Not local, not big, and not clever?
Two stories of unmet social need have featured in the news in the last 24 hours. First, there was David Cameron’s announcement of matched funding to tackle the problems of dysfunctional families. Second, there is today’s report by the Royal College of Psychiatrists highlighting failings in care for patients with dementia. One aspect of these stories is the apparent fading of two key Government principles; localism and the Big Society.
Although we are told Eric Pickles fought off an even more centralised approach, the troubled families scheme will effectively mandate local expenditure on a priority chosen by central Government. The content of the scheme is also likely to be tightly specified by Whitehall. This may not be a bad thing. I am sure my old friend Louise Casey could make a strong argument both that councils should be forced to invest in this area and that there are tried and tested techniques which every scheme should apply. But this effective imposition of a priority through earmarked funds stands in contrast to Eric Pickles’ promises when he abolished Local Area Agreements, the mechanism through which councils negotiated their priorities with Whitehall.
An even more striking example of central control comes in the response of Care Services Minister Paul Burstow to the RCP report. Apparently, next year will see the introduction of a financial incentive to encourage hospitals in England to screen patients for dementia when they are admitted for other conditions. It is hard to see how this kind of micro-management fits with the promise that health commissioning will be localised.
In both cases the Government can claim it is using incentives rather than targets and regulation, but when there is too little money to go around ear marked funds are surely as powerful in driving behaviour as any target.
Also noteworthy in both these stories is the absence of an explicit role for the community in addressing problems. As I argued a few weeks ago in response to the Care Quality Commission’s findings of terrible hospital care for vulnerable elderly people, a crucial factor is the place of family, friends and volunteers providing care and advocacy which goes beyond the basics of medical treatment. I don’t have any evidence to prove my point, but I am willing to bet a substantial sum that a key variable in the quality of institutional care received by older people is simply the number of visitors they have.
The extended family and wider community also have a crucial role to play in helping troubled families. The RSA’s own work with people recovering from substance abuse addiction has developed a strategy in which service users design and help provide the services they need with a particular emphasis on engaging other individuals and organisations across their locality. The aim is to create what we call ‘a recovery community’.
An impressive example of an approach with similar principles is Shared Lives. This long established and expanding scheme involves local co-ordinators identifying and supporting families who are willing to open up their homes and lives to vulnerable people. The families get back up, advice, help if things go wrong and something towards costs, but the scheme is based on relationships not transactions, love and compassion not service requirements.
In the context of growing needs and shrinking budgets it is crucial to develop interventions which successfully blend public services and funding with self-help, co-production and community mobilisation. This should be the golden thread running through every Government public service initiative. That it is not is yet another sign of the failure of the Big Society narrative to be understood or gain traction in Whitehall.
Comments
3 Comments on Not local, not big, and not clever?
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andy bradley on
Fri, 16th Dec 2011 2:43 pm
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junius on
Sat, 17th Dec 2011 11:17 am
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Edward Harkins FRSA on
Sun, 18th Dec 2011 7:56 pm
Dear Mathew,
Thank you.
Mobilising assets, releasing community capacity. Developing the habits of treating each other well:- Listening, asking and thanking.
A compassionate ripple effect can be created and sustained – vulnerability acts as a catalyst for finding our best selves.
http://www.frameworks4change.co.uk
Model is working in hospitals and care homes.
What leadership is required to embed compassion?
Happy to offer this seminar to RSA if welcome.
Warm regards
Andy
A more credible policy in dealing with problem families would be a self-help or mutual aid approach focusing upon, and transferring knowledge from, those families who have successfully turned the corner in overcoming multiple and often compounded problems to those who have not. A mentoring approach would be particularly beneficial. Mutual aid civil associations comparable in approach to Kids Company or the Beehive for young people would be a valuable development to resource for problem families.
The parachuting in, from the centre, of professional “troubleshooters” who co-ordinate services from above will both lack the groundwork specifics and whole picture knowledge necessary for understanding the problems involved and reinforce the client case work or passive recipient status of ‘problem families’.
Where problems involved are not linked to resources- (and it should be noted that the benefit system for those with children can be very generous even though not particularly well targetted to achieve its objectives)- the best way to tackle addictive/ irresponsible behaviour and life-style issues is to encourage those experiencing the problems to address them directly through self-help and mutual aid networks. This is more empowering than merely being the recipient of professional services (no matter how efficiently delivered).
Rewards, if appropriate, should be made after these families have turned the corner and achieved some successes.
On the question of the elderly, the problem of isolation and loneliness is more pronounced for those attempting to live ‘independently’ in their own homes without family networks and regular contacts and who may transfer between hospitals and their own homes without adequate support services.
This populist stunt by David Cameron on families with problems could be very disheartening, if one let it be so. It is the just about the very worst kind of example of tackling such problems that are long-term, intergenerational, deeply embedded and ‘sticky’ and ‘wicked’ by turns.
Highly publicised pronouncements by Ministers who are utterly inexperienced in the matter and proffering top-down driven ‘initiatives’ funded by monies pinched from other , priority, budgets…. I might upset you Matthew by calling it all very New Labour 
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