What’s better: a big shift or incremental change? This was the rhetorical question posed by my colleague Martin Routledge (of In Control and Think Local, Act Personal) as part of a recent discussion about the Care Bill.
It’s apposite, because the Care Bill attempts some big shifts, particularly in the kinds of work which interests us most, which is the shift from thinking about individuals in isolation, to thinking about community development, and from thinking only about people’s needs (identifying those needs and meeting them), to thinking also about people’s strengths, skills and potential.
Incremental change is safer. It takes fewer risks, it builds slowly on what appears to work and there is less obviously someone to blame if it all goes horribly wrong. Big shifts like legislation change or rolling out a whole new service at a national level (I’m thinking of the hundreds of millions which was put into a national short breaks programme for disabled children and their families a few years ago, for instance) offer the possibility of speeding things up, but can also be blunter and risks bigger unintended consequences, or dashed hopes.
Personal budgets were a big shift in many ways. Giving people control of the money being spent on their care was completely transformational for some people and should remain, as the Bill sets out, a clear legal entitlement. It disrupted expectations and assumptions in a very positive way and helped thousands to become equal citizens. But there are also areas where Direct Payments and personal budgets were used as justification for resource cuts and there are examples of planners abandoning their role in shaping care provision, in the mistaken belief that ‘the market will provide’, as well as lots of other poor or perverse implementations of a great idea.
The Care Bill offers the possibility of thinking about “strengths-based” or “asset-based” approaches (which look for skills and potential, not just for needs) being embedded in ‘the system’ for the first time. The first clause of the Bill says that social care will be reframed around the goal of promoting well-being for people, including their roles as family members and active citizens. The Bill also recognises and supports family carers as co-producers of care for the first time.
But the gap between the intentions and the reality for lots of people is widening. Someone who is denied basic social care by their council is unlikely to be excited by the council supporting them to consider their assets. Even setting aside the massive cuts to services, the culture of social care is one in which treating people as equal partners, as experts, is far from the norm. So the introduction of new terms in the Bill will in some areas simply generate new excuses for inadequate service offers.
And yet, the risks which we are poorest at understanding are not the risks of change, but the risks of maintaining the status quo. The Bill sets out the beginnings of a set of expectations which citizens may one day be able to draw on to demand to be treated as equals, as expert partners and collaborators, not as supplicants. There are a hundred things which could – and will in some places – prevent or distort that shift. But we live in a time where incremental improvements, won through rising public service budgets, are turning into incremental losses. It’s hard to see how we can achieve anything better within the current system than a diminishing ratio of resources to needs. The pace at which the welfare state and the social contract which we have grown up with are being chipped away is accelerating. I’m not sure we have any alternative to staking what we have on the big shifts implied by the Bill, however incomplete and risky they seem now, and then sharing the responsibility to make them work.
Escaping the invisible asylum 