How Not To Solve The Health, Housing and Care Crisis

Crisis (noun)

‘a time of intense difficulty, trouble, or danger’.

‘a time when a difficult or important decision must be made.’

The housing crisis can no longer be ignored.

Neither it appears can the crisis in health.

And nor can the social care, or ageing crisis.

Our repeated use of the word crisis is telling and perhaps applied a little too liberally.

In the past couple of weeks we’ve had two major health and housing conferences both crying out for, not unreasonably, immediate injections of cash.

How can it be that some of the biggest players in the social sector face a crisis at exactly the same time. Is it rising demand? Lack or resources? Or the impact of years of austerity?

Or is it something more fundamental. A deeper design flaw – thinking of people as problems to be fixed – that’s been there for decades, largely hidden beneath the surface, only now becoming visible.

On the face of it – resources shouldn’t be an issue.

The NHS and Social Care sectors employ 3 million people in the UK,  the social housing sector about 150,000.

In a population of 65 million that means every person employed in health, housing and social care only needs to look after 20 people. 

It’s a simplistic way of looking at things – but it’s done to consider two points:

  • How much of our impact across the social sector is diluted by our lack of connectedness? To paraphrase Simon Penny – why don’t we have seamless health, care and housing that isn’t compartmentalised, siloed and rationed across disparate organisations?
  • How much of our collective resource is tied up in back office ‘management’ rather than pushing ourselves ever closer to the community? The sheer number of employees and players involved suggest it’s not completely fanciful to imagine a health, housing and care connector on every street corner.

In her book ‘No Is Not Enough” Naomi Klein argues that , far from being aberrations, or even reactions, events like Brexit and Trump are simply a logical conclusion of the path we’ve been on.

An era of hyper-consumerism, of seeing houses not as homes but as ‘assets’, of seeing billionaires like Bill Gates and Richard Branson as the ones to solve wicked social problems.

An era in which organisations and brands come first and communities last. Where resources that are meant to trickle down rarely do.

Even if you disagree with Klein, it’s hard not to see the parallel with the social sector which has become increasingly corporate, paternalistic, brand obsessed and ‘on message’ over the past 15 years.

Brands threaten local community and social movements.  Whilst brands compete with one another for market share or ‘social space’, movements work with whoever wants to reach the same goal.

At at a time when we really should be working together to solve problems in the most effective way we often make decisions based on protecting our brand.

We Need A Plan, Not A Brand

Integrating housing, health and social care systems is complex. Each sector has completely different governance, funding and regulatory regimes. It’s not impossible but it’s highly unlikely to happen.

Perhaps the future will be re-imagined through grassroots movements , both at community and organisational level.

Perhaps it will be explored through people like Bromford and Wigan Council who have resisted the crisis mentality – and invested in services aimed at moving from reactive to preemptive. People like Redbridge Council who see the future of local government as people centred, experimental and collaborative.

As I outline in this podcast – people are up for change like never before – we just need to provide a compelling alternative to services perpetually in crisis.

  •  If we are in a crisis then everyone knows the worst thing you can do is panic.
  • The second worst thing you can do is to throw money at the problem.

The demand issues that are hitting the social sector are a result of complex problems , including our way of life, environmental change, and even a lack of personal responsibility.

Injecting billions of pounds may give some short term relief but won’t tackle the root cause or return us to a golden age.

The past leads to the present. The road we went down got us here.

The future of health, housing and social care means treading a path we’ve never gone before.

It means imagining something that doesn’t even exist yet.


10 thoughts on “How Not To Solve The Health, Housing and Care Crisis

    1. Appreciated Russ and yes – I think this applies to quite a few sectors. There’s a not a lot of evidence to shows pouring cash on something has a long term performance boost

  1. I was directed to this via Russell on LinkedIn. You article sparked in equal measure, interest (because not the usual line), a feeling that you have something, and strong disagreement.

    Disagreement because in the area I know something about, prisons, it isn’t the case that there has been a ‘crisis’ for a long time, isn’t the case that back office functions are syphoning off money (less so than a few decades back, I know for sure), isn’t the case that the crisis is one of ‘connectedness’ (whatever that means) and IS the case that this is primarily a crisis of money and cuts.

    I know less about probation but enough to say the crisis there is about deliberate fragmentation, inexpert new providers and again, money and staffing cuts.

    I know a little about the NHS, but enough to know that costs increased far faster than economic growth even prior to the past decade of exceptionally low growth, because of an ageing population, advances in medical science and increasing demand e.g. the rapid growth in people visiting A and E, in many cases not because they are sicker but they wont wait and think they need to bee seen NOW. One can go back further to when I worked in the NHS, and look at reasons why the service improved so much between say 1980 and 2000. I think (don’t have facts with me) that extra money and staff was a major factor.

    I know even less about housing but I do know that if we have been building houses for the past decade at less than half the rate of the previous decade, and that we sold off most social housing – so isnt it money and cuts yet again?

    If economic growth and therefore state income and therefore state spending had continued after 2008 at pre 2008 levels, would we be talking crisis in this way? I doubt it.

    So much for disagreement.

    Nevertheless there IS something here.

    For example, why are services in small countries often better quality, less bureaucratic and maybe even cheaper?

    Another aspect: prior to 1992 there as remarkably little focus on public services. We did not know how they were doing – that is to say, government itself was remarkably ignorant – and little focus on improvement. The unsung hero of modern public services, John Major, started a revolution when he started setting standards and targets and publishing the results and telling the public they were entitled to better. I recall that waiting times shortened dramatically in just a few years NOT because there was a shed load of new money but because managers (including myself) were made aware that their future was at risk unless they forced themselves to understand how their services produced poor results, and did better. But – maybe – that increase in performance through sheer focus and effort was necessarily a one off – maybe you can pull yourself up by your bootstraps – but only once in a generation?

    My own sense is that at the heart of all this is what I call the ‘over maturity’ of public services, indeed of the State itself (which is close to what you touch on). The NHS was a marvel when first introduced and very cheap to run per head, because people did not expect much and were delighted by the very limited (by modern standards) service they suddenly started to get. Since then the service has got every more comprehensive and ambitious, but expectations, and technical ability, have grown way ahead of supply, so we are now furious about not receiving a service improved out of all recognition since 1947.

    It may be the the ascending line of demand, expectation and technical ability is now so far adrift from the sagging line of economic growth that, whether Labour or Tory Governments are in power, the problem cant be fixed.

    Is this at bottom an economic problem? The post 1960 boom hasn’t lasted and couldn’t last, the party is over?

    And so on.

    So you are article has done what it should and generated half a dozen thoughts in different directions…

    1. Thanks Julian for such a thoughtful comment and challenge!

      Actually as far as the disagreement we are probably a lot closer than appears. I think there IS a need across most of the ‘social sector’ for a short term cash boost to alleviate pressure and give people time to think.

      One of things I see in my day to day work is the expectation sometimes that people can “think big” and re-imagine services at the same time as keeping the shop running. Mostly they can’t – even if they had the time they often lack the skills.

      Your reference to the ‘over maturity’ of public services is key and this is worth much more time exploring than we give it. This isn’t just a UK problem but is a symptom in most ‘developed countries’.

      Great comment – thank you

  2. Getting back to housing/caring/keeping healthy with an ageing population why not a combined effort? The NHS stands to benefit most from the new ‘extracare’ homes so why not chip in to get them built so they can move on patients not requiring critical care? Health and social care financed by County/Unitary Councils stand to benefit from retirement villages with all their care in one place and the facility is more secure in terms of getting the rent than supported housing under 35’s.(tongue in cheek) What is more if the bulk of people in need have some form dementia or extreme loneliness then ‘safe’ villages may well vastly improve the well being of residents so that people might actually queue up for places. (Next door to a nursery school that frequently bring children in for concerts)
    However I would NEVER combine the roles of those involved with residents. You need a housing advocate in case your heating breaks down. A caring advocate in case your care worker does not turn up. AND a Health service that monitors residents and does not rely on either the housing or the care worker highlighting a need. When can I move in?

    1. That’s exactly it – what does a joined up model look like? Too often we start from point of “how do we pay for it” – rather than what should it look like and work back from there!

  3. Here’s another thought. The terms of political debate almost always say the solution lies in more money and/or a reorganised service. Yet when you look at success elsewhere, the key often seems to lie in less easily identified cultural characteristics that are extremely hard to transplant, eg social cohesion, respect for the old. Dowe plough on with the culture we have or is change possible?

    1. Spot on. I’ve just returned from a couple of weeks in Indonesia and without trying to hold them up as example (they have awful poverty and a poor life expectancy) I was struck by the way community binds together for elder care , housing, food sharing etc. Goes back to your previous point!

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