After the storm: Hope in adversity

Covid-19 has shone a spotlight on issues that were known to exist but were not given prominent national focus. The implications of the pandemic, played out in the full glare of publicity, has cast a sharper light on issues of poverty, disability, minority ethnic communities and the unequal distribution of caring responsibilities.

Author: Sam Smith, Founder & CEO of C-Change Scotland and Small Supports partner

It has also highlighted the role of social care but done little to broaden understanding. Rather it has cemented in the mind of the public an association with care of our older citizens, residential care and nursing homes. The crisis has exposed the travesty of defining key workers, upon whom we all rely, as low skilled and deserving of no more than the minimum wage.

But what to do with this accumulated knowledge?

There have been many calls to action, to harness this wisdom and mobilise in support of the steady march of progress. I am all for that, believe me. However, I would also sound a heavy note of caution. No amount of wishful thinking will lead us to the sunny uplands we desire. We should actively plan for the worst that could happen. I am not suggesting anyone is hatching a master plan to achieve some dastardly outcome. No, far more prosaic than that, I am concerned about the seductive pull of low aspiration that may lubricate a slow slide back to same as it ever was, only worse. A number of factors inform this perspective and I will outline them briefly.

1. The economic impact of Covid-19 will need to be paid for. The impact of the 2008 economic crash resulted in policies that imposed 12 years of austerity. The negative consequences of these policies fell disproportionately on those also most detrimentally affected by Covid-19. Why would we expect it to be any different this time (less money)?
   
   
2. There is another Brexit shaped shock to the economy looming on the horizon, creating more uncertainty, more nervousness in the system (more uncertainty).
   
   
3. Years of austerity did more than denude the options of people requiring support, it also impacted upon those serving them. Commissioning and Social Work practice based on gatekeeping resources and slotting people into ‘vacancies’ has deskilled and demoralised the workforce (deskilled and demoralised).
   
   
4. Individuals and families in need of support have been hanging on by their fingernails, trying to get by, while the pandemic works its way through the population. There will be a groundswell of unmet need as the restrictions relax (unmet need).
   
   
5. There will be vacancies left in services by those who have succumbed to the virus. Providers in an already fragile financial state will be looking for opportunities to re-establish their occupancy rates (easy options).

This confluence of predictable factors does not readily lend itself to a better tomorrow we envision; one based on personalisation, self-direction, choice and control. However, by naming the risks and explicitly planning to mitigate them we are better placed to create the future we dream of. At this juncture, allow me to take a slight detour, by way of illustration.

One of my greatest teachers was R. He had experienced a lifetime of institutional care, trauma, rejection and hurt. I had commissioned a number of services that failed to support him and he returned time and again to Assessment and Treatment Units, that also failed to treat the real issues that ailed him.

He had learnt from others he had met on his journey through the system, a broad range of behaviours to express his distress. These earned him a hefty reputation for doing things others found difficult.

As a support provider C-Change committed, alongside a strong and skilled multi agency team, to support R to try and change this life cycle. There was a clear vision that better was possible.

He put us through the ringer.

Every couple of weeks as we got to grips with one challenge it would change to something else. Physical assault, verbal assault, threatening his neighbours, going on hunger strike. At one point he took on the persona of Bobby Sands, the IRA hunger striker, refused to wear clothes and had a dirty protest (yes, s**t on the walls). This was followed by a stint as a native American Indian (“I aint eating no white mans food”). He went on hunger strike, he went missing for three days and he also set his house on fire.

We had planned for most of these eventualities and most particularly the last one. He had a sprinkler system installed in his home, for just such an event. It activated and the fire was extinguished but the lower floor of his house was a bit damp. At this point it was suggested that he be readmitted to hospital. We knew that doing more of the same would not work. We had to think differently.

The less orthodox approach, we suggested, was that we install dehumidifiers in his home and that he remain there. The risks were mitigated, what better place for someone with thoughts of arson than a damp house with a functioning sprinkler system?

And that is what happened. It was possible because we shared a vision with a group of trusting and committed colleagues that better really was possible for R, even when he didn’t believe it himself. We also had honest open communication about the challenges we faced while working together to help him overcome a lifetime of adversity and begin to lead his good life.

Together we succeeded in supporting R to live out the rest of his life in his home in a community where he was known and regarded. He taught me as much as any textbook about holding the faith that better is possible. That if we assiduously plan for the worst and actively mitigate those risks then we can keep on track to achieve the shared vision we have outlined.

People who challenge us also help us think about how we could do better. The communication may be unorthodox but the message, no matter how it is delivered, is clear, you must try harder, you are not getting this right. No amount of wishful thinking alters this fact.

So, taking this back to the issue of social care emerging from Covid-19. We need to be clear what we have learned, be optimistic about possibilities for the future, but clear eyed about the predictable risks that it could be far worse. We need to be explicit about what the worst-case scenario might look like and put measures in place to mitigate those risks. We need to seek alliances with others and work diligently together to build a clear vision of the better society we aim to achieve. We do not have to create these ideas from scratch, we have a clear set of agreed aspiration detailed in the human rights conventions Britain has ratified but not incorporated. These should be ground floor not the ceiling of any aspirations we desire to make a reality.

Having agreed this, we then have to be brave, be clear, be honest, hold tight and stick with it.