A Solution to the Home Care Crisis?

January 29, 2015 by · 5 Comments
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

 

Draft or daft? 12 design principles for creative capacity-building schools

January 18, 2015 by · 2 Comments
Filed under: Education Matters 

Late last year, the US-based Roosevelt Institute asked the RSA to write a policy memo to support its Next American Economy project. This project ‘identifies the trends and challenges that will shape our economy in the next 25 years to better inform the policy decisions we must make today.’

We were asked to explore how school systems can best be designed to develop all students’ creative capacities during their school years, so that young people are better equipped to succeed in the 21st century economy. Although The RSA’s ‘Power to Create’ philosophy is predicated on a belief that creativity has intrinsic and non-economic value for individuals and communities, this memo was driven by the project’s particular rationale – the economic imperative for a more creative workforce. .

Whilst based purely on desk research, the work, helped by the Roosevelt Institute’s recommended structure of ‘situation-complication-questions-answers’ and short word limit, has helped marshall our own thinking. Although our emerging aim – to close the creativity gap in learning - widens the RSA’s lens beyond schools and young people, it’s been useful to concentrate again on the eternally important and contested role of schools.

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Have yourself a merry indie Christmas

December 5, 2014 by · 1 Comment
Filed under: Enterprise, Uncategorized 

It’s Small Business Saturday tomorrow, and small business owners will be hoping for a repeat of last year’s £468 million of sales at special events across the country. It’s a good week to be one of them – as well as the Saturday boost, George Osborne’s Autumn statement extended small business rate relief again and promised a review of business rates for 2016.

shop independent

From @LolaHoadDesign

Since the turn of the century there’s been a 40% increase in the number of firms with less than 10 employees. At the RSA we argue that this growth in self-employment and microbusiness is a good thing, and a trend that should be supported by policy. The RSA’s Power of Small project has found that despite lower incomes and fewer perks, the self-employed are more satisfied and happier overall than most other groups in the wider workforce. It’s an area for high potential growth, although our latest report, Everyday Employers, highlights the need for smarter policy to encourage the self-employed to take on employees. Microbusinesses are also at the forefront of the move to a circular economy. Makerspaces such as FabLab London are providing individuals and businesses with access to sustainable design tools – makers are becoming fixers and simultaneously reducing waste.

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‘Benefit tourism’: policy as ‘values’ and policy as ‘evidence’

November 28, 2014 by · Leave a Comment
Filed under: Enterprise 

We’re pretty complex animals us humans. And every day that complexity is distilled, frozen and separated in partisan, media and social media fuelled political debate. It’s as if, metaphorically speaking, different parts of our brain are positioned at opposite ends of the boxing ring, then set against other in mortal combat. The resulting fracas isn’t pretty viewing.

Nowhere is this process more apparent than in the debate over ‘benefit tourism’. The concept of ‘benefit tourism’ is the notion that migrants from poorer European nations (in the main) are coming to our shores to feast on the ambrosia that is our generous welfare state. In this perspective, this is seen as a significant pull factor in consistent net migration to the UK.

But wait, there is another view. There has been some number crunching activity taking place. It turns out that this is not as significant a problem as those highlighting the problem claim. Migrants are less likely to claim working-age benefits than British citizens; the overall cost is negligible compared to the economic and fiscal benefits that migration brings. There are numbers to prove it. If one looks into the emotively termed ‘benefit scrounger’ debate a similar debate is apparent. Of course, I am giving this viewpoint the ‘evidence’ label but it also expresses a set of deeper values- it is just that they are expressed through the prism of evidence.

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Towards a post-extrinsic society

November 26, 2014 by · 1 Comment
Filed under: Social Brain 

The public realm faces significant challenges that cannot be adequately addressed by instrumental, utilitarian thinking. By public realm I mean the political economy and all the educational, commercial, civic and media institutions related to it; all of which, of course, have human beings inside them.

This is a hopeful point, not a council of despair. As thinkers like Steven Pinker are fond of reminding us, in some ways the world is not doing that badly at all; compared to much of human history, most of us live longer healthier lives in societies that are more or less functional and peaceful. Still, I’m not the only one who occassionally has the impression that, slowly but surely, we are losing our way.

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Using insights from neuroscience in education: using the body to improve thinking skills

October 15, 2014 by · Leave a Comment
Filed under: Education Matters 

This guest blog is from Dr Elizabeth McClelland, who became a Fellow in January 2014.  Elizabeth has been working with RSA Education on plans to expand her programme Move4Words to many more schools in England. You can contact her at www.move4words.org.uk where you also find out more about the research evidence.

I was a research scientist in a former life – Royal Society Research fellow for 10 years at Department of Earth Sciences, Oxford University, then University Lecturer and Director of the Palaeomagnetism research laboratory at Oxford between 1997 and 2003. In 1998, I suddenly became very ill with an unknown virus which temporarily robbed me of the ability to speak coherently, to understand speech or written language or to control my muscles properly. All my facilties came back over the following couple of months, except my ability to read fluently. I could read single words, but couldn’t make sense of a paragraph. I was still lecturing at Oxford, I could do my numerical research, gave talks at conferences and even touch-typed a couple of papers (although was unable to proof-read them). It was incredibly frustrating. Eventually, I found a private physio who used a physical activity programme to help children with dyslexia, and she showed me that I’d lost the ability to control my eye movements, and had lost some cross-body muscular control. She showed me some simple physical and visual exercises, which I practised several times a day, and, remarkably, my reading started to improve after a couple of weeks, and within 2 months it was back to my original rapid reading. It was so dramatic, I vowed to find out more and to do what I could to help others in the same way.

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The Case for Compulsory Sex and Relationship Education

October 13, 2014 by · 3 Comments
Filed under: Education Matters 

Spiritual, Moral, Social and Cultural (SMSC) education is back on the political agenda. Best defined as “…the training of good human beings, purposeful and wise, themselves with a vision of what it is to be human and the kind of society that makes that possible”, politicians in a post-Govian world are waking up to the idea that churning our children through an exam factory system of schooling may not be the best way to develop well-rounded citizens. And so SMSC is now in vogue, with the Lib Dems wanting Personal, Social, Health and Economic (PSHE) education to include content on mental health and sexting, Nicky Morgan’s speech at the Conservative Party Conference commenting on the need for ‘character’ education and Labour recently reiterating their long-held view that Sex and Relationship Education (SRE) should be made mandatory (and you can also read the RSA’s own recommendations on SMSC education here).  Read more

Can spirituality inform public policy? Yes, no, and maybe.

September 29, 2014 by · 3 Comments
Filed under: Social Brain 

If spirit is a name for the resistant and transcending faculties of the agent, we can spiritualize society. We can diminish the distance between who we are and what we find outside of ourselves. - Roberto Unger, The Self Awakened p38.

A few months ago I wrote an extended post about the relationship between the spiritual and the political. The pied piper of our generation, Russell Brand, momentarily adopted it as part of his ‘revolution in consciousness’, tweeted approvingly to his millions, and thousands followed his tune to our website. Happy days.

The political dimension of spirituality is exciting because it’s ‘the vision thing’, it’s about being human, about who we are and what we care about. It’s depth and values and hope and how it all fits together. Moreover, as noted above, it is intellectually safe terrain because even heavyweight philosophers like Roberto Unger take it seriously.

The elusive place where the spiritual meets the political is perhaps the experience of life many of us are looking for; a place where the possibilities for your own power and place in the world make sense. When you are living in that place, life tends to be much more rewarding. For instance, I was heavily involved in Scotland’s recent referendum and campaigning felt distinctly spiritual, a way of connecting identity with meaning and purpose. There was an intense feeling of aliveness for many weeks, which is, etymologically at least, close to the heart of the spiritual.

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If you love Academies, set them free

September 4, 2014 by · Leave a Comment
Filed under: Education Matters, Uncategorized 

It is the first week of the new school year and Academy chains are already back in the news.  Last week Ofsted wrote to AET (Academies Enterprise Trust) expressing concern that too many pupils were not receiving a good enough education, and yesterday the House of Commons Education Committee continued their scrutiny of Academies and Free Schools with an evidence session involving representatives of Academy sponsors and local authorities.

For all the controversy Academies are here to stay, irrespective of the outcome of next year’s General Election.  And good news that is too, given the growing body of evidence that some Academy chains are making a positive difference to outcomes for pupils – see for example the Sutton Trust report Chain Effects on the impact of Academy chains on low income students.  That said, yesterday’s Select Committee reminded us of concerns about the Academy programme as currently conceived that just won’t go away: limited local accountability; too much money being diverted from the classroom through top-slices; and signs that some academy chains are failing to provide sufficient support for school improvement.

A reluctance to address these issues risks damaging the Academies sector as a whole.  Three simple changes could improve the system dramatically. Read more

State or private – it’s the wrong question

July 22, 2014 by · 5 Comments
Filed under: Education Matters 

A recent twitter spat about which of the new set of DFE Ministers are privately educated has got me thinking about whether and how far it matters where the DFE Ministers went to school. My conclusion: state or private is the wrong question.

I’m tempted to leave it there – it’s a hot day and there are other things I should be doing – but let me explain…. Read more

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