Hillary Cottam, Radical Help. Published by Virago LittleBrown, June 2018. 320pp. 

When you think of the word “design”, what comes to mind? The chances are that you immediately think of something visual—perhaps an impactful poster, a beautiful armchair, or an engaging website.

Personal relationships and civic institutions, though, are probably pretty low down on your list of “designed things”. As designers, even when we do work on projects in these areas, our focus is likely to be on creating individual objects, apps, or tools that contribute to some bigger project.

Yet the design process can be so much more powerful than this. If you’re interested in understanding how, look no further than Hilary Cottam’s new book, Radical Help: How We Can Remake The Relationships Between Us And Revolutionise The Welfare State.

About Hilary Cottam

One of the reasons that Hilary Cottam offers a special insight into the design process is precisely that she is “a social scientist, not a trained designer”.

Yet in 2005 she publicly exhibited the problem-solving process behind three projects she had worked on—a prison, a school, and a new health service. Unexpectedly, these projects won her the title of Britain’s Designer of the Year. Her success, she explains, was met with open hostility from designers:

I have never been to art school and my award evoked a passionate and heated response in the design community. I received hate mail and in addition the Master of the Faculty of Royal Designers for Industry spoke out publicly against the worrying abuse of the term designer, asking, ‘Can we please have our name back?’

Cottam brings decades of practical wisdom and global experience to her subject in Radical Help. In the 1990s she worked on community projects in the Dominican Republic, and returned there to conduct research on “the way in which design in the broadest context influences emotions and aspirations, and through this, social structures and economic outcomes”. She also worked as an urban poverty specialist with the World Bank.

Cottam used the modest prize money from her 2005 Designer of the Year award to set up Participle, an organisation that sought to apply design approaches to social problems. Radical Help presents write-ups of five experiments conducted by Cottam and her team between 2006-2015, and reflections on lessons learned from them.

The Welfare State

Each of the five experiments presented in Radical Help addresses a different challenge in contemporary British society. Although the experiments were conducted in the U.K., the challenges are common to every society: family life, adolescence, employment, healthcare, and old age. 

Cottam situates these experiments in the context of the British “welfare state”—which refers to a collection of government-financed social programs that represented a new post-war settlement in British society. Many of these programs were introduced in response to the first “Beveridge Report”—a report compiled by William Beveridge, a progressive Member of Parliament, in 1942. 

The welfare state was put into place through a series of Acts in the years after the end of the war. These pieces of legislation created entitlements to child support payments, unemployment pay, sick pay, additional payments to avoid extreme poverty, free education, free housing for those in need, and, most famously, the creation of the National Health Service in 1948.

Radical Help addresses many of the issues the author raises in her 2015 TED Talk.

Cottam argues that post-war reforms unwittingly created a disempowering relationship between citizen and state, eroding people’s capabilities; she also shows that the majority of money spent in the welfare system is deployed to service the system itself, rather than on the people it was originally set up to help.

Moreover, she says, we face problems today that simply were not envisaged when the system was created. For example, the majority of our health needs are now around complex, incurable chronic illnesses, which sometimes emerge from a combination of social and physiological factors. On the one hand, the costs of managing chronic conditions are potentially unlimited, and on the other, the kind of healthcare system we have created does not actually help patients with many long-term illnesses.

Cottam’s five experiments would not necessarily be recognizable as such to hard scientists or government researchers. Rather, they’re closer to a design process, involving empathy, research into people’s needs, prototyping, reflection, and iteration. Here, we’ll just discuss one of Cottam’s experiments, and perhaps the most challenging and radical. 

The Life Program

In this experiment, Cottam and her team work with families facing a combination of material poverty and other social and personal difficulties. For example, Ella, the mother of one of the families who participate, suffered an abusive childhood. She is struggling to cope with her four children, each of whom now faces problems of their own. 

Her eldest son has a drinking problem, her 16-year-old daughter is pregnant, her youngest son was abused, and her youngest daughter “doesn’t eat properly”, and “shouts and swears”. Ella doesn’t work, and when the team first meet the family, her younger son and daughter are both excluded from school. 

The welfare state currently “manages” this family through a series of separate, uncoordinated interventions involving social workers, the police, and the court system. The government officially estimates the cost of managing each of these “troubled families” (the name of a short-lived government initiative) at £250,000 a year.

Of course, very little of that sum reaches the family as cash. In fact, Cottam finds that up to 80% of the cost of interventions by the welfare state is spent servicing the system: completing administration, reports, and referrals, rather than actually working with the client. What time is spent with the family by frontline workers is perceived as transactional, condescending, and—worst of all—unhelpful.


Radical Inversions

This insight leads the Life team to a number of what Cottam calls “radical inversions”. First is to invert the power dynamic between the family and frontline workers:

The team’s mission was to listen. They had no agenda; they simply observed. They are there on the sofa when the social workers come to call; they are out after dark looking for wayward teenagers who have not come home; they are subject to the angry frustration of neighbours who must experience the noise, tension and craziness that comes from the house next door.

We get to know other families that live on the estate and we drink a lot of tea. This is not the work of a quick statistical survey: we are like detectives painstakingly looking for clues. Why is this family in such difficulty? After all, only a small minority of families [...] live like Ella.

Another inversion was to establish a principle that the Life team should spend a maximum of 20% of their time in administrative tasks, and 80% directly engaging with the family. (This “80/20” principle will be familiar to many designers.)

One of the key early moments in the Life process was to invite everyone who worked with the family to a meeting. The aim was to map out all of their work with the family, which began twenty years earlier, in 1989. The result is reminiscent of a service blueprint, a tool in service design that represents all the interactions between a service and its client. 

What is unusual here, though, is the extraordinary timeframe involved—two decades—and the fact that this is a reconstruction of a constantly mutating, reorganizing system, not a plan. In its own right, this exercise demonstrates how little design has contributed to the existing welfare system. Cottam remarks that:

[c]onstant intervention was keeping the family locked exactly where they were: stuck in the eye of a storm [...] It is the running and maintaining of the system around Ella that is costing a quarter of a million pounds a year. The welfare state is like a gyroscope, expending huge amounts of energy to spin on the spot.

Not one penny of this money was being used to build opportunities for the families or to invest in their development. Every intervention was one of control and restraint.

For Ella’s family and for Cottam’s team, seeing the futility of these interventions spelled out, created an “opening”—shared recognition of a problem, and an opportunity for change. Commendably, the local council responsible for managing Ella’s family fully committed to the experiment, and agreed that front-line workers from all welfare state services would “step back”, and Cottam’s team would “ask the families to solve the conundrum” themselves.

At this point in the experiment, some readers may become suspicious that Ella’s family is about to be subjected to “tough love”, whereby the state withdraws and abandons families in need. However, Cottam’s approach is decisively different. It is about putting in place a new team to actively support people in working towards changes that are led by the families themselves. “To build capabilities,” Cottam remarks, “you need support”.

The way this support was arranged was fittingly radical: Ella herself joined an interview panel responsible for appointing the team that would be working with her family. This is another of Cottam’s inversions; in the Life program, the power to make important decisions like these is not vested solely in state officials, but also in family members themselves. “The families,” Cottam explains, “would drive and lead the change.”

Karen, from another family taking part in the experiment, asks an interviewee how they would handle her son becoming violent, and candidates who fall back on bureaucratic answers are rejected. 

These inversions mean that for the first time, the client’s needs come to the fore and are more prominent than the needs of the system.

Forming A Plan

After this process, a team of eight people were brought together, “relinquishing their departmental identities and programmes.” Cottam explains that “[t]hey did not rely on protocols to make judgements. Instead, they brought their instinctive, intelligent human qualities. They were also not afraid to say ‘I don’t know’, to confess that they did not have all the answers.”

Cottam’s experiment itself commendably embraces this principle. There was no plan for what the team should do once it had been formed. It was up to the families, with the support of the team, to decide. Early activities included working with families to fix broken doors and cupboards, and clean up the front garden. There was also paintballing and McDonald’s. “The activity,” Cottam explains, “did not matter much; what did matter was that relationships started to form between the team and the families as they did things together.”

One of the most striking lessons from this experiment is the importance of time. Cottam explains that it took literally months of working together with the team for families to open up, confiding “both their problems and their hopes”. When this happened, “the team responded with practical and emotional support, suggesting ways to look at things, offering help with any strategies the families decided on.”

As time went on, changes became noticeable. Children returned to school, eviction orders were canceled, and child-protection monitoring plans could stop. These changes saved the state huge costs, but more importantly reflected positive changes in the lives of families. As her capabilities and confidence grew, Ella felt better able to manage her children’s behavior, bringing the family closer. Aspirations that had once seemed remote—in Ella’s case, getting an office job—now felt within reach, and a practical plan could be formed to make it happen. 

The Process That Emerged

Cottam identifies four stages that emerged from developing the Life program. First, an invitation to participate; the program’s meaning and empowerment comes from the fact that participation is not compelled, an inversion of the welfare state’s modus operandi.

Second, relationships are established between the team and the families, and their work together turns to building a plan. This is led by the changes that families themselves need and want to see in their lives.

Third, supported by the team, families work to “build capabilities”. Cottam explains that “[t]he shift in power is inherent in the capability approach: I cannot give you a relationship or do one to you, neither can I make you learn, or be part of a community. Each of us has to do these things ourselves, albeit with support.” The team provided a simple framework emphasizing capabilities in four areas: work/learning; health/vitality; community; and relationships.

And, in the fourth phase, families start to exit the program, and live from the new capabilities and relationships they have built. 

Concluding her write-up of the experiment, Cottam emphasizes that Life was a success for most families involved, but also that it is not a magic bullet. Some families are suspicious of the invitation and will not participate. Other families struggle to sustain changes once the team begins to withdraw. Moreover, its success also depends on the willingness of stakeholders on the state’s side to relinquish control, for front-line workers to embrace new roles and ways of working, and even to tolerate more upfront risk than they are used to. 

What about the bottom line? As with Cottam’s other experiments, the cost of the Life program is dramatically lower than the estimated £250,000 currently spent by the welfare state in managing each household experiencing problems like Ella’s. It does, however, require staffing, and so it comes with direct costs of around £19,000 per family over an 18-month period.

Cottam’s other experiments follow a similar pattern to Life, in the sense that they begin with the “user”, with achieving a deep understanding of their situation, problems, needs, and wants. They then foster relationships, and help people build capabilities and confidence, with the goal of making changes in their lives, whether that’s to do with employment, health and wellbeing, or staying active and connected in old age. 


Too Much Clarity?

Cottam writes with great clarity and compassion. If the book can be criticized for anything, it is perhaps for imposing too much clarity on deeply complex issues.

One such complexity is practical in nature, and concerns how the experiments could be scaled up to become universal programs. Cottam does address this question, which she describes as “a fair one”. 

But, she says, “scaling is the wrong approach. Scale is a process of industrial roll-out [...] the question is better positioned as: how do we create the conditions for growth?” The common factors in successfully growing the programs, she reports, are shared vision, local leadership, and a commitment to core values.

This, though, is where things are bound to get difficult, since in ordinary political conditions, a shared commitment to core values is hard to come by. People hold different values, and it’s hard to imagine how these programs could be implemented by local government without their becoming distorted to the point that they no longer work. 

Cottam’s team experienced this within their own experiments—for example, one council made participation in Life compulsory, short-circuiting the entire logic of the program. Is it realistic to expect councillors, left to their own devices, to deliver programs of this sophistication and subtlety, when some wouldn’t even agree to it with the inventor in the room?

This suggests a bigger problem. Significantly, Cottam’s solutions can probably only work with the apparatus of the conventional welfare state to fall back on. Participation is voluntary, and those families that don’t take part will still require conventional “management”, however ineffective that management might be. The police, courts, and eviction officers will still have their role, and Cottam’s approach can divert some families from becoming a significant additional cost to those institutions, perhaps eventually allowing those institutions to eventually scale down some of their teams. 

Moreover, there is complexity around the socio-economic structures in which “troubled families” find themselves. Extreme inequality of wealth and opportunity is rife in the UK; countries where this inequality is lower experience lower rates of family dysfunction and ill-health. There is a sense in which Cottam presents a more sophisticated and effective approach to firefighting than the conventional welfare state. But the root causes have arguably been placed outside the scope of Cottam’s study. 

The Upshot? Governments Desperately Need Designers

Radical Help presents innovative, sophisticated solutions to some of the most costly and widespread personal and social problems experienced in the developed world. For this reason alone it should be essential reading for politicians of every persuasion.

But it also carries a more profound message about the scope of design. Designers are equipped with the skills to research and define problems, imagine new possibilities, and deliver solutions that change people’s lives for the better.

We tend to think of design as being about graphics, interfaces, objects, or gadgets. These are all essential, valid, and valuable applications of our skills as designers—but they needn’t constrain our practice, and we needn’t silo ourselves into tiny areas of specialization.

User-centered design has become a core part of every designer’s learning. As a designer reading Radical Help, it’s hard to avoid the humbling question: why am I using my skills to choose the color of buttons on a screen, when I could be tackling the big issues and trying to transform lives? 

It’s still rare for designers to regard their work as political, but the striking thing about Radical Help is how readily the skills of modern designers could be turned to developing solutions for complex social and political problems.

One of the reasons for this, of course, is that tackling the big issues is extremely difficult and demanding: socio-economic problems almost never have simple solutions. However, there is also the fact that these problems tend to be “owned” by government, and governments by and large haven’t yet understood what designers can bring to the table. 

For example, another of the most contentious talking points in British society at the moment—the National Health Service (NHS)—has undoubtedly suffered historically from a lack of design, and from piecemeal reforms that have often undermined what little design there was. It is hard to see how the world’s many broken public healthcare systems can be rescued without both a user-centered vision, and the skills of service designers and UX designers to make those health systems usable and humane.

Some of the biggest questions we face as societies—as a world—can legitimately be expressed as design problems. Cottam focuses on the welfare state and how to build the capabilities of people who are struggling. But we could just as readily use our design skills to reshape our democratic institutions for greater participation and responsibility, or to propose pragmatic new ways of tackling climate change. This is the true scope of designing for good.

It remains to be seen whether Cottam’s recommendations for the welfare state will get the hearing they deserve at a government level. But what Radical Help should undoubtedly do is remind designers of the radical problem-solving power we have at our disposal.

Illustrations: Annie Devine

More resources

Enjoyed this article? Try another!

More from the Designlab Blog

Go to blog homepage