This article forms part of the LGA think piece series 'Towards a sustainable adult social care and support system'.
I am currently helping convene a voluntary network called #socialcarefuture. Our aim is to help change how we conceive of care and support and tell a different story about what it can do to the wider public – one that they can get behind. We are learning from UK initiatives like Joseph Rowntree Foundation work on reframing poverty and international examples like Every Australian Counts. We have invited a series of blogs from a wide range of people – offering their hopes and ideas for what the future could be like and the “glimpses” of that future they see in the current landscape.
Blog authors are in no doubt that, as a country, we need to direct a substantial part of our national wealth to supporting each other to have good lives in our communities and at times when we need extra help.
Indeed we need to go much further on this than we currently do. Right now people don’t have rights to be supported well to live full lives in their own homes and communities or get the best care at vital times in life as we operate a low resource, poorly paid and valued system, largely of last resort.
Authors describe a desired future for social care which is “human sized and shaped” facilitating support that starts from what is important to people and families. This support builds on what they have and can do, what can be offered by local universal services and what others in their neighbourhood and communities can bring in a spirit of reciprocity. Professional input builds on these things, starting with adding skills and capacity to support them and help people avoid or limit their need for acute or long term support. When longer term support is needed it will be designed via partnership relationships between professionals and people and families supported to take as much control as they want.
In this future, assistance is not hindered by health or social care professional boundaries but rather helped by workers released from bureaucracy and freed to use their skills and experience to enable integration at the level of and directed by the individual.
Support models and approaches are designed to enable people to stay at home or close to home, use all personal and local assets, to be with those they want to be with. The organisations offering support are mostly local, small-scale, community embedded, often self-managed as cooperatives or community businesses.
This transformation of support approaches and ownership models requires major changes to the behaviour and structures of public service commissioning, in some aspects enabled by national policy changes. Local public bodies will need to increasingly conceptualise their core and collective purposes around health, well-being and the local economy and see these as mutually supportive. Governance and organisational arrangements will need to reflect shared decision making with community groups and organisations, the voluntary and community sector and the workforce. From this will flow different decisions on resource investment and commissioning practice, reflecting new priorities and supporting the growth of new or currently marginalised service models and organisations.
But how do we move towards this future? Even when the financial situation was better mainstream systems, practices and services changed little in decades. The system has recently been referred to as “The Invisible Asylum” reflecting its continuing institutional nature and power imbalances. There is no doubt at all that the massive cuts of recent years have had a devastating effect on many people and that there needs to be a major re-investment and period of intensive support to social care as it moves to a future of equal and stronger integration with health and other public services. This won’t be enough however. My call is to do some serious game changing. Too often reviews, debates and proposals are about marginal changes which might take up substantial resources but not really make much difference. And yet, there are approaches with the potential to effect really worthwhile change if they could move beyond the margins and into the mainstream. The forthcoming Green Paper needs to pay real attention to the issue of how to rapidly identify introduce, test, refine and embed these approaches, some examples of which are outlined here.
It won’t be enough to simply encourage shifts in this direction. Investment is required – which is why I am suggesting a game-changing and significant fund, following the Green Paper, targeted towards real innovation. To ensure that it is used for this purpose it should be disbursed by intermediaries with expertise and commitment to innovation of the kinds described with strong involvement in decision making by those using social care and voluntary and community sector organisations. This investment would need to be supported by support for rapid testing and evaluation – assisting rapid change with an evidence base. With this kind of game changer #socialcarefuture could become a reality.