Category Archives: social mobility

Reflections on 10 years of ‘Access to Medicine’

Last week the Extended Medical Degree Programme [EMDP] at King’s College London celebrated its 10th anniversary with a ‘Celebration of Success’ event.  Before becoming an academic geographer, I was centrally involved in the King’s Access to Medicine scheme, of which the extended degree is part, setting up and running the widening participation outreach element of the project from 2001 – 2007.

I want to use this opportunity to congratulate the students who graduated as doctors last week and to celebrate their achievements.  Many of them I supported through the process of applying to medical school and the early years of their studies.  One or two of them are quite exceptional, and I am proud to have helped them towards achieving their aspirations to becoming doctors.

But I also want to use this tenth anniversary as an opportunity to critically reflect on the work of this widening participation scheme.  In doing so, I accept my own complicity in some of the problematic dynamics I want to highlight.

The Access to Medicine project (now called Outreach for Medicine) was originally established to enable talented young people from ‘widening participation backgrounds’ attending non-selective state schools in inner London to train as doctors.  The scheme ran an extensive programme of outreach activities as a means of talent spotting, assisting young people who aspired to become doctors to achieve their ambition, and encouraging talented young scientists to consider careers in medicine (and related health professions).  Those students engaged in the programme who didn’t achieve the grades to enter a conventional medical degree could apply to the six-year Extended Medical Degree Programme, which recruited with lower entrance requirements and provided additional support to students during the pre-clinical phase of their degree.

One of the key motivating factors behind the establishment of the scheme was the recognition that the King’s College School of Medicine (along with its partner NHS Trusts and the other health-related schools in the College) constituted one of the largest providers of medical education and training in Europe, was located in three of the most socially deprived local authorities in Britain, and yet recruited virtually no students to medical degrees from that locality.  The project has changed that for the better – but, even from the start, it needed to recruit from a wider area of London to meet its entrance targets (and has since expanded its provision into Kent and Medway, as well as across all those London Boroughs with low progression rates into higher education). 

I still believe that there is a valid social justice argument for diversifying the demographics of future doctors, and recruiting talented young people from a wider range of ethnicities and social class backgrounds.  Here, the Access to Medicine project has been successful up to a point – the young people trained through the EMDP come from a far broader range of ethnicities than the those recruited to more conventional medical degrees in London.  However, unless the EMDP cohort has changed significantly in the four years since I left the project, King’s have not been particularly successful in recruiting white working class students or young people of Black Caribbean heritage.  This lacuna highlights a complex and problematic class dynamic amongst the students recruited through the scheme – although many do come from low-income households, many also come from highly educated migrant and refugee families, and that confounds a simplistic identification of them as ‘working class’.  Similarly, there were sufficient loopholes in the project’s selection criteria that more than a few students from professional, gentrifiying families have been recruited to the scheme over the years.  So, while it is easy for the project to continue to justify its widening participation credentials according to many of the benchmarking criteria set by HEFCE and the Office for Fair Access, I question how successful the project has been in widening access to medical education in other ways.  It seems to me that the project continues to fail young people from those social groups that are most under-represented in medical schools (and higher education generally).  To some extent, its real success has been in helping to consolidate a Bangladeshi and Nigerian middle class in inner London (and spurring a similar dynamic amongst some numerically smaller minority ethnicities in the capital).  There is not necessarily anything wrong with that per se, but it is not what the project set out to achieve.

In many ways, this situation also reveals some of the problematics of an approach to widening participation that emphasizes raising aspirations as a route to social mobility.  Although, of course, the irony here is that I don’t think the Access to Medicine project really did much to ‘raise’ young people’s aspirations.  Where its success lay was in supporting young people who already aspired to become doctors and enabling them to act on their aspirations and stand a fighting chance of entering medical school.  Again, that’s no bad thing – within the remit of widening participation initiatives, furthering fair access to medical education is important.  But I think, as the very obvious gaps in which social groups have benefitted from the scheme shows, even after ten years of work, Access to Medicine has had less success in recruiting students for whom the aspiration to become a doctor is completely off their radar.  It takes more than a single project (however well-intentioned or resourced) to have that kind of impact on the social and cultural capital of some working class communities.

Although I am not sure I agree with all of their arguments and analysis, readers might be interested in the following to papers from a few years back that examine the work of the Access to Medicine project and the EMDP:

Garlick, PB and Brown, G (2008), “Widening participation in medicine: reflections on the first six years of the Extended Medical Degree Programme (EMDP) at the King’s College London School of Medicine”, British Medical Journal, 336: 1111 – 1113.

Brown, G and Garlick, PB (2007), “Changing Geographies of Access to Medical Education in London”, Health and Place, 13 (2): 520 – 531.

The phenomenology of aspirations

I’ve recently been reading Sara Ahmed’s book The Promise of Happiness and this has set me thinking about the phenomenology of aspirations.  In her book, Sara makes some references to aspiration and social hope, but doesn’t dwell on the effects (and affects) of those social policy interventions that have sought to work on young people’s aspirations in Britain over the last fifteen years.

As I’ve said before, aspiration (at least as it is understood and promoted in recent British social policy) is a particular expression of neoliberal social hope.  Widening participation interventions that seek to raise young people’s aspirations also function to orientate young people’s lives towards particular imagined life courses that are consistent with this expression of neoliberal social hope.  They are designed to instill in young people a wish for, and a commitment to, a future where they go to university, enter professional graduate employment and are able to be socially mobile and economically self-reliant, seeking privatised solutions for their well-being.

In practice, these widening participation interventions also seek to re-orientate young people geographically, in relation to their home neighbourhoods.  To have your aspirations raised is also to have your horizons broadened.  Young people living in the most socially deprived neighbourhoods in the country are encouraged to look beyond the places where they live to imagine how life could be different.  It is not enough to want to go to university, to have their aspirations (truly) raised, a young person is encouraged to aspire to a middle class habitus and dream of moving away to university.  Physical, spatial mobility is closely linked to the social mobility being promoted in these policies.  This is another way of denigrating (white) working class communities.  Young people from these backgrounds are being taught that there is nothing of value in their home communities.  To have one’s aspirations raised is to want to leave friends, family and home behind.  It is hardly surprising that widening participation initiatives have perhaps been least successful amongst those young people deemed most in need of intervention.

And this brings me to my final point (for now).  The effect of these attempted re-orientations differs depending on the relational geographies of the home neighbourhoods in which the young people they target live – how connected they are to other places – and on the life trajectories of individual young people and their families.  Not all socially deprived neighbourhoods, or the people who live in them, are the same.  It is possible to live on a low income, in an area that scores highly on the indices of multiple deprivation, and still have a wide range of connections with different people that extend across social difference and across space.  This is one reason why I think young people from some minority ethnic communities have done relatively well out of widening participation initiatives.  If your family experience is one of transnational migration; if you and your family sustain kinship networks that extend around the globe; or, if you attend a church, mosque or temple that brings you into regular contact with a group of people engaged in a diverse range of livelihoods, jobs and careers, you are likely to be aware that the way you live your life, here and now, is not the only option open to you. 

So, while I am suspicious about the ways in which the imperative for young people to ‘broaden their horizons’ has become enmeshed with the imperative to raise their aspirations for a privatised neoliberal future, I do also see value in having wide horizons.  Conscious experience of what Doreen Massey would call ‘place beyond place’ can serve to widen your horizon.  Wide horizons, although at times unsettling, can reveal new options and possibilities.  I am critical of how widening participation initiatives envisage only one course across that widened horizon; but I am interested in how widening our horizons may also hold the potential for fostering social relations and social hopes that exceed neoliberal aspirations.

Aspirations for all?

A close reading of the Opening Doors, Breaking Barriers strategy for social mobility reveals some interesting hints as to the limits of the aspiration agenda and raises questions about precisely whose aspirations the government hopes to influence.  As I have previously noted, throughout this policy document there are various references to the need to improve the attainment, skills and aspirations of young people from ‘disadvantaged backgrounds’ and promote ‘fairness’:

A fair society is an open society.  A society in which everyone is free to flourish and rise.  Where birth is never destiny. (pg 3).

The document sets out in great detail how social class and family income continues to impact on young people’s educational attainment, their access to higher education and their likelihood of achieving social mobility.  For example,

Children from the most disadvantaged areas are only a third as likely to enter higher education as children from the most advantaged areas, and are less likely to attend the most selective higher education institutions. (pg 19).

The report even notes that when people from state schools do attend university they often outperform their peers with similar levels of attainment who attended independent schools. So far, so good.  But then the report begins to look deeper at the trends affecting particular sub-groups of students and that’s where it begins to get interesting:

Participation in higher education by white British teenagers is lower than for many ethnic minorities, particularly the middle of the attainment range. (pg 21).

And, a little later, in relation to proposed improvements in vocational education:

There are already many excellent vocational training programmes but some courses currently offer little positive value in terms of earnings and career progression. This is particularly important for social mobility because young people who choose vocational routes come disproportionately from low income backgrounds and from areas of multiple disadvantage.  Where young people from low income backgrounds are choosing low value vocational routes, this may serve to undermine future social mobility rather than improve it. (pg 45)

It is all very well to develop educational interventions that are sensitive to where particular groups of young people are already at, but it seems that for all of the present government’s talk of fairness and the importance of social mobility, these interventions seem to take existing differential levels of attainment for granted and will serve to reinforce not challenge them.  The trajectory of the current policy proposals seems to offer different interventions for different groups of students that will reinforce existing classed and racialised divisions of labour, rather than offer equal opportunities for social mobility for all.  White British teenagers (from families on modest incomes) achieving results in the middle of the attainment range will have their aspirations worked on with the intention that they should progress to higher education.  Low achieving students from low income families in disadvantaged areas will continue to be encouraged to take up vocational training.  Although this approach might enable absolute social mobility to the extent that the present generation of teenagers might be able to do better than their parents, I see little evidence that this strategy will deliver the promised relative social mobility whereby the comparative chances of people from different social backgrounds achieving social mobility will be improved.

Opening doors, breaking barriers

With the publication yesterday of the Coalition Government’s new strategy document Opening doors, breaking barriers, we now have a clearer picture of how the present goverment will approach social mobility.  They claim that “improving social mobility is the principal goal of the Government’s social policy” and that their vision is of “a socially mobile country”.

In many ways, this strategy could have been written by New Labour.  Perhaps this is not surprising given that former New Labour Minister Alan Milburn remains the current government’s Independent Reviewer on Social Mobility.  His previous (2009) report, published under the auspices of the Panel on Fair Access to the Professions, is heavily cited here.  Of course, that report was published with all party support.  It seems there is still political consensus that social mobility is an unambiguously good thing.

As ever in government discussions, social mobility is promoted as a social good for individuals and for the nation:

The lack of social mobility is damaging for individuals.  It also leaves the country’s economic potential unfulfilled. (pg 5)

The promotion of social mobility ties the interests of individuals, in this case children and young people as future worker-citizens, to the interests of the national economy.  Every individual is expected to take responsibility for playing their part in helping the national economy fulfil its potential.  But, almost by definition, the imperative to be socially mobile rests most heavily on the poorest, most precarious sections of society.  In this way, they are expected to do even more to strengthen the economy in the national interest. 

Where there is a distinctive stamp of Conservative and Liberal Democrat policies on the political rhetoric contained in this report is in its approach to ‘fairness’.  Fairness is presented as a state where the individual receives the just rewards for the amount of effort they put into education.  Nick Clegg is quoted in the Government’s press release as saying:

Fairness is one of the fundamental values of the Coalition Government. A fair society is an open society where everybody is free to flourish and where birth is never destiny.

As the strategy document makes clear, this ‘fairness’ is the promised reward for hard work.

What ought to count is how hard you work and the skills and talents you possess, not the school you went to of the jobs your parents did. (pg 5)

With this emphasis on fair reward for hard work, it is not surprising that many of the policy recommendations contained in the strategy document relate to raising young people’s attainment throughout their schooling. Nevertheless, a concern for young people’s aspirations and an imperative to intervene to ‘raise’ them is still present in this document.  Aspiration is central to social mobility.  It is the specific form of neoliberal social hope that locates a happy future as the reward for taking individual responsibility for one’s social and economic well-being through social mobility.

The educaton system should challenge low aspirations and expectations, dispelling the myth that those from poorer backgrounds cannot aim for top universities and professional careers.  Our schools reforms are intended to raise standards across the system, narrow gaps in attainment and raise aspirations.  …  This is not just about schools or government.  We can all make a difference to raising aspirations and helping people make informed choices about jobs and careers. (pg 6)

Intervention to raise young people’s aspirations becomes a national mobilisation – not just the responsibility of schools and government.  There seems to be a shift in emphasis contained in this report concerning who is best placed to shape and influence young people’s aspirations.  Although schools and universities are still seen as having a role to play here, the Coalition envisage a greater role for businesses in this task.  Whilst the state is taking responsibility for mobilising these interventions, it is distancing itself from the delivery of aspiration-raising initiatives.  Politicians will lead by example, but the state will not be seen to provide these interventions.  Apparently every member of the Cabinet has pledged to join a national scheme to mobilise 100,ooo people to speak about their successful career paths in schools.  Promoting an aspirational orientation to the future is all about encouraging the individual to take responsibility for themselves, so what better way to promote it than through ‘successful’ individuals rather than faceless institutions.  More so than under New Labour, it seems education is being promoted, not as an end in itself or a social good, but as an instrumental stepping stone to a highly skilled professional career for the individual.  Looking out for number one is everything.

Aspirations and social hope

There is an interesting article by Nic Beuret in Issue Minus 1 of The Paper .  In this piece, “Hope Against Hope: a necessary betrayal“, Beuret makes a number of very poignant observations about how ‘aspiration’ functions as the dominant form of social hope in neoliberal economies.

“There are competing versions of hope in a given society, but there is also a hegemonic form to hope. For us, living in a becoming- neoliberal world, that hegemonic form is aspiration. Not aspiration in the sense to aspire to greatness in some heroic Greek sense, or something romantic and colourful. No, for us aspiration has a particular hue and tint – it means social mobility. It means a better job, more money, more things and a higher rung on the career ladder. Hope is individual in our world, never collective – the hope of entrepreneurs dreaming of making it big. Not just climbing the ladder but also winning out over all others. We hope for social mobility. … Hope, the dominant form of hope, is to do better than your parents.”

I agree.  As I have argued in my recent writing, over the course of New Labour’s period in government, the central aim of widening participation policy shifted from a focus on promoting social equity to a more explicit attempt to discipline the hopes young people developed for their adult lives.  The aim of ‘raising’ young people’s aspirations was to instill in them a desire for social mobility and the drive to take personal responsibility for achieving this.  In the process, all other hopes for the future came to be dismissed as inappropriate – as ‘low aspirations’.

The revolt of aspirations

The recent protests by school and university students (November/December 2010) about the Coalition government’s proposals to raise university tuition fees in England from 2012 and abolish the Education Maintenance Allowance for sixth form students demonstrate the extent to which many young people’s aspirations have been raised to the point where they expect to undertake higher education, but also the limits of realizing those aspirations in a time of austerity.  

I would suggest there were two main groups of students who were enraged enough to participate in those protests 1) those from middle class families on modest incomes (‘the squeezed middle’, to use Ed Milliband’s favourite phrase) who have come to take a university education for granted, but whose parents may now have to make hard decisions about which of their children to educated to university-level; and 2) working class students (especially those from aspirational BME families) who have been consistently told that a university degree is their only viable route to social mobility and a comfortable life.  Both groups have had their aspirations (and expectations) viz-a-viz higher education ‘raised’ over the last decade.

Of course, for all of New Labour’s talk of ‘raising’ people’s aspirations, as Mike Raco (2009) has articulated, the aim of the political discourse of ‘aspirations’ was meant to lower people’s expectations of what the state could and should provide for them.  This neoliberal reconfiguration of welfare provision (and the consequent shift in the terms of debates around ‘social justice’ to promote individual rather than social responsibility for change) underpinned many aspects of education and youth policy under the New Labour governments.  However, I would suggest that the student protests reveal just how persistent people’s expectations of the welfare state have been (even as they have taken on board much of the individualised aspirational message promoted to them). It also exposes the contradiction that so many families have been reliant on state support in order to enable them to engage in this individualised culture of aspiration.

I’ll be posting further reflections on recent policy changes, the impact of higher tuition fees and student protests in the weeks to come.

Thoughts on social mobility and the Milburn Report

Alan Milburn’s report Unleashing Aspiration: The Final Report of the Panel on Fair Access to the Professions, produced for the Cabinet Office, has received a huge amount of publicity over the last couple of days. 

It’s been personally really rewarding for me to see some of my former students from the Extended Medical Degree Programme, recruited to train as doctors through the Access to Medicine Project at King’s College London so centrally involved in the launch event for the report and featured in so much of the publcity surrounding it.  It was also a pleasant surprise to see a paper I co-authored with Pamela Garlick (http://www.bmj.com/cgi/content/full/336/7653/1111) cited, as evidence in the report.

I’m looking forward to making the time to read the report in full over the next few days, and no doubt I’ll be posting further thoughts once that done.  But, for now, here are some very preliminary reactions to the report and it’s recommendations:

  1. This report recognises the limits of widening participation initiatives over the last twelve years in significantly improving the life chances of young people from working class families.  Certainly, widening participation initiatives have helped widen and increase participation in higher education generally.  But, despite some small scale exemplar projects around the country, widening participation has largely failed to achieve fair access to elite universities and the professions. 
  2. The report acknowledges that the chances of working class young people getting into the upper echalons of several professions are getting worse, not better.  Of course, despite many potentially useful recommendations around educational process and the provision of appropriate careers advice, the report fails to challenge the power of the middle classes to control education as a means to safe-guard and reproduce their privilege.
  3. Although the report contains a whole chapter on ‘raising aspirations’, its title (Unleashing Aspirations) really indicates something of a shift in a way this Government thinks about young people’s aspirations.  The implication is that many young people from all social classes have high aspirations for themselves.  They don’t need their aspirations ‘raised’, they need support realising them, and that entails action to tackle deep-seated structural inequalities in society.
  4. Too many of the report’s recommendations rest on the assumption that the best way to tackle these inequalities is to enable working class teenagers to participate in the type of activities that many of their middle class peers take for granted (e.g. join the Combined Cadet Force to learn how to be a team player) and become more ‘like us’, rather than asking more fundamental questions about the reproduction of privilege, and the social value of generalising the aspirational, middle class cultures promoted here.

Overall, I find myself quite conflicted in my reactions to this report.  I value the social justice argument that it is important to enable all young people to achieve the best that they can, no matter what their social background.  But I also recognise that many of the recommendations in this report (and the ways in which it envisages them being enacted) both re-privilege middle class cultures andstrengthen the neo-liberal forms of governance and educational provision that have exacerbated these growing social inequalities over the last two decades.  I am left asking more fundamental questions about a division of labour that privileges professional careers over other forms of work – and these, in turn, prompt me to think quite critically about the contradictions of ‘social mobility’.