Shift happens
Pivots are uncomfortable. We are in the middle of a major para- digm shift away from the postwar model of economic and social policy. Tom Clark’s piece (“The economics of hope,” December), based on his interview with Carlota Perez, was inspiring. Perez moves from a simple critique of the old to engaging with some of the big contours of a new settlement. And as Thomas Kuhn said, transformation is driven by “the proliferation of competing articulations, the willingness to try anything, the expression of explicit discontent, the recourse to philosophy and to debate over fundamentals.”
Paradigms matter. As Perez says, they keep markets together. But it is not just markets. Across public services, the paradigm of privatisation and efficiency drives has dominated for the last 30 years. This shaped policy, but it also had a profound influence on culture: hospitals were redefined as autonomous organisations with a mission to grow and be “world class,” rather than part of a collaborative system designed around communities; rail passengers were redesignated customers; the provision of social care (be it a bath, having a meal heated or being put to bed) was submitted to competitive tendering for the lowest price. We saw the downgrading of the very idea of “public service,” with a reliance on economic incentives and regulation for those who worked in education, health and local government.
A key issue as we build the new paradigm for public services will be who governs. Leadership matters, but many of the most interesting ideas are challenging some of the fundamental power balances. Work in the US and UK by Madeleine Bunting, Anne-Marie Slaughter and Hilary Cottam, drawing on the rich legacy of feminist economics, is looking to re-imagine care. This work understands human thriving not in terms of maximising individual material gain, but as a shared enterprise in which caring and being cared for is intrinsically valuable.
Care has been marginalised, feminised and racialised; it must be moved centre stage. We need a model where economics works for society, not society for economics.
Anita Charlesworth, Health Foundation