Gravitational Forces

“Meeting a friend in a corridor, Wittgenstein said: ‘Tell me, why do people always say it was natural for men to assume that the sun went round the earth rather than that the earth was rotating?’ His friend said, ‘Well, obviously, because it just looks as if the sun is going round the earth.’ To which the philosopher replied, ‘Well, what would it have looked like if it had looked as if the earth was rotating?’”

Tom Stoppard, Jumpers, Act II

The UK Government’s policy is clear; social care and health services should be personalised ie centred on well informed individuals who are given every opportunity to self-direct their care and support through the control of their funding, even if provided by the state.

It is a Copernican revolution: a reversal in the gravitational forces between professionals and citizens where the individual rather than the professional is in the centre and we the professionals revolve around them.  Amusing though the above quotation is, it illustrates that what Copernicus discovered is still counter intuitive, if no longer heretical. In reality he simply observed the existing order of the solar system- unlike us he didn’t have to try and shift the gravitational forces!

Following the publication of my blog titled: People: Capital or Commodity, I am very grateful for the many comments and in particular those from family members of people who are in, or have been in, care settings.  I apologise if by exposing the nonsense of an ill-considered social care procurement I added further anxiety to those who are already feeling vulnerable and I should like to acknowledge their concerns.  As Vicky Raphael, Co-Chair of the National Valuing Families Forum commented:

“A great fear for families like us is the vulnerability of our children to systems and processes “When we are gone“”.

I was struck by a particularly forthright and poignant comment made by Sue Redmond, Chair and Founder of Full of Life and her use of the word “industry”:

“Our sons and daughters have become an industry for other people…”

I am of course part of that industry.  Some industrial facts: the social care sector is valued by The National Audit Office as £19 billion employing 1.5 million people.  In contrast there are 5.4 million people like Sue and Vicki who provide their care and support to loved ones at no cost and the combined value of their contribution to society is estimated to be a staggering £55 billion.  The Local Government Association estimates that the funding of adult social care has fallen by 26% over the past four years and is set to fall by a further 1.9% this financial year. At the same time they have estimated that cost pressures over the next five years, just to stand still, will require at least an 8% increase in spending even after further efficiency savings.

The central point of my previous blog was to emphasise the importance of relationships behind these cold, industrial scale facts; relationships between professionals and individuals with their families, relationships between commissioners and providers and relationships between managers and frontline colleagues.  How much more perilous will everything become of we lose the good will of Sue, Vicki and the millions of other un-paid carers? By focusing only on the transactional rather than the relational nature of social care we run this risk and miss something vitally important- it is people who make the world go round not money.

If only the procurement team, and others in other councils, who seem to be resolutely fixed to the professional centric approach, had started that process of reversing the gravitational forces.  By consulting with the individuals and families about the existing services they could have taken the opportunity to create their own revolution by transferring the purchasing power to them.  Even if they felt unable to be quite so radical consultation with families would have at least encouraged them to consider the value of continuity and therefore to give appropriate weight to this in their assessment scoring.

Professor of Social Work, Bill Jordan in his article: Social Policy for the Twenty-First Century (2006) undertook an analysis of the origins and development of what he terms the commodification of social care.  He took a critical look at the underpinning political and economic theories which have influenced social policy, how it is paid for and, how it is delivered. He describes how, “…public choice theorists neglected the relational aspect of services, exit became the main mechanism for change” This is nearly ten years ago and by “exit” I think he means a take-it-or-leave-it type of choice; my way, or no way. At the same time he makes the point, “…many costs were concealed, and the contextual value of services was obscured”.  How much of the £55 billion is spent on procurement processes both by those creating them and the rest of us having to respond to them?  How much has this increased over recent years?

Bill Jordan goes on to urge providers of social care to “…recognise that the support they offer is relational as well as practical and one way of recognising that is by better supporting paid carers with respect to the hours they work, their pay and their esprit de corps”. A good challenge and many individuals and family carers rightly insist these are very important factors too.  If they themselves don’t have the direct control over the employment of the paid carers then they have to rely upon the social care industry to do the right thing and put people before process.  Sue refers in her comment to the “wrong hands”- we need to do much more to ensure social care is in good hands.