This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.
In our 2017 State of the Nation report on adult social care funding, we included a series of case studies that described what life is like for people who use, or have recently used, care and support services. Among those was Geoff, a carer to his wife who lives with multiple sclerosis. “The role of social care in our lives has been vital and transformative”, he said before going on to explain that care and support enabled him to stay in work, volunteer in the community, fulfil his duties as Mayor of St Helens, and continue providing care to his wife so she did not have to enter a care home. “Without social care both of us would not have been able to lead such full lives.”
In just a few short lines, Geoff powerfully conveys that adult social care matters because it supports people to live the life they want to live. This links clearly to Lyn Romeo’s point below – that social care is about protecting people’s rights so that people with care and support needs can live “with as much opportunity, independence and control as people without such needs.” In this way the service itself is, as the Association of Directors of Adult Social Services (ADASS) describe it, “distinctive, valued, personal”.
This central value, a “daily essential” as Caroline Abrahams articulates it below, is framed in legal terms by the 2014 Care Act. This is a landmark piece of legislation somewhat rare for its genuine coproduction between government, politicians and all those with an interest in the system. Underpinning the Act, in Section 1, is the general duty on councils to promote an individual’s wellbeing. Wellbeing is drawn deliberately broadly and encompasses: dignity; physical, mental and emotional wellbeing; protection from abuse and neglect; control by the individual over day-to-day life; participation in work, education, training and recreation; social and economic wellbeing; domestic, personal and family relationships; suitability of living accommodation, and; the individual’s contribution to society.
In short, the legislation takes as its starting point the identification of different dimensions of ‘wellbeing’ to ensure care and support is truly “vital and transformative” to Geoff and the many others who receive care and support. And of course, this fundamental principle applies to adults of all ages and their carers – social care is not just about older people, as is too often portrayed in the media.
More broadly, the Care Act sets out a range of other duties that together provide further evidence of why adult social care matters. For instance, it helps prevent or delay the onset of care and support needs, it promotes integration with health and housing, it helps secure a diverse market of providers delivering quality services, it keeps people safe and it personalises care and support so that the focus is on the individual, not the system. Therefore, adult social care matters because the support it offers, in every sense, is geared to the totality of each individual receiving it. For this reason, the letter and spirit of the Care Act matters enormously too and its implementation must be pursued with vigour and determination. We therefore do not need major system reform, we simply need the funding to turn the Care Act vision into reality.
As Kate Kennally sets out below, social workers play a vital role in connecting social care to other local government services and the services of partners. In this way the individual with care and support needs benefits from the full range of support that exists within their community, not just that which exists within the purview of their local council. This is true not just for people assessed eligible needs. Adult social care works closely with public health, community health, primary care, and housing to name but a few services that help address the wider determinants of health.
Therefore, adult social care matters because it is a vital piece of the puzzle that is needed to hold our communities together. In this sense, it is part of on-going efforts to build communities that Rhidian Hughes notes below must be “resilient and sustainable”. As Martin Routledge suggests, social care in this context needs to start with what matters to individuals and then build on that through the support available from the full spectrum of services and agencies in a given community.
As above, social care matters because it links to a wide range of other services that can support people’s wellbeing. Within that range, the relationship with the NHS is particularly important not least because, as a recent Public Accounts Committee report notes, “the NHS is still very much in survival mode, with budgets unable to keep pace with demand”. This is a situation that adult social care is all too familiar with, albeit without the ability the NHS has to run a deficit budget.
Nevertheless, adult social care continues to help mitigate demand pressures on the NHS. Figures published in April 2018 show that, since July 2017, delayed transfers of care attributable to social care have reduced by 27 per cent (compared to a reduction of 8.5 per cent for delays attributable to the NHS). But of course, social care is not simply about support at the ‘back door’; councils work closely with the NHS to improve self-management of conditions, prevention, community support and information and advice, which are all services that stop people presenting at the ‘front door’ in the first place.
In the year that the NHS celebrates its seventieth birthday, it is important to remember that social care will also reach the fiftieth anniversary of the Seebohm Report, which paved the way for the modern adult social services departments we know today. Throughout this period, but particularly in the last decade or so, we have seen that adult social care matters because it is central to the fortunes of our health system.
The scale of the operation
The scale of adult social care is significant. As ADASS have noted, nearly one fifth of the adult population in England will have some contact with the service, be that as part of its workforce, as a user of its services or as one of the 5.5 million informal carers in England.
As Skills for Care’s 2017 report on the state of the workforce indicates, adult social care comprises more than 20,000 organisations, more than 40,000 care providing locations and a workforce of more than 1.5 million jobs. Skills for Care estimate that the sector contributes nearly £42 billion annually to the English economy. The Carers Trust estimate that the economic value of the contribution made by informal carers in the UK is £132 billion a year. Speaking in the LGA’s First magazine, Helena Herklots, chief executive of Carers UK, notes that the cost of people leaving work to provide informal care is estimated at £1.3 billion a year.
Therefore, adult social care matters because its scale and reach provide essential economic value to the country. This is further underlined by the focus on the ‘ageing grand challenge’ as part of the Government’s industrial strategy, which seeks to harness the value of new demands linked to ageing on, for instance, technology, innovation and new housing models.