This was the view given by a speaker at an event today hosted by the North West Regional Employers, as part of a really interesting discussion about what balance is needed between generalists and specialists in future public services. The same person went on to say that generalists don’t know the full evidence base and so need to work alongside specialists who do.
Clearly there is a balance to be struck between generalists and specialists – I would like my surgeon to be a specialist and the person who signs off the safety of new buildings to have technical expertise – but it seems to me that there is a tendency to overstate the dangers of generalism. Generalists who don’t know what they don’t know may be able to be more innovative and experimental than people whose specialism leads them to see an existing service intervention as the solution to every problem.
In support for people with chronic illnesses, with a social care need, or located in vulnerable families with complex needs, key worker models have been really effective. The ability of a worker to provide continuity of support and to speak to a range of issues that cross service silos is very effective, and requires a generic set of relational skills rather than a service specialism. The growth of peer support and service user advocacy in mental health also highlights the scope of people without formal specialist skills to provide meaningful and effective support. Of course these generalists don’t know the formal evidence base, but in lots of the ‘wicked problems’ that public services are addressing the evidence base is indeterminate, and there isn’t time to wait for controlled trials and pilot sites to be fully evaluated: action is demanded now. Approaches need to be improvisatory and dialogical, adapting as you go and learning from mistakes, rather than waiting for the experts to press go.
Generalists are not suitable for all public service roles, but sometimes having a key worker or peer advocate who doesn’t know what they don’t know seems to me exactly how innovation happens.