I read Wuthering Heights for the first time when I was a teenager. I adored the rugged, wild setting of the Yorkshire moors and the passionate love story at its heart. And I still remember the symbolism of the doors and windows and gates that featured at so many crucial moments of the novel.
Thresholds feature strongly in our current world of social care too. We have front doors, closed doors, revolving doors and locked doors. Resources to gatekeep. Floodgates to reinforce. Eligibility thresholds and financial thresholds to maintain.
In Emily Bronte’s novel, thresholds symbolised boundaries between different worlds – often impenetrable, with closed windows, locked doors and barred gates separating, excluding or imprisoning characters. In this blog I’ll explore how the thresholds of our social care system serve much the same purpose – separating ‘them’ from ‘us’, preventing people from coming in, and restricting and restraining people desperate to leave.
Most social care departments have a ‘front-door’: a single access point where people seeking support first contact their local authority. In theory this makes it easier for people to contact us. A single phone number. A sole email address. One doorway. One way in. In reality, channelling everyone through a single point of entry makes it easier for us to screen and triage, to signpost people towards someone else’s door or refer them on to another part of our system – often with its own front door.
Instead of multiple doors into teams in communities – close to people’s lives and their own support networks, and close to others offering support – our centralised front door is separate. It’s removed from neighbourhoods, reliant on people coming to us rather than us making the effort to get closer to them. Call the single phone number and more often than not you’ll get a recorded message. Email the sole email address and you’ll probably get an automatic reply acknowledging receipt. Join the queue. We’ll add you to our waiting list. You’re not really welcome here.
Our social care system (and indeed the wider ‘welfare’ system) is increasingly about closing rather than opening doors. It’s designed to keep people out, with eligibility and financial thresholds filtering out those whose needs are insufficient, or finances are too sufficient, for us to let them in. People are only allowed in when their life is spiralling rapidly into crisis, ensuring dependency despite our goals of ‘independence’.
Often families are kept out too. Treated with hostility, labelled ‘difficult’, and excluded as part of the problem rather than included as part of the solution.
It’s not just the individuals and families in search of support who struggle to get in. Often our colleagues in other teams and our partners struggle too, as our eligibility criteria and transfer protocols extend to them, and we spend our time arguing about referrals and responsibility – passing ‘cases’ backwards and forwards. Often we work in silos – we know our part in the ‘process’ but the next stage is in another department, behind another door.
And we perpetuate our closed doors through our jargon and acronyms – our ‘professional’ language that distances and separates and excludes.
Our social care doors revolve too, as people pass through them again and again. We stigmatise the people we see or hear from regularly. We label them (cruelly) as ‘frequent flyers’. We blame them for coming back too many times, while failing to recognise that their reappearance has much more to do with our failure to find out, and understand, and act on what really matters to them. The failure of a system that celebrates success in terms of numbers, not people – and favours the nearest open door (particularly to prevent blocked hospital doors) rather than the door of choice.
There have been numerous documentaries, books, articles, reports and blogs exposing shocking abuse behind the locked doors of social care, with undoubtedly countless more stories so far untold or not heard. And repeated promises that the ‘inappropriate placement’ of people with a learning disability or autism in secure units will end.
And yet the latest NHS Digital figures show that at the end of February 2020, there were 2,170 people with a learning disability or autism in hospitals in England. Over half (58%) have been in hospital for over 2 years. 1,000 are in a secure ward. Almost half (48%) have no planned discharge date . They’re reported as statistics, not people. Not human.
Still all too often we default to institutions as our solution – grouping older people or people with a learning disability or autistic people together in ‘beds’ or ‘units’ or ‘schemes’ in an artificial world quite separate from the rest of society. ‘Them’, separate from ‘us’.
Them and us
Social work should be about removing barriers. About social justice and human rights. And yet too often we’re imposing barriers rather than taking them away.
It’s easy to blame the thresholds in our system on the years of inadequate funding and increasing budget pressures on local authorities, as successive governments fail to address social care reform. Dwindling resources have led to barriers being imposed through fear. We’re scared that if we open the floodgates, demand will exceed supply and the money will run out. So we’ve got used to gatekeeping our resources and ‘managing demand’. Rather than working with partner agencies, we compete with them to maintain the strongest barriers: reinforcing our thresholds to make sure they remain the toughest, in the hope that we divert the flood elsewhere. And yes, when supply is measured in services – in home care hours, or residential care beds – it’s limited. But if we measure supply in our capacity to listen, learn, be useful, solve problems, support relationships, build good lives, the supply is much less finite.
But we’re not just scared about the money running out. There’s a ‘them’ and ‘us’ dynamic at play here that goes well beyond budgets and finances. In social care, people are either ‘professionals’ or ‘service users’. The assessor or the assessed.
If we really want to break down the barriers, we have to stop the labelling and othering. Stop focusing on difference, and instead recognise similarities. Acknowledge that ultimately we all have the same basic needs, and we want the same basic things. Home. Purpose. Love. Hope.
Opening the doors and unlocking the gates
So back to Wuthering Heights. The classic novel features families, friendships, neighbours. Lovers. Sworn enemies. Births. Deaths. Generations. There is love, joy and hope. Anger, jealously, revenge, violence, grief and despair. Secrets. Misunderstandings. Revelations. Complex, passionate, abusive relationships. Stories and storytellers. Life. Thresholds play their symbolic part but in no way do they dominate Emily Bronte’s narrative. As readers we have plenty of time to explore and understand and reflect on characters and emotions and motivations. The past, and what lies ahead. Memories and dreams.
For too long, doors and gates and thresholds have dominated the day-to-day reality of social care, and prevented us from listening to, and understanding, histories and passions and hopes and fears. Now it’s time for us to tell a different story.
In our better, brighter social care future, we open doors. We remove barriers rather than imposing them. We venture out through our doors, rather than expecting people to queue and wait to get in. Instead of gatekeeping, we unlock our gates. Rather than waiting until people’s lives are falling apart before we let them in, we welcome them early and we have time to explore options and make plans together.
We focus our attention less on our own front doors and more on helping people to establish, maintain and return to their own front doors. We help open doors into communities by investing in small, locally designed and led opportunities rather than perpetuating the institutions commissioned and managed from the top.
Our doors no longer revolve, because we work with people alongside all those in their networks and our networks who are key to making connections to the things that matter most, and to helping people live the life they want to lead.
And because our doors are open we have more time. Instead of arguing with other teams and other organisations, and with people and families, about who should come in and who must stay away – we pass freely through each other’s doors working together with, rather than against, each other as partners. We listen. We work as genuine teams.
Instead of closing our doors through fear, we open our doors and let in hope.
 Learning Disability Services Monthly Statistics (AT: February 2020, MHSDS: December 2019 Final), NHS Digital, 19 March 2020