The cost-of-living budget: why it’s time to focus more squarely on need

Ruth Patrick, Kitty Stewart, and Rosalie Warnock respond to Rishi Sunak’s cost-of-living statement and highlight its failure to address the fact that household needs differ depending on household size

Should we pay research participants? feminist political economy for ethical practices in precarious times

Questions of paying research participants have taken on a new urgency as contemporary geographies of precarity, inequality and austerity affect both potential participants and, to varying extents, early-career researchers, while universities place greater emphasis on public engagement and research impact. Here, we offer reflections and recommendations that come from our experiences as PhD students in London, as precarious researchers researching precarious lives. We make a case for paying participants based on ethics of care and readings of precarity informed by feminist political economy. We discuss how and how much to pay. We recommend changes to institutional norms that have treated payments with suspicion, to research design and funding, and to ethical approval procedures and publishing practices

When the cap really doesn’t fit: populist policymaking and the benefit cap

Ruth Patrick, Rosalie Warnock, Aaron Reeves, Kitty Stewart, Kate Andersen and Mary Reader discuss why the benefit cap was introduced in the first place, its symbolic status within anti-welfare thinking, and the very real harm the policy is causing

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Relational legacies and relative experiences:Austerity, inequality and access to special educational needs and disability (SEND) support in London, England

Through the lens of access to Special Educational Needs and Disability (SEND) support services in London, England, this paper highlights the relative legacies of state-led austerity since 2010. Drawing on findings from a four-month institutional ethnography with a London borough SEND support team and 43 repeat in-depth narrative interviews with 15 parent carers with autistic children, this paper focuses in on two parents: Alice and Lucy. Comparing Alice and Lucy's experiences shows nuanced relational legacies of austerity: families with disabled and neurodiverse children have been disproportionately affected by austerity cuts. Additionally, however, their accounts show their relative experiences of accessing help: some more marginalised families with disabled children are finding it harder under these circumstances than others. Yet a neoliberal myth of meritocracy has emerged during this time which obscures the underlying structural and systemic reasons for widening relative inequality between families with disabled and neurodiverse children. This myth suggests that the parent carers who do manage to secure ever shrinking SEND resources have simply worked harder than others to get there. The result is that parent carers – including Alice and Lucy – have different experiences of trying to navigate and access the same SEND services, in the same place, at the same time. Bringing together geographical and sociological work on austerity, families, disability, and education, this paper extends understandings of how austerity is relational in its effects and shows how these legacies are still unfolding.Short Abstract:Through the lens of access to Special Educational Needs and Disability (SEND) support services in London, England, this paper highlights the relational and relative legacies of state-led austerity since 2010. Drawing on findings from a four-month institutional ethnography with a London borough SEND support team and 43 repeat in-depth narrative interviews with 15 parent carers with autistic children, this paper focuses in on two parents' experiences of trying to navigate and access the same SEND services, in the same place, at the same time. Bringing together geographical and sociological work on austerity, families, disability, and education, this paper extends understandings of how austerity is relational in its effects and shows how these legacies are still unfolding

The banality of state violence: Institutional neglect in austere local authorities

Peer reviewed: TrueTheorisations of state violence under austerity have been criticised for their imprecision. In response, this article introduces the concept of institutional neglect: a specific modality of structural violence. We argue that institutional neglect occurs when state services deny care to eligible clients. This is a normative claim which locates an obligation to care in the body of the state. Through case studies of two local authority-run care services in the UK, we identify three banal, quotidian techniques of neglect: delay, deferral, and diversion. We emphasise that care is not necessarily an antidote to violence; instead, care and violence are increasingly entangled within state bureaucracies under austerity

The banality of state violence: Institutional neglect in austere local authorities

Theorisations of state violence under austerity have been criticised for their imprecision. In response, this article introduces the concept of institutional neglect: a specific modality of structural violence. We argue that institutional neglect occurs when state services deny care to eligible clients. This is a normative claim which locates an obligation to care in the body of the state. Through case studies of two local authority-run care services in the UK, we identify three banal, quotidian techniques of neglect: delay, deferral, and diversion. We emphasise that care is not necessarily an antidote to violence; instead, care and violence are increasingly entangled within state bureaucracies under austerity

Social security, exponential inequalities, and Covid-19: how welfare reform in the UK left larger families exposed to the scarring effects of the pandemic

Covid-19 has put social security systems under immense pressure. Governments saw demand for social security rise dramatically whilst attempting to support those whose employment had temporarily stopped once severe economic restrictions were put in place. Drawing on a range of evidence (including original interviews), this chapter focuses on the experience of larger families (households with three or more children) during the pandemic as a way of illuminating how these pandemic-induced policy responses often failed to reach those groups who have been subject to austerity measures over the previous decade. We explore this in three ways. First, we unpack how the government's response to Covid-19 left larger families in a precarious position. Secondly, we situate the experience of larger families in the context of a wider set of reforms to social security-such as the benefit cap, the two-child limit, and the benefits freeze-which have already pushed even more larger families into poverty over the last decade. The final section of the chapter draws out how these policy decisions exacerbate inequalities between groups, while alluding to implications for protected characteristics as enshrined in the Equality Act 2010. This analysis not only illuminates how the pandemic has increased gender and ethnic inequalities but also suggests that the degree to which the pandemic was inequality-generating is rooted in policy decisions made before the pandemic even began. Avoiding exponential inequalities in response to future crises requires that policies-and the discourses which surround them-are sensitive to the potential for other kinds of societal shock