On June 13 2013 BBC News broadcast CCTV footage of 83 year old Muriel Price suffering in her own home. Like so many elderly people receiving local authority care, Muriel relied on a private provider to send care staff to look after her basic needs. Taken over the course of one month, the footage revealed a pattern of neglect: carers turning up late or not at all; Muriel suffering the indignity of having her incontinence pads changed in full view of her neighbours; her food being prodded by a carer to test its temperature.
Yet despite her treatment Muriel still found a reason to be grateful: ‘It’s terrible the way they treat old people. I’m lucky I’ve got a family to look after me. Those that haven’t got a family – God help them, poor Devils’.
Public concern over the treatment of vulnerable people supposedly being cared for by public services has increased as a number of scandals have hit the headlines with Winterbourne View and the Mids-Staff Inquiries being only the most high-profile. Shocking as these cases are, anyone working in health and social care knows that it’s casual neglect like Muriel’s that is far more common. And with the ageing population and financial constraint that is the backdrop to any contemporary discussion of local public services, the likelihood of others facing similar experiences is growing.
When confronted with these tragedies the question that lingers is: how could anyone treat another human being in this way? How is it possible to knowingly leave an elderly person alone for 13 hours? How could you expose an adult to the shame of having their incontinence pads changed in public when all that is required is that you draw the curtains? Why stick your fingers into someone else’s food? Would you treat a member of your own family like that?
The answer to this last question is (one hopes) “no” – and that of course is the point. As Muriel so rightly points out, she is lucky to have family that care for her and look out for her welfare. It is these relationships that not only give her life meaning (the regular visits of her grandson and trips out in her wheelchair) they also keep her safe (it was her grandson who installed the CCTV). These relationships, built up over years of mutual exchanges of love and practical support, mean that Muriel and her grandson see each other not as ‘clients’ or ‘tasks’ but as human beings to be valued.
The challenge of enabling genuinely relational services is not new, but it is growing and becoming more urgent. It is a simple fact of demography that personal social care is going to become an even greater part of public service and (for the foreseeable future at least) a political reality that the financial resources available to support it are going to be even fewer. Working out how to meet the needs of vulnerable older people with humanity is one of the most pressing issues facing local public services. The relational challenge, however, goes much further.
Firstly, enabling relationships to flourish between public service providers and those they serve – individually and collectively – is an absolute necessity if our aspirations for co-production and behaviour change are to be realised. It is increasingly understood that achieving significant change in so many of the challenges facing society – obesity, living well into old age, educational attainment, training and employment in an uncertain job market (to which you can add the pressing issue of your choice) – requires the active engagement of all of us as citizens. It is therefore at this point of interaction between citizens and the public services they use that we should focus our attention. As the new model of public services presented in Chapter 1 suggests, effective relationships, building trust and behaviour change are intimately connected.
Secondly, we know that the quality of the relationship between citizen and service provider can be a key determinant in the quality of the outcome of the service: evidence from fields as diverse as education, employment services and healthcare all suggest this.
Finally, we are slowly coming to understand that the complexity of organisations like those delivering local public services and the rapidity of change that they face mean that only those that are flexible and adaptive will excel. The process of constant learning needed to enable success itself requires a fundamental shift of attitude towards the nature of work – a shift of attitude that takes seriously the need to create meaning for staff within our organisations such that they carry with them the motivation, courage and adaptability needed to face the challenges of their daily tasks.
In this context enabling genuine relationships – relationships that carry with them more than a transactional or instrumental benefit – are not a soft option ‘nice to have’ but a hardnosed prerequisite for effectiveness. What we need is a relational revolution in our local public services.
This blog draws on ideas in Chapter 2 of a new book ‘Making Sense of the Future’
Chris Lawrence Pietroni joined INLOGOV as an Associate in September 2012. His work focuses on achieving sustainable systems change cross public services in the UK and the US. Building on over 15 years’ experience in local government working with senior leaders on the design of innovative service improvement and community engagement strategies, his work now focuses on the intersection between service design, leadership development and community empowerment. Much of Chris’ current work provides accessible ways for leaders to draw on systems thinking to enhance their collective effectiveness. Together with Mari Davis, Chris is pioneering the application of insights drawn from social movements and community organizing to achieve sustainable systemic change.