- Reform is a profoundly political process, not a technical one
- The political coalition favouring reform has to be based on groups that do not have a strong stake in the existing system
- While government reform reflects the material interests of the parties involved, ideas are critical in shaping how individuals see their interests
- Reform takes a great deal of time.
These lessons are from Francis Fukushima and how to reform patronage-based political systems to modern, merit-based ones, but I’d say they’re equally applicable to most public service change processes – including, of course, personalisation across health and social care.
If we were to apply the four lessons to how things have gone with personalisation so far, I’d suggest the following:
- Personalisation has focused too much on technical changes (e.g. Resource Allocation Systems, online directories of support), and not enough on political ones (including attitudinal and cultural)
- There has been a coalition of people wishing to change the social care and health systems through personalisation. This coalition, however, hasn’t been sufficient, and certainly hasn’t yet engaged enough with groups that have a strong stake in how things currently are (particularly social workers, who broadly remain wary of personalisation)
- The idea of personalisation is a strong one. Indeed, it’s probably driven reform in other areas of public services
- Even if we took 1996 as the starting point for personalisation, we’re still only 20 years into this journey. 2007 is a more realistic starting point (with the advent of Putting People First), and for the scale of political, cultural and attitudinal change we know personalisation requires, a decade is nowhere near enough. If this is in doubt, ask any race, gender or sexuality equality campaigners in the UK, US or beyond.
If we looked at the topic of social care funding, I suspect we’d find even less evidence on each of the four lessons for political change.