Fight The Power?
Personalisation and power in England
Chris Hatton
This is my first tentative foray into blogging, and as an
academic who generally likes to talk about data and is wary of too much
theoretical abstraction this is a weird first blog for me to write. It has been
prompted by a question posed by Martin Routledge (currently Head of Operations
for In Control) on Twitter, which went as follows (I’ve added some vowels…):
“Reflecting that we are good about talking about
personalisation, less willing to accept ways of actually transferring power to
people – why? Institutional history of services? Risk averse organisations?
Interests of commissioners, providers, staff not same as people using?”
I’ve worked with In Control for over a decade on a series of
tools to evaluate the impact of personalisation on people using self-directed
support and family members, and variants of this question (“Why do powerful
people find it so hard to give power away?”) have never been far from my mind.
However, I’ve recently been wondering if this is the right question, and if the
very fact of asking the question in this way sets up as adversaries people who
might otherwise be allies.
As a minor detour, for the past couple of years I’ve been a
PhD supervisor for Dennis Johnson, a retired paediatric neurosurgeon and
creator of a paediatric palliative care service in the hospital near where he
lives in the USA. For his PhD, Dennis spent some months in Romania, closely
investigating a paediatric palliative care service identified as a ‘beacon’ of good
care in a country that was, to put it mildly, not conducive to the provision of
good palliative care support. Dennis’s thesis (which passed last week – many
congratulations, Dennis!) contained an eloquent description of the features
that made the service a beacon in difficult circumstances, but it also
contained an analysis of how the service had managed to negotiate its way round
the hostile power structures that existed in Romania for this type of service.
Rather than seeing power as a property of certain individuals
or institutions, Dennis introduced me to a set of dictums formulated by Michel
Foucault, the French philosopher with an abiding interest in the exercise and
effects of power throughout societies. One interest of Foucault’s was in how
challenges to patterns of established power or authority have historically been
successful, and he came up with 6 common features of such successful
challenges. Given the formulation of the personalisation project in England as
a challenge to established structures of power and authority in social policy
and service provision, I thought it might be useful to see to what extent these
6 dictums apply to the development of personalisation in England, and whether
there are useful lessons to be learned for how (or if?) personalisation can
develop into a meaningful reality for everyone.
So, here goes…
1) Avow ‘transversality' or transnational
citizenship.
Foucault’s first dictum suggests that ideas that change the
world do exactly that (at least partially) – they are thought of as
international and beyond a certain point inevitable and part of the common
sense architecture of how we think. As Sir Charles Geoffrey Vickers in 1958 wrote (in relation to public
health) “The landmarks of political,
economic and social history are the moment when some condition passed from the
category of the given into the category of the intolerable”.
In terms of what Foucault’s first dictum might mean for
personalisation in the UK, my question would be to what extent personalisation
embodies broader changes in international expectations about what is acceptable
and unacceptable in the way societies support all their citizens. For good
reasons (see below), the personalisation project in the UK has largely focused
on the mechanics of implementing personalisation within existing legal, policy
and service frameworks. However, there are at least three risks entailed in
such a focus, and there may be advantages in placing more public emphasis on
the alignment of personalisation within broader movements of ideas.
The first risk is that the focus on the mechanics of
personalisation leads to the perception that personalisation is an end in
itself, rather than a range of vehicles for helping people achieve
self-determination. The second risk is that the focus on service systems leads
to a UK-centric view of personalisation, which risks losing the connections to
broader international movements towards self-determination. The third risk is
the perception that personalisation in the UK has over-stated its originality
and not paid due regard to the national and international currents of thought
and practice that fed it.
In my view personalisation gains strength from taking its
place as one part of a broader international movement focusing on the rights of
all citizens to self-determination. These broader international movements can
shape how societies think about what is ‘given’ and what is ‘intolerable’, in
ways that any national programme cannot.
2) Target the effects of power rather than
confront the sources of power and authority.
On my very cursory reading of Foucault, one of the few
things that stuck was his notion about power being networked, without an
obvious ‘centre’, such that everyone in the network feels (in different ways) constrained
and relatively powerless. While it is tempting to imagine a cackling
megalomaniac pulling the strings of power (or sitting on a huge sack labelled
‘Power’ and refusing to give any of it away), perhaps the reality is more like
the Wizard of Oz – a sad little man sitting behind a curtain frantically trying
to convince us of his omnipotence.
This isn’t to say that differentials in power are not stark
and are not real – clearly a person trying to negotiate the social care
labyrinth is all too often forced into a place of screaming frustration. But it
is to say that if we go searching for the person with the sack labelled
‘power’, with the aim of persuading them to give it up or taking it from them,
we’re going to be searching for a long time. When I listen to and read the
accounts of a lot of people involved in social care, including people using it,
people denied it, families and friends, social workers, managers, proponents
and opponents of personalisation, and even politicians (‘Why won’t the world
just do what I tell it?’), I don’t hear anyone (well, hardly anyone…) rubbing
their hands with glee at the power they are managing to retain and the joy with
which they wield it.
3) Contest the privileges of knowledge (and
contest what is privileged knowledge).
Much of the debate around personalisation rests on a
sometimes acrimonious contestation of what counts as evidence for what is
‘really’ happening with personalisation. Academic research, individual and
family accounts of their experiences, case studies of organisational change,
surveys, and statistics are all being generated in increasing quantity and
variety around whether, how, why, and for whom personalisation is working (or
not). As someone who has helped with the generation of some of this evidence, I
find the diversity of types and sources of knowledge a real asset (in fact,
absolutely necessary) in trying to understand the complexity of personalisation
and its effects.
However, I feel the debates about personalisation are all
too often bogged down in attempts to privilege one type of knowledge over
another. For example, academic researchers can appeal to methodological rigour
to claim that only knowledge produced in this way can be relied on and
everything else is anecdote, and individuals producing detailed accounts of
their own experience can claim that only lived experience counts and academic
research is too remote from what’s really happening on the ground. And these
disputes about what counts as ‘knowledge’ often have power, or perhaps more
aptly a sense of powerlessness, underlying them. People may feel that their
lived experience is unheard and ignored, amplifying a general sense of
powerlessness in relation to service systems. It may be a surprise to know that
academics feel about their research in a remarkably similar way!
For me, Foucault’s third dictum suggests that we need to
contest the idea that any particular type of knowledge is in a uniquely
privileged position, and learn what we can from all the sources of knowledge at
our disposal by putting them alongside each other and trying to synthesise what
we can learn from them rather than seeing them in oppositional terms.
4) Engage the immediate problem rather than
the “chief enemy”.
For me, this is closely related to Foucault’s second dictum,
and has helped me to think about the frequently acrimonious debates around
personalisation. Partly because pretty much everyone feels (in their different
ways) powerless and frustrated with how things are, there is a temptation to
identify someone else as the ‘enemy’ who is the barrier to a goal that seems to
be generally agreed, that of meaningful self-determination for everyone (see
Foucault’s sixth dictum below).
The first problem with this is that people are often
identified as enemies who could be allies and actually have a shared goal – do
debates about how this shared goal can best be achieved need to become
adversarial shouting matches about who is to blame or whose motives are the
most noble?
The second problem with this is that it might make us feel
better (although at the expense of making someone else feel worse), but where
does it get us in terms of the goals we want to reach? If we make social
workers feel that they’re oppressive stuck-in-the-muds who are stopping people
get what they want out of life, does this help us understand why things are the
way they are and what social workers feel about their role? If we make
proponents of personalisation feel like they’re wilful Pollyannas who are
pushing an agenda with no actual regard for the realities of people’s lives,
where does that get us?
Foucault’s fourth dictum is a real challenge, as it suggests
that campaigning against the iniquities of power is not enough on its own, and
also that grand theories providing overarching solutions to problems of power
are unlikely to be found (and are even more unlikely to be useful). Foucault
suggests that there needs to be ongoing, practical engagement with existing
power structures focused on solving ‘real’ and immediate problems for people,
person by person, area by area, service by service. Identifying an enemy is not
enough.
5) Oppose efforts to separate individuals from
the society that nurtures them.
As with much else, opinion is polarised about the intended
and unintended consequences of personalisation on relationships between
individuals using self-directed support, other people close to them, and the
communities and societies in which they live. The benign view is that personalisation
can liberate people from constraining systems of support that are far from
nurturing, with people then able to use their resources to develop nurturing
and supportive social networks stretching beyond the reach of services and to
reconnect more meaningfully with their family, friends and local communities.
The malign view is that personalisation atomises the person’s social world,
separating them from much-needed support, pitting individuals against their
families and leaving them isolated and alone within communities that are at
best indifferent.
In terms of personalisation, Foucault’s fifth dictum
strongly emphasises the importance of connectedness and ensuring that people’s
social networks, lives and communities are genuinely nurturing. For the
personalisation project, it is vital to work on these broader aspects of social
connectedness and communities which stretch far beyond mechanisms of funding
and service provision for individuals and embrace the importance of the
collective and belonging in people’s lives.
6) Preserve the right of self-determination
and resist efforts to control “who we are”.
Self-determination is clearly at the centre of the
personalisation project, but the terms self-determination, choice and control
are often used interchangeably, and there are heated debates about how much
choice and control is possible and/or desirable for various groups of people
potentially making use of personalised support. Without getting into a long
definitional discussion, for me self-determination is the fundamental idea,
with the simple principle that people should be the active agents in
determining the course of their own lives.
Being self-determined does not
necessarily mean having to make choices over every aspect of your life – you may
decide to cede control over certain areas of life, for example, with the
proviso that you can set the limits of this and take back control when you
wish. It also does not mean living a life without being cared for – at various
times in our lives we all need to be cared for, but there are other times when
we want support or liberation rather than care.
With its conflation of choice and control (and less mention
of self-determination), there is a widespread perception that ‘real’
personalisation means in essence supported direct payments, with the person
having to act as employer and co-ordinator of their support. A truly
personalised approach would have no such assumptions, with people being able to
determine at what level they want to have control, the terms under which
control is being ceded to others, and when they can take control back – all of
which may change at different times in the person’s life.
A (non) answer to the
question?
Taken together, Foucault’s six dictums suggest a set of
strategies needed for personalisation to negotiate its way through existing
power structures to become a meaningful reality:
1) Embed personalisation as part of broader
international movements towards self-determination for all citizens.
2) Stay close to the lives of people involved in the
personalisation endeavour, documenting and understanding how personalisation
works (and doesn’t work), and using this understanding to improve how
personalisation works.
3) Use all forms of knowledge to improve our
collective understanding of what is happening, rather than privileging any form
of knowledge or engaging in needlessly adversarial debate about what counts as
‘evidence’.
4) Rather than trying to identify ‘enemies’ to the
achievement of self-determination for all citizens, work together to understand
the systemic constraints and facilitators to achieving self-determination in
specific circumstances and use these to
build better ways of achieving self-determination from the ground up.
5) Ensure that the maintenance and development of
people’s social networks and the promotion of nurturing communities is seen as
just as essential as paying attention to funding and service support
mechanisms.
6) Keep the aim of self-determination (not
necessarily choice) in mind at all times, and design and evaluate personalisation
projects against this standard.
So, what is the answer to Martin’s question? I’m not sure
that there is a satisfactory answer, and even if there is, I’m not sure how far
it would take us in making personalisation a meaningful reality for people. Despite
the attraction of the grand theory and the big answer for academics like me,
Foucault’s analysis of power suggests that there is no substitute for the hard
grind of working through the issues person by person and service by service,
and working through them together.
Reference
Foucault, M. (1994). The subject and power. In J.Faubion
(ed.), Michel Foucault: Power, The
Essential Works of Michel Foucault 1954-1984 (pp. 328-348). New York: The
New York Press.
