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Graeme Cooke and Rick Muir: The Relational State

Catherine Needham

 

The Relational State
Edited by Graeme Cooke and Rick Muir
IPPR, 2012

 

An emergent consensus on the value of relational accounts of public services.

 

At the launch of the national evaluation of the Personal Health Budgets pilots in early 2013, the evaluation team expressed some surprise about how much people had valued the time spent sitting down with a professional to talk at length about their interests and needs – rather than this being merely the means to an end of a care plan and a budget (for the full evaluation report see Forder et al., 2012). Such a finding will not surprise contributors to this new IPPR collection on The Relational State. Although the editors make a claim for the novelty of the content – stating that it replaces the ‘virtual silence across much of the centre-left on questions relating to public services and statecraft’ (p. 3) – it is best seen as a culmination of work on public services emanating from a range of bodies. These include the IPPR itself, Demos, the Young Foundation, NESTA, the New Economics Foundation, Participle and the RSA. Together these works signal an emergent consensus on the value of relational accounts of public services: that ‘recognising the importance of human relationships could revolutionise the role of the state’, as the subtitle of the collection puts it.

The lead essays in the collection are provided by Geoff Mulgan and Marc Stears; they each provide a wide-ranging and provocative piece, followed by shorter articles on specific aspects of public services which situate them in the context of Mulgan’s account of the ‘relational state’. The editors are keen to highlight that there are key differences in what is argued by different contributors: this is not a single blueprint for action. Mulgan, for example, takes a much more instrumental view of relationships and a more interventionist view of the state than Stears. Mulgan, along with the editors and contributors such as Nick Pearce, seem to be explicitly looking for a new ‘centre-left statecraft’ for Labour, and to make peace with its governing legacy along the way. The editors position the ‘relational state’ argument as a ‘blend of “Blue Labour” and “New Labour” thinking’ (p. 10). Others such as Stears are less haunted by the ‘dominant statecraft of the last Labour government’ (p. 8) and more concerned about the democratic potential of a more relational politics. Whereas for Mulgan better relationships are a crucial element of achieving better outcomes in public services, in Stears’ essay democratic relationships have intrinsic value. States themselves cannot be relational, Stears argues; they can only protect the time, the places and the institutions that enable people to engage in relational activity. He frames the state as an ‘agent of standardisation’, whereas ‘nothing is more flexible, contingent, ever-changing, particular or beyond control than a proper, rewarding, human relationship’ (pp. 38-9).

The editors (Graeme Cook and Rick Muir) provide a substantive introductory discussion of these themes and tensions (which is a useful entry point for readers in a hurry). The whole collection is thoughtful and challenging, and it is impossible to do justice here to its full range of ideas and proposals. There are four areas, though, where I would have liked to see the authors set out their ideas more fully.

The first is how people working in public services can be supported to acquire the skills required by the relational state. Mulgan argues that the skills and capabilities of people working in a relational state will be different to those in the ‘delivery state’: ‘the ability to empathise, communicate, listen and mobilise coalitions of citizens and professionals to achieve social goals’ (p. 10). For example, he suggests that we ‘make healthcare more like education, deliberately aiming to raise the skills of the public through, for instance, courses or e-tutorials’ to support people with diabetes and dementia. Such findings resonate with those of the University of Birmingham Policy Commission (2011) into the future of local public services, which identified new roles that staff will play in twenty-first century public services – ‘navigators’, ‘brokers’, ‘storytellers’, ‘resource-weavers’ – as part of a process of supporting citizens to be ‘co-authors of their own lives’ (1).

Supporting professionals in acquiring these skills and building effective relationships is a key challenge, but one which professional bodies, universities and service providers are not yet well set up to meet. There needs to be an emphasis on how to share learning across professional silos and to ensure that those engaged in relational services, such as health care assistants, social care workers, and classroom assistants, are not excluded from a process which is explicitly targeted at the ‘professions’. To embed the right attitudes from workers, the editors suggest that ‘a bargain could be struck’ in which professionals are freed from ‘the worst aspects of a distracting compliance culture’ and rewarded for excellence (‘with their own performance rigorously held to account’) (p. 18). Mulgan calls for professionals to be appraised through 360-degree feedback from key stakeholders. Yet there is a clear danger that such performance measures become part of the ‘audit culture’ which Stears identifies as being completely antithetical to the relational revolution. Alex Heitmuller’s contribution on the NHS raised some concerns for me here. He makes the point that the NHS is starting to appreciate the importance of relational aspects of care, ‘but lacks a consistent approach’ (p. 53). However, the idea of a consistent approach across the whole NHS seems entirely against the spirit of relational publicservices.

A second area where more development would be useful is on how the emphasis on relationships will intersect with an outcomes-focus. Mulgan writes: ‘Some of the goals of government have to be concerned with outcomes – fewer families in crisis, for instance, or better survival rates in hospitals. But others should be relational...’ (p. 25). But events at Mid-Staffordshire remind us that the link between outcomes and relationships of care is a crucial but complex one, and that neglect of the relational can end up also compromising the ‘harder’, more measurable outcomes.

These complex links between relationships, outcomes and culture are underplayed in the book, and would merit further attention, particularly in the context of the Francis Report. A recent article about the NHS argues that over-worked nurses make their working lives manageable by identifying some patients as ‘poppets’ and lavishing care on them, whereas others are treated merely as ‘parcels’ to be processed (Maben et al., 2012). Rustin’s (2005) work on why social workers reacted the way they did in the case of Victoria Climbie described the social workers’ responses as a form of ‘mindlessness’ in the face of unfathomable suffering. Such cases, extreme though they are, remind us of the difficulties of sustaining relationships in understaffed, demoralised, stigmatised services. Such ethical issues are not limited to the traditionally caring professions. In Impossible Jobs in Public Management (1990), Hargrove and Glidewell write of the difficulty of acting ethically in large, complex state bureaucracies in which staff have limited legitimacy, high conflict and low professional authority, and include inner-city teachers and police officers in the scope of their argument.

Third, I would have liked more discussion of how the contributors’ enthusiasm for devolving funding down to the individual level through personal budgets and pupil premiums will intersect with the emphasis on relationships. The literature on social work has highlighted potential tensions between individualised funding and a therapeutic social work based on valuing relationships. Houston uses Alex Honneth’s critique of individualisation in modern society to argue against personalisation: ‘at the heart of [personalisation] is an impoverished ontology, namely one that fails to accord sufficient weight to the primordial and existential realities of human inter-dependence, inter-being and symbolic interaction. This is not to deny the importance of choice and control in life planning ... but rather to argue that they are best positioned within an ontological framework where interbeing, sociality and the socially constructed nature of the self are to the fore’ (Houston, 2010, 842).

Fourth, more attention to broader issues of political economy in the relational state is needed, a critique indeed which Nick Pearce makes of Mulgan in the book. A suggestion by the editors that ‘the level of funding can be weighted to favour those with less power or resources of their own (as is the case with the pupil premium)’ (p. 13), suggests a very unambitious approach to the redistribution of wealth. Hilary Cottam’s point that ‘the most important tool for finding a job is not a CV or a personal worker, but a social network’ (p. 50) sets out a necessary but not sufficient criteria for finding a job in a shrinking economy in which jobs are scarce. Optimism about the role of civil society in providing public services seems somewhat naive given the disastrous impact that the government funding cuts have had, particularly on small charities.

There are some other issues which are underdeveloped in the text. The role that trade unions might play in a relational state is ignored. One contributor writes: ‘Teachers need a proper, independent association to develop their professional skills and protect excellence’ (p. 58), without considering that this might be a role played by trade unions. The contributors assume that much of the work of the ‘relational state’ will be undertaken by third sector bodies, who are not hampered by the ‘compliance culture’ of the state or the profit motivation of the private sector (although the NHS is included in the list of non-state bodies which seems rather disingenuous (p. 18)). These heroic claims for the third sector have been made for a decade whilst the evidence base around third sector contributions – and their appetite for and capacity to provide a ‘supply revolution’ (p. 18) – remains somewhat uncertain. Axel Heitmuller’s claim that we should look to the experience of payment-by-results in welfare to work for ideas on how to reform health is an odd reading of the welfare to work evidence base. A couple of the other contributors call for more local elections along the lines of the Police and Crime Commissioners without dwelling on the legitimacy problems that such elections are likely to generate on the basis of low turnouts. However, these are minor gripes in a book which is stimulating and ambitious, and whose ideas will be central to the future of public services.

 

References

Forder, J. et al. (2012) Evaluation of the Personal Health Budget Pilot Programme, London, Department of Health.

Hargrove, E. and Glidewell, J. (1990) Impossible Jobs in Public Management, Lawrence, University of Kansas Press.

Houston, S. (2010) ‘Beyond homo economicus: recognition, self-realisation and social work’, British Journal of Social Work 40 (3): 841–57.

Maben, J., Adams, M., Peccei, R., Murrells, T. & Robert, G. (2012) ‘Poppets and parcels: the links between staff experience of work and acutely ill older peoples’ experience of hospital care’, International Journal of Older People Nursing 7 (2): 83-94.

Rustin, M. (2005) ‘Conceptual analysis of critical moments in the life of Victoria Climbie’, Child and Family Social Work 10 (1): 11–19.

University of Birmingham Policy Commission (2011) When Tomorrow Comes: The Future of Local Public Services, Birmingham, University of Birmingham.

 

Note

1. The Public Services Academy at Birmingham University is beginning a programme of work around the theme of the Twenty-First Century Public Servant, looking at how to provide training and support for the workforce in the development of these skills.

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