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Social care: who needs enemies?

Wed, 26th Feb 2014

Last week I visited Botton Village. Botton is an extraordinary 230-strong community of people with mental disability, some quite severe, and volunteer ‘co-workers’ who live and work together in a tiny village tucked away in the wilds of the North Yorks moors. Now 60 years old, Botton’s frugal model of self-help and reciprocal care has helped hundreds of residents live lives of dignity and value, and inspired and attracted volunteers from all over the world. It is also a poignant test case for today: can its unique therapeutic community survive today’s rigid, rule-based public-sector management model?

Botton is the jewel in the crown of the Camphill Village Trust (CVT). Camphill was founded in Scotland at the end of the war by a group of Austrian refugees from Nazism, chief among them paediatrician Karl Koenig, basing themselves on the teachings of Rudolf Steiner. Some of Steiner's views are controversial, but what is not in doubt is the record of the experimental communities the refugees set up to offer education and a shared life initially to handicapped children, then when they reached school-leaving age to adults as well. Camphill has sprouted more than 100 fellow communities and imitators all over the world, including one near Moscow; families wanting more for their relatives than the by-the-numbers care on offer in conventional care homes ‘would walk over glass’ to get them taken in, as one parent puts it.

As developed over the years, Camphill communities are a marvel of economy and balance. They are autonomous and self-managing, with the unsalaried volunteers at their centre. Living expenses are shared: everyone, regardless of disability, is expected to contribute, and the community in turn sustains and develops them in a spirit of brotherhood and equality. There is a strong work ethic. Botton, formed from a small estate made available and later made over by the Macmillan family in gratitude for the new life given there to a family member, has five working farms, all organic and biodynamic, workshops and its own school. The Camphill ethos doesn’t suit everyone, so after a month’s trial, new residents and their housemates get to choose whether they stay or go – but those who have found their place there thrive in its accepting embrace.

Over five decades Botton and CVT’s several other UK prospered, prudently husbanding resources and adding new properties to the original Botton base. Botton was the subject of an admiring TV documentary, and in 2005 won the Deputy Prime Minister's Award for Sustainable Communities, which singled out its ethos of sustainability and mutual respect.

But while Botton went its own idiosyncratic way, the world around it was changing. The agenda in social care swung decisively towards personalisation, choice and ‘independent living’. The resulting suspicion of community care has been magnified by a series of high-profile scandals culminating in the notorious Winterbourne View. Risk, safeguarding and compliance with procedures have become the prime indicators of 'quality of care'. Increasing suspicion of communities like CVT was matched by tightening public funding.

For Botton, too intent on its own affairs to pay much attention to the changing environment, it came as a rude shock when concerns were raised over its unconventional management and governance arrangements, followed in 2011 by critical reports from its funders, North Yorks County Council, and the Care Quality Commission. Caught on the hop, and fearing a drying up of funding, the charity's board of trustees were panicked into the drastic step of bringing in a CEO and management team with NHS experience with the aim of reassuring funders and securing compliance with the regulatory regime.

The result has been a train wreck. For a finely balanced constitution that had been deliberately set up by refugees from the Third Reich to dispense with strong central authority, inserting a layer of top-down management was like injecting it with a foreign body. Long term co-workers, the heart and soul of the organisation, have felt themselves sidelined and downgraded by the import of paid care workers who have taken over some of their functions. Being volunteers rather than employees, they have no employment rights, and several have been suspended in controversial circumstances, being required to move with their families out of their homes of many years with minimal notice. Many have given up and moved on, leaving several of CVT’s communities with no or only vestigial co-working – in the view of many an abandonment of the ethos and way of life that they and their relatives signed up for. Even Botton, the Camphill stronghold, has suffered an exodus of residents and co-workers; together with a funding standstill by the local authority, the result is a Botton population that has shrunk by one third since 2011. Some of the workshops have shut, a full-time medical centre lined to the local GP surgery has been mothballed and there are fears for the school.

Most affected of course are the villagers. The ‘decarceration’ movement that gathered pace in the 1990s was rightly concerned with replacing dependency and ghettoisation in giant institutions with self-reliance and ‘care in the community’. But many see life at the now politically correct opposite end of the spectrum as just as restrictive, only in a different way. As former patient and social historian Barbara Taylor writes in her moving The Last Asylum, in the name of ‘choice’ and ‘independent living’, many mentally disabled have been shunted off into bedsits and hostels; nominally ‘in the community’, many live lonely lives with a TV their only company. Many see something similar happening within the CVT communities, where parents report villagers putting on kilos as they ‘choose’ Mars Bars over healthy house meals and decide to stay in bed rather than go to work in the mornings, and disturbed behaviour as individual TVs replace community life and interaction. ‘Another name for independent living is enforced loneliness’, says one insider grimly.

CVT is now facing a full-blown financial and identity crisis. A climate of fear and suspicion rules with tight-lipped managers on one side and many co-workers, residents and their families on the other. Family members say they are frustrated by a lack of dialogue with managers and the latters’ failure to come clean about their strategic intentions, while dire fears are stoked by the removal of co-workers from the board of trustees in favour of NHS administrators and the unpredictable and apparently arbitrary opening and closing of the membership lists. Both inside and outside, concerned observers fear that in the name of regulatory compliance, and with the tacit consent of the trustees, the new regime is bent on ousting the co-workers and turning the CVT communities into the kind of care homes they deliberately decided to keep their relatives out of.

 The Botton experience underlines one of the lessons of Taylor’s book: in difficult and uncertain areas like mental health, management absolutes should be handled with as much care as high explosive. One generation’s political correctness all too often turns into the next one’s anathema. Learning proceeds from difference, as the great anthropologist Gregory Bateson put it, and there is no such thing as ‘best practice’, only hypotheses to be humbly refined and modified in the light of experience and experiment. For any organisation like CVT, human difficulty and dilemma are part of daily life, but it has experienced none of the scandals of the regulated sector. Indeed, it is now becoming clear that regulation is part of the larger problem. More alternatives like Botton are needed, not fewer. And respect for the evidence that for many people a caring, structured community provides a better and happier life than a flat on their own, whatever the dogma of the day says. 

 


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User comments

Henning Sieverts :: 27th Feb 14
I could not possibly agree more with this very moving, beautifully composed, and insightful essay.
John Burton :: 27th Feb 14
Simon, thank you for this. I've never been to Botton but I do know and trust the principles of community living on which it was run. It is heartbreaking that it is now being destroyed by an ignorant bureaucracy of "compliance". The same is happening to countless small "non-compliant" but truly homely and therapeutic residential communities / homes for people of all ages all over the country. This needs a national campaign. Apparently fee-paying boarding schools where the children of the rich are drilled in passing exams and climbing the ladder to "success" are good, but people choosing to live together as a community, support each other, and share is wrong.
Paul Reading :: 28th Feb 14
As someone who works in, and is generally supportive of the move to provide choice and control to citizens as an antidote to the imposition of Command & Control organisations, I immediately recognise the transformation of new policies into new oppression by highly paid consultants and senior public sector managers whose career tells them they know better than the citizens. These people are incapable of accepting the reality of diverse models of care support and the regime of targets, performance indicators and oversight authorities imposed by politicians who are easily sold "certainties." NHS and Local Authority management mostly continue to fail to oversee and prevent poor practice, and CQC have failed so often it would be laughable if it weren't so serious. The only defence unfortunately is the same as developed by oppressed and exploited employees - Unity is Strength. Highly paid managers and consultatnts believe in their own nostrums just as do priests, and must be opposed relentlessly.
Julian Haxby :: 11th Mar 14
Congratulations on your article, which captures the very essence of the issues at stake. It is wonderful to have such an eloquent advocate. I hope you will be able to take a continuing interest in Botton and the other Camphlll communities experiencing similar difficulties. The people in care are suffering, caught in the middle of this clash of cultures.
Alain Castzeflis :: 12th Mar 14
Pitch perfect. Botton is the most illustrious but far from the only Camphill community with tanks on its lawn. Delrow is next. We need to shine a light on this dark corner of the voluntary sector, and encourage an open public debate which articulates a positive, proud vision of their timeless values. Compliance is not the obstacle as many independent Camphills have shown in Scotland and elsewhere. Tunnel vision is.
Ayshayh Middleton :: 11th Jun 14
I visited bottom when I was younger and found the place to be a place of love and encouragement. It was helpful to help me realise that everyone has a purpose in life no matter what. ( I was quite young when I first went).
guest :: 9th Oct 14
excellent article
guest :: 24th Nov 14
Are you sure you have the facts right here? Did you speak to anyone other than the coworkers and Action for Botton? Maybe you should. At least you should be aware that local commissioners have beenr efusing to place anyone there because of huge concerns about safeguarding. Maybe you should also consider the huge inequalities in terms of choice, governance and self direction that exist between coworkers and the people they supposedly care for. Maybe the fact that HMRC has now ruled unequivocally that coworkers - who have been in receipt of personal expenses of up to 100k per family including private healthcare and education for their children, luxury holidays etc - must be classed as employees. Possibly you should ask why safeguarding concerns have been raised BY PARENTS if everything is rosy in the anthroposophical garden? Or perhaps you don't want to ask any questions at all ./... that would certainly appear to be the tenor of your article
David Cannon :: 5th Jan 15
I have come into the fray rather late in the day, but this article reflects my experiences of Botton since the mid 50's when my severely handicapped brother went there as a pioneer, to when he died there peacefully in 2007. In my youth I worked on the farms and in later years visited him. It was Botton that inspired my stepson to become a nurse for people with learning difficulties. The place just exudes love and care. Don't kill it!
maretta fawcett :: 26th Feb 15
Many years ago I wandered in to Botton Village as a young co worker. I was enchanted by the caring way of life...the respect shown- For Everyone- by Everyone...and the opportunities for freedom and free speech for all individuals living within the community. Thank you for your sensitive and empathetic article Simon. My experience in Botton Village inspired me on to further training, as a Care Worker, then as a Social Worker, and on to Training and teaching others. Nowhere in the statutory sector have I ever come across anything to match the humanity I encountered within Botton Village ...each individual for each other.Botton Village must not be allowed to die under a mountain of political-speak and HMRC.
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