Good lives in good places

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

Time for user-led inspections?

Obviously the quality of NHS care is in the spotlight now that the Francis report into appalling failures at Mid Staffs Hospital has finally been published. But social care is also going through some quality changes. The Care Provider Alliance (which I’m chairing for the year) came together with The Nuffield Trust last week, which has been asked by the government to explore the idea of developing a new approach to quality ratings within social care. We used to have them of course: the inspector, before it became the Care Quality Commission (CQC) and its role diminished to inspection of safety and compliance with essential standards, used to rate services on quality. In Shared Lives, we were very keen on this, because were top of the class with 35% excellent, 95% good or excellent. In truth, star ratings were a blunt instrument, but much mourned when they were abolished by the Dept Health.

Things have changed since then. We have moved on from believing that a visiting inspector can comprehensively judge the quality of a service, towards believing that the key issue is the outcomes being achieved for each individual using a service and that best people to judge the achievement of those outcomes are the individual themselves and their families or advocates. After all, many people are now individually choosing their service using a personal budget and in many cases taking personal responsibility for buying that care via a Direct Payment, so ensuring they are involved in monitoring its quality is the next logical step (see below for more on this).

There was a fairly intense discussion: the CPA brings together the representatives from the vast majority of the independent care provider sector, including care homes, home care and community services, of all sizes. However, I felt there was a fairly broad consensus from CPA members on some key points:

• There is a need for quality ratings, which are fair, accurate and proportionate
• There is a need for a strategic overview and leadership from DH to ensure that the Quality Ratings review, NICE Quality Standards, CQC’s activities, PQP & NHS Choices, Healthwatch, the TLAP programme and its quality strand are brought into alignment as part of a strategic vision.  There is currently confusion.
• The starting point must be the experience of outcomes of people using social care – the kinds of outcomes aimed for will often be the same across different settings, even if the approach to achieving them will differ.
• We do not believe we can have a single health and social care rating system without adding to confusion and measuring the wrong things for social care in the wrong way.
• The new system must