Scurvy and social care

By Martin Routledge


The late great Gerry Smale told the tale of the discovery that citrus fruits could prevent scurvy in long voyage sailors and the time it took to “adopt the innovation”

Here is a version of the timeline:

  •  1600-1800 an estimated 1m long voyage sailors died of scurvy
  • 1636 – John Woodall described how it could be prevented with citrus fruits
  • 1747 – Lund experimented with citrus fruits on HMS Salisbury
  • 1795 – Navy mandates use of citrus fruits
  • Merchant navy even later

When thinking with groups about making change happen I often share this and invite people to explore why this change took so long. Typical answers are about communication, power relationships, authority, systems etc…

People speak of the low value and power of sailors, slowness of the spread of the idea given the technology of the time, novelty of the innovation, reluctance by the medical and naval authorities to adapt long-standing approaches, lack of influence of those proposing the innovation, cost and so on.

So change is hard for many reasons – technical and resource obstacles amongst them. But much really does come down to issues of power and stasis. Those subject to the status quo have low power and value in society and those running things are not sufficiently levered or motivated to change things. Those of us with power or influence in social care have to ask ourselves whether this applies just as much to us – however much we like to see ourselves as champions of social justice.

We currently say we can’t change things – time and task commissioning, buying places in massive care homes or assessment and treatment units – because of austerity, but we did all these things before austerity. They are not good enough reasons for denying people flexibility in the use of their personal budget or failing to make adaptations to commissioning practice to allow providers the chance to shift from time and task

Last week I was privileged to hear John Evans and Dame Phillipa Russell tell their stories of the building of independent living and inclusion. Their creativity and courage, fighting for a better future for themselves, their families and others needs to be matched by all who are concerned with the future of care and support.

These changes are the equivalent of lemons and limes.


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