Bringing back the power of community
From a blog at the British Medical Journal and other sources
In November 1942, the Second World War coalition government published the 'Social Insurance and Allied Services' report, which became known as The Beveridge Report. This became fundamental in the founding of the welfare state in the United Kingdom.
It was drafted by the Liberal economist, William Beveridge, who proposed widespread reforms to the system of social welfare to address what he identified as "five giants on the road of reconstruction":
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want – an adequate income for all
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disease – access to health care
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ignorance – a good education
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squalor – adequate housing
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idleness – gainful employment
One of the principles was that policies of social security "must be achieved by co-operation between the State and the individual", with the state securing the service and contributions. The state "should not stifle incentive, opportunity, responsibility; in establishing a national minimum, it should leave room and encouragement for voluntary action by each individual to provide more than that minimum for himself and his family".
The Labour Party won the 1945 general election on a platform that promised to address Beveridge's five Giant Evils. The report's recommendations were implemented through a series of Acts of Parliament e.g. the National Insurance Act 1946, the National Assistance Act 1948, and the National Health Service Act 1946.
However few people know about William Beveridge’s 1947 report, Voluntary Action. For Beveridge private action for public purpose was an essential complement to the welfare state. He recognised that he had made a mistake in leaving out of his plans a greater role for families, communities, volunteers, and civil society. He didn’t like that the state was doing everything. “It did frankly send a chill to my heart,” Beveridge complained. But it was too late - the genie was out of the bottle and the model was also being adopted by other countries around the world.
He worried that some core groups were not benefiting from his reforms; and he was increasingly aware that communities, rather than distant, cold and hierarchical institutions, are often much better at identifying needs and designing solutions.
In a book "Radical Help: How we can remake the relationships between us and revolutionise the welfare state" by Hilary Cottam, visiting professor at the UCL, writes “Beveridge had designed people and their relationships out of the welfare state.” She recognises the centrality of relationships to our lives and health. “Relationships - the simple human bonds between us - are the foundation of good lives. They bring us joy, happiness, and a sense of possibility. Building on relationships enables the growth of further capability: supporting us to learn, contributing to good health and vibrant communities. Without strong bonds with others, or with unhealthy relationships, very few of us can feel fulfilled - or even function.”
She argues that the welfare state, something we all value, no longer responds adequately to 21st century problems: global warming, mass migration, demographic changes, chronic disease epidemics, concerns about security. and escalating inequality. The welfare state needs not just to change but to “pivot…a special kind of change that involves a new vision, a different solution and a new business model.”
A pivot, explains Cottam, is not just another word for change. “The pivot is a special kind of change that involves a new vision, a different solution and a new business model. The pivot offers transformation, the potential for something much better and more successful.” It requires great courage to pivot, and many enterprises and businesses have failed because they lacked the courage.
Cottam argues that “Our most difficult relationship - the one that most threatens our health - is our relationship with the medical establishment. Medicine has captured our hearts and our minds. We are in thrall to the NHS and emotionally attached to our doctors.” We look to doctors, other health professionals, and the NHS to solve problems that cannot be solved by drugs, operations, and even simple advice. To avoid dependency we need to look elsewhere for help - to ourselves, our family and friends, our communities, and civil society.
The NHS, for example, is well designed for vaccinating the population against covid-19 and other infections, but it is not best placed to deal with loneliness, despair, inactivity, and unwise behaviour that may result from life. Death, dying, and grief have moved too far from families, community, society, and culture into healthcare. Health professionals are the best people to administer morphine for pain and treat breathlessness, but not to respond accompany people through the long and lonely hours of dying.
“The current welfare state,” writes Cottam, “has become an elaborate attempt to manage our needs. In contrast, twenty-first-century forms of help will support us to grow our capabilities….Traditional welfare approaches see you as dependent according to their biases and then in response they try to give you something or do something to you, to manage your need in the best way they know how. The capability approach shifts the way support is offered.”
Much of Radical Help describes experiments where Cottam and others have designed ways of responding to problems:
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Identify a problem e.g. loneliness, and a location and partners with whom to work. These include people with lived experience and people from statutory services.
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Define the opportunity. This requires a great deal of listening. Listening works best with people who are not in authority, but who are prepared to listen to those at the edges for a long time.
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Devise a prototype response that may be continually modified. Resources must be unlocked, and there must be a business case made.
The emphasis in Radical Help is on building capabilities. Cottam identifies four that she thinks matter the most:
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Learning: the ability to grow through enquiry and meaningful work - the chance to develop our imaginations;
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Health: our inner and physical vitality are central to a flourishing life, and good health implies a delicate balance between the acceptance of our minds and bodies and a commitment to good habits;
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Community: being part of and contributing at the local and planetary level to a sustainable way of life, working alongside others in an effort to bring about change or to make something together;
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Relationships: a supportive and close network with others, some of whom are similar to us and some of whom are different.
As both state and market fail to resolve social problems, social action has been experiencing resurgence and disruption. New institutions and organisations - impact investing, venture philanthropy and social enterprise – supplement or replace traditional non-profit organisations and charities. But there is still a power imbalance. How should the state, market and community organisations work together? Does the welfare state crowd out valuable voluntary action?
Read more here.
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From a blog at the British Medical Journal and oth, 19/11/2024