This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.
When Chaz* welcomed me into her home recently, she told me how pleased she was that she herself chose the dark floral wallpaper for her front room. Offering to make me a cup of tea, she was also clearly proud to have her own front door - a place to call her own.
Such details might seem insignificant were it not for the fact that Chaz, who is in her early 30s, had until two years ago spent over three years in a long-stay hospital for people with learning disabilities. I met Chaz when I visited the social care provider in the north east that supports her and has enabled her to transform her life, and live in the community.
Chaz’s support reflects why good social care should matter to us all. Her story symbolises all that is right and good about social care. Every day social care services, supported by a skilled workforce, enable people to live the life they choose. There are over 20,000 organisations providing care 365 days a year involving around 1.58 million jobs. Skills for Care estimates that the sector contributes in excess of £40 billion per annum to the English economy.
To get bang for the buck, good social care commissioners are widening their horizons beyond the cost of services. They are focusing instead on outcomes and the social value being delivered locally. For example, there is the housing association that helps people who use its services to create - and own - a spin out quality checking social enterprise. Then there are learning disability support providers who actively help people into paid employment. There is also the work that connects care homes, volunteers and socially isolated people within local communities each week.
These are the kind of initiatives where providers of care and support are investing in local communities and offering additional services. We need more high quality support like that offered to Chaz, but frankly, no public authority has the means of commissioning along these lines during financial stringency.
It is a tough call for commissioners to prioritise social value over simple efficiency or the lowest price, but can we afford not to when the prize is more resilient and sustainable communities in the longer-term?
The crisis in funding adult social care is hurting disabled and older people who are unable to pay for their own care. The Care Quality Commission has pointed to rising levels of unmet need leaving people falling through gaps left by high eligibility thresholds and shrinking statutory funding. In addition the funding crisis is eroding the very services that are contributing to local communities. Meanwhile additional pressures are being piled onto the NHS and these pressures are only going to mount unless we take action. There are, for example, 11 million disabled people living in England today. By 2025, there will be 11.7 million.
At a time when services should be joining up, the circumstances the sector finds itself risks creating a health and social care system that is increasing polarised. Typically the view that the NHS gets all while social care gets less plays to well-worn descriptions of the ‘social care Cinderella service’, as the National Audit Office recently called it.
Such characterisation is neither helpful in terms of public perceptions of the sector, nor particularly effective because pleas for extra funding have largely been met with silence. In fact, allowing health and social care to be polarised makes the job of those seeking to divide and rule much easier.
If we let it, social care will mirror such negative assumptions and behave like Cinderella in a kind of self-fulfilling prophecy. This position will reinforce the view that the sector will wait, as it always has, for money. Such a position ignores the true message that is about the good work being done to support millions of disabled and older people every day; people like Chaz are being successfully supported, despite the rising tide of funding cuts.
Government has set itself on the path of a green paper for older people and a so-called ‘parallel process’ to examine working age provision. There is some merit in paying special attention to the needs of disabled adults. However the risk for the sector is that the dominance of the green paper will overshadow the future support and funding requirements of disabled people. In other areas too, such as the industrial strategy, we see a strong and helpful focus on the ageing grand challenge. But what is an industrial strategy if it does not explicitly focus on disability? Good social policy is holistic, not stuck in silos.
So we need to spark a fresh discussion, with permanent solutions in mind and one approach should be a focus on civic rights. Such an approach would move away from tired notions of eligibility thresholds to an actual realisation of the belief that people have a right to be supported to lead a good life.
VODG’s recent discussion paper, Challenges can fuel change, identifies how older and disabled people need to be enabled to have a louder voice in the future direction and funding of the sector. As our publication explains, if people articulate their own demands for social care, this is a much more powerful way of arguing for care and funding requirements. This approach will also help challenge those organisations stuck in a rut of working in the same way without new incentives to improve.
At a time when providers’ and local authorities’ demands for funding continue to be largely ignored, perhaps it is time to put people who use support services at the forefront in designing a new future for social care.
Dr Rhidian Hughes
Chief Executive, Voluntary Organisations Disability Group and Chair, Care Provider Alliance
*Name has been changed