The Guardian this morning reports that NHS England will be setting up a “TripAdvisor”-style site to capture people’s feedback.
This has a number of implications in lots of different directions, but the one I wanted to briefly comment on is what this says about how markets arise in public services and are then distorted.
In social care, there were 44 care comparison sites at the last count. This “market response” presumably arose because there was a gap in the market: people weren’t getting the information they needed to make judgments about where is/isn’t a good care provider.
In the context of the NHS, and though not exactly equivalent to a comparison site, Patient Opinion has been doing a tremendous job over the last 7 years or so of enabling people to share their experiences of NHS services, aggregating that feedback and supporting NHS organisations to use this information to improve services.
Patient Opinion is a bit like* that really good band only you and a few people know about (a “few” being a relative term, here).
Patient Opinion needed to be created (and was done so very well indeed) because there was a gap in the market. It was an innovator at a time when no one else, including the NHS, was doing feedback particularly well.
Since today’s Guardian effectively says that NHS England is going to replicate Patient Opinion, it could be argued that Patient Opinion’s job is done. When the NHS adopts your idea, you’ve gone mainstream. It’s like EMI signing (or taking over) the band you love, and now all of your other friends and the general public will be listening to the band only you and your friends knew about.
But is this right? Is the presence of government here – in the form of the bizarrely-centralised-though-not-really-centralised NHS – a constructive or distorting market force?
I posed this question to myself when looking at social care comparison sites:
Is it appropriate to think that social care information / comparison sites should be centrally-led, guided more by a visible hand from government rather than by an invisible hand? Or is it ok for information about social care to be provided through the continued emergence of a demand-driven market, reflecting what we see in the film streaming and price comparison businesses around us?
@pubstrat has highlighted the same question using many other examples, such as MyPolice, fishing licenses and Patient Opinion itself, using the metaphor of government as elephant and others as small(er) creatures. He concludes:
I don’t, on the whole, think that government is obliged to leave the field completely clear for others where its own services and information are concerned. But I do think that the asymmetry of power and voice obliges it to take great care where it places its [elephant] feet.
In this case, my initial answer (with explanatory brackets for tortured simile purposes) is that there has to be joint work between NHS England (EMI) and Patient Opinion (your favourite band) to make the most of both unique characteristics they could bring to the question of feedback (your band’s music). NHS England brings scale, significant credibility and brand; Patient Opinion brings the platform, the independence and the learning/innovation of the last 7 years.
If both can work together, then the good music of feedback can be taken to the masses whilst maintaining its integrity. If not, we might end up with another Robbie Williams.
I really hope NHS England / EMI takes the opportunity to work with Patient Opinion.
*I generally don’t like argument by analogy, but make an exception here. Please don’t get too hung up on the band / record company thing.
Update (2 December): Paul Hodgkin of Patient Opinion has written an excellent post here on the topic, and @georgejulian has brought her characteristic “no bullshit” approach to the issue here. Both posts well worth reading.
“You know that song ‘If a body catch a body comin’ through the rye’? I’d like–”
“It’s ‘If a body meet a body coming through the rye’!” old Phoebe said. “It’s a poem. By Robert Burns.”
“I know it’s a poem by Robert Burns.”
She was right, though. It is “If a body meet a body coming through the rye.” I didn’t know it then, though.
“I thought it was ‘If a body catch a body,’” I said. “Anyway, I keep picturing all these little kids playing some game in this big field of rye and all. Thousands of little kids, and nobody’s around – nobody big, I mean – except me. And I’m standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliff – I mean if they’re running and they don’t look where they’re going I have to come out from somewhere and catch them. That’s all I’d do all day. I’d just be the catcher in the rye and all.”
I’ve been put in mind of this this morning. Complicated emotions of feeling complicit in something that just should not be and not knowing what’s best to do: to leave it or to fight.
The consistently thoughtful Stefan Czerniawski (also known as @pubstrat) posted an excellent set of reflections on Remote: Office not required yesterday, itself a book which “shows both employers and employees how they can work together, remotely, from any desk, in any space, in any place, anytime, anywhere.”
I thoroughly recommend you read the whole of Stefan’s post and the excellent discussion in the comments that follow [not often you say that – ed]. Of many excellent parts, how about:
Although few like to admit it explicitly, many managers do not have that trust or, more generously, have not needed to develop a management style which is based on trust.
Stefan also points to an excellent video from the RSA on Re-Imagining Work, which animates a talk from Dave Coplin (we won’t hold the fact he’s from Microsoft against him). It’s well worth 9 minutes of your time.
I’m not quite sure where I am on this. Drawing on my own experiences I’ve worked in places that are the extremes of both office-based working and remote working. Neither really worked for me. Then again, when I worked in a place that was generally trusting and so had a flexible approach to where you based yourself on any given day or week, this didn’t really work for me either. In this case there were different reasons at play: it was less the location of people’s working but more other organisational cultures (grappling with silos, funny enough) which made things difficult.
Inevitably, I don’t think there’s a general conclusion we can draw on where people should work. I know the balance is currently too far in the direction of traditional work models, but equally think the correction shouldn’t be taken too far in the other direction. Let’s work first on trust and approaches to management that are appropriate and relevant to the function of an organisation, and then figure out the form that follows.
Addendum: The opening of Dave Coplin’s talk really hit home with me about people who get the collaborative, networked approach we are moving to now, and how this differs from traditional views of management and work. My (admittedly silly) working theory is both that (a) those people who are more naturally collaborative will more often attribute where their tweets, references or thinking cites others, and (b) they will cite in less traditional ways, using @usernames and links rather than referencing according to the Harvard system or using footnotes.
Today is the 150th anniversary of Abraham Lincoln’s Gettysburg Address.
Four score and seven years ago our fathers brought forth on this continent, a new nation, conceived in Liberty, and dedicated to the proposition that all men are created equal.
Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.
But, in a larger sense, we can not dedicate – we can not consecrate – we can not hallow – this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us – that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion – that we here highly resolve that these dead shall not have died in vain – that this nation, under God, shall have a new birth of freedom – and that government of the people, by the people, for the people, shall not perish from the earth.
Finally, here is the hat Abraham Lincoln wore on the night of his assassination.
John Gray’s writing is challenging. It makes difficult points about doctrines we as humans hold of humankind – our progress, our religion, our place in the universe – and does so in a straightforward way.
For example, in his latest book, The Silence of Animals, we have:
Allowing the majority of humankind to imagine they are flying fish even as they pass their lives under the waves, liberal civilization rests on a dream.
Gray’s main point in this and his other books is that we are bound by our nature to repeat mistakes of the past. What’s worse, we think we have the capacity to get better, to improve, to progress, when history shows we have no such capacity.
Human progress is no such thing.
His argument has developed a little since Straw Dogs, in recognising that some forms of progress have indeed happened – in science and technology, for example. But he notes that the knowledge we gain from the recurring dilemmas of ethics and politics is not cumulative in the way it is in science. Instead, we are not capable of learning from past experiences of previously attempted solutions.
Gray concludes that we will not be different in future from how we have always been. Further, he argues that to think of progress as leading towards a future, attainable goal is wrong:
History shows history to have no goal.
But in this there is the possibility of freedom – a freedom that comes from the world having, in fact, no meaning. Thus, if there is nothing it “opens to us the world that exists beyond ourselves”, and that we can be “liberated from confinement in the meaning we have made”.
This is a similar point to the one made by Albert Camus in the Myth of Sisyphus. He concludes we must find Sisyphus, a man “condemned to ceaselessly roll a rock to the top of a mountain, whence the stone would fall back of its own weight”, happy. Camus says:
Sisyphus’s passion for life won him that unspeakable penalty in which the whole being is exerted toward accomplishing nothing… I leave Sisyphus at the foot of the mountain! One always finds one’s burden again. But Sisyphus teaches the higher fidelity that negates the gods and raises rocks. He too concludes that all is well. This universe henceforth without a master seems to him neither sterile nor futile. Each atom of that stone, each mineral flake of that night filled mountain, in itself forms a world. The struggle itself toward the heights is enough to fill a man’s heart.
Many find John Gray’s writing pessimistic. I find it redemptive, and recommend to you his work.
In what is an otherwise good document, the latest version of the Adult Social Care Outcomes Framework drops a bit of a clanger:
Its content has been co-produced by the Department of Health, the Association of Directors of Adult Social Services (ADASS) and the Local Government Association
Producing something between a central government department and two representative umbrella bodies – maybe a few meetings, each organisation drafting bits, commenting on each other’s drafts, and then jointly publishing – is not an example of the coproduction I’m familiar with.
Whilst recognising its importance, I’ve never been one for getting too bogged down in language and definitions. I’ve suggested previously that, when it comes to coproduction, it’s better to say what it isn’t than what it is (see point 1 here).
To help things along, here are some other circumstances which I’d suggest are not coproduction.
- I was driving to the tip the other day and the person behind bumped into my car. Despite what he said, we didn’t coproduce an insurance claim
- I got home from a long day at work to discover my wife had doubled the number of cushions on the sofa. Even though she claimed we’d talked about it, I don’t think this counts as coproduction
- I’d started off with the intention of coproducing what clothes my kids would wear last week. In the end, though, I had to tell them it wasn’t appropriate to wear only their pants and swimming goggles to school, and that I didn’t care if their socks were “itchy”
- My energy company wrote to me the other day and said that it was basically colluding with the other energy companies to raise prices well above inflation. They can call this coproduction with each other all they like, but it’s bloody not.
- (There are, of course, more serious cases where things masquerade, or just plain aren’t, coproduction)
I hope this is useful. Do please add your own examples of what isn’t coproduction, either in the comments or using #notcoproduction.
A beautiful short film has been produced by MadeGood films on “The Art of Repair”. It captures the trade and ethos of people who repair various objects – instruments, cars, electricals and upholstery – and reflects traditions of making old items new again and countering built-in obsolescence.
Richard Sennett dedicates a section of his book, Together: the rituals, pleasures & politics of cooperation to repair. He notes there are three ways to perform repair:
- Restoration: making a damaged object seem just like new
- Remediation: improving its operation
- Reconfiguration: altering it altogether
Restoration is relatively straightforward: in making something as it once was; it is the business of the craftsmen of “The Art of Repair”.
Remediation is far more interesting. Sennett concludes that it
challenges the repairer to consider different means to achieving the same end.
Remediation is therefore a process by which the function of something is maintained whilst the elements of the form it takes can be changed. To do this requires two types of judgment: the first to know what alternatives can replace existing parts, the second to know how resilient the object being repaired is and so how much change it can take before it becomes something different or breaks.
Sennett calls reconfiguration the most “radical” kind of repair. In such cases the breaking of the object presents an opportunity to create a new object, in both form and function. As there are two judgments in undertaking remediation well, so there are two risks in reconfiguration: curtailing the room for exploration by being too specific in what the reconfiguration should achieve, or forgetting what the problem to be solved was in the first place.
Repair – and particularly remediation and reconfiguration – offers a useful frame for considering a range of issues. A natural one to think of is some type of public service.
If a service is subject to remediation, then the purpose and aim of the service may still hold but the means by which this is achieved need to change. In undertaking this change there is a need for knowledge on what alternatives there are, how effective they might and whether, politically and Politically, the location of the change is resilient enough to consider the alternatives and act sufficiently well on them.
If a service is subject to reconfiguration, there is recognition that what currently exists isn’t working, and so there’s a need for something different. In this case, the two general risks of reconfiguration translate as follows. First, too much of what anything new should look like can be specified in advance. Many would argue the commissioning-procurement-provider triangle does precisely this, resulting in rigid contractual relationships that sometimes hit the target but regularly miss the point. Second, forgetting what aim a service exists for can be forgotten in favour of maintaining the service. The service is the means and end in itself, and its aim – and the people it serves – can be forgotten.
To give an example of repair and public services, many engaged in debates on the health reforms of the last 3 years may find meaning in Sennett’s own conclusion on repair:
An incoherent repair can provide the sensation of change but may sacrifice the value of the initial act of creation.
I, too, found much in one of Sennett’s earlier paragraphs – relevant, I think, to social movements and campaigning:
In fighting against resistance we will become more focused on getting rid of the problem than on understanding what it is; by contrast, when working with resistance we want to suspend frustration at being blocked, and instead engage with the problem in its own right.