Schizoid Institutional Disorder (SID) – The Care Act (2014)

“Clare Gibbs, Senior Director and Commercial Specialist at the Cabinet Office, describes how her team is looking to embed commercial awareness from the word go”. (Source: Civil Service World)


Human beings are wonderfully equipped to live with contradictions, so it should be no surprise that political systems – riven as they must inevitably be with ideological ‘certainties’, tribalism and prejudices – should be susceptible to SID (maybe the WHO will recognise it as a syndrome and attach my moniker to it?).

What is surprising is that the Civil Service, which asserts its objectivity, and academia, which claims to be scientific and evidence-based, have seemingly ‘chosen’ to overlook the explicit and implicit and utterly disabling contradictions evident in both the drafting and subsequent implementation of this ‘psychotic’ legislation.

Superficially the Care Act could be taken for a piece of enabling legislation – please note the words I have emboldened.

“The Care Act helps to improve people’s independence and wellbeing. It makes clear that local authorities must provide or arrange services that help prevent people developing needs for care and support or delay people deteriorating such that they would need ongoing care and support.”

local authorities need to work with their communities and provide or arrange services that help to keep people well and independent. This should include identifying the local support and resources already available, and helping people to access them. Care Act factsheets – GOV.UK (

NB. I’ve specifically drawn attention to LA’s ability to ‘provide’; not in the context of their facility to provide commodified services, but rather highlighting their potential to provide support that strengthens and democratizes communities. In my analysis, much of that potential has been diverted into managing the market at the cost of sustainable and resourceful local communities.

In the light of the Act:

The Health Foundation identified a framework that comprises four principles of person-centred care:

  • Affording people dignity, compassion and respect.
  • Offering coordinated care, support or treatment.
  • Offering personalised care, support or treatment.
  • Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.”

There’s an implication in the text that Local Authorities have the freedom, in the light of local understandings, to innovate and design how they organise support to their citizens, families and communities but this is subtly undermined by the repeated use of the term ‘services’ as the mode of delivery and the pervasive attention to individualisation in the context of service delivery but in apparent denial of the greater importance of social capital.

So, what is it that translates the inclusive, participative, coproduced and cooperative concept of social services into the commoditised, bureaucratised and consumption format of social care. Frankly it’s obvious! It’s central government’s blind adherence to reducing everything to money and trade; and total disregard and seeming willingness to corrupt the core or relational economy. It feels like, “if it’s not a means to profit, then it’s not worthy of consideration.

“The over-riding procurement policy requirement is that all public procurement must be based on value for money, defined as “the best mix of quality and effectiveness for the least outlay over the period of use of the goods or services bought. This should be achieved through competition, unless there are compelling reasons to the contrary.”

One compelling reason could be a policy decision to invest in locally-based, coproduced and democratic, community social work and development with the goal of stimulating rather than undermining the fellow-feeling and interdependence that was so prevalent during COVID.

Public sector procurement is subject to a legal framework which encourages free and open competition and value for money, in line with internationally and nationally agreed obligations and regulations. As part of its strategy, the government aligns procurement policies with this legal framework, as well as with its wider policy objectives.”

So, kow-towing to the pre-eminence of market ideology over the possibility of effective social services, the Act sashays from a recognition that there could be more important contributors to how we care for each other than transacted services into what is effectively a denial of society.

“The Care Act requires local authorities to help develop a market that delivers a wide range of sustainable high-quality care and support services, that will be available to their communities.

When buying and arranging services, local authorities must consider how they might affect an individual’s wellbeing. This makes it clear that local authorities should think about whether their approaches to buying and arranging services support and promote the wellbeing of people receiving those services.

Local authorities should also engage with local providers, to help each other understand what services are likely to be needed in the future, and what new types of support should be developed. To do this, authorities should engage with local people about their needs and aspirations.

A wider range of highquality services will give people more control and help them to make more effective and personalised choices over their care. They should therefore get better care that works for them.    Care Act factsheets – GOV.UK (

8 years on, and more than 30 since the Thatcher-Griffiths market revolution ripped the soul out of human services, it is undeniable – even to the most recalcitrant Thatcherite – that this particular ideological odyssey has proved an ill-founded and unaffordable extravagance. I wonder whether our senior civil servants and grant-dependent academics are prepared to concur?

In popular culture, one definition of insanity is:

Insanity is doing the same thing over and over and expecting different results.”

When this is evidenced in a public system I have coined the term SID – that is Schizoid Institutional Disorder. Do you suffer from it?

Maybe these are key parts of the solution?

Bob Rhodes