‘Unpacking’ – bringing clarity to the ‘Social Care’ calamity

In February 2023 I blogged:

‘My research, and personal experience over more than half a century, leads me to conclude that our current ‘Social Care Crisis’ has roots in the ideological fervour of ‘Thatcherites’ to destroy the inherent interdependent collectivism of humanity – which was misguidedly associated with socialism – and replace it with a culture grounded in consumerism and materialism.’

I would now add, ‘directed by a ruling elite that thought that it knew and continues to believe that it knows better than the evidence, the science, and has a mandate to impose it’s unsubstantiated world view.’

Mrs Thatcher ignored the evidence of Seebohm and, very explicitly, Barclay that the most effective and, crucially, sustainable way forward for Social Services was, and is, to ‘develop a close working partnership with citizens focussing more closely on the community and its strengths.’

On sustainability, Barclay was very clear and, with the benefit of hindsight, accurate:

‘A community-oriented service may initially demand increased resources but will bring new resources into play and make savings in some categories of expenditure. It is the only way in which we think it possible for personal social services to cope with mounting need.’

The Barclay Committee was also explicit about the decentralised and genuinely professional culture of social services they were advocating:

‘… the function of social workers is to enable, empower, support and encourage, but not usually to take over from, social networks.

Such attitudes cannot be expected unless the organisational structure supports them.’

For the avoidance of doubt, what the Barclay Committee was saying amounted to good, old fashioned resource management. Put simply, they acknowledged that the everyday life cycle of human beings is necessarily built upon interdependency and reciprocity because, for everyone, at often predictable stages in our lives we depend upon the care of others; mainly those who are in loving and usually familial or neighbourly relationship with us. In system terms, demand is pretty predictable but capacity is decreasing owing to the demands placed by capital upon citizens to be evermore ‘economically active’. I deduce that Barclay, having observed how local authorities and their communities were organically responding to the excess of demand over resources, arrived at the rational conclusion that developing and generalising what they described as community social work was the only sustainable road to follow. I don’t believe that they appreciated at that time that achieving long term sustainability would also involve a much more societal approach: creating a society where time spent caring for each other is accorded equal value with time engaged in remunerated and surplus-generating employment.

For those of us who were there, the 1970s and 80s were exciting, creative and rewarding times to be involved in the ‘helping business’. Four decades on, the inheritors of the Thatcher ‘reforms’ and the subsequent Blairite preoccupation with risk and regulation, do not seem to be emboldened to innovate, experiment and problem solve; instead they appear exhausted and demotivated on a hamster wheel of process and operational impotence. The inevitable failure of a system that promotes the notion that the only valued solutions to human situations are bought commodities is highlighted by its need to demonstrate that all its customers (not citizens, let alone partners) are treated ‘fairly’ and enjoy the same rationed consequences. The consequences include litigious customers and pissed-off apparatchiks.

So, refocusing on the ‘calamity’, where do we find ourselves? I share John Seddon’s incredulous observation that:

‘In the face of abundant and continuing evidence of failing services and rising costs, successive governments have demonstrated the strength of their unswerving faith in command-and-control ideas by demanding that providers (and commissioners – my addition) do more of the same, only faster and better. As Russ Ackoff taught us, like all attempts to do “the wrong thing righter”, this only makes them wronger.’

Polymath economist and all too accurate prophet of the collapse of Friedman inspired ideological systems, David Fleming, in his description of how rulers would respond to the disintegration of their control-and-command models, observed:

“And perversely, the conventional responses to this phase (consolidation) seem to be devoted to making the system, in its hour of need, even less resilient. As the system scientists Brian Walker and David Salt note, 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, in stamping out any new vision, experiment and self-reliance, and in further elaborating expensive procedures standing in the way of getting things done.

…The problem is the large scale, rigidity and complication; the solution is seen as even larger scale, greater rigidity and further complication – a classic case of the amplifying feedback of a system in trouble.”

So what are these command-and-control ideas over which he (and so many other organisational management and leadership experts) despair?

Command-and-Control Management is described as a top-down perspective in which:

  • Work is divided into functional specialisms
  • Decision-making is separated from work
  • Measures-in-use are related to the budget and arbitrary
  • Management’s role is to “make the numbers” and “manage the people”
  • Worker’s motivation is assumed to be extrinsic (carrot and stick)
  • The attitude to suppliers and customers is contractual.’

This is so evidently not a formulation suited to working collaboratively and co-productively in partnership with citizens in the contexts of their own lives and the lives of those they love. Indeed, many, if not the majority of, business leaders do not apply this out-dated and discredited Fordian approach to manufacturing. Of course, business leaders are explicitly driven by, and ‘live and die’, by their effectiveness in delivering shareholder value and hence are supremely interested in what works. Crucially, many have learned that the key to sustained success lies in maintaining and evolving the system conditions that enable their workers to take pride in their contributions and give of their best. The science is explicit:

‘Deeming taught that 95% of performance is attributable to the system, just 5% to the worker. That means that managers who concentrate on managing people are working on the 5%. Worse, when people are “commanded and controlled”, the system is the greatest inhibitor to them giving their best.’

By contrast, it seems that the system conditions through which public services are mediated are ideologically formulated and seen as immutable by public servants charged with their implementation; as their role is perceived as loyally realising the political will of the government in power. It seems like continually, “doing the wrong things righter”, has evolved into an institutionally shared delusion where eminently intelligent and responsible people apply their talents to ‘modernising’ self-evidently moribund systems instead of studying and critiquing the system and proposing more viable remedies.

In our, that is LivesthroughFriends, sphere – which is predominantly focused upon overcoming the barriers to people with learning disabilities and/or autistic people leaving ‘long stay’ hospital or preventing admission to inappropriate and counterproductive ‘excluding’ institutions – we experience a professional, academic, and organisational culture which has for as long as I can remember been almost exclusively concerned with Deeming’s 5%. During the year, a team of researchers led by Jon Glasby published their report, having explored the experiences and perspectives of 27 people who were asking, “why are we stuck in hospital”: a guide to overcoming the barriers to people with learning disabilities and/or autistic people leaving ‘long stay’ hospital (please note the common purpose with LivesthroughFriends). In the ‘Background’ to the study the authors assert that, ‘very little previous research has engaged directly with people with learning disabilities/autistic people or their families to understand the issues from their perspective. While it may not have the cachet of ‘research’, I have bookcases bending under the weight of peoples’ published stories dating back to 50 years where exactly the same perspectives regarding the operational barriers to deinstitutionalisation are stated clearly by self advocates and their families. Frankly, I’m attracted to the notion that the system’s contemporary willingness to bathe in the misery of its victims is deemed as less problematic than funding competent organisational and economic studies into the structural conditions that underpin and give rise to the operational barriers experienced which, in the main, locate the issues in professional practice – Deeming’s 5% – rather than in the system conditions within which commissioners, professionals and service providers are required to function.  Glasby rightly bemoans the fact that, ‘…professionals often see the individual at a particular point in time (often in a crisis)’, and then, in general, without the longitudinal and holistic knowledge held by kith and kin. I don’t think it is too blunt if I observe that a social services system designed to be supplementary and complementary to the core/relational economy would not have that problem. But I can be angry that the organically evolving community and relational approach that was emerging in fits and starts during the 1970s and 80s was so easily and inappropriately replaced by a cold, transactional process at the behest of misguided ideology and allowed to flounder and fail for more than 3 decades given that the ideological sacred cow has subsequently been enshrined in a miasma of laws and regulations. Suffice it to say that if only we can encourage those who design and enforce the systems conditions surrounding public services –collaboratively with those who implement their fiats and citizens who are supposed to benefit – to engage in normative study of the impacts of their systems, then, with agreed purposes and principles as the bedrock, fit for purpose and often locally bespoke designs will emerge. Seddon describes the fruits of such an exercise: 

‘In these more effective designs, all demand – people putting up their hand for help – is met by someone going out to meet them. No forms, no signposting, no remote contact, no standardised assessment, and no denial of service. The focus of the meeting is to establish what has happened to the citizen, the context – what is going on in his/her life – in the family, the community, or whatever it is that is relevant to the presenting demand. Having understood the need and context, the next step is to help the citizen to establish what, for them, would be a good result. What do you need to live a good life in your terms? Or, it sometimes may be, what do you need to die a good death? The third step is to establish what the citizen can do to take responsibility in achieving that end. Then, and only then, the helper can determine what further support they need from family, from community, from the voluntary sector, or from the state to get there. The provision of specialist expertise is only applied where it is needed and where it is proportionate to actual needs – meeting the recipient’s description of a “better” life.’

During the year LivesthroughFriends hosted a ‘Lighthouse’ event in collaboration with our friends at The Butterfly Garden where colleagues from Europe and North America involved in relationship focused, communitarian practice studied together, supporting each other to develop their work in ways germane to their specific situations. We’ve also assisted family and community initiated enterprises in diverse parts of the world to resist co-option by transactional and consumerised procurement systems and to concurrently secure their values and sustainability despite. We have also, as we have for many years, assisted a small number of long traduced folk with intellectual disabilities or neurodiversity to secure good, often contributing, lives and equipped a small number of support organisations with the culture, knowledge and skills necessary to sustain and develop relationship-focused, communitarian practice.

And, we have continued to campaign and to do all we can to draw attention to the simple fact that there is another way, a better way!

Texts referred to:

Beyond Command and Control:  John Seddon et al: Mayfield Press 2019.

Surviving the Future: David Fleming; Chelsea Green 2016.

Why are we stuck in hospital? John Glasby et al. University of Birmingham 2023

Bob Rhodes 28.12.2023.