It’s not all about the money, money, money

So we have a White Paper on social care at last. Whilst those of us who have been involved in ongoing discussions about its content have done so under pain-of-death conditions of secrecy, most of the key announcements have, of course, already been leaked – sorry, trailed – by Ministers themselves. So there are few surprises in the headlines of this lunchtime’s reading of the paper or publication of the Bill and most of the debate is, rightly, centred on the failure to commit to funding the key Dilnot proposals: to put a limit on the maximum amount anyone will be asked to pay for care during their lifetime (losing your home to pay for care being currenlty one of the few catastrophes in life you can’t insure yourself against, because there’s no limit to your liability) and to raise the means testing threshold from £23k to £100k (in other words, you currently have to pay all your social care costs in later life if your assets and savings amount to more than £23k, including your house as far as residential care costs are concerned). Cameron, like Blair and Brown, came into office promising the middle classes they wouldn’t risk losing their houses and inheritances to care. Keeping that promise is not that much closer than it was in 1997.

All of that is important. If you’re not angry about it, you are probably one of the many who cross their fingers and “hope it doesn’t happen to me” (you’re wrong, it probably will and the average lifetime cost is £30k, with 10% of us paying more than £100k. I don’t like those odds.) But behind the headlines, there is a vision for care and support taking shape which we should feel much more excited about. It still needs a lot of work  – and even more courage – but it’s worth suspending cynicism for, because it’s never been more needed and the appetite for it is real.

The current social care system starts for most people by asking them if they are poor enough to be the council’s problem. Then whether they can demonstrate they are needy and vulnerable enough. If you pass those tests, the conversation moves straight on to which state funded services can most cheaply meet your needs. In a paper we launched with Community Catalysts, In Control, Inclusive Neighbourhoods and Partners in Policymaking, we set out what’s wrong with this “deficit-based” system in more detail and called for an “asset-based” system: one which starts by asking not just what you need, but also what you want in life and how you think you might get there. A system which doesn’t just steer you into “service land” but is equally interested in helping you to stay connected into everything else that may be of use to you in your local community. A system which values time as much as it values money and which recognises that people have problems  – like isolation – which can’t be fixed by services, no matter how expert and well-funded, but which, with a little help, they and those around them can often fix themselves.

The White Paper and the Bill go some way to creating space for that kind of system, and even further towards to removing some of the barriers to that system which exist in the present legislation and regulations. Here are some key points:

  • The government has said that it no longer wants social care to feel like a crisis-only service and that instead it wants a well-being service which is relevant to people with low level needs and those who pay for their own care.
  • To do this, it introduces a duty on councils to develop preventative services, not just crisis ones and a duty to have information and advice services.
  • There are new expectations of help for self-funders (people who pay for their own care) to make more informed decisions.
  • Councils will have to promote diversity of provision in local areas and there’s an expectation that commissioning of care will move away from “by the minute” care, towards paying for outcomes.
  • Family carers are recognised in law for the first time, in (at least partial) recognition of the fact that most care and support has always been, and will always be, delivered by families, not services.
  • There is a move away from medical models of care (will this finally end the – already unlawful – practice of excluding people with ‘moderate’ learning disabilities from services based on IQ tests?)
  • There is promotion of asset-based approaches such as time banking, Shared Lives (woohoo), micro-enterprises (woohoo again) and Tyze care networks (one more woohoo – I’ll stop that now).
  • There is mention of community development approaches and Local Area Coordination.

This is all in the right direction, but we have lots of work to do in the implementation of the White Paper vision and in the pre-legislative scrutiny period of the Bill, to strengthen those ideas, push the government towards something more radical and to make those concepts into reality on the ground. Here’s two suggestions:

The main social care duty remains to provide someone with a needs assessment. Yet the useful part of that process is the action plan which may or may not come out of that – and there’s only a duty to create a care plan for those with eligible needs, which maintains the problem of reserving the energies of social care professionals for those with high levels of need, whilst making others jump through hoops which don’t result in an outcome. So let’s widen the duty to create an action plan, creating an entitlement to support to develop a plan for everyone, regardless of their level of need. If you have high levels of need the action plan may well remain focused on service responses. If you have low levels of need it may be much more about linking you to community groups, or helping you maintain other relationships. That way, every contact the system has with you produces a potentially useful result and rather than all planning taking place during crises, people in a crisis would be very likely to have an existing assessment and plan on which to build.

That assessment duty remains to assess needs which may be met by services. It should also be to assess skills and assets (not just money, but everything people and those around them can bring to overcoming their challenges). And there should be a new duty to record needs which cannot be met and to collect that information for use in an area’s Joint Strategic Needs Assessment, which badly needs rebadging as a Joint Strategic Needs and Assets Assessment.

More ruminations to follow I’m sure, but that’s it for now!

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