Today, social responses to peoples' needs are being pushed to the margin by the reframing of all tasks in terms of economic gain. But the development of human capabilities depends on relationships. A different set of values is needed.
NHS wheel of misfortune illustration showing the possible effects of privatising the National Heath Service. Credit: Demotix. All rights reserved.
Over the summer, another contracted-out service hit the buffers. NHS Direct has pulled out of its contract to deliver the UK's National Health Service 111 non-emergency services because it is not profitable. Yet again we have the proof that complex social needs cannot be met by relations that are driven by the cash nexus.
Human beings come into the world entirely helpless, and are dependent for many years on others. Throughout their lives people are vulnerable to illness. Nearly all will experience a period of time, often at the end of their lives, when they are as dependent as they were when they were first born. Because of this, all humane societies have systems for looking after people in the phases of their life when they need care. Such humane systems lie at the heart of any transformative project
In complex, educated, industrial societies, one could argue that the need for social provision is all the greater because our experiences of dependency are not confined to those given to us biologically. Societies require individuals to develop, take up roles and survive social transitions in the pattern of their lives (for example to and from school, into the world of work, to parenthood, to retirement).
The modern welfare system was constructed as a set of responses to these various phases of dependency. It recognised that the market could not on its own provide for such needs. Money and resources were redistributed to individuals and families at dependent phases of their life-cycles – as they still are.
Many forms of intervention in response to human needs are not, however, financial, but involve activities of nurturing, educating, advising and protecting. In the myriad occupations devoted to these services (child care, medicine, teaching, nursing) the primary work consists of responding in specific ways to people’s needs.
Today, the primary goals of these fields of work are at risk of being pushed to the margin by the reframing of all tasks in terms of economic gain. Under the regime of neoliberalism, a universal model for the provision of services is being enforced. This is based on the doctrine that services will be efficient only where providers are motivated by financial incentives.
This assumption is often false. For example, NHS hospitals and other public bodies have been weighed down with debt in PFI schemes, which turned out to be largely a means of extracting risk-free profits, paid for by taxpayers and service-users – and with no gain in cost-effectiveness.
Neoliberal logic demands that provider organisations operate as businesses, with the state of their balance-sheets given priority over all other indicators. Such market disciplines have been widely imposed on institutions which are still formally public in their ownership, ostensibly as a means to improve their efficiency. But it is clear that the public character of these institutions can become little more than an external shell, covering over a predominantly corporate style of operation, as we see in many universities today.
It then becomes only a further small step to allow fully private providers entry into what have been redefined as markets, and for the privatisation of public services to take place. This is a programme of privatisation by stealth. One hardly has to be cynical to recognise that the tacit purpose of creating a stratum of super-managers paid at something approaching the level of private-sector managers is to weaken their identifications with public cultures and values, and to recruit them as accomplices to the new order of the rich.
How do practitioners in such an institution decide between the priority they give to its clients, and its own financial interest? What may well begin, for a senior public manager, as an external pressure to meet demands for greater efficiency, over time may become an internalised commitment to financial goals. Marketised systems provide strong incentives to cherry-pick and cheat, to find ways of maximising economic returns while minimising the commitment of resources. How much easier it is to demonstrate strong educational performance if one excludes weak pupils; or to achieve high returns in health care if one avoids taking on the most vulnerable patients. Compliance with regulatory systems can become an overriding preoccupation, distracting practitioners from responsiveness to their primary task.
A different set of assumptions and values is needed if this contradiction is to be resolved. The development of human capabilities depends on relationships. This is obvious from everyday experience. We know children do better if they receive high-quality care early on, and learn more in school if they have more attention from teachers. This is why one of the benefits sought in the purchase of private education is more favourable pupil-teacher ratios.
In entering paid work for the first time the finest gift any entrant can receive is a mentor who takes an interest in their development. Furthermore, such qualities of concern can be embodied in institutions over long periods of time. One could also cite the cases of many prominent individuals – including writers, artists and athletes – who have attributed their success to a teacher or coach.
If we are to think of remaking our society in terms of love and social justice, a significant measure of our well-being should lie in the relationships which are available to individuals at each stage of their lives. But at the moment we measure social provision by economic criteria. As the investment in human labour required to produce material goods diminishes, thanks to technology, so the availability of human resources for the development of persons should increase. Looking at society in these terms, there is no conceivable excuse for unemployment, when there is abundant work to be done in expressing human capabilities.
A longer version of this article is available at www.soundings.org.uk and the author will be holding a seminar on 19th September 6.30-8.30 at the Marx Memorial Library.
Tickets are £10 or £3 concessions and available here: http://relationalsociety.eventbrite.co.uk/