The Wrong Kind of Help?

No doubt connected to schools and half term breaks, there seems to be a bit of a lull in activity at the moment, so I've been looking back at stuff there wasn't time to mention over the last few weeks. First off this comment piece from the Guardian's Public Leaders Network of 7th February would seem highly relevant:- 

Too many public services provide the wrong kind of help

Public professionals can do more harm than good if they fail to motivate vulnerable people to change

Ryan had been on and off the streets for 12 years. He was dealing with addiction after being in prison and felt misunderstood by the people who were meant to help him. It wasn’t until he met Aisha from the Mayday Trust that his life started to change. She was, he says, the first person in a long time who stopped, listened and didn’t judge.

Some help, like that Aisha gave Ryan, supports people to feel hopeful, purposeful and take action confidently. This kind of support is core to the work of many community and voluntary organisations, which understand that good help, at the right time, can transform lives. In contrast, the wrong kind of help can too often undermine people’s confidence, sense of purpose and independence.

Sadly, mainstream public services often inhibit this kind of help. To deliver it, staff need to be supported and have the right balance between autonomy and accountability; they need to be able to put service users first; they need technology to make it easier to share data; and they need to feel part of something bigger – that individual and collective action are inextricably linked. This partly explains why many professionals, including nurses, social workers and teachers, are so frustrated. They have been trained in good help but aren’t able to provide it in today’s cash-strapped, target-driven, restrictive work environments, with ever-increasing workloads.

A new report from innovation foundation Nesta, and social impact lab Osca, where I’m director, has investigated the differences between good and bad help. Researchers found that many of the public services designed to help people actually undermined their ability to take action. This can exacerbate acute and obvious issues, such as homelessness or addiction, but also have chronic and more subtle effects, which erode confidence and mental health.

The probation service, for example, is failing to help people lead more positive lives and stop reoffending, with concerns recently raised about, ex-offenders being supervised by phone rather than at face-to-face meetings. Work coaches at Jobcentre Plus have been criticised for undermining claimant trust and confidence, punishing unemployed people rather than helping them find jobs. They, in turn, point to a stretched system where there is no time to provide good help.

Under the cash-strapped conditions in which many public services operate, integrating good help may seem impossible. But it can actually lead to substantial savings, not least by alleviating pressure on other services. The report highlights several projects that have succeeded, for instance, in reducing A&E attendances, avoiding the need for expensive healthcare, and reducing the number of arrests and frequency of imprisonment. 

Groundswell, which supports homeless people to deliver their own solutions to homelessness, reported a 68% reduction in missed outpatient appointments after establishing a peer health advocacy programme. Homeless people were connected with someone to help them address their health needs through new structures and habits, and who attended GP and hospital appointments with them. The scheme also led to a 42% reduction in unplanned care activity, and saved public services £2.43 for every £1 spent on the project. Other charitable organisations, including the Liverpool Waves of Hope project, AgeUK, the Mayday Trust and Community Catalysts, have reported similar savings.

Despite the difficulties, many public service professionals are applying good help methods, including GPs like Doug Hing, whose patients reported greater satisfaction after he started asking them what they wanted to get out of their consultation, and recommending actions they could take in their own time.

Other examples of good help include Brightside, which provides online mentoring to disadvantaged youths, pairing them with volunteer professionals in an industry that interests them. There’s the peer support network Club Soda, which supports people who’ve decided to make changes to their drinking; and Grapevine, which supports young people with learning disabilities to break free from service dependency and realise their full potential.

What all of these organisations and professionals have in common is their ability to use a flexible, rational approach to connect people with their own motivations for change. Our research highlights seven characteristics of good help, including the ability to recognise individuals’ own influence; encouraging people to feel safe and ready to act for themselves; and helping people define their own purpose. It also means stepping back as their confidence improves. Supporting people to develop peer support; cutting through barriers that prevent change; and sharing information between people and practitioners are also important.

The simple truth is we cannot afford to keep providing bad help. The social and financial costs of doing so are huge.

Richard Wilson is the director of Osca. Some names have been changed.

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From the Executive Summary:-

How do you provide ‘good help’? 

We highlight seven characteristics of ‘good help’ that can be built into public services and social programmes:

1. Power sharing 

The relationships between professionals and people should allow power to be shared rather than ‘directing’ people to do things. An adult-to-adult relationship needs to be established, in which each person’s knowledge and ideas are considered equally. 

2.Enabling conversations 

The way that conversations are structured and that questions are asked can help people to think through what’s important to them and to come up with their own solutions. These conversations build a sense of safety, trust, ownership and motivation for action. 

3.Tailoring 

For help to be transformational, it needs to be personalised. This can be achieved by helping people to define their own purpose and goals. This might sound obvious, but many programmes offer a standardised approach that can feel impersonal and mechanistic. 

4.Scaffolding 

Practitioners can start to step back as the people they help build enough confidence to take action alone. This ensures that change is sustained. Help may need to be ongoing for some people, but should create opportunities for people to take action themselves where possible. 

5.Role modelling and peer support 

Positive relationships expand our sense of what is possible and help us do things we wouldn’t attempt alone. Often the most powerful relationships are with people we consider similar to ourselves. 

6.Opportunity making 

Sometimes opportunities need to be created or barriers need to be removed to help people take action. This may require help from an external source. Examples include brokering relationships which lead to new voluntary or paid work, or other health creating or educational activities. 

7. Transparency 

Professionals (and their organisations) often have access to information about people that is not routinely shared with people themselves. Having open and shared data is an important part of building an adult-adult relationship and supporting people to make informed decisions.