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Welfare: The Leadership Challenge

Author: Susan Harrison

Junior Doctors made a collective choice to speak truth to power in their recent decision to withdraw their labour. As individual clinicians they committed to doing no harm and as a group they have chosen to speak truth in power when faced with proposed working conditions they believe will be harmful to patients.

When to withdraw, when to stay and when to speak up is a recurring dilemma on the front line of welfare service delivery; as it is in other theatres of action.

"The way I see it, when you put the uniform on, in effect you sign a contract. And you don't back out of a contract merely because you've changed your mind. You can still speak up for your principles, you can still argue against the ones you're being made to fight for, but in the end you do the job." 

Pat Barker, Regeneration (1981)

These words are attributed to the poet Robert Graves in Pat Barker’s historical anti-war novel. They are spoken in a conversation with William Rivers - the doctor and anthropologist who was offering treatment, care and psychoanalysis to First World War soldiers at Edinburgh’s Craiglockhart Hospital. Graves’ friend and colleague and River’s patient, Siegfried Sassoon, had been outspoken in his protest against the allies’ leadership of the Great War.

Sassoon had written an open letter to his commanding officer. The letter had been widely circulated and had been read aloud in the House of Commons. It began:

"I am making this statement as an act of wilful defiance of military authority because I believe that the war is being deliberately prolonged by those who have the power to end it."

Siegfried Sassoon, Finished with the War: A Soldier’s Declaration (1917)

These sentiments echo in the Junior Doctors’ call to #donoharmJeremy.

The UK’s health and welfare system was born in 1948 in the aftermath of the second Great War. Beveridge’s report - naming the five giant evils of squalor, ignorance, want, idleness, and disease - led to major political reforms of social security, health, education, housing and a the establishment of a policy of full employment. These are policies that have benefited UK citizens greatly. But in the background other things have changed which create new contemporary challenges.

The ratio of those not working and earning and those who are in the workforce has altered significantly in the period since the Second World War. As older people enjoy the benefits of health care and live well beyond retirement from paid employment, the burden on the working population grows. A diminishing group of earners also supports through their taxes the services that contribute to the education and upbringing of children. Changes arising from the dependency ratio were already percolating through into new social policies when the 2008 global financial crisis hit. In reaction to these world-wide events, UK governments have adopted austerity policies, squeezing the funding for the welfare state.

The current public discourse of efficiency and fiscal prudence on the one hand and consumer empowerment on the other creates explicit and implicit expectations that welfare providers deliver more and better with less. Wellbeing is referenced in policy initiatives but elusive in the day-to-day work experience where actual austerity often leads to emotional austerity in leadership behaviours. The front-line experience of workers in the UK welfare state is often one of relentless bombardment – shrinking resources, policy changes, chaotic environments, aggressive institutional demands.

As terms and conditions have been whittled down, the sense of mutual commitment between welfare workers and their employers has corroded. Employment security has been undermined. There has been huge growth in the use of casual workforce – agency staff, zero hours contracts, self-employed workers on piece rate payments. Individuals backing out of their contracts attract less reproach when the state has already undermined the psychological contract so pervasively.

So, if you work in the welfare state, should you walk away in defiance never to return? This is a choice that some are making. But others are choosing tactical action, speaking up for valued principles and arguing against imposed conditions they profoundly disagree with.

Notwithstanding the faithlessness of the state, if we follow Graves’ maxim to do the job in welfare, how can we keep our prophetic and poetic voices strong when we find the environment pulling us into the maelstrom? What helps us to act virtuously even when the context seems to demand compliance with values we can’t support? What choices remain when we feel that defiance is the only option open to us, and yet we know that withdrawing our collaboration all together might be detrimental to achieving the outcomes we hold dear?

Sassoon’s friends and colleagues had contrived for him to be offered sanctuary at Craiglockhart and dodge a threatened court martial. After some refuge, and the opportunity to make use of the talking cure, Sassoon returned to the battle front to lead his troops in their endeavour with his prophetic and poetic voice undiminished.

A concept first developed by another poet, John Keats, may help us here. He coined the term negative capability to describe the artist’s sensitivity and receptiveness to the world as it is. A mindful attitude, if you like, though it was many generations before that term came into the Western lexicon. Roberto Unger, the philosopher, developed the idea of negative capability to describe how people might empower themselves to resist social constraints and move towards change. Sassoon’s respite in Craiglockhart, away from the battlefield and with the opportunity to reflect with others, enabled him to return to the fray, providing leadership. It also sustained his poetic work. The notion that negative capability might support creative leadership has been developed in the systems psychodynamic literature.

Maintaining an open attentive approach is one way in which leadership in the welfare sector can keep faith with the covenant we made to the wellbeing of our society. Those of us in the field, trying to lead in the service of welfare and wellbeing, have a daily task of identifying the spaces that enable negative capability. These spaces already exist and leaders need to act strategically to protect them. The spaces for reflection, contemplation, conversation, tactical action and speaking truth in power are there to be made use of in the service of our community welfare and wellbeing.

The publisher is the Centre for Welfare Reform.

Welfare: The Leadership Challenge © Susan Harrison 2016.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.