1. “Sharp elbows”: Do the middle classes have advantages in public service provision and if so how? Research funded by: Annette Hastings, School of Social and Political Science, University of Glasgow Peter Matthews, School of the Built Environment, Heriot- Watt University

2. “The availability of good medical care tends to vary inversely with the need for it in the population served.” Julian Tudor-Hart (1971) The Inverse Care Law

3. Outline What we did in brief – Research design, methods and scope Do the middle classes have advantages in public services? How do the middle classes gain advantages? Concluding thoughts: what is the role of the state in re-distributing resources and power from those with more to those with less?

4. What we did A ‘realist synthesis’ literature review 65 papers reviewed – education, health services, land use planning, envt services, infra-structure investment; general activism Aimed to build theory capable of linking micro-processes of middle class political activism to ‘who gets what?’ in public services

5. Do the middle classes have advantages in public services? Getting decisions in their favour; land-use planning Getting better services; children into the best schools, or extra help – educational support; gifted and talented classes More productive co-production; longer health consultations Services and policies suited to need; tailored environmental services

6. Theory name Definition I’ll stand as the parish council chair That the level or nature of middle class interest group formation allows for the collective articulation of their needs and demands, and that service providers respond to this. I’ll write to my councillor and complain That the level and nature of middle-class engagement with public services on an individualised basis means that services are more likely to be provided according to their needs and demands. I’ll just phone our doctor That the alignment in the cultural capital enjoyed by middle classes service users and service providers leads to engagement which is constructive and confers advantage. I’ll vote for themThat the needs of middle class service users, or their expectations of service quality, are ‘normalised’ in policy and practice or even that policy priorities can favour middle-class interests.

7. Are the middle classes advantaged and does it matter? The evidence that there is points to middle class advantage Accrues through deliberate, strategic activism But also via alignments in cultural capital - favourable pre-disposition to middle class needs? Evidence base insufficient to assess the scale or import of the problem – could have explanatory power as driver of inequality.

8. What is the role of the state in redistributing resources and power in time of austerity? “the Conservative government was hampered in its policy of reducing state expenditure … by its willingness to favour state provided services that were predominantly used by members of the middle class” (LeGrand 1986: 427)

9. Barr B R BMJ 2012;344:bmj.e537 ©2012 by British Medical Journal Publishing Group

10. Does localism redistribute power from the more to the less powerful? “The time has come to disperse power more widely in Britain today.” The Prime Minister and the Deputy Prime Minister, Coalition Agreement, May 2010 But who already has power? Electoral power of affluent groups mean that policy and resource allocation often already geared to meet their needs. At a local level, real potential for bottom up activism and alignments in cultural capital to bend the spend further. A real danger that localism further empowers those who are already empowered?

11. References Barr, B. R. (2012). "Stop blaming the unemployed and focus on universal system of mutual security." BMJ 344. Hills, J 2011 ‘The changing architecture of the welfare state’, Oxford Review of Economic Policy,Vol 27, No. 4 Le Grand, J. and Winter, D. (1986). "The Middle-classes and the Welfare State under Conservative and Labour Governments." Journal of Public Policy 6(4): 399-430. Hastings, A.Hastings, A., and Matthews, P. (2011) "Sharp Elbows": Do the Middle- Classes have Advantages in Public Service Provision and if so how? Project Report. University Of Glasgow, Glasgow, UK."Sharp Elbows": Do the Middle- Classes have Advantages in Public Service Provision and if so how? Hastings, A.Hastings, A., and Matthews, P. (2011) Connectivity and Conflict in Periods of Austerity: What do we Know about Middle Class Political Activism and its Effects on Public Services? Project Report. AHRC / Connected Communities.Connectivity and Conflict in Periods of Austerity: What do we Know about Middle Class Political Activism and its Effects on Public Services?