Risk adjustment for hospital use using social security data: cross sectional small area analysis

Objectives: To identify demographic and socioeconomic determinants of need for acute hospital treatment at small area level. To establish whether there is a relation between poverty and use of inpatient services. To devise a risk adjustment formula for distributing public funds for hospital services using, as far as possible, variables that can be updated between censuses. Design: Cross sectional analysis. Spatial interactive modelling was used to quantify the proximity of the population to health service facilities. Two stage weighted least squares regression was used to model use against supply of hospital and community services and a wide range of potential needs drivers including health, socioeconomic census variables, uptake of income support and family credit, and religious denomination. Setting: Northern Ireland. Main outcome measure: Intensity of use of inpatient services. Results: After endogeneity of supply and use was taken into account, a statistical model was produced that predicted use based on five variables: income support, family credit, elderly people living alone, all ages standardised mortality ratio, and low birth weight. The main effect of the formula produced is to move resources from urban to rural areas. Conclusions: This work has produced a population risk adjustment formula for acute hospital treatment in which four of the five variables can be updated annually rather than relying on census derived data. Inclusion of the social security data makes a substantial difference to the model and to the results produced by the formula.

Constructing a global understanding of the social ecology of leaving out of home care

Engagement with globalisation is growing in the field of youth transitions from out of home care. This includes cross national exchange of research, policy and practise, regional advocacy networking and global policy development. Furthering this emerging international child welfare perspective requires extending it to countries in the developing world and building conceptual frameworks which encompass a social ecology of care leaving, including its global dimension, the latter needs to address not only the needs, expectations and rights of care leavers but also the theories of change underpinning service design and delivery. Such a model is presented combining resilience and social capital as personal assets situated within a social ecology of support. To illustrate how this provides a means to help engage with the experience of countries where there appears to be very little information available on care leaving, a small scale South African initiative is considered. SA-YES is a youth mentoring project for young people leaving a variety of out of home placements. Planned as a three-year pilot, initial results are encouraging but require more rigorous evaluation focusing on program process and outcomes, quality of interpersonal relationships and synchronisation with cultural expectations and policy environment.

Gramsci, austerity common sense and the attacks on the welfare state: The need to understand and resist the imposition of the global neoliberal agenda and the role of the social work profession.

During the last 30 years governments almost everywhere in the world are furthering a global neoliberal agenda by withdrawing the state from the delivery of services, decreasing social spending and lowering corporate taxation etc. This restructuring has led to a massive transfer of wealth from the welfare state and working class people into capital. In order to legitimize this restructuring conservative governments engage in collective blaming towards their denizens. This presentation will examine some of the well circulated phrases that have been used by the dominant elite in some countries during the last year to legitimize the imposition of austerity measures. Phrases such as, ‘We all partied’ used by the Irish finance minister, Brian Lenihan, to explain the Irish crisis and collectively blame all Irish people, ‘We must all share the pain’, deployed by another Irish Minister Gilmore and the UK coalition administration’s sound bite ‘We are all in this together’, legitimize the imposition of austerity measures. Utilizing the Gramscian concept of common sense (Gramsci, 1971), I call these phrases ‘austerity common sense’. They are austerity common sense because they both reflect and legitimate the austerity agenda. By deploying these phrases, the ruling economic and political elite seek to influence the perception of the people and pre-empt any intention of resistance. The dominant theme of these phrases is that there is no alternative and that austerity measures are somehow self-inflicted and, as such, should not be challenged because we are all to blame. The purpose of this presentation is to explore the “austerity common sense” theme from a Gramscian approach, focus on its implications for the social work profession and discuss the ways to resist the imposition of the global neoliberal agenda.

Social Work in the Republic of Ireland: A History of the Present

This article reports on research carried out into the nature and position of social work in the child protection and welfare system in Ireland. Employing a methodology of a history of the present, this research sought to crtically examine the nature and position of social work within the social as a 'psy expert'. Selected findings relating to the genealogical and archaeological construction of social work discourse in Ireland are provided to illuminate how its particular historical pathways both enabled and constrained its development. It was found that, to some extent, conceptualizations of social work in the context of its space within the social were applicable to the Irish context. however, it was also found that a number of other factors were also significant, implying the need for problematization of existing theories of the social. Although some of the findings relate directly to the particular spatial context of Ireland, others are transferable to the UK and international contexts. The research asserts that, while social work represents a diffuse and complex activity, enabled and constrained by its genealogical context, the potential exists in the profesion for greater attention to be apid to its archaeoloigcal construction. In light of contemporary neo-liberal conditions of governance, the need for such attention is emphasized.

Global Production, CSR and Human Rights: The Courts of Public Opinion and the Social License to Operate

This paper takes at its starting point the responsibility placed upon corporations by the United Nations’ Protect, Respect and Remedy Framework as elaborated upon by the Guiding Principles on Business and Human Rights to respect human rights. The overt pragmatism and knowledge of the complex business relationships that are embedded in global production led John Ruggie, the author of the Framework, to adopt a structure for the relationship between human rights and business that built on the existing practices of Corporate Social Responsibility (CSR). His intention was that these practices should be developed to embrace respect for human rights by exhorting corporations to move from “the era of declaratory CSR” to showing a demonstrable policy commitment to respect for human rights. The prime motivation for corporations to do this was, according to Ruggie, because the responsibility to respect was one that would be guarded and judged by the “courts of public opinion” as part of the social expectations imposed upon corporations or to put it another way as a condition of a corporation’s social license to operate.
This article sets out the background context to the Framework and examines the structures that it puts forward. In its third and final section the article looks at how the Framework requires a corporation’s social license to be assembled and how and by whom that social license will be judged. The success or failure of the Framework in persuading corporations to respect human rights is tied to whether “the courts of public opinion” can use their “naming and shaming power” effectively.

Mapping cosmopolis: moral topographies of the medieval city

Cosmopolis is a concept that has a long history in many cultures around the globe. It is a mirroring of the 'social' and 'natural' worlds, such that in one is seen the order and the structures of the other -- a mutual 'mapping'. In this paper I examine how the presence of cosmopolis -- a Christianised cosmopolis of the European Middle Ages -- was made evident in the representation and formation of cities at that time. I reveal a dualism between the social and spatial ordering of both city and cosmos which defined and reinforced social and spatial boundaries in urban landscapes, evident for example in the 11th and 12th centuries. Recently, Toulmin (1992) has taken the idea of cosmopolis to argue that it has been a persistent presence in Western - Enlightenment science, philosophy, and religion -- a 'hidden agenda of modernity'. I contend that, as an idea, cosmopolis has a much earlier circulation in European thinking, not least in the Middle Ages. Locating cosmopolis in the medieval and the modern periods then begs a question of what is it that really makes the two distinct and separate? All too often human geographers have emphasised discontinuities between the 'medieval' and 'modern' age, locating the 'rise of modernity' some time in the Enlightenment period. However, what 'mapping' cosmopolis reveals are continuities, binding time and space together, which when looked at begin to help query the modernity concept itself.

British drugs policy: Problematizing the distinction between legal and illegal drugs and the definition of the ‘drugs problem’.

This article draws upon an extensive literature review of the social and medical sciences, official documents and various websites to critically re-evaluate the basis of British drugs policy. The article problematizes the rationale for criminalizing certain substances and questions the distinctions created between legal and illegal drugs; in so doing, the article argues that the definition of the `drugs problem' is the real problem. It shows that the debate on illegal drugs is filled less with factual truths and more with misinformation which creates public fear and provides a questionable basis for public policy. The article questions current thinking regarding the drugs/crime relationship and concludes by exploring some implications for policy and practice.

Managing time: integration of care and paid work amongst low income families and the role of the United Kingdom’s tax credit system

Under the New Labour Governments in the UK, successive reforms of the tax and benefit system sought to improve the financial benefits of paid work. Drawing on two waves of qualitative interviews with low-income working families this article examines the role of the UK tax credit system in shaping decisions about employment and unpaid care work. The article suggests that the financial support provided for lone parent participants by the tax credit system enhanced their temporal autonomy, permitting participation in paid work to align more closely with temporally situated notions of parental responsibility for caring. For couple families however, parental perceptions of responsibility for pre-school children, along with childcare constraints and the structure of the tax credit system served to constrain the autonomy of the main carer and implicitly encourage a gendered specialisation in caring or employment.