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?

social movements and institutionalisation

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!

Nothing new under the sun? Originality and think tanks

old sun

I enjoyed this from Stian Westlake at Nesta:

As a policy wonk, I get a sinking feeling when I’m reading a terrific non-fiction book and find there’s a “policy recommendations” chapter.

In a postscript he highlights that feeling applies not just to experts who have written books but to wonks writing think tank reports as well, bringing it firmly into our sphere of interest at arbitrary constant.

Stian notes the two mindsets that lead to dull policy recommendations. The first is the “adviser’s approach”, which:

involves trying to write down the best set of measures to tackle a particular problem. It’s the kind of answer a government expert would use when writing a white paper on the subject that was actually going to be implemented.

What’s good about this from Stian’s point of view is that it provides a good programme for actual action, though a downside is that it lacks originality.

The second mindset is the “wonk’s approach”, whose main attribute is that it is original.

In the postscript, Stian concludes that think tanks in particular should focus on the wonk’s approach through

Produc[ing] fewer me-too policy recommendations, and instead to either come up with original ones, or not to bother with them at all.

Stian’s reflections put me in mind of a few things. The first was an insight from Jeremy Shapiro in the FT:

To the senior official, an outside idea is like a diamond on a desert island: abstractly valuable but practically useless. She feels penned in by politics and resource constraints that outsiders do not acknowledge. As she nods appreciatively and appears to hang on every word, she is, in fact, hiding tired familiarity with ideas she views as either politically impossible or already being attempted (or both).

The next is the third of Fukuyama’s four conditions that have to be in place for political change to happen:

While government reform reflects the material interests of the parties involved, ideas are critical in shaping how individuals see their interests

My final reflection is on the idea of a Basic Income. The RSA has done some fantastic work on this recently. In itself, this is great, but what I find most interesting is that (1) this was a key part of the Green Party’s 2015 election campaign – during which it was, essentially, ridiculed; and (2) there is a very long history associated with the idea of a basic income, stretching back to the 16th century.

What these three reflections sum to is that ideas and originality are only necessary conditions for change, but not sufficient ones.

I’ve noted a personal scepticism before regarding “innovation” (and so originality). My personal predilection is for how to take and use good idea ideas to further public policy and service reform, rather than the originality of ideas per se. To this end, Stian’s penultimate point regarding think tanks is the one that works most for me:

[T]hink tanks add value by framing problems and diagnosing situations rather than by the specific solutions they propose.

The crowdfunding market

Last week I blogged it’s no surprise there are 44 social care comparison sites, because:

  1. Social care is a significant “industry”
  2. Social care is a confusing “industry”
  3. There’s something to be made (be it money, referrals or reputation) from helping people navigate their way through all the complexities of social care

The main question I posed myself was whether social care comparison sites should be led by the visible hand of government or by the invisible hand of the market.

Here’s a fascinating development from Nesta in another growth area: crowdsourcing. They have created CrowdingIn, which supports people to help find the crowdsourcing platform most suited to their financial need.

In the sense of comparison sites, Nesta’s offering is of course only one (compared to the 44 in social care). My point here, though, is this: crowdsourcing has grown exceptionally quickly, with 34 different platforms people can access to crowdsource their funding, such that Nesta’s idea of a comparison site for crowdsourcing sites seems a very reasonable thing to offer.

To me it’s remarkable that so many businesses can exist so quickly on the back of a relatively recent phenomenon to the extent that a site of the second order (first order: crowdsourcing sites; second order: comparison of crowdsourcing sites) needs to exist.

Whether Nesta counts as a visible hand or an invisible hand is a different question altogether. What’s fascinating in the context of crowdsourcing is that the need for the hand exists.

(On crowdsourcing itself, here’s a nice blogpost from Carrie at FutureGov.)