Privilege, power, persuasion — What does the future hold for (adult) social care?
The recent announcement that Camilla Cavendish is to lead on the long-awaited, much-vaunted overhaul of adult social care raised a few eyebrows in this household. Well, it raised one. Mine. The left one to be precise. It’s been getting a lot of exercise recently, that eyebrow. In fact, it’s pretty much permanently raised these days, an arc of anticipatory scepticism. A caterpillar with its hackles up.
But let us not be distracted by the contortions of my forehead furniture — or fauna, to stretch an already tenuous analogy — which, I am reliably informed, is not that easy. This is A Serious Blog.
According to Wikipedia, ‘Hilary Camilla Cavendish, Baroness Cavendish of Little Venice (born 20 August 1968) is a British journalist and former Director of Policy for then Prime Minister David Cameron. Cavendish became a Conservative Member of the House of Lords in Cameron’s resignation honours, but resigned the party Whip in December 2016 to sit as a non-affiliated peer.’ She has been a trustee of the centre-right think tank, Policy Exchange, and won a Paul Foot award for articles about practices in the family courts — articles which were not circumspect in their criticism of the quality of social workers’ practice. Her appointment to the role of Chair of Frontline, the Boston Consulting Group (BCG) founded and backed children’s fast track training scheme, is perhaps unsurprising since Cavendish and Frontline appear to share a belief that the key to improving social work practice is to attract a better quality of person to the profession. Frontline’s foundational commitment to elitist recruitment through targeting high calibre candidates from top universities on the promise of a prestige career off the back of a stint in child protection social work has, predictably, borne bitter fruit. Frontline, like its mental health social work counterpart, Think Ahead, recruits far fewer black and minority ethnic students than the average for all social work qualifying routes.
Cavendish is married to financier Huw van Steenis, former advisor to the governor of the Bank of England and currently senior adviser to the CEO of Swiss bank, UBS. Van Steenis worked for Boston Consulting Group from 1994 to 1999. While Van Steenis hasn’t worked for BCG for 20+ years, this is at least another example of the extent to which the careers of those in influential positions in British commerce and politics have involved a stint at BCG or one of the other big management consultancies. Cavendish herself worked two-year stints at McKinsey & Co and Pearson. Given the importance of networks in the business world and the consultancies’ expertise in leveraging these to maximum benefit, it’s right that we ask questions about the extent of BCG’s and other consultancies’ influence in British public affairs.
For example, the Centre for Public Impact (CPI) is a think tank founded by BCG that presents itself as some kind of independent, pragmatic enabler of innovative social reform. It was founded by the Boston Consulting Group (BCG) a global management consultancy which is by no means averse to working for oppressive regimes and corrupt elites. Protestations that CPI and BCG are ‘separate legal entities’ are hardly reassuring given BCG’s global reach and influence. How, after all, could BCG maintain such reach and influence if it weren’t involving itself in the the reform of systems the world over, whether private education in the Gulf states or social work education in England? Or, indeed, the ‘blueprint’ for children’s social care, which CPI seem intent on pushing as an oven-ready model for children’s social work during and post-pandemic.
CPI’s various excursions into our public systems together constitute an attempt by a global corporation to ‘reimagine government’. That’s not me saying that. It’s CPI’s tagline. Let’s look at the timing of BCG’s setting up of the CPI. In May 2015, the Conservatives win a general election after pledging in their manifesto that they would hold a referendum on membership of the EU. One of the first acts of the re-elected Tory government was to pass that very month the European Union Referendum Act 2015. The CPI was launched in July that same year. Think about that. A US management consultancy sets up a think tank to, as they themselves say, ‘reimagine government’ in the UK in the run up to the referendum on Britain’s membership of the EU? Pure coincidence, no doubt, because absolutely no-one at one of the largest and most successful management consultancies in the world would have thought about the myriad implications for our private and public sectors of Britain’s choosing one way or the other in the referendum. . . Would they? Several million quid — 14.2 million in fact — in Brexit consultancy contracts would suggest BCG very much had fingers on the Brexit pulse. Not to mention arch-leaver Michael Gove’s BCG habit which saw him take advice on unspecified topics from the consultancy on four separate occasions, according to his entry in the MPs’ Register of Interests. This spreadsheet from an obscure corner of the UK government website shows Gove had two meetings with BCG in 2015 — one an ‘introductory meeting’; the other to ‘discuss court reform’ (make of that what you will). And that’s just the times we know about. Gove’s office had already been caught out deleting emails, including those from a private account (‘Mrs Blurt’, anyone? [insert smirking emoji here]) discussing government business with people outside of the actual government, such as his future special adviser and pound shop Bond villain, Cuminic Dommings. Or, as I like to call him since his (alleged) multiple escapades in Durham, OfDom. As in, ‘Where’s Dom?’ ‘Oh, he’s just off to Durham.’ ‘Again?? Tsk. That’s twice this lockdown (rolls eyes).’ ‘Never mind, he left the keys to his hover-car! Let’s go for a spin!’ etc
Which brings us back to Baroness Cavendish of Little Venice, of Mells in the County of Somerset. Her appointment to lead adult social care reform raises the obvious question of what she has in mind for the new social care scheme of things. According to this piece in the Guardian, she is generally quite well-regarded and widely held to be a pragmatist, having expressed reasoned and humane views on the need for a fairer social care system and better systems to deliver it. In 2013, she authored a well-received review that recommended better pay and working conditions for healthcare assistants and social care workers with the key aim of raising standards in the delivery of care by “ensur[ing] care and compassion in the NHS and care settings”. There is much of merit in the report, not least that the contribution of lower-paid workers in our social care and health systems deserves greater recognition and is not currently matched with any formal frameworks to develop and capitalise on their expertise for the benefit of all concerned, especially those who rely on them for care and support. Looking back on the report it’s interesting to note the focus on “getting the right people” into caring roles, a refrain it shares with Frontline and other public sector fast track training schemes. To be clear, I am not suggesting that values aren’t a vital ingredient in care work or social work — they so clearly are. It is the focus on individualist approaches to addressing what are deep-rooted policy issues, not least among them the competitive marketisation of social care, and, I venture to suggest, entrenched social and cultural attitudes to older, disabled and sick people in our society, which, as I have observed myself in my fifteen years in adult social care, play out in team and institutional cultures and individual practice postures in ways manifold, insidious and harmful to those we hope and aim to support. As I say, the Cavendish Review has much to commend it, though with the benefit of hindsight its touting of scandal-hit care providers HC-One and the Priory Group as case examples of the successful promotion of positive cultures rather proves the point once again that competitive marketisation is unlikely to yield the sorts of benefits long promised but seldom delivered by proponents of neoliberal reform in public services.
Cavendish appears extremely keen on the Buurtzorg model, having published a handful of articles in the past year or so espousing it as a model that could transform social care in this country (for e.g. here, here and here). That’s the same Buurtzorg model touted in the ‘blueprint’ for children’s social care shepherded and largely authored by BCG, via what look increasingly like its front organisations, CPI and Frontline, the social work training provider Cavendish chairs. Cavendish’s book on ageing in contemporary society, Extra Time, contains a glowing account of Buurtzorg from a Dutch nurse working within the model. She also spoke at a Buurtzorg event in November 2019, the month of the publication of the Frontline-BCG-CPI ‘blueprint’.
Can we look forward to the Buurtzorg-ification of adults and children’s social care? Cavendish bridges both in her current roles and, as we have seen, is a keen proponent of the Buurtzorg model. Time will tell.
As I have said before, debating the relative merits or otherwise of the Buurtzorg model as advanced by the likes of BCG and Frontline misses a fundamental and important point. In social work, relatively little attention is paid to how powerful corporate entities may exert influence over our public services, and what the implications might be. BCG’s co-option of the Buurtzorg model raises a lot of questions. As a social worker mainly within a a multidisciplinary team for adults, I can see the model’s appeal. It is, I suppose, better suited by design to adult social care than children’s. But, why are BCG so keen to advance this model in English social care? If it sounds like I don’t trust an $8.5 billion a year management strategy consultancy to act solely in the public good then that’s because I don’t, especially ones that are involved in this and this.
Buurtzorg was designed as a community nursing model which fits well with Cavendish’s conception of social care as being predominantly if not exclusively about personal care, meals and medication for older people. While these types of tasks with this group make up the majority of adult social care expenditure I wonder how she will seek to accommodate the needs of other people needing state social care and support, such as those with learning disabilities, physical disabilities, neurodiversity, mental health issues, chronic illnesses, brain injuries and alcohol and substance misuse issues to name a few. Delivering a fair social care system that works for all who are eligible for state support will require taking into account and designing systems that uphold the needs, rights and interests of an incredibly diverse range of people.
Another question concerns to what extent the social work profession will be part of shaping this reform of adult social care, and how. I have searched the blog of the Chief Social Workers for Adults, on the assumption they will be key players, and found no clue as to their involvement. I’ve searched the Twitter feed of co-CSW Mark Harvey and found no reference to Cavendish’s appointment. I cannot say if the same is true of the other CSW, Fran Leddra, because when looking up her twitter account to research for this blog I found I’ve been blocked from viewing her tweets.
Even more astonishing — and infintely more interesting — is that I detect little in the way of discussion among social workers of Cavendish’s appointment to lead the reform of adult social care. Whether the Guardian’s claim that Cavendish plans a merger of social care into the NHS is true or not (it has been denied by the DHSC) the appointment and the role are highly significant. I find it extremely surprising, then, that this isn’t of interest to prominent social workers and social work leaders who usually speak volubly and publicly about policy developments. For me, questions abound about the ramifications for the social work profession of such wide-ranging reform, a key concern being whether the continued alignment of social care with health in the public discourse, and the suggestion that the former will be brought into, or closer to, the latter, indicate the potential for further division of ‘adult’ and ‘children’s’ social work. Again, I’m surprised this is isn’t the subject of more discussion among the social work leadership. Perhaps it is, and it’s just that we aren’t privy to these discussions. Given that closed-door discussions and back-room dealing appear de rigueur for this administration, particularly in the time of Covid, so often used as pretext for accelerating existing reform agendas, a notable example being the debacle surrounding Statutory Instrument 445, this seems more likely than not.
The history of grassroots social and political reform shows that, in order to be meaningful and beneficial to those whose lives and circumstances it is aimed at improving, reform must be driven and shaped by those people. On the other hand, the history of top-down reform under neoliberalist public policy shows that wealthy elites are not best placed to address the problems besetting people and communities suffering social and economic deprivation as a consequence of the very wealth inequalities that benefit those wealthy elites.
And, who asked them? The answer is: they don’t need asking. Theirs is the mandate of the privileged. The CPI, despite its affectations of altruism, is another purveyor of top down corporate reform of public systems masquerading as social justice and driven by representatives of the privileged elite class of wealthy white folk whose key attribute appears to be an abundance of unshakeable self belief. There can be no true social reform without allies who adopt explicit anti-racist, anti-colonial methods. Such methods are anathema to BCG, CPI et al. Their approach — ‘doing well by doing good’ — has inequality baked in; it’s simply not in their interests to eradicate social disadvantage, despite the best intentions of many of those involved, because that would mean ceding their power and resources to others, which is clearly bad for the bottom line. Their version of social justice is a form of colonialism, an outgrowth of the trillion-dollar non-profit industrial complex that has seen NGOs advancing the interests of their corporate paymasters in the developing world for decades, disguised as the altruism of people who ‘want to give something back’ — whether we want what they have to give or not. For entities like BCG-CPI, English social work is just another frontier in the corporate colonisation of states’ public services.
Confronting and dealing with our own privilege is a vital act for any social worker, however uncomfortable we may find that process. But for social workers being uncomfortable is part of the deal. We should be uncomfortable about a great many things. We need to be comfortable with being uncomfortable. That’s the space we occupy. The space of reasoned, informed critical and ethical challenge. That’s not a comfortable place. Yet it seems the very mention of privilege in our own profession gets people’s backs up these days. We are told to be civil and avoid inflammatory language in discourse, lest someone feels uncomfortable, which is a surefire way of heading off critical thought and discourse. Privilege rarely recognises itself, because it doesn’t have to.
As Bob Hudson puts it in his recent article, the fundamental question at the heart of social care reform must be: How can we best support people to live the lives they choose? To even begin to answer that, we must surely ask the people themselves. I sincerely hope that, whatever plans Cavendish has in mind for the reform of social care, asking the people what they need and want from social care is chief among them.
Next: A citizens’ association for social support?
