One of the recommendations which received the warmest welcome from the government, during the discussions which fed into the social care White Paper which we are expecting in the coming weeks, was the idea that we have to move from a ‘deficit’ to an ‘asset’ based view of people. It’s unfortunate that those are horribly jargonistic terms which need some explanation, and which are open to misinterpretation.
‘Deficit-based’ refers to the fact that, at the moment, you may have to prove how bad things are (and often, how little money you have), before you can get a response from the social care system. There’s a reason for this: if services aren’t ‘rationed’, more people might want them and there’s not enough money in the system to pay for them. The problem is that forcing people to prove how little they can do is demeaning and can actually add to the problems a person was facing in the first place.
An ‘asset-based’ approach says that we should always look for people’s strengths, resources and potential to solve their own problems. This has to be right: my kids’ school is open to everyone their age and the teachers are focused entirely on helping the children to grow and become more independent and responsible. It’s a happy place. I feel slightly less positive about my GP surgery – it’s there for everyone, but I only go there with a problem I can’t fix and I’m in the hands of experts who know stuff I don’t understand myself. Social care is often a place of last resort. It is becoming more asset-based, in that, once I am ‘in’ the system, I am more likely to be given choices, control and some responsibility for decisions affecting my life. Getting ‘into’ the system though is still a fairly grim process for many people. And whilst there is a much greater expectation that we will control our social care support than that we will control support offered by the NHS (or the education system, for that matter), how that gets implemented in practice varies enormously, as different bits of the system have remained impervious to the ideas of choice and control behind the ‘personalisation’ reforms in social care.
What can a White Paper do about this? Firstly, it can get the idea of thinking assets and solutions, rather than just deficits and needs, into the water supply. It can also set out some expectations for the new social care law and regulations which are expected to follow, which would create a new front door for social care, that was much more easily opened, and housed a system which tried to treat people as the experts in their lives at every step. We could change the focus of the assessment system from being a list of your needs (often accompanied by the news that there’s no service available to help with them), to being help to draw up a plan. Even where that plan should not or cannot be a list of services, it can be a useful starting point to finding what else there is out there in community which can help.
A White Paper could encourage or even set out a programme of local demonstrations of asset-based approaches, or at the very least shout about those areas which are already doing their best to be asset based, such as Derby and Middlesborough which are bringing in Local Area Coordination, Lancashire which is investing in Shared Lives in place of care homes, the twenty-odd councils which are working with Community Catalysts to develop micro-enterprise-friendly environments and Walsall and Leeds which are embedding community development into all of their social work.
Importantly, it’s time to make sure that when councils carry out a Joint Strategic Needs Assessment (JSNA) – the mapping and analysis they carry out to work out what needs to change and where they should spend their money – that in future they carry out Joint Strategic Needs and Assets Assessments which look at what communities, as well as services, have to offer, or could offer with a little support. A consultation on JSNAs is imminent and this is a message I hope the government will hear from lots of people.
Some people would read a White Paper which talks about focusing on what people can bring, rather than just on what they need, with dread. It will sound to some like an excuse to cut more services. Some councils may well wish to interpret it that way. Helping people and communities to tackle problems themselves does not have to mean cutting services. In fact, community action rarely springs up out of thin air – it happens when the state does something different, not when the state disappears. There will always be people who need services, but those services should always think about people as more than just a set of needs.
Even if there was endless money, it’s becoming ever-clearer that there are many problems which services simply can’t fix. We can supply an older person with a meal in a tin, and even with occasional visits from a befriender. But they won’t fix isolation and loneliness in the way that providing transport to meet with friends will.