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Social Services Are Broken. How We Can Fix Them | Hilary Cottam | TED.com - YouTube
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[12]
I want to tell you three stories
[15]
about the power of relationships
[17]
to solve the deep and complex
social problems of this century.
[22]
You know, sometimes it seems
like all these problems
[24]
of poverty, inequality, ill health,
unemployment, violence, addiction --
[29]
they're right there in one person's life.
[32]
So I want to tell you about someone
like this that I know.
[36]
I'm going to call her Ella.
[38]
Ella lives in a British city
on a run down estate.
[42]
The shops are closed, the pub's gone,
[44]
the playground's pretty desolate
and never used,
[46]
and inside Ella's house,
the tension is palpable
[49]
and the noise levels are deafening.
[51]
The TV's on at full volume.
[53]
One of her sons is fighting
with one of her daughters.
[55]
Another son, Ryan, is keeping up this
constant stream of abuse from the kitchen,
[59]
and the dogs are locked
behind the bedroom door and straining.
[62]
Ella is stuck.
[64]
She has lived with crisis for 40 years.
[67]
She knows nothing else,
and she knows no way out.
[71]
She's had a whole series
of abusive partners,
[73]
and, tragically, one of her children has
been taken into care by social services.
[78]
The three children
that still live with her
[80]
suffer from a whole range of problems,
and none of them are in education.
[83]
And Ella says to me that she
is repeating the cycle
[86]
of her own mother's life before her.
[89]
But when I met Ella,
there were 73 different services
[92]
on offer for her and her family
in the city where she lives,
[96]
73 different services
run out of 24 departments in one city,
[100]
and Ella and her partners and her children
were known to most of them.
[103]
They think nothing of calling
social services
[105]
to try and mediate one of the many
arguments that broke out.
[108]
And the family home was visited
on a regular basis by social workers,
[112]
youth workers, a health officer,
a housing officer, a home tutor
[116]
and the local policemen.
[118]
And the governments say
that there are 100,000 families
[121]
in Britain today like Ella's,
[123]
struggling to break the cycle of economic,
social and environmental deprivation.
[129]
And they also say
that managing this problem
[131]
costs a quarter of a million pounds
per family per year
[134]
and yet nothing changes.
[135]
None of these well-meaning visitors
are making a difference.
[138]
This is a chart we made in the same city
with another family like Ella's.
[143]
This shows 30 years of intervention
in that family's life.
[146]
And just as with Ella, not one of these
interventions is part of an overall plan.
[150]
There's no end goal in sight.
[152]
None of the interventions
are dealing with the underlying issues.
[155]
These are just containment measures,
ways of managing a problem.
[158]
One of the policemen says to me,
[160]
"Look, I just deliver the message
and then I leave."
[162]
So, I've spent time living
with families like Ella's
[165]
in different parts of the world,
[166]
because I want to know: what can we learn
[169]
from places where our social institutions
just aren't working?
[172]
I want to know what it feels like
to live in Ella's family.
[175]
I want to know what's going on
and what we can do differently.
[179]
Well, the first thing I learned
is that cost is a really slippery concept.
[183]
Because when the government says
that a family like Ella's
[186]
costs a quarter of a million pounds
a year to manage,
[189]
what it really means
[190]
is that this system costs
a quarter of a million pounds a year.
[193]
Because not one penny of this money
actually touches Ella's family
[196]
in a way that makes a difference.
[197]
Instead, the system is just
like this costly gyroscope
[200]
that spins around the families,
keeping them stuck at its heart,
[203]
exactly where they are.
[205]
And I also spent time
with the frontline workers,
[207]
and I learned that it
is an impossible situation.
[210]
So Tom, who is the social worker
for Ella's 14-year-old son Ryan,
[215]
has to spend 86 percent of his time
servicing the system:
[218]
meetings with colleagues,
filling out forms,
[221]
more meetings with colleagues
to discuss the forms,
[223]
and maybe most shockingly,
[224]
the 14 percent of the time
he has to be with Ryan
[227]
is spent getting data
and information for the system.
[229]
So he says to Ryan,
[231]
"How often have you been smoking?
Have you been drinking?
[233]
When did you go to school?"
[235]
And this kind of interaction
rules out the possibility
[237]
of a normal conversation.
[238]
It rules out the possibility
of what's needed
[241]
to build a relationship
between Tom and Ryan.
[244]
When we made this chart,
[246]
the frontline workers,
the professionals --
[248]
they stared at it absolutely amazed.
[250]
It snaked around the walls
of their offices.
[252]
So many hours, so well meant,
but ultimately so futile.
[258]
And there was this moment
of absolute breakdown,
[262]
and then of clarity:
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we had to work in a different way.
[267]
So in a really brave step,
the leaders of the city where Ella lives
[270]
agreed that we could start
by reversing Ryan's ratio.
[273]
So everyone who came into contact
with Ella or a family like Ella's
[276]
would spend 80 percent of their time
working with the families
[279]
and only 20 percent servicing the system.
[282]
And even more radically,
[284]
the families would lead
[285]
and they would decide who
was in a best position to help them.
[288]
So Ella and another mother were asked
to be part of an interview panel,
[292]
to choose from amongst
the existing professionals
[294]
who would work with them.
[296]
And many, many people wanted to join us,
[298]
because you don't go into this kind
of work to manage a system,
[301]
you go in because you can
and you want to make a difference.
[304]
So Ella and the mother asked
everybody who came through the door,
[307]
"What will you do when my son
starts kicking me?"
[310]
And so the first person who comes in says,
[312]
"Well, I'll look around
for the nearest exit
[315]
and I will back out very slowly,
[317]
and if the noise is still going on,
I'll call my supervisor."
[321]
And the mothers go,
"You're the system. Get out of here!"
[323]
And then the next person who comes
is a policeman, and he says,
[326]
"Well, I'll tackle your son to the ground
and then I'm not sure what I'll do."
[330]
And the mothers say, "Thank you."
[332]
So, they chose professionals who confessed
[334]
they didn't necessarily have the answers,
[336]
who said -- well, they weren't
going to talk in jargon.
[340]
They showed their human qualities
and convinced the mothers
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that they would stick with them
through thick and thin,
[346]
even though they wouldn't
be soft with them.
[348]
So these new teams and the families
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were then given a sliver
of the former budget,
[352]
but they could spend the money
in any way they chose.
[354]
And so one of the families
went out for supper.
[356]
They went to McDonald's and they sat down
and they talked and they listened
[360]
for the first time in a long time.
[362]
Another family asked the team
[364]
if they would help them do up their home.
[367]
And one mother took the money
[368]
and she used it as a float
to start a social enterprise.
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And in a really short space of time,
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something new started to grow:
[377]
a relationship between the team
and the workers.
[380]
And then some remarkable
changes took place.
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Maybe it's not surprising
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that the journey for Ella has had
some big steps backwards
[387]
as well as forwards.
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But today, she's completed
an IT training course,
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she has her first paid job,
her children are back in school,
[394]
and the neighbors,
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who previously just hoped this family
would be moved anywhere
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except next door to them,
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are fine.
[401]
They've made some new friendships.
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And all the same people have been
involved in this transformation --
[407]
same families, same workers.
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But the relationship between them
has been supported to change.
[414]
So I'm telling you about Ella
because I think that relationships
[417]
are the critical resource we have
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in solving some of these
intractable problems.
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But today, our relationships
are all but written off
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by our politics, our social policies,
our welfare institutions.
[428]
And I've learned that this
really has to change.
[432]
So what do I mean by relationships?
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I'm talking about the simple
human bonds between us,
[437]
a kind of authentic sense
of connection, of belonging,
[439]
the bonds that make us happy,
that support us to change,
[442]
to be brave like Ella
and try something new.
[445]
And, you know, it's no accident
[447]
that those who run and work
in the institutions
[450]
that are supposed to support
Ella and her family
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don't talk about relationships,
[453]
because relationships are expressly
designed out of a welfare model
[457]
that was drawn up in Britain
and exported around the world.
[461]
The contemporaries of William Beveridge,
[463]
who was the architect
of the first welfare state
[465]
and the author of the Beveridge Report,
[467]
had little faith in what they called
the average sensual or emotional man.
[471]
Instead, they trusted this idea
of the impersonal system
[474]
and the bureaucrat who would be detached
and work in this system.
[478]
And the impact of Beveridge
[481]
on the way the modern state
sees social issues
[483]
just can't be underestimated.
[485]
The Beveridge Report
sold over 100,000 copies
[488]
in the first weeks of publication alone.
[491]
People queued in the rain
on a November night to get hold of a copy,
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and it was read across the country,
across the colonies, across Europe,
[497]
across the United States of America,
[499]
and it had this huge impact
[501]
on the way that welfare states
were designed around the globe.
[504]
The cultures, the bureaucracies,
the institutions -- they are global,
[509]
and they've come to seem
like common sense.
[511]
They've become so ingrained in us,
[514]
that actually we don't even
see them anymore.
[516]
And I think it's really important to say
that in the 20th century,
[519]
they were remarkably successful,
these institutions.
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They led to longer lifespans,
the eradication of mass disease,
[526]
mass housing, almost universal education.
[529]
But at the same time,
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Beveridge sowed the seeds
of today's challenges.
[535]
So let me tell you a second story.
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What do you think today is a bigger killer
than a lifetime of smoking?
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It's loneliness.
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According to government statistics,
one person over 60 -- one in three --
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doesn't speak to or see
another person in a week.
[556]
One person in 10, that's 850,000 people,
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doesn't speak to anyone else in a month.
[562]
And we're not the only people
with this problem;
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this problem touches the whole
of the Western world.
[567]
And it's even more acute
in countries like China,
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where a process of rapid urbanization,
mass migration, has left older people
[573]
alone in the villages.
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And so the services that Beveridge
designed and exported --
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they can't address this kind of problem.
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Loneliness is like a collective
relational challenge,
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and it can't be addressed
by a traditional bureaucratic response.
[588]
So some years ago,
wanting to understand this problem,
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I started to work with a group
of about 60 older people
[594]
in South London, where I live.
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I went shopping, I played bingo,
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but mainly I was just
observing and listening.
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I wanted to know
what we could do differently.
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And if you ask them, people tell you
they want two things.
[606]
They want somebody to go up a ladder
and change a light bulb,
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or to be there when they
come out of hospital.
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They want on-demand, practical support.
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And they want to have fun.
[615]
They want to go out, do interesting things
with like-minded people,
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and make friends like we've all
made friends at every stage of our lives.
[623]
So we rented a phone line,
hired a couple of handymen,
[626]
and started a service we called "Circle."
[628]
And Circle offers its local membership
a toll-free 0 800 number
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that they can call on demand
for any support.
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And people have called us
for so many reasons.
[637]
They've called because
their pets are unwell,
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their DVD is broken, they've forgotten
how to use their mobile phone,
[642]
or maybe they are coming out of hospital
[644]
and they want someone to be there.
[646]
And Circle also offers
a rich social calendar --
[649]
knitting, darts, museum tours,
hot air ballooning -- you name it.
[654]
But here's the interesting thing,
the really deep change:
[658]
over time, the friendships
that have formed
[661]
have begun to replace the practical offer.
[664]
So let me tell you about Belinda.
[666]
Belinda's a Circle member, and she was
going into hospital for a hip operation,
[670]
so she called her local Circle to say
they wouldn't see her for a bit.
[674]
And Damon, who runs the local Circle,
calls her back and says, "How can I help?"
[678]
And Belinda says, "Oh no, I'm fine --
[680]
Jocelyn is doing the shopping,
Tony's doing the gardening,
[683]
Melissa and Joe are going
to come in and cook and chat."
[686]
So five Circle members
had organized themselves
[689]
to take care of Belinda.
[692]
And Belinda's 80, although she says
that she feels 25 inside,
[695]
but she also says
[697]
that she felt stuck and pretty down
when she joined Circle.
[701]
But the simple act of encouraging her
to come along to that first event
[705]
led to a process where
natural friendships formed,
[708]
friendships that today are replacing
the need for expensive services.
[713]
It's relationships
that are making the difference.
[717]
So I think that three factors
have converged
[720]
that enable us to put relationships
at the heart and center
[723]
of how we solve social problems today.
[726]
Firstly, the nature of the problems --
[728]
they've changed, and they require
different solutions.
[731]
Secondly, the cost, human as much
as financial, of doing business as usual.
[735]
And thirdly, technology.
[738]
I've talked about the first two factors.
[740]
It's technology that enables
these approaches to scale
[743]
and potentially now support
thousands of people.
[746]
So the technology we've used
is really simple,
[749]
it's made up of available things
like databases, mobile phones.
[752]
Circle has got this very simple
system that underpins it,
[755]
enables a small local team to support
a membership of up to a thousand.
[759]
And you can contrast this
with a neighborhood organization
[762]
of the 1970s,
[763]
when this kind of scale
just wasn't possible,
[765]
neither was the quality or the longevity
that the spine of technology can provide.
[769]
So it's relationships
underpinned by technology
[772]
that can turn the Beveridge
models on their heads.
[775]
The Beveridge models are all
about institutions with finite resources,
[779]
anonymously managing access.
[781]
In my work at the front line,
[783]
I've seen again and again how
up to 80 percent of resource
[787]
is spent keeping people out.
[789]
So professionals have to administer
[790]
these increasingly complex forms
of administration
[793]
that are basically about stopping people
accessing the service
[796]
or managing the queue.
[798]
And Circle, like the relational services
that we and others have designed,
[803]
inverts this logic.
[804]
What it says is, the more people,
the more relationships,
[808]
the stronger the solution.
[811]
So I want to tell you my third
and final story,
[814]
which is about unemployment.
[817]
In Britain, as in most places
in the world,
[820]
our welfare states were primarily designed
[822]
to get people into work,
[825]
to educate them for this,
[827]
and to keep them healthy.
[829]
But here, too, the systems are failing.
[831]
And so the response has been
[832]
to try and make these old systems
even more efficient and transactional --
[836]
to speed up processing times, divide
people into ever-smaller categories,
[840]
try and target services at them
more efficiently -- in other words,
[843]
the very opposite of relational.
[847]
But guess how most people find work today?
[851]
Through word of mouth.
[853]
It turns out that in Britain today,
most new jobs are not advertised.
[858]
So it's friends that tell you about a job,
[860]
it's friends that recommend you for a job,
[862]
and it's a rich and diverse social network
that helps you find work.
[866]
Maybe some of you here
this evening are thinking,
[869]
"But I found my job through an advert,"
[871]
but if you think back, it was probably
a friend that showed you the ad
[874]
and then encouraged you to apply.
[875]
But not surprisingly,
[877]
people who perhaps most need
this rich and diverse network
[880]
are those who are most isolated from it.
[883]
So knowing this,
[884]
and also knowing about the costs
and failure of current systems,
[887]
we designed something new
with relationships at its heart.
[890]
We designed a service
that encourages people to meet up,
[896]
people in and out of work,
[897]
to work together in structured ways
[899]
and try new opportunities.
[902]
And, well, it's very hard to compare
the results of these new systems
[906]
with the old transactional models,
[907]
but it looks like,
with our first 1,000 members,
[910]
we outperformed existing services
by a factor of three,
[913]
at a fraction of the cost.
[915]
And here, too, we've used technology,
[918]
but not to network people in the way
that a social platform would do.
[921]
We've used it to bring people face to face
and connect them with each other,
[925]
building real relationships
and supporting people to find work.
[930]
At the end of his life, in 1948,
[933]
Beveridge wrote a third report.
[935]
And in it he said he had made
a dreadful mistake.
[940]
He had left people
and their communities out.
[945]
And this omission, he said,
led to seeing people,
[949]
and people starting to see themselves,
[951]
within the categories
of the bureaucracies and the institutions.
[955]
And human relationships
were already withering.
[959]
But unfortunately, this third report
was much less read
[962]
than Beveridge's earlier work.
[965]
But today, we need to bring people
and their communities
[969]
back into the heart of the way
we design new systems and new services,
[973]
in an approach that I call
"Relational Welfare."
[976]
We need to leave behind
these old, transactional,
[978]
unsuitable, outdated models,
[980]
and we need to adopt instead
the shared collective relational responses
[984]
that can support a family like Ella's,
[986]
that can address an issue like loneliness,
[989]
that can support people into work
and up the skills curve
[991]
in a modern labor market,
[993]
that can also address challenges
of education, of health care systems,
[997]
and so many more of those problems
that are pressing on our societies.
[1002]
It is all about relationships.
[1005]
Relationships are the critical
resource we have.
[1008]
Thank you.
[1009]
(Applause)
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