This much we know

We know that we need prevention not crisis response – but that commissioners will not invest consistently in prevention, however much we want them to.

We know we need workers to act autonomously and take risks in the individual’s best interests – but that most large organisations will create systems which rule this out (because risks to organisations invariably trump the risks most important to individuals).

We know we need people to see themselves as sharing responsibility for their own health and wellbeing – but that the majority of professionals will feel they should look after the people ‘in their care’, and will risk criticism if they don’t.

We know that the most effective interactions are those we have with people we have had time to get to know, which can only ever be a small number – but that planners will always seek to work at the largest possible scale and see contact time as a reducible unit cost.

We know that to do the right thing consistently, we all need to act as if we are group of humans, but that we all act like we are the subjects of an all-powerful system.

In fact, there’s no such thing as the system: there’s only us and the relationships we have. So we don’t need to – and can’t – try to change the system. Instead we need different relationships with our peers and new relationships with people we haven’t previously thought of as our peers.

Here are four things I think we can do if we’re serious about radical change:

Shift power in the form of money: through handing control of money wherever possible to individuals and small groups, and spend money currently spent on procurement giving them the support they need to spend it creatively.

Shift power in the form of knowledge: through collecting data about the outcomes which matter most to local people and making it available to them in usable ways.

Shift power in the form of accountability. If now we feel accountable first and foremost to inspectors and finance managers, instead we need to ensure we account for ourselves regularly to groups of people who use services and other taxpayers, face to face.

If we do these things, we might just create spaces in our public services for the emotions which make the most difference: empathy, compassion, love.

Improving the social care Bill

I was at a Dept Health briefing on the new Care and Support Bill today, which set out a useful overview of the story the Bill was trying to tell about the new social care system. The Bill starts with an overarching principle, which is that the purpose of social care is to promote well-being, rather than just to respond to crises. The Care Services Minister has noted that rest of the Bill will have to be read in the light of that first clause, which sets a very positive tone for interpretation of everything else. It then sets out some duties on councils which are at the population level – things councils must have in place for everyone who lives in that area. The prevention and information / advice provisions are in this bit (clauses 2 – 7). Then the Bill moves focuses in on an individual’s journey through the care and support system, looking at assessment, care planning and personal budgets.

As I’ve said in an earlier blog, I think there are a lot of places in the White Paper and the Bill where there are deliberate attempts to create ‘assets’ thinking about people’s skills, potential and responsibilities, where previously social care law was all about assessment of needs, vulnerability and (limited) entitlements. But the Bill in particular could go farther in enabling and not getting in the way of an asset-based system. It’s great that the Bill team are up for exploring how to do this and keen to meet with groups of people who use and provide care and support to discuss how.

One of ways in which I think the Bill could be improved will be to look at the distinction outlined above: between population-level / whole-area duties, and individual entitlements. Continue reading