Getting The Best From Our Communities

Nick Johnson, Chief Executive of the Social Care Association, suggests that one answer to ‘The Scottish Question’ (posed in this section by Andrew Lowe), may lie in our communities…

It was Andrew Lowe’s stimulating piece – The Scottish Question – that made me think about what I wanted to say and, hopefully, my words may generate that feeling in another contributor.

What I know about social care is that it has a plethora of people who bubble ideas and one of our biggest challenges is to hear those visionary ideas and pick up the ones we can work with.

I am concerned that a commissioning service that has no capacity of its own to provide becomes wholly the victim of the provider market. In the case of high demand and low provision, the prices go skywards.

Scotland currently has services provided by public, private, voluntary and a developing direct payments sector. I believe it would be an error to be absolutely dependent on any one of these areas because of the effect I describe.

In one authority in which I worked, a Council Service transferred to an external provider and was the last Council owned service of its type. What we had paid for 24 people before the transfer bought places for only 18 within months after the transfer – and all I could do as commissioning manager was wave money! I do not believe the ‘free market’ works in our sector because for there to be choice there has to be excess capacity and for there to be reasonable competition there has to be at least adequate capacity. {mospagebreak}

The commissioning councils (but not forgetting the large number of older self-funding individuals) are servants of the public and any enquiry of the public about care for vulnerable people always attracts high public approval. Of course it is the commissioners’ duty to ensure good stewardship of public money but never at the cost or detriment of the recipient who will have been deemed to be vulnerable and in need.

We are perhaps becoming too individual and self obsessed in our perception of the world and services. We all remember the now famous ‘there is no such thing as society’ comment by Margaret Thatcher. She was wrong about that. Society may be a virtual concept but our interdependence on each other for a variety of core needs is without question.

For example, when we give choice in schools, the effect is that the richest, most able and articulate have the opportunity to gain the greatest benefit and often leave the weakest, poorest and most vulnerable to fend for themselves. Hurricane Katrina demonstrated an extreme example of this effect in the southern United States. If children went to their local school, without an option, I would assert that the most able and best off people would be actively engaged and demand that the school worked well. They would support their children’s education and this would be beneficial for all.
In social care, a constant challenge is to keep those we work with connected to the mainstream. Initiatives to monitor standard grade results on children who are accommodated is a good example.

This thinking should thread through everything we do and apply to every one with whom we work.
Fundamentally, I believe it is not the structures or systems that are most in need of change to enable the aspiration Andrew Lowe talked about, it is the legal framework and the associated regulation on which it depends.

Welfare legislation emerging from the Beveridge Report assumed the generally good motivation of the community, subject to support with health, education and a safety net for a crisis. The statisticians behind him (Beveridge) had worked out that with the average age of death being 67 years old for men at the time of implementation, pension contributions would comfortably cover the cost.{mospagebreak}

We should be pleased with our progress. Part of the reason that pensions are struggling is that 67 turned into 76 years multiplying the expected outlay on pensions by more than 400%!

Similarly, part of the heat in the assessment of charges to older people, free personal care and the issues of property and inheritance, is to do with the fact that so many more people have a house that they own. Interestingly, the financial regulations have hardly changed since they were implemented. It is us who have changed.

All of the people who receive support do not, and should not, receive that support out of pity or any kind of public beneficence. All people are citizens of our society and should receive the support they require to enable them to contribute as fully as possible. This thinking can be applied to benefits, employment, education and health. The legal framework that underpins our daily life needs radical remodelling to allow the creation of this culture of citizenship.

When I was a child, I think there were probably half a dozen callers a day to our house, from mobile fruiterers, grocers, butchers, fish men (and a tea man!), insurance collectors, rent collectors, milk men, postmen. This was on top of any ad hoc callers that might be requested like plumbers, electricians, the GPO etc. All of these people brought and carried news. All of them carried a civic responsibility beyond their job function and (I hope) none of them would have ignored anything that appeared unusual, from the milk not being taken in to there being no answer at the door.

They provided a preventative social care service that now has to be replaced. The Council Departments responsible for the vulnerable did not have the total responsibility for everyone, they had informal eyes and ears all over the place!

Initiatives like ‘keep warm’ projects are an example of pursuing this but they are institutionally based and therefore limited. I have spoken before to a Supermarket about how they can pick up some of this role again as they start home deliveries. Perhaps they and the insurance companies et al should sponsor community action to recreate some of this? The cost saving achieved by losing ‘the man from the Pru’ or the cheap supermarket milk that put the milkman out of work had the effect of disconnecting the community. We seemed to have lost some of the ‘glue’ that kept us together.
Ask yourself, how many people do you know in your close or your street? How well do you know them? Would they take in a parcel or do they have a key? What would they ask of you? Would you trust them to mind the children? Do you routinely socialise?{mospagebreak}

In the 1970’s there was a movement for community social work that attempted to merge the role of the discredited community workers and the generic social worker. The idea was that a locally based (and sometimes resident) worker would get to know and be known by a neighbourhood. I think Paris applied the model quite successfully. It never came off because the level of commitment was way beyond what was being offered by the individual workers or paid for by the Council.

If your answer is ‘no’ or ‘not many’ to the neighbour question, my point is made. We are the socially skilled and able people in the community, trained and qualified to engage with the most needy and vulnerable people and it is we who are most likely to be aware of what is happening. Where does that leave everyone else?

A simple and inexpensive initiative might be ‘know your neighbours’. We could challenge people to know everyone in their close or street, or at least the ten nearest houses by name and if they are older people or have any other needs, have an emergency contact through which you can seek help for them. For the best of reasons, be a ‘nosey neighbour’ (from the project idea to help older people in the early 90’s).

If it works, try doing some things together that build trust and reduce suspicion. Invariably people who know a little about each other are less likely to fight, malign each other or ignore their needs or wants. This is a fundamental principle in hostage negotiations. If we do it in those extreme and distressing situations, why can’t we do it without such pressure?

Municipal organisations should actively make themselves known and be a supportive partner and the emergency contact point for anyone who has no one nearby. The number of people who cannot access their social work department, sometimes when they are already using services, is unacceptable. Unanswered phones, disinterested and unhelpful reception staff and poor publicity all contribute to a lack of trust and confidence. The use of narrow eligibility criteria that open assessments processes with an intent to exclude a person, rather than seek solutions that may not be council driven or paid for, similarly undermine community cohesion and public support.

Without some communal action like this, backed-up by legislative change, lack of contact will breed mistrust and suspicion of everyone and will make the likelihood of high quality, financially well-managed and targeted public services a pipe dream.