Is This How to End Public Service Failure? Suppose You Had to Pay for Medical Treatment-Not in Money, but through Helping Other Patients. David Boyle on the Next Big Idea for the NHS, Schools and Welfare

By Boyle, David | New Statesman (1996), February 23, 2004 | Go to article overview

Is This How to End Public Service Failure? Suppose You Had to Pay for Medical Treatment-Not in Money, but through Helping Other Patients. David Boyle on the Next Big Idea for the NHS, Schools and Welfare


Boyle, David, New Statesman (1996)


Imagine that the people who benefit from public support were asked to pay back in some way, not with money but by helping others. That wasn't how the welfare state was intended to work--but it is an idea being explored at the liberal end of US politics, by philanthropists and professionals. Their answers may turn out to be relevant to one of the central questions facing the "Blair project": why, despite big injections of cash, are the problems that the giant welfare bureaucracies were set up to tackle as bad as ever? Why have nearly six decades of the welfare system made so little difference to poverty, youth crime, ill-health and school failure?

This is a revolution in its early stages. It barely has a label yet--though its practitioners are starting to call the new thinking "co-production"--but it emerges out of the failure of communitarian writers such as Amitai Etzioni and Robert Putnam to come up with much of a solution to the social breakdown they identified.

Put simply, "co-production" means that welfare programmes, policing and health need to be equal partnerships between professionals and clients. Politicians have been paying lip-service to the idea for a generation. What makes this latest thinking more subtle and revolutionary--and why policy-makers in the US and Japan are getting excited about it--is that "co-production" has come up with practical and often surprising ways in which professionals can transform their relationships with their clients.

Such as the poorest neighbourhoods in downtown Boston that work alongside Harvard professors to eliminate drug-resistant diseases. Or the 16-year-olds from some of the most notorious housing in Washington who run their own courts under licence from the District of Columbia. Or the pupils in failing Chicago schools who earn themselves recycled computers by tutoring younger children--with the result that the schools now record consistent gains in maths and reading among pupils who used to fall further and further behind each year.

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Co-production first emerged at the University of Indiana in the 1980s as a way of explaining how policing fails without community support. Its ideas received dramatic support in 1997 from the Harvard School of Public Health. In a study of more than 300 Chicago neighbourhoods, the academics concluded that the main determinant of the crime rate wasn't income or employment but trust: whether or not people were prepared to intervene if they saw local children hanging around.

The concept was extended by the former civil rights lawyer and speechwriter for Robert F Kennedy, Edgar Cahn. He accuses professionals of creating dependency: a dependency of a peculiarly corrosive kind which convinces people that they have nothing worthwhile to offer, and which undermines what systems of local support still exist. "Professionals must learn how to say: 'I need what only you can do as badly as you need what I can do'," Cahn says.

In America, where philanthropy still plays at least as important a role in welfare as the state, most of Cahn's work has been done with charitable foundations. He argues that most philanthropic money doesn't get to the poor. It goes on the infrastructure and the professionals, and the hidden message is that people can gain access to help only if they have problems and crises. "Charity has to become a two-way street," he says. "Money, philanthropy, programmes alone can't cure social problems if we can't enlist those being helped as partners and co-workers."

US professionals who flirt with such ideas are often treated with suspicion by colleagues. …

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