In the midst of headlines about funding struggles and sectors – including social care in particular – jockeying into position for the spending review ahead, I’m really struggling to find hope.
Mostly I can come across as a fairly cynical character. I started working in social care in 1993 so maybe it’s time that does that. I used to comment that ‘just when you thought it couldn’t get any worse – it does’ but that seems less like a joke now – and more like a telling indictment of the last 20 years in social care.
Of course there have been massive improvements – mostly around embedding user voice and choice (although some rather clumpy and sometimes tragic failures in running with repeated meaningless projects which are less about users and more about using and saying the right things). There have also been long leaps backwards in terms of access and eligibility. Some things needed tightening I’m sure but we are way beyond that now.
The privatisation of much of the social care market came at a cost of driving down quality commissioning until price trumps all. That isn’t to say all private is bad and all public is good. I’ve veered away from that. But it has been the increasing lack of knowledge, understanding and checking in commissioning that has led to the race to the bottom. Yes, the govt cuts have impacted this but it seems there are few drivers to re-establish commissioning as a role for people who understand services rather than an administrative task it seems to have become.
The other main positive, I’d say, is the Mental Capacity Act (2005). That improved practice. The sadness is how much work there still is to do in that area but it’s a fantastic piece of legislation that has made a positive difference.
Despite that, I’m struggling at the moment because I can’t see the hope that I used to hold on to. I can’t see where the ‘better’ comes from. I want to hope. It’s a far better place to be. I worry about the work I do which can sometimes seem to do more harm than good on a system level. However much I want to change the world or make fancy pledges about being a change agent, I can’t shake off the growing feeling that – by working in a broken system, I am helping to perpetuate it. Pledging to smile at patients more or tell people my name when I meet them may improve brief interactions but it isn’t going to address the structures and systems which are collapsing under pressure.
I wish I knew where to find the hope again. I’ll keep searching anyway because the alternative – well, it doesn’t bear thinking about.