Reinventing Social Care

As part of its Manifesto for Social Care Reform the Centre proposes a radical reinvention of social services and the reintegration and refocusing of social work on citizenship and community.

Introduction – commodified care

Community/social services are in crisis as a consequence of three decades of disastrous policy leadership from Whitehall and Westminster. Social policies have been built on neoliberal assumptions and an obsession with using markets and managerialism to solve every problem. The failures of this system have then been exacerbated by a decade of Draconian austerity.

The social care system has failed disabled people, failed families and failed communities.

Our use here of the term ‘community/social services’ is significant. Since the Griffiths Report and the Caring for People White Paper of the late 1980s the word ‘care’ has been devalued and misrepresented as a commodity to be consumed. Furthermore the term ‘care’ is now negatively associated with the risks or abuse and the paternalistic control associated with institutional ‘care services’.

True care – care in its best sense – cannot be purchased and it cannot be regulated into existence. It can only be achieved by a robust and sensitive partnership between citizens, families, and their communities. Effective local public services support these partnerships and nurture the fundamental caring that is central to a good society. Public services should see their work as being to sustain that good society.

The market system’s inability to address the real requirements of care means that it fails those it is meant to serve. For example our frail elders are placed in large congregate care homes, young people with disabilities are sent miles away from their homes, people with physical disabilities are often left isolated or institutionalised.

Managerial proprieties have led to increased rationing, inefficiency, growing congregation and bureaucratic regulation. This reality is in stark contrast to the nostrums of politicians and policy-makers, who talk about: increased personalisation, prevention, early intervention, and the pursuit of a good, interdependent, and caring society.

The current system also makes no economic sense. An economically robust and ethical system works with and supports the abundant resources in citizen’s relational and community networks to deliver the care that most closely meets each person’s aspirations. Commodified care struggles to achieve the practical tasks that become its focus, even though these are not the things that really matter to most people. At the same time the system largely neglects and devalues the potential resources and relationships it cannot recognise or control.

What really matters – citizenship for all

For the avoidance of doubt – when we ask people about how they want to be supported to live well, despite their ageing, disability, disadvantage or chronic infirmity, then what people say they want is a good life – what we think of as a life of citizenship – which turns out to mean:

  1. love – to be in loving and caring relationships
  2. life – to be able to contribute and get respect from others
  3. good help – to get assistance as a secure member of the community
  4. home – to belong in our own place in the community
  5. money – to have enough to able to ensure our independence
  6. freedom – to be able to make our own decisions
  7. meaning – to live a life that makes sense and has purpose

While it is undoubtedly the case that the social services system does require a significant increase in funding, it is also painfully evident that the provision of sufficient funding alone will not on its own begin to remedy the current situation. It is particularly important to remember that at least 80% of all care is provided by families and communities – not by services. It is this support which needs to be strengthened and sustained, both with economic and other assistance.

The challenge – fundamental redesign of social services

The whole system requires a fundamental re-design to rid itself of the socially and economically damaging practices and assumptions at its core.

Over the decades since the birth of the welfare state we have increasingly ignored the fact that the core wealth of individuals, families and communities resides in relationships (or social capital). Those devising public/human service policies or designing services must be held accountable for strengthening social capital. We need a new paradigm for social care and need to make it explicit and generally understood that care is not, and never can be, provided as a commodity.

Successive administrations have failed to understand the big picture. Their preoccupation with money and services has seen the slow destruction of society’s innate resilience and has normalised the erroneous assumption that products, professionals and services can deliver comprehensive satisfaction of peoples’ needs and aspirations.

It will be a revolutionary challenge to make the necessary changes.

Put bluntly, there are few remaining in senior civil service, local authority and charitable sector leadership positions, or in practice leadership and coal-face delivery roles, who have experienced anything other than Fordian, transactional, needs assessment-based, resource management systems. As has been the case in so many public services since the Thatcher years, it was asserted that Directors of Social Services did not need to be Social Work professionals. Accountants and general managers were deemed less troublesome and more compliant in the administration of central government imperatives.

Over the years, definitions associated with Social Work have migrated down from the aspiration to assist citizens to assume control of their lives and to resolve problems locally and instead become a matter of administering assessments, determining eligibility, and commissioning services. Notions of collegiate professionalism, practice autonomy, or of the worker being their own key resource, are largely absent. We have also forgotten that classical social work is based upon competence in three disciplines:

  • Working with individuals and families
  • Working with groups
  • Working with communities

The professional training and qualification system has defaulted to creating operatives who simply administer the system, and universities largely resiling their 20th century role as creatively critical friends. 

On top of the immediately apparent adverse impacts upon citizens and communities, and the decimation of the social services workforce, our failure to nurture and strengthen society and communities has engendered dire economic consequences for the state itself. By treating services as the solution to every problem we have contrived to transform competent citizens and whole communities into dependent consumers.

We must also stress that delivering valued care in our society cannot be sectioned off as the business of the social services system. In our analysis, a good society is more likely to evolve and be sustained when we, through the state, ensure that all citizens enjoy both the time and resources to meet their caring responsibilities to each other.

Reforms to social services to enable citizens and communities to take more control of their own support and to end means-testing we will need to be combined with other critical reforms:

  • Move our social security systems towards the principles of basic income in order to redirect time and human creativity towards caring, creating and community contribution
  • Change our systems of democratic governance to enable meaningful planning and collective action at the level of the neighbourhood
  • Recreate genuine community ownership and control over all public services, including health and education 
  • Protecting our common resources – both in nature and in the civic sphere – restricting the invasion of the private sphere into a shared common world.

A new framework for public policy – inclusive communities

A radically different approach to social policy development is needed.

We must do all we can to ensure that our public policy and public services work from the assumption that strong, resourceful and connected communities are critical to the resilience of our citizens and their communities. In the future human services systems must be based upon this assumption and operate according to principles such as:

  1. Develop solutions that are local by default, not impose answers from the centre
  2. Support people to help themselves and each other, not to become passive service users
  3. Focus on the real purpose of our work, not to accept artificial targets
  4. Manage to increase social value, not just to reduce cost

To move forward we must:

  1. Evaluate social policy against these principles.
  2. Pay as much attention to nurturing caring and resilient communities as to organising public services – and invest and prioritise accordingly.
  3. Evaluate whether public services are supportive of the core economy and are sustaining strong, resilient, interdependent and well-connected citizens.
  4. Root out those systems and practices that damage our communities.
  5. Equip the social service workforce with the principles and skills that are consistent with the new direction of travel, and reorient professional training and contemporary practice accordingly.
  6. Establish local democratic systems and enable local communities to set their own priorities.

Good government is concerned to strengthening and inclusive communities, peopled by resourceful and talented citizens. As a society – politically and culturally – we have lost our way and have been seduced into an unquestioning acceptance that the marketplace is at the core of human existence, and that the purpose of life is, in essence, the consumption of others’ goods, services and expertise.

Going back to go forwards

If we now understand that, in commoditising and marketizing social services in the late 1980s, the Thatcher government made a catastrophic mistake then one possible route forward is to retrace our steps back to the evolving system they destroyed.

The Barclay Report of 1982 was the end-result of a two-year inquiry into the roles and tasks of social workers in England and Wales commissioned by the Secretary of State for Social Services in the first Thatcher government and produced by a working party convened by the National Institute for Social Work (NISW) in 1980, chaired by Sir Peter Barclay.

The report identified three main sets of assumptions about the relationship between the state and its citizens:

  1. safety-net approach – which values informal networks and minimal state provision;
  2. welfare state approach – the post-war idea of comprehensive services and citizens having a right to access these
  3. community approach – which believes that people have the potential to care for each other if power is devolved to them and social worker’s role is then to support these informal networks and develop them where they were weak

The majority of committee members supported the third approach, highlighting the value of community social work. They called for more emphasis on community engagement, and a new role for social workers as brokers of resources, working with informal carers and voluntary organisations to support individual service users as citizens.

The Thatcher cabinet of the time disregarded this advice and avidly pursued their market prejudices. It is time we recognise the abject failure of that approach.

We need to develop a new understanding of social services that incorporates a political and professional commitment to working with the whole socio-economic system to facilitate a society where all citizens can be contributors and beneficiaries of comprehensive care – from the cradle to the grave. The ideals of the welfare state are wholly achieveable – but only if we share them as a community – not sub-contract them to services and systems.

The welfare state and the care system is a public good – it is our shared and common property – and we must all play our part in developing and sustaining it.

Barclay observed that social workers “operate uneasily on the frontier between what appears to be unlimited needs on the one hand and an inadequate pool of resources on the other”. The Committee understood the inevitable unsustainability inherent in a system that encourages dependence upon funded service solutions.

The Report went on to recognise the centrality of ‘informal care’ and to recommend the general adoption of the community social work approach that had been witnessed in many neighbourhoods during the Committee’s fact-finding exploration. In contemporary parlance they proposed that social workers should engage in:

  • Holistic approaches and coproduction
  • Devolved responsibility for decisions about resources to local level, with real accountability to families and communities
  • Self-direction and self-help – personalisation and personal budgets
  • A strong focus on neighbourhoods – on the local
  • Supporting family and neighbourly care – (we might say) “keeping people strong”
  • Community work, engaging with the strengths and talents in the neighbourhood and nurturing local voluntary organisations and associations – “helping communities be strong and resourceful”
  • Undertaking local social care planning on an inclusive basis
  • Balancing casework and community work
  • Coordinating access to mainstream and specialist services as necessary, and advocating for their availability when required
  • Enabling, informative, engaging and empowering community social work – incorporating what we might now refer to as an asset-based mindset and a local area coordination methodology.

It seems that they appreciated the long-term, iterative, and developmental nature of good social interventions.

They would have been appalled by the episodic, task focused and target-driven approach that has emerged instead. 

The Report called for a greater delegation to the front-line, more trust, and a greater acceptance of risk. It noted that: 

“things are bound to go wrong from time to time, and this needs to be accepted by management, elected members, and the general public” (p.131).

It went on to call for a culture of professional and personal responsibility and warned against the imposition of rigid hierarchical controls believing that these make the occurrence of disasters all the more likely.

Concluding remarks

The fundamental question for those concerned with social policy can be framed in many ways but boils down to:

“How do we create an ecosystem in which we come together as citizens and live happily and sustainably into the future?”

We need a new paradigm for social care and need to make it explicit and generally understood that care is not and can never be provided as a commodity.

While it is indisputably the case that social care is under-resourced and that years of austerity have massively exacerbated this; it is just as pertinently the case that the market-oriented design of social care will always be under-funded, exploitative of the vast majority of care workers who deliver it, stimulate failure demand, and unforgivably fail too many of those it is supposed to benefit.

In simple terms, true care can only be achieved through a robust and sensitive partnership between citizens, families, and their communities and their local public services. Public services must actively nurture this fundamental caring, that is central to a good society, and perceive their work as being the sustaining of that good society.

We should never forget that, to quote John McKnight: 

“Care is the freely given commitment from the heart of one person to another.”

It is negligent and incompetent to design and operate a care system that ignores this fundamental truth. But this is what the Thatcher government did with the assistance of Sir Roy Griffiths and the compliance of a generation of social services leaders who should have known, and acted, better.

As the late Bob Holman put it

“One of the great failings of social services departments was that they let community social work go. It got the orange light from Seebohm and the green light from Barclay, but only a quarter of authorities ever implemented it. Now social work has got merged with social care and it’s become much more difficult to say what a social worker is. Front-line staff are often mini-managers responsible for care control, monitoring people and soft policing. The basic skill of making relationships with service users has declined, yet this should be the heart of social work.”

Author Bob Rhodes