Two stories of unmet social need have featured in the news in the last 24 hours. First, there was David Cameron’s announcement of matched funding to tackle the problems of dysfunctional families. Second, there is today’s report by the Royal College of Psychiatrists highlighting failings in care for patients with dementia. One aspect of these stories is the apparent fading of two key Government principles; localism and the Big Society.
Although we are told Eric Pickles fought off an even more centralised approach, the troubled families scheme will effectively mandate local expenditure on a priority chosen by central Government. The content of the scheme is also likely to be tightly specified by Whitehall. This may not be a bad thing. I am sure my old friend Louise Casey could make a strong argument both that councils should be forced to invest in this area and that there are tried and tested techniques which every scheme should apply. But this effective imposition of a priority through earmarked funds stands in contrast to Eric Pickles' promises when he abolished Local Area Agreements, the mechanism through which councils negotiated their priorities with Whitehall.
An even more striking example of central control comes in the response of Care Services Minister Paul Burstow to the RCP report. Apparently, next year will see the introduction of a financial incentive to encourage hospitals in England to screen patients for dementia when they are admitted for other conditions. It is hard to see how this kind of micro-management fits with the promise that health commissioning will be localised.
In both cases the Government can claim it is using incentives rather than targets and regulation, but when there is too little money to go around ear marked funds are surely as powerful in driving behaviour as any target.
Also noteworthy in both these stories is the absence of an explicit role for the community in addressing problems. As I argued a few weeks ago in response to the Care Quality Commission’s findings of terrible hospital care for vulnerable elderly people, a crucial factor is the place of family, friends and volunteers providing care and advocacy which goes beyond the basics of medical treatment. I don’t have any evidence to prove my point, but I am willing to bet a substantial sum that a key variable in the quality of institutional care received by older people is simply the number of visitors they have.
The extended family and wider community also have a crucial role to play in helping troubled families. The RSA’s own work with people recovering from substance abuse addiction has developed a strategy in which service users design and help provide the services they need with a particular emphasis on engaging other individuals and organisations across their locality. The aim is to create what we call ‘a recovery community’.
An impressive example of an approach with similar principles is Shared Lives. This long established and expanding scheme involves local co-ordinators identifying and supporting families who are willing to open up their homes and lives to vulnerable people. The families get back up, advice, help if things go wrong and something towards costs, but the scheme is based on relationships not transactions, love and compassion not service requirements.
In the context of growing needs and shrinking budgets it is crucial to develop interventions which successfully blend public services and funding with self-help, co-production and community mobilisation. This should be the golden thread running through every Government public service initiative. That it is not is yet another sign of the failure of the Big Society narrative to be understood or gain traction in Whitehall.