Or From Mondrian to Pollock; from systems to ecosystems: reflections on SCIE’s first social care roundtable
The kind folks over at SCIE have published some thoughts of mine on social care. Below is an extended version of that post (which might make even less sense than the shorter version)
Our concept of social care as a cohesive ‘system’ can compromise our ability to understand how complex it really is. The need to change social care to meet all future demands requires us to think in a much more sophisticated way.
Let’s start by questioning whether social care is even a ‘system’ at all. The formal definition of a system includes ideas like a fixed structure with a range of defined parts. Effects tend to follow causes, no matter how complicated the arrangements are. If one thing here is changed it predictably alters another thing there.
This way of thinking has its attractions, not least of all to politicians, because it suggests that if only the right levers can be pulled then the right sorts of changes will happen. The picture of social care that such systems thinking paints is like a Mondrian painting: it is cohesive, makes a sort of sense, has patches of bright colour (i.e. excellence, though often at the margins) but all of which exists within a rigid structure.
Participants at a recent roundtable hosted by the Social Care Institute for Excellence suggested that a better way of thinking is to recognise the complexity of what we might call the social care ecosystem.
An ecosystem is a community of living organisms that can self-organise and interact dynamically with the environment around them. Its defining characteristic is the network of interactions between all of these factors, with effect only often being deduced from cause only generally in retrospect.
This complex (rather than complicated) concept of social care as an ecosystem better reflects reality. Its ‘living organisms’ are the vast array of stakeholders in social care. Rather than a Mondrian picture, perhaps social care can instead best be thought of as a Jackson Pollock painting:
If we think of social care as a complex ecosystem rather than a complicated system, we need to shift our way of thinking on what needs to be ‘done’ for change to happen. As Mark Foden has said: complicated systems need a “build” mindset for change to happen, whereas a “grow” approach works best in complex ecosystems.
To change social care, we therefore need a much more sophisticated way to approach change.
What does this look like? SCIE’s roundtable identified three possibilities to start things off:
- Distributing power amongst all stakeholders through all aspects of co-production and by creating spaces in which the right mix of people, organisations, power, expertise, experience, styles, and cultures is brought together. (To mix metaphors, it isn’t just the ingredients that are important for change to happen, but also the way – the recipe – in which these ingredients are brought together.)
- Putting people at the centre of their care and support, through personalised approaches and continuing to put money more directly in their hands through Personal Budgets and Direct Payments.
- Spending more time and effort thinking about “scaling across” instead of scaling up, i.e. about spread rather than size. This reflection came from people recognising that approaches, particularly by smaller provider organisations, are working well precisely because their distinctive characteristics work best at a certain scale. Changing the scale risks affecting the characteristics. Rather, then, than fundamentally changing the size of an organisation (through scaling up) the smarter thing to do is think how to replicate it (scale across, or spread).
These three possibilities would work especially well in an ecosystem where the “growing” mindset is preferred to a “building” one. Whilst not abandoning entirely the levers and approaches a mechanistic way of thinking about social care has suggested in the past, now is the time to recognise the complexity of the social care ecosystem and update our approaches to change accordingly.
arbitrary constant 
Great blog. I do think we need to consider the ecosystem as being wider than putting people at the centre of care and support and the varying interactions of a social care system. This in itself may reinforce the concept of care and support being an ecosystem on its own and not one that is fully enmeshed with communities, cultures, streets and groups. When the care and support becomes an ecosystem on its own it tends to resemble a virus that needs to be quarantined. A lovely messy ecosystem that can flourish in every corner can grow much healthier, vibrant, resilient communities some of which have care and support needs that help them remain part of the ecosystem rather than drift out of it. Social Care and commissioning after a decade or more of managerialist and industrialised approaches has done its damdest to operate as an isolated control system and showed that this is an absolute failure. The ecosystem is great but lets make sure we don’t make it an ecology all of its own.
Agree about the idea of social care (and health/public health, come to that) systems being kinetic, and about networks and ecosystems. There is a tendency in social care (and I speak as someone with a social care background) for some of those in it to retreat to their own environment where it’s more comfortable, and live in their own separate ecology: hence a common refrain is “we can’t integrate with health because they won’t let us in”. In reality, many social care providers who have ventured out onto the savannah and looked to work with health, housing and other sectors have had a surprisingly rewarding experience, whether that’s in preventative services (e.g. getting a CCG to pay for on-site medical and nursing care) or in getting people out of hospital and into intermediate care. Perhaps there’s a message about the need to evolve and change if your environment and ecology are changing? (I should stop this metaphor now!).