This is good. It is worth emphasising how many ways the state actively obstructs relational ways of working, starting with Whitehall’s addiction to siloed based services and upwards and disconnected models of accountability.
Yes to all of this. Take parish councils; the best of them are full of people who know their patch and its people inside out and have the motivation and ideas to help. But with the forthcoming local government organisation, their voices will have an even bigger struggle to be heard by huge unitary authorities that aren't close to the people they serve and are – if county councils are anything to go by – more interested in process than in outcomes.
Agree entirely about local government reorganisation which appears to be driven more by the desire to cut costs and make it easier for Whitehall to exert control, rather than any sense of bottom up representation. Quite odd for ministers to adopt the Osborne approach to local government when there’s a very clear sense that people feel that they are “losing control”.
A conversation that could not be more welcome. There has been criminal neglect of this fundamental issue for too long. It is hard not to wonder where we would be if the last 10 years had been focused on it rather than the referendum and it's fallout.
You’re right about the state using its power to enable people to support each other, and to want to do so. Unfortunately that starts to shade into uncomfortable questions of belonging and identity (citizens of somewhere versus citizens of nowhere) which provoke strong reactions because they’ve been weaponised by bad actors. John Denham is addressing these issues in his substack and I thought this was an interesting lecture in that vein, recalling the Blairite mantra of rights and responsibilities https://youtu.be/fLWhiugHkbQ?si=vYFHszJpN_xDjl0n
Hi Polly.. interesting note on relational services.
We should privatise NHS service delivery.
We don’t have one GP with whom we have a relationship, who knows us, who knows our family history, and can advice based on that. Only way this knowledge is retained in the notes they keep writing the entire time we are speaking, so that the next GP who sees us gets context. Not ideal. Getting the same GP is hard because the waits are too long.
I grew up in India where we had a family doctor, he saw all of us, and I mean all, including assorted aunts, uncles, cousins, the lot. Often he had the family news before we found out. He could connect the dots on family medical history, what’s hereditary and what’s not.
I had one GP when I lived in US, very expensive but she was a constant and knew me and my family.
The private sector is better than relational services, they have incentives to do that. France and Germany do public financing of healthcare but mostly private delivery, and it works.
The private sector is also motivated to invest in equipment to be more efficient and invest in back-office staff to keep front lines focussed on delivery. They don’t have the political pressure to want say “We spend X billion on front-lines” by starving the capital budgets.
I gave up on NHS for ordinary visits and subscribed to a private GP practice who provides relatively affordable services (https://mediccaredirect.co.uk/membership/). I know the 2 doctors there, they know me and family, and I can get quick and reliable services. And they are both NHS doctors moonlighting!
I think the problem government has is much the same as the problem in all corporate entities: managerialism. This twentieth celebrity philosophy of managing by targets and budget lines doesn't work in either the public OR the private sector. Yet it is taken for granted that this is the best way to do things. No, it may be the comfortable and established way to do things, but that doesn't mean it works. Remotely. Far better, as the article I think suggests, to give frontline people agency to improve things based on their own insights and, especially, those of the customers they (are supposed to) serve. I recommend the work of John Seddon for practical consideration of how to make the public sector deliver much better value for money - evidenced by numerous real-life examples.
Thank you for articulating something I have been feeling for some time about energy; we solve our energy provision problem by building a few mega power plants in far flung places and then spend a fortune distributing it to everyone in the nation. Why not let councils, local organisations,community groups build their own wind and solar farms locally and benefit from the cheap generation while having none of the costs of distribution? Cheap electricity is good for everyone in the community - individual households, businesses, charities etc
Well blow me down, turns out Edmund Burke and the co-operative movement were right all along, we don't need armies of overpaid Oxbridge-educated busybodies to wipe our bottoms for us after all. Who'da thunk it?
Here are two comments. Relational means trust based interactions, the State often treats citizens with distain - DWP, HMRC and Border Force spring to mind. The tone of entering the country is of being observed and controlled not respected and welcomed home as valued citizens. The second is agency requires resources, mental and physical, hard for folks ground down by exploitative working cultures and impoverished local government. Therefore the central-local balance of power in government and corporate lack of responsibility needs to be addressed. Too much box ticking with the usual suspects and not enough enforcement against exploitative employers, bad landlords and the asset strippers of private equity. The State will regain trust if it earns it.
My own experience leads me to immediately consider education and more specifically education for children with SEND. Yes, there is a huge issue with trust, but this is fundamentally down to competence as well as capacity. This is not to say there aren’t individually competent teachers and schools (there are some!) it’s that education as a system - much like the NHS as a system for an ageing population - has not been redesigned with the new, increasing needs in mind. This is a failure in both vision and purpose, rather than relational design. What is education for? And how does it differ between student? My little girl might get one GCSE maybe, but it’s certainly not exams that should determine her educational experience. And what about the student who is not academic but very intelligent? We tend to assess them as less than they are as a result of our assessment methods.
Can relational design inform the increasingly difficult conversations we need to have about the difference between Healthy Life Expectancy and spending the extra 10 years existing, not living, but not being allowed to die?
What is our vision and purpose for these services, and how can the be understand at both the individual and population level?
Thank you for making the core point about state capacity and demand (and need) so clearly. And really good to see you picking up the relational society point.
One thing I would question is your implication that all prevention work requires costs. In my field - ending alcohol harm - I can instantly list ten highly effective policy measures that are either totally cost free or income generating, and that will cut need and demand (at scale) across the healthcare, social care, policing and criminal justice systems within 24 months.
(The Prime Minister has one big red flashing button on his desk, that if pressed would massively and quickly improve the country, titled "Cut alcohol harm". But due to a lack of understanding of what alcohol harm really is or how it actually works; and a lack of insight that it is a vote winner not a vote loser; he has not yet spotted it, let alone pushed it.)
I was also struck that, despite mentioning volunteering and community groups, you didn't also mention wider civil society: charities, social enterprises, cooperative, etc. These are the institutions that are constantly building a relational society, at scale, with deep skill and insight. I would love to hear your thoughts on civil society generally and/or would/love to chat with you about the hidden roles that civil society plays, and could play more, if properly supported by the state (and I don't mean £).
This is good. It is worth emphasising how many ways the state actively obstructs relational ways of working, starting with Whitehall’s addiction to siloed based services and upwards and disconnected models of accountability.
Yes to all of this. Take parish councils; the best of them are full of people who know their patch and its people inside out and have the motivation and ideas to help. But with the forthcoming local government organisation, their voices will have an even bigger struggle to be heard by huge unitary authorities that aren't close to the people they serve and are – if county councils are anything to go by – more interested in process than in outcomes.
Agree entirely about local government reorganisation which appears to be driven more by the desire to cut costs and make it easier for Whitehall to exert control, rather than any sense of bottom up representation. Quite odd for ministers to adopt the Osborne approach to local government when there’s a very clear sense that people feel that they are “losing control”.
A conversation that could not be more welcome. There has been criminal neglect of this fundamental issue for too long. It is hard not to wonder where we would be if the last 10 years had been focused on it rather than the referendum and it's fallout.
You’re right about the state using its power to enable people to support each other, and to want to do so. Unfortunately that starts to shade into uncomfortable questions of belonging and identity (citizens of somewhere versus citizens of nowhere) which provoke strong reactions because they’ve been weaponised by bad actors. John Denham is addressing these issues in his substack and I thought this was an interesting lecture in that vein, recalling the Blairite mantra of rights and responsibilities https://youtu.be/fLWhiugHkbQ?si=vYFHszJpN_xDjl0n
Hi Polly.. interesting note on relational services.
We should privatise NHS service delivery.
We don’t have one GP with whom we have a relationship, who knows us, who knows our family history, and can advice based on that. Only way this knowledge is retained in the notes they keep writing the entire time we are speaking, so that the next GP who sees us gets context. Not ideal. Getting the same GP is hard because the waits are too long.
I grew up in India where we had a family doctor, he saw all of us, and I mean all, including assorted aunts, uncles, cousins, the lot. Often he had the family news before we found out. He could connect the dots on family medical history, what’s hereditary and what’s not.
I had one GP when I lived in US, very expensive but she was a constant and knew me and my family.
The private sector is better than relational services, they have incentives to do that. France and Germany do public financing of healthcare but mostly private delivery, and it works.
The private sector is also motivated to invest in equipment to be more efficient and invest in back-office staff to keep front lines focussed on delivery. They don’t have the political pressure to want say “We spend X billion on front-lines” by starving the capital budgets.
I gave up on NHS for ordinary visits and subscribed to a private GP practice who provides relatively affordable services (https://mediccaredirect.co.uk/membership/). I know the 2 doctors there, they know me and family, and I can get quick and reliable services. And they are both NHS doctors moonlighting!
Thanks for reading.
👀 great arty
I think the problem government has is much the same as the problem in all corporate entities: managerialism. This twentieth celebrity philosophy of managing by targets and budget lines doesn't work in either the public OR the private sector. Yet it is taken for granted that this is the best way to do things. No, it may be the comfortable and established way to do things, but that doesn't mean it works. Remotely. Far better, as the article I think suggests, to give frontline people agency to improve things based on their own insights and, especially, those of the customers they (are supposed to) serve. I recommend the work of John Seddon for practical consideration of how to make the public sector deliver much better value for money - evidenced by numerous real-life examples.
Thank you for articulating something I have been feeling for some time about energy; we solve our energy provision problem by building a few mega power plants in far flung places and then spend a fortune distributing it to everyone in the nation. Why not let councils, local organisations,community groups build their own wind and solar farms locally and benefit from the cheap generation while having none of the costs of distribution? Cheap electricity is good for everyone in the community - individual households, businesses, charities etc
Well blow me down, turns out Edmund Burke and the co-operative movement were right all along, we don't need armies of overpaid Oxbridge-educated busybodies to wipe our bottoms for us after all. Who'da thunk it?
Here are two comments. Relational means trust based interactions, the State often treats citizens with distain - DWP, HMRC and Border Force spring to mind. The tone of entering the country is of being observed and controlled not respected and welcomed home as valued citizens. The second is agency requires resources, mental and physical, hard for folks ground down by exploitative working cultures and impoverished local government. Therefore the central-local balance of power in government and corporate lack of responsibility needs to be addressed. Too much box ticking with the usual suspects and not enough enforcement against exploitative employers, bad landlords and the asset strippers of private equity. The State will regain trust if it earns it.
My own experience leads me to immediately consider education and more specifically education for children with SEND. Yes, there is a huge issue with trust, but this is fundamentally down to competence as well as capacity. This is not to say there aren’t individually competent teachers and schools (there are some!) it’s that education as a system - much like the NHS as a system for an ageing population - has not been redesigned with the new, increasing needs in mind. This is a failure in both vision and purpose, rather than relational design. What is education for? And how does it differ between student? My little girl might get one GCSE maybe, but it’s certainly not exams that should determine her educational experience. And what about the student who is not academic but very intelligent? We tend to assess them as less than they are as a result of our assessment methods.
Can relational design inform the increasingly difficult conversations we need to have about the difference between Healthy Life Expectancy and spending the extra 10 years existing, not living, but not being allowed to die?
What is our vision and purpose for these services, and how can the be understand at both the individual and population level?
Thank you for making the core point about state capacity and demand (and need) so clearly. And really good to see you picking up the relational society point.
One thing I would question is your implication that all prevention work requires costs. In my field - ending alcohol harm - I can instantly list ten highly effective policy measures that are either totally cost free or income generating, and that will cut need and demand (at scale) across the healthcare, social care, policing and criminal justice systems within 24 months.
(The Prime Minister has one big red flashing button on his desk, that if pressed would massively and quickly improve the country, titled "Cut alcohol harm". But due to a lack of understanding of what alcohol harm really is or how it actually works; and a lack of insight that it is a vote winner not a vote loser; he has not yet spotted it, let alone pushed it.)
I was also struck that, despite mentioning volunteering and community groups, you didn't also mention wider civil society: charities, social enterprises, cooperative, etc. These are the institutions that are constantly building a relational society, at scale, with deep skill and insight. I would love to hear your thoughts on civil society generally and/or would/love to chat with you about the hidden roles that civil society plays, and could play more, if properly supported by the state (and I don't mean £).