Andrew Dilnot is right: the public needs a new story of social care

By Neil Crowther

It was fascinating listening to Andrew Dilnot at yesterday’s Treasury Select Committee on social care funding, talking not only about the detail of the government’s latest proposals, but crucially about the importance of winning media, political, and public support to increase investment to a level necessary to achieve the kind of support we might have reason to value.

Dilnot noted how the government’s funding proposals, the detail of which was published on Wednesday, amounted to the first time any significant increase in spending on social care has been committed by a government for 40 years, but that this fact and the inadequacies of the proposals pointed to how ‘social care simply hasn’t attracted political, public or media support proportionate to its needs…….so I do think the proposed settlement is inadequate, but that’s a problem that implies criticism of all of our institutions and we all need to reflect on why something so important simply hasn’t had the support it needs if it’s to be done well.’  

He went on to say that ‘the sector needs a different kind of profile & there are all sorts of questions about why we don’t talk about this very much.’  He reflected how surveys show that people who draw on social care find people are often happy with their lives and their support, which ran counter to the fears people who don’t draw on social care appear to expressed and perceptions of what social care is and does. 

Personally, I don’t think the challenge concerns ‘the profile of the sector’.  Rather, it speaks to the need to shift the debate from being one that starts with and remains exclusively about money, private assets and ‘systems’ towards one that is about the way we all imagine and think about care and support in our lives and the values needed to support change. Right now, we are missing crucial opportunities to speak to and shape values and thinking about the world we inhabit together, how we want it to be in future and the role of care therein. There is hence little moral context to the discussion, save ‘looking after the vulnerable’ which has little purchase on public salience, or protecting people against ‘catastrophic costs’ which asks nothing of the role that care should play in our lives. Other movements for sometimes complex and technical policy and practice change, and significant financial investment, such as those for climate justice, have learned how starting with these broader ‘who are we and how can we live well together?’ questions are crucial to winning support for reform.  We must do too.  Caring Across Generations explore this and the role of pop culture in shaping how we think about care in this excellent article.

We also need to break free of short termism.  Most campaign messaging on social care is about short-term relief – to relieve current urgent pressures – even as it attaches to a debate about long-term reform.  This criss-crossing of immediate term and long term means that the hard graft of shifting thinking to support long term reform never really begins. To convey urgency, messages centre only on what’s wrong, confirming rather than challenging the negative thinking Dilnot refers to. 

So, in the week that the government has published detailed proposals for long-term reform, the media, many providers, charities and Trades Unions have been focused – understandably – on the immediate recruitment challenges facing the social care sector and on the feared impact of vaccine mandate. Documentaries and news programmes on both BBC and ITV on the ‘crisis’ in social care.  The message, as it has been for several years, is that social care is broken and on the brink of collapse, meaning that ‘people could be left in urine soaked beds’ or ‘not fed on time’.  In a bid to increase the pay and conditions of staff, we are told about how hard and unpleasant care work can be, as though this – rather than the value of the work – is what should command better pay and conditions.  TV documentaries depict people drawing on social care as isolated, distressed and neglected. We rarely if ever hear directly from people that draw on social care, who are depicted as only silent victims, implying ‘social death’.  In this` dominant narrative people are objects, for whom tasks of bodily functioning and everyday living – feeding, washing, dressing, going to bed and getting up – are done to them at great cost to the social care workforce, or their families.

Even the government feels compelled to frame its plans as ‘fixing’ social care or ‘getting social care done’ (echoing the language of Brexit) – as leaving something behind, not building something great for all our futures.  The framing is about loss aversion (not having to sell ‘the family home’) rather than gain (having a good life because of great support).  This is despite evidence from countries, such as Germany  that that key to secure public support for reform is people feeling their money will buy them something that they have reason to value.

Every shred of evidence about the impact of messaging on public thinking finds that urgency absent a sense of efficacy breeds fatalism.  And in a context where many of us have a view of social care as representing loss rather than gain, as something to be avoided, not something that could help us to maintain our wellbeing and life goals, these messages are just feeding the beast.  They reinforce an association between social care and death – the ultimate fatalistic thought. And in the face of death we turn away for as long as we are able to.

In expert debates, ‘care’ itself – what it is and does and whether that is the right way to organise things – is not really questioned.  The focus is on securing more money, but not whether more money will buy us something better.  The offer therefore is that with more money, more of us can have the thing few of us want.  It was also, therefore, interesting to hear Dilnot comment that ‘our best option is adequate funding & innovation…this sector hasn’t radically changed in how it delivers care.’  In the current cycle of ratcheting up urgency to win short term ‘aid’ there is little if any space – rhetorically or in reality – given for new thinking and ideas.  The resultant perpetuation of institutional or time and task, life and limb care feeds harmful depictions of and attitudes towards social care, generating a negative feedback loop. In #SocialCareFuture’s assessment, a message of ‘look how it could be, if only we invested more’ is infinitely more powerful than ‘it’s terrible, give us your money before it gets worse.’ That’s why, in addition to a new narrative,  we have placed so much emphasis on showcasing ‘glimpses of the future’.  

We have to disentangle short term campaigns for injections of funding from the very different kind of long-term work needed to change the weather when it comes to social care.  That’s why #SocialCareFuture developed a vision focused on the future we want to bring about, but we need help to develop and share it more widely and to realise its full potential in reshaping attitudes, assumptions and expectations.  Some donors have been in touch to express and interest in supporting this, but we need to build a coalition of the willing, up for backing and being actively involved a long-term effort to shift thinking, build support and mobilise a movement for deep and lasting change. We plan to convene interested parties to explore this early in the new year.

Underpinning this, we need to shift from protest to proposition, pointing not just what’s wrong, but also to what’s strong, what can be built on and how we can make steady progress towards our vision.  This is about growing the future, not fixing the past.  There has to be a believable plan for change, going way beyond just questions of funding, which we own and deliver together, and that we can invite other people to get behind and we need to stop expecting government alone to lead this work.

And finally, we need the voices of people that draw on, or have cause to draw on social care and the people that care about them to be far more prominent in this debate, confronting ideas about what social care is, does and its value and leading debates about the future. With Community Catalysts and Think Local Act Personal, Social Care Future is working to support more people who draw on social care to be spokespeople, and Social Care Future has successfully influenced events organisers to ensure those voices are on the stage and around the table in debates about the future. We clearly have work to do when it comes to representation in the media and welcome ideas and support in addressing this.

As Andrew Dilnot rightly said, the way social care is depicted and how we think and feel about it is a major obstacle to the meaningful reform we all want.  The only answer for those of us that want to break this deadlock is to mount a serious effort to shift mindsets through concerted strategic communications, focused on long term change.  That’s why #SocialCareFuture is leading work on changing the song people hear about social care and changing the chorus line that they hear it from.  Through our work, we have a produced a story of change that the public shows strong support for.  But we need to tell that story in creative, engaging ways that reach large numbers of people, over and over again.

You might draw on social care, or work in the field, you might be a campaigner or movement builder,  work in marketing or communications, be a journalist or work in social media. You might be in the creative industries or the arts, or be an investor of donor. If you’ve something to bring to this journey –  we’d love to hear from you.


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