Built to scale: the Family Independence Initiative – Jane Mansour

In this post our guest blogger Jane Mansour showcases the Family Independence Initiative in Boston, Massachusetts. The project is a good example of the principles of ‘guerilla policy’ in action. Jane is an expert and consultant in international welfare to work and the commissioning and funding of public services. She blogs regularly at Buying QP. Thanks to Jane for contributing the post, and we welcome your comments.

The argument for the benefits of user and staff involvement in policy making is considerably strengthened by numerous example of projects that have been successfully designed and delivered using this blueprint. These range from actual projects – of which FII discussed below is a great example – to the use of a crowdsourcing approach to gather solutions for identified and specific local needs. These raise questions about the extent to which this approach is scaleable, and how this can be done without losing what made them work in the first place.

This week I met Jésus Gerena, the Boston Director of the Family Independence Initiative (FII). FII families create support networks in their own communities rather than accessing help through a key-worker or institution. As an organisation it has impressive results – in the first six months of operation participating families in the Boston wing of the programme saw their incomes rise by an average of 13% and their savings by 22%.[1] These statistics and many others covering family finances, schooling (both adults and children) and health and activities are compiled monthly. The data is actively uploaded by the participating families themselves. They are paid for this, and for leading, counselling and facilitating the monthly groups they attend. These payments total in the region of $2000 a year per family.[2]

The FII was the brainchild of Maurice Lim Miller; he was honoured this week by the MacArthur Foundation with a ‘genius award’ which carries with it a grant for $500,000. It works by not helping people in poverty. No, that was not a typo. The FII do not help, staff can be (and have been) fired for doing so. What the FII does do is provide an environment in which people have opportunities to succeed. Families work together to problem solve, record their gains and losses and have access to resources should they need them.

There are the three fundamental values that underpin the organisation’s approach. Firstly, the families are in control. Secondly, there is a formal feedback loop consisting of monthly and quarterly meetings and data collecting providing peer accountability. The process of recording information in and of itself, impacts positively on behaviour. Lastly there is access to resources to move forward. These resources are often in the form of matching or doubling the contributions participants make towards education, housing or business goals, but they can also be used to meet urgent practical needs (eg. a car or dental work).

Listening to Gerena’s passion for the FII approach, it is difficult not to get excited about it, about the way that this organisation is not only challenging much of the way that social policy has been cast, but is succeeding in doing so. The scaleability of successful but reasonably small projects is fraught with difficulty. The world of public policy is littered with examples of innovative projects that are hailed, placed in the spotlight, enlarged and ‘replicated’, but that then fail to deliver on the bigger stage. This is then followed by a blame game that often focuses on delivery, sometimes on commissioning, occasionally on design.

In two years the Boston operation has grown from 35 to 200 families. Gerena thinks there is the potential to continue expanding to 1000 families but, and it is an important but, this expansion needs to happen organically through families introducing themselves and others – a combination of ‘core catalyst families’ and ‘ripple families’. Scaling up fails when the guiding values behind success are confused within the method in which they are delivered, when the ‘how’ is mistaken for the ‘why’.

There are broader public policy lessons to be learned from the work being done by FII. These are not that welfare savings can come from the wholesale removal of frontline staff, or that bids to deliver programmes should need to be scored on how often the words ‘family’ or ‘social capital’ occur, or that a new New Deal for Communities is the answer. The lessons are far more challenging than simply producing a shiny new programme.

Miller has written a brief paper identifying the changes he thinks necessary for substantial change in the outcomes for low-income families. It’s worth reading in full. His final call to action identifies four changes that need to happen:

“1. We need to more accurately communicate the resourcefulness, capacity, and caring that is the true picture of lower income families and communities

2. Funders must allow for program approaches that provide help based on family and community initiative and strengths

3. Policy makers, funders and leaders must seek direct feedback from the consumers of programs they create and respond to that feedback

4. The target families must self organize and advocate for themselves and their communities”

As I sat in the FII office, it was striking that there are clear echoes in the UK – in terms of approach, positive outcomes, frustrations with the system, but also in the difficulty in capturing the wins and replicating them either regionally or nationally. Successful, sustainable ideas are evident in individual programmes but somehow the key to why they work gets lost in translation when ‘reform’ or scaling up occurs. Why is it that successful local programmes so often fail on the big stage? To what degree would this failure be mitigated by taking a different approach to both entrenched social issues and institutional frameworks? What impact would the following considerations have on policy design?

Long vs short-term investment: FII is aimed at the working poor – those who are increasingly ineligible for state safety nets, face significant marginal tax rates on any additional earnings and are in real danger of sliding back into poverty (cycling between work and benefits). It relies on the safety nets being there, it is an extension of benefits rather than a replacement for them – any savings to the welfare budget will only be felt in the long-term as people move up the income ladder. When the focus is on cutting spending rather than raising revenue, and results are needed quickly the long-term nature of many interventions is overlooked.

Look for ‘A Duh’ rather than ‘A Ha’ moments (Gerena’s phrase). There is a tendency to look for exciting, new, revolutionary change but often small, practical, simple and obvious opportunities are overlooked. Users and staff are the key to understanding what these are.

It requires a significant power shift to trust in people to make decisions about their own lives, find their own support network and provide the resource to enable them to make positive changes. What could this look like and how can it be supported by the state?

The need to end funding silos for people with multiple needs has been much discussed. The introduction of the Universal Credit in the UK aims to streamline benefits. The focus is on simplifying the benefits people receive rather than on the way they live and how services they interact with are funded and delivered. Bringing funds for the latter into one pot (universal support?) would have a very different impact.

What and how do incentives work for middle and high earners? Can the rewards for initiative they receive be extended to benefit claimants and those on low incomes? Skills policy and funding is an area that immediately springs to mind.

Feedback and data are both vitally important and often overlooked. This involves a change in perspective, from the compilation of simplistic league tables of outcomes towards rich seam data mining of the information gathered on the journeys of individuals as they bounce around the system.

There has been a tendency in policy design in the UK and elsewhere to believe that successful programmes will only come from providing more intensive external support. The experience of FII is that the ongoing cycling between work and benefits can be prevented through the creation of long-lasting social structures and support networks, underpinned by feedback and resources. The challenge is in reproducing co-operative policy making and delivery on a regional or national stage.


[1] These outcomes have improved over time and the experience of the two Californian programmes is of an income increase of 20%.

[2] These sums are not included in the increased income calculations


Open policymaking: Should there be a ‘duty to involve’ for national policy?

As Edward Andersson from Involve noted in his recent blog reviewing the new consultation principles issued by government: “Today consultation has, for many citizens, become a byword for formalistic, tick box exercises, done to mask a decision which is already a ‘done deal’.” Edward rightly suggested that the new principles, while important, fall short of providing the solution to this widely shared view of consultation. Could one solution be a national ‘duty to involve’, similar to the requirement that some local public services are already subject to? In which case, national policymakers should look to their local counterparts for what works.

This post is part of the project on open policymaking and better consultation, hosted by the Democratic Society in association with the Cabinet Office. As Anthony Zacharzewski, head of DemSoc, has summarised it: “Open policymaking is the natural corollary of open data and transparency, requiring openness and allowing public participation at every stage of decision-making and implementation. It supports citizen action and positive involvement of the public in shaping laws and services.” This active engagement is obviously very different in scope and ambition to traditional consultation, but this doesn’t mean we’re starting from scratch. If, as the Government has said, in the future “all policies will be made openly”, we could learn from where there have already been attempts to achieve a different, more deliberative approach to decision-making – in local government and local public services.

Many of these local duties to involve citizens have been introduced through national policy. For example, Section 138 of the Local Government and Public Involvement in Health Act 2007 imposed a duty on all councils and ‘best value’ authorities to involve ‘local representatives’ when carrying out functions by providing information, consulting or ‘involving in another way’. Councils must engage with a balanced selection of the individuals, groups, businesses or organisations the council considers likely to be affected by, or have an interest in, the council’s functions (including children and young people as appropriate). For the National Health Service, legislation which came into force in 2003 placed a duty on certain organisations to involve and consult, but managers were not always clear when they had to involve people or how it was best to do this. The 2007 act aimed to make this clearer; the duty requires NHS organisations to involve users of services in the planning and provision of services, the development and consideration of proposals for changes in the way services are provided, and decisions affecting the operation of services. Section 242 of the earlier consolidated NHS Act 2006 was also supported by useful guidance on achieving ‘Real Involvement‘ from service users and communities.

The NHS’s operating framework further emphasised that this engagement should be ongoing, not just during periods of change. Primary Care Trusts and NHS providers should “…create greater opportunities for their communities to make their voices heard, raising awareness of those opportunities and empowering patients and the public to use them and LINks [Local Involvement Networks]; [and] take greater responsibility for communicating with their local populations and stakeholders to ensure better understanding of, and confidence in, local NHS services.” More recently, the NHS constitution underlines that public and user involvement should be part of the fabric of the NHS: “You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.”

The reality of local engagement might only rarely meet these ambitions, and many local policymakers, managers and clinicians might question the extent to which the public can play a constructive part in decisions on reconfiguring clinical services. Views on the success of local LINks vary widely, and they are due to be replaced by Local Healthwatch organisations in April 2013 as part of the ‘new NHS’. But this gap between aspiration and reality may be more a matter of developing and using the right methods for engagement – and being seen by local communities to be making genuine efforts at this engagement – rather than a fundamental problem with the aspiration itself (these are after all public services, paid for by the public, and they should surely be accountable as such).

Organisations such as Involve (a partner in this discussion) have a wealth of experience about what works locally (Edward referenced some very useful resources in his blog) – surely some of these principles and practices could not only be better shared locally, but applied to national policy as well? As we’ve noted before, one of the reasons that the Government’s NHS reforms ran into such difficulty was the view held by stakeholders that the policy was developed in a fundamentally closed way rather than constructively and collaboratively. The Government says that empowering individual patients and increasing the local accountability of health services is at the core of its reforms; shouldn’t we apply the same principles of empowerment and accountability to the development of health policy as well as the operation of health services – and to any policy for that matter?

The Government’s Civil Service Reform Plan, where its committment to open policy was announced, makes no reference to existing local methods of engagement and how these could inform open policymaking at a national level. Nonetheless, national policymakers should look to the methods that have been used by local policymakers and planners to engage their communities and service users in decision-making – both the successes and the failures – and consider how the most effective approaches could be adopted and adapted for national policy. Open policy is an ambitious agenda. Making it real will require effective methods for engagement, but also ways of requiring that policymakers develop policy openly. As well as learning from local methods of engagement, do we need an equivalent national ‘duty to involve’ stakeholders in policy development?


Consultation can’t fix our broken politics – we need new ways to engage the public in policymaking

Is consultation broken – or is it our political system? Consultation seems to have become the lightening rod for general discontents about politics and policymaking. Let’s improve consultation  but let’s also rethink how we do policy and politics at the same time.

In the Open Policy project with the Democratic Society in association with the Cabinet Office, we’re exploring what ‘open policymaking’ means in practice, and how we make it effective and democratic. But we’re starting the project in consultation – what works, what doesn’t, and how it can be improved.

A widely held view of consultation is that it is a sop – an exercise that governments are legally required to undertake but which rarely changes policies that have already been decided. This might be both broadly true and largely unfair. Consultation is only one mechanism, one particular stage in the policy process; it was never intended as the sole mechanism for engaging ‘the public’, let alone to ensure that policies have a democratic mandate that other parts of the political process have failed to invest in them.

In our previous post for this project we suggested how open policy represents a challenge to consultation. For us, taken to its logical conclusion (to its greatest openness), ‘open policy’ means we need to develop a radically different approach to policy and research. In terms of social policy, this means developing approaches that enable public service practitioners and services users to conduct and engage in research and policy analysis directly. These groups are at the frontline of public services and social issues, and as a result they have practical expertise and experience that could be used to improve social policy, especially to make policy more credible and pragmatic.

Where does this leave today’s approach to consultation? Consultations are often about what government intends to do. It hardly makes sense to complain when government does what it said it intended to (indeed, we commonly criticize government for the opposite). In the case of particularly contentious policies or those that haven’t been sufficiently publicly debated, consultation will never be able to resolve the perceived lack of a public mandate.

As a thought experiment, just imagine a consultation process that was much more ‘open’ – one whereby policy did change dramatically compared to what was originally proposed. The problem immediately becomes apparent: government could in theory find itself in an endless ‘consultation loop’, with each new stage of consultation radically changing the policy in question, to the extent that a new round of consultation would be required to accompany it. Government would never get anything done, and quite rightly this would generate accusations of endless ‘dithering’ and ‘u-turns’ – of being in office but not in power.

In recognition of the devalued nature of consultations and possibly the ‘one-size-fits-all’ manner in which too many consultations are approached, the Government has announced it is moving to a more “proportionate and targeted approach” (this announcement produced what is perhaps the least thrilling headline ever on the BBC News website). The new guidelines recognise the need to “avoid creating unrealistic expectations” by making it clear where policy has been finalised and will not be subject to change as a result of the consultation. This makes sense – much of the criticism directed at consultations stems from unrealistic or inaccurate expectations among respondents. The guidance recommends instead that the objectives of any consultation should be clear, and depend to a great extent on the type of issue and the stage in the policy-making process.

However, the new guidance also risks replicating the current confusion about consultation by advising that: “Engagement should begin early in policy development when the policy is still under consideration and views can genuinely be taken into account.” From a democratic point of view this is unarguable – but the problem is that consultation can’t hope to meet these aspirations. ‘Public consultations’ in most cases aren’t – they don’t reach the public or garner many responses from them. They also aren’t really a form of deliberation; they’re not about policy formulation, rather they are more commonly about policy adjustment. Why be cynical about what should be obvious? Government sometimes makes the mistake of trying to appear as if it is engaged in open policy formulation when it isn’t, but we don’t have to collude in this and then blame government when this turns out not to be the case.

We need new forms of participation for early policy development, and for research, evidence-gathering and analysis. This isn’t and can never be the job of consultation. Unless we create a much clearer distinction between consulting on policies that government intends to enact, and developing new policy agendas where government isn’t sure what should be done, we will see much more of what we call ‘guerilla policy’ – grassroots policy research and development that people and organisations do for themselves without being given ‘permission’ by the policy establishment. There have always been campaigns and protests of course; what’s different now is that people can mobilise, coordinate and share information so much more quickly – including to overturn official policy (or at least severely undermine its credibility). We happen to think that we need more guerilla policy – but we recognise that government might not.

What’s important about this project is that it encompasses how we can improve consultations today, but also how we can develop radical new forms of engagement in  policy tomorrow. The extent of the crisis in democratic legitimacy suggests we need to do both. Sorting out which is which will be crucial to our work. So in the spirit of the exercise, let us know your view – are there aspects of consultation we should retain, or does ‘open policy’ require us to start again with a blank sheet of paper? Comment on this site or on the Open Policy forum for open policymaking and better consultation.


Open policy is a challenge to government consultations – and an opportunity

More than 40 years ago the American sociologist Sherry Arnstein developed the ‘ladder of participation’ to represent the degree of involvement by citizens in decision-making. Arnstein’s levels range from ‘non-participation’ at the bottom of the ladder – at worse, the manipulation of citizens – to ‘citizen power’ and true citizen control at the top. One of the challenges for government today is that many people increasingly agree with Arnstein’s view of consultation as basically a form of tokenism. More positively, Arnstein’s ladder points to the possibility of different forms of engagement that could contribute to a better, more trusting relationship between citizens and government.

The widespread skepticism about consultation reflects a broader context of course – the steady decline in the number of people who say they are engaged and interested in politics and who trust politicians. To its credit, the current Government has recognised the extent of the problem and is trying to do something about it. Its Civil Service Reform White Paper published in June 2012 announced the Government’s commitment to ‘open policy making’, that:

“Open policy making will become the default. Whitehall does not have a monopoly on policy making expertise. We will establish a clear model of open policy making.”

Our own project, Guerilla Policy, is about developing a radically different approach to policy and research. We want to develop a way for public service practitioners and services users to conduct research and policy analysis. These groups are at the frontline of public services and social issues, and as a result they have practical expertise and experience that could be used to improve social policy, especially to make policy more credible and pragmatic.

Unsurprisingly then, we agree with the Government that open policy is an idea whose time has come. Policy development has been too closed, to a too narrow set of participants, for too long. We agree with the Government that Whitehall hasn’t got a monopoly on policy expertise, and we’ve made some initial suggestions about the ways in which Government can make open policy a reality, including by making open policy itself an open and transparent agenda and by opening it up to new participants.

One of the challenges facing open policy is the widespread lack of confidence in consultation, and whether the conventional approach to consultation can be improved or needs to be ditched altogether. Two relatively recent examples point to how significant doubts about the authenticity of consultation processes can very quickly translate into very strong reactions against the policies being consulted on.

First example: more than 538,000 people took to social media to protest against the consultation which proposed to sell off England’s forests (this included a major campaign by the online community 38 Degrees). In the face of an avalanche of protest, Caroline Spelman, then Environment Secretary was forced to suspend the consultation and apologized in a statement to the House of Commons for the way it had been handled: “I am sorry. We got his one wrong. We have listened to people’s concerns.”

Second example: earlier this year the Spartacus ‘Responsible Reform’ report was researched, written and promoted by a band of disabled activists who felt that a consultation on welfare reform was being manipulated by the Department for Work and Pensions. The report, based on a rigorous analysis of responses to the Government’s own consultation on reform of Disability Living Allowance, revealed the overwhelming opposition to the Government’s proposed reforms. The report took the social media world by storm, including trending number one on Twitter.

It’s not hard to see why this is happening; research by the Consultation Institute suggests that in only 40 per cent of consultations is it possible to make a clear link from the outcomes back to the responses received. In response, we are witnessing the emergence of new forms of ‘unsanctioned’ citizen consultation and mobilization. There’s always been protest of course, but these citizen-led campaigns, supported by social media and the internet, are increasingly fast-moving, flexible and distributed. We call this ‘guerilla policy’ – citizens stepping into the gap when they think the political establishment is failing to recognize, let alone act on, their views.

Such campaigns are difficult for policymakers to anticipate, and hard for them to respond to. Fundamentally, these campaigns aren’t just calling for different policies in the areas they care about; they’re also calling for a different way of making policy. In this respect, guerilla policy also offers government the possibility of a more positive approach, one that enables citizens to shape and inform policy in a more meaningful way. Social media-supported campaigns have the power to overwhelm consultation processes if the public loses confidence in the integrity of these processes. But social media also potentially offers a cheap and easy way to engage many more citizens to improve policy.

For us, what’s especially missing in consultation (to quote from the Government’s own proposals) is how to “enable policy to reflect the real-world experiences of citizens and harness public engagement with the policy making process.” We’re not suggesting that government delegates its ultimate responsibility for policymaking – for full ‘citizen control’ in Arnstein’s terminology. But the challenge for government – and for the open policy project we’re conducting with DemSoc – is that unless we find new ways to improve how to develop policy such that it reflects the experience and insight of citizens, then citizens will increasingly do this for themselves, working against government rather than with it.

This blog is the first post for our new project, in partnership with The Democratic Society. You can get involved by visiting the discussion space for the project, hosted by DemSoc in association with the Cabinet Office – and of course you can also share your views on this site.


Open policy needs people to step outside of institutions to tell the truth

Christopher Hitchens used to evaluate the credibility of any person or organisation by their willingness to cite ‘evidence against interests’, that is, to acknowledge facts that are contrary to their own position. It’s a good test – and one that many policymakers, commentators and think tanks would fail regularly. With this in mind, we should challenge our own view that social policy would be better if it was informed by the people who use and provide public services – after all, doesn’t the Hillsborough cover-up show that we can’t trust bodies such as the police not to put their own interests before the public interest?

We’ve argued previously against the view, promoted in particular by right-wing think tanks and commentators but implicitly taken up by much of thinktankland, that public sector workers and ‘user groups’ need to be largely ignored in policy development because they are inevitably self-interested and self-serving. Our view is that social policy would be better if it was informed by the expertise, experience and insight from the frontline.

In the case of Hillsborough, as the publication last week of the report of the Independent Panel confirmed, the police engaged in an extensive and coordinated cover-up of the truth. This went all the way to the top of the South Yorkshire Police. Chief Constable Peter Wright authorised the alteration of police statements to delete words like ‘chaos’, ‘fear’, and ‘confusion’ in criticism of the police operation, in order to enable the police and others to blame Liverpool supporters for the disaster. 164 police statements were altered in the wake of the disaster, and 116 of these received substantial changes to remove comments “unhelpful to the force’s case.”

The coroner also took blood alcohol levels from all of the deceased, including children, to try to draw a link between the late arrival of fans and heavy drinking. Perhaps most sickeningly of all, police officers carried out computer checks on those who had died in an attempt to impugn their reputations. As one comment on the Liverpool Echo‘s website asked last week: “How could such a cover up have happened? So many different authorities getting away with lies. And to get away with it for so long is simply astonishing. They must know the hurt and the pain that they have caused for so long. And still they continued to hide behind the lies, carrying on with their own lives and careers.”

This type of behaviour is not confined to the police of course. NHS staff have abused and neglected patients, and hospitals have tried to cover it up and threaten whistle blowers. Charities have mistreated and ignored the vulnerable adults and children they claim to care for. Public sector trade unions have bullied their own members and failed to represent their real views and interests; they have also stopped managers from dealing with poorly performing employees or from improving services for the public. Given this, why should we listen to the people who provide services? Won’t they always represent their own interests first?

The problem is institutions, not individuals. There will always be some people who act badly and harm others, including inevitably in public services. But only badly led and managed organisations can effectively legitimize such behaviour and try to silence those who challenge it. When we argue that the people who provide public services should have a greater role in policy, we don’t mean a stronger role for those organisations such as large charities or trade unions that can already promote their views to policymakers, rather we’re talking about the individuals on the frontline who are ignored not only by policymakers but also sometimes by the organisations that claim to represent them.

Could the Hillsborough cover-up ever happen again? Some columnists have suggested that the ‘forensic transparency’ now offered by mobile phones and Twitter would make it much more difficult and that there is a danger of over-reacting to scandals such as the Hillsborough cover-up by not trusting any public institutions. But the best mainstream media article of the week for me was by Philip Johnston in the Daily Telegraph, who recognised the broader implications:

“Over the years, the police have been one British institution that has proudly stood comparison with the very best in the world: unarmed (though less so than they used to be), impartial, independent and largely incorruptible. Perhaps that was always a naive caricature; but it was a view so deeply ingrained in our national psyche that we were unwilling to give credence to powerful evidence that suggested otherwise. However, it was not only the police who let down the Hillsborough families: the very institutions that most of us trust to get to the bottom of things – the courts, the media and Parliament – were all culpable.”

This is perhaps a rather middle class view – many working class communities have always had a less trusting view of the police – but it’s a strange week when the Guardian tells us to ‘go easy’ on the establishment and the Telegraph reminds us to be ever-watchful of those in power.

Surely the Hillsborough cover-up demonstrates that policy can’t be left to the establishment – that arrogance and remoteness breeds bad policy and leads to tragedy (as Daniel Taylor argued in the Observer yesterday). It reinforces the importance of the individuals who provide public services having a much greater voice in policy, so that they can speak freely and honestly outside of institutional interests and constraints.

Perhaps what’s most frightening about institutional power is not its ability to make evil decisions but its collective capacity for ignorance regarding of the effects of those decisions. The answer to the question from the commentator on the Liverpool Echo site is that such ignorance comes most easily to those remain safely distant from the consequences – another reason why we should listen more closely to those at the frontline, both service users and providers, rather than the policy establishment. As C. S. Lewis wrote:

“I live in the Managerial Age, in a world of Admin. The greatest evil is not now done in those sordid dens of crime that Dickens loved to paint. It is not done even in concentration camps and labour camps. In those we see the final result. But it is conceived and ordered (moved, seconded, carried, and minuted) in clean, carpeted, warmed, and well-lighted offices, by quiet men with white collars and cut fingernails and smooth-shaven cheeks who do not need to raise their voice. Hence, naturally enough, my symbol for Hell is something like the bureaucracy of a police state or the offices of a thoroughly nasty business concern.”


Andrew Lansley is gone, but his closed approach to policy-making is likely to continue

We have a new secretary of state for health  but not apparently a new policy for health, or a change in the way that health policy is made. The way to improve the NHS is apparently the same as it was before Andrew Lansley was sacked  more outsourcing and competition. Jeremy Hunt has been appointed to implement this policy by being a ‘better communicator.’ But the Government’s reforms are unpopular not because of how they have been presented, but because of how the policy was developed – including the fact that no-one voted for them.

Under Any Qualified Provider, private health providers are likely to profit because, in contrast to existing NHS services, they can offer worse terms and conditions for staff, they will not be subject to the same regulations of transparency and accountability as NHS providers or bound by the same financial regime. AQP is a not about establishing a ‘level playing field’, or even about extending proper choice (since patients will not be told who owns providers including whether they are profit-making). Rather, it’s a programme to turn the NHS into a ‘trojan brand’ for private health provision, paid for by the public, while NHS providers lose income and some will have to close – so making the NHS as a whole less sustainable.

Whether you think these are the right reforms or not, they are not a popular because the public has never voted for them and haven’t been involved in developing them. These policies are not completely new of course – many of these ideas are shared across the main political parties, and this particular policy has already been applied in elective care. But this only reinforces the point. AQP is a classic example of the ‘Whitehall consensus’ – the shared view about the obvious rightness of outsourcing held by the policy establishment in the political parties, most Westminster-centric commentators and think tanks – that ignores what the majority of people who use and provide public services including the NHS actually think and want.

Andrew Lansley’s real problem was that he epitomized this approach to policy-making. The issue wasn’t his personal style or language, more that as a member of the Whitehall consensus he assumed that outsourcing is obviously better than ‘monopoly provision.’ It’s this that explains one of his most famous quotes, to nurses at a Royal College of Nursing conference, that: “I am sorry if what I’m setting out to do hasn’t communicated itself.” He thought the case for outsourcing was so obvious that he didn’t really understand why it had to be made at all.

As befits a former senior civil servant and head of the Conservative Research Department, Lansley’s approach reflected the way that policy wonks often approach public services. They seem to assume that institutions such as the NHS can be re-engineered according to blueprints, rather than respecting them as collective institutions with complex cultural as well as organisational histories. Hiring the like-minded (and self-interested) from management consultants such as McKinsey to sketch out massive structural changes reinforces this blinkered thinking, at the expense of any real world, practical engagement with improving how the health service operates, how patients are treated, and how resources are spent and saved.

In the name of greater efficiency, Lansley’s reforms have already wasted hundreds of millions of pounds and distracted health staff from the day-to-day business of improving services. But the point of hiring McKinsey is that they ‘get it’ – they share the view that the (lack of) evidence for outsourcing doesn’t need to be put before the people because they too assume that private provision must be better than public. This outsourcing of policy to the like-minded, even though they are likely to benefit from the policies they help to develop, is the same reason that parts of public health policy under Lansley were effectively outsourced to fast food companies.

This closed and cosy approach will continue as long as the political class is largely drawn from the same old PPE-think tank-commentator axis which pays the greatest respect to an elegant argument and a nicely designed slide deck, but which lacks any real experience of public services, or indeed any broader experience of life outside the Whitehall consensus. The lack of public engagement, and public mandate, for the Government’s health reforms further erodes public confidence and trust in policy-making. The greatest irony of all is that the reforms were supposed to be about devolving power and enabling shared decision-making between GPs and patients. At the heart of these policies, however, is a fundamental lack of accountability – at the level of some (privately-provided) individual services but also for the reforms as a whole.

What’s worrying about the appointment of Jeremy Hunt is not his lack of knowledge of health services – after all, Andrew Lansley held the health brief for many years, and look what happened. It’s that in his time at the Department for Culture, Media and Sport he adopted a similar behind-the-scenes, and way-too-close, relationship with corporate interests against a loved and largely respected but inevitably imperfect public institution (in this case, the BBC). The NHS is still – just about – a public institution. Its future should be deliberated, developed and determined publicly.


Selling public services – why think tanks promote the ‘Whitehall consensus’ for outsourcing

In posts over the past few weeks, we’ve looked at the issues of accountability, transparency and reliability raised by the Government’s ‘open public services’ agenda, in particular its plans to outsource more public services. We’ve focused especially on how outsourcing threatens to undermine another recently announced Government initiative, that for ‘open policy making.’ In the absence of reliable and rigorous evidence for the benefits of outsourcing, why have so many think tanks continued to push outsourcing?

Some of the loudest cheerleaders for outsourcing have been in think tanks. In addition to conservative parts of the media, many think tanks have played an important role in promoting the ‘Whitehall consensus’ in favour of outsourcing – whatever the reality of outsourcing at the frontline for the people who use public services and the people who provide them.

The explanation for some think tanks ignoring the public and public service workers is that often think tanks consider them to be part of the problem. Starting in the 1970s, a group of commentators began to characterise organised frontline workers and service users as the underlying cause of the country’s problems. These commentators were often found in, or heavily informed, by right-wing think tanks such as the Institute of Economic Affairs and the Centre for Policy Studies.

Their argument was that public sector workers and ‘interest groups’ (including people who benefit from services) in effect hold politicians to ransom until governments pay them off by spending more on services. This only serves to make these interests stronger and so turns the “collectivist ratchet” inexorably away from a free society and towards the big state. As a result, not listening to frontline workers (and ‘self-interested’ service users) became a matter of political principle – the only route to genuine reform in the public interest.

Another implication of this argument was that if the state couldn’t be slashed overnight (because interests in favour of the state were too strong), then private companies should at least be given a much greater role in delivering public services. This would produce more efficient and effective services. It would also reduce the power of public sector unions – and possibly pave the way for privatisation.

A related argument often made by some think tanks has been that public services are over-regulated – over-inspected, over-measured, and over-directed. Combined with outsourcing, in practice this means that private companies taking over the running of public services should expect less close inspection than used to be the case with the public bodies that previously ran services (although the same commentators are largely quiet when it comes to addressing failures of ‘light-touch inspection’ such as Winterbourne View).

It’s not surprising that right-wing think tanks pushed this argument – it’s their job to promote their particular ideology and they do it unashamedly. What’s more surprising is that supposedly progressive left-of-centre organisations have also promoted the Whitehall consensus in favour of outsourcing and less regulation – or as they prefer to put it, for more ‘diversified provision’ and greater ‘innovation’. The question is why – and why they have often seemed so uninterested in asking the more fundamental question as to whether outsourcing improves the quality or efficiency of public services, especially from the point of view of the people who use and pay for these services.

Think tanks often present themselves as fiercely independent – as ‘intellectual outriders’ that are prepared to ‘think the unthinkable’. In reality, think tanks also need to pay the bills, and outsourcing interests often have deep pockets. This is the time of year when think tanks promote their party conference events. Sponsors of think tank events at last year’s party conferences with a direct interest in outsourcing included PwC, VertexPearsonCareers Development Group, the Association of Employment and Learning ProvidersSodexoAvantaManpowerWorking LinksDeloitteKPMG, and G4S.

Most of the time, government feigns ignorance regarding the potential influence of these interests. Last week however, the Department of Health dismissed a paper written by Conservative MP John Redwood for the Centre for Policy Studies as “misleading and inaccurate” in part because of “influence” (unspecified) by Partnership Assurance – “an insurance provider known to be critical of a cap on care costs” (in his paper, Redwood had called on the Government to abandon proposals by the economist Andrew Dilnot to cap the costs of elderly social care).

It’s ironic of course that the Government dismissed the Centre for Policy Studies’ argument for the same reason that the CPS has consistently used for dismissing the views of public sector workers and service users – that of narrow ‘self-interest’ at the expense of genuine public interest. Applying the same logic would mean that government should ignore the arguments made by many think tanks when it comes to outsourcing public services. Should it – and will it?