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No more dogsbodies?

February 7, 2013 by
Filed under: Public policy, Uncategorized 

There is a subtle but important link between two of today’s depressing news headlines: the scandal at Mid Staffs Hospital and the confirmation by the IFS that economic sluggishness means the worst of public sector austerity is still to come.

When talking about the poor performance and low productivity of the UK economy there is a tendency to focus on high skill, high tech areas like life sciences and new materials. As I wrote the other day, R and D investment and commercialisation of these areas is stagnant at best and more likely in decline, but even if were they booming, these sectors – which will only ever account for a very modest proportion of the total workforce – would not be the answer to the biggest problems of our labour market. These lie in a low pay, low skill, low productivity service sector increasingly detached from the managerial and professional classes.

As a number of writers have argued, the most important challenge for the UK economy is improving the quality and productivity of service sector employment. And, by the way, improving the quality of services is also a more environmentally sustainable model of growth than producing and consuming more ‘stuff’.

But what’ the link to the Francis Report on Mid Staffs? Over the last twenty years a major trend in the public sector has been the development of a tier of poorly paid assistants (many of not most of whom would require tax credits  to reach a living income) in jobs with a low skill requirement who are slotted in under the main service professions. In teaching for example the number of teaching assistants has risen from 79,000 in 2000 to over 220,000 in 2011. There has also been a steady rise in the number of health and social care assistants. And the category of police community support officers (PCSOs) which has only existed since 2002 has gone from 6,000 in 2005 to over 15,000 today.

The basic idea is that assistants don’t have highly developed skills and competencies as they will be overseen by professionals who do. But a number of processes undermine this model. Rising demands and multiplying bureaucratic processes, on the one hand, and the natural tendency of professionals to want to spend their time on the most rewarding and career enhancing activities, on the other, mean that assistants often end up performing vital task with limited supervision.

To the case study evidence of service failure by health care assistants provided by the Francis Report and a steady trickle of stories about PCSOs failing to manage difficult situations, can be added telling research from schools which shows that teaching assistants are among the least effective (and most expensive) ways of spending money to improve children’s attainment. Indeed, because teachers often ask assistants to work with the lowest performing children (leaving the professional to work with the more engaged pupils) they can end up worsening outcomes for this group.

Most teaching, health care assistants and PCSOs are hard-working and effective but the system is failing and the assumptions underlying it lie cruelly exposed. The idea of growing a low paid cadre to take the unrewarding, unpleasant, monotonous work off the hands of the better paid university qualified professionals seems like common sense but increasingly it looks like it is plain wrong; bad for staff, bad for service users, bad for the reputation of public services and bad for the economy.

Raising the skill threshold and performance expectations of the public service assistant cadre, while maintaining this as an entry point for non-graduates, should be a priority for public service reform. It is the key productivity challenge and it will require an integrated response starting in schools and FE colleges and reaching into the heart of management, work design and professional boundary setting. But if the public sector could grasp this challenge it could provide a vital lead to the rest of the service sector, which is characterised by very similar problems.

For while it may not be sexy, or offer politicians the photo opportunities they love in laboratories or science parks, it is change here at the bottom of the labour market that is most vital to public service improvement, economic dynamism and social justice.



  • Robert Burns


    agree with you on many of the points you’ve set out in this latest posting, but I must disagree with you on the following:

    A core presumption that runs through your posting is that the emergence and development of cadres of semi-skilled “assistants” under the nominal supervision of “qualified professionals” is all do with taking the “boring” parts of a job off the hands of qualified professionals is fatally wrong.

    This movement is an organizational response to a requirement to maintain a particular scale of presence with reduced economic means.

    It boils down to this: This country is going broke and that fact is having two effects.

    (a) Economic breakdown feeds social breakdown in an expanding, circular relationship; and

    (b) In the short term semi-skilled place fillers can be deployed to deal with the consequences of mutually amplifying economic and social breakdown, but the system must eventually fail when through lack of economic means the core of “professionals” falls below a critical mass and/or the scale of the problem reaches a point where there is no practical possibility of controlling it

    If that sounds far fetched, or even apocalyptic, consider where we are in relation to the following:

    (a) family and community breakdown;

    (b) drug use and the crime committed to support it;

    (c) mass political disengagement;

    (d) persistent unemployment; and

    (e) an economy that, in real terms and for the majority of the population, shrinks year on year

    You write of symptoms as though they are primary causes.

    Do you do this deliberately?

  • ben lucas

    I think you’ve identified a critical issue, but I also think that the argument needs to be broadened. This isnt just about skills it’s about value. The basis of much of 2020’s work at the RSA is the belief that some of the greatest value in public services lies in the quality of the relationships they can foster with citizens. This is a million miles away from what what was valued in mid staffs, and still is elsewhere, in the NHS – which is high tech interventions, and efficient patient transactions. So part of what’s happened is that in response to that professionals have outsourced the aspect of their work which is least valued – the quality of the relationship with patients, pupils etc. That means that caring needs to be much more valued and better paid – adult care scandals are the obvious dimension of this. It means professionals should have a greater role to play in this and that cleaners, assistants and care workers should all be more valued. And it means that the traditional measures of productivity won’t be enough to underpin this – which is where social productivity should help broaden what’s measured. This is a very important debate.

  • Robert Burns


    like MT you miss the core point:

    Lack of money to provide the scale(s) of service response required is the problem.

    Yes, care needs to be valued more highly and those providing it need to be better paid, but where is that money going to come from?

    Yes, the “professionals” need to be more engaged, but there aren’t enough of them because there isn’t enough money to pay for them. Hence semi-skilled “assistants”.

    Lack of money circulating at the “lower end” of the economy of an urban population drives a lot of socially subnormal behavior – that is:

    (a) failures of care for the young, sick and elderly in the family domain;

    (b) children without growing up in home environments that turn them into misfits incapable of integrating into the school environment;

    (c) anti-social behavior and crime

    Measuring productivity on the basis of “social productivity” is both a Middle Class luxury and a left wing pipe dream that this country can’t afford.

  • Zio Bastone

    @ Ben Lucas & Robert Burns:

    ‘Productivity’ could do with interrogation. Production of value. But in what sense? Use value? (We do actually need to be healthy; seven year olds don’t need bras, and yet these are made and sold.) Exchange value? (In Krugman’s splendid sarcasm the world can soon get back to growth by exporting goods to Mars.) Surplus value? (Outsourcing, Adam Smith’s ‘one man draws out the wire…’ in its post industrial form, isn’t about ‘adding value’, with new and more flexible services, but about capturing surplus value, in essence a kind of theft; and in fact some hospital catering contracts are for a term of 20 years.) The production of money by means of money? (Marx’s ‘finance capitalism’, M-M’ in the jargon, or Minsky’s ‘money manager capitalism': in a negative version of this process JP Morgan Chase recently lost more than twice Sierra Leone’s annual GDP through a single trader’s transactions.) And so on.

    Ben Lucas is right about what he calls ‘social productivity’, though it’s not an attractive phrase. And in saying, essentially, that neither quality and quantity nor cooperation and competition are the same. (A proportion of JP Morgan’s losses were through betting against itself; the attitude to care in a hospice, for example, is utterly different to that in a typical hospital, and Allyson Pollock is pretty pungent on the damage visited on the NHS by its marketisation, complete with transfer pricing, under New Labour.)

    Conversely Robert Burns is, I think, quite wrong. Pessimism of the will and dog whistle pejoratives such as ‘Middle Class’ and/or ‘Left Wing’ don’t advance the discussion. On his one substantive issue, ‘Where’s the money?’, he neglects some obvious points. For example,we are busily aping one of the most expensive, least effective healthcare systems in the world; we don’t have to. A jubilee has, in effect, been offered to those who take from the common pool and transfer it to the Haves. So not to the poor or the disabled but, for example, to the banks, the hedge funds. And meanwhile, in the case of healthcare, numerous PFI contractors, Serco, Big Pharma etc are skimming (or scamming?) the system. 

    We are something like the 24th richest country in the world. Rather than pleading impoverishment and hopelessness we need not just to plug up some of these leaks and (instead of encouraging) to reverse these sorts of transfer but also to consider what we want in a way that takes account not merely of price (whereby the rich buy Veblen goods at Louis Vuitton and the poor buy Giffen goods at Lidl) but also of value in the now old fashioned sense of use, of what will actually assist us to live well.

  • Robert Burns

    Zio Bastone,

    answering you on several points.

    (a) Pessimism

    I don’t believe that nothing can be done, just that no one in a position to actually do anything effective is willing to make the mental step outside their comfort zone(s) that will allow them to identify the place and nature of what is wrong.

    To me the blinkered “happy clappy” optimism that so often finds its way onto this blog is an intolerable provocation.

    No one seems prepared to look upon the demon.

    (b) Dog whistle pejoratives: “Middle Class” and “Left Wing”

    No apologies, both of these are thought spaces dominated by the belief that what they want or have is (or can be) conjured up out of some sort of social/economic 4th dimension.

    Attacking them and exposing the fallacies underlying their atavistic “beliefs” is a necessary part of breaking their hold over public discourse and moving the discussion on to a generally productive outcome.

    (c) “We are the 24th richest country in the world”

    This country might well be the place of residence of the 24th largest accumulation of paper money value in the world, but that doesn’t automatically make you or me better off than similar individuals living in the 50th “richest country”.

    Much of this “wealth” is politically protected debt attached to real estate that is used as collateral for further borrowing and this is a big part of what is killing the country and making ordinary people poorer every year.

    A person living on the national minimum wage and parting with 75% of their net income for accommodation, etc. is a little too preoccupied to be part of this mythical “we” who can make “decisions” and what will “assist us to live well”.

    Those with the leisure to follow your advice already know what they “need”.

    That is to keep as many other people as dirt poor as possible so that they can maintain their standard of living (or maintain bankrupt assets on the books) in a shrinking economy.

    I’m not a pessimist, I’m a realist.

  • Zio Bastone

    Robert Burns:

    Four points.

    ‘The challenge of modernity is to live without illusions and without becoming disillusioned … I’m a pessimist because of intelligence, but an optimist because of will.’ So not pessimism tout court but ‘pessimism of the will’. The pessimism evinced when you say, in effect, not that it can’t be done but that it won’t because nobody’s going to do it.

    That’s not facing demons. It is sighing into your beer.

    On neoliberalism, its dominance and its consequences I’m fully as bleak as you. Almost certainly much bleaker. However, there’s a long tradition to which I subscribe of seeing what is wrong as something to put right. It isn’t an excuse to shut up shop. That’s why I indicated on your one substantive point how resources were in fact available and what, in my view, with examples, the direction of change ought to be.

    I shan’t dwell longer on my second point than to question whether in Britain (and I don’t just mean in Parliament) there actually is a ‘Left’ at all beyond a handful of people who tend to come from abroad. To claim that the ‘Left’ holds sway in any national discourse seems to me quite bizarre.

    Thirdly ‘we’. You and I have clashed on this before. Like Matthew Taylor you speak about people rather than as one of them. And where MT seeks a top down liberation of Other People, thereby setting in train a slew of innovations (what he actually seeks, I suggest, is to capture change and control it in the name of some Rawlsian good) you merely observe that all these Other People are in chains, noses to the grindstone and so forth. They cannot help themselves and won’t be helped by those in charge whose interests are not theirs. So it’s hopeless.

    I disagree. We need to embrace being refusés, not to lament not being members of some salon. We should consider what we want and need and act upon our perceptions. That isn’t Winter Palace stuff. But nor is it (©  Joe Hill) vapidly pie in the sky. Rather it is an act (or series of acts) of quotidian subversion, the other face of innovation. Refusing the prevailing narrative, resisting capture by behaviours to which we don’t, in fact, subscribe, is another. And both are things which ‘we’, ie all of us (your class of leisured Hampstead liberals is a myth), can do as part of our engagement with the situation in which we live.

    My fourth and final point. Since you had asked, Where’s the money? I noted how JP Morgan’s ‘London Whale’ losses (small with respect to overall profits) compared to the GDP of a particular third world country to give a sense of scale. I then indicated how rich the UK was in terms of GDP.

    Static measures such as property prices or what you call ‘paper money value’ are irrelevant. As I did rather think I’d made clear.

  • Robert Burns

    Zio Bastone,

    well good for you and it would be great if you were right.

    In my view the talk of “social productivity” is a left wing fetish that has been married to corrupt Middle Class sensibility.

    “Oh, but we want to help the poor and the disadvantaged” – just so long as they don’t stop being poor and disadvantaged and make it into competition with “us”.

    That, my friend, is what underlies all these “schemes”, “projects”, etc.

    Not a single one of them will change the background conditions that create the “problems” they claim to be addressing.

    The UK population has been socially atomised and no one belongs to a “we” in any coherent internal sense.

    Everyone is “they” and the “we” only comes into use when an aggregation of individuals adopt an identity defined by an externally assembled list of shared characteristics or interests.

    Such people are psychologically incapable of understanding how – let alone acting politically – to create autonomous communities from which to break out of the status quo.

    People are conditioned to believe that “freedom” is being a free floating entity without permanent associations – out goes the family, parental authority and ties to community rooted in history and geography.

    All of this is bounded by the status quo and anything that runs counter to this is publicly reviled and demonised as anti-social or criminal (irrespective of what the facts may be).

    Individuals who step out of line don’t fare any better.

    How often does the media portray the family that resists intrusion by the state or consumerist “individualism” as either a place of abuse or a wellspring of criminality?

    MTs attack on Starbucks in the wake of the Parliamentary “investigation” into how a company with such a large turnover generated such low taxable profit is an example of one aspect of what I am talking about here.

    As for people “just needing to engage with opportunity” (I paraphrase).

    Those who can answer that couldn’t be understood by those who need to hear the answer.

    We will not find agreement, leave it at that.

  • Zio Bastone

    Robert Burns:

    I don’t mind you disagreeing. You may indeed feel that nothing works and everything is hopeless, whether top down or bottom up or horizontalidad. However, please don’t attribute to me views I do not hold (indeed I specifically dissociated myself from them last time round) and allegiances that are not mine before condemning top down solutions I don’t and would never propose.