Whose social care future is it anyway?

The Whose Social Care is it Anyway? Inquiry Group issued their first findings today from talking with over 500 people who use social care support. This was done by Social Care Future, a grassroots movement with a vision which sounds very different to so much of what the social care sector talks about:

‘We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us’ 

They talked peer to peer with people about how to make that vision a reality. These are the five changes people called for:

Note that people didn’t talk about quality, safety, prevention, integration, innovation or the other jargony terms that so much social care policy can get wrapped up in.

The report asks whether national organisation like us at Shared Lives Plus will ‘commit to use the Social Care Future vision … in your work? Will you take direct action yourselves and support your members to act on the 5 key changes?’

These are easy commitments for us to make. We agree with these five changes and will try to make them happen. Shared Lives, Homeshare and Family by Family all help people directly with building communities where everyone belongs, living in a place that feels like home and leading the lives we all want to live. We are helping local areas to invest more money in growing those ways of working, for instance, working with the North East councils and ADASS to recruit more Shared Lives carers and match more people into supportive households.

We still have a long way to go on sharing power and being a charity that ‘meets people as equals‘ but our colleagues who have lived experience and are part of our team are helping Shared Lives Plus on that journey, and we are helping our local members to have better planning conversations so that everyone gets to shape their local services.

We are calling on the government to invest in models which bring these changes about as part of the long-awaited long term plan for social care. We could have a very different social care future to the social care we have at present, but only if we recognise that it’s a future which has to be shaped by two groups of people:

  • the people and families who make most use of social care now
  • the groups and communities who are most likely to be ignored or poorly served by social care

Government funds our innovation network

We’re excited to be part of a partnership led by the Social Care Institute for Excellence and the Think Local, Act Personal network, to help local areas scale innovative community-based approaches to social care. This builds on the partners work which has developed models and guides on how to take a whole-area, whole-system approach to innovation, getting away from endless small-scale, short-term pilots which lack ambition. In the current climate where budgets have been slashed and pressures are rising, the most inspiring areas are taking an all-or-nothing approach which recognises that, while initiatives may start small, there must always be a plan to move core resources into the models which work and away from those which don’t. (See Total Transformation, the Asset-Based Area and the family of community-based approaches launched at Social Care Future).

We’ve already had a large number of applications from local areas and from innovative support models and we’ll be building on the 2,000-strong TLAP Building Community Capacity network, which brings together activists, entrepreneurs and organisations working in this space.

Government backing for this initiative is a promising sign that, despite the delays in publishing the Green Paper, the Dept Health and Social Care recognises the need for radical thinking and inspiration for our sector, which is under unprecedented pressure.

The Future is Close

Our public services are a sanctuary: living evidence that we do not abandon people who find themselves needing support to their fate. But every sanctuary has the potential to become prison-like. It is not always easy for those of us who have a hand in building, maintaining or defending those services to recognise the harm they can do as well as the undoubted good. We tend to want to place responsibility for that elsewhere, and in time the things we get wrong over and over become things we take for granted or refuse to see. Even when those problems repeatedly become tragedies that no one can ignore, we can act as if they are aberrations. We will learn lessons. Policies have been changed. They are ‘never events’, until next time. We can trace the exclusion and oppression of people who have a learning disability through countless reports and plans. The Winterbourne View scandal felt like a never-again moment, but it was followed by more failures and in the past few weeks the regulator CQC has been asked to carry out another review into institutional care for people with learning disabilities following more distressing cases of prison-like conditions.

Meanwhile more than a million older people no longer get the support they might have expected previously, and millions more silently suffer loneliness. Social care performance as a whole is improving, but the gap between the best and the worst widens. Some of this is about resources, but not all. Even on a shoestring, caring and motivated people can help people achieve great lives. But how do we create system which sees those good lives become the expectation, not the exception?

This is often described as a ‘culture change’, or dependent on ‘local leadership’. But culture cannot be separated from the structures – what people think they should buy, sell, measure, expect, reward and punish – within which we all work. There will always be leaders – and families and front line workers – strong enough to do the right thing in the face of pressures in the opposite direction. But we need doing the right thing to be what everyone feels safe and able to do, all the time.

Tomorrow the Social Care Future event in Manchester will bring hundreds of people together to try to show that a better way is possible. The local areas who are gathering to share what they have learned have the same pressures as other areas. They do not pretend they have everything fixed, but they are committed to the kind of whole-area change that is needed to bring what works best for people out of the margins and into the mainstream. We will be there to show how the quiet, slow and patchy growth of Shared Lives and now Homeshare demonstrates what you can grow even in an unforgiving climate. Other community-based approaches will be there too: for once, their work will be at the centre of an event, not at its margins.

Crucially, Social Care Future’s participants will be people with lived experience, not just the usual suspects. Those of us in positions of power or influence have demonstrated over years that we can’t dismantle old systems and build completely new ones, certainly not on our own. Real change comes when we are prepared to listen, and to work in support of a vision for a good life that feels real to people who use support and their families.

Social care’s present is over-stretched, under-funded and under pressure. We all need it to have a future worth fighting for.

Huge thanks to Martin Routledge, In Control and the organisers of Social Care Future for dreaming up this event and making it happen for all of us.

Blank sheets or spreadsheets?

This is my blog for the Social Care Future event, which also features here on the In Control website.

The people with learning disabilities who work at human rights organisation CHANGE pointed out to me once that people who have a learning disability are the only group of oppressed people who are routinely excluded from what should be their own civil rights movement.

I am keeping this in mind while thinking about what I and Shared Lives Plus can contribute to Social Care Future, which will run in parallel to the annual National Children and Adult Services Conference in Manchester this year.

Fully coproduced events start with a blank sheet of paper. That’s the best way to produce something like a neighbourhood plan, where the resources to be used are largely those that the participants bring themselves. It can be problematic, though, for making plans to change services and systems, because there can be a disconnect between what emerges on the blank sheet of paper, and what is already written in seemingly indelible ink on the spreadsheets produced by those systems. Conversely, if you start with the services and try to rethink them, it’s hard to get further than a few tweaks, because those pre-existing conditions seem so restrictive.

The Total Transformation model published by SCIE, PPL, Nesta and Shared Lives Plus includes an approach to local change which attempts to find a middle way between pure coproduction and narrow service redesign. The tool identifies five areas in which support and health services impact upon people’s lives and for each, identifies at least one innovative model which can demonstrate good outcomes and lower costs. The five areas of work are:

  • Support in your own home
  • Support with accommodation
  • Day activities and employment related-support
  • Support with leaving hospital
  • Whole-community work

The model suggests having a conversation with citizens about each of the five, which starts with ‘What does a good life look like for people using support of this kind?’, which is honest about the state money currently being used and what those budgets are expected to be in coming years, and which looks at what people like and don’t like about current local approaches, as well drawing no the models with a national evidence base. To be useful, any conversation of this kind needs to arrive at decisions about what share of resources (state money, other kinds of funding, people’s time and energy, community resources) will be put into which kinds of model. This will usually include agreement about reducing time and money spend on some things, to increase it in others.

Think Local, Act Personal’s ‘Asset Based Area’ approach broadens things even further: looking well beyond social care or even services in general, to suggest ten changes that local areas would need to pursue to become ‘asset-focused’ in everything they do.

We need, I think, to have those kinds of conversations at national level too. Could those areas which have started to use the Total Transformation or Asset-Based Area approaches, or other change approaches which have similar goals, share their experiences and their decisions at Social Care Future? Could we identify the features of future support services and systems which we want and don’t want?

In my new book, A new health and care system: escaping the invisible asylum, I argue that we spend so much time tinkering with the big organisations we already have, that we ignore what I see as the most pressing question about the services they provide: what kind of relationship should people who access support and people who offer support have with each other? At present, I think it’s the wrong relationship: starting with proving one party’s needs and dependency, whilst often assuming the other party can do more than any paid professional really can. Not really a relationship at all: a series of brief transactions between a stream of strangers. That can be ok if you have a very specific problem which is quickly and easily fixed, but most people approaching services don’t: they are trying to live well with one or often more long term support needs. They are looking for mutually-respectful and trusting supportive relationships with a small group of people who are in it for the long haul. They want those support relationships to fit with the long-term relationships they already have with family and friends. Models like Shared Lives and Homeshare, which we support and develop at Shared Lives Plus, work in that way by enabling people to choose and build long-term relationships as part of building family and community life. Other models share that approach and I believe that nearly all parts of the health and social care system could try to work in that way.

So perhaps Social Care Future could help us identify not just ‘good’ models to grow (and perhaps some failing models we would like to see less of), but also the behaviours and relationships we expect of every kind of support service. In turn, we would have to identify what we (citizens, families, communities and community organisations) are willing to invest in making that social care future a reality.