Public managers should stop telling people how to behave

First published in The Guardian’s Public Sector Network

There is a fundamental contradiction at the heart of the public policyagenda today. While on the one hand we are urged to build a big society where citizens run things for themselves, on the other we are told to ‘nudge’ them in this or that direction and make decisions on their behalf.

Something odd has happened to public services over the past decade or so. Services that were once a part of the social settlement that led to the creation of the welfare state, have increasingly become a tool for telling people how to behave. Whether it’s creating better citizens or trying to change their lifestyles, the only question raised is how best to do it.

The government’s approach to recycling is to fund local initiatives rewarding good residents with points redeemable at local retailers. “We want to see people helping us to boost recycling rates by putting out their rubbish correctly,” said environment secretary Caroline Spelman as she launched a public consultation on the matter, “but bullying them with fines is not the way to do it.” Opponents, particularly local authorities none too keen on reverting to the weekly bin collection, only object that scarce public funds would be better spent on other behaviour-controlling initiatives such as the cuts-threatened SureStart centres.

The world of social care, while rhetorically in favour of more independence, choice and control, for its users, is obsessed with vetting the behaviour of staff, volunteers, or anybody else that might come into contact with a vulnerable child or adult. The NHS, of Olympic opening ceremony fame, may be free at the point of use. But no expense is spared on posters in GP surgeries and hospital waiting rooms telling patients that they must change their lifestyles – stop smoking, exercise more, lose weight – or to remind expectant mothers that ‘breast is best’.

Housing associations are as busy managing the lives of their tenants as they are managing the housing stock and more interested in building communities than building new homes. Schools apparently cater more to the contents of children’s school dinners and lunchboxes and managing misbehaviour in the classroom, than filling young people’s minds with something that might encourage them to sit still for a moment. Meanwhilea mass movement co-ordinator for the Olympic and Paralympic Games’ opening and closing ceremonies is apparently using dance – in consultation with the Metropolitan Police and the Criminal Justice Board – to reduce youth crime.

Indeed for those driving public policy today the delivery of public services is not the point. It is all about shaping new ‘active citizens’ the better to meet corporate objectives. But surely this gets things back to front? A truly active citizen acts of their own accord and not according to the imperatives of public management. The good news is that by ditching the policing of people’s behaviour we might emulate the vision of a big society in which responsible citizens take the reins. This is why we should adopt an alternative approach: one that genuinely enables people’s autonomy rather than smothering their initiative.

Who Cares?

First published in Huffington Post

Is there a crisis of compassion in health and social care? If the shocking scenes featured in Panorama’sUndercover: Elderly Care are anything to go by, the answer is surely yes. The interim report from the Commission on Improving Dignity in Care for Older People, the latest official response to various scandals in care homes and hospitals, suggests that this sort of thing is – if not widespread – then certainly more common than we might like to think.

As Alka Sehgal Cuthbert argued at a recent meeting of the Social Policy Forum, the report barely scratches the surface. She questions whether new improved national quality standards can make any difference. Such a managerial response is part of the problem not the solution, she suggests. Improving the so-called performance culture will do nothing to address what is going wrong with care. Indeed, if she is right, this sort of approach might make things worse by further undermining the caring ethos.

Instead Sehgal Cuthbert takes us back to first principles. We need to ask ‘what does it mean to care or be a caring person?’ she says. Those who work in the caring professions whether as a care worker, a nurse or – like her – a teacher, don’t necessarily have to even like those they care for. They have what my social worker colleagues like to refer to as a ‘duty of care’ to the people they work with. This relationship between carer and client is part of a wider web of relationships with strangers with which ‘we have a world in common’, she says. Or rather we would, it seems to me, if we weren’t so estranged from and suspicious of each other. As I have argued myself, we tend to exaggerate the extent of abuse in Britain, not only of older people, but of children and people with disabilities too. The fear-mongers have been crying wolf in this respect for so long, that some of us have had to hold in check our own scepticism this time around.

Could it be that these instances of neglect and abuse in care settings are a consequence not of inadequate procedures or the dark motives of unsavoury individuals coming into the profession; but of the very attempt to manage the perceived threat of neglect and abuse in the first place? Perhaps this is the lesson we should be learning. It doesn’t really matter how many supposed safeguards, regulations or vetting arrangements are put in place. They can’t make carers care. As Sehgal Cuthbert says, there is little point in the authorities deciding to ‘put empathy on the checklist’ too. It would be just one more thing to tick off the list. But how else do we go about addressing the crisis of care that she describes and that we keep hearing about? Shouldn’t we be doing something? How do we ensure that those we trust to look after our relatives when they are at their most vulnerable are not mistreating or abusing them? Should we just do nothing?

In a way, perhaps the answer is yes. In order for carers to care they need to be allowed the autonomy to act according to that combination of instinct and experience that allows them to fulfil their caring role. Not, that is, according to the criteria set by performance managers and regulators. This means carers debating the issue amongst themselves perhaps, and coming up with their own criteria for what it means to be a good carer. Logically enough this also means not relying on the Care Quality Commission or the Commission on Improving Dignity in Care for Older People to do it for them; and challenging not only poor care but those who undermine good care by promoting unfounded anxieties. Indeed if both Commissions were to, as it were, decommission themselves, carers might be able to get on with the business of caring, without having to worry about meeting their managerial requirements, and begin to embody the standards that society as a whole expects of them.