By Andrea Sutcliffe
I have been promising Martin a blog for the Social Care Future series right from the beginning, but dealing with the here and now kept getting in the way! My final weeks as Chief Inspector of Adult Social Care at the Care Quality Commission are fast approaching, so if I don’t grab the opportunity now, I will miss out.
What better metaphor for the future of social care than that?! We know the challenges, they are well documented and the most recent CQC State of Care report laid them bare yet again – variable quality and a struggle to sustain good quality; unmet need rising; lack of capacity to meet growing demand; a struggle to recruit and retain the capable, confident staff we need with the impact of Brexit looming on the horizon; funding pressures; battling across bureaucratic boundaries to provide person-centred co-ordinated care. I could go on.
Tackling these immediate problems takes time and energy, it’s no wonder that looking to the future falls into second place. But just like me, if we don’t direct our energies to the future too, we will all miss out. The loss of this blog might be unfortunate but not thinking about and preparing for the future would be a serious failure.
What do we need to do?
Recognise that some things will be different and some may stay the same – we must prepare for both. Change may come about because of new technology, innovative ways of working, new models of care, changes in demography, diverse expectations bringing different responses from commissioners and providers. Some of these we may be able to predict but some are unknown and a flexible, positive response to change and difference will be necessary to make the most of the opportunities that will come along.
But some things may remain – one is the continued need for residential care, particularly nursing homes for people with the extensive, complex needs. However much an individual, their family or the community would want to support people to live and die in their own homes sometimes this just won’t be possible for a whole host of reasons. Let’s not dismiss those current models of care out of hand but challenge the status quo to improve and meet the needs and aspirations of the people they support in creative and innovative ways.
Which brings me to my second point, person-centred co-ordinated care means that there isn’t one magic solution that will solve all our ills. Passionate advocates for one model of care above others are brilliant for providing that challenge but this needs to be tempered by acknowledging one-size does not fit all, which takes us back to flexibility again.
My next point is not a new one from me – it will take a collective effort from everyone involved in adult social care to secure the future we would like to see. Involving, listening, understanding and responding to people who are (or will be) using services is the starting point for staff, providers, commissioners, the government, regulators and national bodies to step up and play their part. Each of us has an important contribution and we need to recognise the contribution of others. Sadly, our discourse about adult social care, whether it is about the here and now or the future, reveals a significant distrust between all these parties, a lack of respect and sometimes the advancement of vested interests. None of that will serve the interests of future generations well, which of course includes me and many of you, as well as our children, family and friends.
Last, but not least, adult social care is all about people as so many of the blogs in this series have shown. It does not exist just to help the NHS to survive. It isn’t to be dismissed as unimportant and un-necessary. The people who work in work in these services are not second-class citizens, they are amazing. Adult social care is there to support people of all ages to live the most meaningful lives possible; assist in achieving aspirations; have some fun despite difficult circumstances; or help people end their days being loved, cared for and supported with dignity and respect.
When I started as Chief Inspector in 2013 I asked CQC inspectors to consider whether they would be happy for someone they loved to use the service they were inspecting. If they were, fantastic, we should celebrate that but if not, we needed to do something about it.
The Mum Test, though not original, has helped to humanise the often-misunderstood world of regulation but more importantly has reinforced that adult social care is all about people. People who use services, their carers and families; the people who work in and run those services; the people who commission and fund those services; and those of us who regulate them. The Mum Test has had an impact and a resonance for people that I had never imagined.
So be flexible and positive, challenge the status quo, recognise one-size does not fit all, commit to a collective effort, remember it is all about the people and don’t forget the Mum Test. That way we can have a future for adult social care that we can all be proud of – and a long-term, sustainable funding solution wouldn’t go amiss either!