Even when it’s a Grand Challenge  the solution is often local – Peter McColl

There are a small number of great challenges facing us as a society. The climate emergency is the most significant, but we have a social care crisis that also threatens our wellbeing and that of our loved ones. Too often the scale of the challenge creates a false assumption that the answers lie in changes at regional or national – or event global –  scale. For some wicked problems, like the climate crisis, this might be so. But care is a great example of why this assumption is wrong. In fact, much of the crisis in care in the UK may stem from the attempt to get grander, more strategic, more all-encompassing solutions to a question that is, in its most profound sense, personal. 

Social Care and how relocalisation could help

Before the Covid crisis, I used to deliver a presentation in which I used ‘Call the Midwife’ as an example of the things that the British state was good at. One of the most popular TV series of the 2010s, it details the life and work of district midwives in the east end of London in the 1950s and 60s. The stories are all very personal, but the transformation of society: the demolition of slums and their replacement with better housing, the creation of a facility for women giving birth that was safe and allowed for better care, and the rollout of the polio vaccine are the backdrop to the substantial improvements in health of the post-war period. I suggested these were things we were still good at. And our failings were in more complex problems.

We are living longer than we did when the current arrangements for local government were designed. This is great, but the number of years of good health have not kept pace. This means that, across the population, the number of years during which we need care has increased. And while increases in life expectancy have stalled, the number of people who will need care is increasing substantially. 

Currently, our Councils are responsible for social care. And rising social care costs are one of the things that is causing significant financial distress for many of those Councils. This is a problem in Scotland, but also across the rest of Britain. The costs are rising because of the number of people requiring care is increasing, but also because of increasing costs for staff. At the same time, the media regularly carry stories about some of the worst cases of care-gone-wrong. Much of this is associated with understaffing, the diversion of resources to profit and the distance between commissioners of care and the recipients of care. 

This makes social care one of the Grand Challenges facing us. 

And the thinking about Grand Challenges very often, focuses on a range of approaches that involve equally grand thinking. Grand schemes, like a National Care Service – long on ambition but worryingly short on detail. These approaches too often ignore the very personal relationships needed to meet the challenge. While we need to create universal standards for care and sectoral deals for workers on pay and conditions, we also need to think about how we can get citizens involved in creating a response to the challenge. 

The best social care systems are very local. All the international experience points to decentralised care working best. Of course, this should be balanced with the need to protect workers and avoid bad care practices. 

Tackling the symptom, not the cause

Our current Councils are in a very difficult position here: too large to connect with communities, too small to be genuinely strategic. Part of the answer to the question is to bring government local to people. To have genuinely local government. 

In other areas, the government has tried to address this problem using workarounds. Identifying a lack of engagement in local democracy, the Scottish Government has done excellent work to encourage schemes such as encouraging participatory budgeting, which allows citizens to propose and develop projects. The community then gets to choose which of the projects gets resources. These are good things in themselves but fail to address the core problem. 

In social care, people have focused on care cooperatives as a workaround for our oversized Councils. These are inspired by the ‘Buurtzorg’ cooperatives that have been successful in the Netherlands. Just as with other workarounds, these have failed to take off in Scotland. Where participatory budgeting has worked it has not expanded beyond the areas where it was introduced, no substantial care cooperatives have developed in Scotland, and the ambition to transform social care with cooperative approaches seems as far away as ever. 

How could relocalising help?

The failure to develop these approaches points to the need to do something different. One reason why there is such reluctance to relocalise our Councils is the failures of previous reorganisations. But these were imposed by governments Scotland did not vote for, and the reorganisation that gave us the current 32 Councils was a model of bad practice, based largely on achieving party political outcomes, rather than improving how our Councils work. We should not let the scars of a bad, top-down council reorganisation stop us from demanding better, more local Councils. And, as with the Campaign for a Scottish Parliament, the demands of a campaign from below will naturally better reflect the demands of citizens and communities.  

Truly local Councils would be well-placed to deliver the benefits of participatory budgeting, and a solution to the challenge of care, capturing the opportunities of localised care cooperatives. Care commissioned and delivered by distant public authorities misses the ability of local communities to pull together and deliver the high-quality care we really need. By combining roles in local areas we can help to address understaffing, by better understanding the needs of citizens we can better deliver care that meets those needs. 

While our Covid response shows we can still roll out a vaccine very effectively, it has become even clearer that we need to adopt new approaches to address problems that are more complex, and more fundamentally social in their character. It often feels like we are trying to treat every challenge like it is rolling out a vaccine – something that can be tackled by experts and professionals alone. That is why we find it so difficult to get citizens involved and engaged in addressing challenges. 

If you have a hammer in your hand you will be tempted to see everything as a nail. That has been getting in the way of more effective solutions for problems that have social causes. ‘Call the Midwife’ showed successes in vaccine delivery, but the stories are profoundly social and the reason so many people watched the series was the attractiveness of those stories. We need structures that allow us to deal with those problems. 

Avoiding the mistakes of previous reorganisations

There are lots of ideas about how we can avoid the complexity and multiplication of effort that are often cited as concerns when reorganisation is discussed. Dave Watson identifies the ‘single public worker’, with conditions and sectoral bargaining as a way to avoid Unions having to negotiate with many more Councils. Where in the 1990s the reorganisation of local government was scarred by discontinuity from the old Councils to the new, we must learn those lessons. This offers an opportunity as well as an assurance. It would require mapping and understanding of what functions local authorities have, where those are located and how they interact with other public services. If we can be clearer about where different tasks are located it will allow better engagement with citizens. 

Applying the learning to other Grand Challenges

There are a range of other grand challenges where we can learn these lessons. Dealing with the climate crisis requires action at all levels – from global to local. And the lack of real local government will hamper our response, especially where we need to adapt to climate change. Anyone who lives close to the coast will know that the increased volatility of weather has had a range of devastating effects on beaches and increased coastal erosion. The response needs to be local, and too often the needs of different areas are being played off against one another. The best answer to the question of who should be the priority for coastal defence is to give that power to communities themselves. Of course coastal defence requires coordinated action, so the planning should be at regional level – it is the delivery that should be relocalised. 

While we face more grand challenges, we need to resist the temptation to be drawn into a ‘race to the top’ in the responses to those crises. We have mostly solved the challenges that can be solved with centralisation. We need to develop the structures that might help us to deliver solutions to the challenges we face. Localisation offers us a way to tailor solutions to these more social, more complex challenges. In this way we can balance the needs of democracy, workers and citizens more effectively and in sympathy to people’s lives as they live them.