Introduction

International non-governmental organizations (NGOs) have become an integral part of global governance and global world order(s). They have played an important role in the development of norms and are by now crucial players in setting agendas and standards as well as with respect to monitoring of policy issues ranging from climate change to trade and human rights (Peters et al, 2009). They have instigated and shaped international institutions such as the International Criminal Court (Pearson, 2006; Haddad, 2013), and the provision of humanitarian or development aid is meanwhile inconceivable without NGOs. In order for such activities to be successful, NGOs often engage in inter-organizational cooperation, defined as the interaction between two or more organizations with respect to information sharing, the coordination of policies, joint decision-making and other activities (Biermann and Koops, 2017). While NGO scholars have begun to inventory and characterize the types of relationship that NGOs enter into, and have studied inter-organizational cooperation regarding its form and function (Keck and Sikkink, 1998; Henry et al, 2004; Yanacopulos, 2005; Carpenter, 2007a, 2011; Ohanyan, 2012; Elbers and Schulpen, 2013; Stroup and Wong, 2013), the inner workings of such cooperation remain largely unexplored.

Therefore, we still have only scant knowledge, particularly of the processes involved and as to who instigates cooperation among NGOs and moves the involved organizations from non-cooperation to informal or formal cooperation as, for example, in the case of the Coalition for the International Criminal Court (CICC). Starting out as a ‘loosely organized coalition of NGOs, it […] transformed into a permanent institution at the court with two headquarters, regional offices, and a secretariat with a permanent staff’ (Haddad, 2013: 189; see also Pearson, 2006). While constitutive of the existing world order with respect to human rights, we know little about how the Court's transformation came about, who were the driving forces behind it, and what prompted NGOs to move from informal to formal cooperation. The same applies to the Climate Action Network (CAN), a large coalition of NGOs that has existed since 1989, and of which Duwe (2001: 182) argues that individual agents ‘act as entry points for the cooperation’ among the partaking NGOs.

As the NHS reaches its 75th birthday, general practice represents something of a policy paradox: it is both highly visible, dominating headlines with perceived shortcomings and failings (Mroz, Papoutsi and Greenhalgh, 2022), and yet strangely invisible, with the most recent NHS reorganisation in England barely touching on its role. For example, in the latest Health and Care Act (Department of Health and Social Care, 2021) mention of general practice is confined to a few references to how it might be commissioned, with nothing at all about its form or function. Most strikingly, the most visible aspect of current primary care policy – an additional contract which provides funding for groups of GP practices to work together in networks – is not mentioned at all in the Act.

In part this dichotomy arises from the historical position of general practice in the NHS. In 1948, general practice was established not as an integral function of the hierarchical new NHS, but as a separate service, provided to the NHS by independent contractors (Peckham and Exworthy, 2003). This independent status has been both a strength and a weakness of general practice ever since (Lewis, 1998). Lauded for the fact that it may support innovation, and usefully allowing the central NHS to avoid providing premises, it has also been identified as problematic, generating unwarranted variation and difficulties in integrating primary care with other sectors (Chapman and Groom, 1999; Jones et al, 2015).

In terms of the themes set up in Chapter 1, general practice is perhaps an outlier, insulated by its independent status from the more significant NHS policy switches around competition or managerialism. Nevertheless, general practice policy since 1948 has seen a shift towards a more atomised approach (Norman, Russell and Merli, 2016), with the professional ideal of providing person-centred relationship-based care in ongoing tension with an approach which seeks to identify and manage biomedical problems in the most efficient way possible (Checkland et al, 2008).

In this chapter we consider general practice in the context of its history, and offer some thoughts about the future which take account of the unique status of primary care as both the entry-point to other services and as a semi-detached quasi-independent service.

Table A2.1 overviews the experiences of the four most heavily- sanctioned women in the study (see Chapter 5).

The experiences of 12 women sanctioned between two and five times during the study (see Chapters 4 and 5) are outlined in Table A2.2.

It’s February 2015 and I’ve travelled north by train between snowy mountains to speak to Michelle, a 23-year-old single woman getting Universal Credit. We settle down in a confusingly repurposed room – recording studio in one corner, desk and chairs in the other – in a hidden corner of an anonymous community centre. Seagulls squawk through the skylight. Michelle is animated. Her pale eyes sparkle as she tells me of her enchantment with the new payment, which is “much better” than Jobseeker’s Allowance. She’s out of work now but boasts an impressive array of vocational qualifications for realistic-sounding job options – hairdressing, interior decorating – and has recent supermarket and call-centre work experience. Michelle is worried about “being sanctioned, basically not having any money”. She recently got a letter from the Jobcentre asking why she missed an appointment. It left her “a bit confused because I honestly cannot remember having an appointment at that time and that date”, which was during a period when she was doing a full-time employability training course. Once she explained, she wasn’t sanctioned. She says: “I really want to find a job, because I’m so sick of not working; I really am.”

In 2016, a soaked train rushes me back to meet Michelle again. We’re in a bigger room, in the same complex. Since we last met, Michelle got a cleaning job at a supermarket, 16–20 hours per week, but it didn’t last. A psychiatrist was assessing her during that time:

Michelle’s mental health problems are now diagnosed. She now has a zerohours contract with a community centre but hasn’t had any shifts yet and she volunteers at a charity shop. She wants to get a nursing degree. “That’s the only thing that prevents me from working sometimes. I’ve got borderline personality disorder. And I suffer with anxiety and depression, so it makes things really, really hard. Sometimes unbearable. … Medicines can’t take it away; they can only manage it.”

Inter-organizational relations as an emerging subfield

As an academic discipline, international relations (IR) is state-centric by definition. It is about relations between nations organized in or as states. Consequently, it has always been good advice for those interested in studying IR to focus on states and their relations. In the early 1990s, however, a common understanding gained acceptance in IR that the political world is no longer just a world of states but of societies – a gesellschaftswelt (Rosenau, 1992). For more than 30 years, the study of non-state entities has become quite prominent in IR, be it of intergovernmental organizations (IGOs) and non-governmental organizations (NGOs), multinational enterprises (MNEs) or other organized forms of representation. The focus of this research is often on relations between states and non-state entities and their impact on each other. It has been only in the past 15 years that IR scholars have started to analyse relations among non-state entities. With a strong focus on IGOs, this subfield was labelled inter-organizational relations. While inter-organizational relations (IOR) may not have joined the discipline's mainstream yet, there is a visible and growing group of scholars researching this topic and translating its importance into multiple research questions.

As a consequence, the subfield of IOR has developed and matured since its creation. This came at a price, though. In the early days, scholars experimented with various theoretical and methodological approaches to study specific cases of IOR. In the recent past, this experimental period was replaced by a tendency to conformity and canonization. This tendency is not only expressed in a concentration on certain theories, methods, organization types and policy fields, but also in a binary understanding of the nature of relations. In theoretical terms, those interested in enquiring into IOR prefer rationalist approaches such as resource dependence and regime complexity (both to be discussed later). Methodological issues are hardly reflected upon explicitly, so most studies can be described, at best, as based on content analysis. There is also an inclination towards studying relations among IGOs or between IGOs and NGOs, mostly those dealing with security or economic policies. Moreover, inter-organizational relations are usually conceptualized in a binary way as being either cooperative or conflictive/competitive.

It is relatively uncontroversial to argue that the past decade has been the NHS’ toughest. Looking back, the NHS had emerged from the 2000s in comparatively good shape, having converted significant investment into radically shorter waits for routine care – at the time the public’s biggest bugbear.

But by the early 2010s, the ‘problem set’ facing the NHS was rather different, and the policy mix of the prior decade was now misaligned with those challenges. The underlying epidemiological challenge was to improve outcomes for an ageing population with multiple long-term health problems. The resulting system challenge was in part to move closer towards what I labelled the ‘triple integration’ of physical and mental health, primary and specialist services, and health and social care. And the economic challenge was to try and do so at a time of deeply constrained revenue and capital funding. Because when the British economy sneezes, the NHS catches a cold, as Anita Charlesworth and colleagues show in Chapter 3 of this volume. The international comparisons are even starker. In the decade to 2019 it has been calculated that the UK spent on average £40 billion less each year than if we had matched average per-person health funding across the EU14. Indeed, the UK would have had to spend nearly a fifth more to match French per-person health spending, and nearly two-fifths more to match that of Germany (Health Foundation, 2022).

Yet despite these pressures, by the 70th anniversary of the NHS in 2018 there were some grounds for optimism. The NHS had just secured a more workable medium-term financial settlement, backed by broad consensus on its own long-term improvement plan. The government had agreed to replace the 2012 Health Act with a legal framework better aligned to population health and integrated care.

However, five years, three prime ministers and one pandemic later, the NHS turns 75 in a more uncertain position. So it is unsurprising that the debate on the NHS’ future is again intensifying. Some argue that the chickens are coming home to roost from chronic political short termism that has repeatedly deferred long-term workforce decisions, underinvested in capital infrastructure and technology (even during a period of negative real borrowing costs), done little on prevention and stalled on social care reform.

Sarah works as a security guard but was sanctioned repeatedly. She was told “I should be searching for work, not looking after my mum”. Sarah is 30 and has “a lot to cope with”. “Family matters” and being “quite poorly” – “in and out of hospital for operations” – meant she had to reduce her full-time job to part-time, which meant irregular hours. Sarah “absolutely loves” working at festivals, horse races and premiership football matches. Her job transports her to “places I’ve never seen, things I’ve never thought of going to”. Universal Credit tops up her variable wages.

Sarah is “hands-on with my family” and “running around for them all the time”. She cares for her mum, her nan, and her 18-year-old sister, who has high support needs.

Relentless sanctions made matters worse. Sarah “didn’t know what they were for”. She submitted written evidence of her distressing and time-consuming family obligations to her work coach to explain her good cause for missing appointments, but: “They don’t really understand it at the Jobcentre. … They said it’s not relevant.”

Introduction

Sarah’s experience reflects irreconcilable differences between welfare conditionality and the everyday realities of women’s family lives. The lives of all three generations of women in Sarah’s family are intertwined. Sarah does not have children and is not a designated carer, but nonetheless, the buck stops with her. The societal expectations of female kin care do not diminish, so Sarah is caught between the government insistence that she work full-time and her family identities – with all the private expectations of what it means to be a grand-daughter, daughter and “just big sister”. Welfare conditionality is not designed to facilitate informal care or reflect family identities. Instead, rules and sanctions push women to fulfil maledefined working norms. This chapter focuses on the 16 women in the study who were sanctioned most often. Sanctions ‘boss texts’ mislead us to expect that those who are sanctioned repeatedly are intentional work evaders, facing rational consequences for conscious wrongdoing.

The alternative consumer cooperatives (ACCs) studied in this book strive to transform the prevailing food production and consumption nexus by re-positioning the petty commodity producers and bridging the gap between the urban middle class and the rural areas. In so doing, the ACCs have introduced fundamental changes such as bypassing the middlemen, de-fetishising foodstuff and experimenting with zero-hierarchy and consensus-based decision-making that challenge the capitalist forms of organizing and doing business. They are not driven by the profit motive and growth-pursuing strategies but instead develop and promote solidarity, collective action and mutuality among and within the urban middle class and rural small producers that have been excluded from the economic realm by the authoritarian implementation of neo-liberal policies. The ACCs are transforming the long-established socio-economic rural– urban relations in agriculture and invite other constituencies (municipalities and professional groups like architects, designers, software engineers and actors) to participate in the diffusion of alternative ways of organizing. The actions taken, tools developed and positions taken are important in understanding this transformation process and assessing its future trajectories. Thus, in this study we have tried to understand and describe how and why the ACCs evolved and how they challenge capitalist logic in food provisioning by experimenting and re-organizing their practices as problems are encountered.

The ACCs are grassroot organizations initiated by petty commodity producers, their representative organizations and the urban middle class who are excluded from the economic and social realm by the implementation of neo-liberal policies. As discussed in Chapter 4, the initiation of the ACCs is marked by the collaboration of petty commodity producers and urban middle-class citizens. As small producers, individual producers (for example, İlhan Koçulu and Ali Ünüvar) that had prior experience with producer cooperatives, Kibele (a producer cooperative) and Çiftçi-Sen (Farmers’ Union) were actively involved in the founding of the ACCs. The association Tohum-İzi Derneği (formerly KEÇI– Solidarity Initiative between Urbanites and Farmers) and the academic and administrative staff of Boğaziçi University were the initial representatives of the consumers. The dominant values that inspired and guided these groups were rooted in the premises of La Via Campesina.

Karen was born in 1955 and “grew up before the human rights thing”. She launched her Royal Navy career in the early 1970s but, two years later, it was over when it had barely begun. Karen was discharged for breaching her contract by becoming pregnant. Because it happened before the Sex Discrimination Act 1975, Karen was lawfully denied her job and her occupational pension for those years of service.

Like many married women at the time, Karen prioritised raising her children. When her marriage ended in the 1980s, she wanted to work but “there was no childcare and all that sort of stuff”. She took part in a local authority initiative for women returners, got a diploma for office work and did a government training scheme working as an administrator with a benefit top-up of £15 per week.

Karen’s “strong work pride” spurred her on and she had full-time and part-time employment continuously for 30 years. These were mainly administrative jobs and varied widely, including managing multimillionpound contracts for a government department, legal work and support for female survivors of violence and sexual assault.

In 1995, half-way through her working life, the government rewrote state pension law. Instead of retiring at 60, Karen would have to wait until 66. Karen was 59 when we first interviewed her in 2015. She gets Universal Credit and is legally required to look for full-time work to receive financial support. At the second interview, Karen is 60 – the age she had expected to retire. She wishes she “could spend time … with my grandchildren and if I wanted to work I could but then it would be choice rather than being forced. I still would”.

Aged 61, the third time we speak to her, Karen has held a series of transitory jobs, volunteered and completed work placements. As for training courses, she has “done them all”. Her generation was the last to be legally excluded from work because of pregnancy and the first to be legally mandated to work full-time beyond 60. Instead of retiring, Karen is stuck in a ‘work preparation’ holding pattern.

Introduction

Yassin Abdullah Kadi, a Saudi Arabian businessman, is the most prominent case of what happens when one has been declared a ‘specially designated global terrorist’ (SDGT). In 1999 and 2000, the United Nations (UN) suspected Kadi to be an associate of Osama bin Laden and Al-Qaeda and placed sanctions against him under UN Security Council (UNSC) Resolutions 1267 and 1333 (discussed later). In October 2001, the US declared him an SDGT, which caused the blocking of all his property and interests subject to US jurisdiction. The European Union (EU) followed suit, as did Saudi Arabia, Kadi's home country. Kadi has repeatedly claimed that he has given no support to terrorism. Mired in limbo over the accusations, Kadi was forced to stay in Saudi Arabia without ever having been informed of the reasons for his listing and – before the EU endorsed the UN listing – without possibility of appeal.

While the human rights concerns are striking, the case of Yassin Abdullah Kadi draws attention to two points requiring closer scrutiny for scholars of inter-organizational relations (IOR) and world order. First, lists have been frequently used by intergovernmental organizations (IGOs) and states alike as a means in counterterrorism (Goody, 1977). For IGOs, lists are a way of governing their own remit, the IOR and an organization's environment, as lists are increasingly operating globally and across multiple jurisdictions (De Goede and Sullivan, 2016; Barnett and Finnemore, 2004). Lists represent the ways in which the external environment of IGOs is observed and internally processed. While IGOs strive to navigate this environment, they aim to reduce uncertainty by using lists that help to make the environment more predictable by explicitly naming those that are considered a threat. The second point resides in how IGOs make sense of their environment, and thereby, govern and shape this very environment – for their own further decision-making as well as for other state and non-state actors.

Introduction

This book reveals the hidden male subtext of punitive UK welfare conditionality for working-age benefit claimants. It begins, as Dorothy Smith suggests, by viewing the social security system from the perspective of women whose lives are shaped by it every day. This creates a ‘way of seeing’ that is grounded in ‘where we actually live’ (Smith, 1987, 13). From this position the underlying gendered ‘relations and powers of the world we live in become visible from the sites of people’s actual experience’ (Smith, 1987, 165). For the 138 women claiming working-age benefits who took part in the Welfare Conditionality study between 2014 and 2018, welfare reforms, in a range of guises, had highly gendered impacts. The seemingly neutral design of Universal Credit, Jobseeker’s Allowance and Employment and Support Allowance policies are rooted in ‘relations of ruling [that] have a strongly gendered character’ (Smith, 1987, 165). Multiple layers of texts reveal the power relations of work and welfare. ‘Male subtexts’ within social security law, guidance documents and policy instruments have, for women, rewritten the parameters of paid work and unpaid caring. This textual mediation of women’s lives is ‘curious in its capacity to reproduce its order in the same way in an infinite variety of actual local contexts’ (Smith, 1990a, 2). Conditional welfare reforms, involving harsh punitive sanctions, are constructed in political discourses, policy design and practice norms as if women were unhampered by intersectional labour market disadvantages that combine gender, race, disability, age and class penalties to constrain employment opportunities, restrict pay and impede retention and advancement. Women are subordinated to a false version of their reality, which they must contort themselves and their intersubjective and interconnected lives to fit. Failure to fit is punished severely by potentially life-changing sanctions.

Despite the global rise of precarious working conditions (Standing, 2009), 21st-century social security reasserts an outdated full-time standard model of paid work and extends it far beyond the traditional targets of intervention – unemployed people. Disabled women and lone parents are required by default, on threat of sanctions, to comply with the same intensive 35-hour-per-week job-search expectations as unemployed people.