Do all public services have to be delivered by professionals?

Libraries run by volunteers and dance as an alternative to prescription drugs are some of the innovations in the ideas pool for salvaging the UK’s public services. But should we disrupt the control of experts over matters of health and education? Ivan Illich, priest, philsopher and "maverick social critic" of the institutions of Western culture would have vehemently argued yes. David Floyd assesses the promise and pitfalls of the latest approaches to delivering public services.

The UK government currently employs over 5.4 million people. That’s a pretty big pay roll but it’s getting smaller. The reduction in state employees that began in 2010 has been described as the ‘largest public sector cull in 50 years’, with more than 1 million workers across various public sector agencies set to lose their jobs over a 10-year period.  

Unfortunately, this shrinking workforce is not happening as a result of a decrease in social need – the opposite is the case with a smaller state confronting growing social challenges such as an ageing population with growing social care needs and a decrease in social mobility. 

Not everyone believes reductions in public services are a bad thing. Aside from those who believe we should cut public services so that we can have lower taxes, others believe that giving trained experts power over our lives is negative in itself. 

Illich's maverick ideas rekindled

One of the most prominent 20th century proponents of ‘deprofessionalisation’ was the Austrian-born priest and philosopher, Ivan Illich. Illich railed against what he viewed as the ‘monopoly’ control of education and healthcare by teachers and doctors, whose hyper-industrial models prevented people from thinking for themselves and looking after each other without being dependent on professionals. 

While Illich has some fans amongst social innovation thinkers in the UK, most current challenges to the role of professionals in public services are more pragmatic than philosophical.  There are at least three sets of reasons why non-professional public service delivery is currently being promoted in the UK. 

The most controversial and least interesting of these is a replacement for services previously provided by paid staff – a public sector agency no longer has the money to employ staff to do a job so it hopes volunteers will step in to fill the gap. The prime example of this is library services. 

An Arts Council England report in early-2013 noted that around 5% of the UK’s 3,300 public libraries were ‘community supported or managed libraries’ and this figure was predicted to rise to 12% in the near future. 

No volunteers no libraries

There are many different models of ‘community library’ in operation but they include libraries where councils have continued to supply books and computer systems but paid staff teams have been either partly or entirely replaced by volunteers. 

The upside to this model is the local community still gets a library and can spend the money that would’ve been spent on staff wages on something else, the (pretty big) downside is that the question of whether or not there’s a library in a particular area is determined by whether local people are ready, willing and able to run it in their spare time. 

More ‘social action’, better public services?

A second approach to non-professional public service delivery is the ‘social action’ model described in Nesta’s recent report People Helping People – The Future of Public Services

According to the report: “Social action refers to a wide array of activities undertaken voluntarily to benefit others. These can include, for example, small acts of kindness and neighbourliness, one–off volunteering in a time of crisis or in response to a specific request, through to regular, formal volunteering.”

While the report also covers forms of social action which have no direct connection to public services at all, its primary focus is on different ways that citizens can support public services by delivering auxiliary activities that can only happen on the basis that an effective professional public service remains in place. 

Examples range from Special Constables supporting the police, to Code Club volunteers running after school lessons teaching children to create apps, to Kings College Hospital volunteers, who work on improving the experience for patients by: “welcoming patients, guiding them around the hospital, providing comfort, support and reassurance in wards, sitting with them and holding their hands during operations.” 

The theory is that more ‘social action’ means more resources are directed at tackling social problems, what’s less clear is how valuable many of these supplementary services would be if the core services they supplement disappear. 

Could we ditch the drugs and dance ourselves into good health?

An alternative approach is one that actively challenges assumptions about the role of professionals in delivering public services. You don’t have to accept Ivan Illich’s arguments about professionalised medicine making everything worse to question whether all medical problems are best solved by a doctor. 

For example, if you experience a mental health difficulty and you go to your GP for help, there’s a high likelihood you’ll either be given some drugs or (less likely) be referred for some therapy. These are treatments that the NHS understands and knows how to provide (even if, particularly in the case of therapy, it doesn’t have the resources to provide them quickly or possibly at all). 

One alternative model for supporting people who experience mental health difficulties (and other long-term conditions) is social prescribing, where patients can be referred to ‘activities from dance classes to knitting groups and cookery clubs’ instead of a conventional medical intervention. 

How do we help this person, not how can we pay for the service

Social prescriptions are no more of a silver bullet solution to the challenges of people living with long term conditions than drugs are but the fact that (some bits of) the NHS are beginning to look at how they can work with other agencies and organisations to help patients - rather than just offering patients the services they themselves can deliver - is a positive development. 

None of these approaches to non-professional public services delivery offer, in themselves, an answer to the question of how to meet growing need with shrinking resources but a starting point of ‘how could we solve this problem or help this person’ rather than ‘how can we fund this service’ is a step towards doing so. 

You can read comments on this article on David Floyd's blog, Beanbags and Bullsh!t.