Radical Help: How We Can Remake the Relationships Between us and Revolutionise the Welfare State, Hilary Cottam, Virago, 2018
Beyond Command and Control, John Seddon et al, Vanguard, 2019
The NHS is seizing up. Patients have to work nearly as hard as GPs do just to get a doctor’s appointment, and hospitals can’t cope. Elder and adult social care are unworthy of the name. Last year 25,000 people in the UK slept rough for at least one night, which is all you need to know about accessible housing and the homeless. As for benefits, Universal Credit, supposedly the answer to a fragmented system and the flagship of recent reform, is a multi-dimensional nightmare, an exorbitantly costly, semi-computerised cross between Kafka and Orwell that treats the poor as morally defective and a creates misery and despair rather than a platform for establishing a good life. In short, the UK’s welfare state is nothing of the kind. Far from providing a safety net to cushion a fall, it enmeshes the needy in a grim battle to prove they are poor or disabled enough to qualify for aid devised to maintain them at subsistence level and no more. The once pioneering, even revolutionary, institutions imagIned by Sir William Beveridge nearly a century ago are still an example to the world, but now a pitiful one of how not to do it.
As these two timely and welcome recent books reveal in their different ways, the failure behind the crisis is not primarily one of money (although austerity has brought things to a head by not only making life more difficult for those already needing help, but also tipping more people into poverty – the signature of an illfare not a welfare state). It is that, partly because of the advances made under the Beveridge settlement, the institutional framework established the best part of a century ago is no longer fit for purpose. As social entrepreneur and activist Hilary Cottam points out, Beveridge’s design was for an industrial age. The remedy for the five scourges he identified – disease, idleness, ignorance, squalor and want – was to build hospitals, houses, schools and factories that would fix them. People would proceed in linear fashion between them until retirement, which no one imagined would last longer than a few years.
Instead there has been a massive failure of the imagination – an ideologically learned inability to see beyond what is to envision what might be. It is ideological because the institutional prison we’re in isn’t the buildings Beveridge constructed but the linear, factory-style processes we use to order what goes on inside and particularly between them. It’s management, stupid.
As Cottam spells out it, the welfare state ‘has become a management state: an elaborate and expensive system of managing needs and their accompanying risks. Those of us who need care, who can’t find work, who are sick or less able are moved around as if in a game of pass-the-parcel: assessed, referred and then assessed again. Everyone suffers in a system where 80 per cent of the resource available must be spent on gate-keeping: on managing the queue, on referring individuals from service to service, on recording every interaction to ensure that no one is responsible for those who inevitably fall through the gaps.’
For the patient or citizen, much of this busy supply-side activity is pointless. As a result, whether in health, education, employment or well-being, the neediest in every area become ‘permafrost’ – stuck blocks of humanity that the current system can’t shift and have no agency to do so for themselves. They are spectators of rather than active participants in their own lives. The buildings – schools, Jobcentres, hospitals – go through their allotted motions, but they no longer connect with the social currents outside. Beveridge’s wants still exist, but in different forms. Ironically, the severest case of ignorance, identified by both Cottam and Seddon, is the state, bereft of ideas for real reform and reduced to cutting costs and demanding more effort.
Cottam sets her narrative – the story of experiments in organising to help people deal with family life, growing up, finding good work, keeping healthy and ageing well – in the framework of Beveridge and his original institutional innovations to emphasize the pioneering heritage the UK should be building on. Encouragingly, but not surprisingly, since both authors think in systems terms, the principles she arrives at largely echo those Seddon has described in previous books: the goal of welfare is the good life (as defined by those living it), the means is helping people to help themselves (building capabilities and possibility), using the joined-up resources of society as a whole, based on relationships rather than transactions. In other words, treating people as humans.
She recognises the importance of measures (‘We cannot transition [to a better system] if we are held to account by metrics rooted in cultures and transactions that we need to leave behind’), and again like Seddon emphasizes that not only do people-centred welfare models cost less to deliver, they relocate you in a different, positive sum game. The knock-on effects of restoring a troubled family to stability, for example, are invisible and cumulative, reducing future demand on police, courts, education and hospital resources as well as social services, while often also creating a new source of community support into the bargain. Engagement is a function of help that works.
Each of Cottam’s experiments ‘can be seen as a response to the failure of a government department to command change through top-down edict’, she says. How and why top-down edicts fail and what to do about it is, as its title suggests, the subject of Seddon’s book (disclosure: I am proud to have helped edit it), which thus neatly complements Cottam’s. Seddon, whom perhaps we should describe as a management activist, locates the sources of the overbearing ‘management state’ in theories of control devised in the industrial era, which are now a serious brake on productivity as well as human feeling. They cause managers to measure and manage the wrong things – unit costs, activity, transactions, people – which tell them nothing about how well they are meeting their proper purpose and turn them into willing prey for purveyors of fads and fashionable tools that falsely promise to make the machine turn faster. Almost all the vast superstructure of management bureaucracy – a $3tr burden on the US alone, according to Gary Hamel – is attributable to add-ons such as risk, performance, culture, budget, and reputation management, which are not just useless, but actively lead performance astray. As examples, Seddon singles out for special attention Agile (what’s the use of doing it faster if it shouldn’t be done at all?), IT (what’s the use of digitising it etc), and, perhaps more surprisingly to some, HR.
HR departments, notes Seddon, are the indirect result of managers’ misplaced obsession with improving performance by managing people. But it’s the system that governs performance (or 95 per cent of it, according to W. Edwards Deming), not individual effort. ‘HR departments grew up to treat the unwelcome symptoms of command and control management and have steadily expanded as the symptoms got worse… Thus, having designed jobs that demoralise and disengage we set PR people to work on measuring the extent of demoralisation and/or [developing] methods to motivate or create engagement,’ Seddon writes. Most of these, notably incentives and appraisal, damage rather than boost performance. Instead HR should be insisting that systems are designed to give people the good jobs that ensure good jobs are done – in which case, you barely need something called ‘HR’ any more.
It is clear from both these books that you can’t get to the properly personalised forms of support that will underpin good lives, a better society and more productive economy from within today’s transactional, Gradgrind management paradigm. The two are simply incompatible. A switch to a new paradigm requires a tipping point. The appalling management behaviour on show at the top of the Home Office and the DWP suggests that there is still some way to go in that respect. But both these books are heartening confirmation that There Is An Alternative that is far better for those in need of help, for those who provide it and for the community as a whole even before you count the social and economic savings that result. And conceptually, it is not complicated. Humanity invented management, Seddon points out; and we can do it again. ‘Counterintuitively… productivity 2.0 isn’t about, scale, huge IT investment or automation. It’s about human beings working together to solve the problems of other human beings.’ These two books bring that future just a little bit nearer.
Perfect summary. I personally have two Iatrogenic conditions that increase my Covid-19 risk, caused by the gate-keeping model of spending control and shorten my future. I work in Adult Social Care which is unsurprisingly close to disintegration resulting from the same management fads. Whitehall is completely besotted with these disastrous systems and we all pay the price, some of us in more ways than one.
Andy Lippok :: 5th Mar 20
Agreed this is a perfect summary, yet somewhat depressing reading as to how such a colossus of a system or multiple systems are to be changed! It also has to change in every organisation as the adverse impacts in that system has knock-on effects. I attended a recent seminar where Bob Chapman the CEO of Barry-Wehmiller outlined how he and his people run their companies. His book "Everybody matters" provides some hope and practices for how things can be and are better!