The government has declared it wants to do more for the poorest 2 per cent of the population and for many needing community care this will be welcome news. At last there appears to be a resurgence of interest in social exclusion. The appointment of Hilary Armstrong, as minister for social exclusion – a former chief whip and a politician with strong credibility when it comes to community issues, is really good news.
It also gives the new Social Exclusion Taskforce some genuine influence over the other key departments that have the biggest roles in putting into practice the new solutions.
This task force’s priorities are children in care, teenage pregnancies, “problem families” and those with mental health issues.
There is little doubt that many of the most excluded 2 per cent will fall within these categories. One key test will be how well we mould services around this group.
And we know too little about our most deprived citizens. We may know where they live, and we may think we have an idea of some of the challenges they face. But I don’t think we understand what drives the choices that people who live in the poorest areas actually make, why they make them and how they engage with public services and in particular social care services.
There is a danger that, faced with this dilemma, government simply casts around for “silver bullet” solutions – projects that have achieved impressive outcomes in a particular area. The problem with this is that many of these successful projects rely on dynamic leadership, innovative commissioning or the passion of a few key individuals – if these factors are not replicated along with the service model we can’t expect results to be repeated on a massive scale. A second problem is what I call “let a thousand flowers bloom” law which is the opposite of this. The assumption is that “it may have worked there, but it won’t work here” and that every locality has to find its own solutions. Yet the problem with growing a thousand flowers in order to find the few successful blooms is that you waste an awful lot of fertiliser.
The task force will have to ensure that, when trying to replicate successful projects, they’re working on the right things.
The Connected Care pilot that my own organisation is running in Hartlepool is generating some important lessons.
First, services need to be accessible, as determined by the most excluded 2 per cent, not as determined by professionals. If we fail to understand the way people interact with, talk about and navigate services we negate valuable information that is needed to understand gaps in services or to look critically at services in terms of outcomes for people who use them.
Second, demarcation and boundaries used to allocate health and social care services are often barriers to accessing services for those with most complex needs. The Social Exclusion Taskforce would do well to remember that the teenage parent in need of support could also be the young hoodie with an antisocial behaviour order.
Finally, we need to be able to identify and respond to people’s needs comprehensively. Those using services are simply not interested in budget streams, contractual arrangements or commissioning processes. They simply want support and advice.
These three principles are critical to any intervention that is going to reverse the plight of the worst off 2 per cent, and critical to the success of the task force. My hope is that the new cabinet-level group will bring together disparate departments so that these principles are brought to bear. As groundbreaking as the Social Exclusion Unit was, its recommendations were sometimes overlooked within the bureaucracy of individual departments.
The new task force, on paper, has the potential to overcome this and finally see the bottom 2 per cent at the top of the agenda.
Lord Adebowale is chief executive of learning difficulties, mental health and substance misuse charity Turning Point