All too human: the need for coalitions across different motivations and organisations

Here’s a post I’ve written on the need for coalition building across a range of motivations and organisations if successful change is to happen in social care. This is part of the #socialcarefuture series that @mroutled has been bringing together, designed to create a space to get past just thinking about stabilising the current social care system which isn’t fit for the future. Here is the rest of the #socialcarefuture blog series.

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Much debate in public policy focuses on the “why” and the “what”. Why is this issue important? Why should it be prioritised over something else? What should be in place that isn’t? What needs to change for this to happen?

Comparatively little focus is placed on “how” – the practicalities of putting the why and what into action. The “how” follows once the “why” and the “what” have been largely agreed, and is important because it’s in this space that all of people’s experiences are generated. It’s also where good ideas can turn into bad delivery.

But below the “how” is a question even less attention is given to: “who?” Rarely is it considered: who is asking for this change? Who is the change being asked of? What are the motivations of these respective groups?

It is too easy to lament how poor commissioning and commissioners are; or how it would be so much better if only senior leaders recognised the radical difference that x or y would make. But this is to fall into the trap of “what’s the matter with these people?” rather than thinking, familiarly enough, “what matters to these people?”

This thought came home to me when, for around three years, I was simultaneously on both “sides” of a policy argument. For around half of my time I was working in a disabled people’s user-led organisation (DPULO), advocating for disabled people’s equality and rights, delivering user-led services and promoting choice and control through personalisation in social care. The other half of my time was in, of all places, the Office for Disability issues within the Department for Work and Pensions (DWP_.

What was fascinating about this was, even though I would say exactly the same things when wearing my DPULO or DWP hat, people would receive a message considerably differently depending on how they perceived me in that moment. Disability rights campaigners would broadly be ok with my thoughts when shared from a DPULO perspective. But the exact same thoughts wouldn’t be acceptable if I expressed them from a DWP platform.

In neither situation was the idea that disabled people’s equality and rights mattered to me. Nor was it recognised I was consciously choosing different means to others by which to achieve what was, in fact, a common goal.

This leads to two connected conclusions relevant for #socialcarefuture.

The first is to understand that what matters to people, matters. Motivations for engaging in an issue will differ. There will be a junior minister who wants to be promoted; there will be lifelong advocates who have dedicated themselves for 25 years to a certain change; there will be civil servants who want a pragmatic solution to a pressing problem they are facing. But all of these different motivations are as present as each other, and can be skilfully aligned to achieve a common change that works for all.

The second is to recognise that such a broad coalition of people with different motivations will be located across a wide range of organisations. Indeed, the coalition has to be widely distributed if it has any chance of succeeding: each participant will have access to something others don’t, and that is needed for the overall change. As a result, some coalition members will be “inside” the system. Some will be outside (possibly literally, chained to railings or waving placards). Some will be in the grey area that is neither inside nor outside (the voluntary sector is most often found in this space). Some may not even know they’re in the coalition.

What leads to change is consciously acknowledging and valuing the existence of such a broad coalition across motivations and organisations. Each participant – each “who”, with their all too human motivations and positions – makes a needed contribution, and it is only through this coalition that successful change will come about.

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(For those interested in the public policy theory that underpins such coalitions, this primer on Advocacy Coalition Frameworks https://paulcairney.wordpress.com/2013/10/30/policy-concepts-in-1000-words-the-advocacy-coalition-framework/ is excellent.)

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The Tory answer to the question “who pays for social care?”: You!

Image via WikiHow

Two excellent responses to the Conservatives’ social care manifesto proposal: Torsten Bell at the Resolution Foundation and, of course, The King’s Fund.

It took me quite a long time to figure out the main implications of the proposals (I’m not sure I understand them even now).

We can summarise them as:

• If you have assets under £100,000, you’re a winner
• If you have assets over £100,000, you’re not a winner

In essence, the Tory answer to the question “who pays for social care?” is “you, not us”.

Coupled with the proposal to scrap the universall Winter Fuel Allowance, one argument is that the Conseratives’ proposals are progressive, redistributive mechanisms that will benefit people from lower incomes, or working-age people who have been reliant on social care for their adult lives (and are less likely to have built up assets).

The counter argument – including when comparing the proposals against the Dilnot Commission’s proposals – is that these proposals create a further breakdown in the inherent universalism and sharing of risk that only government can provide (see also: the NHS).

These proposals may provide a financial solution to the social care crisis*, but they certainly don’t shore up the idea that “we’re all in this together”.

*Though deferred payments from housing still requires large short- and medium-term injections of cash, and we don’t know how inheritance law and behaviour will respond to these announcements.

The institutionalisation of successful social movements: peril or pragmatism?

Nesta’s #peoplepoweredhealth event earlier this week was hugely enjoyable. It built on the vast range of work Nesta has done on this topic over the last few years, and brought together a wonderful and diverse range of people.

“Work” shouldn’t be this much fun.

It was a privilege to be part of the session on “People powered health: how to make it stick?” I’ll write up what I said another time, but wanted to share something else that occurred to me through the discussion and after reading this excellent related report on health as a social movement (pdf).

It focuses on the question of what success looks like for innovative approaches:

What if social movements were so successful that what they advocated for was completely taken on by institutions (such as the NHS)? What if people powered health became so sticky that the NHS completely appropriated it?

If this happened, would this count as success? Or would it represent too much of a compromise or dilution of what the pure approach was when it was outside the grip of a big institution?

We don’t need to look very far for examples of where this has happened before. In social care, Direct Payments in 1996 were an innovation proposed and owned by the disabled people’s movement. Fast forward to 2014 and personal budgets are the default delivery mechanism for all community-based social care. Along the way, many disability campaigners have become anxious about the compromise of notional budgets or the use of resource allocation systems.

More recently, social prescribing could be argued to be an example of an innovation whose adoption by the formal health system has meant it has moved away from what it was originally intended to be.

And yet in the case of both personal budgets and social prescribing, their ultimate net benefit is greater for their adoption by large institutions than if they’d have stayed as small but perfectly formed innovations.

I wonder if most social movements start out with the hope of what they advocate for becoming part of the system? And I wonder if the inevitable pragmatism that’s needed to reach that point imperils the very value such approaches represent?

My personal view, as I’ve written before, is that if such appropriation makes things a “bit” better for a “few” more people, then it’s worth doing. But it would be fascinating to know what you think!

Avoiding a hierarchy of equalities

There was a major general election announcement over the weekend that focused on mental health policy. Whilst this is great news in itself, I’ll bet someone, somewhere, has written that there should be an equivalent for people with learning disabilities, or for people with sensory impairments, or for carers, or for older people with x condition etc. etc.

This is not where we want to be.

As I’ve written before:

Whilst there are arguments which could be made for each [impairment group requiring something separate], to my mind there is no overarching framework within which all of them hang together. There is no agenda around which all people with a commitment to disability rights and equality for all disabled people can coalesce.

In the absence of an overarching disability rights and equality framework, what we end up with is a hierarchy. In such a hierarchy, mental health is currently doing (relatively) ok, but learning disability less so. And if learning disability ends up with a new cross-government strategy then what about… and so on. Goodness knows what happens if you’re a person who happens to tick more than one box.

The point can also be extended to other equality groups: there is common cause, for example, in closing the gender pay gap and the disability employment and pay gaps (as exemplified by the nonsense suggestion that people with learning disabilities should be paid below the national minimum wage).

Insteaf of separate policies we should be calling for a reignited overarching disability equality strategy, which builds on the heritage of the Life Chances report, the Independent Living Strategy and Fulfilling Potential. Underneath this could easily lie dedicated action plans and analysis that relate to particular impairment groups, and so still taking account of the specific barriers some groups face. Such a strategy would clearly link to a general equalities strategy, showing common cause across all protected characteristics. This should all be backed by a strong central government presence, including through a significantly rejuvenated Office for Disability Issues, through the Government Equalities Office or, perhaps, through proper resourcing and respect for the Equality & Human Rights Commission.

By avoiding a hierarchy of equalities, the common cause of everyone will be improved.

Are you feeling lucky?

We tend to remember the obstacles we have overcome more vividly than the advantages we have been given.

This quote comes from an article about what this tendency (or cognitive bias) to remember how we overcame adversity instead of remembering the easier times might imply for public policy to try and make things more equal for people.

I found myself agreeing with this on at least two fronts:

1. “Hard” levers of change, such as legislation, regulations and targets, focus much more on addressing obstacles than they do on creating better opportunities to address equality issues
2. I’ve often thought of my own luck at various points in my life (making a good friend, having a good teacher, having a godparent who was very interested in sharing books).

We can easily translate this into the “luck” of having a good social worker, doctor, employment adviser etc. and ensuring the opportunities and experiences that public services provide are equally available and good to everyone. I have always been motivated by ensuring that this luck (or “luck”) systematically comes the way of as many other people as possible.

Three pieces on Future Labour

I continue to struggle in the aftermath of Brexit.

Not, necessarily, just because of the result – it was a long time coming, and perhaps has woken the individualised and consumerised winners of the last 30 years from their torpor.

But also because of where it leaves Labour – stuck, somewhere, fighting the battles of the 20^th century.

I’m not sufficiently informed, connected or clever enough to know where the Labour party should go and to offer a view on where the destination is and how to get there. There’s also little I feel I can personally do to help steer or jump on board with where Labour should go. I do know, though, that (1) I have been a Labour party member since 1998; (2) even now, I’m not sure if there is another “party” I would want to belong to; and (3) the current party cannot be or do what it should.

I therefore continue to look for the best diagnoses of Labour’s current situation in order to understand it as well as I can, and for glimpses of what the future could be and how Labour might plot a course to get there.

Three pieces I’ve found particularly useful of late are from John Harris, Neal Lawson and Anthony Painter. Here they are on where we are:

1. John Harris in the Guardian:

As with the centre-left parties across Europe in the same predicament, Labour is a 20th-century party adrift in a new reality. Its social foundations – the unions, heavy industry, the nonconformist church, a deference to the big state that has long evaporated – are either in deep retreat or have vanished completely.

2. Neal Lawson on Open Democracy

Everything that once made Labour strong and the 1945 settlement possible; a unified working class, a bureaucratic system of governance (Fordism), memories of the war and the depression and the existence of the Soviet Union as a global counter to capitalism had gone. They have been replaced by forces inimical to traditional social democracy, namely financialisation, globalsiation, individualization and consumerisation. Labour, I argued, was a ‘Kodak party in a world of instagram’.

3. Anthony Painter:

The point is that the working class – Labour’s alleged base – is irrevocably split. Moreover, there is no going back now. The schism is permanent.

And here they are on where to go.

John Harris:

The left’s future will involve many Labour people, but also some in the Greens, Liberal Democrats – even one-nation Tories – and thousands of people with no affiliation at all. However it is organised, it will have to start with an understanding of the fact this is a crisis of democracy, and support a change to the electoral system and a move towards multi-party politics.

Neal Lawson:

[We] must recognize that no single party or movement has all the answers. The future will not be imposed but negotiated. Most immediately it needs to be negotiated by all the progressive parties in a Progressive Alliance to try and counter the massive shift to the right we are experiencing.

Anthony Painter:

Instead of expending energy on saving Labour, something entirely new is needed. Labour was a movement before it was a party and so should whatever replaces it from within or without be.

This movement would seek to build from the cities out. It would embrace pluralist progressives – from the remain labour working classes to social liberals. It would be a movement that sought to build the right networks and platforms for social justice.

A movement of citizens that would over time seek elected office, it would espouse democratic, economic and social reform…

This movement would demand a new social contract; the current state fails to support the reality of modern economic life and leaves families and whole communities locked in insecurity and poverty. These would be new platforms for economic security such as Basic Income and social mobility. Security and mobility would be seen as dependent upon one another- holding no one back, leaving no one behind.

Remembering “Rise of the Meritocracy” was a satire

From the New Statesman:

But I am also a big problem. People like me, who get educated and quickly head off to London when things aren’t going our way. We invested in ourselves, sometimes at state expense, and never really thought about putting that back into the places where we grew up.

There weren’t the right opportunities back home and that still stands. But, rather than doing something about that, people like me lazily joined the gravy train for London and now we’re surprised we feel more kinship with a 20-something from Norway than we do with someone who we used to knock on for when we should have been at school.

Reading this reminded me that Michael Young intended his 1958 essay “The Rise of the Meritocracy” as satire, not as a platform for policy. As the Economist noted:

Young… conjured up an image of a society obsessed with talent. The date was 2034, and psychologists had perfected the art of IQ testing. But far from promoting social harmony, the preoccupation with talent had produced social breakdown. The losers in the talent wars were doubly unhappy, conscious not only that they were failures but that they deserved to be failures. Eventually they revolted against their masters.

The vote to leave the EU feels precisely like a revolt by the “losers in the talent wars” against their masters.

Young, at least, offered a positive vision for what it could, should be like:

“In the light of this approach [they] sought to give a new meaning to equality of opportunity.

“[It] should not mean equal opportunity  to rise up in the social scale, but equal opportunity for all people, irrespective of their ‘intelligence’, to develop the virtues and talents with which they are endowed, all their capacities for appreciating the beauty and depth of human experience, all their potential for living life to the full.

“The child, every child, is a precious individual, not just a potential functionary of society. The schools should not be tied to the occupational structure, bent on turning  out people for the jobs at any particular moment considered important, but should be devoted to encouraging all human talents, whether or not these are of the kind needed in a scientific world. The arts and manual skills should be given as much prominence as science and technology.

“[All] schools should have enough good teachers so that all children should have individual care and stimulus. They could then develop at their own pace to their own particular fulfilment. The schools would not segregate the like but mingle the unlike; by promoting diversity within unity, they would teach respect for the infinite human differences which are not the least of mankind’s virtues. The schools would not regard children as shaped once and for all by Nature, but as a combination of potentials which can be cultivated by Nurture.”

 

 

Breadline or Left Behind: social work schemes for graduates from the university of life

Frontline and Think Ahead are new routes into children’s and mental health social work respectively for graduates with a 2:1 degree or better. The principle behind them – derived from Teach First – is to attract the “brightest and best” into a job / career they may not otherwise have considered.

My feelings about these social work training programmes have developed over time. Initially I wasn’t keen, but now I feel that anything which promotes social work as a good profession should be, broadly, welcomed.

How my feelings have developed have probably reflected the way the programmes themselves have been refined since their inception. Where before there was arguably an elitist, Oxbridge focus on who the programme’s participants might be, now it feels they’re much more interested in good graduates from a broader set of universities.

I wonder, though, if by focusing only on people graduating from university with 2:1s or above we’re missing an opportunity?

What if, as well as this, we had well-resourced and targeted recruitment campaigns focused on bringing people into social work who are likely to graduate cum laude from the University of Life?

These would be people who never made it to university; a high proportion of them probably wouldn’t have A-Levels. They will have faced adversity at many points in their lives and been used to navigating a whole host of difficult environments. But, despite the many challenges they will have encountered, their character, resilience and way of thinking has meant they have flourished.

If people like this became social workers, imagine the experience and perspectives they could bring to social work! Imagine the difference they could make to people whose lives they would truly understand!

We could call such programmes Breadline or Left Behind – anything that reflected the exact opposite of what Frontline and Think Ahead represents. Without denigrating these existing schemes, though, I think we’d find ourselves with another group of people whose contribution to social work could be significant.

Now, if only we could a think tank to take up the idea…

The opportunity for public services of truly engaged expert citizens

The World Wide Web was invented in 1989 and Google was incorporated as a company nearly a decade later, in 1998. AirBnB started in 2007 and Uber in 2009.

I wonder why there was such a big delay between the web and Google, and then Google and AirBnB, Uber etc., and then a subsequent delay in their reaching a tipping point in terms of awareness and use by the general public?

I ask this because there have been a very wide number of approaches and initiatives for improving public services, not least health and social care, through technology and particularly the web. For example, there have been care comparison sites a-plenty, much talk of open data and suggestions of location-based services to replace off- and online directories. And yet we see relatively little evidence of these approaching a tipping point, let alone being used regularly by local authorities, providers and the general public when it comes to health and social care.

The prompt for these thoughts is this excellent, detailed post at Policy Exchange about the rise of the citizen expert.

In it Beth Simone Noveck (former United States deputy chief technology officer and director of the White House Open Government Initiative) takes as a starting point another area of public policy – citizen engagement – and notes how the obvious opportunity to improve public services and local communities hasn’t been taken in the way it could have been.

Citizen engagement isn’t just the equivalent of technology: it’s clearly bigger than that. Beth makes clear this point by showing how better harnessing the interests and expertise of citizens can help both bridge the democratic divide and make the most of people in contributing to their local communities and society.

The internet is radically decreasing the costs of identifying diverse forms of expertise so that the person who has taken courses on an online learning platform can showcase those credentials with a searchable digital badge. The person who has answered thousands of questions on a question-and-answer website can demonstrate their practical ability and willingness to help. Ratings by other users further attest to the usefulness of their contributions. In short, it is becoming possible to discover what people know and can do in ever more finely tuned ways and match people to opportunities to participate that speak to their talents.

But she also notes the most significant barrier to this: the continued dominance / monopoly of policy- and service-elites in the work that they do:

[There is a] long-held belief, even among reformers, that only professional public servants or credentialed elites possess the requisite abilities to govern in a complex society.

Why? Because it is believed

Citizens are spectators who can express opinions but cognitive incapacity, laziness or simply the complexity of modern society limit participation to asking people what they feel by means of elections, opinion polls, or social media.

The shifting of the cause of the problem of a lack of engagement onto citizens themselves rather than the professionals asking the questions is a familiar refrain. We regularly hear laments about “the usual suspects”, limited response rates or adversarial consultation processes that create more problems than they solve.

But this characterisation of this situation only makes sense for one set of players: it suits both the technocratic elites who dominate public policy and services, and the other well-embedded elites with (vested) interests who can mobilise quickly to respond to consultation/engagement that affect their organisations.

It is, of course, a characterisation that doesn’t really stand up to scrutiny. For example, we know that (proper) co-production in health and social care has a solid evidence base in the difference it makes. But we also know it continues to be at best a nice-to-have rather than a must-have.

Thus we come back to the questions kicking about in my mind at the start of this post: if the ability to do this sort of thing exists (be it citizen engagement or technology), why hasn’t social care and the like made the most of this opportunity?

It’s largely because elites aren’t yet comfortable with distributing leadership and expertise.

One of the ways to overcome this discomfort, then, is to make it valuable and rational for the existing elites to engage in effective citizen engagement by ensuring a ‘good’ group of people are engaged and involved in public service reform in the first place.

Noveck rightly says:

To make all forms of engagement more effective, we need to increase the likelihood that the opportunity to participate will be known to those who need to participate. If a city really wants to improve the chances of crafting a workable plan for bike lanes, it should be able to reach out to urban planners, transportation engineers, cyclists, and cab drivers and offer them ways to participate meaningfully. When a public organisation needs hands on help from techies to build better websites or data crunching from data scientists, it needs to be able to connect.

To do this:

[I]nstitutions [must] begin to leverage such platforms to match the need for expertise to the demand for it and, in the process, increase engagement becoming more effective and more legitimate.

This is appealing. Citizen engagement may not be valued by elites because there hasn’t been adequate effort or ability to engage sufficient citizens to make it worthwhile enough.

As Noveck concludes:

This is about chances for civic participation; to be a member of a local community and to make a contribution based on this… It has everything to do with what it means to be a citizen in a contemporary democracy.

This is why I particularly like this: this isn’t just about technical changes around the edges of public service economies, but the broad meaningful difference it could make.

 

Public services: only a means to living full and active lives

I’m involved with the Get Yourself Active campaign and recently wrote a blogpost for it, which is reproduced below. There’s also a fantastic post by Anne Beales of Together UK (on small steps and grand plans) and from Leanne Wightman (who is doing a great job of running the whole project) on the opportunity of Get Yourself Active. You can follow Get Yourself Active via @GetYrselfActive

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There were some headlines recently about how people were using their Personal Health Budgets. Concerns were raised about whether items like games consoles, a summer house and satnavs were the best use of public money, with the inevitable calls for resources instead to be focused on traditional ways of doing things – beds, staff, medical equipment.

A positive aspect of the debate was it provided an opportunity for people who have Personal Health Budgets and the professionals who support them to explain why they’re so important in meeting their care and support needs. Kevin Shergold, for example, highlighted:

The PHB has given us freedom to live our lives as we choose – in a way that’s sensible and cost effective. Developing a severe disability might seem hopeless, but I want people to know that it’s possible to live a good, full, interesting life when you have the right support and choice.

This gets to what I think is a vital but often unasked question: what is the point of public services and so the money that funds them?

The vast majority of people with lived experience and who have used care and support services say that they want a life, not a service. Their focus isn’t on getting a few more hours of home care here or seeing an occupational therapist there; it’s about living as full and enriching a life as possible.

Norman Kirk – a New Zealand Prime Minister in the 1970s – described it this way:

People don’t want much. They just want someone to love, somewhere to live, somewhere to work and something to hope for.

He could well have added “something to do”, because wanting to be physically active or play sport is often reported by all people, including disabled people, as a key source of general wellbeing.

The point of public services and the money that funds them, therefore, covers being a means to support wellbeing and achieve what people want to do in their lives – including being active and playing sport. We have already heard from a number of people through the Get Yourself Active project that using their personal budget in this way has changed things for the better.

This means there are three main reasons why I feel Get Yourself Active is such an important contribution:

1.  It helps to support people who use care and support services and the professionals who work in them to recognise the value of physical activity and sport
2.  It provides a much-needed wider focus on how Personal Budgets can be used to directly support such activity, and not just focus on traditional ways of meeting people’s needs
3. And, by the way, it helps councils and their partners meet the general wellbeing requirements of the Care Act.

If this leads to more stories about how Personal Budgets are being used to fund exercise classes, gym memberships or being involved sporting activity, I for one won’t be disappointed. It will mean that public services are doing their job well.