Title: The Governance of Specialist Care: a question of ethics?
Author: Philip Boxer
Category: Presented at OPUS Conference 2014
This paper describes a two-year intervention within an organization providing residential care for men and women with mental health disabilities. This intervention, in support of the CEO and senior management team, took place during the mid-90’s when the UK Government was engaged in de-institutionalisation, making the transition to Community Care and instituting internal market reforms. The intervention itself was concerned with supporting innovations in the way the work of the organization supported the lives of its residents. These innovations were necessary to the continuing viability of the organisation as a specialist care organisation. The paper is written from the perspective of 20 years later, making it possible to contrast the hopes and aspirations of both the consultants and the client at the time of the intervention with what actually happened to the organisation subsequently. The paper describes the way the authorisation of the consultants was drawn from the consulting approach. It describes the orthogonality that this demanded of the consultants, through which underlying dilemmas could be surfaced about the nature of the client system’s work. Three issues emerged from the intervention that are addressed by the paper: firstly, the nature and complexity of the client system in its networked environment and the extent of the innovation that this demanded (Trist 1977); secondly, the nature of the consulting approach involved in responding to this demand; and thirdly, the implications this approach had for the governance of the client system (Hoggett 2006). From the perspective of 20 years later, it is not a surprise that the social defences against anxiety won out over the desire for innovation(Long 2006). This gives rise to a fourth issue however: what change in the relationship to the unconscious was being expected of the governance of the client system, what kind of courage did this demand, and what were the unconscious dynamics underlying the Trustees’ refusal to innovate(Boxer 2013c)? The paper concludes by considering the nature of orthogonality and the change in the relationship to the unconscious that this demanded of the governance of the client system, a change that involved an ethics that could move from ‘defending against anxiety’ to ‘being true to desire’ (Lacan 1992 [1959-1960]; Lacan 2014[2004]). The paper concludes by considering the implications these ethics have for a different kind of group relations experience that can explore the existential impact of such changes, so necessary in networked environments.