Select Committee on Public Administration Minutes of Evidence

Examination of Witnesses (Questions 390-399)


26 APRIL 2007

  Q390 Chairman: Thank you very much for coming. I am sorry we are running a few minutes late. I hope it has not inconvenienced you too much. We are delighted to have David Boyle from the New Economics Foundation, Matthew Taylor, now at the Royal Society of Arts, previously at other places, and Sophia Parker, associated with Demos, and I am not entirely sure what you are doing at the moment. The point is that, as you were hearing, we have had a session with people who, as it were, represent service users, and I think we have got you on as the thinkers, the people who have given some sort of theoretical attention to these matters. That is what we would like to do, and perhaps I could start in the way that we ended the last session, to say that we have been worrying for at least a generation about how we can remedy the deficiencies of representative democracy by having a more participatory system and involving users in public services more directly, and here we are, as it were, still having the same conversation. We may use different words now. We may have introduced words like "choice" and "personalisation" and the rest of it but we are still on at the same thing. What I would like to ask you as people who know about all this is, have we made some real progress with this in a way that we think about how state services operate and, whether we have or whether we have not, what is the next agenda that we ought to be turning our minds to? Is that a reasonable question to ask you? Even if it is not a reasonable question I am still going to ask you to answer it.

  Mr Boyle: I think very great steps have been made; there is a new agenda. I think I am primarily here to talk about co-production. If I can say a word about what I think that agenda is, I noticed in some of the documentation to the Committee that the term "co-production" was used in a wide variety of ways and I promised myself that the first thing I was asked I would nonetheless say something about where that term came from because I think that might be useful and because it explains where the agenda is going in the future. It came from three places, I think, almost independently. One was the University of Indiana in the 1970s when Professor Elinor Ostrom was asked to explain to the Chicago police why the crime rate went up when the police came off the beat into patrol cars. She used the term "co-production" really as a way of explaining why the police need the community as much as the community need the police and why when they stop asking for help things unravel. Secondly, Anna Coote at the IPPR[7] and the King's Fund explained the extent to which doctors need patients as much as patients need doctors and that when that relationship is forgotten things tend to unravel. Thirdly, Professor Edgar Cahn, the civil rights lawyer, who is developing time banks, wanted to explain why this was so of all professionals, and that perhaps doctors in that context also required the help of the patients, and not just the patients but also their families and their neighbours. I think what co-production is saying and what I think the next agenda is saying is also a critique in some way of conventional participation and consultation. It is saying that unless people are also involved in delivering services, unless they have something to do, something that recognises that they have something to offer and that their time and their experience and their know-how and their willingness to help is of importance to the public services, then we never quite get beyond the position we are currently in, and that consultation without active involvement can be a dead end which increases the frustration that both sides have for each other. I think that is where the agenda is coming from in the future.

  Q391 Chairman: "Co-production" is an unlovely phrase, is it not?

  Mr Boyle: Yes, especially as it comes from the television, but I am not sure what one does about that since we have got it.

  Q392  Chairman: You just do not see it on the banners, do you, "Co-production Now"?

  Mr Boyle: No. I am not going to apologise for it because I did not invent it myself but I have tended to use it because I think that it does in fact refer to a body of thinking which all of us in different ways are in the business of unpacking here, but I also think it has at its heart a challenge, and quite a big challenge. It is a kind of critique of welfare.

  Q393  Chairman: As you describe it though it seems to me there is a kind of soft version of it, which is that the terms of trade between professional providers and users should alter and that that is to the benefit of both. That is one thing. Another thing is when you say, "Actually, users should then be involved in delivering the service". That seems to me to be a much harder version of what you are describing.

  Mr Boyle: Stronger, I would perhaps say, rather than harder. I do think that is right and I think the danger is that when we lose the sharper meaning of the word we lose that challenge and I think that challenge is very important because when users are not asked to play a role in the delivery of services (and it may not be the same role that the professionals play) the danger is that they become wholly passive recipients and you might have people who are never asked the whole of their lives, although they receive services intensively, to give anything back. There are reasons why over the last generation we have felt that is the right thing to do but it also gives the wrong message to people, that they have nothing worthwhile to offer, and to make those services effective it seems to me we desperately need to involve people and almost everybody who is also receiving. It is about the relationship between professionals and users and how to make it more reciprocal and by doing that make the services more effective. In the end, this is about making professional services work.

  Ms Parker: Maybe I could clarify what I am doing now. I am still associated with Demos but I also spend some of my week working at Kent County Council. I am here today in my capacity as a Demos associate. To go back to your question about whether we have made any progress and where next for the agenda, it is very interesting to see the extent to which the commitment to engagement and participation has definitely risen up the agenda, whether you are looking at the Local Government White Paper or the pre-budget report and indications about what is going to be in the comprehensive spending review and so on. The government has clearly adopted this commitment to engagement and participation of users pretty strongly. Unfortunately, as the emphasis has increased, the clarity has decreased about what we mean by these terms, engagement, participation and co-production. That for me presents a very significant set of challenges because there is a danger that we are going down the route of seeing them as panaceas, as answers to everything and not really understanding what we mean. In my view there are quite significant implications about organisational change, cultural change implied by the terms. That leads to my views about where next for this agenda. For me the real challenge is to start thinking about engagement and co-production as a way of doing the business of government rather than an additional thing to do. We had a lot of conversation in the previous session about consultation and the fact that it costs a lot and takes a lot of time. That is all true but that is exacerbated by the fact that we still see consultation as a thing you have to do in addition to your day job. Many of the examples of organisations we have seen which seem to be doing interesting work about working with users see it as part of the day job.

  Mr Taylor: I am fascinated by your idea of what you put on the banner. Politics generally speaking is about a battle to describe what the problem is. The difficulty is that we do not understand the scale of the problem and its urgency. We face at the ground level a social aspiration gap with the society most of us want to live in. One of the characteristics of modern Britain is there is a quite high degree of consensus about the kind of society we want to live in. It is not the same in Iraq or America but in Britain you could probably throw a blanket over 80 % of people and they would broadly agree about what society is. The problem is we do not will the creation of that society through our actions. The great challenge is how do you encourage citizens to behave in the ways they need to behave in to create the society they want to live in. For me that has three dimensions. Firstly, which is to do with democracy and decision making, how do you encourage citizens to participate in decision making at all levels in a mature, thoughtful and responsible way rather than in the attitude of facility and self-righteous rage which is the general attitude of citizens to politicians at the moment. Secondly, how do you create citizens who are, as far as possible, self-sufficient in order that we can focus limited resources on those people who are not self-sufficient. How do people look after health, education, provide for their retirement? That is a necessity. Thirdly, we need citizens who are civically altruistic in terms of how they behave with strangers, the caring they do, the volunteering they do. If you believe that closing that social aspiration gap is the critical task facing us, it leads you to ask what contribution public services, which are funded by us, accountable to us, are making to closing that social aspiration gap? That leads you to asking whether the organising principles of public services now fit the social challenge that we face. For me, co-production is a small part of a much broader set of questions around how public services engender the right attitudes and behaviours in citizens in order that those citizens are able to create the society we want to create. That is the thing that you put on your banner. How you crystallise that I do not know but that mission is what this is about for me. It is not a tactic to improve a couple of public services. It is not some new fad around public service delivery. It is much more fundamental than that. It is about an analysis of what is needed. In public discourse people increasingly want to talk about issues that are not just about what the government does but about how we live our lives, how we get on with each other. David Cameron has been very clever at articulating this sense of what we want to talk about now, what is going on around us in society and how we get on with each other, not just how the bureaucracy operates. One of the reasons this stuff is so difficult is because engagement, empowerment, co-production, call it what you will, one of its difficult characteristics is that if you do it badly it is worse than not doing it at all. That generally is not the case. A mediocre school is better than no school. A moderately effective doctor is better than no doctor at all—we can argue about that—but bad public engagement, making a promise you do not deliver on in terms of co-production leaves people more alienated than at the very beginning, which makes it hugely challenging. It means that this world is full of people who say, as MPs always say to me, "I have tried it and all I did was get shouted at. I am never doing that again."

  Q394  Mr Prentice: Maybe that is why people are so cynical. You heard the people before us just a few moments ago talking about consultation overload, consultation fatigue. What is the point of getting involved because nothing that they suggest is ever picked up by the government?

  Mr Taylor: We have missed the point in terms of a lot of discussion about what is wrong with democracy, political engagement and consultation because we say it is to do with process and institutions. For me, it is about the question that is asked. If the question is asked by a group of people up here of a group of people down here, it does not matter how you do it. There is something difficult about that question because that question is, "What do you think of the way we are performing and could we perform better for you?" That is not the question. The question has to be, "What do we want? What are we willing to do about it?" At the end of that, what are you willing to devolve to us as a group of politicians to do on your behalf? As long as the conversation we have about society is government-centric rather than citizen-centric, consultation cannot work because it is based upon an inadequate description of what the problem is. Most of the social problems we have to solve are as much to do with what I do as a citizen as they are to do with what you do as a politician, but that is not how most consultations are framed. They do not start with, "What are we as a community going to do to make our community safer? Let us spend a day talking about that together and from that we will derive some things that the council should do as well as a rich amount of things that we are going to do." It starts from a group of people on the panel saying, "What do you think about the way in which we are policing your community?" You create a language of disempowerment as a consequence of which you feel quite rightly that people are just shouting at you because you almost invite the public to make a set of incommensurate demands to you. The room is full of people demanding this, that and the other. You do not give them the responsibility of trying to reconcile these conflicting demands. You invite them to be unreasonable to you and as a consequence you say, "This did not work. I am not going to do this any more."

  Q395  Mr Prentice: Before, we had two agendas. We had a government inspired agenda and then we had an agenda that emerged from the voluntary sector who were not being listened to. Now we are being invited to believe through co-production and so on that there is an emerging, single, common agenda. I am not entirely sure that that is the case.

  Mr Taylor: I do not think anyone is saying this is easy. This is the problem with it. I do not know how many of you have children. It is always easier to tidy your child's bedroom than to negotiate with them about tidying their own bedroom. That is because if you negotiate with them about tidying their own bedroom it takes a lot of time and argument. The worst thing about it is they will define what tidiness means. They will not let you define what it is. It will be their sense of tidiness but what are you going to do? Are you going to carry on tidying the kids' bedrooms until they are 25 or are you going to enter into the messy process of getting some agreement with them about some sort of shared notion of what tidiness involves?

  Q396  Chairman: The answer to your question is yes, you carry on until they are 25.

  Mr Boyle: I very much agree but the government-centric versus people-centric question is precisely the same deeper inside the public services. There is a sort of professional-centric agenda of the great providers and a plan centred agenda. What co-production is saying is that when you keep those things too far apart (a) the poor professionals get completely overloaded and frustrated that they are being asked too much and (b) the people, who may have no assets at all apart from their own need, will use that to get what they need—so you are not looking at them according to what they can do and provide. You are then on a hiding to nothing. This is about sharing action and what needs to be done. The co-production project which I have been most closely involved with, which is in a GP's surgery in Catford through a time bank, where patients are able mutually to support each other, maybe not doing the same as the doctors do but crucial work nonetheless, there is something alchemical that happens there. There is a different, more equal relationship that is happening which also is more democratic, but it does not start from consultation. It starts from what can be done. It is more about `ask not what your health service can do for you; ask what you can do for your health service'. There is an openness in the public towards that.

  Q397  Mr Prentice: I do not doubt that there are not those examples but is not this whole co-production thing being massively over-hyped? Lots of voluntary organisations do not have the capacity to take on these additional responsibilities. They may not want to because they think it would compromise their independence.

  Mr Taylor: It is about mainstreaming. You are viewing this as a set of functions which have been outsourced to the voluntary sector.

  Ms Parker: I promised myself I would not do this but we do need to think about the distinction between co-production which for me is very much a way of understanding how you achieve some of the outcomes we are talking about, recognising that if you want to create a society of life long learners, if you want to create a healthy population, that is not something that can be delivered by some institutional public service. It needs to engage all of us and motivate all of us not to smoke, to eat healthily and so on. We have to distinguish between co-production in that sense and co-design which for me is very much about the way in which you involve users. It might be consultation. It might also be all the other techniques by which you bring users into the process of understanding what that service might look like, how it can be improved and so on. It is in that realm that you really have to think very carefully about whether we are asking questions from the service institutional perspective, how do we make this hospital better, or are we asking it from a user perspective: how can you be more healthy? What resources can you bring to the table? How can we support you?

  Mr Taylor: Let me give one very strong example of that. The government's policies on training, which are commendable in their objectives and not bad in some other outcomes, are based primarily on the assumption that people do not want to learn so you need to bribe them to learn and employers do not want to train people so you need to bribe them. We have educational maintenance allowances which are a bribe to people to learn and Train to Gain which is a bribe to people to let their employees learn. They are fine but the problem is if you have that as a policy you will have two inevitable consequences. First, a massive deadweight cost because you will be paying people to do things they were going to do anyway. Secondly, you will get perverse outcomes because people will do things they should not really have ever done because you are bribing them to do them. You will have some spurious training; you will have people learning things they did not want to learn. If you had started from the problem being why is it still that hundreds of thousands of young people leave the education system every year saying, "I am never going to do that again. That was horrible. I do not like learning. I cannot do that", you would say, "How do we redesign the curriculum and education so that what we are producing is a group of people who have an understanding of and self-confidence about their need to and their capacity to learn throughout life?" It would have taken you a lot longer. It is a much more complex challenge but for me it is a much richer challenge. You could not deliver on the second challenge without some sort of co-productive method because you are trying to change the individual's perception of themselves. The former method, the government's schemes, you can do to a passive population. You just throw these incentives at them and they will respond to them. It relates to what is your objective here. It relates to the ambition you have for what public services do for people. If your organising principle is to put people more in control of their lives, it will lead you to different strategies.

  Q398  Mr Prentice: I am not entirely sure I buy your example of the educational maintenance allowance as a bribe because there are lots of young people in my constituency and all over the country who stay on in education because of the educational maintenance allowance and they come from poor families. The pressures for them to get out and earn some money would be immense without the educational maintenance allowance so I just do not buy that when you characterise it as a bribe. It is all very abstract, is it not? I am just a novice in these things. I am just trying to get concrete examples where there is interaction between the centre and voluntary organisations will make a difference.

  Ms Parker: There is a brilliant example, interestingly, in social care. There is an organisation called In Control, and if the Committee has not already spoken to In Control I strongly recommend that you do because they are an incredible organisation. They were set up with a very small amount of money from the Department of Health, I think it was about half a million pounds, and they are developing a very powerful and impressive model of person-centred support, as they call it, a model of social care that I think is beginning to turn our understanding of social care inside out, but they are not doing that within government; they are doing that through working with about 80 local authorities. It is still officially called a pilot but I think it is in about 80 local authorities. You speak to any person who is on that In Control programme and you will find the examples you are looking for. Just one I came across a couple of weeks ago was of a woman whose son has been using social care for some time and went into the In Control pilot, which is very much about giving people a budget and letting them determine how that budget is spent. Enormous amounts of trust are implied by that. His mum, his main carer, was saying, "We did not want a service. We wanted a lifestyle". This goes back to some of the things said in the earlier session here today. This boy had had 40 different care managers visiting him in his home over the previous six months because it was being delivered as a service. The minute that that family were put in control of their own budgets and being able to decide what kind of support they wanted they were able to think in lifestyle terms rather than service terms and that was an incredibly powerful example. In Control is full of stories like that.

  Q399  Chairman: I wonder if that does not in a way challenge Matthew's original statement of what the overall context is: we all believe the same thing; we just have to work out how to do it. Surely you could say that part of the difficulty with the whole co-production agenda is that society has changed so fundamentally in an anti-collective direction, that it is fragmented, it is individualised, people are less committed to the collective now, and that we are looking for models of social provision that reflect that which you are describing, the agenda that is all about personalisation, direct payments, choice. It reflects the turning away from the age when we had collective institutions that could do these kinds of things and that people felt reasonably connected to. This is surely a social policy for an individualised age, is it not?

  Mr Boyle: I do not want to get carried away on that because I think that there are ways in which that is undoubtedly true, but there are nonetheless drawbacks even if you welcomed in the individualised age which you simply have to address just to keep that individualised age on the run. I just wanted to come back to what you were saying about voluntary organisations because I think the co-production agenda is as much a critique of the way voluntary organisations work as it is of public services. If those voluntary organisations are simply handing out largesse to passive recipients and not asking for anything back and not expecting them to do anything with it in return. I wanted to give another example, which I hope answers what you said, which is that I remember Professor Tom Craig from the Institute of Psychiatry saying recently: one of the main difficulties he faced delivering mental health in south London was that the main factor which determined the recovery of any of his patients coming through the door was the extent to which they had social networks at home, that they had friends and maybe family or at least some aspect of that, and yet he was very aware that an awful lot of what they were doing, once they had started treating people, was actually undermining their social networks, taking them out of them, losing them their friends and disempowering their families. I do not think it is necessarily rolling the clock back about individualisation to recognise that that is a problem, and the way in which they recognise it in the South London and Maudsley is to roll out time banks which measure and reward the extent to which those mental health users are playing a role with other users, building communities themselves which can support them and their fellow patients.

  Mr Taylor: I think it is important to distinguish here between stateism and collectivism. I think there is a new collectivism and I actually think that when you look at examples of this co-production what you will see is that people quite quickly do come to collective solutions. If you talk about, for example, the work that Charlie Ledbetter and Henry Cottam did with diabetics in Bolton, one of the things they found was that these people had been individually asked to improve their lifestyles for years and they never did because they were diabetic, they had low self-confidence, they were overweight, they were unfit, and it did not work. What the research found was that a lot of these people were dog owners and that was the one thing they did that was getting them out and being physical, so they created a dog walkers' club of the diabetics who went out and just walked a bit further with their dogs and that became something which they did which made them feel better and fitter and it worked. I think it would be pessimistic to believe that when you go through this process it leads to individualist solutions. It very often leads to collectivist solutions. It leads to people establishing new services together, possibly outside the state or in a different relationship with the state, so we should not confuse stateism and collectivism. Just very quickly on the EMA[8] point, if EMAs are simply a way of saying that people who learn should have a decent income, that is fine; it is a perfectly good and progressive policy. It tends to be measured in government in terms of its contribution to increasing participation rates, so inasmuch as it is measured by its capacity to make people do things they would not do otherwise it simply reflects a sort of pessimistic sense of what we have to do about learning; that is my point. It is a perfectly good policy as a social welfare policy.

7   Institute for Public Policy Research. Back

8   Educational Maintenance Allowance. Back

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