“Care is not an activity that can happen by the clock… Care belongs in the world of Kairos time (measured by flow and connection) as opposed to Chronos time (the industrial time measured by minutes and deadlines). Care is not the same as cure – yet it so often seems we have confused these categories. This is why our care systems ‘think’ in terms of an activity that is costed, rationed and meted out in response to a specific need or life moment, as opposed to an ongoing human activity.”
Hilary Cottam [1]
Kairos time is fluid. It’s the time of nature, of seasons and weather and tides. Of creativity, and possibility, and opportunity, and serendipity.
The time of flow and connection.
In this blog, I’ll explore what care and support in the world of Kairos time could look like. And I’ll hopefully show that if we’re ever going to achieve more relational, human ways of working, we have to move away from the industrialised, institutionalised ‘care system’ dominated by the clock that I described in my previous blog, to a world where we have a different relationship with time.
From Chronos time to Kairos time.
Early ‘intervention’
“Rather than focusing on approaches to delivering care that intervene at a time of crisis, care and support services should intervene early to support individuals, helping people retain or regain their skills and confidence, and prevent needs from developing.”
Department of Health and Social Care [2]
‘Early intervention’ is one of those jargon terms we throw around along with ‘prevention’. However, behind the jargon lies a fundamental shift from the ‘come back if things get worse’, rationing approach of our current system – which perpetuates our permanent state of crisis response – to a more open, visible, proactive and timely approach.
Earlier conversations create space for strengths and aspirations to be considered, options to be explored, choices to be made and capacity to be built.
I’m not a huge fan of the term ‘intervention’ as I feel it has overtones of meddling and interfering. This is not, and cannot be, about a ‘professional’ wading in from ‘outside’ wearing a lanyard and an air of superiority to take charge and prescribe. Instead, it’s about partnership and trust and choice and control. About listening to people and their families to understand what a good life looks like, and working alongside them to make connections and build relationships and remove barriers so they can get on with living the life they choose to lead.
“We need to open the gates, go outside and seek people as early as we can find them. If we have time to understand what they really want and need in life, our services will be a vital – but small – part of it.”
Alex Fox [3]
Time for stories
“We need to spend more time finding out who [people] are and who they want to be in the world.”
Gord Tulloch and Sarah Schulman [4]
Our current approach involves people ‘telling their story’ time and time again to multiple different professionals. ‘I should only have to tell my story once’ is a familiar and justified aspiration of individuals and families exhausted by repetition, and of national and local ambitions for reform. Too often though, this ‘story’ isn’t a story at all, but a fragmented list of labels and problems and risks repeated in response to a narrow, deficit-based and potentially traumatic line of questioning. Obviously only having to answer the same questions once rather than multiple times is an improvement. Having a coordinated plan in response is better too. But it’s not enough.
When we can tell stories about our lives to someone who is genuinely curious, who listens with no agenda or judgement or interruption, and who recognises what we don’t say as much as what we do, it’s powerful.
“People are stories, and knowing these stories gave more agency and currency to help than any assessment I’d ever seen in my whole career. People were helped out of decades-long slumps because they were understood, and time was invested in them.”
Mark Adam Smith [5]
We need time to listen to stories, and time to build the trusted relationships required for people to share them and to know they will be heard.
“Listening to stories takes time, but stories are abundant and in this rich, unruly mix we find the seeds of ideas that can be grown”.
Hilary Cottam [6]
Lifetimes
“Despite being homeless, it started with sorting his teeth. Then a better sleeping bag. Then a bicycle (we scourged a free one) and then a place to stay. This was his order of things. We don’t know best. He’s stopped offending and getting help with his addiction, but crucially he’s thinking longer term. We’re working with him at his pace. There’s a relationship and support, where there used to be (non) eligibility criteria and transactions.”
Mark Adam Smith [7]
We need to shift from our focus on the present moment, on quick fixes for immediate needs. We need to see people in the context of their whole lives. Look back, be aware of and informed by what may have happened before. Appreciate and harness the experiences and skills and knowledge people collect and carry with them. Look around, consider – and challenge – the barriers. Be alert to, and embrace, the opportunities. Look ahead – be curious about, and prepared for, what could happen next. Understand the hopes and desires and wishes and dreams people cling to. Create the space and the time for the past to be acknowledged, the present to be explored and the future to be imagined.
(Safe) waiting
“Safe waiting. I think what it is is a stance, like a professional position, that we can take when supporting someone. It’s kind of a commitment you make with that person to stick with them while life unfolds, whatever pace it wants to go at. And I guess that’s waiting. The safe element of it is that we, as professionals, safeguard people.”
David Oliffe [8]
Safe waiting is about being present – for as long as that presence is needed. It’s not about rescuing or fixing. It’s about walking alongside people at a pace determined by them, not by a process or a performance indicator.
It’s about waiting for the right moment, and recognising that takes time.
Pausing
“The power of a pause. It takes a moment, but it can change everything. Pause, reflect and go again.”
Elly Chapple [9]
Our ‘fast-paced environments’ and ‘busy teams’ offer little, if any, opportunity to pause. The relentless pace drives rapid decisions and quick fixes. Labels and assumptions dominate. Indeed, they are essential for us to control and channel and sort and process. ‘Low-level’ that way, ‘eligible’ this way, ‘complex’ over there.
Pausing creates space for curiosity and connection and compassion. It allows perspective and prevents snap-judgements. Breathing space. Time to think, to imagine, to create, to reflect, to learn.
Indeed, pausing is built into our statutory guidance, which suggests “the local authority may ‘pause’ the assessment process to allow time for the benefits of [preventive] activities to be realised” and highlights opportune times during safeguarding enquiries for “appropriate pauses for reflection, consideration and professional judgment” [10].
Reflection time
“It is interesting you ask about reflective practice, once past the stage of ASYE this is not seen as important as it doesn’t relate to a PI.”
Social Worker [11]
A third of the social workers who responded to the British Association of Social Work survey said they spent no time on reflective practice per week, and 42% said they spent less than an hour [12].
Reflection time has been squeezed out of practice as ‘case management’ dominates. But critical reflection is, well – critical. Time to reflect is essential for social workers to analyse and challenge their assumptions, beliefs and values, to consider context, to speculate and to learn.
Reflection time isn’t just important for social workers, it’s important for people and families too. Whether it’s facilitated through family group conferences, or local area coordinators or another approach, it provides space to reflect on what matters, what a good life looks like and how it might be possible to achieve and sustain that good life.
“The poignant part of all this is that the people we support, for whatever reason, may never have been given the opportunity to think about what would make a good life for them… It often takes time for an individual to think about what the real answer to the question is for them.”
Ralph Broad [13]
Time to be human
As I said at the end of my previous blog, our current approach reduces people working in social care to robots, and people seeking or drawing on support to widgets.
The industrialisation of care has suppressed individuals in favour of consistency and efficiency [14]. We’ve divided people into ‘professionals’ and ‘service users’, ‘providers’ and ‘consumers’, ‘them’ and ‘us’. Identities hidden behind labels and lanyards, and all the stereotypes and assumptions and judgements and rules and boundaries they bring.
We can’t work in a relational way without allowing time for relationships to form and grow. These relationships are built and maintained through trust, and trust can only be established and sustained through human connection. We can’t work in a relational way unless we have time for empathy, and honesty, and kindness, and vulnerability, and love.
Unless we have time to be human.
Time to care
Institutionalised care is about efficiency, not efficacy. “I have worked in a care home and hated it. Not enough time per resident it felt like a conveyor belt” [15]. Caring for, not caring about. “There is no quality time spent with the residents, it’s all about getting everything done and everybody done in record time” [16]. Care as a task (‘care for’) or a service (‘delivering care’) or a setting (‘in care’).
We need to recognise care as a relationship and a vehicle, not a transaction or a destination. Care as compassion and creativity and curiosity and connection and community.
And we have to have time to care about each other, and time to care about ourselves too.
The right time
“For everyone who draws on care and support – no matter their age or circumstances – achieving the choice, control and independence set out in our 10 year vision starts with making sure they are listened to, understood, and get the right care, in the right place and at the right time.”
Department of Health and Social Care [17]
Our current approach starts with ‘how much time do you need?’, translates the answer into budgets and services, and ends with ‘how long did it take?’ Chronos time care prescribed and scheduled and delivered and measured by the clock. The ‘right time’ determined by processes and providers and performance indicators, not the right time for people seeking and drawing on support.
Our future approach must start with ‘what matters to you?’, but if we’re going to ask the question, we have to have time to listen to the answer, and the flexibility to respond.
The right time for conversations and support is personal and unpredictable. If we’re ever going to achieve this relational way of working, our organisations need radical change. We need to open our doors and remove our eligibility criteria. Flatten our hierarchies and step out of our silos. Listen rather than assess. Create records instead of filling in forms. Embrace self-management and autonomy. Invest time instead of managing time. And recognise that not everything that can be counted counts, and not everything that counts can be counted.
This is not some fantasy world, an impossible dream.
The foundations of this world of Kairos time are built in existing law and statutory guidance. Our legislative and best practice frameworks advocate a more human, relational approach, and there are numerous examples of this approach in local areas and community groups and micro-providers and social enterprises.
However, Chronos time undoubtedly still dominates the world of statutory social care.
If we’re ever going to achieve more relational, human ways of working – and a better, brighter social care future – we have to develop a different relationship with time.
Shift from Chronos time to Kairos time.
And unless we begin to step in to the world of Kairos time, we won’t have time to pause and to reflect on what really matters. To listen to stories and to share experiences. To visualise this different world and to work together to achieve it.
We’ll always have our eyes on the clock.
We’ll always be too busy, and we won’t have time for change.
References
[1] A radical new vision for social care: How to reimagine and redesign support systems for this century, Hilary Cottam, The Health Foundation, November 2021
[2] People at the Heart of Care: adult social care reform, Policy paper, Department of Health and Social Care, Updated 18 March 2022
[3] A new health and care system, Alex Fox, Policy Press, 2018
[4] The trampoline effect: redesigning our social safety nets, Gord Tulloch and Sarah Schulman, Reach Press, 2020
[5] Eligibility criteria – what if we just turned them off?, Mark Adam Smith, Changing Futures Northumbria, 10 August 2022
[6] Radical help, Hilary Cottam, Virago, 2018
[7] Despite being homeless… Mark Adam Smith, Twitter, 10 July 2022
[8] Safe waiting, David Oliffe, Local Area Coordination Network, November 2021
[9] #Flip the narrative, Elly Chapple, Twitter, 8 November 2021
[10] Care and support statutory guidance, Department of Health and Social Care, 16 June 2022
[11] 80-20 campaign final report, British Association of Social Workers (BASW), 17 September 2018 {ASYE = Assessed and Supported Year in Employment, PI = performance indicator
[12] 80-20 campaign final report, British Association of Social Workers (BASW), 17 September 2018
[13] Local Area Coordination: from service users to citizens, Ralph Broad, Centre for Welfare Reform, 2012
[14] The trampoline effect: redesigning our social safety nets, Gord Tulloch and Sarah Schulman, Reach Press, 2020
[15] [16] ‘To ask about opportunities starting as a Care Worker’ on Mumsnet, 28 December 2019
[17] People at the Heart of Care: adult social care reform, Policy paper, Department of Health and Social Care, Updated 18 March 2022
Rewriting social care 
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