There's a crisis in social care – without a doubt. Dwindling resources, low morale, lack of capacity in support providers, a sense of anxiety about Care Quality Commission inspections. Notice I haven't included the concept of demand. Well just for the record our work shows that up to 50% of ‘demand' (measured by ‘contacts' in the ‘front door' of social care systems) isn't demand, its people hopelessly lost in the impersonal bureaucracy – on one or more waiting lists, trying to find out what is going on, what is going to happen, when, and with whom.
I believe the default system is broken and doesn't deserve to be fixed – we need a radical alternative
Supporting more than 50 local authorities over the past decade by introducing The Three Conversations approach has taught me many things. Namely there is also a crisis of culture – how we treat people, how we speak with them and each other, what kinds of relationships we form. What if it was really true that we can achieve better lives and experiences for people, improve morale and satisfaction in and with public services, and become more financially sustainable by changing the conversation?
I believe the default system is broken and doesn't deserve to be fixed – we need a radical alternative. Our data shows that on average people contacting adult social care systems get passed around at least five times with nobody owning the relationship. This is deeply unsatisfying both for people and families, and for practitioners working in the system. Those practitioners spend 80% (yes 80% - BASW figures) of their time filling out forms. One authority currently has a 16-page assessment form – like many others – where half of the questions are irrelevant, and 20% are just downright rude and intrusive. But the computer demands an answer.
The default system dehumanises people who are asking for help, and also the people working in the system. People are ‘cases'. They are categorised and given a label in order to decide which pathway to send them down, or which list to put them on. We have got lost in a ridiculous world of dehumanised language – when did I last wake up hoping to ‘meet my outcomes'?
We are wasting precious time and money doing the wrong things, making the pressures worse. Our data shows that if we stop ‘assessing people for services', if we stop acting as processors, sorters and sifters, then different and better things happen. For instance, the number of ‘packages of care' you have to deliver can be significantly reduced (by up to half).
If we adhere to the Care Act requirements to record ‘proportionately' then the time spent filling forms is dramatically reduced.
So where is the hope? If we liberate ourselves from being processors, form fillers, rationers, better things happen. If we accept some new non-negotiable rules like ‘no handoffs', ‘stick to people like glue when they are in trouble', ‘stop screening and triaging', ‘always know the neighbourhoods and communities of people you are talking with', ‘have conversations based on what people want to talk to you about rather than what is on your form', what happens? People feel listened to. We really get to understand what matters, what is important and what will help someone live their best chosen life (what I think the Care Act means by ‘assessment'). People and families are amazingly grateful for simple things – like us doing what we said we would do, by really listening, by really helping. Recently a mum of a son with a ‘severe learning disability' explained that it was her best experience of interacting with her local authority in 30 years. And a social worker shared that it is the happiest they have been in 18 years of social work. Practitioners become the people they want to be as they are encouraged and liberated to treat people as people – with hopes and fears, and back stories, not just as needy consumers of services and money.
How does this happen? By creating safe spaces within local authority environments where we stop doing the default processing and instead focus on listening, being curious about what's really important and collectively working out what is the right thing to do – and recording our work swiftly and proportionately.
Believe it or not the good things follow – people and families enjoy the experience and live more of their chosen life for longer, practitioners get a sense of fulfilment in their work, and do more work, become more productive, and we waste less time and spend less money (£5m recurring annual saving for one local authority). What's not to like. Let's invest in that. It's time for a revolution.
Sam Newman is a former social worker, social work manager and advocate of relationship based social work at Partners4Change
