Commissioning social care – do we aspire to be gardeners, or architects?

Dr Culley discusses the future of social care as we emerge from the crisis period of COVID-19.

I started at Quarriers in the middle of a pandemic, in a world of virtual communications and remote working. A highly coordinated operation involving daily virtual meetings supported the ongoing management of the organisation. I spent the first few weeks of my new job supporting that work and getting to know my new colleagues within the organisation and across the sector.

Since then, I have been thinking about how we have responded to the threat of Coronavirus – as an organisation, as a sector, as a nation. There are things we have done well and things we would do differently were the virus to spike again. At the national level, I thought it was remarkable the way that the NHS was deconstructed and then reconstructed to deal with the anticipated influx of patients with COVID-19. On the other hand, we probably didn’t think hard enough about social care – particularly older people’s homes.

The harmful economic impact has yet to be fully understood or experienced. More positively, some are beginning to see an opportunity for social reform, though there’s no real consensus about what that looks like. So far, we’ve heard people say nice things about the social care sector – I just hope that translates into something meaningful, something that sticks. Most would agree that people in the social care sector are over-worked and under-paid. There’s talk of a national care service, though few have been prepared to say what they mean by that.

My thoughts have turned to the commissioning of social care – one of the important issues to address if we are to make the radical progress that many prescribe. There are different views about how we can change the commissioning relationship and I don’t pretend to be an expert. But there is one abstract question on which I’ve been reflecting in relation to the commissioning process – do we aspire to be gardeners or architects?

The job of the architect is to create complex superstructures. Developing an over-arching blueprint, with great precision, ambitious plans are subsequently turned into reality. The problem with this process is that it can be rigid, and it creates unalterable structures. And there may be dialogue between the architect and the builder but be under no illusion: the former creates the instructions for the latter. If this is the commissioning model we want, we should be very careful not to imprison ourselves in the vast walls that we build around ourselves.

The gardeners also work from plans, but these change shape and colour as they’re put into place. It is a collaborative effort – less hierarchy and more imagination. But gardening is not without its challenges: it can be labour intensive and great care needs to be taken to stop unwanted weeds sprouting. It also takes time before the garden takes its form, before the impact is achieved. It is a labour of love.

To my mind, we get the best results from the commissioning process when we see the task as a gardener would: as a collaborative and organic process.

In my short time at Quarriers, I’ve seen examples of the types of care and support that only gardeners could have brought into being. Take our family resource centre at Ruchazie (this link will take you away from our website) this was an idea nurtured by a few of Quarriers’ leading lights more than a decade ago. Many an evening was spent by those colleagues in community halls to cultivate ownership from local people – if this were to work, it would need to draw on community capacity, from their imagination and skills. Over time, the family resource centre grew. New services came into being – children and families have complex needs and this centre sought to respond to those as they emerged. It took time. It drew on funding from multiple sources. And gradually its roots took hold.

I can’t take credit for any of this. But Quarriers can and the local community can. It’s what happens when we collaborate, when we plan for the long-term. It’s what happens when we use our collective resources and imagination to grow a garden.

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