Our response here is intentionally brief, and intended to serve as an introduction and invitation to health and social care organisations, and other businesses, in the UK to partner with us to solve the problems they perceive with necessary systemic transformation.
The cart before the horse
Labour’s burning desire to reform the NHS, reduce waiting lists, and give patients greater autonomy and choice, relies on social care reforms; social care reforms which won’t even begin to be considered - by the groan-inducing “Commission” - until April 2025, with a very slow burn to a potential action plan being available sometime in 2028 - just in time for another General Election, and, very likely - given Labour’s proven ability to alienate every single demographic in the UK within their first six months in government - a new government.
The proposed intentions around social care reform are another example of the cart being put before the horse; they all rely on systemic changes from across the spectrum of government departments and social concerns to ensure they are actually viable, resilient, and able to be implemented by teams who will still have to manage their routine jobs. The intentions around social care reform include pressing needs for wholesale cultural change in UK attitudes and assumptions, which is the furthest from happening as it’s been in about thirty years, and likely to be set even further back by the rising influences in America, and the unchecked power of social media, on which anyone, no matter how ill-informed or ill-intentioned, can become an exceptionally powerful source of influence over a vast number of people from across the globe.
Recruitment ambitions
The ambition for social care recruitment centres around recruiting more men, graduates, and career changers to the sector. Typically, the response is “Well, then, you’ll need to pay better!” - but we are rapidly seeing the very real, negative impact to society of “just offer higher pay” - pay increases, the cost of being in business increases, the costs of goods and services increase, providers of goods and services record higher incomes, their tax burden increases, the government assumes this means “things are going great!” - and free-at-point-of-use services are cut, because “everyone’s clearly so well off, they don’t actually need free services - they can pay for them, they just don’t want to!” Council taxes and rents are increased, because obviously people can afford it, new ‘mandatory’ (and expensive) aspects of social bureaucracy emerge, instructions are given to employers that very specific (and costly) evidence of Right to Work must be provided by all applicants, any flexibility and ability for HR to use their discretion is removed… And a population that is already being impoverished by the increased cost of living and the financial toll of statutory obligations suddenly finds there’s new, and higher, barriers to actually entering the workforce in the first place, because if you can’t afford the specific evidence that the UK government will accept income tax from you, tough luck - you can’t get a job, however much you may want to. (This, it is important to note, is the reason “all these immigrants off the boats” can’t “get jobs, instead of taking our benefits!” - they’re not allowed to claim UK benefits, nor are they allowed to get jobs here.) Impoverished people who are not able to secure employment create a punitive demand on the welfare state… Are you starting to see how the cycle goes, and how fatally flawed it is, now?
Increased pay, therefore, isn’t the answer - especially not for the demographics that are being targeted, who have considerable capital in terms of their ability to command the kind of pay they want in sectors that aren’t inflating their pay as a knee-jerk response to changing political appetites.
What is necessary to attract these demographics to social care is a complete rethinking of how social care sees itself, and how it markets itself as a sector. Currently and historically, the narrative around why you should want to work in social care is about the relationships you’ll build, and the sense of wellbeing you’ll create - very vague, broad-brushstrokes concepts, which appeal very much more to women than men, to those with lower academic achievement backgrounds than higher, and those with limited focus and ambition in relation to employment, versus those who have considerable employed experience, and a likely stronger focus on what they want out of life, and how they’re going to go about getting it. For the cohorts being targeted in these new recruitment ambitions, social care needs to become more outcome focused, with a more open, accessible, and clearly communicated career progression route, which is available from day one to anyone who expresses an interest, rather than being barriered behind soft skills, office politics, and very ill-defined and amorphous “relationship dynamics”.
I have professional experience from the health and social care sector, and it is a very real fact that if your manager doesn’t like you, or your “face doesn’t fit”, you are not going to be offered any progression opportunities, no matter how hard you work, how well-informed you are, or how good you are at your job. Health and social care organisations do not look widely for their talent. In the NHS, particularly, the pervasive view is that no one lower than a Band 5 has the “necessary acumen” to be considered for progression. Even if you prove yourself to be an exceptionally insightful and competent Band 4, you’ve got a minimum of three years before you’ll even be glanced at where progression is concerned. NHS leadership will claim that they don’t think like that, that “these are just salary bands!”, but anyone who has ever worked at a Band 2-4 role can tell you that what happens behind the closed doors of NHS institutions is very different to what the NHS discusses on panel shows and in media articles. The cohorts identified as being “needed” in a reformed social care are cohorts whose focus is on progression - not necessarily linear, or traditional, but very much real and accessible.
Social care will also need to become more accessible to people with disabilities, including disabilities which prevent them from being legally able to drive, and more accessible to those who already have unpaid care commitments for children or dependent adult family members; this is going to require a radical reconsideration of how social care is actually provided, including the lynchpin commitment that social care is “about ensuring people can remain independent in their own homes for as long as possible” - keeping people ‘in their own homes’ is a laudable aim, but becomes logistically challenging if you need to accommodate non-drivers, ensure that care can still be delivered if a carer’s vehicle breaks down, or accidents or severe weather prevent vehicles being able to actually reach individual residences. It becomes expensive when your care organisation is having to pay mileage to carers who are attending clients who live miles apart from one another; a significant issue in rural and coastal communities, where there can be several miles of literally nothing between villages.
UK governments typically seem to jump to “make it a mandatory degree profession!” at the least provocation - but that excludes people from working class backgrounds who may not be able to afford the resources required for academic study. It excludes people who would be excellent at the hands-on demands of a sector, but are not able to engage with academic study owing to neurodivergence, cognitive impairment, dyslexia, or their own unpaid care commitments - or, indeed, their own need for care provision. And it is fundamentally unnecessary; social care is inherently a dynamic, practical, physically challenging premise in its frontline commitments; theory doesn’t tend to survive contact with reality in any sector. Back office administrative and technological functions can typically be best learned on the job. Leadership’s current poor reputation among the frontline workforce stems from the perception that people in leadership and management “wouldn’t last five minutes actually doing the job.”
Increasing reliance on ‘care tech’
Technology is expensive. It becomes outdated, and incapable of hosting emerging apps, within a couple of years; many of the “affordable” smartphones are already outdated in that respect at the point of purchase from new.
Technology does offer considerable possibilities for efficiency savings, and more personalised, responsive, and relevant care, across what is only going to become an ever more diverse population of care clients, but putting technology to use in order to harness these positive aspects means that every single care client needs to be able to reliably and easily afford up-to-the-minute-current, future-resilient tech, as well as having on-demand access to professionals who are able to support them to use the tech to its fullest possible capabilities from the moment they receive it. This can only realistically be achieved in one of two ways; either all tech has to be made free to everyone - because anyone can find themselves in the position of needing social care, at any time in their life - or disability and State pension benefit payments have to be substantially increased, and fully protected, to enable individuals who are most likely to find themselves in need of long-term social care to achieve the income identified by Loughborough University and funded by the Joseph Rowntree Foundation as the “Minimum Income Standard”; currently, for a single person of working age with no children, this is £28,018 per year, or £437.76 per week, while for a single pensioner it requires a minimum pension of £17,155 per year, or £349.04 per week. At the time of writing, ensuring disabled people who are not able to work owing the real-world impact of their disability, and pensioners, who are clients of social care, and thus expected to have completely up-to-date, fully reliable technology, and reliable wi-fi access, can achieve the Minimum Income Standard would require a significant uprating of the UK National Minimum Wage, because the UK population can only conceive of “fairness” as being “working people getting significantly more than people on benefits” - a view which is consistently echoed by the government via the mainstream media. Centring tech in care, therefore, is a costly consideration, even before you look at the fact that there will be an incredible job of work involved in addressing often very tech-resistant attitudes among those currently employed in social care, and rising frustration with the tech-centrism of everything in generations which are newly entering the workforce.
Questions to answer
This article barely scratches the surface of what needs to change to ensure effective, resilient, accessible, person-centred social care can be realised, and thus support genuine transformation of the NHS; to go into all of the considerations involved would result in a book, rather than an article.
There are several questions that need to be put before the social care sector for consideration; the most pertinent of those questions are:
1. What would independence that isn’t centred in a person remaining in their own, individual, general-community-location property look like, so that social care becomes less vehicle dependent, less of a contributor to pollution (and the associated health impacts), and more open, accessible, and inclusive to a wider pool of potential applicants?
2. Are you looking to tech for the sake of tech, or are there existing, accessible ways to achieve the same results ‘novel care tech’ is promoting?
3. How accepting and genuinely inclusive of LGBTQIA+ people, working age disabled people, and people with care needs who “don’t look sick” is your current workforce? How are you ensuring you’re recruiting the right attitudes in your future workforce in these regards?
4. Do you, as a sector, know how to articulate outcome-focused job attractions? What would a ‘from day one’ progression route for an entry level community care assistant look like?
5. What is the most persistent problem for your current frontline staff? Why hasn’t this problem been solved yet?
About the author
Ash Ford-McAllister (he/him) is the Director of The Productive Pessimist Ltd, a consultancy and leadership coaching organisation where professional experience in sectors including healthcare, finance, retail, hospitality, and non-profit are combined with lived experience of disability, mental ill-health, neurodivergence, kinship care challenges, gender marginalisation, and financial exclusion.
The posing of 3-5 questions to the organisation we're supporting is central to The Productive Pessimist method. Often, people know how to work on solving a problem themselves; they just become overwhelmed by the size of the problem, or the breadth of its impact scope, and 'forget' the knowledge, experience, and insight they already have. By narrowing the initial focus to no more than five pertinent questions, The Productive Pessimist team not only gains a clear view of what the actual problem is (because complex challenges and large-scale change propositions often result on people incorrectly identifying what the "problem" actually is at the outset, which causes avoidable delays, frustration, and expense), but are also able to 'clear the path' for more productive thinking from those we're working with.
The scope of the systemic 'critical flaws' in both the proposed social care and NHS reforms is far wider than we've discussed here, of course, and we're keen to work with invested organisations to discuss, and solve, sector challenges, and support businesses and organisations to remove barriers to necessary reform, and long-term success and resilience.
If your UK business or organisation - from any sector - feels The Productive Pessimist can bring insight and impact to the way you work, the way you want to work, or the challenges you face, then reach out to schedule some time with us - Email: theproductivepessimist@yahoo.com
Our consultancy services cost just £45ph/£300per day, and we also offer a range of affordable support interventions for businesses which do not feel a full consultancy partnership is required at this time.
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