It should come as no surprise to anyone that there is a growing crisis in adult social care. Policymakers, practitioners and people using services alike all argue that the current system is fundamentally “broken”. This is not the fault of current managers or front-line professionals – we just have a 1940s system designed with 1940s aspirations and society in mind, which feels increasingly unfit for purpose in terms of how we live other aspects of our life in the early 21st century.
This has come to the fore yet again this week, with debates about 15-minute home care calls and accusations from a leading charity Leonard Cheshire Disability that older people are being left with their needs unmet. With massive cuts in services and rising demand, adult social care has effectively become a “poverty” service – provided only to people with very low incomes and very high needs. Anyone else simply has to manage by themselves as best they can.
To older people and other members of the public who thought the welfare state would support them from the cradle to the grave, these harsh realities feel like a major betrayal.
Part of the problem is that the current system is based on identifying what people can’t do for themselves and then providing services or funding from the state to make up any shortfall. This is a negative way of working, and people in need feel they have to highlight their deficits and problems – only to find that they often aren’t eligible for any support at all.
Even worse than this, such an approach means formal services often ignore – and sometimes even ride roughshod over - the natural support and community resources that people may have (possibly making things worse rather than better). While the Care and Support Bill (which is currently at report stage in the House of Lords) helps tidy up the previous legal framework and provides a partial way forward, much more fundamental change is required.
Instead, in a new policy paper I have drafted with some colleagues, I argue for a new approach that starts in a more positive place with what people can do for themselves, any natural supports they have from their family, friends and communities, and any additional resources available locally.
Rather than formal “services” the latter could be a cafe where local people meet, a library that has a mobile lending service, a leisure centre that runs exercise classes or a local voluntary group that runs a “good neighbours” scheme. Rather than being “care managers” (as at present), social workers would once again be community development workers, based in local communities and working alongside individuals, groups and communities to find new ways of meeting need.
If we started here then any formal services that might be needed would build on and enhance local resources – rather than replacing them. People would also be less segregated and more fully connected to their friends, families and communities.
A number of councils are exploring this approach, partly because they can’t afford not to in the current financial climate but mainly because it’s just the right thing to do. Surrey, for example, has set up a series of high street “citizen hubs” run by people with experience of using services to provide support to other disabled people.
Shropshire has asked a local community organisation to support people coming out of hospital by linking them to peer supporters to help think through how they can make the move back to the community, and even given delegated authority from the council to spend up to a certain amount of state money each week to help with this period. Other organisations (such as community catalysts) work to support people using services to set up their own small businesses helping other people in similar situations, while some agencies run “timebanks” or employ local residents to gather information on community resources and signpost people with low level needs to things that might help locally.
Ironically, while several previous social care reforms have attempted similar changes, the current financial problems facing councils might mean that more radical change is finally possible (with necessity being the mother of invention). Whatever happens, there only really seem three options:
Increasing services to meet rising demand (with no extra money).
Managing demand as best we can (which might mean longer waiting times, reduced quality and/or fewer people being eligible for support).
Reducing demand by meeting needs in new ways.
Of these only the final option feels credible in practice, but only if we really mean it when we say it this time.