It’s almost a truism of regeneration policy – non-deprived communities complain more about local public services and so get better services.
From community development projects of the early 1970s onwards the focus of regeneration policy has often been community development, or community capacity building, to enable those in deprived areas to interact with local public services on an equal footing to their more affluent neighbours.
This empowerment agenda has received criticism, yet there is still a belief that deprived communities must be engaged in the regeneration of their communities for a key practical benefit. It is presumed that many of the problems of deprived neighbourhoods persist because service providers do not know about them or provide the wrong solutions.
What is needed is community input to get the right, sustainable solution, first time. In this logic there is a presumption that more affluent, or middle class neighbourhoods, are sustainable because service providers do know what they need and that the middle classes successfully capture the benefits of services.
The present period of austerity has meant that specific regeneration funding streams such as the New Commitment to Neighbourhood Renewal in England and the Fairer Scotland Fund in Scotland have been either cut completely or severely reduced. Yet the broad localism agenda, and the Big Society, mean government is still focused on getting people and communities involved in the delivery of public services.
If the middle classes are particularly good at capturing services for their own benefit, does this mean that the Big Society will damage regeneration by skewing priorities towards the middle class? What is the evidence base for this? There is a broad and somewhat contested literature on the ‘inverse care law’ – the famous statement by the Welsh GP Julian Tudor-Hart that ‘the availability of good medical care tends to vary inversely with the need for it in the population served’.
Through a methodologically novel literature review – a realist synthesis – funded by the Arts and Humanities Research Council, we reviewed 69 papers on middle class activism to understand its role in creating inverse care laws.
The method used aims to produce causal mechanisms that are explanatory and useful to policymakers. Across the studies we looked at – from health, education, environmental services, land-use planning, emergency services, public administration and community activism – we identified four causal mechanisms. They might seem obvious and intuitive, indeed the names were chosen to evoke behaviours we had recognised ourselves through prior experience.
1. ‘I’ll stand as the parish council chair‘
The middle classes are more likely to join interest groups and importantly join groups that matter, such as the parish council or parent-teachers association. This allows for the collective articulation of their needs and demands, and service providers respond to this.
2. ‘I’ll write to my councillor and complain’
The middle classes and higher socio-economic groups are more likely to complain about a service. They are also more likely to actively co-produce services as they are more confident and have greater knowledge, such as attending parents’ evenings or working to reach a diagnosis with a health practitioner. As a result services are more likely to be provided according to their needs and demands. This can be self-sustaining, as a feeling of being successful is likely to result in further engagement.
3. ‘I’ll just phone the doctor’
Most middle class service users are interacting with middle class bureaucrats. This means that their ‘cultural capital’ (knowledge, mores and norms) is aligned. This leads to engagement which is constructive and confers advantage. It also enables service-users to gain access to greater knowledge and networks of influence.
4. ‘I’ll vote for them’
The needs of middle class service users, or their expectations of service quality, are ‘normalised’ in policy and practice, for example through prioritising expenditure on services they use, particularly health and education, or that introduce policies they can get particular advantage from, such as the choice agenda in public services. This means that policy priorities can favour middle class interests.
The evidence for the four causal mechanisms was extensive and problematically it suggests that rather than ‘capturing’ public services for themselves as suggested by a theory based on community activism, the middle classes are just generally advantaged when it comes to using public services. In none of the studies we accessed was their evidence for a spill over of these benefits to deprived neighbourhoods of non-affluent individuals.
For us this raises key questions about delivering regeneration through improving mainstream services or the Big Society. Firstly, it is possible that even if we can empower individuals in deprived neighbourhoods, this may be a Sisyphean task for these community activists against the overwhelming capture of the state by the more affluent. However, a key evidence gap was the link between the above mechanisms and eventual outcomes in terms of policy delivery. A focus could be to unpack this relationship and provide policymakers and communities with tools and tactics to overcome disadvantage.
Secondly, regeneration programmes were, and are, politically popular as a way to redistribute resources while maintaining the buy-in of the more affluent to the universal welfare state. The evidence we reviewed suggests this buy-in is at the cost of these people disproportionately benefiting. For us, this points to the need for a continued focus in what kind of outcome, and particularly equality outcome, we are looking to achieve with regeneration and similar targeted policies. Are we wanting to deliver better services for more deprived communities, or equal access to equal services between communities?
Finally, a lot of the evidence on service-level, outcomes and deprivation comes from a macro-level perspective, looking at broad trends over wide areas. The review focuses our attention downwards on the micro-level processes, the meetings and appointments, by which policy is delivered on a day-to-day basis. It seems we know remarkably little about these interactions and how individual responses might accumulate to broader patterns. If mainstream services are to be successfully targeted in deprived communities then we need a much better understanding of these processes.