Good news from governments | Financial Times

This book really grabbed my attention when it turned to the dismal-sounding topic of Dutch social care. About 30 years ago, politicians tried to “professionalise” a personal calling and almost ruined it. Managers arrived where there were none before. Caring activities became “products”, atomised into different tasks and given targets. Vulnerable individuals were sometimes seen by up to 30 different nurses each month. Highly-qualified nurses left the service. Costs were higher, quality worse and the government had fallen into a trap of its own making.

But Jaideep Prabhu’s How Should a Government Be? is a collection of optimistic stories. In the Dutch example, a particular nurse returned to the profession to start an organisation called Buurtzorg. It had a simple question — how would all this work if care was seen from the perspective of the patients? The answer: small teams focused on small communities, protecting the vital nurse-patient relationship. Everything that mattered for care would be devolved to these teams, and everything else handled by web-based tools. The result: seven years in, Buurtzorg was serving more than 70,000 patients with 9,000 nurses, generating consistently high satisfaction.

We are living through a period where demands on government are as high as they have been in peacetime. It is also an era of governing pragmatists and ideological magpies. No more do parties of the left insist on the government holding the commanding heights of the economy, but nor do those of the right insist on trying to shoehorn market discipline or private sector capital into every state activity. In the UK, the supposedly rightwing government claims to venerate free trade and markets, but has a political strategy built upon massive public spending to revitalise regions lagging behind, a state-directed push to become a science superpower, and an unswerving rhetorical devotion to the NHS.

This creates an environment ripe for the lessons imparted by How Should a Government Be? and its insights about a better functioning state. What matters now is what works.

Do not expect neat answers. This is not necessarily a criticism. Rather than a grand theory, here instead we find case studies showing how well-meaning entrepreneurs, politicos, officials and citizens have innovated smarter ways to deliver key services. You can read about how Kenya’s government approached the M-Pesa system of mobile payments; the UK government’s momentary infatuation with behavioural economics; or the earnest efforts of the Mayor’s Office of New Urban Mechanics (Monum) in Boston.

There is plenty of material for inspiration, but nothing so simple as a formula for governing success. M-Pesa, for example, would have been stifled by too heavy-handed an approach to regulation at the outset — but the author concedes that often the problem is a state not reacting quickly enough to a new business idea, such as social media or ride-sharing.

The lack of formulaic rules does not mean there is nothing to learn. Technologically-savvy, engaged public servants close to their public and given the freedom to innovate, often achieve splendid results. Consultation and evaluation, openness to new ideas and the leeway to take risks all make a difference. This reader came away inspired by the dedication and energy of characters like Michael Tubbs, the young mayor of his Stockton, California, hometown, or Jos de Blok, the founder of Buurtzorg. I am also impressed by the inventiveness of US city mayors and their cities’ role as policy laboratories. The UK has much to learn from them.

If I had a criticism, it is that such a method is inherently vulnerable to survivorship bias and intellectual capture by the heroes of the stories that are told. I was surprised to read quite so much reference to the brilliance of the governing innovations launched by the UK’s coalition government (2010-15), which at the time felt beset by crushing financial pressures. The policy innovations often felt like gimmicks, because next to the challenge that local government faced in handling a 40 per cent budget cut, that is what they were. When the pandemic struck early in 2020, it did not feel like the UK system of government exhibited many of the innovative, responsive qualities that this book would recommend.

A really thorough account of “how a government should be” ought to have more tales of failure. Most of the obstruction that happens in government is for a good reason. Dealing with bad ideas is important work, just as is nurturing the good ones, but does not attract the same attention. Nevertheless, I put down this book more cheerful about the prospects for democratic government than I was when I picked it up. During these dark days, that is more than enough reason to read.

The reviewer is a specialist partner at Flint Global and is a former government adviser and FT journalist

How Should a Government Be? The New Levers of State Power by Jaideep Prabhu, Profile, £20, 336 pages