Don’t panic! Why the social care crisis will not be solved by making a crisis out of social care

by Neil Crowther

 

Corporal Jones

 

Understanding means finding a story you already know and saying, ‘Oh yeah, that one.’ Once we have found (the) story, we stop processing.”

Roger Schank, Tell Me A Story, 1998

One of mankind’s most incredible recent success stories – vastly increased life expectancy – is now most often described using metaphors of impending catastrophe such as ‘silver Tsunami’ and ‘demographic timebomb.’   More recently, a polarising discourse which pitches old against young has taken hold and begun to shape debate.  As a result, our ageing society is increasingly framed as a problem and a threat, rather than as a success and an opportunity.  Like debates around immigration, discourse around ageing casts it as creating ‘pressure’ on public services, the economy and communities.  In short, it is overwhelmingly positioned in public discourse as a growing crisis.

Debates about the future of health and social care are contributing to and being shaped by this narrative. ‘Integration’ of health and social care is positioned as a solution to the crisis in the NHS, with older people ‘bed-blocking’.  At the same time, debates concerning funding of care in later life have centered on individuals drawing on the equity in their homes, ideas that are quickly dismissed as ‘taxes’ upon death or dementia.   Younger people who require care and support feature barely at all in this debate, a fact that appears to be behind the governments’ decision to address its incoming Green Paper exclusively to older people.   The following paragraph from a piece by Rachel Sylvester in the Times Newspaper on 16 January 2018 exemplifies these themes:

‘The NHS crisis is really a social care crisis, created by an ageing population and exacerbated by government cuts.  Although health budgets have been ringfenced since 2010, there has been a £6 Billion cut in spending on social care and an entirely related 50% rise in the number of older people stuck on hospital because there is nowhere for them to go in the community.’

The debate around the future of health and social care is hence dominated by the language of death, bed-blocking, tax, unfairness between young and old, losing our homes, unaffordability and crisis, which together is likely to encourage fatalistic thinking about the future.  It is little wonder then that governments since the mid 1990s have struggled to command public engagement and support for a long term funding settlement.   The December 2017 Ipsos-MORI  ‘Issues index’, which maps public priorities, found only 2% of the public listed ‘ageing population/social care for the elderly’ as the most important issue facing the country today, and only 12% highlighting as an ‘other important issue’.   The challenge is both that the issue lacks public salience (or the public are reluctant to express it) and insofar as it enjoys public salience, the salience it does enjoy is deeply unhelpful.

Have those advocates striving to seek a new settlement for social care challenged or helped reinforce these narratives?  The Frameworks Institute, a US-based organisation increasingly working with social partners in the UK, lists the features of poor communications practice as follows:

  • Employing crisis communications and highlighting problems, rather than solutions, encouraging fatalistic thinking.
  • Leading with unframed facts and evidence, and professional jargon, rather than values and frames which appeal to people’s feelings and aid understanding, or employing unproductive or unhelpful values and frames.
  • Telling individual stories without explaining the systemic factors lying behind them, which encourages people to see the problem as residing with the individual.
  • Engaging in myth-busting, which often reinforces, rather than challenges the myths by repeating them.

Conversely, effective communications:

  • Combines urgency with efficacy – people must feel a problem can be solved.  Set out the solution and avoid crisis language.
  • Leads with values and employs ‘metaphors’ or ‘simplifying models’ that engage with productive feelings about an issue and that create ‘pictures in our minds’ to aid understanding.
  • Uses thematic stories, not individual stories to foreground the systemic factors shaping outcomes.
  • Connects outcomes to society as a whole – explain how the positive or negative outcomes related to social care affect everyone.
  • Contextualises numbers – don’t expect them to speak for themselves.
  • Avoids myth busting – it tends to affirm the myths, not overcome them.

A quick look at recent communications around social care by a selection of public-facing organisations in the field suggests that they are contributing to the problematic way social care is framed.   Almost all of the large NGOs in the field, spanning older people, disabled people are carers are leading on ‘social care crisis’ in their communications.  None posit solutions other than ‘more funding.’  Most use unframed statistics about the situation facing their client group to convey a sense of urgency.

Research by IPPR and Price Waterhouse Coopers for the Labour government in 2009 found ‘Low awareness and uncertainty: confusion about the nature of social care services.’  Yet insofar as organisations attempt to describe what social care is in their headline communications, little attempt is made to convey any ambition beyond basic ‘life and limb’ services. Even within those limited ambitions communications fail to convey the value to individuals, families and wider society of social care, nor do they employ any ‘metaphors’ or ‘simplifying models’ to aid understanding.

The story of social care needs to be told within broader human narratives around relationships, family and community, in the way TV shows like 24 hours in A&E, One Born Every Minute or Educating Essex have done so for the NHS and education for example.  We need to learn from the way other policy issues have been framed.  For example, the benefit of ‘flexible working’ is not found within the workplace, but in having time to spend outside the workplace with and on family life.  Hence the most effective ‘frame’ through which to communicate the benefits of flexible working is the family, not the workplace.  Where does social care have meaning and value to people?  We also need to overcome the ‘othering’ that can infect perceptions of social welfare, particularly ‘needs- based’ social welfare that is targeted on particular groups, as social care is.  Again, this suggests that more effective communications might foreground stories of family life and use the voices of wider family members, such as grandchildren, to convey the universal importance and value of social care.   There are also major lessons from the reframing of ‘gay marriage’ to ‘equal marriage’ which consciously shifted from invoking the ‘civil rights’ of a minority to emphasising the universal desire for love, relationships, family and stability and so on (i.e. the things people commonly value about getting married, which for the most part isn’t their civil rights).   What is it that people commonly value and which social care helps to protect or extend?  How far are these values embedded in our communications and the frames we employ when talking about social care?

The fact that social care enjoys low public awareness and understanding is, perversely, a major opportunity to define and articulate a new story of change, especially as evidence also suggests there is at the same time a strong desire for more information and debate about its future.

We require a new narrative, employing values and frames to enlist support for and building understanding of the crucial role that social care can play in creating a better society for all.

Communicating effectively is an empirical question, requiring research, development, testing and refinement.  There are a number of initiatives underway in the UK presently to strive to reframe debates, such as work by to reframe poverty, work on immigration, criminal justice, children in care, child protection, climate change and human rights.   There is no equivalent work on social care.

It involves work to clarify the communications goals and current practices of communicators in the field and the values and frames embedded in these, to map current discourse and public attitudes and the values and frames embedded in them and to explore the impact of the above on what people think, feel and are prepared to do about an issue such as social care.  It then involves work to identify values and frames that might affect more productive attitudes and understanding and hence enlist stronger support for our goals and to begin to construct narratives and messages in which these are embedded.  Finally, it involves the dissemination of these new values-based frames, including via guidance, training spokespeople, coordinated communications activity and proactive campaigns.

The process can be a challenging one for those in the field, confronting their own practices and beliefs.  It needs, by design, to be iterative and to bring people on a journey, otherwise it is likely to be rejected.   It requires expert support and funding.

Who’s on board?

@neilmcrowther

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