The wide-angled lens

Citation

Johnson, R. (2013), "The wide-angled lens", Housing, Care and Support, Vol. 16 No. 2. https://doi.org/10.1108/hcs.2013.54616baa.001

The wide-angled lens

Article Type: Editorial From: Housing, Care and Support, Volume 16, Issue 2.

One of the running themes for this journal is the belief that we only truly understand our own world, and our place and work within in it, if we can also see it through others’ eyes. Those others might be colleagues in the same field; or “stakeholders” – that is, the other agencies that we work alongside, whose efforts affect our achievements just as ours affect theirs. In particular we will need to see ourselves through the eyes of our service's users, customers, tenants and clients, whose views on what we should be doing and what we are achieving can often be surprisingly different from our own. But whether our business is service provision, and best practice; or research, and best methodology; or commissioning and evaluation, and simply best intentions, in each case we need to communicate and to learn from each other.

We have argued here that the epidemiologists are right to say that housing is one of the key social determinants of health; and for us, those who create and manage our housing – planners, developers, home-owners, landlords – are therefore key co-producers in the effort to improve the health and well-being of the nation. But whereas we may be entitled to think that health issues may be fairly international – the human body being much the same the world over – the social organisation of these social determinants varies widely from country to country.

How far, then, can we really understand the nature, roots and life course of ageing, for example, or of homelessness, if we do not seriously explore how these issues are played out in other countries, with different GDP or funding streams, welfare philosophies or machinery of government, and different climate or culture and beliefs, which may throw up problems in different ways? Accordingly in this journal we aim to encourage a discussion of issues in the relationship between housing care and support that is increasingly international in the perspective we can bring. Two papers in the current selection do this quite explicitly.

In the first, Eileen Thompson reflects on the lessons she takes back, for her work on housing for older persons in Northern Ireland, from a recent study tour of the USA and Canada. In this, the first of two papers on her experiences, Thompson describes her visits and discussions with the staff and developers of a variety of models of self-help and “village” communities for the rapidly ageing generation of post-war “baby boomers”. As she observes, “In many communities, people already help and support each other; this model simply structures this”. From the country that gave us “Bowling Alone” (not to mention the über-individualism of Ayn Rand and her followers), it is heartening to see a very different spirit motivating progress.

Thompson concludes that there is much of value that we can learn in developing services in the UK. As social care funding in the welfare state countries comes under the pressure from a combination of demographic changes and financial austerity, the lessons of self help communities, and the role of housing density in helping create such communities, are ones we may need to learn. Indeed, as the population ages, dementia-friendly neighbourhoods, along with special needs housing for older persons, moves from being a concern for a more vulnerable minority to something that we may all need to consider, some day.

Even so, there are also significant differences between the US and the UK, and in the second paper from her study tour, Thompson will be exploring some aspects that may be initially harder to translate from the UK to the UK, such as the greater involvement there of private sector funding and development. But of course, that is the situation in many other countries, and some of the learning here might be equally or more relevant for countries that do not have the configuration and history of services that we find in the UK. Moreover, as more welfare systems develop in the direction of a self-funding, the difference between public and private is becoming blurred; and we may learn lessons from any quarter.

Our second paper taps into deeper waters still, however, in looking at the difficulties entailed in research to compare services in one country with another. We need to develop good evidence on “what works” in preventing or alleviating homelessness, especially perhaps among younger people, at a most formative stage in their lives and careers. But we then also need to know to what extent what works in one country will also work in another, perhaps very different, country (although the same might also be asked of different regions or states in countries with very advanced decentralisation systems).

Joan Smith's paper describes the unexpected complexities in setting up, and in interpreting the findings from a four-site study of youth homelessness. The study compared four countries, all within the European Union, but with great contrasts between them: two, the UK and the Netherlands, with relatively well-developed welfare provision, and two – Portugal and Poland – without. The explicit intention was to check how far policy and practice in the more “advanced” countries could be rolled out and recommended as the way forward.

Smith's careful dissection of how the term homelessness has entered the vocabulary of government in each country, and the impact that this has, in each jurisdiction, on definitions used, services developed and data that can be collected, is a nice reminder of the extent to which social statistics are themselves socially constructed. Without an appreciation of the institutional frameworks and policy agendas which shape our services, and the pathways we then create for service users, without an awareness of such structures, attempts to unravel social epidemiology are akin to trying to study human anatomy from clothes hanging on a clothes hanger.

Our third paper is equally trans-national, though in a different way. Pat Dearnaley analyses here the development of the market for social care in the UK, in terms of the business models and strategic marketing thinking that is regularly promoted in business schools not just in the UK but across the globe. Voluntary sector or “social” housing services in the UK are already active in providing support services to vulnerable tenants, and have developed all the necessary quality assurance, governance, training and ethical dimensions entailed. They are well placed to enter the market as providers of care services. Dearnaley's paper here in fact arises from a project in which she was originally involved, developing ways to assess the prospects for social housing providers in entering this new area.

Dearnaley begins by tracing the development of market approaches to welfare, with the gradual introduction of the philosophy of “New Public Management”, first in the UK and then throughout most western economies. This model is becoming known now to the general public mainly through some of its more eye-catching expressions, such as the over-reliance on targets for performance management of contracts, out-sourcing of functions that then disrupts much-needed integration and a growing awareness that being good at winning contracts is not at all the same as being good at delivering services.

But Dearnaley's analysis suggests that the introduction of market models in social care for the vulnerable is more problematic still. This “contrived” or “quasi-market” is a considerably more complex and subtle economy than standard-model business practice can readily recognise. There is a particular irony here. For many years we have been told that the public and the voluntary sectors need to become more business-like, to compete alongside private sector provision on a “level playing field”, with no special favours for their different character. Dearnaley's analysis suggests that both private and voluntary sector organisation will need to reconsider the tenets of standard business practice, if they are to operate in an area so deeply steeped in regulation, quality assurance, and social purpose. In a world where corporate social responsibility is now becoming a major expectation for all businesses, care and support providers perhaps now have as much to teach as they have to learn.

In further papers in this series, Dearnaley will explore further the tensions and opportunities within this new market, and the strengths of voluntary sector social housing services as providers of care, as well as the need for new conceptual tools to chart a path through the vicissitudes of this volatile market economy.

Finally, our fourth paper returns us to the more local and practical focus of a particular service – which is, after all, where most social housing, health and support staff actually are. Kate Karban and her colleagues here describe a three-year service re-configuration, in which 300 residents of long-stay hostel accommodation with mental health of learning difficulties moved to more independent living, with support, in smaller, custom-built but otherwise ordinary homes.

This paper by Karban and her colleagues may also be particularly valuable for non-UK readers for the clarity with which it spells out the policy and funding context in the UK which made possible and motivated this service re-configuration. Their literature review is a very useful summary for those wanting a quick overview of the importance of ordinary, non-institutional housing in enabling greater independence for vulnerable people and yet the organisational and cultural challenges entailed in bringing this new vision into reality. (One telling expression of the culture shift they describe was the use of “co-researchers” alongside the professional research team, in planning and then evaluating the project.)

Their report is not starry eyed; they identify on-going problems, uncertainties, and issues un-resolved, to be continued. Whatever the good intentions, there is no ideal world. But the picture they present of “the uneven and seemingly paradoxical nature of change” has an authenticity to it that service users, carers, staff and managers will recognise. Especially welcome, perhaps is their conclusion that, in such transition work, some attention needs to be given to the emotional journey for the staff involved, as well as for the service users. In the final analysis, we are all just people, struggling to do our best.

Robin Johnson