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Healthcare – the next five years

Michelle Mitchell, Anita Charlesworth, Mike Birtwistle, Kieran Brett, Dr Charlotte Augst, Professor Gabriel Scally, Tom Wright, Heléna Herklots, Julie Wood, Rick Stern, Rob Webster, Richard Murray, Gillian Fawcett, Christopher Ridley OBE. Edited by Michelle Mitchell

Published March 2015. Price £9.99

In this timely and important report leading experts from the health world set out their views on what needs to change to ensure the long-term sustainability of the NHS. With the challenges of austerity, an ageing society and more expensive treatment the authors add their thoughts to the on-going debate on prevention, integration and funding.

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Joining the dots - making healthcare work better for the local economy

Professor Sarah Curtis, David Buck, Joni Jabbal, Professor Dame Carol Black, Christopher Pope, Dr Tim G Townshend, Professor Rose Gilroy, Ann Schofield, Pamela J Chesters and Eugene Milne. Edited by Professor Rose Gilroy and Professor Mark Tewdwr-Jones.

Published February 2015. Price £9.99

This timely collection of essays addresses the connections between healthcare, planning and economic development. Better integration of the new planning and healthcare systems is seen as critical to creating prosperous and sustainable communities. According to the 2010 Marmot Review there is not only a strong social justice case for reducing health inequalities, but also a compelling economic case. Failing to plan for growth and for an ageing society carries a huge cost to the nation. Furthermore, local councils are taking more of a place-based approach to improving health and wellbeing, with a renewed emphasis on preventative action and integration between health, planning, housing, transport, and economic development. The book features contributions from leading policy makers and practitioners who set out what is and can be done to make healthcare work better for the local economy.

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The local double dividend: securing economic and social success

A Smith Institute ‘policy in the making’ discussion paper by Neil McInroy and Matthew Jackson, the Centre for Local Economic Strategies (CLES)

Published February 2015

This new discussion paper makes the case that devolution offers the chance to tackle poverty and inequality by doing things differently – but current thinking may lead us towards the same mistakes. The authors argue that With a national economic model which seems incapable of dealing with poverty and inequality, there is a chance that a fresh action by cities and local government can get to the roots causes of weak local economies and social exclusion. The report argues a ‘Double Dividend’ approach is required in which both economic and social success are seen as intrinsic to local prosperity. Social outcomes such as decent wages, and enduring social institutions, are key to an area’s sustainable economic success but are too often seen as a barrier to growth. 

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Are housing associations ready for an ageing population?

By Martin Wheatley

Published January 2015

This new report questions whether housing associations are ready for the challenges presented by our ageing population. The report addresses the future housing needs of older people and the role of housing associations in providing supported accommodation and care. It examines these challenges over the medium term investment horizon to the 2030s. In particular, it explores what the older population will be like at that time, what housing association boards should be thinking about now, and what the sector and government need to do to realise the opportunities and manage the risks associated with older people’s housing. The report also considers how the links between housing, health and social care can be improved, and asks if housing providers understand the expectations and aspirations of their tenants as they grow older.

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Wealth of our nation: rethinking policies for wealth distribution

By Ashwin Kumar, Kitty Ussher and Paul Hunter

Published October 2014

This paper explores the implications for public policy from the new Office of National Statistics (ONS) data source on wealth distribution in Britain, and what we know about future trends in savings, longevity, property prices and inheritance.

The case for having a greater policy emphasis on wealth - as opposed to simply focussing on income - is that a household’s wealth at a given point in time is often a better indicator of its economic wellbeing. The ONS has now made this point explicitly, stating in July 2014, that “it is important to consider both wealth and income when assessing the economic well-being of households”. Yet the policy implications are under-explored.

Using the relatively recent data source the paper describes the current distribution of assets in Britain. It then explores how this might be expected to change in future years given what we know about longevity, inheritance patterns and other demographic and policy changes. Finally we draw out implications for the public policy debate focussing primarily on intergenerational transfers including inheritance, as well as issues relating to housing and consumer debt.

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Making work better: an agenda for government

October 2014

In this major Smith Institute report, Ed Sweeney, the former chair of the Advisory Conciliation and Arbitration Service (ACAS), shows that Britain has too many poor performing workplaces where employees are often badly treated, underpaid, over-worked and ignored. The report argues that this long tail of broken workplaces is holding back the recovery and costing the nation billions in lost income and welfare benefits to those in work.

The report, welcomed by Labour, the TUC, and EEF the employers’ organisation, calls on government to do more to narrow the divide between the rest and the best and to positively intervene to tackle problems at work. The evidence to the report demonstrates the urgent need to improve employment conditions and raise management standards as a means to boosting productivity and making work better for the UK’s 30m workers.

The report is the product of a nine month inquiry on the world of work, involving research, interviews, discussion events around the country and opinion polling. It provides a comprehensive and up to date examination of the good and bad in Britain’s workplaces. It calls for a fresh approach to improving employment practices centred on the idea of ‘workplace citizenship’, with employees having a greater say, new employment rights and support for fair pay: including a right to request extra leave after five years of employment; rights to information on executive pay and low pay; extension of free childcare for working parents and ‘use it or lose it’ parental leave; reform of the ICE regulations to strengthen employee voice; and mandatory living wage contracts in all public procurement.

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Outsourcing the cuts: pay and employment effects of contracting out

September 2014

Contracting out public services in the UK is now well established. Nevertheless it is still a deeply divisive issue and the debate about outsourcing tends to generate more heat than light. What is particularly surprising given the scale and scope of contracting out is how little researched it is, not least in terms of how it affects employees.

This report, commissioned by UNISON, seeks to help bridge that information gap by profiling and evaluating in some detail the impact of contracting out on employee pay, terms and conditionsin five case-study contracts. The findings raise some important issues for politicians, policy makers, and contracting authorities and agencies, some of which should cause deep concern. In particular, the lack of information about terms and conditions, the impact of the cuts on outsourced low-paid workers, and the growth of the two-tier workforce (and the widening gap between them). It also raises wider questions about the impact of outsourcing on the quality of public services and the broader social effects (not least the public cost of failing to pay public-sector workers a decent wage). Click here to view.

Older publications

We are currently updating our website. Reports published before May 2010 are not available on the website at present. However we can send them by email on request, just email us on Please bear with us and sorry for any inconvenience.

Housing and planning: What makes the difference? A Smith Institute survey and discussion paper on the relationship between councils and house builders

By Andrew Heywood

Published July 2014. Price £9.99

This discussion paper and survey is the latest in a series of Smith Institute reports on housing and growth. Our focus is on what can be done to boost housing supply, provide more affordable homes and create better places. This paper makes an important contribution to that debate, not least in highlighting the evolving relationships between councils and developers. As the report makes clear, getting that relationship right is critical to addressing the nation’s housing crisis. There is historical data available on planning applications and the performance of local planning authorities (LPAs), as well as plenty of technical guidance issued by the Planning Advisory Service and others. However, there is little academic research on the planning process and its outcomes, and even less on best practice and “what works”. This review and survey of councils and developers is intended to help address that information gap and provide some new insights into how individual LPAs and developers shape local housing markets. The paper does not claim to be an authoritative guide to the rights and wrongs of the council/developer relationship, but hopefully does capture the experience and opinions of those involved.

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Housing associations and the NHS: new thinking, new partnerships

By Denise Chevin

Published July 2014. Price £9.99

The treatment and care of more people in their own communities and the provision of more support to allow them to stay in their own homes or in specially designed accommodation is vital if our society is to cope with an ageing population and the growing number of people with multiple long-term conditions. Furthermore, given the increase in demand and the consequential rise in healthcare costs, it is essential to secure efficiency savings and productivity improvements wherever possible. Much greater integration of health and housing is widely seen as one way of meeting these challenges, yet progress has been painfully slow and often unnecessarily bureaucratic. Although in theory there is everything to be gained from the health and housing worlds working closer together, all too often they operate in silos and are disconnected and detached from each other. This report, which captures the views of a range of healthcare and housing professionals and experts, explains why that is so and asks what can be done to remove the barriers to collaboration. That discussion is then followed by perspectives on what works and how new partnerships are reaping the benefits of better integration. In particular, the report breaks new ground by highlighting some excellent pioneering schemes and different types of innovation. 

The report provides a snapshot of current thinking around some elements of the agenda, including using surplus NHS land to improve clinical outcomes. The report aims to stimulate a debate across both disciplines and help shape the policy response.

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