We can all agree social care is complex. But does that help?

Catherine Needham, Professor of Public Policy and Public Management at the University of Birmingham and Associate Director of the NIHR School for Social Care Research (SSCR), reflects on the complexity of social care and why it must be approached as an interconnected ecosystem. She highlights the skills leaders need to navigate uncertainty and the importance of staying optimistic. SCCR and ADASS formed a partnership earlier this year, aimed at strengthening relationships between adult social care and research.

It is a truism to observe that public services are complex adaptive systems. Looking at the programme for NCASC, the full range and complexity of social care is in evidence. Some sessions are about single service models, organisational types or issues (e.g. care cooperatives; workforce pay; AI), but many extend the boundaries well beyond service specifications. They are about violence and trauma; poverty and abuse; voice and power. Housing is there, along with broader issues of neighbourhood and place.

We need this wide lens because people live interconnected lives, in which their health and social care, education, employment, housing and income have to be considered holistically rather than fragmented into the neat silos of government bureaucracies. As one councillor put it, in our project on Care Ecosystems, “The same people were being seen by a number of services and it didn’t really make much sense to me that we were spending all this money on what we felt from our data…was not really making people healthier.”

Efforts to work more holistically aren’t easy. We know, because we’ve seen it happen, that neat policy initiatives get messy in practice, that it’s hard to sustain ‘fidelity’ to new interventions because humans behave in unpredictable ways. We talk about ‘place’ and try to collaborate with partners in whole system ways. But even the best collaborations strain when budget savings accrue to a partner rather than to us. Collaborations crumble when staff move on and relationship-building has to start again.

These are features of complexity – its compositional complexity (so many moving parts) and its dynamic complexity (nothing stays the same). These are two of the four categories of complexity set out by French et al. (2023) in their book on how to harness complexity to improve outcomes. The others are experiential complexity (everyone experiences things differently) and governance complexity (so many actors are involved). The upshot is that outcomes are emergent and unpredictable, things are constantly shifting and no one can even see the whole system, let alone control it.

For people involved in social care it can seem like this complexity is overwhelming. Whether as a recipient of social care, an unpaid carer or someone working in the sector, the path to better outcomes can feel shrouded in fog. Some key elements of social care – who should pay what? what should the family do? what should be picked up by the state or the market? – remain unsettled and contested. Reflecting this ambiguity, we see national reform initiatives get shelved one after another.

In our research for the ESRC Centre for Care about care as a complex adaptive ecosystem, we’re looking at ways to better understand complexity in social care, and – crucially – to support people to work well within it. Making effective, joined-up interventions, will continue to be a challenge for local authorities. For senior leaders looking at how to work well within complexity, here are some places to start:

• Get the right skills

As we wrote in the first edition of the DASS Guide, being a senior leader in social services is ‘more rave than waltz’. It requires skills of improvisation, of tolerating mess and uncertainty. Whilst many senior leaders will have been on systems leadership courses, it can be hard to bring back the learning from those programmes into local government. The ideas of emergence, interconnectedness and learning from failure, don’t necessarily sit well with the accountability and performance regimes of the sector. It can be hard to espouse the values of experimentation and failing forward when the leader of the council or the local newspaper are knocking on your door asking for definitive assurances. Thriving in a complex system requires being able to work well with people who aren’t interested in complexity.

• Find intuitive ways to talk to others about complexity

Inspiring others to see the value of appreciating complexity means we have to stop making it so obscure and difficult to grasp. System maps that are hugely complicated and immediately out of date, or modelling methodologies that require too many simplifying assumptions, are not the only way to represent complexity. In our research we worked with people with lived experience to develop an image of a social care ecosystem which is inspired by a natural landscape. This uses the metaphor of a thriving natural ecosystem to convey how multiple, interconnected parts can come together in a flourishing equilibrium. We can understand the mutual interdependence of a nature landscape without needing a degree in biology to unpick all the forces at work. Whilst social care can sometimes feel like a degraded tundra rather than a verdant hillside, the flourishing landscape represents a destination we can all work towards.

• Stay optimistic

An awareness of complexity can lead to fatalism, a sense that there is no point trying to intervene when so much is uncertain. In his book on Magical Thinking, John Boswell reminds us that we rely on practitioners continuing to strive for better public services, even in the face of failure and frustration. The subtitle of the book (‘Why naïve ideals about better policymaking persist in cynical times’) points to the willingness of practitioners to get stuck in and try to improve outcomes for residents and communities, even when past initiatives have failed. By naïve, he doesn’t mean foolish or over-simplistic; he is referring to the willingness of people working in public services to keep going, even when more cynical voices are pointing out all of the reasons why nothing will ever improve. This spirit of learning and optimism, of coming together with others to discuss how things can be better, is what NCASC is all about.

SSCR has a stand at NCASC so come and say hello!

Catherine Needham is Professor of Public Policy and Public Management at the University of Birmingham, and Associate Director of the NIHR School for Social Care Research (SSCR).