Book Review: ‘Radical Help’ by Hilary Cottam

I am wary of the word ‘radical’. It feels brash, idealistic, even aggressive, somehow. Maybe it’s just been overused, it seemed to crop up everywhere during my Masters degree, attempting to appeal to some sort of youthful optimism – ‘this is radical! new! you young people will love it! a complete overhaul will happen right away and it’ll be fantastic!’ – and precisely because it was everywhere, it seemed to disprove itself. The word radical became mundane, so I stopped trusting it.

It might have also become too strongly associated with the political left, as in ‘radical socialism’, and I’m still hurting from the labour party’s bitter defeat at the recent General Election. I too was blissfully caught up in the London-centric media bubble that made us optimistically believe Corbyn might actually win. The reality hit home painfully hard that we still very much live in a conservative country, and it is only to our detriment that we forget or ignore that fact.

But, I understand why Hilary Cottam named her recent book Radical Help. Her whole argument is that drastic solutions are necessary, and they are the only hope we have left if we want to save our welfare system. I broadly agree with her on this, but at the same time, I can’t help but feel that we might not succeed if we frame our argument in these terms. Quite simply, people do not like radical change, and I think (from my limited knowledge, so please correct me), history seems to suggest that slower and gradual solutions are a bit easier to take, and therefore more likely to succeed in the long run. Even shifts that seem radical in hindsight are probably more likely the result of multiple gradual causes coming together and reacting in some lucky way, rather than a genuinely novel and unprecedented ‘pivot’.

Anyway, there are many things I liked about this book. It is clearly written, inspiring, informative, and it covers a lot of ground. Hilary Cottam is a social activist and designer with an academic background in economics and history, and she has made it her mission to reduce inequality and fight social injustice. You can really feel the drive and determination that has propelled Cottam in her work, and as my mother reflected, the world would be a far better place if more politicians had these hopes and ambitions…

In the first part of the book, Cottam describes 5 experiments that she and her team designed and ran, all focusing on different populations and using different methods, but with the shared aim of increasing 4 main ‘capabilities’ of individuals that she thinks are vital to living a good life: learning/work, health/vitality, community and relationships.

Her team work by first identifying a problem, then by getting deep into the matter by immersing themselves practically with the issue at hand (speaking to people, living with them, actively listening to them), then they design a prototype and run it straight away, starting small and then hoping to grow bigger and bigger.

Here’s a quick summary of the 5 experiments:
Experiment 1: ‘Life’ worked by inviting families who are experiencing a variety of difficulties to participate, then they selected a team of service workers who were focused on helping the family to help themselves, those teams discussed amongst themselves best ways forward, and the Life family took an active role in making a practical plan of what their goals are and how they could go about achieving them.
Experiment 2: ‘Loops’ joined young people with managers and workers at companies/organisations related to their interests, hoping that they would form relationships with adults who could then work as ‘mentors’. This project failed and was stopped for potentially being dangerous to the young people. One of my first queries was, are these young people essentially working for free? And also, I thought this was a bit too idealistic because she imagined that life-changing mentor-relationships were easy to spark, which is unlikely to be the case…
Experiment 3: ‘Backr’ was an alternative to the JobCentre approach, and essentially was a MeetUp Group trying to unite unemployed people with others, plus some employed people, in the hope that someone might tell someone else of an opportunity that otherwise they wouldn’t have heard of. The rationale behind this one was that most jobs these days aren’t advertised but are found via word-of-mouth, so we just need people from different backgrounds getting together and discussing job opportunities more openly.
Experiment 4: ‘Wellogram’ focused on patients who had been informally classified as ‘heart-sink’ patients, who were suffering from a number of problems, and invited their doctors to come together to discuss each case. It was an attempt to see the patient’s whole life, rather than each little problem divorced from its wider context, in an attempt to understand the root causes better.
Experiment 5: ‘Circle’ was a technology-based attempt to bring together older individuals so that they could help each other with tasks that needed doing, because some will have capabilities that others won’t, allowing everyone to feel like a ‘helper’ rather than someone who is in need.

What I loved about her approach in each of the experiments was her fearlessness of failure. Too many development projects are run which are too scared of failing, so they rely on methods that have been used far too many times before, and no longer yield novel or unexpected insights. Straight out, Cottam acknowledges that mistakes will be made, wrong avenues taken, but she decided early on that the best way of learning is by trying, so what seems like a big mistake is actually the best way to learn.

Her main findings from all of the experiments seem to be that it’s best to start small and locally, really understanding the people and problems you are working with; people need to be ‘helped to help themselves’, not made dependent on aid; and that the most important of her 4 capabilities is relationships, what the welfare state needs to facilitate is strong bonds between people so that resources can be shared, rather than more money in the wrong places.

I agree with all of these sentiments. But, I have some criticisms (of course) that I’d like to think through…

The first, and obvious one, is that small projects are much easier than large ones. It’s easy to provide thoughtful and time-effective help when you are working with fewer people, as soon as systems get larger they automatically become more cumbersome and inefficient. Her hope is that these programs would grow organically, and that they would actually become more efficient as more people joined (because, more relationships mean more resource sharing) and she argued that ‘our capacity for relationships is infinite’. But I’m afraid I don’t agree. We obviously can’t have infinite relationships, there simply isn’t time in the day nor mental space. All of her projects, thought focusing on different populations, seemed to boil down to a kind of ‘Meet Up Group’, which was facilitated by a ‘reflector’ (or, what I thought was more like a therapist). If people with similar interests but different backgrounds are brought together, helpful connections will be made. And it works best when those people join actively as agents, rather than join feeling like they need to passively receive help from their group. This seems obvious? But it’s also obvious that bigger groups get less personal, so less meaningful, they become a crowd; and, it’s also actually quite difficult to get people involved in this way. We, especially Brits, are quite embarrassed to go to ‘Meet Ups’.

Another point of contention was that many of her projects relied on a therapist-style role, someone who knows when to step forward to offer help to the person needing it, but also when to step back and let them work it out on their own. This role was holistic, and was designed to see the individual being helped as a person with hopes, dreams and wishes of their own, rather than the specialist approach that we have at the moment (with various roles all focused on solving one specific ‘need’ or problem in an individual’s life, rather than concentrating on how to reach potentials) where none of the service providers actually get a good sense of the individual. While I totally agree with the problematic nature of Multi-disciplinary Teams that we have going on at the moment, because so much time is wasted with trying to share information across all the members involved, how are we supposed to get one person to focus and know it all? That, essentially, is a therapist dedicated to each individual needing help, and if we could do that financially, we would.

Finally, after finishing the book, and in writing the summaries of the experiments for this post, I realised that her projects weren’t really that novel or ‘radical’. What Life and Wellogram tried to do was encourage the many service providers to discuss each individual case in more depth, so that they could make a more comprehensive plan of how to help. This is what the welfare system already tries to do, but it is literally impossible to provide that kind of focussed attention on each individual. That’s why we have so many online databases and attempts to share information across services, which is exactly why the system feels cumbersome, and why so much time is wasted on admin. And in the other 3 experiments, the main idea was to form groups around similar interests but different backgrounds, hoping to forge friendships across people to get them to help each other rather than rely on services. These are both good ideas, but they are difficult to implement precisely because they are good when they are not enforced from above, which is what she acknowledges herself!

So, to conclude, I wholeheartedly admire her approach and ambitions. I think it’s vital that innovative and bold individuals try out new projects, methods, designs; because we need to learn practically, and in the real world. Having done from academia to the NHS as a support worker, I see and feel acutely the huge gap between thinking about helping people, to actually trying to do it.

I also totally agree with her conclusions – the fact that what is needed is not (just) more money, but that we also need to make the sharing of resources and connections more efficient. We live in a very well-off country with enough to go round for everyone, the problem is mainly to do with inequality of distribution. We need to forge connections, so we desperately need to value the power of supportive relationships and bring them into our welfare system. We need to stop thinking of individuals who need to be ‘helped’ or ‘cured’ alone by taking a pill or just telling them to exercise more. Cures work best when they are social, because we are social animals and are formed by the groups we are part of.

But, I’m not quite sure that she has designed viable ways of reaching these conclusions yet in any large scale. I think her projects were interesting and moderately successful predominantly because they were small, but I doubt her when she says that they could be organically grown and remain as useful. She may have slightly underestimated the difficulty of growing groups and projects… Having said that, she probably knows far more about it than I do, and probably goes into a lot more detail in her reports, as this book is supposed to be a summary rather than a detailed explanation. So I should read her project reports before I make too sudden a judgement, but that was my inkling.

Has anyone else read this book, and if so, what did you think?

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