The ways in which we care and support each other is undergoing fundamental and enduring change. Martin Elliott FRSA argues that current thinking about care as a system will not meet our needs.
In trying to respond to the looming crisis in care, the problem is framed in the context of solving a riddle: how do we reshape the health and care system to meet the increasing demands of people living longer with greater degrees of disability? The Government is intent on reducing resources and trust is placed in the market and the power of the consumer. Organisational and service integration is promoted as the method of achieving a financially sustainable and effective new system.
There is an argument that current policy is simply a return to a pre-welfare state approach to the poor; a political agenda cloaked in the language of reform. Conversely, there is the compelling argument that the harsh realities of the market economy in global recession, has led governments to live within their means.
But is this line of thinking actually the problem? Can human care be reduced to a system that can be reformed and targeted in order to deliver efficient, measurable and rapid solutions? One example of going beyond the over simplified focus on activity was a social worker who identified that someone was approaching the end of her life. The daughter was upset and later said that the most important benefit was the emotional support she received.
Or do we need to think differently? In many ways there is an emerging paradigm that has already left the argument about the state verses the market behind. It does not propose a step-by-step transformational programme and it is pretty well immeasurable.
Firstly, we have to let go of the tools that have not served us well. There is a prerogative to embrace creativity and innovation as they emerge. Rather than imposing solutions, we should be curious about how care and support are experienced and the starting point for this is to better understand our motivations, relationships and behaviours.
There is already growing interest amongst GPs in the motivation of the patient to engage in managing their health. Quite simply the more motivated, the more likely we are to manage our health and better able to deal with long-term health issues. But even self-awareness is not always sufficient in changing people’s behaviour. A sense of purpose is linked to high engagement and good health and where this is lacking; there is often a sense of disengagement and isolation. Loneliness, depression and poor health can be manifest. An individual’s level of personal motivation and control is important, but so too is the context that it takes place in.
Understanding context means taking into account what is around the individual: their environment, relationships and aspirations. This is too often overlooked.
One way to explore the context of care and retain the importance of personal relationships at its core is to look for and listen to people’s experience of personal networks. Too often ‘networking’ is associated with the internet and the way in which we have adapted our behaviour to be successful in a complex global environment. But networks cut across organisational hierarchies and provide a viral model of communication but on and offline. People connect and share. This is reinforced by the RSA’s Connected Communities programme that builds on social networks.
The importance of networks have been recognised in more sophisticated and complex understandings of inequality, one that identifies economic, social and cultural capital. However, the problem is that capital implies a measurable value, which is unhelpful. What is useful is to consider the strength of someone’s social, cultural and economic networks, not just numbers.
This approach would be fundamentally different and would start with an understanding of a person’s current networks. If these are impoverished or unstable, there is a greater need for support. Those who can afford to can simply strengthen their existing networks when their health or care requires it. But most people do not have unlimited resources and need to make compromises and for some there simply are not the resources available and they are likely to fall under the various auspices of the state.
I would argue that the economic network is less important than the social and cultural networks and only becomes an issue when it is insufficient. In terms of the economic network the principle should be that the required spend is equal to the economic resources of the person. The principle should be that a strong network should not be threatened by the lack of funding available to the individual. This cannot be achieved by recycling diminishing organisational funding but by a universal scheme based on this principle. The person should have direct access to the resources they require in order to maintain strong social and cultural networks.
Where required the network will need to be strengthened and extended around the person as directed by themselves. When they lack the capacity to safely do so, a representative acts in their best interests. In providing this function, professionals and families could work in loose association rather than through organisational hierarchies. An example is where someone is caring for a family member; it is not unusual for them to coordinate support from 20 professionals. This may range from a consultant, social worker, home carer, GP and handyperson. A great deal of everyone’s time can be spent on coordinating and negotiating organisational cultures. With increased autonomy these people could work directly to the person needing care. They could enhance what is already offered by the family and communities rather than attempting to impose pre-conceived models.
Care is a fundamental human experience and we need to free ourselves from behaviours that see care as a system to be reinvented. Once we have done that we are open to listen, connect and share.
Martin Elliott is a social worker and senior manager across local authorities and the NHS. He is self-employed and holds a MSc in the Sociology of Education.