Radical Help How we can remake the relationships between us and revolutionise the welfare state-Notebook

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Radical Help: How we can remake the relationships between
us and revolutionise the welfare state
by Hilary Cottam
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427 Highlights | 2 Notes
Highlight (Yellow) | Location 104
I wanted to better connect the good intentions and the resources of big institutions with the know-how of those
living difficult and complex lives.
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Ella desperately needed help, and seventy-three professionals had been involved in just that – trying to help in
some way or other. But ‘the social’, as Ella loosely referred to all those in her life who work for the welfare
system, seemed to her to be part of the problem.
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Trying to support the overstretched professionals are thousands of so-called front-line workers, who labour for
minimal pay on insecure contracts. They too are distressed by the mismatch between the care that is needed and
the resources and time available.
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Our welfare state is not fit for purpose. It cannot support us in an emergency, it cannot enable us to live good
lives, and it is at a loss when confronted with a range of modern challenges from loneliness to entrenched
poverty, from a changing world of work to epidemics of obesity and depression.
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It wasn’t always like this. In the beginning, the welfare state felt modern and visionary.
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Everyone suffers in a system where 80 per cent of the resource available must be spent on gate-keeping: on
managing the queue, on referring individuals from service to service, on recording every interaction to ensure
that no one is responsible for those who inevitably fall through the gaps.
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These services were seeing the same individuals over and over again; people who – like Ella – seemed tangled
and trapped in safety nets that were meant to support them.
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managing the queue will not sort out our problems. Money alone is not the answer either.
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The solutions that have been developed are affordable. They cost less to deliver and they save money because
they bring about change in people’s lives.
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And the emphasis is not on managing need but on creating capability: on addressing both the internal feelings
and the external structural realities that hold us back.
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At the heart of this new way of working is human connection. I have learnt that when people feel supported by
strong human relationships, change happens.
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Each of the experiments started in the same way: I published a small pamphlet setting out the problem to be
tackled. These pamphlets were an open invitation to anyone who might be interested in collaboration.
Collaborators came from government, from business and from communities across Britain. They brought
funding, expert knowledge, ideas and lived experience.
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We focused on those places where there was broad agreement that the welfare state is not working. Over ten
years we created five core experiments, and each one forms a chapter of this book.
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In each experiment we designed a solution and tested it with hundreds, sometimes thousands, of participants in
different settings.
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Modern welfare must create capability rather than manage dependence; it must be open, because all of us need
help at some stage in our lives, and when we are thriving many of us have help to offer; it must create possibility
rather than seek only to manage risk; and it must include everyone, thereby fostering the connections and
relationships that make good lives possible.
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War had revealed the defects of existing services, which could not cope with the disruption. Just as importantly,
Britons had got to know each other across the divides of class and geography.
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The middle and upper classes, many of whom had been brought up to think of poverty as something brought on
by laziness, something that only happened to the feckless few, realised they had not seen the full picture.
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Beveridge slaying the Five Giant Evils, 1942
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Opposition, then as now, focused on two issues: cost and the role of the state.
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In the 1930s, the state accounted for 20 per cent of national economic activity (GDP). By 1945, this figure had
risen to 45 per cent. Some of those who argued that this expansion of the state must be controlled were, like
Hayek, ideologues implacably opposed to the state
Highlight (Yellow) | Location 377
Beveridge became increasingly ambivalent about his own reforms. He had envisaged both a strong role for the
state and for volunteer organisations, and he was alarmed to see the state increasingly taking over.
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Crisis and division came in the 1970s, when economic growth stumbled and unemployment rose.
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The welfare state had been a cross-party project, but economic crisis forced the polarisation of views.
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new public management.
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sceptics also point out that only large multinational corporations can afford to bid, which distances the providers
of services from the communities they are serving.
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There are three reasons why our welfare state cannot work for us in this century. First, we are facing big social
challenges that were not foreseen when our welfare state was designed. Challenges such as obesity, ageing and
the globalised changes to work are not only new, they are different in nature, and need new types of response.
Second, we have a crisis of care. We cannot find ways to provide or pay for kind and human care. This
challenge is not new, but as our population ages it has grown in scale, threatening to overwhelm the very
possibility of a welfare state. Third, poverty and inequality have not been adequately addressed. Over one
million people in Britain today are considered to be destitute, and the inequalities between us are greater than at
any point since the nineteenth century.
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(1) Twenty-first-century problems
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The welfare state is an industrial system. Its institutions and services reflect the era in which they were designed.
This was the era of mass production, of hierarchy and rules, of command and control.
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The NHS functions like a factory, managing the distribution of drugs and patients. The latter move mutely
through the system, like any other industrial unit: they are lined up, placed in beds and moved along the
conveyor belt.
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Modern diseases are chronic – that is they last a long time, often a lifetime – and cannot be cured.
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Again, such systems were appropriate in the 1950s. Schools were preparing pupils for a life within similar
hierarchies.
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Beveridge designed a system to manage what were expected to be temporary disruptions in the pattern of a job
for life. But today work is not stable and periods out of work are normal as we move between jobs.
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Solutions require us – communities, the state, business and citizens – to work together, drawing on new ideas
and above all on each other to create change. But our post-war institutions were not designed to help us
collaborate or to come together to sustain changed ways of living. In fact, they were more often designed to keep
us out, at arm’s length, where we could be managed.
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(2) Who cares?
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Beveridge and his contemporaries decided that care would be unpaid, domestic, women’s work.
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by the 1960s seismic social change was under way and the cracks were beginning to show.
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as the challenge of trying to balance too many competing demands and desires forces parents apart. When our
relationships fracture, finding time to care becomes even harder.
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Modern work also demands greater geographic mobility.
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forced to migrate from communities where social bonds are strong but good work can no longer be found, or
where housing has become unaffordable.
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a particular challenge when elderly relatives may need many years of support.
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while our existing arrangements have helped us to live longer, they can no longer help us live better.
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Local governments preside over shrinking budgets and growing numbers of elderly residents. They face almost
impossible choices and have attempted to manage the ensuing crisis according to orthodox common sense.
Firstly they have tightened the criteria that older people must meet in order to receive help.
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local authorities have opened up the provision of services to the market.
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Ninety per cent of care in Britain is provided by nineteen thousand private sector organisations that cannot
deliver what they promise on the budgets provided. Teams of well-intentioned but often poorly trained and badly
paid care workers are allotted ten-to fifteen-minute slots to make home visits in which they are expected to
bathe, dress and feed an older person.
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Reducing the provision of social care does not save money.
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Without support at home older people increasingly find themselves in hospital, often languishing as ‘bed
blockers’.
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the more we focus on the top-down reorganisation of institutions, the more the answers seem to elude us.
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the challenge of caring for an elderly population within our current systems and services seems so huge and so
expensive we appear to be paralysed:
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How we can care for our small children is no less of a dilemma. There are parents who need or want to work.
There are others who want to care for their children and feel bewildered that this fundamental role no longer
appears to have any value,
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The answers proposed are always based on low wages for carers and as many little children as possible allocated
to each carer.
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Caring for each other is not about efficiency or units of production. It is about human connection, our
development, and at the end our comfort and dignity.
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(3) Modern poverty
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The welfare state has not eradicated poverty.
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In fact, poverty in Britain is persistent and growing.
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Today, most people who are poor are in work.
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23 Contrary to widespread perceptions, 1 per cent of the welfare bill goes to support the unemployed (£3 billion
a year) and over 30 per cent (almost £70 billion a year) goes to support those who are in work but who are paid
too little to survive.24 The fundamental contract on which our welfare state is based – that work is always a
route out of poverty – is broken.
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the dramatic and growing gulf is between a small elite pulling away at the top and an increasingly isolated and
marginal group to be found at the bottom, the so-called precariat.
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spiralling inequality is transforming the nature of British poverty.
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The elite not only enjoy high incomes, they are further cushioned by high savings and high house prices. Their
lives are distant, not just in terms of wealth, but also in terms of who they know, the things they enjoy and where
they live (mostly in the Home Counties and certain parts of London).
Highlight (Yellow) | Location 579
Living in this unequal world makes all of us anxious. There are those who are not ‘poor’, but whose incomes are
declining.
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Money does not equate to the good life, as Aristotle told us thousands of years ago, and in this increasingly
unequal world it seems that even the well-off do not feel that they have enough.
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There is the psychic pain of feeling inferior, the frustration at not being able to stand on one’s own feet, the lack
of autonomy endemic in modern low-wage work. All of these exert physical effects: they lower the immune
system, make us feel ill and lead to shorter lives.
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the need for the right phone, the right suit, the right teeth, in order to take part socially or to succeed at a job
interview.
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And while the welfare state can hand out money, it has little help to offer those facing the increasingly complex
social and emotional effects of modern poverty.
Highlight (Yellow) | Location 601
This particular school shared a boundary wall with one of London’s top prep schools. On the prep-school side of
the wall was a swimming pool. The longing, it turned out, was not so much for a pool, but to belong on the other
side of the wall. To be one of those expensive-looking pupils with expensive-looking lives full of hope and
promise.
Highlight (Yellow) | Location 604
Modern poverty is about money and about a breakdown in our social fabric, a rent in our relationships and our
shared experience.
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education can no longer compete with the structural transfers of wealth between generations.
Highlight (Yellow) | Location 609
Income transfers – the benefits paid to working families – might prevent starvation, but they also build
resentment.
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Our welfare state might still catch us when we fall, but it cannot help us take flight.
Highlight (Yellow) | Location 627
New public management has been presented as a neutral theory of administration merely concerned with
efficiency and technical adjustments. But, with hindsight, we can see that this is a programme of far-reaching
cultural change.
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We are encouraged to rate our doctors or our bin collectors much as we might rate a film or a visit to a
restaurant. Nobody feels part of an important shared project.
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In 1946 Beveridge published a report on voluntary action, in which he voiced his concern that he had both
missed and limited the power of the citizen and of communities. The people’s William didn’t like the way
citizens were prevented from contributing time or money to the cost of services;
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he was increasingly aware that communities, rather than distant, cold and hierarchical institutions, are often
much better at identifying needs and designing solutions.
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Participation cannot be seen as something special or unusual that must be celebrated. We need to create systems
that make participation easy, intuitive and natural. And to do this we need to start in people’s lives.
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The gap between the idyll that Ella imagines others are living and her own reality is a source of anguish.
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There is also a lingering sense that Ella is to blame.
Highlight (Yellow) | Location 734
‘I bet they all have iPads and massive TVs,’ people respond when I say where I am working.
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Ella sees her problems as rooted in personal failure. She continually blames herself
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family breakdown is estimated to cost the taxpayer £48 billion a year, a sum that is almost double the budgets
allocated to families with complex needs.
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So money is an issue, but it is not the only one. The parents’ own childhoods is another significant factor.
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For every problem a service had been suggested, but nobody had sat down with the family and looked at the
cause of their suffering and the connections between their difficulties. No one had a plan, and Richard and
Emma were in freefall.
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We also stay alert, listening and watching for the good things that might be covered over, the threads of hope
that would help us build a way out.
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I am struck by the way the families and the professionals mirror each other in the ways they talk and act. The
professionals alternate between attempts to rescue the families and heated, angry responses born of their strain
and desperation. Enforcers, with their authoritarian commands – ‘you need to change’ – are met with aggressive
responses from the families. ‘Change – how?’ the mothers yell back.
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Professionals complain that the families are not honest and open, but the families say there is no safe space to
ask for help. Both sides are terrified:
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The families fear that honesty and seeking help will lead to the removal of their children.
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I am struck by the fact that there is no discussion, no talk of what could be changed. There is just the recording
of facts, the processing of problems.
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what is recorded as ‘face-to-face’ time serves only to distance Ryan from Tom.
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We invited everyone who worked with Ella’s family to a meeting, and we asked all these professionals to help
us map their work with the family.
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Constant intervention was keeping the family locked exactly where they were: stuck in the eye of a storm.
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It would not be accurate to say that Ella and her family cost the state £250,000 a year. It is the running and
maintaining of the system around Ella that is costing a quarter of a million pounds a year.
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Not one penny of this money was being used to build opportunities for the families or to invest in their
development.
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In a remarkably brave step, Swindon’s leadership agreed. Front-line workers would step back. They would stop
offering their existing menu of services. Instead, we would ask the families to solve the conundrum.
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To get started, we needed to find those who could help the families make change – those who would be
courageous enough to offer support, but let the families lead. To build capabilities, you need support.
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We set up an interview panel and asked Ella and Karen to sit on it, along with members of our team.
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Rule one: an inversion of time. Eighty per cent of the team’s time would be spent by the side of the families, and
only 20 per cent on administration. Rule two: an inversion of power. The families would drive and lead the
change.
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The mothers were looking for people who were real, who were intuitive. The families won’t choose anyone that
will talk down to them. They won’t choose anyone they see as soft, either.
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A team came together: eight people from different backgrounds and departments including housing, social work
and the police. We gave our experiment a name – Life – and they called themselves the Life team.
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one thing was clear: to break the gridlock of misunderstanding, the families would need to be able to really trust
the team and this would mean getting to know one another.
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Gradually, very gradually, over a three-month period, the families began to open up to the team,
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Within the first twelve weeks there were changes in all six families.
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one child about to be removed into care was able to stay
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two children no longer needed monitoring
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a neighbour stopped her and thanked her for moving Tom out of the home. ‘It’s made such a difference to our
lives.’ But Tom had not been moved anywhere. He had gone back to school.
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The families argued less and had time to think and remember how much they loved their children despite the
challenges.
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With a greater sense of calm, the families began to grow their ambitions. For Ella that office job she had felt
foolish to even mention started to seem like something she could realistically aim for.
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The families also started to offer help to one another, sharing experiences and making new connections.
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These small early successes had a similarly galvanising effect on the Life team.
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Now they were remembering what they were capable of as professionals and growing in confidence.
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Life has four broad stages. It starts with an invitation to participate. Families who accept the invitation spend
time getting to know the team, gradually opening up and building the confidence to really look at the challenges
they are facing.
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In the second phase, with relationships established between the team and the family, the work turns to the
families’ futures – to building a plan. ‘Help me to help myself make things better and live my life,’ one mother
has written
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the purpose of the plan is not to have a tool to measure the families by. It is the process of plan-making that is
important: in weaving together a new story, families have a purpose and a reason for building their capabilities.
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In the third phase the work starts to build capabilities.
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The shift in power is inherent in the capability approach:
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We had a simple framework that emphasised the four capabilities we believed all of us need to flourish: the
capability to work/learn; to be healthy; to be part of the community; and to nurture relationships within the
family and beyond.
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they also started to interrogate why we emphasised four capabilities. ‘You need to talk about love,’ we were told
more than once.
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we expanded our health capability to include internal worlds and how we feel about ourselves.
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In the fourth phase families start to exit the programme.
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it helps to have some sort of structure, but the programme is not linear.
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it took an average of eighteen months for a family to progress through the programme, but families of course
move backwards as well as forwards.
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it is not logical to concentrate all our efforts and resource at the beginning. Imagine a first date: you feel a little
apprehensive, you want to get a sense of the other person and you are unlikely to divulge what you really think
about your own family or any other inner secrets.
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Not an order, or a command – an invitation. Would you like to work with us?
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The message went out: you can trust these people, you will be in the driving seat, they will stick with you.
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neighbours and wider family members started asking us if they could participate.
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Participle responded to requests to set up Life in three different locations and in one of these places the
programme did not work. Here, leaders of the services could not genuinely embrace the invitation phase.
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But for Life to ‘work’, it is not just the families that must change. Professionals must change,
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Local leaders must create room for the new approach and, in the early days, work tirelessly to champion work
which might look too different or too risky to some.
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There is a premium on being dispassionate, on keeping our distance. Detachment is prized.
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The Beveridge bureaucracies emphasised cool neutrality and the importance of treating everyone exactly the
same.
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systems put in place to mitigate these difficulties were in fact exacerbating the stress and anxiety of the nurses
and leading to lower job satisfaction.
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professional remoteness was causing stress: it was disrupting human relationships with colleagues, with patients
and with families.
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nurses were not working at their full capacity since all parts of the system were distracted by the pervasive sense
of impending crisis caused by a lack of humanity and strong supportive relationships.
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Taking care of the team was as important as taking care of the family.
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All our experiments were expressly designed with this double purpose in mind: to bring about change both in
individual lives and within the wider welfare systems.
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Both Ella and Karen were able to leave the Life programme ready to contribute to the wider world. Ella’s
children reentered mainstream schooling and Ella herself completed her training course and found her office job
– her first job. She may stumble in the years to come and, given her family history, she is likely to experience
tough times, but her life will not be the same, because she has experienced how it is to live in a different way,
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Life costs £19,000 per family. This figure is based on a family working within the programme for eighteen
months, of which six months involve deep, intense activity with the Life team.14 The most significant cost is
staff time. In addition, a small sum (£100 per family per month) was allocated for each family to use at their
discretion to support developmental activities, such as Ella’s training or Karen’s son’s Outward Bound course.
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Life saves money not because it manages people more effectively within the system, but because it spends on a
programme that can remove families from the system,
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we wanted to know next was whether we could open these approaches up to greater numbers;
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Unicef had produced a shocking set of statistics which showed that young people in Britain were amongst the
unhappiest, the unhealthiest, the poorest and the least educated in the developed world.
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For every problem there will be a service, was the implicit message.
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as austerity started to bite, many of those same services, including SureStart, were dismantled.
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Where services remain, the criteria for entry are ever more stringent: only those facing the greatest of risks will
be considered.
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One in ten young people in Britain between the ages of sixteen and eighteen is not in employment or education,
and it is conservatively estimated that this costs the state £12 billion a year.5 But far more important is the
human cost, the loss of potential and possibility that results from not taking care of young people.
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As adolescents we put down the foundations for good lives and we also have a vital second chance if things have
gone wrong in our early years.
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there is another, darker reason behind the rationing, and the investment in increasingly expensive and
complicated gate-keeping. It is about control. I had made a critical error in imagining that something open would
be seen as a good thing.
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Gradually he persuaded Melvin and his friends that they could do something much bigger to honour his son:
they could start to help other younger boys, to make sure that they would not, in turn, lose their lives.
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For Melvin, the deepening relationship with his friend’s father led to a connection with the church that Melvin
describes as his new surrogate
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Mo, unlike Melvin, does not have colourful stories to tell, nor is he on anyone’s radar.
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Mo is getting by, but he is not thriving. Melvin has been at risk, but he is now flourishing. Why is it that some
young people prosper against the odds and others do less well? Youth services – like most welfare services – are
designed around the identification and management of specific risks:
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Sociologists differentiate between what they call ‘bridging’ relationships – those that connect us to people and
experiences different from ourselves – and ‘bonding’ relationships
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Bonding relationships can be useful. These are the ties that lead to strong neighbourhoods, where we look out
for each other and drop in on the lonely person who lives next door. But bonding relationships can also serve to
keep others out.
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He still has ties to childhood friends, many of who are not doing as well as he is. He also has newer bridging
relationships that have enabled him to create distance from his more negative experiences and find a new path.
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Upper- and middle-class parents are more involved than ever in their children’s lives: organising clubs, helping
with homework, ferrying their children back and forth. On the other side of the divide it is a different story.
Poverty and the need to juggle many low-paying jobs, often in time-poor single-parent households, means there
is no bandwidth to make sure teenagers do their homework, much less become involved in projects or sit round
the dinner table. As one mother told Putnam, ‘We ain’t got no time for that talk-about-our-day stuff.’
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relationships protect middle-class kids from the ordinary risks of adolescence. His datasets show that richer
children drink more and take more drugs, but their families and communities are like ‘airbags’ protecting them
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One of the most striking aspects of Putnam’s work is the way in which he frames the role of school. School is
seen through the lens of relationships. It is who you go to school with that matters:
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The family is £3500 in arrears with their rent and also paying back a pay-day loan. All of these worries narrow
Rose’s horizons still further: she has to live from day to day and cannot think beyond the present.
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Together in the youth centre, Megan and Rose can shut out their problems at home and at school, evading the
need to make other friends, face their challenges or grow in independence.
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Neither of the girls is at risk of physical harm, but they are each being lulled into a false sense of security that
offers no real way out.
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The risk-free adolescence is a strongly gendered idea. The girls who are at home caring or in the youth centre are
not causing trouble, they are seen as having been ‘saved’ – and this is considered to be enough.
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The challenge is not one of how to contain, but rather how we can open up.
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the team asked the groups to make short films – to show us what a good adolescence might look and feel like.
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In every film young people connected themselves to the wider world. Yet our public services emphasise youthonly activities and spaces and so they break the natural links through which young people learn and flourish.
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We went back to the streets and we knocked on doors: shops, hotels, a waste management business, art spaces,
market stalls, a cinema, the doctor’s surgery. We asked everyone we met if they could provide a young person
with an experience – for free – and almost every single person said yes. More than that: most were clearly
thrilled to be asked, to have the chance to do something for their community.
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We called the experiment Loops, because we expected young people to go round and round again, broadening
and deepening their experiences and their relationships. This was not a service with a target and an end point:
the loop expressed the continual nature of our development.
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When we design the experiments we combine our on-the-ground experience – listening, observing, making –
with academic research and ideas we borrow from other places and contexts.
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without a space to pause and reflect they could not internalise what they might have learnt.
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The reflector is not a coach. They are not attempting to teach or guide learning. The role is more like that of a
psychoanalyst, who encourages their analysand to do the learning.
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We found reflectors within the community: Laura’s mum, Amelia’s dad, youth workers who loved what we
were doing, and other young people like Melvin, who had grown through their own experiences. We offered a
short training: an introduction to how to be a mirror and guide, and how this might differ from the behaviours of
teaching or coaching,
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Some adults found the role of reflector difficult: they wanted to be in control, to point things out or to tell the
young people what to do and how to be.
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am drawn to focus on those at the margins, those that policy-makers call the ‘hardest to reach’. But I have learnt
that too narrow a focus is a mistake.
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people from middle-class homes had problems too: the pitiless pressures of many schools; parents who were
working long hours and were rarely at home; the anxiety of keeping up with peers.
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Loops had to be young-person-led. Ensuring young people informed the culture and collaborated in the running
and continual updating of Loops would be essential for authenticity – we were asking young people to grow and
take on new roles. And Loops would need to be built to multiply: we wanted all young people in Britain to have
a chance to be part of Loops.
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I would call this new form of organisation relational, because it is characterised by relations between peers
rather than through the control of traditional management hierarchies.
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Loops is the experiment that failed.
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we could call Loops a £52 investment in every young person since, rather than containing young people or
fixing their problems, we were investing in their potential as active and participating citizens who would have
the relationships, capability and resilience for their future lives. Providing Loops to every young person in
Britain would cost in the region of 2 per cent of the budget spent annually on those who fall out of school and
education.
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they were calling their supervisors to report young people mixing with others who were not always their own
age, doing things apparently unsupervised in other parts of the city. The young people were at risk, the project
was a risk – how could this be contained? On that morning in a sun-washed workspace the possibility of human
connection and development confronted the culture of risk and management – and lost.
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I also learnt that change cannot – for now at least – be so radical. I needed to find ways to bring the same ethos
and values closer to existing systems. Perhaps we could do this with one of the pillars of our welfare system:
services to support those out of and looking for work.
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Work brings money and a sense of purpose.
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Two-thirds of those in any Jobcentre are going round again for the second, third, perhaps the fifteenth time. The
system has a 66 per cent failure rate.
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Finding work is not enough: we need to find good work, and we need to find new ways to progress in work.
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In this century the links between work and a good life have been broken. For millions, work equates to drudgery
and poverty.
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Your adviser must do their best to persuade you to take the first job available to move you along the production
line and off benefits.
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They had not been consulted and they felt vulnerable administering the same hated systems in environments that
now left them with no protection against their frustrated and angry ‘customers’. Today panic buttons are back
under the desks, biros are retractable to make sure they cannot be used as weapons and security guards are on the
doors.
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Universal Credit – an attempt to replace a number of benefits with one monthly payment that can taper gradually
as an individual’s income rises – sounds logical.
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a system that still very much resembles that of the 1950s in its core offering – advice and benefits – but which,
with its more specialised production lines, is now so complicated that few can comprehend it.
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This is the problem: the reformers, deep in their mathematical models, are not attuned to social realities. They
have become – like those using the services – lost inside the system.
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It is worth repeating that a far greater proportion of benefits are paid to those in work on low wages than to those
out of work,
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We are in the early throes of a Great Restructuring: technology has changed the jobs available, the conditions
within which we work, the places where we work and the distribution of incomes.15
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Health services and universal education allowed for the required workforce. Employment services and cash
benefits eased the path for those in between work or unable to participate in the new economy, while decent
unionised wages ensured mass demand for the goods produced, so creating a virtuous circle.
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The economist Carlota Perez has been studying the links between technology and broader social change for
decades, as she seeks to understand and explain what she calls techno-economic paradigm shifts: the seismic
changes in how we produce, consume, live and work that are driven by changes in technology.
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we can move beyond an obsession with individuals and how to move them into work. We can see instead the
wider patterns of change and we can think about the systems that would better support us in navigating these
rapid, deep shifts.
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the truth is that eight out of ten jobs are not advertised. Today, most jobs are found through personal connections
and word of mouth.
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LinkedIn was the first of many companies to realise that job advertising and executive search was a thing of the
past. They have built an online, networked approach to employment
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It turns out that the best route into work is something completely invisible to our twentieth-century welfare
systems: our relationships.
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a tangential approach is important. No one wants to be forced into a low-paid job with no prospects, but
everyone wants to do something interesting, something we can see as part of a bigger story about our own lives.
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Work would be a way to get much-needed money. But more than that, work would be a route to meaning.
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And good work keeps us healthy and living longer.
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broader view of work used to be integral to economic theory.
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For Smith (who drew on Aristotle) it was not just about work, but the right work. Deskilled work, he wrote,
would produce ‘stupid and ignorant’ creatures incapable of good judgement or full participation in society.
Smith argued it was the role of the state to ensure good work and that we have the chance to develop the human
abilities we are born with.
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Graeber coined the term ‘bullshit jobs’ in 2013 to describe roles that are demeaning or exploitative, and often
unnecessary.23 The sociologist Richard Sennett draws on pre-industrial models of craftsmanship to suggest that
good work must include a degree of autonomy, the chance to develop skills and exercise judgement.
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Firstly, there is the fundamental importance of finding personal motivation: uncovering the dream. Secondly, we
need relationships: the connections to new experiences and support. Thirdly, a modern approach must put as
much emphasis on progression as on finding an initial job.
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With Backr, like Life (experiment #1), we learnt to provide a semi-formal path without expecting every
individual to participate at the same pace. Through the weekly sessions participants learnt about networks – how
to use and build their own
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Practice is at the heart of Backr: sitting face to face with others who are not like you and practising talking about
what you want to do, what experience you have, sharing connections and ideas, and through this process
developing self-confidence, self-awareness and capabilities.
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It was a pattern: we found most members needed to come to three meetings, and find confidence through
practice and overcoming a personal struggle, then something changed.
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It is very different to do these simple exercises in a group setting, where other participants have ideas and
connections or ask you questions that make you realise something new about yourself.
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Inevitably, people became tired and tried to push back. ‘Can’t you just do my CV?’ A learnt dependency crept
back in.
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while relationships play a critical role in getting good work, few of us are either conscious of this or can admit to
it.
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Technology makes low-cost expansion possible. A simple digital platform makes it affordable to run a network
that includes those out of work, those in work and those in-between.
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Backr is a social solution enabled by technology, not a technology solution. The distinction is important. We
have to design for people who are not functionally online.
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Currently, most of those predicting an end to work are focused on policies to provide a universal basic income.
Bill Gates, for example, has suggested a tax on robots to help fund this idea.
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I do not see basic income as the answer. Predictions suggest the income will be low so most of us will still want
and need to work,34 and while a basic income might provide welcome time in which to learn, care and create, it
will not resolve personal challenges, nor will it deliver the bigger vision and purpose we are searching for in our
lives.
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With a few notable exceptions, such as the work of Carlota Perez, the emphasis is on analysing the
disappearance of roles as opposed to the harder task of tracking the appearance of new roles.
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Some had momentum and needed connections to grow, some needed support to make a plan and others were
stuck.
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just as in the Industrial Revolution, we need to reinvent a wide range of organisations, including the unions and
the further education sector, and we need to connect different spheres of the economy in new ways.
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An independent evaluation of Backr by PwC showed that 87 per cent of its members made measurable progress:
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Backr cost one-fifth of the sums currently expended by the providers of Welfare to Work services.
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is easier to find our purpose and to make change when the challenge is seen as collective and the systems are
designed to make collaboration and new connections easy and part of everyday lives.
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It is thought that half of British adults live with pain
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the
Hola veveesito
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Instead of focusing on how we can ‘fix’ the NHS, I want to ask how we can prevent and address the illnesses
that affect most of us today
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Wellogram emphasised the idea that chronic conditions are part of everyday life. Wellogram did not focus on
the specific condition but the wider social context and what could be changed.
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A pivot is not just another word for change. The pivot is a special kind of change that involves a new vision, a
different solution and a new business model.10 The pivot offers transformation, the potential for something
much better and more successful.
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A modern health system cannot treat us; instead, it must help us to make change in our day-to-day lives and –
even harder – sustain those changes, often over decades.
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As we have seen, Beveridge became anxious that the welfare state was eroding people’s sense of their own
potential. And ideas about personal responsibility are increasingly part of the debates about our health service.
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alone, people cannot make change because they have no control over wider economic and social structures that
play a part in determining diet, income, housing and other factors critical to our help.
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The search, then, is for a model that can embrace these wider structures and help people to support themselves.
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The Peckham Experiment was an early social business and the founders were committed to an ethos of financial
sustainability, based on the membership subscriptions. It was this last principle that eventually led to the
Experiment’s demise. The designers of the National Health Service were not prepared to include co-payment
models.
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Wondering how we could make room for change in a life governed by illness, I invited all of Anne’s doctors to
come together and talk with us about her case.
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They also considered all but one of her specialist doctors to be unnecessary. They developed a care plan, and in
effect made themselves redundant.
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We would offer no formal programme, but instead each person would be assigned a Wellogram guide and
together they would come up with a plan of action.
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Open listening is an important part of helping someone, because the sense of truly being heard is empowering. It
encourages story-telling, and when you can tell a story about yourself you can start to make change.
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we listened without an agenda and we encouraged participants to practise new things. We were willing to accept
imaginative possibilities:
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Experience has taught me that we need to turn this logic on its head: we need to do first and reflect later. When
we see the change in our lives, we can accept the rationale for it.
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Relational work is a little like this: it can blend the new and the old and bring into the centre things that were
once considered to be of little consequence. What is different – the crucial pivot – is that the purpose is not to
patch up another’s needs but to foster their capabilities.
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True help is an art. The founders of the Peckham Experiment recorded that their biggest challenge was finding
health professionals who could manage the anxiety of not intervening.
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In the barrio, where emotional entanglements were at the heart of everyday conversation, there was a popular
saying, ‘un clavo saca al otro’:
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To pivot we need to withdraw from the doctor, and to do this we need to connect elsewhere.
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constant comparison may be a source of our illness:
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Illness – from back pain to obesity – spreads through social networks in ways that are incontrovertible but hard
to explain.
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Could we spread good health in the same way?
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we asked people to find someone in their existing network to ‘hold them’ to a new health behaviour. Sign up to
do something positive – walk further, or eat your five a day – and find someone who would either join you or
keep you accountable.
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We had several problems. Firstly, participants found it hard to focus on something concrete
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difficult to get the sustained engagement of those who were fit and healthy; and thirdly, when it came to asking
someone else to be involved most people felt too embarrassed, or just didn’t bother.
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people who make change with others are able to make bigger changes and to sustain them.
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relationships are never designed into any of our solutions.
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The tool has four quadrants: work/learning, health, community and relationships,
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Some participants genuinely could not imagine how reaching out and involving others could help. In other cases
the participant was embarrassed to share their request with another, sometimes because they simply could not
think of anyone else to include and often because they were ashamed to admit the depth of their loneliness – that
there really wasn’t anyone else.
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we need to know when to accept the opinions of others and when to try to persuade with knowledge that needs
to be more widely shared.
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There are two factors that do make a long-term difference: interventions that touch on relationships and those
that reach into the more spiritual side of our lives.
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Today approaches like Wellogram cost less and improve clinical outcomes, but they rarely have an impact on
the wider system because the frameworks governing what is provided and what is funded are not changing.
These pilots cannot get the investment to grow and the resources remain locked in old systems.
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A twenty-first-century health system needs to do four things: work with the best science; integrate the best care;
prevent where possible; and foster a culture within which professionals can flourish and do good work.
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These systems have helped us to live longer, but now they cannot help us age well.
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We are suffering from an epidemic of loneliness.
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loneliness is a bigger killer than a lifetime of smoking or obesity, and perhaps a root cause of some other
diseases such as Alzheimer’s and dementia.
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Our phone service was small and cheap: we just needed a coordinator, phone lines and volunteers to host. It ran
with support from the local council for six months. During this time we learnt that with a light touch we could
foster bonds between older people who were alone and isolated and that a very small intervention could
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Some of the older people I work with have a cleaner and almost all of them value the company of the cleaner
more than the quality of the cleaning.
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There is a coherent, simple and shared vision of what a good third age would look like. Three things are needed:
someone to take care of the little things – to go up a ladder and fix the light bulb before you fall over in the dark;
good company – people who share your interests and with whom you feel at ease; and a sense of purpose and the
support necessary to make the shifts into different ways of living as our interests and life phases change.
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A Circle is part social club, part concierge service, and part cooperative self-help group.
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While the idea of a life coach appealed, the reality was found to be too abrupt. A much better route, it turned out,
was to make some new friends with whom to mull things over at first and then try things out.
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We were to learn that checking someone gets home safely is a small but vital act of kindness that allows
members to go out and do things they want to do, safe in the knowledge that they won’t return to a dark and
empty house, to a life where no one actually knows whether you made it home or not.
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How things are done matters as much, if not more, than what is done. The ‘how’ is particularly important where
relationships are concerned.
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front-line workers who see the personal reality choose to refer to a more expensive, specialised service rather
than leave an individual without support.
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services designed on the back of a war economy took on the character of their age.
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at the very stage in life when we are most dependent on the state, we become dependent on a set of institutions
and arrangements that not only lack resources but somehow have the culture of lack imbued within their every
action.
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jam-jar economy: a jar for the shopping; a jar in case the boiler breaks down – a big fear this one; a jar for bills,
and so on. Just as the state locks down resources in tightly boundaried pockets, so older people do the same in
their homes.
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Circle, in contrast, is a model of abundance. It is designed to unlock people – their capabilities and relationships
– and to unlock resources – the skills, support and money needed to live a rich third age.
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Each Circle was underpinned by a simple piece of technology: a CRM (customer relationship management)
platform. This widely available technology helps businesses of all types manage their customer’s needs: it
records what they like, what they use and want and, in our case, what they can give.
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If a lift to hospital is required, the platform tells you who can provide it; if a space is needed to get together, the
platform tells you whose home is available or what public space is suitable
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Shared Lives, for example, is a social business that has successfully encouraged young and old to share homes to
mutual advantage, creating housing for the young and companionship and light-touch support for the old.
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We want to find the local sources of energy and ideas, and also to make sure we are not stepping on the toes of
local community organisations that might already be offering elements of what we do.
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Each Circle was financed with a start-up grant from the local authority or, in the case of Rochdale, a housing
organisation.
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Future revenue would be generated by membership fees and payments from local councils for services that
Circle could do in a more efficient and personal way
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In every location leaders were apprehensive about whether their communities would really participate and
contribute. ‘This will never work here,’ we were told.
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Circle blends the traditional boundaries: of who is helped and who is helping, of what is social and what is
practical. It also blurs the distinctions between different forms of resource: time and money; personal money and
state money.
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For those who take a more traditional view of the welfare state and believe that services must be provided for
free, Circle can look like the introduction of co-payment by the back door.
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120,000 new relationships were fostered; and the unnecessary reliance on formal services was reduced by 26 per
cent.
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there are six core principles that constitute this new framework. Each represents a shift from our current practice
to a new way of thinking and doing.
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1. Vision: the good life
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vision we must aim for is good lives well lived.
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Beveridge’s vision of a better, fairer Britain created a broad and shared ambition. The Beveridge vision no
longer holds.
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People need meaning, Aristotle argued, and they need support to grow and develop. Aristotle spoke of
eudaimonia, which is often translated as happiness, but he was not in pursuit of an individual’s elusive happiness.
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Eudaimonia is better translated as flourishing.
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2. Capabilities
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current welfare state has become an elaborate attempt to manage our needs. In contrast, twenty-first-century
forms of help will support us to grow our capabilities.
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These internal factors and the wider webs and structures we are part of determine what real possibilities we have
in our lives.
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People who starve are almost always close to food.
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The capability approach was pioneered by the Nobel Prize-winning economist Amartya Sen and developed by
the philosopher Martha Nussbaum.
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The factors that enable us to seize opportunities around us (or not) are the factors that make up the notion of a
capability.
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we started instead by asking families what sort of life they would like to lead and then we supported individuals
in taking charge of their own lives, their own growth and development.
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Martha Nussbaum says that too much government policy fails because it reflects the biases of society’s elites.
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The capability approach shifts the way support is offered. A capability cannot be done to you.
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what capabilities matter? We chose four: learning: the ability to grow through enquiry and meaningful work
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health: our inner and physical vitality
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acceptance of our minds and bodies and a commitment to good habits; community: being part of and
contributing at the local and planetary level to a sustainable way of life, working alongside others
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relationships: a supportive and close network with others, some of whom are similar to us and some of whom
are different.
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3. Above all, relationships
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they are what Martha Nussbaum calls ‘architectonic’.6 Building on relationships enables the growth of further
capability:
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We must design ways to encounter and get to know those who are not like us if we are to flourish.
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4. Connect multiple forms of resource
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when we talk about money we move inexorably to discussions about our existing systems, what they cost and
how they should be fixed or curtailed. We can’t start here.
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think instead about the vision and the capabilities and then ask what wider forms of resource are available and
how we can connect them together
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The experiments created resources. Circle, for example, made visible different forms of wealth: knowledge,
time, skill, a car for lifts, a room for meetings, personal money and funds held by different government bodies.
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the sense of having something to give is part of the process of change.
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there is money but it is in the wrong place:
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5. Create possibility
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Each of the experiments started from possibility.
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6. Open: take care of everyone
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a principle of inclusivity was at the heart of our twentieth-century systems. Today, with the exception of core
health and education services, our welfare systems are open to ever-smaller numbers who must first navigate the
labyrinthine and costly systems of assessment. In these systems, everyone suffers.
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The new systems are open: they include everyone and they take care of everyone,
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Each of the experiments in this book was devised using a design process.
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What we hear depends on the questions and who we – the questioners – are perceived to be.
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If the subject is difficult, personal and perhaps shameful (as most issues of welfare are) the conversation is likely
to be much more honest if people do not have to look directly at each other and have something to do while they
talk.
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first step in building trust, showing we have come to listen and learn not to instruct or order.
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In the first wave we understand the problem or the opportunity. In the second, we create a solution. Each wave
diverges – at first the thinking is wide and generative – and then converges as ideas are sifted and consensus is
built.
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Moving through the two waves takes about nine months. Within these two waves are four broad areas of work:
framing the problem/finding the opportunity; idea generation; prototyping; launch and replication.
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Setting up
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partners who would fund,
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design process is participative from the outset, so we also needed to find people to design with. We start with
small numbers
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We want to learn from those who are flourishing and those who are not.
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if we can design something that works for those who are hardest to include and those from whom we have the
most to learn, then we will have something that works for everyone.
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We think from the very beginning about groups – families, friends, neighbours – rather than individuals. Those
who know each other cross-check and prompt each other’s stories, adding depth. We also start to draw in
professionals
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Frame the problem/find the opportunity
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This first stage is like an archaeological dig. We find unexpected things, we gently dust them down and we keep
excavating.
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asking ourselves, is this a root cause or just a symptom,
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In this first phase of work we are spending time in people’s lives, chatting and doing everyday things together:
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We are not yet concerned with costs and business modelling, but like magpies we are always looking for what
might be to hand to help our work.
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The design process differs from other participative processes of social enquiry or research because problems are
framed in relation to opportunities.
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Idea generation
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We want to hear what professionals and workers at all levels would like to do differently.
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We combine this research with our own insights and ideas.
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We have what Tom Kelley, one of the founders of IDEO, would call ‘focused chaos’.
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Above all, we try not to flatten stories. We don’t want to weave things together in a way that looks neat but no
longer represents anyone’s reality.
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In the second wave of work the prototyping process described below generates further ideas. We are looking at
this stage for practical ideas around implementation and business modelling.
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tracking money and other resources that may frequently be abundant but currently inaccessible because of the
way they must be managed and accessed.
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Prototyping
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A prototype is not a pilot. In a pilot, a new idea is tested at small scale: it runs at arm’s length and then the
results are analysed. Prototyping is a verb: it is an active process – we are in there, observing, playing roles,
taking apart and remaking.
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Prototypes allow us to start small and to tinker, to fail early and cheaply and then to incorporate what we have
learnt in the next version.
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When we take a prototype away to rework it, there can be a sense of loss.
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Disappointment evaporates when everyone can join in and be part of the changes.
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Go live/replication
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We: the team
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Participle team was interdisciplinary.
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Wherever possible our funding and hosting partners were also integrated within the team.
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We know which parts of the process create anxiety and which parts create friction with the existing system, and
so we can anticipate the emotions and conflicts
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Tools and roles
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Some tools are borrowed; others are created by the participants in the process. They are democratic: they can be
used with ease by the team, families, social workers, children and the elderly.
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Active listening means listening in so far as is humanly possible without judgement and without an agenda. We
cannot put all our preconceptions to one side, but we can be aware of them. We are also listening for silences
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we ask them to take pictures and make videos.
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Story-telling is one of the most important tools we have. We tell stories about what matters to us and we can talk
about things we long
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As participants rehearse their stories they too begin to see things differently.
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focus groups often suggest improvements to the existing system: more youth centres, better meals on wheels,
rather than radical alternatives.
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Segmentation
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Tools to facilitate capability growth
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generally a distinction between the tools we use to design the solution or service and those that are to be used as
mechanisms within the fully developed new solutions or services.
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Sticky steps works backwards. For example, if Earl wants to be a chef he has to say to himself, ‘In order to be a
chef I would have to … have a qualification and experience, in order to have a qualification I would have to …’
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This
Quiero ir a 234 sólo Jiménez UIT Hola WWE Gobierno
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Roles
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We experimented with numerous roles.
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men were often happy to join Circle as helpers, but not as members
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in the beginning the creation of this role helped define Circle as a place that both men and women were willing
to join.
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New roles developed in the experiments include the reflector and the relational worker.
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Design and technology
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The welfare state was a building programme: houses, schools, clinics, prisons, community centres and more
were constructed. And just as we try to fix our post-war systems, so too we are tempted to pour resources into
rehabilitating post-war infrastructure. With the exception of housing, we should resist that temptation. Health,
learning, caring: in the twentieth century these activities were organised around buildings. Infrastructure was the
destination. Today infrastructure is the route, the spine along which we link to and share the things we need.
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Ultimately it is not the gadgets, the hardware or the software that matters, it is the technology mindset. This
mindset thinks of sharing as a norm; it asks how to do it, not whether to do it.
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‘It’s great, but can it scale up?’ This is the question I am often asked
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scaling is the wrong approach. Scale is a process of industrial roll-out.
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question is better positioned as: how do we create the conditions for growth? Scale is a linear process, but
growth is modular:
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We learned that success was dependent on three factors: a shared vision, local leadership and a commitment to
core values.
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The experiments require support both from the top and from the grass roots.
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when corners are cut, the change process is weakened and transition cannot happen.
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Where families are mandated to attend the Life programme rather than invited to come, the programme fails.
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The key thing is that core values are maintained:
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There are three challenges to switching: the conceptual, the organisational and the political.
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Resistance can be forceful and overt: we could not continue with Loops. Or it can be small and surreptitious: a
programme takes on the new language, but it is only speaking in new ways to veil the fact it is still fixing in old
ways.
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Resistance can be presented as a technical problem.
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larger organisations feared that the success of Circle would be interpreted as a critique of their own approaches
and might also limit their future funding.
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Transition involves protecting the work long enough for change to take root.
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New work is ‘allowed’ while the numbers are small and we appear to be amateurs. Innovation that does not
encroach on the existing system and can be contained as an interesting pilot, or published as an inspirational case
study, is usually celebrated.
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usual that whispered conversations happen in corridors, and very often the issue is personalised.
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We tried in vain to explain that more money was not needed, nor were new professionals required. What was
needed was permission to free those at the front line to work in new ways – ways in which they want to work.
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Financial incentives are a modern version of command and control.
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we could not persuade central government to think differently.
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Times of transition can enable new thinking, new ways of organising and collaborating.
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On the side of success
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New organisations
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Spanish co-operative group Mondragon, the biggest industrial federation in the Basque region, splits after
reaching a certain size, reproducing like a cell, at once growing its influence and its stability through a continued
sharing of infrastructure in the form of knowledge, resources and finance.
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We can imagine a national network of Circles growing in this way
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Economies of scale concentrate on the growth of organisational infrastructure. Economies of cooperation share a
purpose and grow through people and relationships.
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Ivan Illich described the good institution as one where the components can be taken apart, re-used and reassembled.
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Growth reduces the challenges of transition.
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New measures
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we tried to get round this problem by measuring our work in three ways. We are pragmatic and so we measured
cost and a set of established, existing outcomes. We also designed a set of indicators that would measure
capability.
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The experiments were designed, expanded and often replicated with partners facing draconian cuts to their
welfare budgets, so they had to be cost-effective.
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Usually the problem is more mundane: those in charge just don’t know what things cost.
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Then it gets really complicated and highly political. Existing services that may no longer be needed become
visible. Overlapping services are also visible.
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by the time the experiments yielded the data – it was informally agreed that they cost less – no one dared verify
our findings.
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those who flourished stayed and supported others who needed similar help. These families and individuals
contributed to the systems and solutions we designed, but these investments and contributions were not captured.
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The second tool of measurement is to benchmark our experiments against the outcomes of the formal system. In
this case, the process is to ask partners what existing measures they value most highly and to compare the
equivalent outcomes from our own experiments.
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Thirdly, we measure capability. Capabilities are hard to measure. We need to plot points on a journey, not an
end point, because with capabilities we hold important the idea that we are continually developing through the
course of our lives.
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Two factors help us measure capabilities. First, restricting the capabilities we are focusing on to four and
collecting a defined set of indicators for each capability. Second, technology simplifies and reduces the cost of
collection. All our experiments rely on a digital platform for coordination, and data can also be captured by this
platform very often without having to directly ask members for information.
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Capability indicators needed to be both personally relevant and true to the approach, and comparable.
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Our measurement systems are mechanical and linear. Their instruments for tracking inputs and outcomes reflect
an industrial mindset and they carry a number of assumptions that are complicated and sometimes misleading
when it comes to thinking about human beings and social change. They ignore context
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Leadership
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Peter Senge, a systems scientist, has for many decades led research at MIT into effective system leaders. He
finds that these leaders share common traits: they know how to let go; they create space within their
organisations for change, for reflection and for others to grow.18 ‘The great leader,’ wrote Lao Tzu, the fifthcentury Chinese philosopher, ‘is he of whom the people say, “we did it ourselves”.’19
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In Britain there is a public expectation, often mingled with distrust, that politicians will fix things for us. ‘The
Minister will see you now,’ I am told, and with that magnificent phrase I am ushered into another plush room
full of expectation.
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To transition we are going to have to accept that we trap politicians with our expectations: to command change,
to be seen to be doing, to never be learning but to have all the answers. And we are going to have to ask our
politicians in turn to stomach more risk, to invest according to principle, to dare to extend the timescales to allow
new work to take root, to learn new skills and to be a little more heroic.
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Many of these politicians were also convinced that any attempt by the state to become involved would ‘kill it’.
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The work at the front line is to be alert, to know when and how to step forward.
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Welfare re-stated
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The debates about welfare have been dominated by discussions as to whether the state or the market should
provide services and at what cost. I am suggesting a new relationship between people, communities, business
and the state. Everyone has something to bring to radical help. But the state – whose purpose is the development
of its people – has a particular and unique role. Only the state, our leaders and political actors can create the
pivot we need, developing the new framework, supporting the vision and nurturing the principles
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From space travel to the internet, it is the state that has created the primary conditions for change in economics,
technology and research.
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The state’s role can no longer be that of pulling the mechanical levers of power. Instead they must be like a head
gardener: setting out the design, planting, tending, nurturing and, where necessary, weeding.
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An Invitation
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Each of these experiments started with an invitation: would you like to work with us, would you like to try
another way? The invitation is open to all of us.
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Creating a shared project in which we can all participate is in and of itself a good. Participation in the welfare
state is not an expensive activity that we should try to limit, but a core part of our national identity that we must
encourage.
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Beveridge told a story: about a Britain in which everyone could flourish and play a part. Like all the best stories
– the ancient myths, a Victorian novel or an African fable – Beveridge’s story had elements of struggle.
Beveridge did not promise that everything would be provided; he talked about the importance of help and of selfhelp. We were all on a quest to build a better country and be part of that country.
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Firstly, we can identify those existing initiatives and experiments that are true to the principles I have described.
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Secondly, we can continue to grow practice and practitioners.
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We must also find new ways to support professionals.
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We need new career structures that recognise the importance and prestige of doing and supporting change,
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Thirdly, we need to invest in the new. We must prioritise funding for those models that are being run according
to the core principles of radical help.
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We can also tell stories – they are a critical part of change.
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The work requires courageous leadership and many ordinary conversations.
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boundaries between those ‘helping’ and those needing ‘help’ blurred and the capabilities of all involved
deepened.
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Our existing welfare systems are not designed for collaboration and so sometimes we start to believe that people
do not want to participate or share.
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Devolution of power to local regions and communities could create the possibility for new models.
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And could we design around social networks rather than the individual? We could. Bring your friends and
family, we suggested
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What I could not see at first, and had to learn through practice, through observing, listening and through the new
forms of measurement we designed, was that relationships are the element that matters, the foundation of a new
system,