by Neil Crowther
'Understanding means finding a story you already know and
saying, 'Oh yeah, that one.' Once we have found (the) story, we
Roger Schank, Tell Me A Story, 1998
One of mankind's most incredible recent success stories - vastly
increased life expectancy - is now most often described using
metaphors of impending catastrophe such as 'silver Tsunami' and
'demographic timebomb.' More recently, a polarising
discourse which pitches old against young has taken hold and begun
to shape debate. As a result, our ageing society is
increasingly framed as a problem and a threat, rather than as a
success and an opportunity. Like debates around immigration,
discourse around ageing casts it as creating 'pressure' on public
services, the economy and communities. In short, it is
overwhelmingly positioned in public discourse as a growing
Debates about the future of health and social care are
contributing to and being shaped by this narrative. 'Integration'
of health and social care is positioned as a solution to the crisis
in the NHS, with older people 'bed-blocking'. At the same
time, debates concerning funding of care in later life have
centered on individuals drawing on the equity in their homes, ideas
that are quickly dismissed as 'taxes' upon death or
dementia. Younger people who require care and support
feature barely at all in this debate, a fact that appears to be
behind the governments' decision to address its incoming Green
Paper exclusively to older people. The following
paragraph from a piece by Rachel Sylvester in the Times Newspaper
on 16 January 2018 exemplifies these themes:
'The NHS crisis is really a social care crisis, created by an
ageing population and exacerbated by government cuts.
Although health budgets have been ringfenced since 2010, there has
been a £6 Billion cut in spending on social care and an entirely
related 50% rise in the number of older people stuck on hospital
because there is nowhere for them to go in the community.'
The debate around the future of health and social care is hence
dominated by the language of death, bed-blocking, tax, unfairness
between young and old, losing our homes, unaffordability and
crisis, which together is likely to encourage fatalistic thinking
about the future. It is little wonder then that governments
since the mid 1990s have struggled to command public engagement and
support for a long term funding settlement. The
December 2017 Ipsos-MORI 'Issues index', which maps public
priorities, found only 2% of the public listed 'ageing
population/social care for the elderly' as the most important issue
facing the country today, and only 12% highlighting as an 'other
important issue'. The challenge is both that the issue
lacks public salience (or the public are reluctant to express it)
and insofar as it enjoys public salience, the salience it does
enjoy is deeply unhelpful.
Have those advocates striving to seek a new settlement for
social care challenged or helped reinforce these narratives?
The Frameworks Institute, a US-based organisation increasingly
working with social partners in the UK, lists the features of poor
communications practice as follows:
- Employing crisis communications and highlighting problems,
rather than solutions, encouraging fatalistic thinking.
- Leading with unframed facts and evidence, and professional
jargon, rather than values and frames which appeal to people's
feelings and aid understanding, or employing unproductive or
unhelpful values and frames.
- Telling individual stories without explaining the systemic
factors lying behind them, which encourages people to see the
problem as residing with the individual.
- Engaging in myth-busting, which often reinforces, rather than
challenges the myths by repeating them.
Conversely, effective communications:
- Combines urgency with efficacy - people must feel a problem can
be solved. Set out the solution and avoid crisis
- Leads with values and employs 'metaphors' or 'simplifying
models' that engage with productive feelings about an issue and
that create 'pictures in our minds' to aid understanding.
- Uses thematic stories, not individual stories
to foreground the systemic factors shaping outcomes.
- Connects outcomes to society as a whole - explain how the
positive or negative outcomes related to social care
- Contextualises numbers - don't expect them to speak for
- Avoids myth busting - it tends to affirm the myths, not
A quick look at recent communications around social care by a
selection of public-facing organisations in the field suggests that
they are contributing to the problematic way social care is
framed. Almost all of the large NGOs in the field,
spanning older people, disabled people are carers are leading on
'social care crisis' in their communications. None posit
solutions other than 'more funding.' Most use unframed
statistics about the situation facing their client group to convey
a sense of urgency.
Research by IPPR and Price Waterhouse Coopers for the Labour
government in 2009 found 'Low awareness and uncertainty: confusion
about the nature of social care services.' Yet insofar as
organisations attempt to describe what social care is in their
headline communications, little attempt is made to convey any
ambition beyond basic 'life and limb' services. Even within those
limited ambitions communications fail to convey the
value to individuals, families and wider society of
social care, nor do they employ any 'metaphors' or 'simplifying
models' to aid understanding.
The story of social care needs to be told within broader human
narratives around relationships, family and community, in the way
TV shows like 24 hours in A&E, One Born Every Minute or
Educating Essex have done so for the NHS and education for
example. We need to learn from the way other policy issues
have been framed. For example, the benefit of 'flexible
working' is not found within the workplace, but in having time to
spend outside the workplace with and on family life. Hence
the most effective 'frame' through which to communicate the
benefits of flexible working is the family, not the workplace.
Where does social care have meaning and value to people?
We also need to overcome the 'othering' that can infect
perceptions of social welfare, particularly 'needs- based' social
welfare that is targeted on particular groups, as social care
is. Again, this suggests that more effective communications
might foreground stories of family life and use the voices of wider
family members, such as grandchildren, to convey the universal
importance and value of social care. There are also
major lessons from the reframing of 'gay marriage' to 'equal
marriage' which consciously shifted from invoking the 'civil
rights' of a minority to emphasising the universal desire for love,
relationships, family and stability and so on (i.e. the things
people commonly value about getting married, which for the most
part isn't their civil rights). What is it that people
commonly value and which social care helps to protect or
extend? How far are these values embedded in our
communications and the frames we employ when talking about social
The fact that social care enjoys low public awareness and
understanding is, perversely, a major opportunity to define and
articulate a new story of change, especially as evidence also
suggests there is at the same time a strong desire for more
information and debate about its future.
We require a new narrative, employing values and frames to
enlist support for and building understanding of the crucial role
that social care can play in creating a better society for all.
Communicating effectively is an empirical question, requiring
research, development, testing and refinement. There are a
number of initiatives underway in the UK presently to strive to
reframe debates, such as work by to reframe poverty, work on
immigration, criminal justice, children in care, child protection,
climate change and human rights. There is no equivalent
work on social care.
It involves work to clarify the communications goals and current
practices of communicators in the field and the values and frames
embedded in these, to map current discourse and public attitudes
and the values and frames embedded in them and to explore the
impact of the above on what people think, feel and are prepared to
do about an issue such as social care. It then involves work
to identify values and frames that might affect more productive
attitudes and understanding and hence enlist stronger support for
our goals and to begin to construct narratives and messages in
which these are embedded. Finally, it involves the
dissemination of these new values-based frames, including via
guidance, training spokespeople, coordinated communications
activity and proactive campaigns.
The process can be a challenging one for those in the field,
confronting their own practices and beliefs. It needs, by
design, to be iterative and to bring people on a journey, otherwise
it is likely to be rejected. It requires expert support
Who's on board?
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.