The Scottish Question

Andrew Lowe, Director of Social Work, Scottish Borders Council poses The Scottish Question…

Having returned to live and work in Scotland the year before last for the first time since 1982 my head has been full of questions as I absorb the manifold change and progress that has been the Scottish experience in the intervening period.

The 12 local authorities I left behind have transformed into 32 and I return to a devolved nation with a Parliament “no longer adjourned”, a stunning parliament building, an energetic Executive and an imaginative approach to the conception and delivery of public service.

One of my first tasks was to get myself briefed on the 21st Century Review of Social Work which is currently deliberating and due to report in the autumn. Browsing through the materials on the website

I came across this question posed by CARE 21 in their excellent pitch “Personalisation through Participation” as follows:

The Question:
Can we build a model of public service delivery that overcomes limitations of both paternalism and consumerism?

It made me think about the challenge and the way to encapsulate it.

The Scottish Question, as I conceive it, is this:

Can we build a model of public service delivery and resource re-distribution for social care that overcomes limitations of both paternalism and consumerism and meets the needs and aspirations of Scottish people? {mospagebreak}

It is my contention that as we venture further into the 21st century we must leave the pattern of post war welfare behind, whilst taking with us the founding principles and re-envisioning a new model of inclusive well-being and social advancement. It was Sir William Beveridge who produced plans for national insurance that assumed a free health service. He wanted a pre-war government to attack the five great evils of disease, want, ignorance, squalor, and idleness. Aneurin Bevan turned these noble aspirations into the practical reality into which we were born.

We must continue to guard against the five great evils but the very language in which they are expressed suggests that they are due for revision. Equality of opportunity, social inclusion, freedom of choice, achievement and ambition are more pressing. Municipal housing, education and welfare programmes were well matched to their era but are not well matched to the way we live now. Who wants to ask permission of the landlord to keep a dog, to paint the front door or replace the windows? Who wants to send their children unflinchingly to the local school regardless of its record of safety or achievement? Who wants to choose institutional care rather than their own front door?

Finally, who wants to spend their final years in a residential home without all but the smallest of their possessions, without their privacy and, despite the best efforts of staff, often without their dignity?

My answer to these rhetorical questions is a firm and resounding negative – ‘no-one’.
Accordingly, while I welcome the 21st Century Review and the promise that social work can re-invent itself, I despair to hear the reheating of tired old polemics about professionalism v bureaucracy in their Interim Report and the talk of keeping the best of what works.

Does it work? We continue to be large scale direct providers of care services, many of which are antiquated and expensive. While Councils have invested more effectively in residential and day services in recent times, the formula is reaching the end of its useful life. Directors of Social Work need more cash, not more services. More liquid, purchasing cash to meet increasing needs more flexibly. Increasingly people want to have their needs met in ways that can express their own lifestyle. Since the mid 1980s a succession of people living with Aids have demanded of their local authority a self-managed care system which would enable them to employ their own carers and protect them from the unwelcome gaze of an ignorant care service. Together with other people, commonly those with physical disabilities, they paved the way towards a new bespoke model of care where the user is the employer and calls the shots.{mospagebreak}

Social care has fostered dependency and exclusion despite our best efforts. It has nurtured these characteristics whilst professing inclusion and enablement. We aren’t bad people, we have only the best motives at heart; but the net effect of all this caring has, for many people, been regressive.

In May I did a shift with a home care worker and saw life on the front line. Our first call of the day at 7am was to a lady who needed to be got up for the day. She was lovely; warm and friendly and she had been in bed since 7.30pm the previous evening. Her circumstances were such that she was required to “pad up” at bedtime despite being fully continent. Her care was good, delivered to a high standard by staff who want to do their best. But it is not difficult to see that this scenario raises many questions regarding person-centred and timely care and at the base of this problem is resources…not the usual moan about budgets, but the real hard one – how do we best spend the resources we have for optimum impact on people’s lives?

So, last year I went to Edinburgh for the annual conference of the European Social Network. I went in search of new ideas, new ways of addressing old problems. I met and talked with delegates from Iceland to Estonia. I was particularly impressed by a young manager from Tallinn and the optimism with which she approached the new future for her country, which was part of Russia until 1992, then independent Estonia, and now, since 2004, our newest partner in the European Union. Her government is starting with a clean sheet, making social services work out from the cities to the countryside in a centrally directed service, but one which is pluralist and seeks to be person centred.

Of more direct relevance to social work in rural Scotland was the action being taken in the countryside around Barcelona where the municipality is approaching the issue of providing personal care for people within their own homes in a novel way. Here Angels and her team are encouraging enterprise by setting up training schemes within small communities and encouraging unemployed people to become self-employed carers for people within their own localities.

Overall the conference, held in the shadow of G8 riots, was a tonic and an encouragement but I returned as I arrived, convinced that we need to rethink our priorities, and in particular that we need to reconsider free personal care – the social care equivalent of the Common Agricultural Policy – a poorly targeted, indiscriminate subsidy. Re-investment of the £130,000,000 towards properly assessed direct payments and other forms of self-directed care would kick start modernisation in an exciting way.

Whether we take these sort of steps or not, a review of social work has got to start thinking about these issues – increased flexibility, direct payments, self directed care…and when it comes to my turn – don’t you dare put me to bed before Newsnight!