Our public services are a sanctuary: living evidence that we do not abandon people who find themselves needing support to their fate. But every sanctuary has the potential to become prison-like. It is not always easy for those of us who have a hand in building, maintaining or defending those services to recognise the harm they can do as well as the undoubted good. We tend to want to place responsibility for that elsewhere, and in time the things we get wrong over and over become things we take for granted or refuse to see. Even when those problems repeatedly become tragedies that no one can ignore, we can act as if they are aberrations. We will learn lessons. Policies have been changed. They are ‘never events’, until next time. We can trace the exclusion and oppression of people who have a learning disability through countless reports and plans. The Winterbourne View scandal felt like a never-again moment, but it was followed by more failures and in the past few weeks the regulator CQC has been asked to carry out another review into institutional care for people with learning disabilities following more distressing cases of prison-like conditions.
Meanwhile more than a million older people no longer get the support they might have expected previously, and millions more silently suffer loneliness. Social care performance as a whole is improving, but the gap between the best and the worst widens. Some of this is about resources, but not all. Even on a shoestring, caring and motivated people can help people achieve great lives. But how do we create system which sees those good lives become the expectation, not the exception?
This is often described as a ‘culture change’, or dependent on ‘local leadership’. But culture cannot be separated from the structures – what people think they should buy, sell, measure, expect, reward and punish – within which we all work. There will always be leaders – and families and front line workers – strong enough to do the right thing in the face of pressures in the opposite direction. But we need doing the right thing to be what everyone feels safe and able to do, all the time.
Tomorrow the Social Care Future event in Manchester will bring hundreds of people together to try to show that a better way is possible. The local areas who are gathering to share what they have learned have the same pressures as other areas. They do not pretend they have everything fixed, but they are committed to the kind of whole-area change that is needed to bring what works best for people out of the margins and into the mainstream. We will be there to show how the quiet, slow and patchy growth of Shared Lives and now Homeshare demonstrates what you can grow even in an unforgiving climate. Other community-based approaches will be there too: for once, their work will be at the centre of an event, not at its margins.
Crucially, Social Care Future’s participants will be people with lived experience, not just the usual suspects. Those of us in positions of power or influence have demonstrated over years that we can’t dismantle old systems and build completely new ones, certainly not on our own. Real change comes when we are prepared to listen, and to work in support of a vision for a good life that feels real to people who use support and their families.
Social care’s present is over-stretched, under-funded and under pressure. We all need it to have a future worth fighting for.
Huge thanks to Martin Routledge, In Control and the organisers of Social Care Future for dreaming up this event and making it happen for all of us.
Escaping the invisible asylum 