This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.
The immensely positive role that social care plays for millions of people in our country is so easily lost amidst the discussion about how much it costs and how these costs can best be met. This is not to deny the central importance of politicians – indeed of all of us – being prepared to face up to and resolve this difficult question, rather than turning away as has so often happened before. But we could perhaps be accused of losing sight of the true value of social care – perhaps partly because it is often a private, quite hidden activity going on in people’s homes or residential settings.
Talk to those who receive it though and you hear a different story. For many disabled people who aspire to play a full role in our society and to fulfil their innate potential, just like everyone else, a good, reliable social care service is an essential building block for living a decent life and achieving their ambitions.
Equally, for older people in declining health and with associated care needs, social care is literally ‘life support’. For many, life would be at best intolerable and at worst impossible without help to wash, dress, go to the toilet and eat. Of course, social care is about a lot more than this – or at least it should be - but stripped to the bone, as it is so often today because of funding constraints, it is not a ‘nice to have’, or a personal consumption choice, but a daily essential, delivered by a crucial public service.
Over the last year I have seen it at close hand because my mother has been in the system and I have learned some important things as a result.
One is that social care is par excellence a relational business: so much depends on the quality of the rapport and communication established between those who deliver care and receive it.
At the moment, for people in need of care of all ages, ‘care’ can often seem purely transactional, because carers don’t have enough time. A person may still, just about, be getting their personal care needs met, most of the time, but if this is happening at breakneck speed then something important will be lost, and the benefits will be diminished for the care giver and receiver alike.
The third party in the equation is, of course, the family and network of close friends – if, that is, the person in need of care has them and they are available, near at hand and willing and able to help: many are not so lucky. At Age UK we hear from many informal carers who want to do everything they can to support their partner, parent or friend who needs care, including providing some or all of it themselves.
But it seems to me that life is altogether better for everyone, as well as more sustainable, if the situation is such that the efforts of informal carers are supported and complemented by those of high quality paid carers – certainly when a person has profound health and care needs.
When there is a team around the person in need of care, with high degrees of trust and a commitment to listen and respond positively to them, this strikes me as likely to deliver the happiest outcomes.
For many people who need care, especially perhaps older people whose health is waning, a team approach that spans health and care is what they really require, able to respond flexibly on a number of different fronts to whatever issues may present. Some of the best practice I have seen of this kind is a ‘Hospital at Home’ team in South London that spans two boroughs and works with three hospitals. Consultant led, it is comprised of doctors, nurses, allied health professionals and carers, all working together in a climate of mutual respect, dedicated to trying to enable people of all ages to be at home rather than in hospital, if this is best for them. There is clear accountability for decisions but team members from all professions and at all levels of seniority are encouraged to express views and their insights are listened to. And families are involved and listened to as well. Surely this is a microcosm of what we need to see more broadly in our evolving health and care system.
Social care has traditionally been viewed as ‘women’s work’ and it suffers from a legacy of low status and low pay. Today though, in an era when closing the gender pay gap is making front page news I hope its time has come. It certainly deserves it and so too do millions of our fellow citizens for whom life without social care would be no life at all.
Caroline Abrahams
Charity Director, Age UK