Mandatory reporting on child abuse and neglect: the consultation

I’ve just responded to the government consultation Reporting and acting on child abuse and neglect which closes on 13 October. It’s prompted some thoughts;

The challenge

Preventing children being harmed. Obviously.   But that’s a pretty broad remit. Local authorities and the agencies they work with have a statutory duty to ‘make arrangements for ensuring that their functions are discharged having regard to the need to safeguard and promote the welfare of children’ (s. 11 Children Act 2004). Basically they should have appropriate procedures in place. That prompted this comment from Eileen Munro in her Review of Child Protection;

‘…instead of “doing things right” (i.e. following procedures) the system needed to be focused on doing the right thing (i.e. checking whether children and young people are being helped)’ (Consultation document para 5)

Since the 2004 Children Act, safeguarding children seems to have had an increasingly high profile; promoting the welfare of children appears to have taken a back seat. Here’s how the current government sees it;

“…Safeguarding children – the action we take to promote the welfare of children and protect them from harm…”(para 2)

In other words the broad duty to promote the welfare of children – with all that that entails – now boils down to protecting children from abuse and neglect.  And the child protection system doesn’t always work. Numerous people have pointed out that no system can guarantee the protection of all children; we don’t have, and never will have, the resources to do that.

The nation has been, understandably, shocked to the core by accounts of the appalling abuse some children have suffered. The news that one child each week is killed on our roads and over 2000 a year are seriously injured in contrast barely makes the headlines; child protection isn’t just about abuse and neglect.  But children are abused and neglected and recent high profile cases have been shocking partly because they’ve highlighted clear failings in the child protection system. The reporting and acting consultation is part of the government’s response.

What the consultation proposes is that reporting and acting on suspected child abuse and neglect is made mandatory for people working in certain organisations. If they don’t report and take appropriate action, they could face serious sanctions. The people include not only those working directly with children but support staff and senior officers. As the consultation document points out, the possibility of sanctions introduces a significant risk of unintended and unwanted outcomes, such as unwarranted intrusion into family life and even more problems with recruitment and retention of social workers.

The evidence

On the face of it, mandatory reporting and acting looks as if it makes sense; if everyone reported and acted on their concerns, surely children would be much safer. But the evidence doesn’t support that reasoning. The evidence shows that when mandatory reporting is introduced the number of referrals increases dramatically (in Australia it doubled), but the proportion of substantiated cases is low (around 20% in several jurisdictions).   As the consultation document itself says:

‘Overall, the literature seems to show that “there remains some question about the efficacy of reporting laws in achieving their ultimate goal: protecting children from harm”’(Annex D p.22).

The causes

Not only does the evidence demonstrate that mandatory reporting doesn’t help, but reporting and acting per se don’t play a major role in the failures of the child protection system to protect children, either. Serious case review after serious case review identifies complex decisions to which there is no obvious right answer, and not following existing procedures properly, as key factors in the failure to protect children from harm. SCRs are littered with accounts of novice social workers being assigned to difficult cases, agency staff unfamiliar with cases, inadequate supervision, lack of understanding of the law and poor communication between agencies – all signs of services that don’t have the capacity to meet demand. In the vast majority of cases, the problem wasn’t that no one had reported their suspicions or failed to act on them.

Given the lack of evidence for the effectiveness of mandatory reporting and acting, and the fact that reporting and acting weren’t the main causal factors of failure, why is the consultation happening at all?

Why consult?

The consultation appears to be have been prompted by some recent high profile cases where abuse and neglect was known about but ignored; the consultation document cites Jimmy Savile’s activities and the sexual exploitation cases in Rotherham, Rochdale and Oxfordshire. Mandatory reporting and acting has been suggested by “MPs, MPs, Peers, campaign groups and members of the public” (consultation document Foreword). But MPs, Peers, campaign groups and members of the public might not be familiar with the evidence for the efficacy of their suggestion.   The way the child protection system is designed isn’t a matter of opinion, it’s a matter of the evidence for what’s effective.

The only reason for consulting that I can think of that is that it’s politically advantageous; the government is seen to be doing something. As the consultation document says “… it is crucial that we do all that we can to strengthen our arrangements to minimise the risks as far as possible” (para 14). Yes, it is, but there’s no evidence to suggest this is the way to do it.

If there are problems with a system, the only way to address them effectively is to identify the root causes of those problems.   SCRs provide a wealth of evidence for those root causes. We need to be looking at them, not quick fixes that we know won’t work and could make things worse.

The ‘Baby P effect’ and home education

In August 2007, a toddler living in the London Borough of Haringey died. 18 months later on 11 November 2008 his mother, her boyfriend and her boyfriend’s brother were convicted of causing or allowing the child’s death. The toddler was Baby P, eventually named as Peter Connelly.

Media interest was intense. On the day of the conviction, Sharon Shoesmith, director of Haringey’s children’s services, and Jane Collins, CEO of Great Ormond Street Hospital (GOSH) held a press briefing that mentioned the disciplinary proceedings against individual social workers finding no evidence of gross misconduct. On the following day, November 12, the Department for Children, Schools and Families (DCSF) issued a press statement condemning the behaviour of those convicted.

Later that day, at Prime Minister’s Questions, Gordon Brown (then PM) appeared to be taken by surprise by David Cameron’s (then Leader of the Opposition) criticism of the way Haringey Council had responded to Peter Connelly’s death. Cameron asked who was taking responsibility and why no one had resigned. He followed up his attack later with an emotive article in the Evening Standard, and the next day with a letter to the Sun. The Sun launched a petition calling for Sharon Shoesmith, the social workers involved, and a paediatrician at GOSH to be sacked, and by the weekend could claim the petition had 1.4 million signatures. The Government’s reaction triggered a chain of events culminating in a ‘perfect storm’ that had significant, far-reaching repercussions for national and local government, the news media, social work as a profession, children’s services, individual social workers and vulnerable children.

The Government response

The Government’s response to the criticisms was swift and robust. A press officer was sent to Haringey Council and on 1 December the Council leader George Meehan and the cabinet member for children and young people Liz Santry, resigned. Ed Balls, Secretary of State for Children, Schools and Families announced in a press conference that he was replacing Sharon Shoesmith with John Coughlan, then director of children’s services in Hampshire, and appointed Graham Badman, previously director of children’s services in Kent, as chair of Haringey’s Local Safeguarding Children Board. A week later, Shoesmith was formally dismissed by Haringey Council.

Shoesmith didn’t take her sacking lying down. She appealed and in 2011 the High Court ruled that Ed Balls and Haringey Council acted unlawfully in dismissing her. In 2015, she completed a PhD through which she had tried to understand the psychosocial factors involved in the aftermath of Peter Connelly’s death. A couple of weeks ago, she published Learning from Baby P, which draws on her research. In the book, she notes some of the factors that prompted the government to act as it did. Shoesmith’s analysis is well worth reading; it’s incisive and insightful. My only quibble is that she appears to accept some conceptual frameworks uncritically, such as the feminist, psychoanalytic and medical models.

Shoesmith points out that by late 2008, the ‘New Labour project was running into trouble’ (pp.123-127). Gordon Brown had taken over from Tony Blair as PM the previous summer, but in May 2008 Labour had had its worst local government election results for 35 years and Labour’s attempts to reduce child poverty were faltering. In October 2008 the Healthcare Commission’s investigation into the Mid-Staffs scandal was completed revealing significant failings, and the global financial crisis prompted a £500bn rescue package for UK banks.

Cameron’s framing of Peter Connelly’s death in political terms had significant implications for the Labour government. Their flagship strategy Every Child Matters couldn’t be seen to fail, nor could Ed Balls, who had been Brown’s chief economic adviser until Brown became PM. Then there was Haringey. Haringey had high levels of deprivation and a history of what Shoesmith calls ‘defining events’. It had witnessed the Broadwater Farm riots in 1985 during which PC Keith Blakelock had been murdered, and the death of Victoria Climbié in 2000 that had led to the Laming Inquiry and significant changes in child protection policy. In addition, Haringey Council had long been perceived as hailing from the ‘loony left’; understandably a centre-left government might want to distance itself. Lastly, the government felt compelled to align its narrative with that adopted by large sections of the public and press – that public sector services should to be seen to take responsibility for Peter Connelly’s death.

All three key political figures – Cameron, Brown and Balls – used the press directly to manage the political narrative.  It could be argued that the press used politicians to the same end. In July 2007, six months after he’d resigned as editor of the News of the World following the conviction of two reporters in the phone hacking scandal, the Conservative Party had appointed Andy Coulson as its director of communications. The Sun, another News International paper, had a history of campaigning for changes in the law as a result of high profile child abuse cases; for longer sentences following the death of James Bulger in 1993, and for disclosure of previous sex offences following the death of Sarah Payne in 2000. During the Leveson Inquiry into phone hacking, it was suggested that after the Baby P trial the Sun put pressure on Ed Balls to order resignations (p.183).  The press narrative in the Baby P case centred around calls for the resignation of professionals involved with Peter Connelly. Shoesmith explains her reasons for not offering to resign, but I think the issue of resignation warrants further comment.

It’s a resigning matter

Traditionally, tendering your resignation if something goes wrong is seen as an honourable thing do to – even if no one believes you’re responsible for what went wrong and your resignation isn’t accepted. A resignation symbolises acceptance of responsibility and would have been one factor in the calls for resignations over the Baby P case. But Shoesmith makes it clear in Learning from Baby P that she saw voluntary resignation as an admission of responsibility for Peter’s death, an impression she wanted to avoid – understandably given the introduction of the offence of ‘causing or allowing the death of a child or vulnerable adult’ in 2004 to close a legal loophole. Although the offence can be committed only by people living in the same household as the victim, its title begs the question of who else might be responsible for causing or allowing a death of a child by, for example, neglecting their professional duty. Police officers, social workers or paediatricians might be brought into the frame, something that could be inferred from David Cameron’s Evening Standard article (p.144).

But there’s another factor involved in the calls for sackings; it’s the assumption that if a public sector worker failed to prevent the death of child, they would have been able to prevent it if they’d acted differently. That’s nonsense of course. Even if a child were taken into care or a social worker were to live with the family, no child can be totally protected from harm. But the idea that children can be fully protected persists. Cameron, Brown and Balls all vowed to ensure that nothing like Peter Connelly’s death happened again (p.178) – even though, in reality, such promises are meaningless.

Child protection had become a political football and government, opposition and the media were vying for control of the ball. Ironically, the outcomes had significant negative repercussions for vulnerable children. Directors of social services became very nervous about their jobs, and social worker recruitment and retention, already under strain, became even more challenging, further increasing the vulnerability of the children social workers were dealing with. Local authorities made sure they erred on the side of caution; between October 2008 and March 2012 the number of applications for care proceedings increased by 79% (p.19).

Elective home education and the Badman review

The ‘Baby P effect’ rippled out to another group of children Shoesmith doesn’t mention – those educated at home. English law gives parents a duty to cause their child to receive an education suitable to their age, ability, aptitude and any special educational needs they may have (s.7 Education Act 1996). Local authorities can intervene if it appears a child is not receiving a suitable education (s.437(1) Education Act 1996). The law, rightly, puts the individual child at the heart of the education, and sensibly, gives final responsibility for the child’s education to parents. Some parents make a complete hash of bringing up their children, but historically they’ve done a much better job than the state. Home education has been a contentious issue however, and in 2007 Alan Johnson, Ed Balls’ predecessor at the then Department of Education and Skills, published a set of guidelines for local authorities about elective home education.

In January 2009, Ed Balls announced a review of elective home education. Home educating parents were perplexed, not least because the guidelines had been issued only a year or so earlier. Also, the review was framed in terms of home educated children being ‘hidden’ and home education being used as a cover for child abuse, even though there appeared to be no robust evidence of this actually happening.   In addition, the review conflated education and welfare, which are treated as distinct issues by the law.

The review was led by Graham Badman, introduced as the former director of children’s services at Kent County Council. A month earlier, Balls had appointed Badman as chair of Haringey LCSB, but unless they’d been following the news closely, most home educating parents wouldn’t have made a connection with the Baby P case. They would also have been unaware that in May 2008, seven year-old Khyra Ishaq had starved to death at her home in Birmingham. She had been educated at home for the previous six months. Khyra’s death came to public attention only in June 2009, when the trial of her mother and her mother’s partner began. Her death was presented as reinforcing the government’s call for reforming the law relating to home education, rather than as a trigger for the review happening in the first place.

In 2009 Graham Badman was busy. In November 2008 he’d set up an education consultancy, Nektus, that carried out two local authority progress reviews in its first year.  In December he’d been appointed Chair of Haringey LCSB, to oversee the aftermath of a very high profile child protection case.   In January 2009 had become a visiting professor at the Institute of Education, and Acting Chair of BECTA – being appointed Chair on 1 May. He became a Trustee and Board member of UNICEF in July. His elective home education report was published on 11 June, and his recommendations accepted in full the same day by Ed Balls. Given all these commitments, it’s not surprising that more than one organisation complained that Badman’s account of what they said to him wasn’t quite what they recalled saying, and that Graham Stuart MP, a member of the Children, Schools and Families Select Committee felt obliged to point out that Badman had made a significant sampling error in his assessment of the risk to home educated children.

Badman made 28 recommendations, including giving local authority officers the right to enter the homes of home educated children, to interview them alone and to assess their educational progress.  A public consultation on Badman’s proposals followed, with a record number of responses. The full government response to the Badman report wasn’t published until October 2009, towards the end of the consultation period, so many people who responded to the consultation wouldn’t have seen it. Throughout the review, I got the strong impression that the Government didn’t see those who disagreed with the proposals as citizens expressing their opinions, but as political opponents. The Government planned to include the Badman proposals in the Children, Schools and Families Act 2010, but many were abandoned in the ‘wash up’ prior to the 2010 General Election, due to opposition from other parties. Conservative MPs had, not surprisingly given the political overtones of the review, been quite supportive of home educating parents. In December 2009, a record number of petitions protesting against the proposed changes to the law were presented to Parliament, a strategy initiated by Graham Stuart.

Learning from the Baby P effect

The primary task of government, national and local, is to protect the population to allow us – all of us – to go about our lawful business without let or hindrance. Obviously, there are going to be instances where legislation that protects one group of people inconveniences another – the law has to weigh up the interests of different parties. On the face of it, it looked as if that the actions of government, opposition and press in the wake of Peter Connolly’s death could result only in beneficial outcomes for vulnerable children. But their focus was on only one aspect of child protection and other aspects got completely overlooked, including local authority priorities (disabled children are also children in need but LA thresholds for support are set so high many disabled children get no social care support), social worker recruitment and retention and the consequent impact on vulnerable children, and children being taken into care unnecessarily. The proposals for home educated children, such as social workers being entitled to enter the family home and to interview children alone had significant implications for a number of important legislative principles.

Government, opposition and the press framed child protection solely in terms of the behaviour of individuals, whether they were adults who might harm children directly, social workers who might fail to prevent harm, or elected members of local government responsible for implementing national policies. Little attention was paid to the effectiveness of legislation, key legislative principles, local authority resources, the impact of the government’s action on social workers and on children deemed to be at risk when they weren’t. Good legislation requires careful thought and wide consultation, not a knee-jerk response to a party political attack. If government is seen as a party political project, rather than an institution that exists to serve the population, it puts everyone’s welfare in jeopardy, not least that of vulnerable children.

Reference

Shoesmith, S (2016).  Learning from Baby P.  Jessica Kingsley Publishers

Updated 4 September 2016 with minor corrections.

policy makers on the brain

moving on from bowlby

Findings from neurobiology research are presented as ‘medical evidence’ by politicians Graham Allen and Iain Duncan Smith to support their proposals for early intervention programmes for children from deprived backgrounds. Before looking in detail at what they have to say about brain development, it might be helpful if I summarise my understanding of the process. It squares with the account cited by Munro here [1]; so I’m assuming I’m on the right track.

Brain development

Brain development is an outcome of the interaction between four factors [2];

• genetic
• epigenetic (the impact of the environment on gene expression)
• environmental (from nutrition to the behaviour of others)
• behavioural (the impact of the child’s own behaviour)

The relative impact of the different factors varies between individuals and at different stages of development.

The number, formation and location of brain cells (neurons) is almost entirely genetically determined, although…

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what’s wrong with attachment theory?

moving on from bowlby

I’ve encountered enough examples of inadequate, chaotic, manipulative and abusive parenting to understand why people working with troubled children might view parents as prime suspects. However, there are many possible causes for children’s unusual behaviour and a focus only on parental behaviour means that other causal factors are likely to be overlooked.

In the next few posts, I want to explore three concepts – Attachment Theory, Fabricated or Induced Illness (FII) and the ‘cycle’ theories of deprivation and abuse – that attribute the cause of children’s abnormal behaviour primarily to parental behaviour. Although these concepts aren’t directly related to autism, parents of children with developmental issues and learning difficulties have reported these ideas being proposed as causes for their children’s behaviour despite evidence to the contrary.

Attachment theory

Attachment theory was an idea developed by John Bowlby, born in 1907, one of the six children of Sir Anthony Bowlby…

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Invisible disability: Building Great Britons

A report was published on Wednesday by the All Party Parliamentary Group (APPG) for Conception to Age 2 – the First 1001 days. It’s called Building Great Britons.
The thrust of the report is similar to Early Intervention: Good Parents, Great Kids, Better Citizens (2008) and Early Intervention: The Next Steps (2011) from MPs Graham Allen and Iain Duncan Smith. Building Great Britons sets out a policy framework aimed at preventing the social problems believed to originate in adverse experiences between conception and a child’s second birthday.

Breaking the cycle

The conceptual model underpinning the report is a familiar one. Neglect, maltreatment and insecure relationships in early childhood are assumed to be a primary cause of mental health problems and antisocial and criminal behaviour. Parents who had such experiences during childhood tend to adopt the same child-rearing strategies as their parents, setting up a damaging (and costly) self-perpetuating intergenerational cycle.

Like the Early Intervention reports, Building Great Britons argues that preventing child neglect, maltreatment and insecure attachment will save money and result in a flourishing society due to the emergence of well-rounded citizens who are “physically and mentally healthy, well educated, empathic, prosocial, hardworking and contributing to the costs of society” (p.3). As Tim Loughton, Co-Chair of the APPG says “the economic value of breaking these cycles will be enormous” (p.4).

“This” it’s claimed, “is not ‘rocket science.’ Technically it is ‘neuro-science’” (p.3).
The basis for that claim seems to reside in repeated references to brain development, although there’s no detail about how brain development is involved. The association between early adverse experiences and long-term unwanted outcomes is well established, but there are some problems with the model.

what causes what?
The first is that just because two things are correlated, it’s not safe to assume that one causes the other. They might both be caused by something else, or be totally unrelated. So parents might neglect, maltreat or form poor attachments with their children because their parents did, or because the family has a genetic predisposition towards severe post-natal depression, or because they are grappling with challenging life circumstances.

multiple causes
The second problem is that even if we could predict with certainty that all neglected, maltreated, chaotically attached children will develop mental health problems or anti-social behaviour in later life, the causal chain doesn’t always hold in the opposite direction because mental health problems and anti-social behaviour have other causes such as poor physical health, adverse life events or peer pressure.

looking back vs looking forward
A third problem is that retrospective surveys linking adverse childhood experience with later health and social problems, such as the ACE study referred to in Building Great Britons (p.14), tend to rely on self-reports – not always the most reliable sources of information, especially about early life. Prospective assessments that track children through their life course such as the Dunedin and Cambridge studies tend to be more reliable. They have also found correlations between adverse childhood experiences and problems in later life but that the emerging patterns are quite complex.

When reading through the research findings, I was struck by how often researchers expressed surprise at the frequency of adverse childhood experiences. The ACE study was prompted by the unexpectedly high incidence of sexual abuse in childhood reported by people dropping out of a weight loss programme. The Dunedin study began as a small-scale follow-up assessment of perinatal risk. Its scope was broadened after researchers found a higher incidence than they expected of accidental injury and impairments to sensory function, development and behaviour in 4/5 year olds. The implication wasn’t that the children had been neglected or maltreated (although some might have been), but that developmental impairments in the general population were more frequent than had been previously thought.

children with disabilities: noticeable by their absence

This brings me to a glaring omission in Building Great Britons. One group of children is especially susceptible to social, emotional and behavioural problems and is at increased risk of poor physical and mental health in later life. They are children with disabilities. But the only mention of disability that I could find in Building Great Britons was of children with Foetal Alcohol Syndrome, caused by a mother’s excessive alcohol intake during pregnancy.

Childhood disabilities can be caused by neglect or maltreatment but they can also be caused by factors such as;

• inherited genetic conditions
• spontaneous genetic variations at or before conception
• mother’s illness during pregnancy
• environmental damage during gestation (e.g. exposure to toxins)
• childhood infections
• accidental injury.

Whether you think disability is caused by a ‘functional impairment’ or by the way society responds to that functional impairment, for administrative and legal purposes a clear-cut distinction is usually made between someone who’s deemed disabled and someone who isn’t. But from a biological perspective the boundary is rather blurred. As the Dunedin study found, a significant proportion of children has some sort of developmental impairment; currently in the USA it’s 15%. In the UK, only 6% of children are classified as disabled, but that figure rises with age. Around 16% of the working-age population has a disability.

Not all disabilities are obvious, and some are difficult to detect. The average age at which autism is diagnosed, for example, is 5.5 years, and diagnosis is often much later than that. Autistic children have unusual attachment patterns and autism is so frequently confused with attachment disorder that Heather Moran, a consultant clinical psychologist, devised the Coventry Grid to help professionals distinguish between them.

There’s little doubt that neglect, maltreatment or poor attachment in childhood can, and does, lead to social, emotional and behavioural problems and to impaired physical and mental health. But what Building Great Britons does is to frame the causes of those problems solely in terms of neglect, maltreatment or poor attachment, and more specifically in terms of the ‘troubled families’ who are deemed to be the source of these societal ills (pp.3-4).

When I was delving into the thinking behind the Early Intervention reports, I asked a few researchers who’d been actively involved how some obviously erroneous claims about brain function had crept in. None had had a say in the final content of the reports, but one told me that it was sometimes necessary to present data in a way that was most likely to persuade government to come up with funding. I take his point; but I couldn’t see how that justified presenting the data in a way that was misleading.

What the data on social, emotional, behavioural, physical and mental health problems tell us is that children by definition are vulnerable, and parenting by definition is challenging. They also tell us that we are all, at all times, at risk from unforseen life events that could trigger social, emotional, behavioural, physical or mental health problems that result in us needing help from the community. That’s why in the developed world we have education, health and social care services.

It’s true that a minority of families cause a disproportionate number of problems, for themselves and others. There are good reasons why early intervention is appropriate for them. But because all children are vulnerable and all parenting is challenging, there are good reasons why early intervention should be available to all families. We shouldn’t have to justify it in terms of ‘good citizenship’ or the financial costs for ‘society’ – which at one time we were told didn’t exist.

Nor should reports produced by Members of Parliament about vulnerable children and challenged parents look right past one of the most vulnerable groups of children and one of the most challenged groups of parents. In the total of 351 pages that make up the two Early Intervention reports and Building Great Britons, childhood disability is mentioned, in passing, only five times – and three of those references are to Foetal Alcohol Syndrome.

When I contacted @first1001days, the Twitter account for http://www.1001criticaldays.co.uk/ to point out the omission, I got a prompt response inviting me to write some supplementary material. Within an hour, another parent and I had responded with a paragraph summarising the main issues, and notified @first1001days. I wasn’t surprised not to get an immediate reply, as the report was being launched that morning. But we’re still waiting…

Disabled people are still invisible, it seems.

the evidence: NSPCC briefing on home education

logicalincrementalism

When I first read the NSPCC briefing Home education: learning from case reviews I thought the NSPCC had merely got hold of the wrong end of the stick about the legislation relevant to home education. That’s not unusual – many people do just that. But a closer examination showed there was much more to it than a simple misunderstanding.

The briefing claims to consist of ‘learning about child protection pulled from the published versions’ of seven serious case reviews (SCRs) involving children educated at home. But the claims and recommendations made by the briefing aren’t an accurate reflection of what the SCRs tell us – about home education or child protection. The briefing also calls into question the current legislation relevant to home education, but makes no attempt to explain the legislation or the principles on which it’s based. So what ‘learning’ can we ‘pull’ from the NSPCC briefing?

legislation

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help: NSPCC briefing on home education

logicalincrementalism

The NSPCC briefing Home education: learning from case reviews highlights recommendations from seven serious case reviews (SCRs) published between 2008 and 2013 involving home-educated children.

In the previous post I mentioned that the primary purpose of legislation is to protect the liberty of the individual. Historically the primary purpose of national government has been to protect liberty by defending the nation from attack from abroad, and of local government to do so by maintaining law and order.

But you’re unlikely to enjoy your liberty very much if you’re starving, sick or homeless. The massive increase in urban populations following the industrial revolution eventually resulted in the UK government, national and local, turning its attention to people’s quality of life. Over the last century or so national education, health and social care systems have been developed. Currently, education and healthcare are universal services, available to all. Significantly, social care isn’t.

social…

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