The Care Bill – first thoughts

The government has published the Care Bill, which was published in draft form as the Care and Support Bill. The draft Bill set out some positive changes to social care, attempting to make the system more future focused and preventative, with more scope for assessments and processes to consider what people can do for themselves, particularly at an early stage, as well as what services can do for them. We think a system of this kind creates the space for approaches which focus on supporting family and community contributions and community development, which fits the ethos of our members, who deliver Shared Lives, Homeshare and micro-enterprises, very closely.

We had a number of conversations with the Bill team and the Joint Committee scrutinising the draft Bill, which made lots of very positive recommendations. The Joint Committee Chair, Paul Burstow, chaired a roundtable at RSA where we discussed strengths-based approaches and he wrote the foreword to a pamphlet, the New Social Care: strengths-based approaches, published by RSA which I edited (www.SharedLivesPlus.org.uk).

So have any of the changes we were arguing for happened?

In summary: yes. Councils will in future have to fund or commission agencies which reduce or delay the risk of people needing care and support (Clause 2). There should be much more useful information provided to anyone at risk of needing a care service (Clause 4). Whilst the Bill does not categorically set out the wide entitlements to up-front planning support, regardless of eligibility tests, for which we argued, the Bill and the accompanying explanatory note are clear that the most recent changes are intended to ensure that the Bill is the bones of an ‘assets’ or strengths-based approach which can be fleshed out in regulations and guidance.

My initial conversations with colleagues in the sector have tended to be about whether the new parts of the Bill which are intended to maximise the resilience of individuals, families and communities, create a risk Continue reading

Have we become a neglectful society?

Norman Lamb, the Care Minister, gave an interesting interview in the Telegraph over the Christmas period, which was given the rather unfortunate headline, “Neglectful Britons blamed for forcing elderly into care homes”. This picked up on the Minister’s view that we have become a “neglectful society” and that we need to rebuild “neighbourly resilience”, without which, he was quoted as saying, pensioners lead dismal, lonely lives.

Mr Lamb was given a hard time for this by Sarah Ditum, writing in the Guardian, who said that “The government has some cheek to say we’re not caring enough” and pointed out that more unpaid family carers are caring for more hours per week than ever; a huge contribution which Ditum argues the coalition is undermining with cuts to public services.

Ditum is right that, as social care services are being ever more tightly rationed, whilst the impact upon the NHS is starting to show, the impact upon family carers is often hidden, yet very real.

However, I don’t read the Minister’s comments as being about unpaid family caring. His suggestion that we have become a “neglectful society” is strikingly reminiscent of John McKnight’s suggestion, that we (in his case, the ‘we’ being US citizens in the 1990s) have become “a careless society”, in his book of the same name. McKnight was one of the founders of ‘Asset Based Community Development’, an idea which Lamb’s predecessor, Paul Burstow, talked about approvingly in the run-up to launching the social care White Paper. ‘Asset-based’ or ‘strength-based’ approaches start with the premise that seeing only people’s needs and vulnerabilities (their ‘deficits’) will lead to services being designed to impose outside ‘expertise’ at the expense of individual, family and community resilience. In other words, poorly designed, if well-intentioned, social services can become part of the problem, ‘colonising’ communities and ordinary human relationships and leaving citizens who have, in McKnight’s words, “grown doubtful of their common capacity to care”.

So McKnight was not arguing that people had stopped caring about each other, but that they had stopped seeing the active support of those around them as their role, instead believing that only the state was qualified to provide support. It’s a powerful – and by virtue of its power, a dangerous –  argument, but one which needs serious consideration.

A small-state fanatic could see it as an excuse to cut services in the naïve belief that people will start supporting each other as soon as the state ‘gets out of the way’. McKnight was instead arguing for services which were more led by people and which worked alongside and supported their relationships, rather than supplanting them. You only have to look at the isolation of thousands of older people or the disempowerment of many people with learning disabilities living in ‘service settings’, to realise that even well-funded traditional services cannot address isolation, in all its many forms.

I met Mr Lamb a number of times in the Autumn, including to discuss asset Continue reading