In 1839 Thomas Carlyle said “the condition of the great body of people in a country is the condition of the country itself”, and yet 175 years later we still fail too many people with multiple, complex needs who are acutely in need of our help.
Typically we start in the wrong place, with the problem and not with the person themselves. It limits our chances of success from the outset and frequently forces our attention towards the one, most visible problem in isolation from the rest. Too often we label people – as ‘homeless’ or ‘addicts’ or ‘offenders’ for example – when the real problems are about depression, loneliness, lack of resilience, relationship breakdown, institutionalisation and a chronic lack of opportunity. Focusing on the person would tell us that, but too seldom are our systems shaped around this understanding.
The last Labour government did understand this and created a series of structures to focus on people and their multiple needs – the Supporting People programme, New Deal for Communities and Sure Start. These led to good – sometimes striking – results, but because they were bolted onto mainstream services they proved too easy to dismantle. Meanwhile, mainstream public services continued to find people with multiple needs too difficult to help. Some excluded them from services while others addressed individual problems instead of dealing with the whole person, leading them down the wrong path. According to the charity Centrepoint, 33 per cent of homeless young people have mental health problems, yet only 7 per cent have a formal diagnosis. Instead many teenagers whose mental health problems bring them onto the streets are treated for the more visible problem of drug or alcohol addiction, tackling the symptom and not the cause of the problem.
Putting people back at the centre of our vision would require us to rebuild public services that recognise them as unique individuals with their own lives, contexts and individual solutions. This is more than a reheated version of a personalisation agenda that created choice between different, similarly inflexible services. We need a richer, more complex approach that sees the whole person and works with them to find structural answers to deep-rooted problems. This would allow us to focus on the potential people have instead of the problem they pose.
We know that what sustains people through the most difficult times in their lives are good, strong, healthy relationships with friends and family. Relationships are the thing that both adults and children most value in their lives, but too often the systems we’ve constructed drive a coach and horses through those relationships at the time people need them most.
Take nine year old Amy, who I met last year. At six she was removed from home for her own safety and sent to live in foster care, miles from home, because the council would fund a foster placement but not kinship care. The bond with her closest relative, her grandmother, was broken and she had to move school. Needlessly, at the most traumatic time in her life, Amy lost her friends, her home and her family. For another child going to live with foster carers might have been the right decision – children’s needs and experiences differ hugely – but the system doesn’t always recognise this, to the detriment of far too many children. The same is also true for many adults. When a man’s marriage breaks down and he becomes homeless, the last thing that he needs is to be placed out of area in a hostel where he loses contact with his children, his friends and his wider family. When we don’t value people’s relationships, we make things worse not better.
This goes further than a failure to understand and support the personal relationships that keep people resilient, happy and safe. We also fail to invest in the many and varied relationships between people, the state and civil society. As a result, people’s experience of the state and some societal organisations becomes transactional, impersonal and characterised by a uniform approach that works for some, not others. It is a huge mistake and frequently stops people getting the help they need.
Before I was elected to parliament I spent nearly a decade working with and for some of the most vulnerable children in the country. They left me in no doubt that a good relationship with an adult they trusted mattered above all else. When someone listened and understood for the first time, trust was created and lives began to change. Many charities know this well. “No amount of professional help with getting a home or tackling a drug or drink problem will persuade people to come off the streets if they feel there is no one on the other side who cares if they live or die,” said Shaks Ghosh of the charity Crisis over a decade ago.
These relationships can be a lifeline yet we invest relatively little in them. A child like Amy is allocated a social worker whose job it is to understand, guide and support her but policymakers pay scant attention to whether the relationship between them is strong and persists. Most social workers tell a familiar story of spending too much time on paperwork and too little time with children like Amy. The same is true of key workers supporting adults in homelessness, substance misuse, mental health and criminal justice services. For the sake of simple factors like good-quality administrative support, satisfaction is low, burnout is common and turnover is high. As a result Amy has had six social workers over three years, the very people who were supposed to help her have failed and she has been left angry and isolated.
She is not the only one. There are too many people whose experience of the state and civil society is incomprehensible – computer-generated letters churned out by jobcentre plus, navigating the automated tax credit helpline, or the ordeal of repeating personal, painful details to dozens of people in frontline agencies. Others put up with the indignity of countless strangers arriving to wash, clothe and feed them, or make endless, lengthy trips to hospital because support is unavailable locally and the system has no flexibility to bend to individual needs. These experiences disempower people and they disempower the professionals tasked with helping them. Professionals are left feeling they are ticking boxes, unable to devote the time and energy they need to the individual in front of them and without the tools they need to help them. This is not the fault of the professionals themselves, but the unintended, damaging consequence of the system in which they work. As a result, despite the best efforts of many frontline workers, kindness and empathy is squeezed slowly out of the system and the individual’s voice is lost.
When we do listen, it makes a difference. Major improvements have been driven in mental health services in recent years by an understanding that the people who use services are best placed to shape them. Yet still this experience is far too rare. We know that what most homeless people want – supported accommodation – is also what works, but because the system is not designed to provide it on a large scale we provide hostel accommodation instead. We could do so much better than this.
We need to relinquish the power to make decisions to people and those tasked with helping them. In practice this means pooling budgets so that arbitrary barriers to help are dismantled, ensuring professionals work to shared outcomes, not departmental targets, and allowing people the flexibility to manage things themselves when they can, providing help when they can’t.
It means understanding that people draw strength from their families and communities and that requires us to look outwards from the individual to understand the strengths of the wider community and identify where the potential for supportive, lasting relationships lie. It means asking ‘what are the strengths of the families we are working with’ rather than ‘what are the weaknesses’? Charities like Grapevine, working with Coventry Law Centre to empower local communities in one of the most deprived areas of the city, are already proving that it can be done.
A relational approach also means making sure that whenever people come into contact with the state or civil society that it is a humanising experience, from the receptionist in the housing department to the caretaker at the town hall. Releasing power to the frontline would give local communities the ability to reorganise services so that people have an ongoing, positive conversation between ‘the system’ and the person and allow us to hear the voice of the individual much more clearly in our public services at an earlier stage.
David Cameron’s ‘big society’ has rightly faced criticism but its basic recognition that between the state and the market there is a much bigger space – society – matters. Society is where most people quietly live out their lives and where most of the country’s energy and creativity is found. In the face of the twin challenges of scarce resources and rising demand, harnessing the energy of individuals, families, neighbours, charities and communities is not just desirable but essential.
To make it work we need to understand where the big society took a wrong turn. As the Centre for Social Justice recently argued, the big society didn’t “trust the sector to innovate and develop effective new approaches to tackling social problems, preferring to concentrate ever larger sums of money on favourite, well-established charities, often asking them to deliver government’s work in government’s way through large prescriptive contracts”. Moreover it was blind to the huge inequalities between communities, some of whom lack time, resources, networks and confidence, found Civil Exchange’s Big Society Audit. The state is central to ensuring that communities, individuals and people-focused civil society organisations have the support they need to succeed. Without this, those who most need help in a human, relational way will be least likely to get it.
In the longer term this means tackling the root causes of inequality: poverty, lack of confidence, education and social connections, and the combined effect of this in some areas of the country. This is what defines Labour’s ‘one nation’ politics, going beyond a transactional approach to tackling inequality to a focus on transforming the basis of the economy and wider society. As Jon Cruddas has argued “if it lacks the spirit to transform people and give them hope for a better life then it will fail to tackle the fundamental power relations that keep them in their place.”
A ‘one nation’ approach to multiple needs is not an attempt to achieve a utopia where social problems no longer exist. At times in our lives all of us will need help with ill health, depression, loneliness, addiction, housing, debt and other problems besides. When we look for help we should find a state and a civil society that respects our uniqueness, understands and values the relationships that sustain us, and is willing to invest in helping us to help ourselves.