Unemployed workers at a training scheme in west London take a
break. The government’s talk of “personalisation” is not an attempt to improve provision for them (Pic: Jess Hurd/ Top-down
Leadbetter’s 2004 pamphlet, Personalisation through Participation: A New Script for Public Services, comes with a glowing foreword by David Miliband MP, the then minister for school standards.
Miliband writes, “This pamphlet engages with the key debate facing politicians, policy makers, staff and the public – whether we can build a model of public service delivery that overcomes the limitations of both paternalism and consumerism.”
For most of the 1990s, and into the 2000s, the rhetoric of consumerism in health and social care – “customer choice” – dominated the policies of both mainstream political parties. The reality continued to be top-down financial management and services based on strict eligibility criteria.
In recent years, however, consumerism has lost its positive sheen, having come under attack from a number of directions. Most importantly, there has been the critique of neoliberalism from the anti-capitalist movement that asserts that the world is not a commodity and that citizens are not simply consumers.
Leadbetter sees personalisation as the logical development of neoliberal policies. He writes, “Privatisation was a simple idea… personalisation is just as simple… Services will be more effective by mobilising millions of people as co-producers of the public goods they value.”
He cites a department of health announcement in March 2004 which stated that the number of deaths due to heart attacks in England and Wales fell by 23 percent between 1997 and 2004. Two factors, the statement suggested, were responsible for this reduction.
The first was reforms in NHS cardiac services, including, for example, an increase in the number of people taking cholesterol-reducing drugs.
The second factor – that Leadbetter sees as particularly significant – was lifestyle changes 20 to 30 years earlier, when people gave up smoking in their millions.
Contained within this example, he suggests, are two accounts of how the public good is created. The first comes through the state providing more effective and efficient services to society. The second is through millions of people making what he calls “loosely connected decisions in society” to change the way they live.
He writes, “In this model the state does not act upon society – it does not provide a service. Instead the state creates a platform or an environment in which people take decisions about their lives in a different way. This is bottom up, mass social innovation, enabled by the state.”
The distinction between change from above – action by the state – and what Leadbetter calls “bottom up” change is a potent one. The contrast between change from above and change from below has a very long pedigree within radical left movements.
However, the notion that the state should play a reduced role in the provision of services and that individuals should take on greater responsibility for their own lives is, of course, the central tenet of the neoliberal common sense. This now underpins the programmes of most political parties the world over.
The co-option of left wing terminology is no accident. It is an attempt to dress up an assault on welfare provision in a way that serves to confuse those who would normally be expected to oppose such attacks.
To see the process at work we need only look at last week’s policy review. It was promoted in terms of personalisation, but the substantial proposals in the report involve increasing privatisation of health, education and welfare – including the rights of firms to launch hostile bids to run public services.
What Leadbetter misses in his smoking example is the structural inequalities that impact hugely on people’s health and welfare.
For, while levels of smoking have indeed declined significantly over the past three decades, as he himself acknowledges, this decline is mainly due to the number of middle class men who stopped smoking two decades ago.
The link between smoking and class is of course well established and shows little sign of having changed over these decades.
The New Labour model of personalisation also fails to consider the limited choices that exist for many users of welfare services. A 1997 study, for example, showed that the most common shared characteristic of those who use social work services is that they are poor – with nine out of ten reliant on state benefits.
They are also likely to experience a range of other, often poverty related, difficulties, including mental health problems, violence and experience of the criminal justice system.
This means that while we should support and encourage the expansion of users’ control over services, the choices that are available to many who rely on the welfare state will often be very limited, especially for those designated as “involuntary clients”.
Some of the consequences of shifting emphasis from the state onto the individual can be seen in the government’s attacks on those claiming disability benefits.
Denouncing the “dependence” of those on benefits and emphasising their responsibilities can legitimise policies that are not empowering, but punitive.
On one issue at least, however, the proponents of personalisation are absolutely correct.
In an interview in early 2006, David Miliband – at that time the minister for communities and local government – argued that the central issue of the 21st century is “about people having more control over their own lives… there is this sense of powerlessness… and it’s important that we come to grips with it”.
That very real sense of powerlessness is indeed a key issue for our concern. Despite all its rhetoric to the contrary, the government does not want the empowerment of people who claim benefits and use services because it would mean placing the needs of people above the needs of the free market.
The logic of personalisation is for the individual to accept that whatever difficulties have befallen them are their own fault and their own responsibility. The welfare state can, therefore, impose strict limits on its willingness to provide help and support.
Overcoming the sense of powerlessness that Miliband notes will require something very different – the development and strengthening of collective organisation both amongst those who use public services and amongst those who provide them.
Iain Ferguson is a senior lecturer in social work at the University of Stirling