Change that leads to better lives

Bending the arc

‘The arc of the moral universe is long but it bends towards justice’
Martin Luther King Jr.

SAM BLOG 3 692 462

Author: Sam Smith, Founder & CEO of C-Change Scotland and Small Supports partner

Martin Luther King Jr.’s famous quote is full of optimism, a sense that progress is inevitable. The notion that a hopeful future of greater equality, health and wellbeing is somehow preordained. In these turbulent times such assertions seem increasingly uncertain. What is clear is that if we want to bend the arc, we need to work at it. But where should we focus our efforts?

In my previous blog I outlined some of the challenges that face social care; less money, greater uncertainty, commissioners and social workers feeling demoralised, the needs of individuals and families not being met and a default to transactional ‘easy options’. Here I want to suggest possible ways to navigate through this complexity.

There is a pervasive assumption that drives the social care system: everyone is out to get as much as they can and that social workers need to gatekeep the states precious resources. This fallacy is based on a self-referential dysfunctional system.

Most individuals and families just want the right amount of support to lead their good life. They do not want more than they need. More than what you need gets in the way, it becomes a bad thing. However, the social care system is predicated on the notion that resources need to be rationed. Eligibility criteria stop individuals and families receiving timely access to resources that would prevent their circumstances escalating. They absorb these pressures until they reach crisis. At which point, having met the eligibility criteria, they invariably receive a reactive, “what’s available”, response from an overstretched system. This typically results in increased cost to the state but even greater costs in terms of the welfare of the individuals and families involved. This cycle drives the notion that the system cannot afford to support people earlier because of the needs of those presenting in crisis, and on it goes. This way of working perpetuates a view that we cannot afford to do better.

A more productive perspective might be to consider how and where money has the biggest impact. When budgets are tight, the imperative must be to spend it wisely. That we deliver it, as directly as possible, into the hands of those for whom it would make the greatest difference.

The following short story illustrates this point. Names have been changed to preserve anonymity.

Peter was 8 when we met him, along with his mum Kay and dad Andrew. We had been asked to work with the family as their Social Worker had run out of options to help them. Peter doesn’t use words to communicate and is intellectually disabled [1] and physically disabled. He also has complex health needs that could be life threatening. He attended school but other supports such as respite or after school clubs had resulted in serious health risks, so had stopped.

Kay and Andrew both worked and supported their son full time. They were at crisis point. They had been allocated a small budget but were unsure how to spend it.

With support they came up with 3 things that would make a real difference to their lives.

  1. Getting the laundry done externally. This quietened the house and relieved them of a daily workload. They were then able to spend more time with Peter.
  2. With help they recruited and trained two Personal Assistants who lived in the local area. Two days a week they would meet Peter returning home from school and support him with his favourite activities, they would also start his night time routine. Kay and Andrew would use this time to do the weekly shop, spend a couple of hours together and take a breather.
  3. Paying the airfare and hotel cost of an adult family member so they could go on a family holiday together to Disneyland Paris. Sharing the support made that seem possible.

What does this short story tell us about how we might navigate the challenges facing social care? If resources are tight then we need to make best use of them. Not only did Peter, Kay and Andrew extract every last drop of worth out of the money that the state made available, they contributed to it. They added their knowledge and creativity, their wisdom and their lived experience to come up with imaginative and cost-effective solutions, that made a real difference to their lives.

We live in times of great uncertainty and we need to embrace it. It is tempting to retrench into command and control based operating systems that provide false certainties. The hidden costs of this approach are twofold. It builds transactional costs into every stage of the command structure as the more bureaucratic the process, the more costly it is to administer and the more divorced it becomes from the impact that it is making. Equally important, it dehumanises all those involved. It makes it harder for professionals to be honest about the fact that they may not have the answer. It also makes it more difficult to draw on the skills, knowledge and resources of those who need support to develop the solutions. Decision making by or as close to the person as possible has the potential to add the precious resource of lived experience and human ingenuity to the balance sheet.

We need to challenge the fallacy that our fellow citizens are a drain or a burden on the system. Guided by the universality of human rights, social care should be reframed as a positive and valued function of our community life. A resource that evidences our commitment to dignity and respect for all. This would enable us to recast our fellow citizens as valued contributors to community life regardless of their age or stage in life. This is not fanciful talk, the Independent Living Fund in Scotland provides a great example of a rights based resource delivery mechanism with low transaction costs. Direct payments and small supports organisations using Individual Service Funds offer cost effective rights based approaches that ensure power, control and decision making sit with or as close to the person as possible.

The arc will not bend without concerted effort to transfer power to our fellow citizens. We can wait for big systems change to achieve this or we can recognise that we, each of us, have power at our disposal in our everyday interactions with others. We can commit to ensuring wherever possible that those who require support have direct access to the resources they need and the power to decide how to use it, in ways that make sense to them. The definition of good social care should be determined by those in receipt of it, not by those who deliver it, who commission it or even those who regulate it. It is personal, it is intimate, like human rights it happens in small places.

“Where after all, do universal human rights begin? In the small places, close to home – so close and so small that they cannot be seen in any maps of the world. Yet they are the world of the individual person; the neighbourhood (s)he lives in; the colleges (s)he attends; the factory, farm, or office where (s)he works…Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.”[2]

[1] Terminology used in accordance with the UNCRPD

[2] Eleanor Roosevelt an excerpt from a speech at the presentation of ‘In Your Hands: A Guide for Community Action for the Tenth Anniversary of the Universal Declaration of Human Rights’, 1958

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