Processism

Stephen Bush writes about Sir Keir Starmer, the UK Prime Minister: 

Instead Starmer believes that the combination of the right process and hard work is enough to solve more or less any problem, and that mobilising the right amount of institutional memory will result in a better standard of government. This, then, is Starmerism: the belief that process can, in and of itself, lead to better outcomes. The trouble is that this approach is wrong...[t]he job of prime minister isn't to follow process; it is to navigate and advocate for trade-offs. The Mandelson fiasco reveals true nature of Starmerism, Stephen Bush, 'Financial Times', 21 April 2026

In today's policymaking world, the notion of tradeoffs is largely absent from debate. It's a world in which vague promises can be made and nobody dare publicly identify the people who will inevitably lose out from any particular policy. There's no long-term strategy: faith in the legislative process is what passes for strategy and vision. Government bodies, politicians and their paymasters in the large corporations - or their lawyers - are the only people who can understand, follow and manipulate the policymaking process, which they do to their advantage. 

A Social Policy Bond regime would be different: policy would be expressed in terms of long-term outcomes rather than process. This would bring more public participation into the policymaking process - an end in itself as well as generating more of the buy-in that is essential when policy goals have to be prioritised and costed. Goals would be explicit and stable and achieved with maximum efficiency. Discussion would centre on what vision and strategy, rather than process. 

For more about Social Policy Bonds, see here. 

Focusing on health outcomes

 Dr Vernon Coleman compares healthcare in the UK today to how it used to be in the 1970s:

The main single advance in medicine [in the 20th century] has been the (accidental) discovery of penicillin and other antibiotics. The discoveries of insulin, steroid hormones and a few other pharmaceutical products made a difference. But most of the essential and useful discoveries were made in the first half of the twentieth century. Since then the pharmaceutical industry has produced very little of consequence. Vaccines have been incredibly profitable for drug companies and a disaster for patients. There has been no heart drug as effective as digitalis (from the foxglove) and no pain killers as useful or as safe as aspirin (from the willow tree) and morphine (from the opium poppy). 

On the other hand the practice and management of health care has become incredibly complex, bureaucratic and expensive and patients are provided with much poorer care than their parents, their grandparents and their great grandparents. In the UK, the National Health Service has far too much money but most of it is wasted on administration, meetings, paperwork and pointless regulations. Trade unions and disciplinary bodies seem to me to be little more than outposts of the drug industry and seem to serve their interests rather than the interests of patients. Why doctors now do more harm than good, Dr Vernon Coleman, 18 April 2026

Given the widespread distrust of pharmaceutical companies, it would seem that this is the time to move towards rewarding those who achieve favourable health outcomes, rather than those who merely engage in activities purporting to deliver those outcomes. Those currently employed in healthcare are reacting rationally to the incentives on offer, to the detriment of our physical and mental health. And those incentives encourage over-screening and over-treatment, and the neglect of commercially nonnviable preventive interventions. It's the same, or worse, in the US:

The system is deemed broken, consuming 17% of GDP yet ranking last among high-income nations in life expectancy, maternal mortality, and preventable deaths, with 26 million uninsured and 43 million underinsured. Employer costs rose 160% in 20 years, driving wage stagnation and ER overuse; premiums for Obamacare and employer plans are surging in 2026 amid subsidy expirations. Shortages loom for providers, especially in rural areas, amid corporatized care and underfunded public health. US healthcare system is in crisis, James K Elsey 5 February 2025

It's time for a new approach. My suggestion is that, rather than policymakers' focusing on the means by which they think good health can be achieved, they instead focus on targets for good physical and mental health, and provide incentives for people to achieve those targets. The Social Policy Bond concept, applied to health, would do this, and more: it would inject the market's incentives and efficiencies into all the processes necessary to improve a nation's health. Health Bonds would channel our scarce resources into the most efficient means of improving our health, including those currently neglected or not even considered by our current healthcare bodies, most of which have little incentive or capacity to consider broad health outcomes that fall outside their increasingly specialised remit.

Health Bonds wouldn't stipulate how our health goals shall be achieved, nor who shall achieve them. This allows a broader approach. For example: our current compartmentalised accountancy-driven policy approach would not take into consideration the adverse health impacts of subsidising advanced driving courses for young owners of motorbikes or cars. But holders of Health Bonds would look at such measures, investigate their possible health impacts, and make an informed decision as to how any improvement they might bring to the nation's health compares to other possible interventions.

Nuclear peace; not much else matters

It's difficult to write about social problems when war looms so large, especially the possibility of nuclear conflict. Even global environmental concerns like climate change, or the destruction of fishing grounds, would fade into the background if the taboo against the use of nuclear weapons were ever to be broken. I've written copiously about the sustained nuclear peace, urged the issuing of Nuclear Peace Bonds to achieve it, mainly because the need for it is so great, but also because it would make an ideal target for a Social Policy Bond regime: 

• Existing policies don't appear to be doing anything to reduce the likelihood of a nuclear conflict;
• Nuclear peace sustained for at least 30 years is the sort of long-term goal that will require a lot of groundwork with many different approaches that will need winnowing out to find the most promising;
• Verifying whether the goal has been achieved would be easy; 
• The range of possible approaches is big, and there are complexities and feedback loops that make conventional policymaking, limited as it is by the imaginations and time horizons of its practitioners, useless; diverse, adaptive approaches are needed; and 
• There are few financial incentives to those people or organisations trying, or pretending to be trying, to achieve nuclear peace. 

The last of these requires some explanation: financial incentives are not solely about making the people who work for nuclear peace better off (which is not in itself an ignoble outcome), but also about attracting resources into what is currently a policy goal as unglamorous as it is urgent and necessary. With more funding, organisations working to achieve nuclear peace could employ more people and more resources, giving them a better chance of advancing the goal. 

All my work on Nuclear Peace Bonds and, more broadly, conflict reduction, can be found via this page. It is all available free of charge, including the text of my book on World Peace Bonds, though printed copies can also be purchased. 

The legibility of complex societies

The late Professor James C Scott wrote: 

Throughout the book I make the case for the indispensable role of practical knowledge, informal processes, and improvisation in the face of unpredictability. From the Introduction to Seeing Like a State, May 2020

From the summary of the same book, on the Lies are Unbekoming website:

James C. Scott’s “Seeing Like a State” offers a penetrating analysis of how modern states attempt to make complex societies legible and controllable, often with catastrophic consequences for the people they claim to help. Scott examines the fundamental tension between the state’s need for simplified, standardized information—cadastral maps, census data, permanent surnames, geometric city plans—and the intricate, locally adapted practices that actually sustain human communities. These “state simplifications” are not inherently evil; they enable taxation, public services, and citizenship itself. The danger emerges when states...attempt to impose their simplified maps onto reality, destroying the complex social and ecological relationships that make life possible. Unbekoming, 26 March 2026

All this points to the need for diverse, adaptive approaches, and a policymaking system that encourages them. The legibility that Professor Scott discussed is a self-entrenching way of looking at the world, and it applies at all levels of government. There are many aspects to it, but one is that it takes existing institutions as a given: what they cannot see or do not wish to see, is ignored or regarded as a threat. Government bodies have their own agendas, primarily self perpetuation, and the practical knowledge, informal process and improvisation that Professor Scott mentions do not fit in with them. 

A Social Policy Bond regime would be different. Taking a long-term view, it would target the outcomes that we wish to see and encourage diverse, adaptive approaches to achieving them. Any institutions that would arise from a bond regime would have as their one over-arching goal that of achieving social and environmental goals as quickly and efficiently as possible. In such a way, we'd combine the better aspects of 'state simplifications' with the practical, diverse and adaptive knowledge of the people actually working to achieve society's goals. The best of both worlds.