It is surely time for a new concept of public services to emerge from the rubble of the increasingly discredited paradigm of New Public Management (NPM)?
It will take a generation for a new way of thinking to become dominant and, given the challenge it represents to current practice, there is no guarantee that it will succeed. But – and here the contrast with NPM is stark - the process of challenge and reform can itself mobilise and inspire public servants and wider civil society.
The core ideas of NPM – greater reliance on market based mechanisms and contracting out, greater separation of decision making, professional and process functions – have been in the ascendancy for at least two decades. Today, the evidence of their failure is all around. Public service productivity has stagnated and fallen in the countries where NPM has been most fully applied. In the UK, the Private Finance Initiative – which as well as being a crude way of circumventing short term public spending limits is also heavily influenced by NPM thinking – is now exposed as a disaster (by the way, unless someone in Whitehall gets a grip quickly Payment by Results will be the next PFI). And this morning in The Times we read nurses’ leaders admitting that the professionalisation of nursing and separation of medical and caring functions - again based on NPM ideas of efficiency - has in essence destroyed that quality of their vocation (the combination of vocational skills and caring ethos) the public most valued.
The new paradigm calls for the re-socialisation of public service, a process which requires us to challenge not just the ideas of NPM but the deeper bureaucratic/professional foundations of public service practice. Two examples from current RSA sources make this idea concrete.
Writing in the latest edition of the award winning RSA Journal, Robert Whitaker exposes the disastrous record of modern psychiatric care. Outcomes for people with severe conditions have failed to improve. Indeed the evidence suggests not only that outcomes were better 150 years ago, before modern psychiatry was invented, but that they are also better in developing countries which lack the infrastructure of modern mental health services. In essence, we have turned conditions which were seen by sufferers and communities as challenging but manageable and episodic into conditions which are now seen as chronic, debilitating, and requiring lifelong pharmaceutical and therapeutic intervention. Increasingly the evidence indicates that psychotropic drugs are better at creating mental illness than curing it.
A different approach to vulnerable people with challenging behaviour has been adopted by the RSA Whole Person Recovery project. This seeks to turn post treatment recovery into a community based process. The integration of recovering addicts into the community as full and vocal citizens and the mobilisation of the community as partners in recovery enables better outcomes for individuals and enhances civic capacity.
It is time to re-conceptualise public service goals as the outcome of social processes. The role of politicians, public managers and professionals is to serve and support those social functions. So, for example, instead of children’s learning taking place in schools with the occasional (often tokenistic and patronising) attempt to ‘engage the community’, children’s development into adulthood should be seen as a function of families and communities with schools being judged by how well they support and enhance that social process. Professional norms need to refreshed by reference those things we value and seek to enhance in civil society. The goal of good nursing practice should be to replicate the values of familial care and community compassion in a professional setting.
As in all paradigm shifts, that from new public management to socialised public service will involve continuity and gradualism as well as transformation. The conceptual core will shift but the circles of practice around it will see overlaps between the new and the old. (So, for example, the new paradigm is just as critical of public service producerism as is NPM, but whereas the latter seeks remedy in public servants imitating market actors, the former exhorts respect for the strengths of what Avner Offer calls 'the economy of regard'.)
Defenders of NPM will fight on. Like post war communists distancing themselves from 'actual existing socialism' they will say the problem lies not in the theory but that fact it has not been properly or fully applied. But the question now is what will emerge from NPM's ashes. Its death exposes both the limitations of the New Labour model of top-down modernisation (of which I was an advocate and architect) and the gaping disconnect between the valuable diagnosis of the Big Society and the dispiriting practice of public service reform under the Coalition.
Most of all, the new paradigm offers the only credible way of addressing the social aspiration gap which exists between our hopes for the future and our current trajectory. Unless we start to close that gap the guiding light of social progress – which is essential to the legitimacy of liberal market societies – will, in time, be extinguished.
Our healthcare system needs transformational change that creates the space for a new paradigm to emerge. Read about how our public entrepreneurship project can support this.