Death of Deference and its impact on social care

The public’s veneration for professionals is fading. No longer do people turn up at their GPs, cap in hand, to be prescribed cures without question. Instead, many arrive with sheets of internet printouts to challenge and negotiate their treatment like never before. In a new report for the Social Market Foundation (SMF), Simon Griffiths has labelled this change the “Death of Deference”. Published next month, his research sets out to analyse our declining reverence for professionals, and explore its implications for public service provision.

“Users are more pushy, demanding and assertive than ever before,” says Griffiths. “We still have experts and gatekeepers, but they have to operate much more on a level – and that’s a good thing.”

Senior research fellow at SMF and part-time lecturer at London’s Goldsmiths College, Griffiths began his research by holding a series of focus groups with parents, teachers, GPs and patients. Anecdotal evidence suggested that users had indeed become more assertive. There was a consensus that they wanted their interaction with professionals to be characterised by negotiation rather than instruction, dialogue rather than dictation. As one service user put it: “The professional might be an expert in their field, but I’m an expert in me.”

The focus groups’ findings chimed with recent academic literature and empirical research. According to the World Values Survey, a long-running review of changing global attitudes, traditional virtues of community and authority are being eroded.

Although Griffiths’ research focuses on health and education, he says his findings have implications for social services. Indeed, some of the biggest changes taking place in social care today can be seen as a reaction to the death of deference. The move towards more user-oriented services and the corresponding drive to roll out personalised budgets are examples of the state acknowledging that the user sometimes knows best.

“Individual budgets are an obvious way of empowering users,” says Griffiths. “The big criticism is that when individuals are given money they’ll spend it on things that are unsuitable. But evidence shows this is not the case. One man who I was told about who was part of an individual budget pilot had acute anxiety. He wouldn’t leave the house. He didn’t spend his money on therapy – he bought a whippet. People were sceptical, but he found that having a dog around the house was comforting, and it meant that he had to leave the house every day. His health outcomes improved dramatically.”

As social services become ever more user-oriented, Griffiths believes the role of practitioners will have to change.

“There is going to be a much bigger demand for advice,” he says. “It isn’t enough just to tell people they can spend money on what they want – people need advice to help them get the most out of the system. This might mean that more social workers are needed to negotiate and commission care rather than to provide it themselves.”

But the changes don’t stop there. Griffiths believes that, once the balance of power between user and practitioner shifts, the reverberations are likely to be felt all the way up. Some of our strongest assumptions about the role of long-standing institutions will be brought into question.

Break up

“Once you make the user the commissioner of the service the old top-down structures are likely to break up. You won’t get councils commissioning services en masse – the users themselves will be commissioning services that suit them. This is going to create challenges for practitioners – they’ll be working for individuals rather than the state.”

Griffiths believes that these changes are, to an extent, inevitable. The rise of assertive individualism has been ushered in by a tidal wave of change that is beyond our control. New technology has broken the monopoly of information professionals have held in the past. The rise of education, the dissolution of traditional class structures and the growth of consumerism have broken down old hierarchies and changed expectations. If public services don’t adapt to these changes, they will face redundancy.

Griffiths believes that one the biggest challenges will be accountability. After all, if users choose their own treatment plans, whose fault is it when things go wrong? Social workers will need guidance on these issues. They will also need training in the negotiation skills necessary for working with a new generation of more assertive users.

Despite the challenges, Griffiths believes the “death of deference” is a good thing.

Further information

Expert guide to personalisation

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