The first part of Associate Director Matt Leach's speech delivered to the King's Fund on the future of health in the Big Society
The recent Third Sector magazine survey of local government employees -
“Big Society: We'll have a go, but what is it?” - reports that sixty per cent of people in the voluntary sector and local government think that the government's big society is a good thing in principle - but 65 per cent do not have a good understanding of what it is. I suspect that there is a similar or perhaps lower level of knowledge within the health sector.
We need to shift those numbers, because the Big Society is not going to go away. The amount of time given to the concept in the Prime Minister's speech is evidence that it wasn't a pre-election gimmick.
Indeed the fact that the government found it hard to sell on the doorstep, but has persisted with it emphasises the extent to which it is a narrative that will continue to define significant parts of the government's direction into the future.
So it is important that we spend some time talking about what the Big Society is, what it will mean for government, communities and public services.
One thing to make very clear, is that the Big Society is a broad vision and a work in progress, and the extent to which it has been fully explored in particular policy areas, and I would include health in that, varies considerably. As a consequence, there can still be misunderstandings about what it is about. And its worth clearing some of them up.
Contrary to what might be claimed by some commentators, I would argue that it is not all about outsourcing public services to civil society organisations or others. There are lots of good reasons for doing this - not least to increase plurality of supply, competition and value for money, and because services are often delivered better by organisation based close to beneficiaries. Greater involvement of civil society organisations in delivering public services can contribute to achieving Big Society objectives, but it is not the principle point of the Big Society vision.
It is not about short term changes in public spending. Although the Big Society has been launched against the background of a crisis in our public finances, and may over time help us - collectively - to adjust to changes in the role and reach of the state, in thinking about the Big Society, we should look less at short-medium term spending decisions - including those announced in the Comprehensive Spending Review - and rather towards longer term shifts in the ways that government and communities organise themselves, which - given the scale of that ambition - is a generational, rather than a 3-4 year project.
In that sense, it should not be seen as a conventional government programme, with a budget attached, a defined timeframe, and a set of clear targets against which progress can be tested and checked, and performance measured. It is broader and more ambitious than that.
So what is it? I would argue that it is as much an analysis as a programme. What underpins it is a deep and genuine concern that - over many years - the strength of the links between us as individuals, within communities, within our neighbourhoods, have been weakened by a political and economic system that has sought to monopolise power and responsibility and crowded out the space previously occupied by what is currently called civil society.
As the size and areas of competence of the state has grown, we have collectively looked, and been conditioned to look, increasingly to government to do something, be it through legislation, regulation or funding, at the expense of generating solutions for ourselves.
For many - rather than being participants in economic activity, we have instead become passive worker/consumers, with both those who employ us, and those who manufacture what we buy, or lend us the money to buy it, located remotely, with no genuine ties to or stakes in the communities and localities that we live within.
This weakening of both personal responsibility and community strength has contributed to a society that it increasingly atomised and fragmented.
That - in itself - has direct and indirect health impacts. Poverty, loneliness and isolation are all major factors affecting both physical and mental health. And networks and connectedness, the strength of the family and community ties we have can have major positive health impacts, as well as providing sources of support when we need it. Given the likely pressures we will face over the next twenty years arising from the ageing population, this is an area that will be of growing importance...
Part 2 of Matt's speech argues that the health services must look towards designing interventions that build social capital and community confidence