What should we do with the welfare state? Our once brilliant welfare institutions transformed lives and were emulated globally, but they no longer work.
Invest more money argue those on the left. Better management counter those on the right.
The truth is that our troubles run deeper. Working with communities across Britain I have seen how systems designed in a different era cannot help us with the challenges of today.
I have learnt that we must start again, asking not how we can fix our post war institutions but rather how we can support flourishing lives. It’s a way of working that led me to Anne.
Anne is unwell, in pain and overweight. Keeping appointments with nine specialist doctors is her full-time job. But when I meet the doctors, they tell me something Anne already knows – the drugs don’t work. Anne needs radical help to change the way she lives.
Anne represents the biggest challenge faced by the NHS, and health systems globally: how to shift from the last century’s fight against infectious disease to today’s challenge of living with chronic illness.
One in four of us have a chronic condition: ailments which include diabetes, depression and the complications of old age. Our health services can’t cope. 70 percent of hospital expenditure is dedicated to managing these complex conditions which cannot be cured.
We need motivation not medicine and this requires a different approach.
The mismatch between the services on offer and 21st Century challenges goes well beyond health. From loneliness to ageing, education to modern work, our once brilliant welfare system is out of kilter and beyond re-organisation.
It’s near impossible for the dedicated professionals involved and promising more money, nurses or carers won’t work either.
Employment services illustrate the challenge. They have been re-named and the benefits re-calibrated but the essentials remain the same: money and advice. It’s no surprise that the failure rate is 66%. We are at the start of a new industrial revolution powered by digital and other emergent technologies. We need new skills and different ways to find work. Today most jobs are not advertised. To find work and to progress you need social connections. The millions of Britons struggling in low paid work know this. They need something new.
I set up a door in a South London job centre: ‘Get Me Out of Here’ read the words emblazoned across it. I wanted to try a different approach: one that started with people’s own dreams. We connected those in and out of work together and focused not on the job alone but on how to get up the ladder when in work. I asked anyone who wanted to join to pay £5 and come through the door.
With those who walked through, I used simple tools and public meetings to connect people and take practical steps towards long term goals. Low cost digital platforms enabled us to work with many at low cost. We had an impact. Our approach cost one fifth of current services, fostered skills and enabled 87% of members to make progress in or towards work.
This is 21st Century welfare. It starts where you are and instead of commanding change or trying to fix you it offers support to grow capability. It includes as many people as possible given that it is our relationships that help us find work, keep healthy and care for one another.
I design with people. I ask families isolated on tough estates, who feel angry and locked out, to draw on new support with transformative results; I work with older people on a community service that brings joy and affordable warm care.
With Anne we create an alternative. The remedies might look unfamiliar – change for Anne started when she was encouraged to start her needlework again – but the results impressed clinicians.
Radical as they may sound these ideas are not new and they cost less money but they are on the margins, working in spite of our post war institutions.
As Britain emerged from the ravages of war and the economic crisis of the 1930s William Beveridge – the architect of the welfare state – declared it was ‘a time for revolutions, not for patching’.
Today we need our own revolution. We must combine a big vision with what is already working on the ground. This new social contract must start with us, it must move the new from margin to centre, harness the resources of this century and liberate our professionals to support change.
Hilary Cottam is the author of Radical Help: How We Can Remake The Relationships Between Us And Revolutionise The Welfare State