Social Care: There is another way… so why isn’t it discussed?

It’s no secret that Social Care is in crisis. It has been pretty much since the term supplanted ‘Social Services’ consequent upon the Thatcher-Griffiths marketization of health and social services ‘reforms’ of the early 1990’s. The establishment and system would have us believe that the ‘crisis’ is a consequence of under-funding and mushrooming demand. But, at no point in the last 3 decades has there been a smidgeon of a public debate about the impact of the ‘reforms’. It is as though such thoughts are unconscionable, unthinkable, out with the hegemony.

Yet, throughout the last 30 years, there has been a multi-disciplinary tide of professional and academic evidence that the radical policy shift of the early 1990’s has proved fundamentally ill-founded, wasteful, uneconomic, unsustainable and societally damaging. But, when the ‘crisis’ in social care is, as it is, regularly in the news, there is never any reference to the simple fact that there is ‘more than one way to skin a cat’ nor invitation to informed critics of consumerised and commodified ‘care’ to propound alternative visions.

The ‘reforms’ of the early 1990’s had much in common with Liz Truss’s blind adherence to the notion of ‘growth’. They were ideologically rooted, untested, and dismissed prior experience and learning. In 1982, the ‘Barclay Report’ (Social Workers – Their Role and Tasks – a broad-based working party commissioned by the Secretary of State for Social Services) concluded that, “if social needs of citizens are to be met in the last years of the twentieth century, the personal social services must develop a close working partnership with citizens focussing more closely on the community and its strengths. A move towards what we are calling community social work is the start of such a development.”

This conclusion derived from a review of learning and progress since the establishment of the first social services departments in 1970 hard on the heels of the Seebohm Report in 1968.

It went on to observe, “If social work policy and practice were directed more to the support and strengthening of informal networks, to caring for the carers and less to the rescue of casualties when networks fail, it is likely that the need for such referrals would be reduced”.

Instead, as our experience at LivesthroughFriends will demonstrate, local personal social services capacity to implement this preventative and societally strengthening approach has been incrementally dismantled as professionals’ roles have been radically reconfigured to administrate the transactional arena that social care is.

PLAN founder and Ashoka ambassador Al Etmanski, in his foreword to Bartnik & Broad’s Power and Connection in 2021, coldly summarized the failure of our approach to caring for each other in much of the ‘developed’ world as follows:

“Our social welfare institutions are undemocratic. They are designed:

• To manage
• To ignore natural relationships
• To eliminate reciprocity
• To restrict eligibility
• To enable a few to control the many
• To provide order, consistency and predictability
• To minimise controversy
• To maximise compliance.

They turn beneficiaries into clients… The record shows that institutional decision-making undermines citizen action, ignores community solutions, increases dependency, and preserves resources to maintain out-of-date approaches … we need to shift governments’ responsibility from producing and financing managerial care to supporting the problem-solving ability of individuals, families and communities, and to removing the barriers to inclusion.”

As far as I know, the paths of Al Etmanski and Professor John Seddon have never crossed but, with Seddon coming from a very different systems’ science perspective, their analysis are remarkably akin. In 2014, Locality published ‘Saving Money By Doing The Right Thing’, which reported upon studies undertaken jointly with Seddon’s Vanguard Team across a wide spectrum of public and third sector systems and services. In his foreword to the report Locality Chief Executive Steve Wyler explains that the studies indicate that, “far too many public service systems assess rather than understand; transact rather than build relationships; refer on rather than take responsibility; prescribe packages of activity rather than take the time to understand what improves a life.”

All of which is symptomatic of a system established to prescribe and dispense commodities!

Wyler goes on to assert that, “The result is that the problems that people face are not resolved, that public services generate ever more ‘failure demand’, resources are diverted to unproductive ends, and that costs are driven ever upwards.”

In the Executive Summary, Seddon states that, “Perhaps the most surprising finding… is that real demand for most public services is not rising.”

The conclusion is that, within the structure of a centrally controlled, marketized system, an unjustified faith in economies of scale and standardised services fails citizens and generates huge swathes of repeat or failure demand. As a consequence, new principles for services that meet peoples’ needs had emerged from the study sites. They focused on systems:

• — Being ‘local by default’
• — Helping people to help themselves and each other
• — Ensuring a focus on purpose and not predefined outcomes
• — And managing value and not cost.

My colleague at LivesthroughFriends, Julie Boothroyd, when head of adult services and subsequently Director of Health and Social Care in a county council, where she worked with Vanguard and ourselves, describes the impact of finding ways of implementing these principles. The starting point was, “moving from asking “What’s the matter with you?” to “What matters to you?” Asking the former leads a service down the path of prescribing a set of predetermined service-driven solutions to a problem. The latter leads to a conversation about what a good life looks like to an individual citizen…

Asking different questions is just the start; combining the answers with a system redesigned to cope with the inevitable variety of responses leads to a profoundly different set of outcomes. It delivers bespoke, personalised solutions that put back – as far as is possible – independence and resilience into peoples’ lives. Proof of the pudding: the authority has underspent its adult services budget in successive years, and there has been a concomitant drop in demand into the service from 8000 to 3000 cases per year.”

Reported in 2019 in Beyond Command and Control (p70), John Seddon et al.

At LivesthroughFriends (www.livesthroughfriends.org), and long before in other contexts, we have been overtly and often provocatively flagging the multiplicity of dysfunctions implicit to commoditised, transactional social care since the 1990s. We work alongside open-minded statutory services and service providers to demonstrate how people with disabilities or mental health challenges can achieve their Good Life when you step outside narrow, service-dominated responses and focus instead on each individual’s strengths, aspirations and harness community assets. We demonstrate how to deliver Good Lives by playing a role as independent, expert commissioner of personalised support. Much of our current work is supporting those with complex and challenging reputations who are being held in restrictive and controlling environments (special hospitals, ATU’s, psychiatric units etc) to move back to living in the community with personalised support and a sense of purpose enabling a good life. Our expertise has been hard won over four decades of praxis and action research hands-on delivering deinstitutionalisation and good included, and often contributing, lives for and with people destined for lives of, often abused, incarceration. (See: Much More to Life than Services. Bob Rhodes 2010). It is a product of detailed study.

Our referrals come from harassed Commissioners and distraught families. And our message to Commissioners is uncompromising: “We can and will assist, but not if you insist on applying your usual procurement practices and fail to implement and subsequently support the unfolding ‘good life plan’ we will develop”. In reality we know that our statutory partners – who are, when push comes to shove, mid-ranking officials – will initially sign up to our conditions but at some point be forced to renege by the ‘Organ Grinders’ who really make the decisions and who are in turn slaves to systemic directives that are totally divorced from the purposes associated with the good lives of individual citizens. In our experience, our statutory partners are good folk who know that the system is harmful but feel powerless in eliciting change.

Meanwhile, our learning has incrementally taught us that, in order to help extremely traumatized people translate from ‘custodial care’ to included and contributing citizenship, we have to be clear about what we are working to achieve, our purposes. A key part of developing a vision of what anybody’s best life might look like is finding out what really matters to them. Long ago we understood that there are fundamental things that matter to all of us:

• — Loving and caring reciprocal relationships and belonging – this is by far the most important!
• — Enough wealth to have some degree of choice
• — The self-respect and respect of others that derives from being a contributing citizen
• — Somewhere we call home – where we can be ourselves in safety and choose to be
• — And the fundamental safety and security experienced given satisfaction of the first four requirements.

When you study this list objectively, and normatively in the context of the life of someone you are working to assist, one can’t avoid the conclusion that services are generally not best suited to satisfy these needs. Services, even those specified for one person, more often than not become closed system institutions. To address what it means to be human we need to be organised to work with kith, kin and community relationships and for the services we engage to be integral to those relationships and supplementary and complementary to what Edgar Cahn described as the ‘core economy’.

From this epiphany, and the consequent expeditions to learn from others (PLAN Institute, ABCD Institute, GoMAD Thinking, Vanguard Method, Studio 3, Local Area Coordination, etc,), our ‘Framework’ of really important things to address continues to evolve.

• — Ask HOW you want to live? What’s the best we can envisage?
• — Start with the ‘core economy’ – Supplement & Complement
• — Strengthen/build reciprocal relationships and social capital for and with the person
• — Promote Effective and Creative Thinking, Possibilities & Problem-Solving
• — Contribute to, receive from, and build ‘community’
• — Address behavioural issues from a very skilled Low Arousal perspective, focused upon supporting participation, inclusion and relationship building
• — Everyone is different – bespoke works; the service ‘menu’ usually doesn’t
• — It’s a Journey – not an episode
• — Remember, it’s not (only) about the money! Attend to that where it adds value
• — Show another way – It’s about LEADERSHIP
• — BE TENACIOUS – there’s rarely a compromise that works!
• — Organize and systematize to serve these aspirations.

LivesthroughFriends aspires to remain a relatively small organisation, not least because it’s our experience that ‘big’ rarely translates into aspirational, bespoke support. In the main, the providers we partner with are local, small, and led by passionate practitioner leaders. Initially, our core ambition was to ‘infect’ the local systems with which we collaborate. Despite the fact that we have never advertised nor seriously promoted our services we are in constant demand which could be an indication that folk talk! However, there is no point in deluding ourselves that the success of our approach, no matter how much that is applauded, is having any impact on mainstream policy.

So what’s going on? What is it that prevents so-called rational people from exploring alternatives when the social care system is patently not working?

Maybe the underlying problem resides in a misplaced belief in the ‘rightness’ of rationality?

Our friends at Vanguard introduced us to Intervention Theory – see: The Planning of Change (1985), Warren G. Bennis, Kenneth D. Benne, Robert Chin. Intervention theory teaches us that profound change cannot be understood and implemented on a rational basis (discussion, classroom-based learning, etc.), but must be undertaken normatively (in the work, seeing issues personally). The research is very clear – it is extremely difficult, if not impossible, to change people’s assumptions through persuasion.

The research sets out three methods to undertake a change in thinking:

• — Rational – reports, research, data, presentations, websites, meetings, conversations, etc.;
• — Coercive – do it or else / do it and you get a reward;
• — Normative – people experience something live and tangible that enables them to challenge their own assumptions.

The research conclusions are:

• — Rational approaches rarely change peoples’ views.  Even well researched and proven statistics are dismissed as not valid if they challenge an individual’s assumptions or a politician’s long adhered to ideology;
• — Coercive approaches do change behaviour, but only in the short term while attention is being paid, and do not change thinking;
• — Normative study leads to a sustainable change in thinking and is, therefore, far more likely to lead to a change in behaviour.

As such, the findings suggest that we need to create normative experiences for people to test and challenge their assumptions. I wonder what the chances are that a group of senior politicians from across the House plus some civil servants, political advisors, Directors in Health and Local Authorities, and perhaps some Third Sector leaders might give up a week during next Summer’s parliamentary recess to properly study the impact of current policy on it’s presumed beneficiaries? We would be pleased to organise the event!

Perhaps this is fanciful? The acclaimed polymath David Fleming thought so. He warned that while resilience demands that we recognise the terminal collapse of a system as early as possible and respond creatively, it is an unfortunate fact that there is overwhelming evidence that those with the largest investment – political, economic, cultural or personal – in the imploding system and, often, the most power and influence will doggedly fight to protect their deluded self-interests rather than contributing to radical and innovative solutions.

In Surviving the Future (2016) Fleming opines that, “perversely”, when a system is collapsing, “the conventional responses to this phase seem to be devoted to the cause of making the system, in its hour of need, even less resilient… solutions are sought in standardisation and efficiency improvements, in increasingly centralised command and control, and in tighter insistence on process, rules and procedures – that is, stamping out any new vision, experimentation and self- reliance… the solution is seen as even larger scale, greater rigidity, and further complication – a classic case of the amplifying feedback of a complicated system in trouble”.

He concludes ironically; “There are some harmless lunatics who think differently”. I guess he means us!

Bob Rhodes

January 2023