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Adult social care: seven principles for reform

Seven principles that should underpin social care and support reform in light of COVID-19.

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COVID-19 has brought into sharp relief the challenges facing adult social care, many of which existed long before the pandemic. But it has also powerfully underlined the essential value of social care in helping people to live the lives they want to lead. The public, political and media spotlight that now shines on social care provides an important opportunity; a moment to grasp as we collectively seek to shape the future of care and support. 

We believe the future reform of social care and support should be guided, and underpinned, by seven key principles.Taken together, these principles and their accompanying asks of Government chart a way forward for ensuring the very best local care and support in the future, so that people can live their very best life.

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1. People first and the value of social care 

Whatever emerges post-COVID-19 should be rooted in, and guided by, what works for people, not what works for systems or structures. It must help support the realisation of the Think Local Act Personal ‘Making it Real’ framework that articulates what quality, personalised and community-based support looks like from the perspective of people, and also reflect the real and wide value of social care in its own right, both to people and to communities. In this way, social care must be considered as an important way in which we improve social justice and inclusion, and support people’s freedoms and human rights. COVID-19 has helped raise awareness of this and that must be built on for the future. 

Ask: To work with all parts of social care, particularly those with lived experience including unpaid carers, on a way forward for the long-term future of care that is informed by the many valuable lessons from the pandemic on the role and value of social care in all our lives.

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2. The importance of ‘local’ 

Social care plays a key role in making connections in our local communities between a wide range of public, private, voluntary and community organisations that all work together in supporting people to be well, safe and independent. Links with housing are particularly important so as to support people to remain independent at home and in their community. Councils’ democratic accountability and leadership supports effective partnership working at the local level and the Government should follow this lead by working with local government and its many partners as equals in helping to build resilient communities that are geared towards prevention, wellbeing and public health.

Ask: In its work on the future of care and support, the Government should actively promote the ‘principle of subsidiarity’ as a necessary underpinning feature of effective health, care and wellbeing and consider how that can most powerfully be brought to life.

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3. Funding 

Any additional funding that is made available to social care, whether in the short- or medium-term, should not simply be used for ‘more of the same’ and the pre-COVID-19 status quo. Rather, it should be used to help us move to a more person-centred and preventative model of social care that is rooted in supporting people’s wellbeing in line with the Care Act and building resilience in our local public services and communities.

Ask: Government must provide funding that is sufficient to meet additional demands arising from COVID-19, plus pre-existing pressures. This should be made available with as few a set of conditions as possible. At the point of such funding being made available, the Government should indicate how it is intended to protect and enhance social care for the benefit of people who use services and to enable them to live the lives they want to lead in the future.

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4. Workforce 

The future requirements of and for the social care workforce should be a far more prominent consideration for Government, both as a standalone priority and in respect of its links with NHS workforce planning.

Ask: The Government should commit to a new deal for the care workforce, comprising action on pay, training and development, career progression and professionalisation, and recognition.

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5. Providers and commissioning 

Traditional services (such as residential care, domiciliary care and day centres) will continue to have a role to play in the future. But they need to be part of a much broader local offer including smaller, more bespoke providers, micro-enterprises and wider community assets such as community-owned care, mutual aid and shared lives, that have all played a part in responding to the current pandemic. These help bolster community resilience and their potential to help secure a more preventative approach to wellbeing that supports people to live safely and well at home must be harnessed.

Ask: The Government should work with people with lived experience including unpaid carers, councils and providers to consider the incentives and barriers to creating more person-centred services that help prevent, delay or reduce the need for more formal care services.

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6. Health and integration 

Health and social care are equally important and decisions and prioritisations about the future of each should reflect that. The needs of one should not be addressed to the detriment of the other and both should unite around embedding a far more preventative approach to wellbeing that works closely with public health and housing.

Ask: To signal and secure greater parity of esteem, the Government should create a ‘duty to cooperate’ requiring STPs and ICSs to engage with health and wellbeing boards as part of developing local plans to reshape and integrate health and care services that are genuinely locally agreed.

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7. Care and support reform 

Protecting a person from having to sell their home to pay for care is certainly one element of the ‘fairness debate’ at the heart of the question about long-term reform. But it is not the only one. The scope of and ambition for social care reform must be far greater, support adults of all ages including unpaid carers, and have at its heart a commitment to the Care Act wellbeing principle and improving people’s choice and control of the care and support they use to live their best life. Progress must be made quickly.

Ask: The Government should work with all social care partners, including people with lived experience including unpaid carers, and on a cross-party basis, to agree the scope of social care reform before it embarks on its own detailed work. As a minimum, the Government should publish its timetable for reform before Parliament returns from Summer Recess.

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