Thursday 9 June 2011

All the World's a Business Opportunity

In Wednesday's Guardian, John Harris bemoans the fact that 'the world needs a new Marx, but it keeps creating Malcolm Gladwells'. I've just been reading 'The Social Animal: The Story of How Success Happens' by David Brooks (another New York Times columnist), the latest manifestation of this phenomenon, and - like its predecessors from 'Blink' to 'Nudge' - being devoured by the political elite.

What all these books have in common is the promise to reveal the hidden workings of the human brain, the unconscious but pro-social, pre-rational bases for our behaviour. Here we have 'the emotions, intuitions, biases, longings, genetic predispositions, character traits, and social norms' which influence decisions below the level of awareness (Brooks, p.x), enabling people to read each other, grasp situations and contexts, build networks and become 'street smarts'.

What these texts seek to demonstrate is that successful people have intuitively been practising these arts since the human world began. It was philosophers and political theorists from Plato onwards who have misled us into a hyper-rational view of society, leading either to utopian visions of a perfect order through enlightened individual choices, or to complex bureaucratic designs to control our irrationality for us.

So who were these smart operators who had it right all along? Why - you guessed it - business people of course. The way they laid out supermarkets, to get us to spend more than we planned; the way they created brand loyalties; the way they sold us insurance and pensions, all drew directly on their implicit understanding of our unconscious desires, fears and habits. They had intuitive knowledge of the brain science,the behavioural economics and the sociobiology that that researchers have only just turned into a systematic 'revolution in conciousness', to put philosophers and politicians on the right path.

Brooks's version of this story is told through the lives of Harold, the dreamy, clever, kind but slightly ineffectual offspring of a conventional, privileged couple, and Erica, who has escaped deprivation and psychologicl damage in a Chinese-Mexican household to become a driven entrepreneur. Although they eventually move sideways to work in government, their identities and career pathways are forged in business, and their success is confirmed by a prosperous old age.

Why is this stuff seen as so important by those who exercise power on our behalf? And why, as Harris asks, does our age produce so much of it?

It seems to me that this is not so much because of the failure of the grand political projects of the past three centuries as because humanity has surrendered the quest for control over its destiny to impersonal forces. We have chosen to entrust our fate to computer-operated trading floors in currency and stock markets, and to geeks designing electronic systems for eliminating risks through feedback loops. The 'revolution in consciousness' provides us with an alibi for this surrender, and tells our political leaders that it is OK to manipulate our behaviour while dancing to the tune of global market forces.

But closer examination shows that it should supply us with no such excuse. The tricky shift in Brooks's book is to treat the world of commerce as given, the 'natural' environment and context in which we must all find meaning, purpose and fulfilment. His whole story depicts people with well-functioning stone-age instincts and skills getting by in a society shaped by business plans and corporate strategies.

This is deeply misleading. During my lifetime, almost every institution which defined our way of life, from the post office to care homes, has been turned into a business. The latest victims have been universities, demeaned by the requirement to sell themselves to student 'customers', who are themselves forced to mortgage their futures for the price of a degree. In this context, the creation of an elite 'New College', charging twice as much as the going rate, and staffed by television celebrities, can claim to be a defence of true scholarship.

People are indeed 'social animals', but this is not a reason for putting us in a cleverly-organised zoo, run by the super-rich. A true 'revolution of consciousness' would be a revolution against these restrictions on our potential achievements.

Wednesday 1 June 2011

Social Care?

Social care for frail elderly and severely disabled people is in the news for all the worst reasons. The revelations on the BBC1 TV Panorama programme about abuse of patients in a private hospital for people with learning disabilities and autism followed the equally disturbing news that a mega-provider of care for older people, Southern Cross, is in serious financial trouble. Both the organisation of care and its practice are under critical media and political scrutiny.

The obvious link between the two stories is that both involve for-profit enterprises, wholly or mainly paid for out of public funds. The principle of contracting for care, which is supposed to improve quality and efficiency, is clearly unreliable. We cannot trust the business models of large firms like Southern Cross not to collapse, with serious costs to taxpayers, nor can we depend on companies earning huge fees for their supposed expertise in specialised care like Castlebeck to supply even the basics of dignity and protection for those entrusted to them.

But nor can we trust the inspection and regulation body, the Care Quality Commission, to provide an adequate regime of supervision, even when they are tipped off about abuse. Generating paperwork and ticking boxes is no substitute for a genuine, qualitative assessment of how such institutions are functioning.

These problems are not new ones. The 30 years after the Second World War, when most such care was provided by the NHS and local authorities, were punctuated by scandals over abuse and neglect, especially in what were then called 'subnormality hospitals'. These Victorian institutions, often in remote places, were at best deadening and impersonal, at worst cruel and oppressive. So the state did not do this work well either.

The aims of the reforms set in motion in the late 1970s were laudable. Residents and patients were to have more individual personal care, and be more involved in local communities. They and their carers were to exercise more choice, partly by access to a market in providers, encouraging innovative approaches.

But the policy-makers and regulators were always in danger of forgetting the grim reality of the task. As researchers had pointed out for decades, after all those who can live an 'independent' life in the community have received the necessary financial and practical support, there will always be some who are left outside the mainstream of social life, because of the severity of their impairment, or because of sheer old age and infirmity.

Staff who care for them must overcome an atavistic tendency to devalue and demean all who cannot earn the esteem and status given through work, family and civic interactions. To do their job well, staff must create their own culture, through which residents are given value simply for their humanity. This requires leadership, example and mutual support; without these, the tendency is to revert to indifference or cruelty.

Individual care plans can be faked, activities fabricated and management goals invented. No checklist can capture whether a regime has the ingredients to treat residents and patients with dignity and respect, or create a sense of belonging to a community of hope and purpose. Managers and inspectors who lack a feel for these things are of little use.

If the public culture of a society is one of individual achievement and self-reliance, all this becomes even more difficult. Depending on others, needing to be looked after, are seen as discreditable. Care is counter-cultural in such a social context.

This problem is not confined to the private sector. Recent reports on NHS care for elderly hospital patients have been highly critical of nurses, grudging about giving time, callous about distress, careless over nutrition. Here again, it is a challenge for professional leadership to reject a purely technical approach, and create an environment of sensitivity, concern and empathy.

But the Southern Cross story really is about the shortcomings of treating care as a business. It exposes the myths of choice for residents and efficiency of private provision. Block contracts which have given Southern Cross 31,000 residents in 750 homes do not give choice, and the strategy of selling its stock and leasing it back has left the business with annual losses of £300 million, all underwritten by council taxpayers. And guess who owns Southern Cross and devised the stategy. A private equity company, of course.