Filed under: Design and Society, Fellowship, Innovation
The BBC reported yesterday that spending on care is in down by a fifth. While this puts a figure on the amount that it’s been cut over the past decade, the fact that home care is in crisis is well known. Demand is up, money to fund it is down, too few people want to do the work and the way it’s run keeps meaningful, caring relationships from forming between workers and those they care for.
In response, Labour announced this week that if it wins the election it will integrate services ‘from home to hospital’, helping end 15-minute care slots and incentivising providers to improve social care. Not only that, they’ll also provide 5,000 more home care workers and offer all vulnerable older people a safety check.
While this is all good, there’s something not quite right about it – the whiff of advisors sitting round a table shouting out solutions to someone sticking a stack of post-it notes on the wall. ‘A safety check for everyone’ ‘Free walking sticks for all’ ‘A 1,000 extra homecare workers’ ‘Is that enough?’ ‘Make it 5,000 then’.
Other parties will not be too far behind in their promises, which will be less or more generous, but will all share the same trait. They will be headline grabbing, with this amount of money pledged or that policy change all that’s needed to make the difference. It will lack the sense that they’ve thought deeply about the problem and reached a considered response working in partnership with those closest to the issues.
Here at the RSA we’ve been discussing home care rather a lot recently, more specifically a Dutch home care company called Buurtzorg, due to its pioneering organisational model. It’s a company with 6,500 nurses and 35 back office staff. Yes, that’s right, 35 back office staff supporting 6,500 frontline staff who in turn look after 60,000 patients a year.
The way they work is to arrange nurses into autonomous units of 12 and let them operate largely as they decide. A strong IT system not only makes the finance, HR and other central parts of the business easy to use and efficient, it also provides strong social networking to share ideas and help each other solve problems.
This lack of hierarchical management, replaced by self-organisation and increased trust, has turned the traditional hierarchical model on its head. Care workers decide themselves how to spend their time, choosing to spend more of it with individual clients, building up relationships and trust. In a study of client satisfaction Buurtzorg came top out of 307 community care organisations. It turns out to be cost effective too as the model leads to more prevention, a shorter period of care and less spending on overheads. This is all incredibly impressive.
One of the powerful things about it is that it began with nurses themselves. Jos de Blok, the founder, is a former nurse who didn’t like the way home care was organised in Holland, which was similar to the way it is currently organised here with very short, timed visits and no allowance for the social side of care or the development of a meaningful relationship between carer and client.
Rather than wait for someone else to fix it he decided to do something about it himself, starting his own organisation with three other nurses in 2006. There were no special dispensations from Government, no grants to get it off the ground, he competed with everyone else on equal terms and Buurtzorg is now the leading supplier of home care in Holland by a large margin.
Something similar would be fantastic to have here, not only to improve home care in this country, but also to increase staff well-being and to demonstrate that a completely different type of organisation is possible. You can wait to see if political parties and their pledges can make all the difference, but I wouldn’t hold your breath. Instead, if you are a Fellow working in this area, I’d love to hear from you to see if we can start a Buurtzorg type revolution ourselves.
Oliver Reichardt is the Director of Fellowship at the RSA
Follow him @OliverReichardt
‘Bob’s Big Idea’: Harvard Professor Robert Kegan (Bob) has been arguing that we are living longer for a reason – to give us time to evolve a different order of consciousness (5th stage, or inter-individual in his model) to deal with the problems created by the prior 3rd (socialised) and 4th(self-authoring) levels of consciousness.
Older? Yes – always, alas. Wiser? Sometimes. More creative? It depends what you mean…
In Spiritualise we argue that facing up to the inexorable nature of death is part of being more fully alive. But we rarely manage to achieve this, partly because of our cultural fixation with youth. “Hold on to the phase of life that keeps death at arms length”, we seem to say. But that’s a futile, unhealthy battle. In a society with good public mental health we would all feel that the best age to be is the age you currently are, but that would mean viewing the ageing process in a positive way that didn’t seem like a consoling fantasy.
We should all try to live such that the best age to be is the age you currently are.
Let’s start with the phases: In most OECD countries in the early 21st century, ‘childhood’ is thought to last around 18 years. Pre-birth and infancy are important parts of that, and ‘adolescence’ complicates matters, arguably a distinct state extending from young teenage years up to around 25. ‘Adulthood’ goes up to about 45, when we talk of ‘middle age’, and then around 65, at least until recently, we begin to talk of ‘old’ age, but that feels increasingly obtuse, mostly because so many people view this phase of life much more positively, and it’s hardly a minority interest.
Here’s the thing: “Of all the human beings throughout human history who have ever lived to 65 or more, two thirds of them are alive today.” – Robert Kegan (Speaking at the RSA c11 mins in video above)
There is something that is quite corrosive in our public life. It is our reaction to new ideas. If we were societies facing few challenges, completely at ease with ourselves, in a state of domestic and international tranquillity then this might be explicable. But given the scale of political, social, economic and environmental challenges, now more than ever we need access to creativity. Sometimes this creativity will seem crazy and it may even, on an occasion, risk serious harm. But we have to find a way of allowing creativity into our democratic processes – we don’t even know all the possible answers as things stand.
It is in this context that two developments are particularly eye-catching- one of international significance and one that is more parochial. Yesterday, Syriza won the Greek election. The received wisdom is that this will be a complete disaster. And it could be. However, what is clear is that the EU (or Troika’s) Greek bailout put in place a debt maintenance plan but failed to establish an economic recovery plan. Consequently, you have a deflating economy with an enormous debt. You don’t need much by way of mathematical nous to see this as unsustainable.
Hello world! The indefatigable members of the events team have just emerged – blinking in the bright sunlight – after an inspiring, provocative, and (blisteringly exhausting) triad of events. Of course a week doesn’t go by without an acclaimed thought-leader or practitioner popping up on our stage, so this week is in many ways ‘business as usual’ for us. But I think this particular trifecta really encapsulates the unique ambitions of the RSA’s programme of activity, and thanks to some propitious stars aligning (and, regrettably, a lot of refined sugar) we managed to deliver something approaching our Platonic ideal of an event offering. Read more
Comedy is simply a funny way of being serious. - Peter Ustinov
Last night’s climate comedy featured an exacting gig for professional comedians at the RSA, but they all took the task very seriously (one aspect of comic expertise, I noticed, is skill in the art of pretending not to prepare).
Individually, and together, they delivered a wonderfully diverse take on the climate challenge. It was a great fit for the project, because it echoed the core point about the need for a diversity of perspectives and approaches to the challenge. I am grateful to all the comedians for their hugely creative contribution; in fact I feel I learnt something about the creative process by watching what they did with the issue. I’m especially grateful to Pippa Evans for rallying her colleagues and hosting the event with such elan (even if she did call me ‘little beardy Rowson‘ on stage). Read more
A talent for speaking differently, rather than arguing well, is the chief instrument of cultural change. – Richard Rorty
Today is a climate change bonanza at the RSA. We are hosting ‘Seven Serious Jokes about Climate Change’ tonight (live streamed from 6.30) and launching our paper (co-written with COIN): The Seven Dimensions of Climate Change
Dear Climate Change,
I’m terribly sorry I haven’t been in touch since October. Let me assure you, I received your recent letters and graphs with all due consideration and affection. It’s just that I have been so terribly busy these past months, what with getting Spiritualise out the door, and then Christmas and what not. But you have been in my thoughts almost every day, and I am so very glad to now have the chance to reestablish contact.
Looking at the various election predications in terms of seats, it is entirely possible that no party will be able secure a decent majority- even in Coalition. This has led many commentators to speculate that this may be a year of two elections. That’s all well and good but who is to say the outcome of a second election would be any more decisive? Some have even suggested that there might be a grand coalition between Labour and Conservatives. I rarely gamble large sums of money but I’d put down quite a wager against that happening. So perhaps a third outcome is far more likely – gridlock.
Yes, US style gridlock could be coming to these shores. The party with the largest number of seats may be able to form a Government through a confidence and supply arrangement or through a narrow-majority Coalition. They may calculate that they would be no better off from a second election or the Fixed-Term Parliaments Act may prevent a second election being called (given its super-majority rule for any early election to be called). They would be able to form a Government and pass a budget but little else for which there wasn’t broad consensus in Parliament. They would be hostage to their own backbenchers on some issues and to other parties for other legislative proposals. So gridlock- the inability to pass significant legislation – could be upon us.
At the RSA, we always set out to engage, connect and inspire Fellows across the UK and now we will be using a new event format to boost this. Our RSA Engage series has been turbo charged for 2015- moving from its trial phase in 2014 to become a cornerstone of our activity.
The Engage series is a national programme of events aimed at showcasing RSA activity and providing space for our Fellows to meet, share their ideas and offer support to Fellow-led projects in a simple and structured way. To give you a flavour of what we have in store, here are some of my favourite stories from 2014.
Okay, so this isn’t a story, rather a call out for you to create the story. 2014 Engage pilots saw a raft of great people and ideas brought together. 2015 is going to be bigger and better through our Engage and Connect events will have created space for 184 project pitches and 44 Connect discussion slot. That’s 228 potential new ideas to be discussed and shared. These events are free and open to all, so do invite friends and colleagues that are keen to find out more about the RSA.
Imagine a world where we don’t throw anything away. Everything is reused, composted or recycled and people living on the same street work together and share resources.
Katy Anderson FRSA from social enterprise Cwm Harry is working towards this vision of a zero waste world through The Rubbish Diet, the UK’s slimming club for bins. She would like to invite Fellows across the UK to join the thousands of people who are helping bringing zero waste closer by committing to a completely new kind of New Year’s Diet.
Across the UK, huge amounts of valuable recyclable materials are being lost to landfill and incineration. In West London, where the Rubbish Diet is working in six boroughs, 67% of the waste sent to landfill could have been recycled.
It goes to landfill by train, the waste train is one-third of a mile long, taking 1,000 tonnes of “rubbish”, six days a week. 1,000,000 recyclable bottles a week go to landfill every week on the train, when they could have been made into new bottles and been back on the supermarket shelves in just 3 weeks.
How does it work?
Anyone can join The Rubbish Diet by taking an easy online challenge to slim their bins. The Diet will motivate you to set a goal and measure your progress by tackling two simple steps over just a few weeks.
You’ll receive emails with great tips on how to recycle to the max, make the most of your food and avoid waste altogether. Dieters experience very quickly the positive difference their actions make to their waste and they are encouraged to share their ideas and questions, creating a whole new conversation about waste reduction and the positive impact it has on our lives.
Dieters then spread the word amongst their friends and family, and so the Diet grows…
Crucially, The Rubbish Diet tackles the issues that make it hard to avoid waste – this quarter we’re focusing on packaging, culminating with a workshop at the Resource Event on Thursday 5 March 2015.
On average people slim their bins by 40% on the Diet, and the change is permanent. Slimming your bin will save you money as you’ll reduce food waste and start reusing more, and it has obvious benefits for the environment – food waste alone in the UK is the equivalent of one in four cars on our roads in terms of carbon emissions.
Thousands of people have already taken the Rubbish Diet across UK, taking it online, in collaboration with their whole street or in a group. Jackie and Howard from Shrewsbury took the Diet with their street, meeting to talk rubbish with their neighbours over tea and cake. They now have slim bins, run clothes swaps and share trips to the recycling centre, and have gotten to know their neighbours! Since they started two years ago, they’ve saved 6 tonnes from landfill.
Simon who shrank his overflowing wheelie bin by two thirds said:
“I’m so proud of what we’ve achieved – you could heat the house on my smugness. The whole family is loving our weekly trip to the market where we can buy food with less packaging, and save money too”.
Taking a close look at what we throw away has a real impact on our lifestyles. As Dieter Sarah from Harrow explains.
“I thought I was good at recycling, but The Rubbish Diet Challenge has really made a big impact on how I view, well, everything in fact. It’s really changed my life. It made me think about the make do and mend culture that everyone had back in the 1940s, 50s and 60s. I am much more careful about what I buy, and I reuse and mend much more than I used to. ”
The Rubbish Diet solution finally provides a structured, yet fun, community based way to recycle. Sign-up and let Katy know how you think it could be shared in your area.