A Major Oxymoron

Vic Citarella remembers the days before there was social care

Listening to former premier John Major sounding off about Europe on TV this week prompted a memory – one that could be completely incorrect, but nonetheless its mine. The recollection being that he was credited to be the first senior politician to publicly use the term ‘social care’ back in the 1980s. Anyway this was what was said back then amongst those promoting the standing of residential, day and domiciliary care workers. Those arguing for investment in status, training and recognition and the professionalisation of social care as distinct from social work. 

It is now 30 years since Major was Minister of State for Social Security – the most likely time when he would have made a speech about the care sector. In that time since 1986 the cause of professionalising social care has made little progress. It probably peaked with the creation of the General Social Care Council in England in 2001. The code of practice was about social care and the intent was to register domiciliary care workers straight after social workers. By the time the GSCC was closed in 2012 the idea of registering any social care workers was long buried under burgeoning bureaucracy and costs. It remains alive and flourishing in the rest of the UK.

Why is social care in retreat in England? Why did the former Social Care Association struggle with membership? Why do the one and a half million people who work in what we call social care still have low skill, low pay and low esteem standing? Listening to Major again something about his stance on Europe and the NHS made me consider the possible oxymoronic juxtaposition of the words social and care. Like, as in, was he a ‘caring Conservative’?

Consider how far social care is a truth particularly in our times of personalisation and individual care planning. Most people want their care to be private rather than social I suspect. Consider the contradictions in the need for companionship and activity alongside the need to go to the toilet, go to bed, get up, wash, dress and be fed. The one involves groups of people and the other is – or should be – just you and the care worker. Consider many people’s preference to have support rather than care.

Perhaps, with hindsight, it was a mistake to coin the term ‘social care’. Residential, day and domiciliary care had the benefit of less ambiguity, more exactness.  It still does – people know what you mean if you say you work in a care home, a children’s home or if you are a Home Help or work in a day centre. Precision in terminology can put pressure on politicians, be understood by the public and attract investment.  With that comes professional respect and standing for the practitioner.  So out with the Major minor oxymoron of social care and let’s think about the major key alternatives.

Language with a bad name

So management is set to join bureaucracy and institutional in social care’s negative box? Institutions are structures and mechanisms of social order and cooperation. Bureaucracy has as its antithesis adhocracy. It is intended to anticipate need and improve efficiency.

Managerialism is castigated as the cause of the bureaucratic inhibition of best social care practice. It is thought likely to lead to and promote institutional thinking and practice. Self-evidently this is not the case. It is leaders who create law, policy and regulation, that set targets and determine how managers and bureaucrats implement in practice. Social care and social work are not different from any other policy area in this respect.

So for Steve Rogowski (Front Line Focus – Community Care 17 June 2010) to say: \’One cannot get away from the fact that the introduction of managerialism from the private sector over the past 30 years has been the key driver in public services, including social work. Such services have had to become more like businesses and operate in ways influenced by them, including social workers needing to be involved in the competitive stimulus of market forces. The result has been managers rather than practitioners, being the main instrument of effective social policy. This has necessitated social workers essentially having to comply with what managers, at the behest of government, required. Hence, we have had to strictly adhere to targets and performance indicators. Put simply, social work success is now measured in terms of whether someone else’s target has been met, rather than being measured by the practitioner and user(s) between themselves\’ misses the point of how managers should be supported through (good – this word has to be inserted) bureaucracy and institutions. It is the role of leaders nationally and locally to do this for social care.

Like a lot of social workers Steve appears to resent managerial power. He fears that they will carry on… controlling what social workers do. Well of course they will. It is to what purpose they control, how they go about it, their background, training and support that Steve and all of us should be concerned to influence.

In business there is a concept called customer and this is sacrosanct – meeting customer needs at a price they can afford is the key to business success. That applies whether the business is run by practitioners (social work practices), customers (user-led organisations) or managers (bureaucracies). Deviate from that and social care organisations like other businesses will fail.

The problem for social care (and particularly statutory child care and mental health) is that it is not clear who the customer actually is. Leaders in the business give managers mixed messages. This applies whether those managers are in bureaucracies, user-led organisations or in professional practices. If the customer is truly the user of services then they need to have proper purchasing power or what the state says it can afford – personalisation has a model to do this. The role of management is clear in this scenario – to secure the most effective way of meeting service user requirements. If the customer is actually the state (society, communities, the law) then that is a different scenario. Here the manager has to secure the most effective way of meeting what the state determines the service user’s needs to be.