Author: Bob Rhodes
In this short piece Bob Rhodes questions whether life is really all about public services.
A few days ago I met some inspiring people who had succeeded in the eye-watering commission of brokering a regional five year Strategy for Adults with a Learning Disability between 5 local authorities and a health board. I was flattered. They met me to explore whether I would consider chairing the key implementation mechanism for the strategy, entitled Meaningful Lives. I had been advised in advance that critical friendship and radical thinking would be central to the contribution I might make, and that my stance might be “a bit rich” for some tastes. I’m relieved to report that I connected happily and easily with all my hosts but not, it transpired, with the strategy document which I took away to read after the meeting; a document that bears little relation to the exciting and optimistic conversation I’d enjoyed with its proponents.
I should not be surprised at people’s capacity to tolerate and disregard intellectual dissonance, illogic and contradictions. After all I’ve spent most of my ‘leadership’ life addressing institutionalisation, socialisation, and organisational change. But I always am.
To kick off our discussions I’d asked for a summary of the vision and how it had been evolved. There was joy on the face of my informant when he described how the strategy had its roots in consultation with “service users and carers” and that the key priorities specified and developed in the plan fully reflected their wishes. I observed that, historically, such consultations have too often been pre-empted by the programmes and services flavour of the questions asked and constrained by the limited knowledge and experience plus institutionalisation of the respondents. These observations were taken on board – which I found really encouraging given my day by day experience of defensiveness and rationalisations – and led to vigorous discussion of what has been learned from asking open ‘Good Life’ or “what really matters and is essential to you leading the life you want despite your frailty or disability” questions.
I had pointed out that, while it was reassuring that some people had identified a desire for friendships and relationships as top priority (it came top with 42 votes out of 246 cast so was only important to a sixth of respondents in the context of this exercise), nearly all of the priorities were recorded in language that related to services. This was hardly surprising as, when I got around to reading the document, it stated that participants had been “asked to identify the key themes and priorities for learning disability services”. Subsequently, it seems, the same exercises had been undertaken with a full cross-section of institutional stakeholders and the priorities forthcoming checked against the “national legislative and policy framework and related local health and social services strategies”. The document does not tell us how things might proceed if peoples’ wishes did not comply with pre-ordained constraints.
With hindsight the dissonance between our on-going conversation and the strategy document is all the more bizarre. I had developed the conversation by suggesting that the role of services should be supplementary and complementary to, and sustaining of, lives based upon relationships and belonging (that is, for the avoidance of doubt, lives spent reciprocally and interdependently amongst family, friends, neighbours and the communities within which folk contribute and associate). We’d talked enthusiastically together about the potentials inherent in self-direction, about the leadership challenges associated with reversing the current of social care consumerism and dependency, of educating the wider political and bureaucratic cultures away from fixing and social engineering to enabling and supporting, and been excited by the possibilities engendered by restoring and supporting civil society and returning power and responsibility in that context to citizens. We’d been in clear agreement that the starting point lay in helping folk get clear about what matters most them and then helping them generate lots of possible routes to evolving the outcomes that make their lives progressive and fulfilling. We’d animated discussion about methods for promoting effective and creative thinking both in the workforce and amongst the wider population. We’d told stories of creative solutions and the evolving nature of real live as against the episodic and often inert realities of service interventions. Without doubt we had ‘buzzed’.
So it was disappointing, on reading the strategy, to see the same old chestnuts, the service and institution centred assumptions dominating the core principles that were deemed to have been derived from consultation with citizens. Instead of statements starting with terms such as People, Citizens, Families, Networks, Circles, Associations, Peer(s), Communities and Neighbourhoods the emphasis of nearly all of the thirteen statements stated or heavily implied, “Services should”. On not one occasion did a statement lodge the power nor the responsibility with individuals or families.
And the killer statement - that sums up the worm in the bowels of the thinking and places all accountability and authority squarely in the hands of local authorities and professionals, and which paradoxically follows immediately after the injunction to “promote independence and social inclusion” – is set out in principle 2:
A comprehensive range of services should be available for people with a learning disability which provide timely, responsive person centred solutions” (my emboldening)
Any objective examination of the document will leave the reader in no doubt about the implicit beliefs, assumptions and, perhaps unwitting and unintentional, objectives of the authors. Implicitly the most important element of the lives of people with learning disabilities is, in this institutional culture, the public services that they receive. There is barely a hint in the document of any other perspective. As a consequence the whole tenor of the strategy is concerned with service improvement and user and carer involvement in their oversight.
When a Carer explains that, “Carers need emotional, practical and social support”, the Strategy immediately asserts that, “it is necessary to ensure individuals have access to appropriate information, a carer assessment and a flexible and creative range of support options to meet their respite needs. In addition carers should have opportunities to access appropriate training and support.” In other words serviceland is saying, “We’ve got the answers. Just plug into our comprehensive services. It’s just a matter of funding them.” And that, frankly, is plain stupid! Carers who have, or have been helped to have, their own meaningful lives with intentional and loving (hardly a service term!) networks of family, friends, neighbours and enabling professionals deem the service options, when available, as hollow alternatives. And, beyond that, when I have something to sort out I habitually ask myself how might I or we (preferably) possibly deal with this. I doubt that if I need emotional, practical or social support that public services will figure high on my list of desirable possibilities.
And so, if I do have the opportunity to assist these authorities along the journey to enable people with learning disabilities in this part of the world to secure and sustain meaningful lives, the first thorny question will be how we might reinvent the strategy so that it reflects and reinforces the aspirations and passions of the people I met. I guess that a good starting point will be to develop a concise and simple guide to the strategy that will become the implementation ‘bible’? This should provide clarity of vision – clear about values, beliefs and principles; clear about required outcomes; clear about the subsidiarity of ‘serviceland; and, crucially, setting out the initial targets for systemic and behavioural change – asking and responding creatively to the ‘good life’ question would seem to be the most apt launch pad. Additionally, in setting out a vision for how the ‘social contract’ between citizens and their public services will be rekiltered, the ‘agenda for action’ document needs to be explicit that everyone is part of this transformation and that, at the least, representatives of everybody will be actively engaged in its iteration.
In closing I make a very simple observation. When we set out to bring about change and this is validated by a public statement that takes its credibility from its roots in the democratic process and public consultation, it is crucial that we design and carry out the consultation exercise with reform rather than tinkering in mind. This consultation implicitly announced that the intention was to fine tune and improve the existing machinery rather than explore more effective possibilities. Now it will be necessary to do the consultation again as part of the implementation of a reform strategy. It would be sensible to consider making this the foundation of the ongoing evaluation process?
The publisher is The Centre for Welfare Reform.
Bridging the Rubicon © Bob Rhodes 2012.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.