Sunday, 16 February 2020

How might we go about enacting a no #tickbox policy?

This post first appeared on the Radix blog...

Here are the three most egregious versions of tickbox that I have run across in the last few days…

First, the government’s proposals to reform the early years foundation stage, which the Early Years Alliance warns is risking turning it into “a series of bullet points … a narrow tickbox approach.”

Second, the unmissable NHS blogger Roy Lilley used a similar word to attack the CQC, the doyennes of tickbox in the health sector:

“The Confed, Providers, NAPC, the Shalfords, the Mulberries, unions, the think-tanks should find the guts to say what the dogs in the streets know…

…it is time for a narrative that says; when we started to look for quality improvements all we had was a clip-board and a box to tick. Now, we have data, algorithms and machine learning. We are able to spot problems in the making, warn leaders and support them to sidestep disaster. Keep us safe...

When there are viable, sensible alternatives, to carry on with clapped-out inspection wins no applause from the people failed by quality…”

Third, the so-called uberization of mental health in an important article by Dr Elizabeth Cotton who writes the blog Surviving Work. The article followed the conference last year called the ‘industrialistion of care’.

This refers to the way the government’s favoured IAPT approach to mental health is “based on a series of patient assessments that use tightly-scripted questionnaires allowing only minimal freedom of discussion between therapist and patient.”

This is the model that is increasingly being delivered online, often by staff unqualified as psychologists.

Complaining about people’s lack of qualifications is the layman’s version of tickbox, but there is no doubt that people’s special mental health needs requires this excessive simplification. More on the mental health aspects of tickbox in my book.

I suppose I would probably add the government’s consultation on green regulations for new homes, now closed. Stupidly in my view, they want to prevent local authorities from experimenting with setting their own higher environmental standards for new build – on the grounds that you can save money if everyone has the same regulations.

Thus is a classic tickbox mistake, because economists tend to measure economies of scale but ignore the diseconomies of scale.

So whether it is bowlderisation, stupidiification or uberization – or McDonaldisation (the title of a 1993 book by Georg Ritzer) – we know tickbox now for what it is, an insidious and creeping problem that is suffocating our ability to act on the world.

I proposed in my last blog a self-denying ordinance, a pledge signed by professionals, promising to ignore the tickboxes imposed on them and do what is necessary for who ever stands before them.

That seems to me to be one approach, appealing to the humanity and pride of the professions and challenging them to show they have not been completely hollowed out.

Could we also legislate for large organisations so that, when they use a tickbox system, they must also provide an obvious and easy access to a human being if people want one? But then, what such legislation would actually be trying to tackle would be the way that some organisations, public and private have such overwheening confidence in their own systems (the Immigration Service and myHermes spring to mind) that there is no way to register a complaint which has any chance of reaching a human being.

What else do we need for a fully-fledged No Tickbox policy that might be enacted? Please let me know…

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Blissex said...

Your argument is based on a very optimistic political premise, that affluent property owning voters from "Middle England" want to pay more taxes for "scroungers" to get professional judgement and personal attention in their services, be those mental health, or fast food.

The concept that instead is being pushed is that of "plan", that is copper plans for the lower classes, bronze plans for the middle class, silver plans for the upper-middle, and gold plans for the upper class. In the same way there is shopping stratification: Aldi and TESCO for the lower classes, Sainsbury for the middle class, M&S and Waitrose for the upper-middle class, and F&M for the upper class.

The overall idea is that copper plans will be selected purely for being cheap as they will be funded by the state, bronze and silver plans will be paid by employers, and gold plans will be paid by personal wealth. The old notions of 1st, 2nd, 3rd class and steerage class service have become "plans".

Inevitably the copper plans will be delivered in the cheapest, most oppressive "tickbox" fashion and bronze plans will be halfway, based on the universal conceit by the middle, upper-middle and upper classes that they will fall on hard times, so what happens to the lower classes does not matter because it will never affect them.

Blissex said...

«based on the universal conceit by the middle, upper-middle and upper classes that they will fall on hard times»

Oops, that should have been "will [never] fall on hard times". And that includes their childen or grandchildren, if any.

Blissex said...

«the ‘industrialistion of care’.»

The point I am making is that the beneficiaries of gold and silver plans are not impacted by “the industrialisation of care”, and don't want to pay more taxes to fund better service for bronze and copper plan subjects, and also many bronze plan beneficiaries are fearful that even just upgrading copper plans to bronze plans will raise taxes on themselves or result in an averaging out of copper and bronze plans. Put another way, many voters are thatcherite.

The question that matters about copper "steerage" and bronze "3rd class" plans driven by tickboxes is: who is going to pay for that “pledge to [...] do what is necessary for who ever stands before them”.

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