Post welfare or fully integrated: what will social care be like in a decade?

http://www.theguardian.com/social-care-network/2014/dec/15/welfare-state-social-care-future

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What will social services look like in 10 years’ time? And how can we create a common vision of the future we want? That was the motivation behind the Institute for Research and Innovation in Social Services’s (Iriss) imagining the future project, of which I am an associate. Iriss has published four provocative scenarios describing very different notions of the social and political realities in Scotland in 2025.

The four scenarios (“post welfare world”, “new normal world”, “yesterday is another world” and “fully integrated world”) are the product of a year-long futures project exploring the relationships between a complex range of factors and policies.

The “new normal world” is driven by people power and an asset-based approach to community and support. It is balanced. Professionals are defined by an ethos of enabling rather than simply providing; providers are far more responsive to those they serve in this person-centred world. A major culture change in how we accept and give care has occurred. There is no stigma for people accessing services; everyone does at some stages in life. It’s completely normal – the new normal, and identities as providers, citizens, consumer and customer are interchangeable. Social cohesion is strong.

Is it possible to realise such a world in ten short years? Six months ago, I would have said not. However, the level of civic debate during the independence referendum and the renewed political and civic commitment to social justice, to reduce social inequalities and increase prevention efforts, should make us all rethink what kind of cultural and political shift might be possible over a decade.

The other three scenarios are less attractive but may be realities we could sleepwalk into. The “post welfare world” is based on the premise that welfare provision and the NHS cannot continue in the face of repressive financial cuts and ever-growing demand for services. Something has to give. In 2025, post welfare is a communitarian world where people are able, and enabled, to find support for themselves. There is no welfare state and local economies are driven by local commerce and a basic citizen’s income for all. Care has become the natural response of families and community but it is a world full of risk and a hard world for those who fall through society’s cracks.

“Yesterday is another world” is a critique of the professional workforce. It says that one of the biggest barriers to change is professionals trying to retain power based on values of yesteryear. To be radical and effective in the 21st century we have to abandon that mentality, redefine our roles and share power.

Some have suggested that planning for this world is planning for the status quo. One commissioning county council who reviewed the scenarios saw this scenario as their reality five years ago and something they must never return to.

In the “fully integrated world”, the big surprise is that while there is structural integration by 2025, the reality is that it is clinical, impersonal and a betrayal of the promises made a decade before. This is a highly managerial, technology driven, cost-saving world with poor leadership. This world reminds us of the need for humanity in care and about the emotional dynamics of change.

The signals of us moving to at least elements of this world are already evident, particularly in a UK context. Last month the health secretary, Jeremy Hunt, announced that “access to care would become as easy as internet banking” and that the “NHS must make better use of technology to slash costs”.

The scenarios offer a compelling read for anyone interested in the future of social care and use literary devices to convey ideas and evidence, such as NHS whistleblowers, the secret social worker blog, apparently leaked memos and fictitious radio reports.

The Imagining the Future project involved 700 participants from sector leaders to communities in Govan. Ultimately, it is likely that by 2025 we will see elements of each scenario. Because each is based not on forecasts or predictions, but on a vast amount of research, drivers of change and workshops, the set are a powerful tool for anyone thinking about workforce planning, approaches to leadership or testing strategic plans.

In Scotland, local authorities, civil servants, voluntary and private care providers have responded well and are already using the scenarios, and rehearsing their responses to the different futures. The scenarios have engendered stronger confidence in people when planning for the future. Perhaps they will also encourage more positivity and higher aspirations in the coming years.

You can find imagining the future resources here.

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