Do we need a Paradigm Shift?
I've been reading a really interesting document from the New Local Government Network called The Community Paradigm - Why public services need radical change and how it can be achieved.
It isn't hard to see that things aren't really working all that well in public services. As somebody who has spent many years working the in NHS, I have quite a few suggestions about how things might be improved in our health service but this document isn't specifically about the health service but more about big government versus small government; governing from Westminster versus governing from our local community.
The authors, Adam Lent and Jessica Studdert, look at how public services have been delivered. This isn't just to do with how we look after the poor but also how we manage the whole community. Local infrastructure has been the domain of local authorities for several hundreds of years although the way that the poor have been cared for and who paid for improvements within our communities has varied. The authors look at how things have changed over the years and how different systems have been used to meet the needs within our communities. They then suggest how this might be changed and how a new approach, The Community Paradigm, will provide a better solution to the provision of public services.
The Civic Paradigm
From around the 16th Century to the mid-twentieth century we had a civic system of providing public services. The main purpose was to alleviate destitution and deliver basic local infrastructure. Local government had a responsibility to make sure that infrastructure was in place and that society could function, whether this be repairs to roads, removal of waste or other equally exciting activities. They also had a responsibility to help the poor.
It's interesting to see how attitudes to the poor have changed over time and it is clear that laws have been put in place to try to correct a problem only for that to create a different problem that needed correcting. Obviously a changing/growing population and changes in work/industrialisation make a difference to how well things operate and it is clear that some of the problems that we currently face are due to failure to adapt to changing circumstances. We never seem to learn from history.
In 1572 a local property tax was introduced called the poor tax and the money used to relieve 'aged, poor, impotent, and decayed persons.' Although I'm not entirely sure what constitutes a decayed person. However, this meant that money was available to house and provide for poor people. Overseers of the poor tax would provide materials such as flax, hemp and wool to provide work to those who were able.
There were also a number of workhouses some of which were run by local parishes and some by third parties. You had to be pretty desperate to go into a workhouse as conditions were pretty severe. In cases where workhouses were run by third parties, the workhouse owners charged the parishes for the upkeep of the people but kept any income generated from the work done by the poor in the workhouses. You only have to think of Oliver Twist to get the general idea. Feed the people with cheap gruel, get them to work for you, make a lot of money and it really doesn't matter too much about the health and well-being of those in your care. It seems that exploitation of the poor isn't just a problem of our current age.
There was also some provision for the working poor or for those unable to work (children, the elderly, the infirm etc.). However, like today, the provision of support for poor brought with it its own controversies. The Royal Commission of 1832 conducted a detailed survey of the state of poor law administration and prepared a report. The report took the view that poverty was essentially caused by the indigence of individuals rather than economic and social conditions. "Thus, the pauper claimed relief regardless of his merits: large families got most, which encouraged improvident marriages; women claimed relief for bastards, which encouraged immorality; labourers had no incentive to work; employers kept wages artificially low as workers subsidized from the poor rate."
You can almost hear the same frustrations today with claims that people get benefits regardless of their merits: those with larger families getting huge amounts of money in benefits (remember the Channel 5 programme Benefits House which highlighted families such as those of Peter Rolfe, with his 26 children and having claimed more than £500,000 in benefits in the 20 years since he became a father); single mums having more children but being unable to work because they need to look after their ever growing families; people who are capable of work not working because it doesn't make economic sense to do so (they are better off on benefits); and then we have the minimum wage which clearly isn't enough to provide for families, particularly those living in areas where house prices and rents are high or where the cost of public transport to get to work is high.
In essence what they did as a result of the Royal Commission was to make conditions in the workhouses even less desirable with the idea that anyone prepared to accept relief in the repellent workhouse must be lacking the moral determination to survive outside it. Today our government just put in place austerity measures.
Although new laws relating to the poor and what should be done to provide for them were introduced, nothing really changed radically and workhouses continued to exist, many with appalling conditions. It wasn't until a new Royal Commission in 1905 that the suggestion of prevention of destitution rather than its relief were even considered.
However, outside of this care for the poor, there were a number of benefactors who gave money for worthy causes, whether that be setting up schools, colleges, libraries, hospitals, public areas for recreation etc. This wasn't considered fundamentally the responsibility of the government but the rich supporting the poor or contributing to their local communities. There was a sense of duty and responsibility amongst those better off in our society.
Most of the early hospitals were opened for the poor and were often free hospitals - think of the Royal Free Hospital in London or the John Radcliffe hospital in Oxford. These were provided by money from benefactors to look after the poor. The patients were not expected to be in a position to pay for their treatment but the hospital was funded by subscriptions.
This civic system was one lead by the civic association and its leaders. The leaders were often not paid (as in the case of those responsible for collecting the poor tax) and were voted in. It was a pretty hierarchical system and didn't really provide much opportunity for the poor to rise from the lowly status or to have a say in what was done for them. To some extent it was community led but led by those in the community who were wealthy or professionals rather than the whole community.
The State System
The two World Wars had a major impact on society as a whole. The country suffered greatly and struggled to get back on its feet. There was a need for provision of public services to support a society that had given so much. Much of the infrastructure had been destroyed and there was a period of austerity with rationing being continued for many years after the end of WWII.
The system of workhouses had been abolished in 1930 and there needed to be provision for the poor within our society. The aim of the state system was to provide for needs of everybody from the cradle to the grave.
The system was run by experts and bureaucrats and paid for by the state. A number of institutions were instigated such as the National Health Service and the Welfare State. The problem with this system was that it soon became quite inefficient. There was an enormous amount of waste and to get anything to change was like changing the course of a massive ship.
Instead of a system run by volunteers and provided for by benefactors we had a system were we had paid civil servants and where it was the responsibility of the state to provide for all our needs. We became passive receivers of whatever we were given and those in power knew what was best for us.
The grand idea was to eradicate the five Giant Evils of squalor, ignorance, want, idleness, and disease. However, what we received was a overbearing bureaucracy and a state structure where the recipients of the services were like children with mis-guided parents. They thought they knew what was good for us and what we needed and took control of every aspect of our lives from health to education and housing. I love this quote from the paper from Jay, D (1937) in the Socialist Case:
....housewives as a whole cannot be trusted to buy all the right things, where nutrition and health are concerned. This is really no more than an extension of the principle according to which the housewife herself would not trust a child of four to select the week's purchases. For in the case of nutrition and health, just as in the case of education, the gentleman in Whitehall really does know better what is good for people than the people know themselves.
Unfortunately, little has changed, we are still told what is good for us whether that be a low-fat diet or avoiding red wine (or is that good for us again now, I really can't remember) and in the case of education, those in favour of home-schooling feel very threatened by a state which seeks to take away the right of parents to educate their own children, after all the state knows best when it comes to schooling (right?) but fails to provide schooling that is suitable for a whole section of society. In the State Paradigm, the state was in control and more importantly, the state was right.
However, the situation was unmanageable, the state-owned public services were inefficient and the public had no choice. In addition, the trade unions became stronger and productivity and profitability were being held back. And then came Margaret Thatcher.
The Market Paradigm
As a child of the 80's I had a particular dislike for Mrs. Thatcher. Although the situation between the 1940s and 1979 was far from ideal, it was a society where people looked out for one another and tried to support one another. The birth of privatisation completely changed the feeling in the country. The nationalised industries like telecoms, gas, electricity, water, railways were all sold off. This was great for some people, they bought shares at low prices, waited a little while and sold them for a profit. Everybody was interested in how much money they could make. It wasn't so much as "tell Sid" as "look how much money I made Sid".
There were 2 major problems with this selling off of the nationalised industries, firstly that they were sold off so cheaply and secondly that only those who were on the richer end of the spectrum could actually afford to buy shares - the rich became richer and the poor lost out. In fact everybody lost out; society become more self-centred. It wasn't the privatisation that was the problem, but how it was done.
The public services were trimmed back and a more business like model adopted. Service users became customers and there were choices to be made - although in most cases there was and is still no choice (if I want to take the train to London and arrive as quickly as possible, I still only have one choice of provider).
One major change was the way that health care was provided with the setting up of Trusts and the introduction of a division between providers and purchasers of care. However, in practice the system is flawed and has led to an increase in middle management and a lack of ability to share resources and skills across the NHS. There was terrible wastage in the NHS prior to these changes and huge improvements were made on a practical level but the over-regulation has led to more people being required and highly skilled employees moving from hands-on providers of services to glorified clerks writing documentation and reports. The Labour government from 1997 failed to improve the situation by bringing in ever increasing levels of regulation, inspection and target setting. We have a situation where purchases and provision of services go out to tender and the customer (us) usually don't get the best deal due to the way the process is carried out and the inability to negotiate prices post-tender.
Similar situations exist across the whole public sector whether it be waste collection, schools, health care providers or any other area of provision. We are customers with choice but there isn't really any choice and we aren't really customers. The system is very top heavy with Whitehall being in control of how money is spent and the end users having very little control. Central government has no idea what is going on at a local level and can have little if any insight into the needs of individual communities.
The Community Paradigm
The Community Paradigm advocated by the New Local Government Network seeks to put control back into the hands of the local community; a move from big government to small government. Actually, it isn't so different from the situation which existed prior to the 1940's however the fundamental difference is the idea that decisions should be made with far greater reference to the local community.
Instead of delivering services that government thinks that the local community need, it is more about working with the local community to provide the services that the local community actually needs. It seeks to empower and improve the local community. A fundamental characteristic of such an approach is to put the power (for power read money) in the hands of the local community and for the local community to decide how to spend that money.
I liked the example given from Gdansk. "After a widely-perceived inadequate response to major flooding in the Polish city of Gdansk, the city authorities took a different approach to enacting a new flood mitigation plan. Rather than implement a plan informed by the usual partners, a citizens' assembly was drawn together to hear expert testimony and design a solution. The approach is now embedded in practice in the local authority, and assemblies have deliberated on issues as wide ranging as air pollution, civic engagement and the treatment of LGBT people."
The assemblies have direct power to make city policy and to spend city funds. They are made up of about 60 people from a cross-section of the population (determined by a lottery system). These assemblies have proved a positive way of solving controversial and politically difficult issues.
A shift to a Community Paradigm would be very difficult to achieve in the current political climate, it would involve giving up of power (and therefore money) by central government to local authorities and in turn by local authorities to the people. It would require the mobilisation of a rather down trodden and apathetic population more used to being served by the public services than serving.
However, there has been a major shift in politics with splits in both main political parties and discontent leading to more independent candidates being elected in local elections than ever before. There are people within our community with a desire to see change and the community itself is far from the sick patient that it is perceived to be; I can hear the heart beating and the people emerging from their slumber.
The paper is a really interesting read and I like the ideas behind it. I've increasingly been in favour of small government but exactly how that can come about is really a big question which I didn't feel was adequately answered in the paper. However, I shall keep my eyes and ears open for developments in this area because it could make a real difference to the lives of people, particularly those living in more deprived areas like our own.