Cuts can"t stop genuine people power, but professionals can | Richard Wilson

It is becoming increasingly clear that many of our public service systems undermine people power.

Problems like obesity, depression, addiction and finding a job require us each to take individual action. Of course there are all kinds of support to help us keep fit, ace job interviews, or live without drugs, but control always lies with the individual, not the state. We decide what food to put in our mouths or whether to go to the gym.

But this vital truth seems to have been absent in designing our public services.

Take, for instance, a GP appointment. Most last 10 minutes; the GP asks a few questions and then tells you either to take some medicine, adopt new habits or see someone more qualified. The trouble is, we don’t do what we’re told. The World Health Organisation has estimated [pdf] that only 30%–50% of us take our medication as prescribed, in what is being described as an “epidemic of non-compliance”. Many of the changes required are intimately connected to our sense of who we are and what others think of us – and it’s very hard to change a habit. Anyone who’s tried having a “dry January” will know the challenge.

Ideas about co-producing public services, with professionals and users working together, have been around for years. What’s interesting right now is the new movement of practitioners delivering “people-powered services” that aim to improve self-efficacy at a low cost and with high impact.

One example is homelessness charity Groundswell, which provides peer support to people experiencing homelessness to help them address their health needs. Athol Halle, Groundswell chief executive says that when you provide support in this way, there are health benefits for individuals – and cost savings for the NHS. That’s why Groundswell receives in the region of £500,000 from health commissioners. It is not alone. Club Soda is working to reduce alcohol dependence, Brightside Trust is working in youth unemployment, Community Catalysts in adult social care, and Self Management UK in health. All of these organisations are based on putting users in charge of their service.

However, this is much easier said than done. Supporting people to take control is a subtle discipline in which most people working in public services have not been trained.

Here are five basic principles of how to help people take control that you can adapt according to your circumstances:

• Accept the user wherever they are.


• See users as having all the resources they need to start taking action.


• Change is only possible if the user wants it.


• Users’ solutions are the best solutions.


• Never assume users think like you.

At first glance these five principles might seem plain wrong. Not everyone has all the resources they need, especially in this era of deep cuts.

But for services where individual action is a requirement, the essential ingredient is user motivation. So whether they do in fact have everything they need is not what’s important; what matters is that they believe in themselves enough to make a start.

For most professionals it takes a fundamental reorientation to start supporting individuals to take action themselves. Anand Shukla, chief executive of Brightside Trust, says it is often quite a leap for professionals to support people to make decisions and to take action. What’s crucial, says Shukla, is to identify right from the start people’s priorities and wishes, rather than jump in and tell them what you, as a professional, think they should do.

These principles need to inform not just conversations between service professionals and users but the whole way public services are designed: system design. Without that, the work of people like Halle and Shukla will be stifled by systems that claim to want people power but, in fact, work against it.

If you’re a public service professional working in people-powered services – or an individual taking action – drop us a line and tell us how you’ve got on: public.leaders@theguardian.com

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Cuts can"t stop genuine people power, but professionals can | Richard Wilson