There is so much happening now, it is hard to keep-up; when I say ‘happening’, I mean change… When Macmillan talked about the winds of change in 1960, I don’t think he had the 21st Century on his mind, and, in particular the macro/microcosm that is health and social care in the UK.
Although I haven’t written a great deal about the plans for the Doncaster Wellbeing team I have been involved with developing over the past year – here I hope to explain why we don’t want carers but Wellbeing workers.
If you want to read more in detail, understand some of what has been happening under the surface, please go to Helen’s blog.
From my perspective though, narrowing the scope, what is wrong with care?
I have been frustrated with the name ‘Trust’ particularly since it came into use in the 90’s with the start of NHS Trusts and, in particular the marketisation of the NHS. I can recall the first time I walked into the Northern General Hospital in Sheffield, where I was working at the time and saw the italicised blue NHS logo (which is now fiercely protected and copyrighted) – I think it was my realisation that the NHS was no longer a family, a grouping of people working together to achieve wellbeing, but, a corporation – the Orange in Laloux’s world.
Over the years I have seen both the folk-work, the generous, supportive, you-can’t-pay-people-to-do-this type of acts that aren’t necessarily at the soul of corporation. I have also seen top-down, reorganisation and restructuring, target-driven obsessiveness.
My point is that using words such as trust, or care, don’t necessarily make things so. Often indeed, I am at my most suspicious when someone says, ‘Trust me,’ ‘Honestly,’ or, ’Believe me,’ so, I suppose when one of the modern mantras is rolled-out – ‘care’ – I am suspicious.
I believe that the majority, that is 99.99% of people are ‘caring’ – part of their everyday routine is to think of others before themselves – this is evolutionary. We exist, we have survived the millennia to reach where we are today because of the caring of our parents, friends and family, their self-sacrifice and love; clearly there is a lot of non-caring in the world, but the dominant human paradigm is this.
(Incidentally, I suspect, although, George Coxon, please let me know if I am wrong, it is this aspect of Person-Centred care that riles you – the objectifying of what is obvious)
And, it is when we objectify that people are less likely to question, to stop thinking, and, become automata.
Care – ‘We Care’ is a national mantra. I don’t know who invented it or whether they have earned any money from the logo, yet, it is endemic.
The risk however, with care, trust, safeguard or whistleblowing (all within the NHS 21st Century lexicon) is that once these words become part of our narrative, or perhaps, the process, we stop thinking about them and they are devalued.
Wellbeing is at risk of this, although as it is still on the fringes, used currently by the grass-roots, I believe it still retains its purpose and meaning.
Wellbeing Workers, are who we have recruited to our nascent teal teams. Their goal is certainly to care, without care being part of a process and without it being an absolute of the relationship – this goes back to something I have already discussed, specifically, that the goal of doctors, nurses and therapists is to not have patients, just as, the goal of carers is to reach an idealised state where they don’t have to care (as people are independent).
Clearly this is not possible in many instances. In particular however, is it not interesting, that, with the evolution (explosion?) of chronic long-term illness in our society is also the unspoken agreement that, ‘now you have ‘X’, you need me, and you will go on and on needing me,’ ‘me’ being doctor, nurse, health or social care professional… there is no escape from Anno Domini and diabetes.
What we want however is to either slow-down this dependency, some people call this disease compression – we aim for people to have as healthy, productive disease and dependency-free lives for as long as possible, with all their morbidity, that is, ill health, dependency and disease compressed into their final years.
You don’t want cancer, a heart attack or stroke when you are 40, let it happen to the 90 year old – this is our current social contract, which in my experience people often embrace. (having the stroke when you are 40 and living to 90 is another matter.)
The current health and social care world is idealised as one in which people self-care or manage, look after themselves, exercise, eat and sleep well, steer clear of cigarettes and alcohol, and so on. We know this is not necessarily a representation of what is happening, particularly in a socio-economic sense, but it is the best we can do.
The next idealisation is that if you are unwell, ill, diseased or non-specifically broken, you will be looked-after in hospital, until you are strong enough to be home – and, like disease compression, this is becoming shorter and shorter. (in the NHS, we call this ‘length of stay’, which like compression isn’t a bad thing, although it can sound a little harsh at times.)
Yet, it is essentially the ‘care’ element that potentially gets in the way. To care, you need someone to care for – without them, you are left hanging. Without a dependent, what do you do? We don’t consciously make people dependent and it is likely part of that spectacular evolutionary realm that places people into these funny relationships.
‘Here, let me give you a drink,’ indeed, don’t let me stop there, let me boil the kettle, get the tea bags and milk and sugar and the spoon and raise the cup to your mouth. (I’m not mentioning ‘Sippy-cups’ which translate into another layer of dependence), and, the opposite, do it yourself, fail, fail and learn is not acceptable either – we need to strike a balance.
The balance is Wellbeing Workers –
These are the new roles we have created to work within our self-managing, whole-person, evolving and quality improving teams.
People for whom caring is so inherent, so part of the job-description that it needn’t be said – like breathing, moving, loving – imperatives of existence.
People whose goal it is to ensure that people remain people, that is independent, autonomous, self-caring, self-managing for as long as possible, and, for those who have fallen-down the rabbit hole of dependency and disease, support their recovery as is possible.
This is the teaching how to fish rather than giving a slice of smoked salmon concept.
Wellbeing support takes longer than care, for, in care you don’t necessarily have to think about yourself – you just focus on the other person, this is great, until you realise that you have covertly exchanged care for dependence.
Wellbeing is constantly thinking, considering ways in which you can make yourself redundant – obsolescent. How you can minimise your impact on the life of another so that when the time comes they won’t even notice your absence, when you have faded into the wallpaper. When their lives are so much on track, so much engaged with their families, communities, selves and societies that the requirement for care evaporates.
There are clearly extremes here and just like the person who is dependent on another to do certain tasks – feed, wash, dress, this is not one-size fits all, it is, however, the way in which we can seek to ensure that the system is not one of dependency – instead, independence is the key, it is central to how we ensure longevity of both our system and individuals, it is how meaning is fed-back into life, when it might otherwise be subverted.
Let’s tear-off the over-thick packaging, the cotton-wool, acknowledging that there are times when it is needed, but let us not integrate this fragility into the persona of those we support, let us see, that although care is required at times, it is the maintenance of Wellbeing that adds flavour and meaning to life.