This chapter examines the connections between the capability approach and human rights. It considers the links between the capability approach and the international human rights framework and discusses the treatment of the relationship between capabilities and human rights within Sen’s research agenda, Nussbaum’s work and the broader literature on the capability approach. Interdisciplinary perspectives spanning law, ethics, public policy and political economy are addressed, and four distinct ‘entry-points’ for examining the connections between the capability approach and human rights are explored. The first focuses on the capability approach as an ‘informational space’ for human rights monitoring, assessment and evaluation. The second focuses on normative concerns and the importance of the capability concept for theoretical thinking about human rights. The third focuses on practical initiatives that explicitly combine the capability approach and human rights as a basis for specific applications and public policies. The fourth addresses the instrumental role that human rights recognitions play within processes of capability expansion (as elements of public action and as mechanisms of broader social change).

The situation on the eve of the crisis

On the eve of the financial crisis, in the summer of 2007, the UK was experiencing a period of substantial and sustained increases in real public expenditure on health. Looking back to 1997, Labour had made the transition into power with health at the top of the political agenda, with Blair urging voters to support Labour in order to ‘save the NHS’. Successive Labour Party manifestos, in 1997, 2001 and 2005, had put emphasis on an overall commitment to the NHS, free at the point of delivery and based on need, not the ability to pay, while highlighting the need to finance a major programme of healthcare investment, modernisation and reform. Real public expenditure on health in the UK had almost doubled during Blair's decade in power, with a real increase from £64.4 billion in 1997/98 to £116.9 billion in 2007/08 (HM Treasury, 2015c).

The results of Labour's large-scale cash investment in healthcare are discussed in detail in our companion paper (see Vizard and Obolenskaya, 2013). The substantial growth in resources during Labour's first two terms in office financed a major supply-side expansion in healthcare, with a considerable expansion of NHS inputs and outputs including staffing, services and healthcare activities. Substantial returns to Labour's investment in health over this period were also reflected in overall indicators of healthcare quality and satisfaction. In 1997, the public had been highly dissatisfied with the NHS, with long waiting lists, pressure for more expenditure on healthcare and demand for private medical insurance going up. By 2007/08, waiting list length and waiting times were down, growth in spending on private medical insurance cover was down, and satisfaction with the NHS had increased substantially.

On healthcare modernisation and reform, a new framework for inspection and regulation had been put into place after 1997 and further evolved during Labour's first two terms. The purchaser– provider split that had been introduced under previous Conservative administrations was retained under Blair, and further reforms emphasised commissioning, organisational decentralisation, competition and patient choice, and information on outcomes. By 2007/08, Labour's healthcare delivery model included autonomous NHS foundation trusts, practice-based GP commissioning and a new system of payment by results, based on the principle that resources should ‘follow’ the patient to the service they choose.

The situation on the eve of the crisis

In 2007/08, just before the financial crash unfolded, spending on adult social care in England had reached £20 billion (in 2014/15 prices) after a period of sustained budget increases under Labour in response to the expanding ageing and working-age disabled populations, and in recognition of the historic under-investment in social care. This was providing services to 1.8 million adults, including some of the most vulnerable people in our society: the oldest of the old, younger physically disabled people, people with mental illness or cognitive impairments, and people with drug and/ or alcohol problems.

Complexity in the financing and provision of social care, especially long-term care, was a widely acknowledged problem. Boundaries between the NHS and local authority services, between residential and community care (including domiciliary or home care), between universal and means-tested entitlements and privately paid care, and between formal services and unpaid care provided by family and friends, combined to produce considerable uncertainty among people in need of care and their families about what services they might receive and how much they would be required to pay. Major commissions and inquiries at a rate of one per decade (Griffiths, 1988; Sutherland, 1999; The King's Fund, 2006) had produced recommendations for reform, but none had been fully implemented, as a result of lack of crossparty support or due to concerns about the cost to the public purse. However, in Scotland, the Sutherland Commission's recommendation to fund personal care costs from direct taxation while retaining meanstesting for housing and living costs was adopted in 2002 for people aged 65 or over.

Meanwhile, the trend away from direct provision by local authorities and increasing use of private and not-for-profit providers was continuing (HSCIC, 2014a, Figures 4.5 and 5.1), as was the increase in the number of people receiving payments from local authorities with which to arrange their own care (‘direct payments’). Between 2000/01 and 2008/09, there had been more than a 10-fold increase in the number of working-age people using direct payments, and an even faster increase among the over-65s (from a much lower base), so that by the end of this period there were more than 86,000 recipients of direct payments in England (HSCIC, 2014a, Annex M).

In June 2007, when Gordon Brown took over from Tony Blair as Labour leader and Prime Minister of the UK, the climate for social policy-making in the UK was decidedly warm. The country was enjoying a sustained period of economic growth, the current budget deficit and public sector net debt were both lower than when Labour came to power, and the electorate was broadly supportive of the government's expansive social spending and the improved public services they had delivered.

Our own assessment of Labour's decade under Blair highlighted a complex and nuanced story, but one which indicated a shift towards a more equal society in several important respects (Hills et al, 2009). Inequality at the very top and the very bottom of the income distribution had continued to rise, as had absolute gaps in wealth and a range of measures of inequality in health outcomes. But there had been notable reductions in child and pensioner poverty, improvements in the relative position of disadvantaged neighbourhoods, narrowing gaps in educational achievement between children from lower-income families and others, and narrowing gaps in employment, education and incomes between some minority ethnic groups and the majority white population. The significant increases in the ‘social wage’ delivered through education and healthcare spending had had a substantial equalising effect. Looking at a range of official Opportunity for all indicators, trends had improved from 1997 compared to the decade before for nearly half of them, although they had deteriorated for a quarter. Where significant policy initiatives had been taken – and many were – we concluded that outcomes had generally moved in the right direction, if not always as rapidly as policy-makers and other observers might have hoped.

The period that followed, until the election of the Conservative government in May 2015, was an extraordinary one in British economic and political history. As has been well documented elsewhere, the global financial crisis that began to unfold in the summer of 2007 and culminated in the banking collapses and bailouts of autumn 2008 plunged the UK, like many other countries, into their worst recession since the 1930s, and punched a large hole in the public finances (see, for example, Gregg et al, 2014; Riley and Chote, 2014).

In this book, we set out to describe how different parts of social policy in the UK have changed in the eight years from the beginning of the economic crisis in 2007 up to the end of the Liberal Democrat- Conservative coalition government in May 2015. We have also looked at what is known so far about outcomes from those policies and changes in them, although given lags in both the effects of many policies and reforms, and in data that allow one to assess them, this must inevitably remain an interim assessment.

Given the scale of the economic shock – unprecedented since the 1930s – and the effect it had on public finances, and then the change in government priorities after Labour lost office in 2010, this was, indeed, as suggested in the Introduction (see Chapter One), an era with a ‘cold climate’ for many areas of social policy. As the contrasts between the chapters show, however, this has been by no means a uniform history. There were some strong contrasts between the policies Labour continued to pursue until it lost office in May 2010, and those of its successors (although there were also continuities). But as we have documented, there were sharp differences between social policy areas under the coalition, especially in how severely each was asked to contribute to that government's plans for reducing the public budget deficit. There were some areas that were comparatively insulated, although still affected by major reform, while in others the role of the state has been redrawn or even substantially withdrawn. Writing early in the life of a new majority Conservative government, much of this conscious reshaping of Britain's welfare state is set to be continued or intensified.

Social policy in a warmer climate

In an earlier book (see Hills et al, 2009), we surveyed what had happened to a comparable range of policies in the period of Labour government ending as the economic crisis began. We concluded that the picture was neither that a government with a strong parliamentary majority, egalitarian objectives and a favourable economy had decisively reversed the gaps in society that had widened over the previous two decades, but nor was there a simple pattern of the betrayal of those egalitarian ideals.

Introduction

This chapter examines the programme of equality and human rights reform undertaken by New Labour. The reform programme is evaluated against two benchmarks: (1) Labour's 1997 election manifesto commitments to ‘end unfair discrimination wherever it exists’ and to incorporate the European Convention on Human Rights (ECHR) into domestic law; (2) more far-reaching reform models that view equality and human rights standards as elements of a broader social justice agenda. As well as providing a retrospective analysis of Labour's equality and human rights programme, the chapter has a forward-looking aspect. Increased momentum in the reform programme since 2005 has resulted in a new equality and human rights landscape that provides a distinct point of departure for tackling horizontal inequality and disadvantage. The chapter considers the importance of the arrangements and their potential role in tackling horizontal inequalities during New Labour's third term and beyond.

Overview: New Labour's equality and human rights reform programme, 1997-2008

Equalities and human rights champion Lord Lester recalls that in 1997, when New Labour came to power, there was talk of the need for a Single Equality Act that would provide a comprehensive, integrated and overarching legislative framework for combating discrimination and disadvantage in Britain. There was also talk of the need for a single equality institution – a permanent, independent body with overarching responsibilities for addressing inequality in Britain, with investigative and enforcement powers, that would function as a watchdog and spearhead a process of long-term change – and a similar independent body providing institutional support for human rights. However, while there was talk in 1997, there was an absence of political momentum – either for a Single Equality Act or for an independent single equality and/or human rights institution (Lester, 2003a, 2003b).

Eleven years on, the machinery of equality and human rights regulation in Britain is in the process of being transformed. A Single Equality Act has been included in the government's draft legislative programme for 2008-09, while an independent equality and human rights institution – the Equality and Human Rights Commission (EHRC) – became operational in October 2007. The EHRC replaces the pre-existing strand-based equality bodies and has an overarching mandate to combat inequalities and disadvantage based on a broad range of characteristics (gender, ethnicity, disability, gender, age, religion and belief, transgender and sexual orientation) as well as for protecting and promoting human rights.