Article

The care system needs a revolution

Sam Newman, Director at Partners4Change, explains why kindness and compassion need to be at the core of social care.

Sam Newman, Director at Partners4ChangeLet’s start with the story of Guy. He’s a 70-year old man with a disability, living in a national charity home at a cost of £50,000 a year for the past 10 years. His situation is reviewed regularly by the local authority. He became part of one of our ‘innovation sites’ where we ask social care workers who are interested in working in a new way, to put down forms, processes and agendas and start listening properly to people instead. It turns out that Guy wanted a blanket, which seemed strange when the authority paid £50,000 a year. The social care worker visited his room with him to discover his mattress was 'soiled and rotten'. Not ‘a bit dirty’ or ‘a bit smelly’, but 'soiled and rotten'. Now, she was a good social worker, principled, good-hearted, but with the existing processes, she would never have seen that mattress. The local authority took rapid action with a safeguarding process. The real risk is that the result will be a new box on a new form. That is not the answer.

Care is a relationship, not a transaction

Guy’s story is not a one-off and illustrates some key points about our care system. A deep, endemic flaw is our focus on processes, completion of documents and services, so that our system is set up to assess people and transact for ‘care’. It creates a bureaucracy. Instead, we need to return to knowing people, being curious, and recognising what will help, connecting people to each other and to community resources, ’Getting to know people’ should be our currency in care, with kindness the default and the assumption, not the exception because  an individual decided to go the extra mile.

Liberating not training

In my experience it's not the people at the frontline who are the problem – not Guy’s social worker or the care workers on minimum wage – it's a system that appears to be telling them that bureaucracy is their job, that is the problem. Most of the carers I’ve met over 35 years have really good hearts, training and skills. They don't need training, they need liberating.

Creating a new language

We also need a new language. We shouldn’t use the word 'care' – 'care provider, care manager, care delivery, care assistant, care package' – until we have earned the right to use it again.  Currently we talk of assessment, review, triage and hand-offs, referral, front door, customer journey.

While these words may help us diagnose and treat people, and push them around a system or sorting office, they also dehumanise us and those people and limit our ability to get closer to people. We need to stop using these words, and the behaviours that sit behind them.

We need a new language to rethink the interaction between the current state provision and local people who need their support. Not 'patients', not 'services', not 'consumers'; it's 'people' and 'families'. It’s all of us.

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A care revolution

The state of our current care system is such that we can't grow a new way of doing things from the old. The last thing we should be doing is putting more money into it or it will go to the wrong things, like more residential care to resolve ‘bed blocking’. I recently asked a manager responsible for 300 enhanced assessment beds (which is code for ‘what we do with people we don't know what to do with’) how many people end up there that shouldn’t be there. The answer was 70%. That's not the system getting it wrong sometimes, that's the wrong system.

We need to turn care on its head. We need to walk away unilaterally from the lack of compassion, kindness and interest in people. We need a revolution. We need to grow care from the bottom-up, where the state becomes part of local communities, interested in people and working out the nuances of how to help people get on with their lives.

Proving that care is productive

We also need to prove that kindness and care can be more productive compared to the current system, otherwise change will not happen.

Currently we do extremely risky things in the name of being risk averse. The belief is that regulation and safeguarding keeps people safe, and that putting people with dementia into respite units is a good thing. Yet the research says the opposite.

While kindness sounds a bit fluffy or intangible, there is a link with productivity, and we need to evidence it.  If we can do that, change will be irresistible. Being interested and being kind means we are much more likely to do what is really useful and effective with and for people.

Creating a new future

The good news is that there is a huge appetite for change. Austerity has created an opportunity to free people up who have worked in the system for a long time to do things differently. This is not just vague aspiration. We are close to getting real evidence that a kinder and less transactional approach can increase productivity. A different approach with compassion and kindness at its heart is possible. Let’s raise people's expectations rather than manage them; encourage them to believe that they'll find kindness everywhere in the system. Kindness should be the rule, not the exception.

To get involved in our caring society project, please contact Alex Khaldi, or join the conversation on Twitter at #ACaringSociety.

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