Book Review: Radical Help - Hillary Cottam

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

A challenging read for civil servants and policy makers. When old institutions and systems don't produce the results needed, just how radical are we prepared to be?

Much like the book "Good Services" this advocates for a co-designed method of service design. Putting users at the heart of addressing their problems and working with them to discover solutions which are achievable.

Cottam's book is refreshing in that in honestly addresses the failures that she encounters. Not every programme is a success - and that's an important step in the design journey. The cost of early failure is a necessary price to pay to prevent expensive failures later.

What's interesting is that none of the ideas sound particularly radical. Help people live better lives, foster meaningful connections, use relationships to change behaviours, and work towards attainable goals. It's less subtle than "Inside the Nudge Unit" - but is more focussed on individual change. And I think that is the first part of its problem.

As the book mentions, it's hard to consistently replicate these radical changes. It's possible to enact change when you have a dedicated and highly motivated team - but the real challenge is creating a system which can work despite demotivated and disinterested staff.

The second problem is that I think the book falls into the trap of "we can't fix anything until we fix everything". The state is a complex system. We can't replace the whole thing over-night. Indeed, the interconnected nature of the system means that even tweaking one bit of it can have serious knock-on effects on disparate parts. Cottam correctly identifies this resistance and understands the system's self-preservation motive.

Can we radically change one part of, say, the welfare system successfully? My heart says yes, but my head says no. These small interventions work brilliantly. But scaling up is like taking a boutique coffee shop and accelerating it into a national chain. It inevitably loses the unique identity which made it so successful. I think the challenge is not on wholesale reform to every part of the state simultaneously, but giving the tools to committed teams so that they are empowered to make effective local changes.

This is an essential read. Even if you don't agree with the interventions, it's important to understand how design thinking can be used to improve the way outcomes are delivered - and the inevitable push-back against such sensible ideas.