The book is based on qualitative longitudinal research from the ‘Sanctions support and behaviour change: understanding the role and impact of welfare conditionality’ project, funded by the Economic and Social Research Council’s Centres and Large Grants Scheme Grant (2013–19, grant number ES/K002163/2, www.welfareconditionality.ac.uk). The Welfare Conditionality project aimed to create an international and interdisciplinary focal point for social science research on welfare conditionality and brought together teams of researchers in six universities: York, Glasgow, Heriot-Watt, Salford, Sheffield and Sheffield Hallam. The original research questions were:

• • How effective is conditionality in changing the behaviour of those receiving welfare benefits and services?

• • Are there any circumstances in which the use of behavioural conditionality may, or may not be, justifiable?

This book presents reanalysis of original data generated in interviews from three rounds of innovative repeat qualitative-longitudinal interviews. The full study involved 481 ‘welfare service users’ (1082 interviews in total) subject to a range of conditionality measures in nine policy fields: Universal Credit, job seekers, disabled people, migrants, lone parents, ex-offenders, family intervention, homeless and social tenants. Many of the participants were subject to work-related conditionality while claiming benefits, especially those who were selected because they claimed Universal Credit or Jobseeker’s Allowance. However, other types of behavioural conditionality like antisocial behaviour orders and family intervention projects were included too. This book focuses only on female research participants with experience of social security benefits.

In total, 213 (44 per cent) of the 481 welfare service users who participated in the project self-identified as cisgender women and 268 as cisgender men. Chart A1.1 shows there were higher proportions of women sampled as lone parents (85 per cent) and social tenants (70 per cent). Fewer women were sampled as ex-offenders (21 per cent) and homeless people (27 per cent). The sampling strategy was based on statistical evidence of gender distributions in each of the categories at the start of the study in 2014. Chart A1.2 shows the age distribution of all 481 men and women at the start of the study.

Introduction

This chapter focuses on the changing local structures of patient and public involvement (PPI) in the English NHS, and on their basis in health policy. Reforms to processes of PPI intersect with, and have co-existed alongside reforms to, all the key analytic axes highlighted in this volume: hierarchies, markets and networks; the public and the private; professionals and the state. However in this chapter, our focus is how PPI intersects with one of the axes identified by the editors: dynamics of centralisation and decentralisation in the NHS. At the core of this interest is something of a paradox. Greer et al have argued, with a focus on health governance during the pandemic, that political decisions about centralisation and decentralisation are a question of credit and blame: ‘politicians who wish to be effective and elected seek credit and avoid blame’ (Greer et al, 2021). In this view, decentralisations – especially those driven by New Public Management logics – are a route by which government ministers avoid public blame and muddy accountability. Thus we might assume that questions of public voice are better served by a centralised healthcare system with clean, direct lines of accountability. To draw on one of Bevan’s ever-quotable speeches (discussed further in the next section), the ‘slops bucket’ is knocked over, and a patient’s complaint will be heard in Whitehall. However, the English NHS, is, by the standards of similar health system types, far too large for this centralised vision of responsiveness to be viable via command and control. Substantive calls for greater democratic control of the NHS are invariably couched at the local, and not the national, level (Klein, 2010).

The NHS in England has seen repeated attempts to devise adequate local structures of patient and public voice over the decades, alongside repeated dynamics of decentralisation, and recentralisation, in broader structural change (Peckham et al, 2005). Within the reforms (listed in Table 12.1) we argue that there are at least two competing visions of effective PPI, reflecting a distinction Day and Klein (1987) posit between political and managerial accountability.

Bridget is living a “nightmare”. She is 36 years old, White British and lives with her 18-year-old son. She left her stressful social care management job three years ago, for her “own sanity”, after being bullied. She spun “into a complete and utter downward spiral”. Unable to work she withdrew “from everyone”. Without any income, she used a credit card to pay her mortgage. ‘I bought right at the height of the housing price, and my dad had given me a big deposit, so even with that I’m still in negative equity, so I was kind of stuck in the house.’ Bridget stopped opening her post. The debts mounted up. With severe depression and on the brink of eviction, a friend and former colleague stepped in. Bridget’s mortgage provider suggested applying for benefits. At the medical assessment, Bridget was deemed ‘fit to work’, despite her debilitating mental health condition. She qualified for Employment and Support Allowance (ESA) but was put in the Work-Related Activity Group instead of the Support Group. This meant she was required to do regular work-related activities. The Work Programme was “just horrendous” and heaped “sanction upon sanction upon sanction upon sanction” for missing appointments that she knew nothing about.

“Long periods of time … without money” felt “impossible”. Being sanctioned nearly every month for a year “delayed my recovery and it exacerbated a situation that was already at a breaking point of going further and further into a black hole”. At Bridget’s “lowest point” she was reassessed. This time she was placed appropriately in the ESA Support Group, without any work-related conditionality, which put an end to “catastrophe after catastrophe”.

Freed from conditionality, Bridget “instantly had relief ”. She started to recover, changed medication and got counselling support. Then she took on “a real battle” to successfully appeal her original Work Capability Assessment outcome and got a small pot of backdated benefits. She appealed her sanctions. Bridget started doing voluntary support work a few hours a week as ‘permitted work’. Over the next year, a local support agency “helped me get back into my normal, full-time professional job”. Another year later, Bridget passed her six-month probation period as a full-time social worker. She is “still struggling a bit” with her mental health but “definitely better off financially”. She is looking forward to a surfing holiday for her son’s 21st birthday.

Organizing is politics made durable. From cooperatives to corporations, Occupy to Meta, states and NGOs, organizations shape our lives. They shape the possible futures of governance, policy making and social change, and hence are central to understanding how human beings can deal with the challenges that face us, whether that be pandemics, populism or climate change. This book series publishes work that explores how politics happen within and because of organizations and organizing. We want to explore how activism is organized and how activists change organizations. We are also interested in the forms of resistance to activism, in the ways that powerful interests contest and reframe demands for change. These are questions of huge relevance to scholars in sociology, politics, geography, management and beyond, and are becoming ever more important as demands for impact and engagement change the way that academics imagine their work. They are also important to anyone who wants to understand more about the theory and practice of organizing, not just the abstracted ideologies of capitalism taught in business schools.

Our books offer critical examinations of organizations as sites of, or targets for, activism, and we will also assume that our authors – and hopefully our readers – are themselves agents of change. Titles may focus on specific industries or fields, or they may be arranged around particular themes or challenges. Our topics might include the alternative economy; surveillance, whistleblowing and human rights; digital politics; religious groups; social movements; NGOs; feminism and anarchist organization; action research and co-production; activism and the neoliberal university, and any other subjects that are relevant and topical.

Organizations and Activism is also a multidisciplinary series. Contributions from all and any relevant academic fields will be welcomed. The series is international in outlook, and proposals from outside the English-speaking global north are particularly welcome.

There could hardly be a more essential subject to human life than the focus for the fifth book in our series: food. We buy it, cook it, consume it every day. It is essential to survive, and also plays a pivotal role in our overall health and wellbeing. Yet food is more than this. Food is not merely sustenance; it is a source of pleasure, cultural identity and social connection. From birthdays to weddings, holidays to festivals, food takes centre stage in commemorating these important moments in our lives. Food matters.

Introduction

This chapter zooms in on the dynamics of competition that shape interorganizational relations (IOR) in world politics. More specifically, it probes into the competition over authority that pervades global governance: the quest by various actors to become epistemic authorities – the key knowledge producers – on the objects that are governed in world politics, such as international security, the global economy or the climate. Does this competition make the epistemic practices of these actors more similar or more distinct?

This question is key to understanding how IOR affect the ordering of world politics. If the competition fosters a diversity in the epistemic practices, this may make the objects more ambiguous, thus complicating efforts to develop frameworks and tools for their governance. One example for such an ambiguity is the world-wide level of armaments, for which military expenditures are a prominent indicator. Several organizations produce international statistics on military expenditures, vying for attention and influence in debates about security politics. Their statistics, though, diverge. The Stockholm International Peace Research Institute (SIPRI), for instance, estimates that the military spending of the US in 2019 (US$732 billion) far surpassed the combined spending of China (US$261 billion) and Russia (US$65 billion) (Tian et al, 2020). The US State Department, in turn, publishes a range of estimates on the patterns of military expenditures for the same year, with the upper end of the estimates suggesting that the combined spending of China (US$417 billion) and Russia (US$170 billion) was much closer to the US spending (US$730 billion) than the SIPRI figures indicate (US State Department, 2021a).

The chapter builds on and further develops theorizing on organizational fields to explain the effects of the competition over authority. Sociological neo-institutionalists have developed and used the concept of organizational fields to study how the interaction of organizations generates field dynamics that shape the form and practices of these organizations (for overviews, see Scott, 2008: 181– 209; Wooten and Hoffman, 2017). Isomorphism, for instance, denotes field dynamics that make the forms and practices of the organizations more similar over time (see Boxenbaum and Jonsson, 2017). Scholars in international relations (IR) have drawn on this theorizing to probe into different aspects of world politics, such as isomorphism among states (Farrell, 2005) or among governance institutions (Dingwerth and Pattberg, 2009), processes of policy change (Vetterlein and Moschella, 2014) and the evolution of ecologies of governance institutions (Lake, 2021).

Introduction

How did alternative consumer cooperatives (ACCs) emerge and how do they function within a context characterized by an exit from democracy, the rise of political Islamism and the populist neo-liberal policies (see, for example, David and Toktamış, 2015; Toktamış and David, 2015; David, 2016; Öktem and Akkoyunlu, 2016; Özden et al., 2017; Çalışkan, 2018; Adaman et al, 2019; Toktamış, 2019; Adaman and Akbulut, 2020)? In a political and economic milieu characterized by the dominance of a strong state tradition and a commitment to the premises of neo-liberal policies, affecting various aspects of social and economic life as well as the daily practices of citizens, how did a non-capitalist form of organizing emerge from those excluded from the political and economic realm? What were the major factors that mobilized the urban middle class to build networks of solidarity with other excluded groups and the petty commodity producers?

Although the neo-liberal turn in Turkey started with the 1980 structural adjustment programme, its full-blown implementation happened in the early 2000s when the ruling party, with the guidance of international organizations, instigated a political project to refashion Turkish society by combining neo-liberal economic policies, democracy and Islam (Çelik, 2015; Tuğal, 2015; David, 2016; Tansel, 2018). The model, usually described as ‘passive revolution’ in Gramscian terms (Tuğal, 2009), was implemented in a top-down fashion by the appointed bureaucrats and elected politicians. This neo-liberal Islamic model was successful in facilitating the inclusion of some groups (pro-government entrepreneurs, journalists, academics, bureaucrats) to the economic and political domains of society. The model also had a neo-liberal populist character in its capacity to include the new urban poor and informal sector workers by addressing their needs for housing and social assistance (Özden and Bekmen, 2015; Batuman, 2019). The government took certain initiatives (gentrification, low interest rates) to solve the informal housing (gecekondu) problems which later gave way to urban exclusion and the occupation of public spaces by mosques and shopping malls (Alonso, 2015). This neo-liberal populist, political Islamist project with its emphasis on the inclusion of the urban poor with the pro-AKP factions was, at the same time, exclusionary (Tuğal, 2015).

Introduction: social care anniversaries

Although NHS anniversaries have been widely celebrated and form the basis of a number of detailed histories, adult social care has tended not to receive the same attention and focus. The National Assistance Act – the piece of legislation which many see as leading to the creation of the modern adult social care system – received Royal Assent on 13 May 1948, just weeks before the launch of the new National Health Service. In one sense, therefore, all the anniversaries set out in the opening chapter to this book could also be seen as joint anniversaries of both health and social care. This is very fitting, as health and social care have been so inextricably linked ever since – with a series of attempts to break people’s lives down into separate ‘health’ and ‘social care’ needs proving increasingly meaningless over time. However, the vast majority of previous accounts have focused solely on the NHS, and adult social care is rarely mentioned, even in passing. As a result, the history of adult social care is largely overlooked – and even people working in adult social care may know little about the origins and evolution of their current services and roles.

In many ways, the current adult social care system is based on the legacy of the Poor Law, with frail older people, disabled people and people with learning disabilities or with mental health problems initially supported within local communities, and then – as problems of poverty and rapid industrialisation and urbanisation increased – in infamous institutions known as ‘workhouses’ (see Payne, 2005; Means, Richards and Smith, 2008; Pierson, 2011; Glasby, 2017; Humphries, 2022; for an overview of the history and development of adult social care and of the social work profession). Faced with more need that they could ever possibly meet, workhouses were deliberately designed to be as a harsh as possible so that only people who were absolutely desperate would seek support, with everyone else doing all they could to remain as independent as possible (a principle known as ‘less eligibility’). After the Second World War, an attempt was made to distance modern adult social care from this controversial and unfortunate legacy, with a clear separation between national financial support for those on low incomes or unable to work (‘social security’) and practical care and support for people who are frail or disabled (‘adult social care’).

In recent years the Turkish political domain has witnessed a multitude of solidarity initiatives such as consumer cooperatives, women-owned producer cooperatives and neighbourhood assemblies formed by citizens in an effort to express their discontent with the hegemonic neo-liberal project and the tone of its implementation. These initiatives, in response to full-blown neo-liberalism and the increasing drift towards authoritarianism, can be taken as enclaves of ‘hope’ where, through direct democracy and solidarity among various constituencies, excluded groups can be repositioned within the political and economic realm and citizens can have a voice in politics. Activists involved in these initiatives demand a ‘just’ distribution of resources within society and claim that by realizing their capabilities, by pursuing their ideals and by offering their time and labour they can shape power relations at the local level. Participants from diverse social and economic backgrounds – workers, professionals, university students, the unemployed – question the predominant norms of the existing political system and develop alternatives that can lead to change. In this book we focus on one of these initiatives: the alternative consumer cooperatives (ACCs) as spaces for prefigurative food politics.

In Turkey, the ACCs are different to conventional consumer cooperatives (CCCs), which have been instrumentalized either by the state or by companies for private gain. The ACCs proliferated after the 2013 Gezi Park protests as a reaction to the hegemony of capitalist relationships in the production and distribution of foodstuff. They are governed by activists who disregard managerialist logic and experiment with alternative ways of governance such as a zero hierarchy and consensus-based decision-making. The daily activities of the ACCs are carried out by consumers who offer their labour voluntarily and who provide examples of non-marketable forms of economic transactions such as reciprocity and social obligation. Given all these features, in this book we view ACCs as spaces of prefigurative politics where politically positioned consumers not only experiment with and gain insight into alternatives to the capitalist logic, but also reshape the existing power relations in and around the ACCs. In so doing, we expose the strategies employed by the government in the construction of a globally oriented capitalist production/consumption nexus in agriculture and explore how ACCs develop counter-strategies to resist and challenge the status quo.

As the NHS celebrates its 75th anniversary, all is not well. Alongside the familiar list of ailments – chronic staff shortages, decaying infrastructure and waiting lists longer than the average lifespan – are doubts about the spiralling costs of managers. As the Tory MP, Philip Davies, glibly informed one of his constituents: ‘The problem is that the NHS is appallingly run with far too many overpaid and utterly useless senior managers who wouldn’t be able to get a similar job in the private sector’ (McKay, 2023). Such claims are a recurring and depressing theme in contemporary public debate (Kirkpatrick, Veronesi and Altanlar, 2017a; Kings Fund, 2011) and, if anything, seem to have become increasingly common. Most recently, with great fanfare, the Daily Mail heralded a ‘Bonfire of the pen pushers’, reporting plans by Health Secretary Steve Barclay to ‘Crackdown on NHS bureaucrats costing taxpayers £2.8 billion a year’. The government will ‘root out waste, wokery and deadwood to cut costs and free doctors from red tape amid backlog crisis’ (Huskisson, 2022). Even the political opposition are getting in on the act, with Kier Starmer, leader of the Labour party, pledging to slash ‘nonsense bureaucracy in [the] NHS’ (Turner, 2023).

Hence, for many concerned observers, NHS managers have become part of the problem. The dominant view is that the NHS employs too many managers and back room administrators, soaking up resources, stifling creativity and interfering with the work of frontline clinicians. Of course, some have challenged this view. According to Managers in Partnership (2015), ‘[NHS] Managers make a distinct contribution as the people who organise care, fix problems and ultimately take responsibility for the services people depend on’. Ultimately, ‘Managers are the people who keep the show on the road, day-in day-out’. Claims about unsustainable management costs have also been subject to critical scrutiny by researchers (Kings Fund, 2011) as has the very idea that an organisation as large and complex as the NHS could ever function without managers to coordinate things (Mintzberg, 2017). This is especially in light of current plans to re-organise around integrated care and continuing problems associated with workforce planning, unequal access to services and ‘unwarranted variation’.

Introduction

In recent years, following the 2013 Gezi protests, citizens across Turkey have expressed their discontent with the prevailing neo-liberal system and political regime by establishing various forms of solidarity initiatives – consumer cooperatives, producer cooperatives and neighbourhood solidarity initiatives. These initiatives, while adhering to the spirit of Gezi, were driven by a claim to take an active role in issues concerning all the citizens in a specific locality. Gezi protesters, while responding to ‘the institutionalization of neo-liberalism and centralization of powers’ (Akçay, 2021, p 93), also developed a hope that through direct democracy, resistance and solidarity, citizens could have a voice in politics (Öztan, 2013; Parlak, 2013; Sevinç, 2022). In the local initiatives that proliferated after Gezi, through forums and neighbourhood assemblies (Mahalle Meclisleri), public opinion on issues such as food, child abuse, violence against women, betterment of labour conditions and collective action for resolving persistent problems was developed (Doğançayır, 2022; Kahraman, 2022). Mahalle Meclisleri (Olcan, 2020), were later named as district solidarity initiatives and, as noted by Fırat (2022), proliferated during the COVID-19 pandemic. After the announcement of the Coronavirus Support Programme by the government, 17 new solidarity initiatives were established in İstanbul, Ankara, Bursa, Ayvalık and Mersin. In this chapter we focus on one of these initiatives, the alternative consumer cooperatives (ACCs) and elaborate on their work in reclaiming the public sphere with a transformative potential that is shaped through the politicization of consumers and petty commodity producers. In so doing, we investigate how a public sphere concerning food politics in Turkey has been developed, who the main actors are, what types of media they use, and which other constituencies have been drawn in.

Borrowing on the Habermasian (1981, 1987, 1989) concept of the public sphere we see the ACCs as a space for the development and articulation of a special discourse. We consider the public sphere as a formation where groups of activists come together and question normative arrangements. We focus on the discourse, that is, how activists reflexively negate and question prevailing habits, practices and assumptions, and how the ACCs try to re-moralize everyday activities (for example as consumers, as volunteers), re-politicize the politics of food and build awareness for an ‘alternative’.

Introduction

The impact of globalization and neo-liberal policies in Turkish agriculture has been marked by the subordination of the petty commodity producers to market forces and their displacement from land and farming tradition. After the 1980 structural adjustment programme, governments with legislative reforms withdrew subsidies, reduced price supports and privatized parastatal organizations which in turn compelled small producers of agricultural products to rely on their own resources in their struggle within local and international markets. The pervasive implementation of neo-liberal policies, especially after 2002, transformed both production and consumption in agriculture.

On the production side, with the increasing dominance of agro-food companies and the commodification of foodstuff, petty commodity producers were driven out of the market. According to the official data of the Social Security Institute (SGK), in the last twelve years the number of insured farmers has dropped by 48.6 per cent (see Figure 6.1) and, in the last eighteen years, the amount of arable land has decreased by 3.150 million hectares (Tuncer, 2019). Small farmers deprived of government subsidies became more reliant on bank loans for the provision of their seeds, pesticides and machinery. As explained by the president of Çiftçi-Sen (the Farmers’ Union), the petty commodity producers’ debts for agriculture to the banks and credit cooperatives increased 53 times between 2002 and 2020 (Çameli, 2021), while subsidies were reduced by 48 per cent. In this transformation process, as well as increases in input prices, petty commodity producers faced stiff competition from imported foodstuff. However, it is worth noting that, currently, due to foreign currency fluctuations and the Turkish lira losing its value drastically, lowering trade barriers does not work as a viable strategy. In such an economic and political milieu, the petty commodity producers are left with a choice between leaving their farm and/or negotiating contracts with the agro-food companies.

On the consumption side, after 1980, with the implementation of free-market operations and the deregulation of agriculture, a major transformation in the food industry took place; the number of foreign companies increased and major international food processors and retailers entered the Turkish market either as greenfield operations or as joint ventures with local big capital (Yenal, 1999; Atasoy, 2013; Değirmenci, 2021).

Introduction

Military interventions involve a wide array of intervening actors, ranging from international and regional organizations to nation-state actors and violent as well as non-violent non-state actors. Mali is a prominent example of a contemporary intervention site where several military missions and mandates overlap and where a large number of intervening actors have been engaged since 2012. After several coups d’état in Mali, the further proliferation of jihadist groups in the Sahel region and the (partial) withdrawal of European troops in 2022, the country is increasingly seen as another potential case of failure of international interventionism, shortly after the disastrous withdrawal of Western troops from Afghanistan in 2021.

This chapter will not deal with the overall question of whether the international interventions in Mali can be assessed as success or failure. Instead, it seeks to highlight a more specific ‘dark side’ of inter-organizational interventions in Mali during the last decade. The cooperation among international organizations (IOs) such as the United Nations (UN), the European Union (EU), and new regional coalitions of states, such as G5 Sahel Joint Force, has yielded several negative effects on the protection of civilians (PoC). Given that PoC is a core norm of peacekeeping missions, the weakening of the implementation of this norm also impacted negatively on the local perception of the UN Multidimensional Integrated Stabilization Mission (MINUSMA) in Mali.

In the fields of international peace and security governance, policy makers and analysts alike have often treated cooperation among IOs as a desirable policy objective in itself. The burgeoning rhetoric of security partnerships among organizations after the end of the Cold War is an indicator of this optimism. Franke (2017: 19) has noted in a review of theoretical approaches to IOR that ‘current research is restricted by the still dominant equation of (inter-organizational) relations with cooperation, coordination, or collaboration. Examinations of competition and conflict already take place but should be strongly encouraged and expanded.’

In the spirit of this suggestion, this chapter seeks to elucidate more problematic and conflictive dimensions of inter-organizational collaboration itself: the weakening of the implementation of a core norm of peacekeeping missions.

Introduction

Public spending on health has increased substantially over the past 75 years. In 1949– 1950, the first financial year after the founding of the National Health Service (NHS), UK public spending on health was £16 billion (2022–2023 prices; HM Treasury, 2022b). This was 3.5 per cent of national income and accounted for 9.2 per cent of total public spending. By 2019–2020, just before the COVID-19 pandemic, publicly funded health spending had increased more than tenfold to almost £180 billion (2022–2023 prices), accounting for 18.6 per cent of overall public spending, 7.3 per cent of GDP.

Throughout the last 75 years, funding for the NHS has risen by more than inflation and by more than GDP, and, on average, healthcare spending has increased by 3.6 per cent in real terms (Figure 3.1). Reductions in real spending have been rare. Spending fell in the early 1950s as budgets fluctuated sharply in the early years of the NHS and prescription charges were introduced. In the late 1970s health spending fell as part of widespread cuts to public spending under the terms of a loan from the International Monetary Fund.

As the NHS marks its 75th anniversary, health service funding is under pressure and the outlook is hugely challenging. The health service has experienced comparatively low funding growth for more than a decade, and now faces the pandemic’s legacy of major backlogs, questions over the service’s resilience to future health shocks and the pressures of an ageing population with rising multi-morbidity and inequality.

The pressures on NHS funding are not happening in isolation: Office for Budget Responsibility and OECD forecasts for the UK economy and public finances for 2023 are bleak (Office for Budget Responsibility, 2022b). The performance of the economy is very important for healthcare. In 2019 before the pandemic health spending as a share of GDP was broadly in line with that of the 14 major European countries (9.9 per cent compared to the EU14 average of 9.8 per cent). But when we look at spending per head over the decade 2010 to 2019, UK spending was almost a fifth lower than the EU14.