Hilary Cottam’s 2018 Radical Help is a critical book that challenges us to rethink today’s welfare system. Cottam is a renowned reformer of the welfare state, pioneering large-scale innovative projects and working within communities across Britain. Throughout her career, she has worked all over the world, including Northern Ethiopia, the Dominican Republic, and the United States, leading radical projects in the field of social change. In 2006, Cottam set up Participle, the organisation which is the foundation of the book. This was a 10-years experiment developing and testing innovative new ways of working within our communities, through restructuring cost-efficient projects, including community reform and famine relief.
Cottam suggests that our current welfare institutions, inherited from the 1940s and 1950s after the Second World War, are no longer adequate in supporting modern-day needs, such as obesity, precarious work, ageing, changing roles in the family, and mental health problems. Therefore, Cottam argues that we must redirect the welfare institutions into more open networks of relationships with support from technological tools. Her solution is building relationships, working from people’s strengths, and expanding on the service benefactors’ capabilities through their own networks as opposed to rigid vertical relationships that reinforce top-down power structures. Ultimately, Cottam argues that “caring for each other is not about efficiency or units of production. It is about human connection" (p. 49). These small changes of approach and new ways of thinking and organising living, can create more sustainable and beneficial outcomes for society which can transform our social and health care systems. In order to do this, Cottam takes a strengths-based approach, moving from assessing and managing risk, to emphasising possibilities through networks that will support individuals to grow their capabilities.
Cottam presents practical change through five collaboration projects within communities across Britain that aim to help build capabilities and relationships over long term work in domains such as family, teenage years, employment, and old age. This takes the human approach through self-reflection and listening to the stories of those who are in need. Communities must work in much more aware, constructive, supportive, and meaningful ways, in order to encourage individuals to take agency in their lives. The programmes start with an ‘invitation’ to join, which is the first step to rehabilitating the welfare system. Cotton adopts an Aristotelian eudaemonia (human flourishing) theoretical lens and puts human relationships and self-determination at the core of complex problems that our current society deals with. There is a push to go back to simpler times of natural social systems and “to nations that touch on the spiritual side of lives” (p. 196).
On reflection, I have found myself wondering why these ideas have never been applied on scale before and perhaps how simplistic policy and societal injustice is presented. There is also the problem of trust as it takes time to develop meaningful and genuine connections and if so, who is liable for when problems arise in these shared collaborative projects? Is complete trust in service benefactors to make good decisions for themselves possible? Cottam herself discovered that one of her projects Participle’s Growing Up aimed at young people was not effective because “human connection and development confronted the culture of risk and management” (p. 127) which indicates how this radical shift is not easy. Cottom’s work is an insightful contribution to the things that are possible when redirecting the focus of our health and social system, but more work is needed on its implementation across the country so we can start with informing practice rather than radically changing it straight away. In recent years there has been lots of restructuring to shift processes in these vertical organisations and reduce the time spent on administration. However, the blame culture and risk management have made a radical shift difficult as shared responsibility becomes a grey area. What Cottam does not address is liability for decision making when thing go wrong. The reduction of bureaucracy and risk management to allow for creativity and instincts can have serious repercussions for service benefactors, as well as health and social care workers.
Nonetheless, ‘Radical Help’ wonderfully articulates the inadequacies of our welfare system and how the simplicity of working with core human values can have a transformative impact on lives. This book is a highly recommended read for those interested in social democracy, particularly those working in the relevant fields of social and health care. It is a well-documented and evidenced piece of work that I hope will be the foundation for more relational and strengths-based practice around the country.