I spoke at the National Children and Adults Services conference last week, giving a providers’ perspective on the Care Bill alongside Sandie Keene, ADASS President, giving a commissioners’ perspective and Jon Rouse, Director-General of Care Services, giving the Dept Health’s view on the way forward. Here’s what I said:
The Care Bill recognises that our current range of processes and services do not consistently add up to an experience which is either fully caring or fully social. It tries to do something quite profound, in re-framing the whole of social care assessment, commissioning and provision around helping people to achieve ‘well-being’. Well-being in the Bill isn’t just physical and mental health, it’s also about the strength of our relationships. It’s about whether our needs are met, but also about whether we have the opportunity to contribute to those around us.
This takes social care deep into territory where services are a vital, but junior, partner in a complex ecology of care and support. The challenge becomes not integrating health and social care but integrating our formal and informal care systems into a networked model of care.
That idea of a sector whose job is to help people not only to get good support but also to live good lives, can be seen in the Bill’s attempts to ensure assessments and planning processes not only look for people’s needs, but also help people to build upon their strengths, in the new rights and recognition for family carers and the new duties intervene early, rather than leaving people to slip into crisis.
It all sounds a long way from the procurement of 15 minute slots of minimum wage care which many providers are asked to deliver, but which few local people want. The key to change will lie in the success of the Bill and subsequent guidance in demonstrating that meeting the new duties is the only hope for sustainable services and that meeting them requires putting citizens at the centre of every stage in decision-making.
Because if we get serious about co-design and co-production, supporting the creativity of citizens and providers, we will focus on the things which really matter to people: on good lives, not cheap services. We will listen to older people who say they hate feeling lonely or useless. We will commission services which meet care needs but which also help people to contribute to those around them. We will want to help people to stay safe, but also to connect with each other.
In other words, services will arrange themselves around the contributions of individuals, families and communities; contributions which can be the care and support system’s biggest resources, but which are too often under-valued, exploited or inadvertently undermined.
At the Care Provider Alliance, as representatives of providers who are passionate about good care, we know only too well how scarce the money is and that’s why we cannot tolerate it being wasted on poor or low-outcome interventions which are a poor fit with people’s lives. Every penny of public money must be spent on achieving good lives, not on ticking off tasks.
In my view, the Bill still needs to get tougher about outlawing practices which clearly contradict that goal, such as per minute procurement of care, failing to resource staff training and imposing prescribed provider lists on personal budget holders. Banning practices which restrict citizens’ choice-making is not anti-localism, it’s ultra-localism, because it puts citizens who are amongst the most marginalised in control of local decisions.
We cannot start with the goal of making short term savings, because that will lead us only towards ‘less of the same’, but there is undoubtedly money to be saved in investing in helping people to build their strengths and support networks and to maintain those networks through difficulty and challenge.
If we succeed in making this shift, we might see an end to the vicious circle in which crisis-responses eat up all of the money, whilst prevention seems less and less affordable. In place of seeking to buy cheaper maintenance-only services, commissioners will recognise that every cost-effective intervention is a future-focused intervention, which leaves the individual better informed, better connected to those around them and more confident.
This is asking commissioners and providers to take some huge risks. Some of the most promising approaches are those which have benefited from the least formal research. But we have to set the risks of a leap into the unknown against the certainty of failure if we stick with models which don’t help people and families to achieve lasting changes.
Many providers and communities have shown that they can make this leap if they are challenged and resourced to do so. This is true of care of all kinds: community-based care, home care and care homes.
Whilst some older people are warehoused in soulless boxes, some care homes are recreating themselves as community hubs and placing older people in leadership roles. Some people with learning disabilities live in isolation between fleeting support visits, but others have become the directors of their own micro-enterprises. Some home care services compete only on cost, others on reablement outcomes. Thousands of disabled people have started to reshape care provision themselves, through hiring and firing their own teams of Personal Assistants.
Our own members’ Shared Lives services help people make more friends than other approaches, for instance, whilst also realising significant cashable savings, because Shared Lives carers and their families and friends feel confident enough to treat a disabled adult or older person as a human being, not just as a client.
Social care, more than any other sector, has demonstrated its ability to transform itself. Today’s best practice would have been unthinkable only a couple of decades ago. Clause 1 of the Bill points the way towards one of the most radical ever re-imaginings of a public service, resetting it to the goal of people living good lives in good places. It’s a vision not just for social care, but for all public services. Upon our success in realising its ambition, may rest not just the future of social care but the future of that fragile covenant which we call the welfare state.
Escaping the invisible asylum 