Scaffolding, but not as we know it Jim.

It is funny how something small can trigger a train of thought. I read an article last week that reported on the acute shortage we have of scaffolders in the UK. Given that we seem to have constant waves of shortages of everything from lorry drivers, toilet rolls, fresh fruit and vegetables and, it seems, honest politicians, perhaps I shouldn’t have been surprised.  The story did, nevertheless, stir my little grey cells. Until the middle of last week, we have lived with a dirty sponge poking out of the end of a scaffolding pole, which was located directly in front of our front door. It was not our sponge, nor even our scaffolding pole. It was, however, our front door, which is actually located on the side of our house.

In early 2020 our next door neighbours decided to sell their house. They had lived in it for some 34 years and, to be fair, they hadn’t done much in the past 20 years in terms of modernisation, painting and decorating and so on. Despite being in their seventies, they started to prepare their house for sale with great gusto. Which, at first, was wonderful to witness. It was the time of the early lockdowns. We didn’t do ‘working afternoons with wine’ in our garden; there was, after all only J and me in the house/extended office environment. We did however like to sit outside in the sunshine, but often had to give up as the sawing, grinding, cursing and hammering from next door made it impossible to sit outside for too long. Like our Prime Minister, we could usually endure it for 25 minutes or so, before retiring inside away from the noise of people working. The building work went on for much of 2020. Fast forward to February 2021 and the house is sold, and the new owner, immediately starts work on stripping out the whole house right back to the bare brick work.  

Long story short it’s been a challenge. We kept expecting to see Kevin McCloud turn up with film crew in tow. Thankfully he didn’t. Our new neighbours ‘Grand Design’ includes re-rendering the outside of the house. After a near fatal accident where one of the workmen fell off a ladder while starting on this work, the whole house has been wrapped in scaffolding for the last five months. It hasn’t just been Covid-19 that made 2021 a difficult year for us. Living next to a construction site has been a nightmare.

But actually, none of the above is what I wanted to write about – the original story sparked a train of thought about a different kind of scaffolding. Students of psychology and/or education will know of the concept. It is most often associated with the Russian psychologist Lev Vygotsky, although he never actually used the term in his writing. Scaffolding as a concept can be traced back further to the likes of Foucault, Derrida, Geertz and White; that latter possibly the most well-known for his work on how scaffolding can be used in therapy and learning environments. An important element of this scaffolding is what has been described as the ‘zone of proximal development’. This zone bridges the gap between what is known and what is possible to know. It is within this gap that learning occurs.

In my work with my long time collaborator and writer, Professor Sue McAndrew, we developed this notion further to suggest that learning and understanding best occurs at the gap between knowledge, and knowing, that is ‘not knowing’. Scaffolding can be useful in helping others move from being dependent on others for understanding and explanation to independence in thought, understanding and action. Whether it is in the therapeutic or educational encounter, scaffolding requires the presence of someone with knowledge and skills beyond that of the patient or learner (the knowledgeable other). It is the therapist or teacher that guides the patient or learner on a journey of personal discovery. This journey helps with the acquisition of the skills and learning required to resolve mental health challenges and/or problems that might inhibit normal growth and development.  

Thinking about all of this did make me wonder whether scaffolding might also be a useful way of conceptualising the Health and Care Bill, currently making its way through the House of Lords. Last week I was fortunate to be part of a conversation with Baroness Glenys Thornton. She is a formidable woman, who has been a long time campaigner against inequalities of all kinds. She has, since the age of 16, being a member of the Co-operative Party. She was also a former Labour Minister for Health and is currently shadow spokesperson for health. Our conversation started with a discussion on the process of the Bill’s passage through The Lords, and then what some of the issues were that had been raised by some 302 amendments submitted since the Bill was in the House of Commons. It was an insightful discussion.

My take home message was that the Bill is reminiscent of my neighbour’s scaffolding. In itself, it isn’t a home or even a house. The scaffolding is there to enable a transformation to occur. Once that transformation has happened, the scaffolding should be removed. Those amendments mean that we haven’t got the scaffolding in the right place just yet. There are too many dirty sponges to be seen. We should not end up with an Act of Parliament that constrains ambition, or transformation. The Act should be there to facilitate the achievement of its ambitions. Top of which are to more effectively deal with health inequalities, deliver place-based services, make best use of new technologies and reduce the need for acute hospital services. 

Sadly, social care reform doesn’t feature much at all in the Bill, but that is something for another blog. However, talking with Glenys last week, I came away with a much greater sense of confidence that these issues were at the forefront of people’s minds, across all sides of the House of Lords. I hope in the fullness of time The Lords will be able to provide the Government with a well-thought through and evidence-based second opinion.