Tuesday 16 July 2013

How to broaden and deepen what public services can do

They finally let Norman Lamb into the Today programme yesterday morning at the last possible minute before 9am, to talk about the potential role of neighbourhood watch groups in looking after older people.

I’ve done that Today slot myself and it doesn’t give you much chance to say much, still less to answer whatever bizarre take on the subject that John Humphries has in his head that morning.

And this is a pity because, far from a peculiar thought by the social care minister (Lamb) - after the disastrous coverage of NHS hospitals over the weekend – Norman’s proposals are absolutely central to the new public services that are struggling to emerge.  By which I mean better and more effective than the old.

It reminded of what Julia Neuberger said about the last days of her uncle. In her book about older people, Not Dead Yet, she described with horror how her uncle was neglected in three of the four hospitals in which he lived his final weeks. She explained that the one exception was also the hospital which was most cash-strapped:

“When my uncle eventually died, in the hospital which really understood and respected his needs and treated him like a human being, there were volunteers everywhere. In contrast, there was barely a volunteer to be seen in the hospital which treated him like an object, although it was very well staffed. At a time when public services are becoming more technocratic, where the crucial relationships at the heart of their objective are increasingly discounted, volunteers can and do make all the difference.”

She was writing shortly after the first Mid-Staffs revelations. What she suggests is that volunteers are the antidote to this. In wards where older patients might otherwise be mistreated or ignored, she says, “the mere presence of older volunteers are the eyes and ears that we need.” Human beings provide that kind of alchemy, however target-driven the institution is around them.

Now, Julia Neuberger was talking about hospitals, not about social care and companionship, but the move towards getting volunteers into public services to work alongside professionals is not just about using resources better – it is also humanising. It is the antidote to de-humanising targets, and to hidden brutalities in the system that we find out more about every time the Sunday papers drop through the letterbox.

I wanted to say three things about this.

1. There is huge demand from the potential volunteers. Patients working alongside professionals is not just a nice add-on, it is the future of public services – and on a scale way beyond anything we have contemplated so far. Working on the Barriers to Choice Review convinced me, not only that there are huge potential benefits to this kind of approach, but also that there is a huge appetite among people to do it – over 17,000 trained volunteer health champions in Yorkshire alone. They welcome it is a way to feel useful and to get training and experience and this needs to shape the future of services on a much bigger scale.  Sceptics say that people won't be prepared to volunteer for public services; on the contrary, a lot of people will.

2. It can broaden and deepen what public services are able to do. It can provide services with an ability to reach out into neighbourhoods and visit people when they’ve just come out of hospital, help children with reading, befriend lonely people, and do all those things that services really ought to do now but actually can’t (this isn’t about cutting services, it is about extending them). We need to use public services as a backbone for what would otherwise be an amorphous and vague Big Society, to knit communities back together around services on a massive scale. As the main thing they do, they will be asking their beneficiaries to give something back.

3. It can blur the boundaries between services. Because, when you work with what people really need, face to face, they don’t fit neatly into departmental boundaries. So when you start this co-production approach, you automatically start making all public services multi-departmental and multi-disciplinary. So I’m not at all surprised that Norman Lamb extended the idea of a policing initiative to tackle loneliness. That is what co-production does. It makes services more all-embracing, more human, more informal and less rigid.

That is the direction we need to go in. It means an enormous extension in volunteering, not through the voluntary sector – this is not about middle class semi-professionals ministering to the needy – but through the public sector, where the beneficiaries support each other.  As a major element of their new design.

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