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Relieving the ‘stress and strain’ in social care

The Observer newspaper and Andrea Sutcliffe of the Care Quality Commission (CQC) did a good job on Sunday to highlight the ‘stress and strain’, as she put it, afflicting social care.

‘Stress and strain’ is putting it mildly, as has long been obvious to anyone who works in or uses the service. But if repeatedly highlighting the failings of a broken system was enough to fix it we would not be where we are.

Valuing the commitment and skills of good care workers is undoubtedly necessary, and the terms of Unison’s Ethical Care Charter are a minimum expression of that.

But raising the status and employment standards of the workforce probably cannot be sustained, and certainly won’t be enough, without radical redesign of the service.

The core flaw is commodification of care, and by that I do not mean the involvement of non-state providers. In fact, as the fantastic success of Buurtzorg Nederland has shown, they can pioneer the kind of change required.

By commodification I mean the fragmentation of what should be relationship-based care into a production line of standardised tasks with standardised times.

Person-centred service, by contrast, demands that care workers focus — as most wish to, and many do the best they can — on the unique and changing needs of the human being to whom they offer support.

Social care of the future will be a professional vocation in which care workers have the freedom and responsibility to provide appropriate supports to strengthen and complement the capacity of the client and her networks.

Buurtzorg has shown that such an approach not only produces better quality but can lead to savings by reducing the number of hours of care required.

Additional savings and quality improvements come from providing the Buurtzorg service through self-managed teams supported by an IT system, regional coaches and small back office that support rather than control the frontline.

The UK Homecare Association (UKHCA) has warned: “The additional costs of the new National Living Wage could lead to a catastrophic failure of home-based care services, unless there is urgent action from Government and local councils to address underfunding.”

That is true, but why invest in a broken model when the returns from supporting transition to a better one would be so much greater? A co-ordinated effort by national and local government, health and social care providers and the workforce itself could make that happen.

Unfortunately, the government responded to the Observer article with denial, claiming that the “‘fit and proper person’ test for directors and a care certificate for frontline staff” would ensure compassionate care.

But the unsuitability of a few directors is not the fundamental problem — most want to do a good job and will sail through the test.

And while staff certainly need better training, the care certificate does not disrupt and could even reinforce a failed model that objectifies the client and undermines the carer’s vocational ethos.

We can wait for the next scandal or we can do our best to prevent it. That’s why Public World is working with Buurtzorg to test how to make person-centred, relationship-based care through self-managed neighbourhood teams work in the UK.

If you would like to help us, or if we can help you, please get in touch.

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