How can we close the Care Act rhetoric reality gap?

Martin Walker and mother - Copy

Following the social care future gathering in Manchester, Martin Walker from Think Local Act Personal (TLAP) reflects on what he learnt and what needs to happen next.

What’s the difference between the reality of people’s experience of care and support and what they should be entitled to? I was really pleased talk at Social Care Future in Manchester with my colleague Rachel Mason, from the National Co-production Advisory Group, about self-directed support and try to fathom this out.

For some time now at Think Local Act Personal (TLAP) we’ve been talking about a gap between the rhetoric of the Care Act and the policy of personalisation it embeds into the health and care system, and the reality that people needing care and support experience day to day.

We weren’t quite prepared for the stark opinions from those participating in our session about the size of the gap. My reflection is that it seems more of a chasm than a gap.

We were particularly reminded of the ongoing injustices that many people with mental health needs and those in assessment and treatment units still face. They are not benefitting from a self-directed approach to meeting their needs under the law.

Lack of trust surfaced as being at the root of the problem. Trust between people and practitioners. Trust between commissioners and providers. Trust between regulators and those with other statutory functions. Trust at an individual and at a system level.

But trust about what? I’m not sure we answered that question but it feels like a line of enquiry we could usefully pursue at TLAP, along with our partners.

There seems to be a hunger to hear about places that seem to be getting past these issues and to know what the ingredients for success were. In my experience, authentic co-production is fundamental to this. You can read some stories of success in my articles here.

At the workshop there seemed to be a need to out the scale of the frustration about the size of the gap so we didn’t really get to what we’d hoped for; a harnessing of collective knowledge experience and brainpower to work the problem and come up with a positive way forward.

Rachel and I put to the group some of our ideas, founded in both academic evidence and lived experience:

  • People should be helped to develop their care and support plan should they need it by skilled people outside statutory services.
  • The value of peer support with the whole self-directed support process has been under-estimated, investment needs to be made in Disabled People’s organisations.
  • These organisations would be best placed to provide Direct Payment Support services which could include the development of care and support plans.
  • We need to bust the myth that Direct Payments are not for older people.
  • Similarly, Direct Payments are not about only employing a Personal Assistant. Some people are successfully self-building their care and support in innovative ways, often with other micro-providers. More could be done to share these experiences.
  • Every area should have an Individual Service Fund offer. The potential of Individual Service Funds to transform how social care works is being missed.
  • The offer to carers to get meaningful breaks needs to change. Many do not want to put their loved one in a care home in order to have a break from caring.

We also reflected on the number of networks that operate specifically about self-directed support. My own experience is that each often talks about the same stuff and frustrations. How do we move on?

We could usefully think about how we form a positive coalition around self-directed support to engage at the highest levels. We need to promote ideas about how to close this gap from the knowledge we keep gathering. You can’t bridge a chasm by taking baby steps when we need a leap of faith instead.

As one delegate ably put it – we know what works, we just need to get on with it.


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