004. Three hypotheses on these relationships are formulated and examined, indicating different patterns. The reinforcement hypothesis, stating a negative relationship does not get any support. On the other hand, the compensation hypothesis, stating a positive relationship gets some support. In general, however, the indifference hypothesis, stating low or no correlations seems to be the most adequate. The hypotheses are also linked to prevalent administrative doctrines, and the empirical findings indicate how relevant they are. © Springer Science+Business Media, LLC 2008.

SOCIAL-CLASS, CLASS ORIGINS AND POLITICAL PARTISANSHIP IN THE REPUBLIC-OF-IRELAND

As Laver (1992) notes, people who write about Irish politics frequently describe Ireland as a rather peculiar place. One aspect of this peculiarity is that voters in the Republic of Ireland do not behave like their European counterparts. In particular, Irish voting patterns appear to be only weakly structured by social class. Recent contributions to the debate employing a more sophisticated categorisation of classes have led to some qualification of the 'politics without social bases' description, but still lead to the broad conclusion that any relationship which does exist between social divisions, on the one hand, and party preference, on the other, is, at most, quite marginal. In this paper we draw on data from the 1990 European Values Study to re-examine this issue. We apply a variety of models to the data, including logit regression and diagonal reference models (Sobel 1981, 1984) to explore the complex fashion in which class and political preferences are related in Ireland. We argue that the relationship between such preferences and social divisions are, in fact, greater than has been hitherto thought. In particular, we show the importance of taking into account not only social class but also class origins and class mobility in understanding the nature of political partisanship in the Republic of Ireland.

Dimensions of Financial Autonomy in Low-/Moderate-Income Couples from a Gender Perspective and Implications for Welfare Reform

The ‘unitary household’ lives on in policymakers’ assumptions about couples sharing their finances. Yet financial autonomy is seen as a key issue in gender relations, particularly for women. This article draws on evidence from semi-structured individual interviews with men and women in thirty low-/moderate-income couples in Britain. The interviews explored whether financial autonomy had any meaning to these individuals; and, if so, to what extent this was gendered in the sense of there being differences in men's and women's understanding of it. We develop a framework for the investigation of financial autonomy, involving several dimensions: achieving economic independence, having privacy in one's financial affairs and exercising agency in relation to household and/or personal spending. We argue that financial autonomy is a relevant issue for low-/moderate-income couples, and that women are more conscious of tensions between financial togetherness and autonomy due to their greater responsibility for managing togetherness and lower likelihood of achieving financial independence. Policymakers should therefore not discount the aspirations of women in particular for financial autonomy, even in low-/moderate-income couples where there remain significant obstacles to achieving this. Yet plans for welfare reform that rely on means testing and ignore intra-household dynamics in relation to family finances threaten to exacerbate these obstacles and reinforce a unitary family model.