Speaking truth to power

Written by: Audrey Birt, Associate Director Health and Social Care Academy, the ALLIANCE

Audrey shares her views on power and courageous leadership as part of our blog series tied to Co-production Week Scotland 2017.

Has there ever been a time when the abuse of power is such an all pervasive theme in our society? Whether we are witnessing the fallout from political sex scandals or the tax evasion of the rich, or indeed everywhere across our society where hierarchies exist, it’s a reminder of the many faces of the abuse of power. Power is the theme for Coproduction Week and I’m keen to talk about the loss of power experienced when you are living with long term illness or disability. The question I’m holding is in what way is this connected to the abuse of power across society? Because my sense is that it is.

The evidence is plentiful that a diagnosis of a long term condition, including cancer, results in financial inequality. The experience of loss of work, of income, of opportunity, and of influence even is backed up by plenty of data. Too frequently those living with long term conditions that impact on their ability to work and socialise (very often there may be a stark choice between the two) find themselves detached from the world they took for granted in the past, or that they would love to have been a part of. There’s a frosted glass of separation between their world and the one they might wish to inhabit. In that sense they can be hidden from wider society and consequently too often forgotten.

With a dominant economic philosophy at play that echoes a Darwinian belief in survival of the fittest, it’s almost acceptable that those who are not in full health flounder and become powerless to change that. Our welfare state has shifted from the philosophy of a safety net for times of need, to what seems more like a judgement on the deserving or undeserving. Welfare is not currently treated as a human right for all in the UK, but instead the need for it is frequently seen as a sign of weakness or failure. Many older workers, who more likely to be living with long term conditions, are often caught between being not old enough to retire with a pension and not seen as ill enough to require a financial safety net, thus creating a significant inequality of both income and power.

Coproduction means a move to the balancing of power in both the design and production of health and social care services, as well as within the therapeutic relationship where expertise is shared and mutually respected. Care relationships in the future will need to reflect a shift of power, to reflect an approach of “doing with” not “doing to”. Deteriorating health should not be compounded by powerlessness and dependency, but should instead be met with processes that enable an individual or community’s voice to be heard, concerns to be addressed and assets recognised and supported.

More than two million people in Scotland live with long term conditions and a dynamic society will ensure all its citizens can contribute to their own communities and their own and others wellbeing in its widest sense – and that requires doing things differently. If we don’t address the abuse of power then can we really coproduce health and social care? Or are we merely paying a pale lip service to it? Does it take initiatives like citizens basic income to ensure that all in our communities thrive, to enable people to share decision making, shape their care and to have the ability to make decisions that enhance their wellbeing?