Taking The Wrong Turning – Community Care to Social Care (and back)

Bob Rhodes and Ralph Broad argue that social work and social care should return to the thinking set out in the Barclay report and renew their commitment to community. https://www.centreforwelfarereform.org/library/by-az/revisiting-barclay.html

In the years before Roy Griffiths and Mrs Thatcher imposed their transactional interpretation of the world on public services, social work was taught and practised as three disciplines – community social work, social work with groups, and casework. While work was often organised with an emphasis on one of the strands and organisational structures and relationships reflected this, skilled and thoughtful practitioners frequently integrated all three approaches in their quite commonly self-directed work. These workstyles had evolved organically in response to a cultural and political reality. The establishment of the universal National Health Service had made a bold statement that responsibility for the health of the nation rested with the State, funded by taxation. No such commitment had been made about how we as citizens, families and communities would assist each other through times of vulnerability and dependence upon others. In essence, there seemed to be a consensus that social work (and other human services like Youth & Community Work – note & Community) existed in order to assist us to support each other and to strengthen what, in contemporary parlance, we might call the core or relational economy. This expectation was progressed, not always comfortably, alongside prevention and protection responsibilities. Social Workers were never not agents of social control.

I am struck that I am writing this article at a time when it is alleged that one in eight of our young people experience mental health problems. Personally I doubt the veracity of that assumption and will explain why in my analysis of the changing relationship between the Citizen and both the State and the Professions. Suffice it to say that we have allowed many aspects of life to become inappropriately pathologised, despite an absence of good evidence that they should be. I would also observe that such an exponential growth in the numbers of youngsters presenting with difficulties is much more likely to derive from the nature of the society in which they are developing which, if that is the case, suggests that it is far less nurturing of its young than heretofore – the remedy being societal rather than medical in many cases.

In my book, Much More to Life than Services (2010), I shared case histories from my experiences co-ordinating a Child and Adolescent Psychiatry service in the 1970’s. There was Peter, struggling to cope with the existential threat of cystic fibrosis and punishing the world at large, whose life was turned around by athletics – not the first thing a therapist might prescribe – success as a cross-country runner and his immersion in that community. And Andrew, massively anxious, his life defined by encopresis and enuresis, who emerged as a gifted table-tennis player – competing in the local league and winning the respect and friendship of opponents who became friends – whose bowel and bladder problems steadily resolved. Counselling and drugs – experienced over many years – had failed them. Finding and working with their gifts by really getting to know them (and involving those who loved them) cannot be an appointment or a session. 

I also recounted a similar history of work with six teenagers with learning disabilities whose development and subsequent life chances were being curtailed by the well-meaning over-protectiveness and low expectations of both their families and professionals. We helped them become competent kayakers who, within a year of taking to the water, all completed a 3-day/100 -mile survival test with flying colours and have never looked back.

As the Barclay Report (1982)* chronicled, community social work approach was sometimes messy and unstructured – but it worked and nurtured a resilient civil society:

“The report identified three main sets of assumptions about the relationship between the state and its citizens: the ‘safety-net approach’ (which values informal networks and minimal state provision); the ‘welfare state approach’ (the post-war idea of comprehensive services and citizens having a right to these); the ‘community approach’ (which believes that people have the potential to care for each other if power is devolved to them and SW’s role is then to support these informal networks and develop them where they were weak). The majority of committee members supported the third approach, highlighting the value of community social work. They called for more emphasis on community engagement, and a new role for social workers as broker of resources, working with informal carers and voluntary organisations to support individual service users as citizens.

The report’s recommendations were largely ignored by Margaret Thatcher’s cabinet…” 

UK society was changing fast during the second half of the 20thcentury and in ways that meshed with Thatcherite convictions regarding self-reliance, individualism, managerialism, competition and the centralisation of power. 

The UK had become (and is even more today) an intensely consumerist entity. Peoples’ behaviours indicated an unsatisfiable appetite for more and more ‘stuff’. Manufacturers, service providers, and commerce worked tirelessly to ensure that folk remained unsatisfied and aspirational. As a consequence, most nuclear families aspired to have all working age adults in employment and the luxuries of the past were reassigned as basic rights. Rights are and were assumed far more easily than duties and responsibilities with demands that ‘they’ should provide more to support ‘us’ in our pursuit of consumer heaven.

Politicians love giving people what they want, insofar that it is affordable (at least in the short term). And, saliently, the promotion of strong domestic consumer demand suited the economic dividends pursued by all governments to this day – regardless of the societal and environmental consequences. As McKnight and Block observe: 

“Consumerism is not about shopping, but about the transformation of citizens into consumers”. (John McKnight & Peter Block – The Abundant Community)

Not only was the relationship between the Citizen and the State radically changing; a similar shift in the power relationship between people and professionals was also in train and gaining speed exponentially as the impact of service commoditisation and marketization was felt. Over many decades, professionals (and more recently managers of professionals) – fired at least as much by self-interest as altruistic fervour – have invaded and occupied territories that were previously the realm of kith and kin; and frequently with no regard at all for the ‘babies they are throwing out with the bath water’ and little understanding of factors outside their sphere of interest that may be at the heart of issues they have chosen to define within the remit of their ‘bubble’. 

A contemporary instance resides in the NHS’s seeming interest in community participation as a contributor to wellbeing. The institutionalised misunderstanding evident in so many of their forays into funding initiatives in community participation lies in the imposition of evaluations relating to less or more appropriate engagement with the NHS rather than seeking to identify the benefits of community participation.

In 1995 John McKnight remarked:

“There is no greater power than the right to define the question. From that right flows a set of necessary answers…. He has the power to determine the need of his neighbour rather than to meet his neighbour’s need.”

Our contemporary quandary resides in the fact that citizens and politicians defer too easily to ‘experts’, don’t review the ‘science’, and too rarely ask, “are there other ways of viewing this”. In respect of the purported mental health crisis, I have yet to hear influential voices asking whether it is not time and took a long hard look at our society and whether, as the sixth most successful economy in the world we have got our political priorities, our purposes, clear. In truth we seem to tolerate – perhaps because we have ceded power and accountability – a system of centralised government that thrashes around in the chaos of events with no clear sense of purpose and very compromised principles.

I have spent my professional life working with excluded and severely disadvantagedpeople, families and communities with the logical expectation that my interventions will enable their inclusion and resilience. Policy repeatedly stresses these aspirations. But the system conditions deriving from so-called social value commissioning leaves practitioners striving against the grain and ‘files’ people according to their needs descriptions in silos that are, to many of us, institutions without walls. The shame is that it seems that, to the powerful, the market ideology is of far greater import than the people they purport to serve.

It should not be contentious to insist that effective social work is based upon clear purpose. Recently Simon Duffy (Centre for Welfare Reform) proposed a definition of that purpose that provides a really strong foundation from which to completely redesign our community (social) care arrangements:

“The purpose of social care is to enable people to live an independent life of citizenship, with their own distinct and personal goals. Social care is not a treatment, instead it involves building on gifts and needs, and a mixture of practical assistance, access to community life, and possibly additional resources. Management of social care should be creative and empowering, with decisions and partnerships primarily driven by the person themselves. Social care, at its best, is not standardised, not rigidly systematised, but is entwined with the capacities of individuals, families and communities.”

His motivation to restate purpose derived directly from a radical change in the national leadership of ‘social care’ which slipped by with little comment. The integration of Social Care with the NHS within the Department of Health and Social Care simply bolsters the journey towards the medicalisation, managerialism, monetisation, industrialisation and commoditisation of social services begun by Thatcher and Griffiths nearly 30 years ago. The Fordian mindset implicit in these terms also accords with a trust in ideas like standardisation and economies of scale which are incompatible with the bottom-up, organic, messy and enabling approach – “supplementary and complementary” as boiled down by Al Etmanski (in A Good Life) – that not only secures better lives for recipients but also collaborates in the core economy, promotes resourceful and interdependent communities, and makes far better use of (wastes less) public funds (See Saving Money by Doing the Right Thing – Why ‘local by default’ must replace ‘diseconomies of scale’; Locality/Vanguard, March 2014).

The ‘restoration’ of community social work and community care is unlikely to result from top down decisions and reorganisations. A public expectation has been intensively nurtured in which we have all become complicit in proclaiming our rights to have our needs defined, stimulated and met by commercially and publicly provided products and services. All stakeholders in the prevailing system will be challenged by and seek to compromise the changes proposed unless the ‘revolution’ is widely owned and competently demonstrated.

Fortunately, community social work and community organising, in which the principles of participatory democracy are practised, have survived in the form of a plethora of inspirational local projects despite the ‘industrialisation’ of public human services. The Common Platform has the potential to be the vehicle to bring all these initiatives together to collaborate on much more than survival; to create and implement a powerful strategy for change. Such a strategy will likely forge a forum for not only the professionals but more importantly the communities of citizens engaged in these projects to come together, share and campaign – and promote a wider ‘conscientization’ debate. 

During the last 20 years I have frequently been engaged to help staff in public and voluntary organisations acquire community (social) work knowledge and skills, and the confidence to utilise their learning despite contradictory systems. Too often I have been struck by the complacency, compliance and absence of critical thinking exhibited by many of the folk I’ve ‘challenged’. It seems to me that our qualification courses are no longer producing motivated, reflective, ‘collegiate’ professionals, but rather too many systems operatives who are far more likely to campaign over their pay and conditions than about the injustices meted out to vulnerable citizens. In building a national movement of vibrant community initiatives I would hope that we will turn our attention to providing a spectrum of training and development opportunities – from apprenticeships to post-graduate degrees – to build and energise a workforce that is able to facilitate and sustain community-led change.

While influencing at the ‘top’ is important, it seems to me that the most important deliverable for this initiative must be to stimulate and inform a national debate about a Good Society and how we might get there. This cannot be simplified into the redistribution of wealth and power debates of the last century. We live in an intensely consumerist reality. We are facing environmental catastrophe. We, as a society, have been complacent and ceded power in return for ‘bread and circuses’. We are all complicit and, arguably, those in power most complicit of all. If we are to react, to change, then self–reliance, reciprocity, interdependence, sociability and communal cooperation will all be part of the mix. Community Workers and Organisers – professional and unpaid – are key resource in meeting challenges that market has, in part, spawned and cannot resolve.