In 1950, the Pioneer Health Centre in Peckham closed. Faced with a lack of funds, Dr Innes H Pearse, its co-founder, remarked: “This is a true health centre, not an ill-health centre, and it is the only one in the world.” 950 working-class families used to pay a subscription for swimming, exercise, games and workshops and doctors researched positive health impacts of social medicine. However, the NHS was the way that people met their health needs after 1948. There was little place for the likes of the Pioneer Health Centre after that point. And yet, we now know, it was onto something.
Today, as we consider how to construct the civic bonds of society afresh and rekindle the positive social influences on well-being, we might reflect exactly what we lost at points of our history. The Pioneer Health Centre is but one example presented in a new book, Taking Power Back by Simon Parker. It is a strikingly convincing account of how to unleash a wave of civic energy across the UK. Even Nye Bevan, the creator of the NHS remarked ruefully: “Machines are important, but democracy is a way of life.” For Parker, civic renewal is a mission to underpin a better life for all. It’s not simply about bureaucratic reorganisation; it’s about social justice and freedom.
The tension between big and small power and the need for greater ‘person-to-person social justice’ is a theme worth returning to time and time again. As Leviathan, faced with ever greater burdens with increasingly scarce resources, begins to buckle under the weight of expectations, what can we do? The mix of austerity and the ‘big society’ pulling away has failed to provide a better future. Is there a way out through civic innovation?
One of Parker’s big ideas is that the state should concentrate on investing in innovation. Localities would focus on particular challenges such as increasing school attainment. Then a range of services, civic groups, private or social enterprises would be commissioned on the basis of what they could contribute to securing better social outcomes. Commissioning ‘hubs’ would create long term plans around social change and would pool resources. Moreover, a series of foundations would be established with public and private funds to support innovative models of civic improvement. A city’s well-being would be measured by ‘total social returns’ rather than the economic variables we tend to lean on. There are many similarities here with the RSA’s own work on social productivity and collective impact.
All of these approaches tend to rely on the state doing what it doesn’t do very well now: thinking long-term, measuring social outcomes, innovating, co-ordinating with non-state actors, and retaining focus. If a large private firm wishes to fundamentally reorganise, it accesses capital markets. Too much state investment is devoted to hard infrastructure such as buildings rather than soft innovation that can have an even greater impact.
In our recently published report, Safer Together, we recommended a whole series of reforms to policing and community safety in London. We challenged the Metropolitan Police to work more collaboratively with others, to share resources and data, and to open up its organisation. It should engage more deliberately and consistently with Londoners. We even outlined what the organisational consequences of these changes would be from a change in ethos to a break-down of traditional internal staff and officer barriers.
But there is a severe tension here with the need to find £800million or so of efficiency savings or ‘cuts’ as they used to be called. Our proposals are the only way that the police have a realistic chance of meeting the obligations and demands they face and yet where is the capital fund to invest to make them a reality? A strategic state would, even in times of austerity, identity ways of innovating to bring together services with the people they serve to improve social outcomes. It feels instead that we may well see a retreat without anything to fill the gaps.
Is devolution a way to close the innovation gap? Done right, yes. And that means devolving power and resources to localities to change the way significant social problems are confronted and economic opportunities are captured. But we really are in a race between change and resource constraint.
The state as envisioned in Taking Power Back is one that provides a basic foundation including a basic income (more on this from the RSA to come) and universal childcare, promotes innovation and opens itself up to the democratic commons. It’s radically different to the vestigial social democratic state we have. Getting there is not going to be easy. It is more likely we’ll arrive with a sense of political rather than purely bureaucratic mission. Too often, the moves to devolve power in recent times have been bureaucratically driven and that’s why they feel so fragile despite the ‘powerhouse’ vernacular.
The tragedy of the post-war state is that it traded civic energy for social justice. The risk of the current direction is that we will end up with neither. Better instead that we strive for a person-to-person social justice supported by big power rather than at risk of being smothered by it.