“The lesson for a futurist: history is made of unintended consequences. Whenever you think about a solution to something, deeply examine the possibility that it will create opposite effect. Every solution bears seeds of a new problem.” Marina Gorbis, Institute For The Future: Executive Director
Palo Alto, California
David Boyle has suggested that “anything we can do to help define a new direction for the radical centre would be very timely”. This is my response.
In this piece, in addition to writing from bottom-up, I have a vested interest. I have personal experience of old age: I am 81 years old.
I think the UK is now in a muddle. It is impossible to understand how things are now, let alone the direction in which the nation is travelling. Except in one aspect.
There is one thing we can now be certain of. There will be an increasing number of old and people with physical or learning difficulties needing care. And we DON’T KNOW what to do about it!
Mindful people might agree that the increasing dependence on the state, which most of us have ‘enjoyed’ for all our lives, is going into reverse. This may slow down for a while, if we have a government which conjures up extra public spending from somewhere. But, I see a future of unavoidable no-growth.
Those who reject this view assume that funding will be found to provide care services. So they must think there isn’t a problem! To me, this is a mindless head in the sand view – but then, I am prejudiced.
Even if more funding is found, the problem of how to manage the increasing demands for social care seem to me to be intractable with the current system. I cannot believe that sufficient care staff will be available to provide the services. Wages are low, caring is an unpopular occupation and immigrants seem unlikely to provide a continuing source of cheap labour.
Also the big care home companies are saddled with debt and have profit seeking owners and share holders.
We must assume that there will be a continuing shift towards individual self-dependence. And that it will be up to us, as individuals, families and local communities to look after ourselves. In health, work, social and cultural activities and especially in old age.
The problem then is how to manage this move towards local community care. It has to happen. The longer the delay, the greater the problem will be.
It can’t be left to a free local market. It doesn’t exist in care.
Local community-based organisations will have to take the lead in providing and managing care services.
In this piece I focus on the management of community care services. Which is so important now. Community ownership will have to follow later.
At first sight, it may be assumed that relatives of those needing care will have to play an increasing role in their own homes. But what will then happen in the care homes?
Full-time caring for elderly parents in your own home is understandably unpopular in the modern UK culture, in which more than one income is essential for comfortable living. Not only is it unpopular, but it is also impracticable with an aging population in which very old people have to be looked after by old people.
There is an alternative but it is not legally possible at present, because of local government funding processes, Care Quality Commission inspection and regulatory systems, the personal taxation system and employment laws. All of which inhibit breaking away from how things are done now.
The alternative would be to activate and legitimise the grey economy locally. [Wikipedia: the informal sector, informal economy, or grey economy is the part of an economy that is neither taxed nor monitored by any form of government.]
The grey alternative would enable volunteers, relatives and friends, to be ‘employed’ in care homes and residents own homes, on very low wages, providing supporting roles. Undertaking cooking, cleaning and maintenance.
Most important, spending time with individuals in care, who may include their own relatives. Spending time in conversation, sharing memories, encouraging mindful thinking, playing card games, sharing old photographs and generally helping to maintain positive thinking. Becoming the friends many people in care no longer have.
Carers in the grey economy would be paid low wages (say £2 per hour) and receive out-of-pocket expenses, on such things as travel, special clothing and for their meals in the homes. They would be paid by a local organisation, specialising in the management of grey care.
This approach reflects the fact that care cannot be financial viable in the conventional economy. Which is perhaps a portent of things to come in a no-growth economy.
Supporting people to stay in their own homes is a crucial aspect of this alternative.
The reasons why people become unwilling to remain in their own homes are not fully appreciated until you get old. It is not just that those needing care are less able to look after their bodily functions, which in truth is probably rare. It is more to do with help needed to look after their homes.
People become reluctant to stay in their own homes because they are unable to deal with the day-to-day problems of living in and maintaining their houses and gardens. Changing a light bulb is a problem for those unable to balance on a chair or steps. Reaching things in top and bottom shelves becomes impossible as you get older.
People who have tended their gardens all their lives can’t bear to see their cherished borders become weed infested. Aspects of daily life which are seen by younger folk to be trivial become all-consuming problems in old age, leading to decisions to move to a care home or put pressure on their children to take them in.
Electricians, plumbers and builders already provide their services free of time charges to their own relatives, but those without relatives locally do not get this benefit and end up in despair at the inability to care for their own property. This is a particular problem for elderly people without relatives nearby. Community care must deal with this problem. It must include help to care for peoples’ homes.
Trust is all important. Knowing that someone at the front door comes from the local community organisation, and that organisation is known to be responsible for those they employ, will provide the kind of trust which is all too often missing today.
This is a kind of community care which overcomes the problems to do with people being unwilling to care for their relatives in their own homes. Would they rather stay at home caring for their relatives and not get paid for it, or spend time when it suits them, and be paid pocket-money, to help in their local care home? Looking after their relatives and others needing help.
Also, bear in mind that relatives of those currently in care homes are generally dissatisfied with how their parents, siblings and children are looked after. A kind of resigned dissatisfaction which is despairing of ever being able to get things done like they want.
For community care to work, the responsibility for managing these ‘grey’ care services will need to be undertaken by legitimate not-for-profit local organisations, with their own local funding. Raising money from community fun events (which incidentally would generate community development), endowments from relatives and those who have benefited from the system and support from local businesses. Why not pay for the care services you have received after your death?
These local organisations will have to be authentic, autonomous, and unhindered by top-down edicts from self–interested social service and health authorities.
But there is a problem. There are few formally constituted local organisations in most areas, which are empowered to undertake the kinds of services described here. Organisations which would be not-for profit companies, perhaps in mutual ownership, as co-operatives.
But how do they get started? They need lawyers or capable individuals to incorporate them. They need to make their doings financially viable. Not by conventional grants and loans, but by raising money and developing resources locally. Especially not by borrowing money – this leads down conventional pathways with hidden potential for disaster.
I have previously suggested that the way bureaucracies plan local services needs to be changed. What follows is one possibility.
I propose that local authorities should help local communities to establish and incorporate organisations which can provide and run care services for their communities. The local authorities would provide templates and support to informal local organisations to enable them to become legally incorporated, with proper financial systems.
There are already national organisations which provide this advice to self-funded local organisations, but I consider that it should to come from the local authorities. They would then have to recognise these new kinds of local organisations as legitimate and work with them. But in no way must they control them.
Politically, this is neither left, central or right. It is down to the local communities.
The government should promote the idea, with suitable financial motivation, to get the co-operation of the local authorities.
Cultural changes would be required: in social service and NHS funding process of care services; in Care Quality Commission inspection and regulatory systems; in the way that the employment related laws deal with the personal taxation system of volunteers; and laws relating to minimum wages.
Little new legislation would be needed. Just changes in mindsets and abandonment of vested interests.
When it is found to work, as it will, it will point the way to new kind of future for all kind of public services as their funding dries up.
It would be a future in which power would be transferred down from public authorities to individuals and their local communities. It would contribute to a fundamental system change. It challenges established notions that the establishment knows what is best for us. Most important, it will have the potential to begin to create a new kind of society.