Mental health, social care – complex, not complicated

Thanks to @pubstrat I came across this excellent post on complexity and government by Mark Foden (@markwfoden).

Mark draws out nicely the difference between stuff that’s complicated and stuff that’s complex.

Complicated is something like putting a man on the moon:

There was a clear objective – success was easily measured. The laws of physics pertained and sending a rocket to the moon did not change those laws. Effect can be predicted from cause. It is possible to make big, long-term plans and be reasonably certain of achieving them – London 2012, Channel Tunnel, Crossrail etc.

Complexity, however, is a different beast:

Dealing with something like poverty is complex. Poverty is hard to define meaningfully. It is difficult to measure improvement. It is subject to changeable human behaviour and action is persistently met with unintended re-action. Effect can be deduced from cause, but only in retrospect.

In complicated problems, Mark notes that the “build” mindset works, whereas in complex situations it’s the “grow” approach that works best.

The bit of Mark’s analysis that hit home for me was this:

The problem is not in plans, people or methods – it’s in mindset. Trying to build things that really need to be grown just won’t work – no matter how they are managed.

He also notes that we shouldn’t necessarily just abandon “programmatic approaches” but ensure we understand when complexity is at play and change our approach accordingly.

His thinking is mainly applied to IT infrastructure, but the applicability of this thought to social care or mental health is clear.

Both are significant systems with large amounts of money, buildings, providers, commissioners, wider stakeholders and, most importantly, users and families. Neither are particularly well-defined or have a particularly clear idea of what their end goal is (for mental health: better mental health of the population? More cost-effective services? More people with mental health problems in work? Less stigma? For social care: more money? More integration? Less integration? More care homes? More community provision?). And, goodness me, human behavior and action within the mental health and social care systems is changeable!

Indeed, I’ve always thought the mental health and social care systems are a bit like a Jackson Pollock painting:

To this end, it’s always been clear that the mental health and social care systems are complex. But plans to try and improve them have always tended to rely on top-down, “build” solutions.

Whilst equally not calling for the abandonment of good programmatic approaches in social care and mental health, what we do need to do is recognise the complexity at play and update our approaches accordingly. In these cases, such adaptations include: (1) distributing power amongst all stakeholders through all aspects of co-production; (2) putting people at the centre of their care and support, through personalised approaches and money more directly in their hands through Personal Budgets; and (3) creating a more equal playing field for a wider variety of providers based in across a range of settings.

If people like Mark are clear the “grow” mentality needed by complexity applies to the (supposedly) deterministic world it’s easy (but wrong) to assume government IT is, then it’s pretty obvious that the equivalent “grow” approach is needed for the future of the mental health and social care systems.

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Man walks into a column, no.35: Cognition

The Social Animal by New York Times columnist David Brooks was, by some measure, the best book I read on my recent Antipodean excursion, and certainly the most thought-provoking. It merits several blog posts all on its own, such is its range, but for now I wanted to expand briefly on just one of the many ideas about human interaction and cognition that the book explores.

The central argument of The Social Animal is that human beings depend for much of their cognitive, emotional and even physiological development on interaction with other people. This is because we are not in any meaningful sense of the word rational beings, or rather the reasoning part of our minds, whilst important, makes up only a small part of cognition.

Instead – Brooks argues – the act of perception is not just a simple or passive matter of ‘taking things in’ but a thinking and skilful process, one governed to a large degree by emotions, unreasoned cues/triggers and the subconscious mind. You can argue about the degree of influence one should accord to the non-rational mind but it seems difficult in light of the weight of scientific and other evidence to dismiss the basic principle that it’s jolly important.

It follows from this that we should pay much greater attention to the perceptual, the emotional and the subconscious processes in realms such as education, the workplace and even social policy, because this kind of broader focus allows for greater creativity, innovation, productivity and so on. It’s the workplace I want to concentrate on for now, and in particular what a greater focus on subconscious cognitive processes might mean for a public sector workplace.

Brooks’ narrative device is to follow the lives of a hypothetical North American couple, Harold and Erica, from birth to old age, in order to explain and demonstrate the ideas – drawn from neuroscience, philosophy, economics and sociology – that he covers. Halfway through the book Erica goes to work for a large telecommunications firm that is failing because it is in thrall to rationalist modes of organisation and doing business.

As recession hits, the company’s management team responds as only it knows how, by driving through efficiency savings, including cutting office space and eliminating all company gatherings that were previously a space to build personal bonds and trust between employees. All policy changes are driven hard from the top and no-one dares question the CEO.

Now this is in one sense strictly fiction, but I couldn’t help but see similarities between this fictional workplace and the local and central government office environments that I’ve encountered over the past few years. They are, I think without exception, strictly hierarchical, rule-bound and dominated by the rationalist paradigm.

Trivial but illustrative examples abound: the sign on the wall of a government department room instructing employees to keep meetings to a 90 minute maximum (we were into our third hour), the normally opinionated civil servant who literally said nothing when his boss was leading the session, or the dandyish local government officer who was given a stern talking to for wearing a (very smart and stylish) cravat rather than a necktie with his three piece suit.

Forming an argument based on anecdotes is not my style. So let’s say instead that my working hypothesis, which I’m keen to find time to test and – please! – have tested by the insights and experiences of others, is that the vast majority of public sector workplaces would benefit enormously from following a looser, more human and social model. What do you think?

Man walks into a column, no.28: Ideology

When launching Monday’s Open Public Services White Paper, Mr Cameron said ‘It is not about ideology. It is about the best way of getting things done’. This left me wondering whether the White Paper had too much ideology or too little, and either way why ‘ideology’ has become something politicians want to distance themselves from as much as humanly possible.

First, let’s clear up some terminology. Dictionary definitions of ‘ideology’ include ‘a system of ideas and ideals, esp. one that forms the basis of economic or political theory and policy’, a ‘set of ideas that constitute one’s goals, expectations and actions’, and ‘the ideas and manner of thinking of a group, social class or individual’.

Should this kind of White Paper be ideological, then, based on these definitions of the term, irrespective of whether it actually is? The Coalition makes clear that this is a ‘comprehensive policy framework’ but also, essentially, an agenda: because of the need to engage, consult and, y’know, listen the paper also outlines a range of ‘wider ambitions’ where the Government will consult over the next few months.

Policy frameworks and ambitions… sounds pretty ideological to me. Then there’s the joint Cameron/Clegg foreword, which is not so much ideological as fervent: ‘the forces which restrict opportunity for some inflict an injury on all’ and ‘every pair of idle hands, every mind left uncultivated, is a burden on all society as well as a weight on our conscience’. The overriding tone of the whole document could be summed up with the distinctly ideological phrase ‘power to the people’.

And actually I think this kind of agenda setting is an entirely appropriate focus for a White Paper of this nature. It’s not a White Paper about a specific sector or policy issue, it articulates the values, principles and underpinnings for the whole of the public service system.

So what’s the problem with ‘ideology’, then? Why when this clearly is and indeed should be an ‘ideological’ document is Cameron making such a point of saying it isn’t? When did ideology become such a tainted term, synonymous – it seems from the PM – with the dreaded ‘dogma’ (‘The old dogma that said Whitehall knows best – it’s gone’ he said)?

In this context specifically what Cameron means when he says this is ‘not about ideology’ is ‘this is not about us having an ideological preference for private sector companies taking over public services’ – in response to problems with Southern Cross and other companies messing up. They do, however, have an ‘ideological preference’ that provision of public services should be opened up to providers from more than one sector, principally in order to boost citizen choice.

More broadly what Cameron means is that Whitehall should not be dogmatically telling local areas what’s best for them. That’s fine in principle, but in order to make this work in practice the Government will need to do at least two things. First it will need to fulfil its side of the bargain, and resist the urge to squish local solutions that run contrary to its preferences (and there are plenty of examples, especially in local government, of this not holding true – the so-called ‘Pickles effect’).

Second, the Coalition needs to provide or at least facilitate support and capacity building for key local actors to step up. Commissioners need help in incorporating choice, diversity and a fuller appreciation of ‘value’ into their procurement decisions. Local politicians need support in order to become the ‘community champions’ the White Paper envisages. And local staff and residents need substantive reassurance that if they take a risk and try to take over running a public service, local and national government will be on their side. As far as I’m concerned, being ideological is not the same as being dogmatic: it’s about knowing where you stand.

How #localgov can help during the recession

There are lots of ways local government can help businesses and people during the recession.

Corby Council, for example, has come up with a particularly innovative way by, erm, paying its bills on time:

Businesses in Corby are being helped through the recession by the council which has pledged to pay its contractors in extra-quick time. The authority has promised to pay the invoices of businesses who are employed to work on borough council projects within 10 days where possible, and within 30 days if it cannot do so any quicker.

Seriously.

I don’t know if this quote from the Chief Executive of Corby Council makes it better or worse:

Chief executive of Corby Council Chris Mallender said: “There was some research done to show that local authorities are really slow at paying their bills so we wanted to ensure that we were not one of those authorities.

We are trying to do everything we can to help local businesses to survive this recession.

So last month we paid 99.5 per cent of our bills within 30 days, and 84.8 per cent of our bills within 10 days.

Every little helps, I suppose.

That pesky local decision making thing

I’d like to be a fly on the wall when Grant Shapps – he of Councillors should be volunteers fame – meets his Conservative Councillor colleagues from Barnet Council who, in these times of austerity, have awarded themselves allowance increases of between £7,351 to £10,126 a year.

Don’t forget, folks: we’re all in this together.

“Councillors should be volunteers”

I think they’re doing it just to deliberately annoy people now. Y’know, the coalition government, wilfully mixing up and conflating issues and prescribing completely ridiculous policy solutions to address said issues.

Take this from Grant Shapps:

Proposed increases to councillor allowances are “unjustifiable” at a time when public sector workers are facing a two-year pay freeze, local government minister Grant Shapps has said.

Mr Shapps criticised recommendations from the Local Government Association (LGA) to increase member allowances by 2.3% this year as well as paying councillors attending the LGA a £152.77 “daily rate”, calling on councillors to freeze their allowances in line with public sector workers.

The Conservatives said the proposals were indicative of a “worrying trend for the professionalisation of councillors, who should be volunteers”, citing a BBC survey conducted last year which revealed that councillors’ pay had risen by above inflation in the past four years.

I happen to agree with the idea of freezing Councillor allowances – this is only fair when local government workers face the same. (I don’t agree with freezing pay or allowances per se, by the way. But if you’re going to apply it, at least do it consistently.)

But it’s quite a leap from freezing allowances to saying that Councillors are being “professionalised” and that they should be “volunteers”.

Local Councillors are some of the most selfless, committed and passionate people I’ve ever known. They give so much time and effort of themselves to their local communities that I honestly have no idea how they do it. For example, you only need to follow Cllr Daisy Benson to realise – irrespective of politics – what a huge difference she makes in her community. There are hundreds like her across throughout local government.

And the responsibilities of Councillors mean that you want someone who is so dedicated and, frankly, able, to undertake those roles. A bit of professionalism, given those responsibilities, is in no way remiss.

Of course, one of the key problems with Councillors is the supply-side: the quality isn’t always there, and there are too many retired Brigadier Generals passing their halcyon days in town halls the land over. But how – given this supply-side problem, and the responsibilities the coalition government are apparently keen to press on local government – you come to the view of suggesting that Councillors should be volunteers as a solution to the issue of rising allowances is, frankly, a load of contradictory nonsense.

Maybe Shapps is just continuing his Secretary of State’s propensity for humour a bit too far? After all, he’s talking such crap that I can only assume he’s joking.

Eric Pickles: comedian

Did you catch Eric Pickles’s speech at the LGA conference last week? I say “speech” when really I mean “comedy routine”:

You’ve been a prisoner of regulation, chained to the radiator with red tape, for too long. I want to liberate you…

And I can announce today, as I promised to a fringe meeting here two years ago, we’re also abolishing the TLA. The three letter abbreviation…

If I just wait around, it’s a bit like saying I’m going to abolish the death penalty, but then saying, everyone on death row must be executed so that we can have a clean slate…

Like the law from 1919 which says that when councils want to buy new land for allotments, I’m supposed to sign it off. After all my years in politics, I finally get to choose who gets to grow carrots and who doesn’t. But there’s a problem. As Mrs Pickles will tell you, I’m not a dab hand with the trowel. So what skills am I supposed to bring to this job? What searching questions can I ask the applicants. How big are your marrows?

Now a few years ago, when myself and Mrs Pickles came down to Bournemouth, it was raining, so we went to the cinema. And we saw this film: Jerry Maguire, with Tom Cruise and Cuba Gooding Jr. And they had a phrase that stuck. ‘Show me the money’. That’s what we need to do.

Now, over the past few weeks, it’s been clear that there are various things we can learn from the German nation. And various phrases have entered our language. Deutschland vier, Argentinien null.

Sure, there was some important stuff in his speech as well, but I personally found it a bit distasteful that a Secretary of State can be as flippant as Pickles was in his speech.

It’s therefore hard to disagree with Patrick Butler’s analysis in his (excellent) Society Daily bulletin (and I’m not just saying that because he quoted me!):

I followed Communities secretary Eric Pickles’ speech to the Local Government Association conference yesterday on television. If there was a serious message in there somewhere, it was crowded out by a procession of terrible, over-rehearsed jokes, and a truly awesome smugness. Pickles looks like he ought to be a natural wit[,] but this was glib, Daily Mail-pastiche, stuffed with cliche and mixed metaphor.

“No budget to spend”

Where to start with this?:

A website manager employed by Portsmouth City Council left after just six months on the job because he was frustrated at a lack of funding. The council spent around £25,000 recruiting and paying the unnamed employee to transform their website, but when he discovered he had no budget to spend on the service he quit.

(via Carl Haggerty)