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Is social care as we know it fundamentally bust?

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

 

 

#socialcarefuture has been developed to create a space, including a gathering in November, for a wide range of people and voices to debate and take action for a positive future.

We want to get past just thinking about stabilising the current system which isn't fit for the future. We want to make a contribution to a much more positive vision, share what's going on now that helps get us there, and find ways of supporting each other as we build the future.

In Control is part of the informal group supporting #socialcarefuture and as part of this we are hosting this blog series. Many people will be blogging and their views are their own.

1 comment for “Is social care as we know it fundamentally bust?”

  1. Gravatar of Tony BaldwinsonTony Baldwinson
    posted 16 February 2018 at 06:19:15

    Thanks, lots to think about.

    On the Richard Handley Inquest, one problem was in law. In criminal cases there are charges for, in effect, acting in concert - being responsible for a harm even if you didn't do the worst or final act - without having to show pre-planning. One for the legal minds probably.

    Another crucial factor was the de-registration from nursing home to supported housing.

    As a method of analysis, I am a great fan of how aircraft accidents are investigated and then lessons learnt. Essentially aircraft are safe systems and tolerate most mistakes. But when 3 or 4 build up one after another, then an accident happens, so investigators drill down into how to design better interruptions so failure 1 doesn't start a chain and lead to failure 2. Also they insist on a one-system approach whether it is maintenance, flight crew, parts, traffic control, handling, whatever and whoever.

    In terms of #futuresocialcare, the fundamental point is bankrupt and near-bankrupt local authorities. Education and social services are the two big departments in every council (exclude district councils here). School reserves are rock bottom. SSDs are running on empty tanks and vapours.

    After that, I feel the analysis has ignored the role of social workers. Partly this is, I think, because SWs are overwhelmed by child protection pressures and the threat of a media then political shitstorm which doesn't apply to adults (pace Richard); and partly because SWs are culturally devalued as teachers were 20 years ago. This isn't to argue that we should "leave it to the professionals" but radical / left political thinking has been lazy when it comes to the role potential, for example, of SWs as community development, and of the interplay with community nursing and community matrons.

    Finally, a starting point would be to talk with disabled people in and around SSDs and SW.

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Last Updated : 14 February 2018. Page Author: philippa.barker.