The Big Society: collaborative advantage or policy vacuum?

30th November 2010

Peter Totterdill and Rosemary Exton discuss what the Big Society means for workplace innovation and public service reform

“The truth is that we need a government that actually helps to build up the Big Society” 

Speech by the Prime Minister, 19 Jul 2010

As the Coalition government’s big idea, the Big Society seems not to have generated much innovative thinking. Standing aside from the widely held view that the Big Society is a mask for rolling back the state, it is worth engaging with the idea on its own terms. We know that the Big Society is about the state being less involved in the “micromanagement” of service delivery, but working models of the Big Society are scarce especially in relation to public service transformation.

If the Big Society is to be more than a passing political fad “with the resonance of a political epitaph”¹ then there is a need for a robust policy framework that can animate and resource the engagement of employees and consumers alike in renewing the public sphere.

In the post-war era the complexity of policy issues such as multiple deprivation, industrial restructuring or integrated healthcare was matched by the dominance of programmatic policy interventions, problem-driven with a defined timescale and governed by measurable performance targets. Governments of all political colours enthusiastically adopted programmatic interventions, a trend which reached its climax in the centrally-driven targets that have infused every area of public life since the mid-1990s. Clearly programmatic modes of public policy sit uncomfortably with the new agenda, but as yet there are few signs of what the “whole new approach to government and governing” sought by the Prime Minister might look like. How do we move from regulation to what might be characterised as “policy entrepreneurship” – a mode of policy which creates new coalitions, stimulates creative dialogue and harnesses collaborative actions in which diverse organisations and individuals work towards common ends?

Taking the second strand of the Big Society, public service reform, let us examine what such an enabling policy framework might look like in practice.

“Disillusioned, weary puppets of government targets”: staff engagement and patient care in the NHS

David Cameron’s description² of how the target culture has affected “motivated public sector workers” will have resonance with those who know the NHS well. Innovation based on local knowledge and creativity has been all but stifled by management behaviour focused on target compliance, often with perverse results. According to the NHS Staff Survey many staff feel excluded from decision-making and there is a strong view that senior managers do not act on feedback.³

The King’s Fund argues that targets have made a significant positive impact on NHS performance. But targets are not enough, and the performance management regime distracts management effort from sustainable change. Observers and practitioners have long argued for balancing regulation of quality standards with animation of improvement and innovation by harnessing the knowledge and creativity of frontline NHS staff.⁴

It is clear that the regulatory grip is to be loosened and perhaps this could, as Cameron argues, help put power back into the hands of NHS staff. But loosening the grip alone will be insufficient to engage frontline NHS employees in quality, productivity, performance and cost containment.

As far back as 2005, Sir Nigel Crisp argued for “entrepreneurial leaders” capable of bringing “vision, leadership and passion” to the NHS, and who “generate new and alternative solutions that extend the boundaries of healthcare (and) challenge fa2v+2MYevoyu8h5BITFr3mhqLs/f9nd refuse to accept the status quo”.⁵ Harnessing the language of entrepreneurship was a clever PR ploy, creating associations between NHS transformation and dynamic private sector business innovators. The problem is that nobody really took the time to find out why entrepreneurial behaviour was so difficult to unleash in the NHS.

Recent research provides a valuable insight into how service innovation and improvement is stimulated within NHS organisations. Our study⁶ examines the Improving Working Lives programme and finds significant variation in outcomes between eleven different NHS Trusts. Each Trust was required to reach identical standards in improving HR practice over a set period. Achievement of the standards was validated by external peer-review, and the outcomes contributed significantly to overall performance ratings.

In each organisation implementation was driven by a “Lead” from line management, and three of these individuals form the focus of the study. Sally’s approach is categorised as “conformity”: programme objectives were successfully met through focussed effort on compliance (“ticking boxes”). However there was little engagement with staff or unions and the initiative did not lead to real or sustained change. Jess, in contrast, had to work outside the formal organisational structures and chains of command. While meeting targets, Jess achieved real improvements in frontline practice. Lacking Board or senior management support however her entrepreneurial approach ran into resistance from middle management. She was removed from post and gains were not sustained once accreditation was achieved. Sonya was equally entrepreneurial in her approach and commitment to securing real workplace innovation. Unlike Jess she enjoyed full senior management support and the active engagement of Directors and staff side representatives. Building on widespread staff involvement she was able to secure sustained changes in HR policy implementation and working practices; the organisation even changed its objectives to reflect the new priorities.

However of the eleven Trusts in the study, all but Sonya’s reflected either Sally or Jess’ experiences. When visited 18 months after the end of the initiative, most of the Trusts failed to demonstrate any sustained change despite more than four years’ effort.

While the study highlights the importance of entrepreneurial behaviour in the transformation of the NHS, Sally and Jess demonstrate in different ways that managerial culture and working practices inhibit the full engagement of staff, and the use of their knowledge and experience in service improvement and innovation. The NHS Leadership Qualities Framework⁷ talks about “leading change through people” and “empowering others” but there is little evidence of a large-scale change in management behaviours. The expectation that the current reorganisation of the health sector will transform bureaucratic organisations into dynamic enterprises overnight is far from realistic.

Effective and sustainable change means finding the convergence between improved patient care and better working lives for NHS staff through more participative work practices.  However the study also demonstrates that quick fixes are not available to the Coalition government, which seems not to have added any new tools to the toolkit.

Hard choices

It is not just the fiscal crisis that requires hard choices.  If there is to be any conviction that the Big Society will become more than a political epitaph then the Big Society requires a strategy for policy entrepreneurship. Building and maintaining trust-based relationships that lead to collaborative advantage between stakeholders, whether in our NHS example or more widely, requires careful animation and facilitation. We need to learn from the experiences of Sonya and Jess. The twentieth century legacy of the state, with its focus on programmatic forms of intervention does not provide the skills and competencies relevant to such animation and facilitation.
 
Here there are lessons from progressive private sector companies such as BT and Ericsson. BT’s “Pride Builders” and Ericsson’s “Inspirers” are ordinary employees given the additional task of asking difficult questions and identifying creative solutions by bringing people together. Reform inside the public services (and inside social enterprises) needs to be driven by such people, but unlike Jess they should be rewarded rather than punished for doing so. 

We need to take much more seriously the evidence that employee involvement strengthens service quality. Vince Cable as Secretary of State for Business, Innovation and Skills has yet to show much enthusiasm for the last government’s MacLeod Review of Employee Engagement.⁸ Yet if the Coalition is serious about the transformation of public services then it has no reason not to become an exemplary employer in terms of employee involvement and participation. Moreover as Cressey and Farr show in their Bath University research, empowered frontline staff are the key to empowered service users. The real question – and the challenge for the Big Society – is whether politicians and senior managers in the public service are willing to give up their command and control culture.

Support for policy entrepreneurship and the empowerment of frontline public employees are the key tests of whether the Coalition’s commitment to the Big Society is real or rhetorical.

Peter Totterdill and Rosemary Exton

UK Work Organisation Network

Peter Totterdill is Joint Chief Executive of the UK Work Organisation Network (UKWON), created in 1997 as a forum for diverse social actors including employers’ organisations, trade unions, professional bodies, NGOs, universities and other interest groups to explore ways of shaping the future of work and organisations in ways that achieve optimum social and economic benefits. peter.totterdill@ukwon.net

Rosemary Exton is a Director of UKWON with international experience of employee involvement and participation. She is also a practicing midwife, a trade union steward and a Council Member of the Royal College of Midwives. rosemary.exton@ukwon.net


1Warner, Gerald (19 July 2010). "Dave's Big Society is not a top-down project – that's why it was launched by the Prime Minister" (http:/ /blogs. telegraph. co. uk/ news/ geraldwarner/ 100047805/daves-big-society-is-not-a-top-down-project-thats-why-it-was-launched-by-the-prime-minister/ ). The Daily Telegraph.  Retrieved 27th September 2010.
 2Speech by the Prime Minister on the Big Society, 19 July 2010.
 3Care Quality Commission (2009), Supporting Briefing Note: Issues Highlighted by the 2009 NHS Staff Survey in England.
 4See for example Moss, E., Totterdill, P. (2003) “Building an Organisational Framework for Effective Clinical Governance” in M. Tavakoli and H. Davies, 2003, Healthcare Policy, Performance and Finance. Ashgate Publishing.
5Crisp N. (2005) Speech by Sir Nigel Crisp to the CNO Conference entitled Nurse Leadership for the Future on 10th November 2005.
6Exton, R. (2010) "Enterprising health: Creating the conditions for entrepreneurial behaviour as a strategy for effective and sustainable change in health services", Journal of Health Organization and Management, Vol. 24 Iss: 5, pp.459 – 479.
7 http://www.nhsleadershipqualities.nhs.uk/what-is-the-lqf. Retrieved 11th October 2010.
8 http://www.bis.gov.uk/policies/employment-matters/strategies/employee-engagement. Retrieved 11th October 2010.