Radical Help: How We Can Remake the Relationships Between Us and Revolutionize the Welfare State

by Hilary Cottam

How should we live: how should we care for one another; grow our capabilities to work, to learn, to love and fully realize our potential? This exciting and ambitious book shows how we can re-design the welfare state for this century.

The welfare state was revolutionary: it lifted thousands out of poverty, provided decent homes, good education and security. But it is out of kilter now: an elaborate and expensive system of managing needs and risks. Today we face new challenges. Our resources have changed.

Hilary Cottam takes us through five 'Experiments' to show us a new design. We start on a Swindon housing estate where families who have spent years revolving within our current welfare systems are supported to design their own way out. We spend time with young people who are helped to make new connections - with radical results. We turn to the question of good health care and then to the world of work and see what happens when people are given different tools to make change. Then we see those over sixty design a new and affordable system of support.

At the heart of this way of working is human connection. Upending the current crisis of managing scarcity, we see instead that our capacities for the relationships that can make the changes are abundant.

We must work with individuals, families and communities to grow the core capabilities we all need to flourish. Radical Help describes the principles behind the approach, the design process that makes the work possible and the challenges of transition. It is bold - and above all, practical. It is not a book of dreams. It is about concrete new ways of organizing that already have been developing across Britain. Radical Help creates a new vision and a radically different approach that can take care of us once more, from cradle to grave.

Genres: Nonfiction, Politics, Sociology, Economics, Social Work, Psychology, Society

320 pages, Hardcover

Published February 19, 2019

Reviews

[Keith Potts · Rating 4 out of 5]

Probably a 4 point something! Such an interesting read on how the welfare state no longer really works for our current day society. As the book points out ... a purpose of the state is the development of its people but, in order to do this now when it is obvious that government departments are failing so many people, the state must seek out and support alternative models to help it's people develop. This book provides a number of ways to begin such a process.

[Charlotte Ainslie · Rating 3 out of 5]

Had some very strong feedback on my normal distribution approach to ratings in 2024, so reverting back to "traditional" ratings going forward.

Appreciated the discussion but minus points for both lack of actionability and distinct lack of commas. Took me a long time to get through which is probably mostly my fault but -0.5 for nothing sucking me back in.

3.5

[Ella Porteous · Rating 5 out of 5]

This book says how good it is so have conversations with people and give them space to reflect on their lives. fuck off to margaret thatcher

[Austin Steinhart · Rating 3 out of 5]

most importantly, i entirely agree with the premise of the book. we mustn’t be afraid of radical change to existing systems of support and most often will only find success when we center meaningful, locally rooted, and mutual relationships. attempting to change systems from the outside without those actually impacted by the problems at the table will never lead to beneficial or transformational change.

with that being said, i found the experiments repetitive in substance, a lack of clearly defining the guiding principles and best practices at the end, and generally an air of ‘saviorism' despite its good intentions.

[John Wade · Rating 5 out of 5]

A fabulous book. A must read for anyone remotely interested in strengths based working.

[Mandy · Rating 5 out of 5]

If every NYT news alert is chipping away at your will to live, current administrations are making you question the sanity of an entire nation, and you find yourself staring at your public administration degree wondering what the point was when everything is so f*cked, Hillary Cottam is here to sweep in and save your mental health (at least for the few hours or so you spend reading her book). Hillary Cottam ran a workshop earlier in the year and I remember being so enamored by her ideas that I immediately ran out to buy this book and god am I so glad I did. This is a complete reimagining of what a welfare state could look life if people's humanity and the end goal of a 'good life' were put at the center of the system.

Cottam takes a ~design thinking~ approach to redesigning welfare systems with a central focus on empathy, self-determination, and social relationships to bring wellness to people and their communities. Her experiments are small scale but the ideas behind them reminded me a lot of some of the feminist systems change noted by Lola Olumenfi in her book Feminism, Interrupted that we looked at in my Power of Politics and Systems Change module last year and I think the two go together as a perfect set. Sometimes the answer isn't spending more money or adding more programs to an already unruly and overburdened system: true systematic change means reconsidering the system in its entirety, identifying and eliminating redundancies, encouraging communication within communities, and most importantly, listening to what those engaging in welfare programs actually want and need.

One part designer, one part political scientist, one part psychologist, Cottam takes a comprehensive look at the lives of those most dependent on Britain's Welfare State and considers not which of the existing programs these individuals should try or what new programs should be added, but what comprehensive support they need to remove themselves from the Welfare network altogether. It seems simple, but nobody wants to do the work of overhaul and so, alas... here we are.

Anyways, if you did a little hope for the power of people to make a difference and need to escape to a hypothetical world where we all care for and support one another; my copy of this book is yours to borrow.

[Millie · Rating 5 out of 5]

There are so many books out there (and I’ve definitely read a few) that dedicate most of not all of their time to explaining why the system is broken with. Sometimes there’s a final chapter that feels like an afterthought for ‘what we could do differently’ that’s often too high level or feels totally detached as to be worth it. This book is different, the author knows the system is broken and she knows that we know that too and so instead we are invited to focus on the possible solutions. There are specific examples from the authors experience yes, and the stories they tell are interesting and thought provoking. But perhaps more so is the principles the author presents for how to design better systems across our services to make them fit for a changed and ever changing world.

I could review this book for hours if not days, as someone who is passionate about the arts the participation of designers in these processes is worth unpacking. But overwhelmingly I found the book fascinating and challenging - challenging in that it forces me to think differently about the way that I think and work and how I can embed and encourage these principles and help realise change and lasting impact. Lastly, it gives me hope - things are broken yes but there are ways we can and should work to fix this and at the heart of this is us, people, and the relationships between us that are key to our shared future.

[Claire McCormack · Rating 5 out of 5]

“To stimulate love, joy and hope, the emotions that lead to and sustain change, you need others. The love, joy and hope that make up a good life are dependent on good relationships, which is why in turn we need a relational approach to any future welfare solutions and, if we are going to measure, we need to find a way to keep these human factors in view while not reducing them to yet another exercise in box-ticking.”

Hilary Cottam outlines with precision how our existing post-war welfare arrangements (Social Work, youth services, Jobcentres, the NHS and elderly social care) are under intolerable strain because they are no longer fit for purpose nor are they designed for our current demographics, cultures or experiences. Policy must be rooted in everyday lives at a *granular* understanding in order to see change.
Cottam beams optimism for practitioners and people of all ages, attitudes and abilities as she models her services on abundance: what we have and what we can do, starting with human relationships.

Honestly a gold star book. Finally a glimmer of hope for how we can all begin to live good lives full of capability and continual growth, not threadbare with scarcity and misunderstanding.

[Kathy · Rating 4 out of 5]

Critical book to helps us rethink system change in today’s welfare system and in any helping profession . To create sustainable change it is all about building relationship , working from people’s strengths, expanding on their capabilities through building social capital and identify each purpose . Ideas for this type of total reform are the cornerstone of RENEW, and school to career transition intervention for vulnerable adolescents. To find out about RENEW go to:
https://iod.unh.edu/projects/resilien...

[Kira · Rating 5 out of 5]

One of the most powerful and mindbending books I’ve ever read. This is a handbook for the current moment, and how we can hope to get out of this mess we all find ourselves in. The transactional approaches of the twentieth century are no longer working in our VUCA context. Cottam’s work is revolutionary and continues to evolve. Radical Help is a practical text book and companion to guide tough work on complex issues. At its heart is the idea of relational practice. What could be more simple, or more transformational?

[Emmaby Barton Grace · Rating 4 out of 5]

really enjoyed this! my main issues with the manifestos i read last week were that they provided no actual solutions to the problems/solutions that fit with what they wanted. this book provided lots of successful examples of what implementing this would look like in theory. however - this book was also a lot less radical than the manifestos/didnt have the same theory/overarching visions, hence the 4 stars... but i really enjoyed it and it made me so excited and happy to read about real-world examples of things working!!

[Sam Dodge · Rating 5 out of 5]

Inspiring work that chronicles Ms. Cottam’s experiments in redesigning social services to be more horizontal, social, and build capacities, particularly relationships. The theories underlying her work are Aristotelian eudaimonia or human flourishing particularly as it is worked out by Martha Nussbaum. What at first seems like a weakness turned into the most rewarding part: none of the experiments have replaced the existing system. But the honest discussions about the difficulty in changing an interlocking cultural/economic/bureaucratic system and the relatively long term work over many experiments in many domains from family, teenage years, employment, to old age. The use of the fairly consistent diagnosis of flaws and antidotes are compelling. She takes what is so known and well documented from “Bowling Alone” through social determinants of health to addictions links to loneliness and boredom to philosophical articulations of the need components of a good life and works to adjust and redirect the welfare institutions into more open and facilitated networks with support from technological tools. Much to grow from here. A good read for all interested in social democracy and our transition to a better world where mutual care replaces toil and we degrow the economy to a sustainable good life for all.

[Eirwen Abberley · Rating 4 out of 5]

Something I could justify reading during work time - I’m going to try and weave it into my ILM dissertation. It’s not perfect but I commend anyone who can imagine and experiment with alternative systems to the broken ones we have now.

[Casey Moore · Rating 5 out of 5]

Highly, highly recommend for anyone interested in social entrepreneurship and innovative ideas on how to fix the welfare state.

[Onyeka · Rating 4 out of 5]

#RadicalHelp by Hilary Cottam (3.5/5) was gifted to me for Christmas by my boss due to my interests in social justice and modernising government.

Hilary explains the history and demise of the Great British welfare system, humanising it’s failures with stories of the detrimental real-life impact it’s had on people’s lives. Inspired by these lives, Hilary showcases a suite of people-centred ideas that could replace the current juggernaut of a service.

It is at that very point that she kept losing me. I couldn’t help but smirk at how fortunate she was to have secured enough funding to experiment with people’s lives. How simplistic she made policy and societal injustice seem, if only displaced individuals’ interests were ascertained and invested in. (tut) How privileged a perspective is that?

This book is as heartbreaking as it is inspiring, and I for one, learned a whole lot more about the history and reasoning behind the way UK system operates.

[Megan · Rating 4 out of 5]

"What we hear depends on the questions and who we — the questioners — are perceived to be."

Hilary Cottam's book diagnoses a central problem with the UK's welfare state: it was designed for an industrial economy and a world in which the primary threat to our health was acute, infectious disease. She posits that we need a new model that suits our post-industrial economy, where chronic conditions like diabetes are pervasive, and that this new model will not come about through "better management" and "greater efficiency" alone. Welfare reforms tend to focus on management, but not changing the system or its approach. Further, our welfare system is increasingly transactional, when true change is built upon strong, healthy relationships. Finally, the current system treats people as problems to be solved, rather than as humans with inherent value and with capabilities they already have or can grow.

The author shares five experiments she worked on to try to innovate and overhaul the system. What's sad is that these experiments don't feel particularly revolutionary, though they probably are. The underlying principles are subtle: invite, don't compel; help people solve their own problems (by building capabilities); help people connect to healthy, supportive relationships...

She is preaching to the choir here.

Along the way she shares stories of the kind of friction her experiments ran up against... Fundamentally everyone wants change, but very few want *to* change, least of all the bureaucrats.

But that's the REAL challenge with systems change... not the experiment that proves another way might work better... the real challenge is achieving change that sticks.

Ultimately, if you look up the organization (Participle) that ran all these experiments, it doesn't seem to exist anymore. So it doesn't seem like she was able to achieve lasting systems change. It doesn't mean the work wasn't worthwhile... it's possible, and it even seems likely, that there was lasting change among individuals involved in the experiments.

But the fact that the system seems to have reverted back to where it was reminds me of this article about Design Thinking: https://www.technologyreview.com/2023.... To quote the article:

The first step of the design thinking process is for the designer to empathize with the end user through close observation of the problem. While this step involves asking questions of the individuals and communities affected, the designer’s eye frames any insights that emerge. This puts the designer’s honed sense of empathy at the center of both the problem and the solution.

In 2018, researcher Lilly Irani, an associate professor at the University of California, San Diego, wrote a piece titled “Design Thinking: Defending Silicon Valley at the Apex of Global Labor Hierarchies” for the peer-reviewed journal Catalyst. She criticized the new framing of the designer as an empathetic “divining rod leading to new markets or domains of life ripe for intervention,” maintaining that it reinforced traditional hierarchies of labor.

Irani argued that as an outgrowth of Silicon Valley business interests and culture, design thinking situated Western—and often white—designers at a higher level of labor, treating them as mystics who could translate the efforts and experiences of lower-level workers into capitalistic opportunity.

Cottam was an Ideo consultant, and it is clear that Participle was a spin-off.

In any case, while I am skeptical about the long-term value of the experiments described in the book, they are good food for thought so long as you apply a critical eye. The background and history of the British welfare state was worthwhile, as well as the discussion of the philosophical underpinnings of the capabilities model.

[heidi · Rating 5 out of 5]

"Our current welfare institutions cannot provide care. Worse, they cannot even speak a language with which we might begin to think warmly and humanly about what is needed. Caring for each other is not about efficiency or units of production. It is about human connection, our development, and at the end our comfort and dignity."

Wonderful analysis of what's wrong with the system we have paired with proven solutions on what can be done to make it better. The foundation of the welfare state envisioned in the Beveridge Report (and largely in the U.S. welfare system) assumes that depersonalized transactions would level the playing field, that care work would be relegated to the unpaid domestic sphere, and that an industrial management style would be most effective in the distribution of social services. Eighty years ago, this orientation addressed a multitude of post-war social needs. The unprecedented complexity of our 21st century social ills can no longer be addressed using this outdated mentality. Cottam calls for a new framework that allows for us to truly care for each other, focused first and foremost on the power of relationships.

Through her five experiments, she reveals tried and true insights on how we can invert traditional welfare paradigms to empower and support people to improve their lives. She takes a holistic view of what is needed not only to survive, but to flourish — the capability to work and learn, to be healthy, to be part of the community, and to nurture relationships — and backtracks to create programs which take real-life constraints and motivations into account. Through fostering relationships between care workers and those seeking help, as well as providing the space for those seeking help to improve their existing relationships, we are better able to see real needs and disrupt limiting narratives.

"What we can be or do depends upon our inner worlds, our beliefs, our self-confidence, our skills and our concrete realities: where we live, whether we have money, and how we are connected. These internal factors and the wider webs and structures we are part of determine what real possibilities we have in our lives."

The ability to perform this holistic, empowering work is largely predicated on systems which operate in opposition to any altruistic aims. Funding follows metric evaluations which fail to capture qualitative realities, disincentivizing many well-meaning professionals and politicians from making the major changes needed to break the mold. Innovation is championed and praised for its inspirational qualities until it becomes a threat — then the system aggressively reasserts itself. Public policy has the sole ability to shake existing foundations to create an atmosphere that supports the passionate work done in smaller, grassroots circles.

"Only the state, our leaders and political actors can create the pivot we need, developing the new framework, supporting the vision and nurturing the principles that will guide the behavior, funding and activities of others."

Thank you, Hilary, for your compassionate vision of what future systems could be like.

[Aviva Rosman · Rating 5 out of 5]

Hilary Cottam's premise is that our welfare systems are outdated and should be vastly re-imagined for the 21st century.

While most of the discussion of the welfare state hinges on spending and means-testing, Cottam's own series of experiments over 10 years across the United Kingdom demonstrate that it's not money preventing change but rather the entrenched habits of the bureaucracy and a failure of imagination.

She begins by outlining all of the social services provided to one family living on a council estate - social workers for mom and children, rental assistance, rehab, therapists, police, school tutoring. Everyone is trying their best, but no one is asking Ella - the mom at the center of the family what she wants. No one is treating her as a partner. And all of the services, which at one point the entire team maps out over the course of over two decades, have succeeded in stabilizing Ella's family.

Cottam's team takes a different approach. They move into the council estate and ask Ella what she sees for her future. They build relationships with her, her children, and other people on the estate. They don't mandate and they don't prescribe. They work across fields and they take Ella and her wishes seriously. The approach is radically different from our current one - and it makes a difference.

One of the chapters that pushed my thinking was Cottam's experiment with youth centers. I've always taken it as a given that we needed more of these in the U.S. to quote "keep kids off the streets." But Cottam considers the effects of kids only hanging out with other kids vs. thinking about their futures. She asks kids to make videos of what they are looking for and connects them to job shadowing opportunities with potential mentors in the community. Of course it gets shut down quickly when professional adults start worrying about risk and lack of supervision. But while it takes place, the kids form genuine connections with adults and start to envision their futures differently.

Cottam is not naive about the difficulties of implementation - she's not here to "scale" these programs, she knows she needs to prove results and save money, and she understands all of the entrenched forces threatened by a different approach.

But her methods, her results, and her recommendations are indeed radical and hopeful. Seventy-five years after the creation of the modern welfare state, we have an opportunity to shift our conversation to what's possible and what the state should do to support not just survival but flourishing.

[Gin · Rating 4 out of 5]

A refreshing look at how we can better help people by changing the way the welfare state functions. Her point is that the welfare state was fit for purpose when it was conceived and implemented back in the early 1950s. However, given the massive social and technological changes since then, such as greater longevity and the rise of chronic illnesses, the welfare state is no longer able to function as it was intended. Coupled with the infusion of New Public Management ideas into the reforming of the welfare state in the 1990s and early 2000s, which prioritised efficiency rather than the care of the people, the welfare state has never been so unfit for what it is supposed to do.

Her book thus sets out a series of experiments to improve the way disadvantaged citizens experience help and assistance from the state. Covering four main areas - dealing with the poor, the public health system, the young and seniors, Cottam wrote about how she and her team sought to help, and the common underlying theme is allowing for those who need help to lead the way, for them to convey what it is that they need and thus to shape the interventions. Cottam goes into a lot of detail, detailing the successes and failures and in the process, coming up with new and innovative ways in which the welfare state can better serve the people.

This is also where it gets tricky for her and her team, as she mentions how difficult it was for them because they run into entrenched interests within the public agencies and among NGOs tasked to help said disadvantaged groups.

It is an interesting and timely relook at some alternative ways of doing social policy, and makes a lot of sense in today’s world. But changing the way the system works continues to be a tall order, as new and experimental methods such as theirs are regarded as an outlier at best, and a hindrance to said entrenched interests at worst.

The last section of the book covers the principles and processes of putting into action the earlier mentioned experiments. This can get a little dry for the average reader but for public policy wonks, they can be very useful in helping them look at where their policies could be improved for the benefit of the people that they serve.

[Clare Williams · Rating 5 out of 5]

This is a book everyone should read - especially academics drafting their own monographs and wondering how to make research accessible, engaging, and deeply thought-provoking.
The subject at hand here is how small changes in approach can vastly alter outcomes. The subject is the welfare state and its various tasks; health, social care, education, and so on. Cottam shows that by building capabilities, the welfare state can foster a space in which people can be guided to fix their own problems. This is in contrast to the learned dependence that the current systems addressed in this book foster.

While Cottam’s ideas and experiments seem to have enjoyed remarkable amounts of success, it would appear from the book that none have been expanded across the country, and the recurring reason for this is the system of procurement and implementation that is unable to reframe its own purpose and mission. This is unfortunate, and I wonder if Cottam is planning another experiment targeting decision making in “the system”, and applying her own learning and strategies to the parts of the state that commission and implement. Regardless of this, her argument is often that the state needs a much lighter, but better, touch to be effective and to work better in society. The welfare state that resulted from the decade after the Second World War was a compromise then, but it simply does not work effectively or efficiently at all in modern society.

This is a book that should be priority reading for anyone interested in the kind of society we live in, and how things could be better.

[Jack · Rating 4 out of 5]

Cottam eloquently dismantles the existing suite of services for their inefficiency: they simply do not work as well as they should. She advocates a more person-centred approach in which listening lay at its heart. Instead of analysis, referring and re-referring, perhaps the power relationship between social worker and their 'cases', for example, should be upended. That is to say, let's give a voice to the voiceless. The research supports this, Cottam says, but it's success is not guaranteed by money, and cannot be scaled up in the same way as existing services - the services she's ran and witnessed are tailored, personal. Yet for me that is part of the problem with the book. Cottam supposedly debunks the welfare system and shines a light on what we really need and want. I cannot help but think it is more nuanced than this. Behaviour change alone is not the solution - and Cottam herself does concede some of her services cannot work within the current institutional framework, and are subsequently shut down. The nexus of change needed to upend the welfare state are conceptual, institutional and behavioural. I congratulate her for trying, and I certainly am on board, but there is a long way to go.

[Martin Henson · Rating 5 out of 5]

Where on earth do people like Hilary Cottam come from?! This kind of genius for turning abstract analysis and general principles - such as those of Amartya Sen and Martha Nussbaum - and turning them into practical action is remarkable. Her general approach - social design - that is described in detail in the last part of the book is preceded by a number of astonishing "experiments" involving interventions covering family life, transitioning to adulthood, work, health, and ageing. She has accomplished so much it would not be surprising to find her an octogenarian ... she has packed so much into her active life so far. The approach is antifragile (in the sense of Taleb), tinkering and experimental, focused on and informed by the human, and only latterly reflective (the book adopts the same strategy: the experiments (doing) comes before the analysis (reflections)). So much of the material is inspiring, and it is heartbreaking to find out how some ultimately failed - for example the Loops project which foundered on entrenched and established ideas and organisations, and the poisoned chalice of being admired by a Tory Prime Minister. However, she has ideas that are extremely powerful and could transform the future. If anyone is still listening in these dark times.

[Charlotte Mylifeinbooks · Rating 4 out of 5]

“Our welfare state might still catch us when we fall, but it cannot help us take flight.”

My Non-Fiction fix for August was Radical Help. I’ve enjoyed every minute of this book.

Cottam takes a look at Britain’s welfare state and how we could revolutionise it. What I loved about this book was how Cottam has picked away at some of our welfare systems and proven how they are not fit for purpose.

It also highlights how us fellow Brits look at those on Welfare and cannot begin to even imagine the complexities of life on benefits. How programs like “Benefits Britain” has stemmed hate between the haves and the have nots.

Unlike a lot of books in this field Cottam has been involved in a number of experiments that have produced better results and more support than our current systems. She delves into the NHS an organisation crumbling from the bottom up. Disability benefits and those declared fit to work who quite clearly aren’t and how the job seekers of Britain fall victim to a process so demoralising that there leaves little hope to flourish.

A real eye opening read that shows investment in people and relationships are the only way to combat the benefits crisis we currently face.

[Barbara · Rating 5 out of 5]

This was a book worth more stars, what I call a ten star book. A wonderful mixture of analysis and real effective action, partly by getting down on the ground, hearing people, taking in their difficult and complex worlds and finding ways of drawing on the resources and contributions of people who are often seen by authorities as entirely negative. The descripton of a Jobcentre is spot on. I and my family have often struggled to get any kind of service out of the public sector and have also worked in it and know how futile that can be, particularly when you are, so to speak a 'foot soldier' on the ground. I do think though that Hilary herself is a huge catalyst and resource and that attempts to offer the same services may not succeed so well, because people don't really get it. In my very small world, it encourages me to keep on trying, OK we couldn't get a shared outdoor bench for our senior citizens but I will work on something else and return to this book should my spirits flag. As she says it is all down to relationships, hard to build during covid, but now a priority.

[KT · Rating 3 out of 5]

A good if disappointing read given the recommendations and great reviews for the book

I thought the author did a good job of laying out the history of the Beveridge report and the welfare state in the UK and why it's no longer fit for purpose in today's day and age

The author also does a great job in explaining their experiments, the design process, and how and why they succeeded especially in the context of a failed welfare state

However I thought the book fell flat in its claim of revolutionising the welfare state given that the underlying context of capitalism in the UK was never criticised or inspected as to why the welfare state has fallen short given the exploitation that capitalism necessitates and resulting inequality

So then looking at the book through the lens of reforming the welfare state , I also thought the book failed in addressing why certain aspects of its experiments failed and simply hand-waved concerns away, which underlined the well-meaning, but naive bleeding-heart liberal tone that featured throughout the book

[Edmund Wigley · Rating 5 out of 5]

A plan for rationalising the welfare system to refocus on learning, health, community and relationships. Hillary argues that the our current welfare system today is flawed. Too many organisations, managed too bureaucratically and designed for triaging / referring / curing. She argues for devolving administration away from c-suite type management and to connect different organisations into local hubs which will tackle different segments of society. Almost all of Hilary’s new plan start with building a relationship with the individual in need, and rather than treating them like widgets to rehumanise the welfare process.

The humanising narrative is extremely compelling and Hillary builds upon her theories (or rather exposes them) via various experiments taking place within the neighbourhood. She talks briefly about why the state model rather than a private sector model is best suited for this, I would love for her to spend more time expanding on this.

[Philip Horspool · Rating 5 out of 5]

Our current ways of educating, supporting and helping people have a fulfilling existence don't work and as a result people's health, education and overall lives are suffering. This book centres around our broken welfare state but instead of saying ' scrap it' and let private enterprise deliver, it offers tried and tested ideas for delivering people based practical ways of working together in a cost effective way. The bottom line is we need a new system because no amount of tinkering will make this one work. And what you get from this book is a sense of what could be achieved and a sense of hope. It made me think what can I practically offer that might benefit some who need support in my community and what do I need? It doesn't have to be anything too radical, small acts of support, an opportunity given to talk and share ideas, an offer to help. This book is about dreaming but more importantly about making those dreams become reality. Read it.

[Rahul · Rating 4 out of 5]

As someone not relying on or supporting the current care system, i am unlikely to deeply understand the full ramifications of this book.

But having heard lots about the book, I’m pleased to have read the fruit of Cottam’s labour over many years.

It describes how
- existing systems treat people like bundles of symptoms to be managed - it is unsustainable.
- the importance of relationships, capabilities and of nesting agency as close as possible to those that need support - the potential is boundless.
- the reticence of many in the system to try to change the system, often despite an underlying desire to do so

The final chapters distilled the learning from the experiments covered through most of the book. I am sharing the ideas with colleagues and friends, hoping their perspectives will further enlighten me.

The principles resonate with discussions of changing systems and behaviour more broadly, like on the environment.

[Ishaan Kumar · Rating 4 out of 5]

amazing read on the way to redefine the welfare state with building capabilities (Amartya Sen) as opposed to meeting managerial quotas. 4* because in its effect to be "unpolitical" it ended up being so. the rise of managerial capitalism and austerity have profound impacts on the welfare state i.e we can't accept those conditions even if programs could be made more efficient. as a consequence this analysis doesn't tackle structural problems, nor imperialism.
general notes below
1) detachment of workers to patient in welfare state now
2) idea of capability - removing people from welfare state not making them dependent. from needs to capabilities
3) relationships and relationships and relationships especially with old people
4) Adam Smith and role of the state
5) increased limitations to care don't help much because social workers will recommend the higher care anyway
6) Beveridge as creator of welfare state and his own critique of lack of community engagement

[Victoria Roe · Rating 5 out of 5]

Finally managed to finish a book this year! I enjoyed this although felt it got a bit heavy towards the end as it slides into the technicalities of how to implement her new approach to welfare provision. Obviously this needs to be included but it was quite close to a lot of the type of thing I see at work, although with some interesting counter-arguments to some of the philosophies at the heart of organisational change, but that made it drag a bit. The first two sections - the “why we need a new approach” and the experiments - was great; very compelling and convincing discussions. A must for any public sector worker and anyone working in change, and really fascinating to read on the heels of How to Be a Liberal by Ian Dunt! Very good.