Examination of Witnesses (Questions 390-399)
MR DAVID
BOYLE, MR
MATTHEW TAYLOR
AND MS
SOPHIA PARKER
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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