By Alan Rosenbach

Social Care has always been and always will be political and so about money and power. To see how we might shape the future for social care we best understand the recent past. “The rise of the welfare state in the late 19thCentury was in response to the growing popularity of left-wing politics, especially among the working class. Conservatives and Liberals in the late 19th early 20thcenturies could see no greater threat to their political position than that posed by socialism[1]“. The socialist aims were for a much greater role by the state in tackling poverty, poor health and inequality between rich and poor. The response by the ruling elites was to cede ground on meeting health needs in the early 20th century through voluntary hospitals meeting acute care needs and a means tested pension for older people by 1908.

Then, as now, the majority of carers were family members looking after their older or disabled relatives. We should not romanticise this idea. High rates of death in children, families moving away, immigration and war meant many disabled and elderly people had no support.

Left-wing politics in the middle of the 20th Century shifted the debate from the deserving and undeserving poor to the setting up of the National Health Service, free at the point of use, and the National Assistance Act at the same time in 1948, which means tested social care. The concept of the state supporting you from cradle to grave was established. So successful has this system become that we are all living longer, which may or may not be a good outcome.

We have learnt along the way that support in or closer to people’s homes and in communities rather than in institutions leads to improved health and well-being. We have shifted from local government running services to the development of less than perfect public service markets for care and support. We shifted from:

  • Professionals deciding what is best to
  • Central government targets to
  • Voice of the consumer to
  • Choice of the person using service

being the driving factor in market design. Voice and choice are still somewhat limited and there is a gap between rhetoric and reality. We have the not-for-profit sector, the public sector, voluntary and private sector all contributing to care and support. There are debates about small being beautiful, particularly if it is not-for-profit, versus large being less than satisfactory, particularly where the for profit sector is the provider. These are features of imperfect public service markets.

So, what of the future for social care? It looks bleak not least because we would need to double run the funding of care and support from the ‘as is now’ to where ‘we want to be’. Unfortunately, ‘we’ don’t have a consensus about where we want to be and how we might get there. I have great faith in experts, but we don’t have a determined evidence base about what works best for older people’s support or for working age adults in terms of service configuration and interventions, or a requirement where we do have the evidence that these must be implemented. We also have a significant problem with workforce shortages.

Let’s scenario plan here in summing up. We are designing a sustainable system for care and support that would help us to shift from our current broken system to one that works for individuals and families. What do we need?

Funding a care and support system that is:

  • Funded by general taxation for working age adults;
  • Funds through general taxation dementia care;
  • Funds through general taxation end of life care;
  • Abolishes the role of local government as a conduit for funding;
  • Makes financial resources directly available to citizens through the benefits system;
  • Extended investment relief for companies developing new technologies including artificial intelligence capability to improve care and support;
  • Enhancing tax and housing benefits specifically for those choosing a career in care and support;
  • Defining and implementing integration between health and care where the evidence supports an initiative of this type.

We have regressed back to the idea of the deserving and undeserving poor and we have come to see the welfare state as a burden. We have allowed the poor to carry the burden of economic failure, privatised the profits and nationalised the failures in economic policy. The most recent analysis of satisfaction with social services makes for grim reading. Satisfaction was 23% in 2017. The change from the previous year was not statistically significant. At the same time, dissatisfaction with social care services increased by 6 percentage points in 2017 to 41%[2].

What might services look like that meet need?

There are today aspects of care and support that meet the needs of individuals, families and parts of communities. These are all predicated on managing the asymmetry of power. In these circumstances, the state and its institutions are prepared to cede power determinedly and purposefully back to the individual, the family and communities. Importantly they come in all shapes and sizes. This series of blogs have highlighted the work of Community Catalysts, Shared Lives Plus, Local Area Co-ordination and community well-being teams. I know from my experience of working with the voluntary and for-profit sector that these services too cede power away from the staff to individuals.

Social care must find a coherent and articulate political voice that spells out the inequities of the asymmetry of power between state its institutions and citizens; highlight the positive approaches of services ceding power back to communities. It must do so in such a way that it threatens the status quo and so drives the positive change.

@AlanRosenbach


[1] Richard J Evans, The pursuit of power; Europe 1815 -1914.

[2] Kings Fund: Public satisfaction with the NHS and social care in 2017 Results and trends from the British Social Attitudes survey.
https://www.kingsfund.org.uk/sites/default/files/2018-02/NUT_KF_BSA_2018_WEB.pdf

By Jenny Pitts

There are many reasons to be pessimistic about the future of adult social care and social work services at the moment; is it, as Chris Hatton says, fundamentally broken? Well documented statistics such as the difficulties in recruitment and retention of social work staff, the continual gaping hole of the funding gap etc. don’t need repeating here.  We know that doing nothing isn’t an option – something has to change and that change has to be quite radical and deep; we can no longer tinker around the edges while expecting real and sustaining change – waiting lists to reduce, person-centred and community-based solutions to flourish, people’s experience of services to improve, etc. Achieving these things and more is only possible if those leading change work very differently and are prepared to put everything on the table in terms of questioning what needs to change and, importantly, to let the people who know best about what will work drive those changes at a local level.

I talk to many social work teams across the country and all too often hear that they strive to put the person at the heart of practice but that they often feel constrained by the burden of the internal and cross-organisational bureaucracy. With pressure on teams as intense as we have known it, we are using up our greatest asset – the staff – to carry out laborious and often unnecessary process and form filling.  The answer doesn’t lie in a new IT care management system but in many areas the system is dictating practice and tying up hard pressed practitioners to spend significantly more time inputting a person’s notes on the system and processing the next steps than they spent talking with the person in question – this is not good for people they support and serves to damage the motivation of practitioners. Systems which have a ‘one size fits all’ approach mean there is no room for proportionality. An assessment has become defined as a document and a stage in the IT system that is needed to unlock other stages, not a rich process that seeks to really understand what’s going on in a person’s life.  Changing this is part of the solution but not a solution in itself.

A system that is process-heavy is fundamentally predicated on a culture of mistrust and this works against any desire to be creative and it fuels the urge to cover one’s back in the event of there being any legal challenge, let alone a challenge from panel.  Funding panels generally only add to the bureaucratic burden and serve to further damage morale within practitioner teams. Fragile resilience and confidence can be obliterated by the experience of “going to panel”. There are better ways to make decisions about allocating limited resources that don’t ride a coach and horses through the worker’s professional self-esteem and that ultimately better serve the interests of people they’re supporting.

The challenge is complex and if the solutions were easy we would be in a different place. There is no blueprint, no quick fix nor magic bullet but there is a great deal of commitment, knowledge, expertise and learning within social work teams and within the communities they serve. Harnessing this is the key. I would suggest that we already know what we need to do – it’s the doing it that’s the challenge. For decades practitioners have said that we need to reduce bureaucracy so that time is freed up from the ever increasing form filling and process, we need to be more preventative and find ways people can talk to someone before they’re in crisis, we need to reach out and collaborate with all the organisations and community groups who are working to achieve the same end – no organisation has all the resources needed but pooling resources at a community level and people coming together to agree how they can genuinely collaborate as equal partners around a shared vision is powerful.

We’re privileged in the NDTi to work with a host of people within services and across communities who are doing just this and there is a rich body of learning and experience from that preparedness to share. When change starts to happen locally the momentum develops a life of its own and more and more people want to get on board because they see that it works. So we know that it is possible to not have waiting lists, for people to see someone within a week, to have a good conversation that focuses on what matters to them, what they want to achieve and to identify solutions, for practitioners not to be overburdened by paperwork and process and for decision-making to sit at a local level. Morale increases, practitioners feel valued and trusted and empowered to use that thing that has been fragile and wafer thin for too long – their professional judgement. Confidence increases as teams support each other through peer support, reflective practice and shared decision-making. Moving towards a culture of trust and empowerment, within services and across organisations is, in my view, essential but this takes time and it takes bold leadership.

Is this a return to “good old-fashioned community social work”? Maybe. People talk fondly of days when they used to go out with a notepad and pen to conduct their assessment. Did it feel any more risky? Not at all. Did they feel they were using their skills? Yes. Practitioners talk about how they’ve lost sight of the reason they came into the profession – to make a difference in people’s lives, to use their skills in working with people in listening and understanding what matters. This passion and dedication hasn’t gone away but I would suggest that the more we overburden practitioners with process and bureaucracy and rely on IT care management systems that don’t allow them to use their judgement, we run the risk of losing that most precious resource.

Those areas implementing Community Led Support have found that many people benefit from having an appointment with a social care practitioner in a welcoming community venue where they can find out what’s going on locally, what support might be available. These ‘hubs’ often involve community groups and volunteers and can take place in libraries, town halls, community centres, voluntary run cafes, GP surgeries, church rooms and even fire stations, to name but a few. They offer a valuable experience for the person who is offered an appointment usually within two weeks, often days, and mean that with proportionate recording, the practitioner can be far more efficient and have time to follow up any actions.  Not everyone needs a home visit but if they do they are therefore able to experience that much more quickly than they would otherwise.

These hubs are one of the ways that services can be far more responsive but are not an end in themselves, they need to be underpinned by skill of the worker to have an effective and strengths based conversation, to have permission to record what matters and to be trusted and supported in that judgement, to have time to connect with the organisations in that community to understand what they offer and work together better. It requires the entire experience of the person to be smooth and joined up – this includes working with customer services teams who so often do a fantastic job in beginning that conversation and understanding what matters and the outcome the person requires.  The good conversation, the language that doesn’t confuse or mislead, needs to start as early as possible and be followed through, including that bit of customer service that social care is so poor at – finding out how useful the person found it, did it make a difference, how they can talk to someone again in the future if they need to. Only then we can really understand how effective services are.

There’s a lot of talk about asset-based social work at present but this shouldn’t be some new thing; this is what social work practice should be all about – but we need to allow it to flourish and enable creativity and flexibility and allow people who work in services to do what I believe they do best and what they came into the job to do.  If we address that people are more likely to stay and to invest in a career in an underrated but so vitally important a profession.

@JennyPittsNDTi

By Jenny Morris

I haven’t been able to blog for a while but recently two key questions have got me thinking…

 

The first was a challenge from Catherine Hale, who leads the Chronic Illness Inclusion Project, put to me and a few others: “The term Independent Living” she said, “does not seem to have resonance for people with chronic illness and has been corrupted by those implementing Care Act in the service of cutting costs”.

The second was a blogpost by Chris Hatton posted as part of the #socialcarefuture debate.  He asked: Is social care as we know it fundamentally bust?

Linking the two challenges has led me to ask: Is it time for us to admit defeat and abandon the term ‘independent living’ to describe our aspirations as disabled people?  If so, how can we articulate these aspirations in a way which addresses the current problems with social care?  And what would that mean for what we now call ‘social care’?

I don’t want to focus on the question of whether the term ‘independent living’ is particularly problematic for people with chronic illness, partly because it deserves consideration completely separate from the question of the current state of social care. However, the second reason Catherine gives for questioning its continuing relevance – the way the term has been corrupted by those implementing the Care Act – is relevant to all groups of disabled people and is directly related to Chris Hatton’s challenge.

So to start by addressing the challenge to the term ‘independent living’ (but emphasising this is just my attempt to open up debate rather than my firm conclusion):

1. Maybe we have to admit that talking about ‘independent living’ is not useful to us at this point because we have failed to achieve general acceptance for our insistence that it should mean ‘having choice and control over the support needed to go about daily life’.  Instead, many working in health and social care, and also the general public, still take these words to mean ‘doing things for yourself’.  Moreover, too often it seems the terms ‘independent living’ and ‘independence’ are used to deny the reality of someone’s support needs. The rationing of services goes along with an unequal power relationship between the person who needs support and those responsible for funding and delivering it, and can result in a denial of needed assistance in the guise of encouraging ‘independence’.

2. At the same time, we need to recognise that independent living was never just about social care.  Yes, its origins were in replacing institutional and institutionalising services with direct payments, which enabled people to employ their own support workers, but this didn’t deliver what we meant by independent living unless other barriers were addressed: the barriers to accessible, affordable housing, transport, to employment, to participating in family and community life and so on.  This wider vision is reflected in the last Labour Government’s Independent Living Strategy which defined independent living as:

Having choice and control over the assistance and/or equipment needed to go about your daily life; and

Having equal access to housing, transport and mobility, health, employment and education and training opportunities.

That Strategy envisaged:

a single community based support system which focuses on all aspects of what people [of all ages] need to maximise their health and wellbeing and to participate in family and community life. The right of the individual disabled person to determine the kinds of services and support that they need will be at the heart of this reformed system.

3. We need to return to the roots of what disabled people in the 1970s and 1980s were trying to achieve. When I was carrying out research on independent living in the early 1990s, I consulted with the British Council of Disabled People about what the term meant.  The first principle they identified was that “all human life is of value”.  This echoes the UN Declaration of Human Rights: “All human beings are born equal in dignity and rights and all life is of equal worth” which is also, of course, the starting point for Article 19 of the UN Convention on the Rights of Persons with Disabilities (CRPD), the right to independent living.

As the UN’s Committee on the CRPD pointed out, “The foundation [of Article 19] is the core human rights principle that all human beings are born equal in dignity and rights and all life is of equal worth”.  Article 19, they explains:

has its roots in civil and political as well as economic, social and cultural rights: The right to liberty of movement and freedom to choose one’s residence (art. 12 of the International Covenant on Civil and Political Rights) and the right to an adequate standard of living, including adequate clothing, food and housing (art. 11 of the International Covenant on Economic, Social and Cultural Rights) and to basic communication rights form the basis for the right to live independently and be included in the community. Liberty of movement, an adequate standard of living as well as the ability to understand and have one’s preferences, choices and decisions understood, form indispensable conditions for human dignity and the free development of a person.

This makes clear both how comprehensive the concept of independent living is within the international human rights framework, and also how a denial of independent living is a denial of human rights.

4. In the current context, where the term independent living has – as Catherine Hale says – been corrupted by those responsible for implementing the Care Act, perhaps we need to frame our aspirations and our demands in terms of human rights. Articulating our aspirations in terms of our human rights would enable us, for example, to see the rationing of support to a level which prevents people from even going outside their own home, or which forces them into residential care, as a human rights abuse.  It would also enable us to see a failure to recognise how someone communicates as a human rights abuse.  Segregation and isolation from family and community would be seen as a human rights abuse as would many other features of the current broken system of social care.

5.  The answer to Chris Hatton’s question is that, yes, social care is fundamentally bust.  This is partly because our society has not chosen to put enough resources into what is currently called ‘social care’. We used to talk about how the question was not so much the level of resources put into such services but how the money was used. But we are now in the situation where there is widespread agreement that not enough money is going into social care.  The problem is that this is only being brought home to politicians and the public because of the impact on the NHS and the danger is this agenda will only identify solutions in terms of what social care can do to prevent hospital admissions and delayed discharge.  Instead, we need to ensure that this political and public debate includes a wider vision of community support which enables people, whatever their age, impairment or circumstances, to access their full human rights.

6. But it is not just about the level of resources, important though this is. Social care is also fundamentally bust because we have constructed methods of rationing and of delivering such services which mean they cannot be relied upon to protect and promote older and disabled people’s human rights.  Direct payments, the original mechanism which aimed to deliver choice and control, were intended to place decision-making powers in the hands of people who needed support to go about their daily lives.  Personal budgets were similarly intended to empower people who did not want to employ their own support workers but who – through being able to control how the resources to which they were entitled were spent – would thereby have choice and control.  Neither have fully delivered on this vision, partly because it is hard to change the local authority culture which relies on bureaucratic processes to maintain control – and this even harder when budgets are cut back so significantly. And partly because the so-called ‘market’ in social care is dysfunctional – there isn’t a real choice of service provider for either local authorities or self-funders, and one in four social care providers do not even provide ‘safe’ care, according to the CQC.  Social care is just another privatisation which hasn’t delivered.

7. But, as I wrote in a previous blogpost, the answer is not to go back to state provided services – that doesn’t address the power imbalance.  Instead, the answer is to develop new ways of delivering support services, such as user-led services and co-operatives – not old style charities run by the great and the good with the values of ‘doing unto people’ but non-profit community-led organisations which are truly accountable to those to whom they provide a service: support which is designed and delivered for the community by the community. Vidhya Alakeson, Chief Executive of Power to Change, gave some examples of this in her blogpost – and incidentally, Vidhya mentioned that some communities no longer even have a cafe where they can meet “to plan a different, better future”; but my community now does thanks to Power to Change part-funding our new community shop and community cafe.

8. New ways of both delivering and commissioning services also require some fundamental changes to how we make decisions about how to raise resources and what level of resources should be put into community-led services. In that previous blogpost I argued that the current system of means-testing social care is unjust because it is a matter of luck as to who needs a substantial amount of care for themselves or a family member. The NHS is funded on John Rawls’ principle of the ‘veil of ignorance’ – in other words no-one knows whether they are going to be struck down by serious illness and it is therefore in all our interests that healthcare is funded by a progressive taxation system to ensure that health care is there if and when we need it.  This is the same basis on which community support services should be funded. Community-led, not-for-profit services should therefore be funded out of our society’s collective resources, free at the point of use.

9. However, decisions would still need to be made about how to allocate those resources.  We therefore need to think about developing new and more democratic ways of commissioning services. Chris Hatton mentioned participatory budgeting in his blogpost, and there certainly seems enormous potential for promoting deliberative democratic decision-making in both the allocation of resources and in the delivery of support. But we haven’t been bold enough yet in this country; instead we have only tried to make gains within existing systems and there is inevitably a limit to which this can bring about real change. We have talked about co-production but even where this enables genuine participation it does not enable control over resources and thus does not tackle much deeper issues about democratic decision-making.  We need to be experimenting with mechanisms which “give people real power to effect change in their lives, communities and beyond“. We need to use an idea like participatory budgeting to give local communities real power to determine how resources are used.

10.  So my answer to both the challenges posed by Catherine Hale and Chris Hatton, is: let’s frame our aspirations in terms of our human rights and let’s redesign and properly resource a system which is collectively funded, free at the point of use, and where resources are democratically allocated to forms of support which are designed and delivered by and for local communities.

@jennifermor

By Sian Lockwood, Community Catalysts

Debenham

Debenham is a large village in Suffolk, where 8 years ago people came together to take action about a common concern that friends and neighbours with dementia were having to leave their community for care.

Over 100 people came to the first village meeting and agreed a long term vision of extra-care facilities in the village. They appointed an action committee and mandated them not just to deliver that vision but also in the meantime to ‘just do something’. With very little financial support from statutory sources, they set up a range of activities and supports which help friends and neighbours with dementia to stay at home for longer. I visited the village in 2012 and was blown away by the numbers and variety of people involved and the creativity of their ideas and activities. The pop-up dementia-friendly restaurant and emergency weekend hotline stood out for me during that visit but there were many other small and large initiatives that made a real difference to people’s lives – for example, people really appreciated the local librarian’s visit to the bi-weekly Carers Café to help people access web-based information about dementia and were excited by the idea of a local homecare agency staffed by local people. The project has changed and adapted with local need and the energies and skills of local people but is still going strong 6 years later. The action group (80+ strong) understands that each individual activity has a natural lifespan and that the gap left by the ending of one activity will, with the right kind of encouragement, be replaced by another. They also know that initiatives work when they are led by local people – well-meaning help from professionals can be the kiss of death to a new activity. As the co-ordinator of the action group says: ‘professionals should only do what professionals can do – we’ll do the rest and tell them when we need them’.

Somerset

Somerset Council was concerned that people living in the most rural parts of the county could not access help to stay at home – it was just uneconomic for some traditional care agencies to provide care in these remote rural areas. They asked us in to work with local partners (parish councils, GP surgeries, churches) to help local people set up enterprises that would provide the help and support that was unavailable from more traditional sources. 3 years later there are nearly 300 enterprises, working in many different ways to support almost 1000 people to stay at home and connected to their community.

Sharon Walker has a lot of experience working in traditional care services. She took a career break to look after her mother in law and was profoundly affected by the experience of delivering person-centred care. Spurred on by this and with support from Community Catalysts, she decided to set up Care4U in December 2015. Care4U provides highly personalised, flexible and consistent support to older people in and around Sharon’s Somerset village. After 14 months running Care4U she explains the difference it has made to the people she supports:

‘I can organise my time so that people can get what they want at a time that suits them, it gives me the freedom to work around their family…’

The courage and trust shown by the council in the approach that it took to the originalchallenge was vital to the success of this project. As well as commissioning some capacitybuildinghelp the council trusted its people to make good choices by giving them directpayments and information about the range of enterprises in their neighbourhood.

Wakefield

Wakefield Council wanted to find ways to work more collaboratively with their communities. They commissioned a collective of organisations to work intensively with two self-defined neighbourhoods, finding out what was already happening, understanding the positive forces that helped get things done in those neighbourhoods, what local people felt was needed and how the council could help.

This comparatively small project provided new insights into a future for social care where the relationship between public services and local people is very different. It found:

That local people in the two neighbourhoods already had a really clear grasp of the challenges facing people in their communities and good ideas about possible solutions, but didn’t know who to talk to and how to make them happen;

Public sector initiatives working in parallel or cutting across each other;

Community initiatives inadvertently damaged by public sector activity that knew nothing about them or did not fully appreciate their value;

National initiatives that were not integrated with each other let alone into those of local communities;

Untapped or misaligned resources in local businesses and local charitable organisations. One of the neighbourhoods, for example, had a number of small charities working in isolation from each other as well as a large business with a community fund worth £250,000 which it ‘didn’t know how to use’.

Those neighbourhoods had plenty of internal and external resource, the problem was that much of it was being delivered in silos or was unvalued and therefore unused. There were no mechanisms which allowed local people to be fully involved in deciding local priorities, shaping local solutions and directing the use of resources to help deliver those local solutions. It was clear to all those involved in the project that putting local people at the centre of decision making, with public bodies there to inform, support and work collaboratively would make much better use of scarce resource. Almost as transformative was the realisation that the resources provided by the state were just part of the resources in the neighbourhood (people, buildings, money) – local planning needed to take account of all the resource available locally.

A glimpse of a positive future?

These three glimpses of a social care future show people with passion and a desire to make a difference to their own lives and the lives of their neighbours and community. They show that the appetite for community enterprise and action is alive and well, needing just a little encouragement and support to make a real difference to people’s lives. They show that you don’t have to ‘go big’ to scale – many very small enterprises or activities can have just as much of an impact on an area as one or two big enterprises. They show that an approach that helps unlock people’s imagination and talent and gives them the right kind of help allows many different flowers to bloom – and stay blooming. They show the importance of ‘place’ and understanding and engaging all the resources available in a neighbourhood. They also show a very different relationship with public bodies – one where the community has responsibility for determining local priorities and shaping the solutions that will address those priorities; where public bodies trust local people to make good decisions and wait to be brought in to ‘do those things only they can do’; where they help behind the scenes by making sure communities stay central and are respected; that public activity is co-ordinated, good information is available and money flows are identified and unblocked to help deliver community priorities.

Many areas provide glimpses of this social care future. We need one (or two, or three) brave areas to take all of this learning on board and demonstrate the creative power of a place where local people have the responsibility and resource needed to help people in their community live the best life they can and where the public services… well… serve.

 

 

@SianCommCats

by Chris Hatton

Ever since I was asked if I wanted to write a blog for #socialcarefuture I’ve been struggling. I’m not a deep thinker, more a shallow magpie thief of others’ insights. I’m not a doer (come on, I’m an academic!). I’ve not been on the receiving end of social care (yet). My blogposts have been known to make people nauseous rather than optimistic. I waffle. And my thoughts on social care are as coherent as socks in a tumble dryer. So – all I’ve got are two whirligigs of confusion to share with you.

First of all, what exactly is social care? There’s lots around on raising awareness of it, reframing it, fighting for it, but what is it? As far as I can see it’s either defined by what it’s not (stuff the state decides to maybe help people with that isn’t healthcare or education), or by current institutional administrative convenience (it’s what social care services do/commission/ration). Public perception of the NHS? Free, there for us all, owned by us. Public perception of social care (if there is one)? Have to fight to get it, only begrudgingly free and have to pay for some of it, mainly for other people, at the mercy of a market. Is social care helpful as a descriptive term, rallying cry, or organising principle for how people help each other?

Social care also often doesn’t seem to be about engaging with people as complete human beings. The heartbreaking live tweeting of Richard Handley’s inquest (@HandleyInquest) showed that people in a supported living service no longer considered it their job to pay attention to Richard’s health, such that a man in his 30s died (died) of constipation. Years ago Susie Baines and I did a project where social care workers were for the most part actively hostile to the idea of supporting people’s engagement with religion where this was important to them. And the same can be found when it comes to people falling in love, having sex, having a social life that extends beyond 9pm, wanting meaning in your life, and so much else. If these things aren’t the very essence of social care, what’s left of it but cruel warehousing?

This depressing picture, together with the operation of violent bureaucracies, the violation of human rights, and the spreading dysfunctionality of social care ‘markets’, makes me wonder if social care as we know it is fundamentally bust, and any amount of tweaking or extra money won’t fundamentally help.

Which leads me to my second whirligig of thoughts. This starts with the question – is small good stuff the future of beyond social care? I’m a big fan of so much that’s happening at the moment (some of which has been described in other #futuresocialcare blogs) that’s about helping communities to support each other in ways that are outside the purview of a social care ‘service’ – small, starting from where people are, helping people to help each other. I find myself really drawn to these – their human scale, their anti-bureaucratic nature, their focus on bringing people together, and their ignoral/subversion of what a ‘service’ is. Can they be a big part of the answer? I hope so, but sock in tumble dryer questions that nag at me are…

Q1: Can they go big without going bad? Examples are legion of the ‘scaling up’ of good ideas resulting either in bloated, sclerotic organisations that lose sight of their original purpose, or a duplication of them that, without the commitment of their originators, turns a bit ‘meh’. Is this inevitable? Do ideas like ‘scaling across’ rather than ‘scaling up’ help, or not?

Q2: Does naming and describing a good idea pin it, fix it and kill it in shiny innovationitis and bureaucracy, particularly when the idea becomes approved by branches of the state? If this is a problem, how do good things spread?

Q3: Many of these good ideas rely on the positive properties of communities – but communities can and do segregate, exclude and discriminate. How can small good stuff encourage (insist on?) inclusive communities?

Q4: Do these approaches have the potential to entrench or worsen existing inequalities, and what are their limits in terms of supporting people?

There is also a bigger question about small good stuff – what I’m going to call the ‘folk politics’ question. In their book ‘Inventing The Future’, Nick Srnicek and Alex Williams rather sniffily describe the ‘folk politics’ of what they call the left as a set of preferences that rather alarmingly map closely on to many of the characteristics of what I’m attracted to in the kinds of small, local ways of doing things springing up in #socialcare future. As they describe it “Against the abstraction and inhumanity of capitalism, folk politics aims to bring politics down to the ‘human scale'”, involving being reactive and spontaneous rather than having long-term strategic goals, favouring the local, small and unscalable, preferring actions taken by participants and emphasising the importance of personal experience.

Their (perhaps harsh) critique of this approach is that it is startlingly ill-equipped to deal with the big issues – it is overwhelmed by the complexity of how the world works so seeks to occupy some niches within it, and it offers no vision or strategy for defining and working towards changing the structural rules of the game to offer a future that works for everybody. In my shallow reading of the book for my purposes here, are these approaches trying to play a game within rules set by somebody else, with the deck stacked heavily against them? If so, a vital question for #socialcarefuture is what rules of the game need to be changed for basic humanity, the currently not guaranteed bedrock of social care, to sustainably flourish in ways that are equitable? Some of these are questions that go way beyond whatever social care is or might become, for example:

1)      If we are to live together better, people’s available time, confidence, mental space and money/resources need to be much more evenly distributed. Does something like universal basic income have potential here?

2)      Do we need a market for social care that has the visible shell of a competitive market (commissioners, tenders, endlessly complicated procurement processes, prospectuses, business park offices) but none of the supposed benefits? We don’t need state-run behemoths either. Can’t we look at participatory budgeting (where communities control the cake), regional investment banks to support new good small stuff to set up, ways to make it impossible to make a quick buck, local ownership, and/or limits on the size of organisations providing support?

3)      What does eligibility policing get us? More violent bureaucracy, relationships that are poisoned from the start, mistrust and constant anxiety. And a whole host of potential problems for people stored up to bite them harder later. We all need support all the time (public transport, clean air and water, schools, roads), it’s just that for many of us it’s not always in the kinds of ways that look like a ‘service’? Why not make ‘social care’ part of the basic, universal infrastructure – which may well mean much of it wouldn’t look like social care at all?

4)      Much more routinely accessible and affordable housing, so people’s homes can be more adaptable to people’s needs over their lifetime within communities where people have laid down connections.

5)      Again, the Richard Handley inquest showed us how, when ‘everyone is responsible’ across artificially imposed bureaucratic boundaries, then all too often no-one is. Everyone loves to diss ‘silos’, but without them you presumably just get your fields flooded with sileage. Starting from the point of view of us all as human beings, what boundaries are least harmful and irksome?

6)      Finally, recognising that everyone is a human being, and everyone contributes. Cleverness is no virtue – what about kindness, bringing joy, honesty, making someone laugh, being loving (in all its forms) – and then being a person that receives any or all these with grace?

See what I mean about my confusion? The upshot, I think, is that for small good stuff to really reclaim humanity and community, the rules of the social care game need to be radically changed. And – does this mean the end of ‘social care’ as an entity?

 

@chrishattoncedr