This note and artwork by Dr Pen Mendonça offer a summary of thinking and ideas generated by #socialcarefuture network members in Birmingham on 28 November 2019. It is presented here as a starting point and comments and suggestions and you are invited to help us to develop it, either using the comments box at the bottom of the page, via Twitter or Facebook or by contacting us at email@example.com
#socialcarefuture’s work on a new story is following the four stage research process outlined by the US-based organisation ‘Heartwired’: what is the change we seek and who do we need to persuade? What is the current landscape of discourse and thinking? What are the mindsets of our target audiences and how can we most successfully persuade them to support our values, vision and ideas? Clarifying the change we are seeking and who or what needs to be persuaded by a new story to achieve it is the crucial first stage. This session was organised to explore those questions. The note below is based on the record of discussions taken down on flipcharts by colleagues during the session.
What is the big change we want to see?
‘It starts with dreaming’
‘Social care’ as usually described, understood and done as a single one way service that ‘cares for’ older and disabled people, either in a person’s home or in some form of group arrangement. ‘Care’/being cared for itself is seen as being the product. Ideas and discussion about social care are nearly all based on what has been called a “professional gift” approach, with low expectations of those older and disabled people needing support, which can be stigmatising.
Those coming together in the #socialcarefuture network practice and aim for a quite different model, whereby the ‘product’ is the person who needs support better positioned to lead a life they value, supported by and contributing to a shared web of community support. Rather than ‘caring for’ older and disabled people, the starting point is ‘caring about what people care about’ and working alongside people to make it happen. It is a model that is about the person establishing or re-establishing their identity and building upon their own strengths, including through the ‘glue’ of their relationships with the wider community. Any support is designed to transport a person towards achievement of their life goals (however seemingly modest), and not to constrain them. It is about establishing or restoring people’s potential and about supporting people to ‘be awesome in our own ways’. If working well, people with high support needs will be visible in their communities.
If this change is achieved, getting support won’t lead to stigma, just as going to see your GP doesn’t. Nor will it involve battle or cause fear. People will get support through a range of ways-in, with peer support available in hospitals, via the police and so on. Both those looking for or receiving care and support and those involved in providing or helping it happen will know, assert or live by their rights and obligations, with human rights being front and centre.
As a result, rather than a single “transactional” service, achieving these results involves activity to secure or build ecosystems of mutual formal and informal supports. When working well, this web of relationships, living conditions and support acts as the ‘invisible scaffolding’ that provides us with what we need to lead our lives as we want to. Formal and informal support will be blended.
Like life, this approach to supporting people is messy rather than uniform. But it doesn’t just happen. More financial investment is necessary, but it must come hand in hand with reforms to unlock imagination, creativity, problem-solving skills, resourcefulness and the power to make change that exists across all our communities.
What are the main obstacles in our way?
Dominant definitions of social care are too narrow
Social care is being politically “framed” as about protecting property wealth or as free personal care for older people only. This begs the question: is what we want served well by the name ‘social care’? The media ‘don’t quite get social care even when trying’
Problem attitudes and baked-in low expectations
The general public does not see social care as having immediate relevance to them. Experience of the social care system has reduced expectations among people and their families about what is possible. People are worn down and prepared to accept mediocre support. Ageism and paternalism influence (and are influenced by) narrow ideas about social care. It is sometimes argued that our ideas don’t really work for people with significant impairments and health conditions such as late stage dementia. There is also a lack of trust in people and communities to take charge of their own care and support or to spend public money properly.
Rigidity and resistance to change
The imagination and creativity that can be found in the approach of members of the #socialcarefuture network is not routinely valued. Commissioning, procurement methods and regulation are often rigid and suffocating. The regulator is not measuring the right things and lacks ambition. The system’s desire to control struggles with the messiness of community doing it for itself. The “sector” prefers re-organisation to overall system change and is risk-averse. It approaches scaling through standardisation in a way that can crush creativity e.g. social care workforce development and recruitment-drives are focused on a fixed idea of the ‘care worker’ quite at odds with the idea of a personal assistant. Even where there is progressive leadership in local councils, a disconnect can exist between leadership and commissioning practices.
Power and influence lies in the wrong hands
The sector sees itself as the experts. There is little ‘consumer voice’. A culture of ‘us and them’ persists between those ‘providing’ and those ‘receiving’ services. Few organisations understand how to work co-productively. There are powerful vested interests perpetuating existing approaches. Social care continues to be based on a ‘gift model’ ‘theirs to give’ (gatekeeper) rather than ‘ours to take’ (rights).
Who are our ‘persuasion targets’?
Participants identified the following as key ‘persuasion targets’:
- Social care leaders and commissioners
- Those who come into the social care workforce
- The media and public who lack ‘a positive contemporary story of social care’
- The public who don’t understand what has to change or their part in it
- Politicians who get their ideas from the unambitious ‘sector’ or think tanks that are not well connected to the lives of people using social care – not from people or a more demanding public
Ideas for winning the change we seek.
Changing the story
A new story to reframe what social care is for and how it works, should centre on stories in which the role of care and support is embedded rather than stories which begin with social care, helping it to be understood as a means to other (commonly valued) ends e.g. Stay up Late’s focus on going to gigs. It should also major on these ‘better ways’ to help redefine what social care is understood to be and how it works well – for example, a recent news story of an older man going to school to have his lunch and talk to kids; of the pub opening up to offer free meals and company on Christmas day
We should support the development of a local, regional and national network for change. Borrowing from the ‘Every Australian Counts’ campaign, for example we could promote a national coffee morning, encouraging people to come together and to talk about how they can together improve care and support in their area
We should promote “legal literacy” among those using and those delivering care and support, including the Care Act, Equality Act and Human Rights Act. We should encourage legal enforcement in the field of social care by the Equality and Human Rights Commission
Rebuilding self advocacy
We should encourage and push for investment in family, peer and self advocate leadership
Social care should be seen as sitting alongside housing, health, education, community development and regeneration in making good places to live rather than a standalone service, or adjunct to the NHS.
We would like to extend our special thanks and good wishes to Dr Pen Mendonça