A long-term framework to transform social care?

by Neil Crowther

We all want to live in the place we call home, be with the people and things that we love and do the things that matter to us, in communities where we all care about and support each other. 

If we, or those close to us, have a health condition or disability during our lives, we might sometimes need some extra support to achieve this.  This is the role of social care.

When designed well, social care helps to weave together the web of relationships and support that we all need to lead the lives we want to, with meaning, purpose and a sense of belonging.

Some places are already thinking and acting differently, finding imaginative ways to connect people and all of their local resources together to improve everyone’s lives.  For example, facilitators who bring family, friends and neighbours together to support someone to do what matters to them, strengthening the relationships of everyone involved. Personal assistants, supporting people to live their lives as they wish to. And organisations that connect people with local opportunities to use their skills and talents, contributing to the community while improving their own wellbeing.  

We believe this can and should be happening everywhere and for everyone, no matter what age or stage we’re at in our life. 

To get here, those of us that share this vision need to come together, develop and then collaboratively begin to implement a long-term framework for change. We need the government to back it by starting to invest in all of our futures now.  And we need more councils to be open to and supportive of growing these new and more effective ways of doing things, alongside their local communities.

What might we mean by a long-term framework to transform social care?

The framework we’ve begun to imagine would be unashamedly ambitious, purposive and expansive.  It will bravely dismiss the emphasis on ‘containment’ that infects so much of the debate about social care and take the direction communications expert Anat Shenker-Osorio advises which is to say ‘we deserve and can have nice things’.  It won’t get lost in a debate about ‘how to fund social care’ but will be about ‘how to invest in all of our futures’

It would take the 9 wellbeing principles from the Care Act as ‘wellbeing goals’, and develop measures for each.  The framework could be about progressive achievement of those goals, with long, medium and short-term action and change objectives.  

The framework would not be ‘owned by’ government.  Rather, it could be in the form of a ‘covenant’ between people, places and government. It would include some very specific tasks and asks for national and local government though.  

National government would be charged with incrementally increasing investment towards developing the framework, starting with an immediate injection of significant funding to stabilise social care as is.  It would also be tasked with addressing legal or regulatory hurdles (including a targeted drive to reduce red-tape) and to support the improvement of data collection especially using new technologies.  In common with a broader shift, it would also be asked to help cultivate the idea of the collaborative society‘ inviting individuals, communities, the local State, the voluntary sector and business to see themselves as having roles to play and to ensure policies supported rather than got in the way of this.

At an early stage we would ask government to contribute towards a significant endowment to support the development and proliferation of innovative practices, perhaps match-funded by the National Lottery Community Fund (in the model of Power to Change).  In particular, we would encourage a major investment in the proliferation of ‘connectors’ and ‘platforms’ modelled on ideas such as Local Area Coordination, Circles, Shared Lives and Disabled People’s User Led Organisations.

We would strive to establish targeted innovation accelerators to develop and model viable, sustainable housing and support alternatives to large scale congregate care facilities for those with the fewest current options, including people living with dementia and those with autism and/or learning disabilities.   

 
We would work with the Local Government Association, ADASS & others to begin to transform (or replace) ‘commissioning’ with a shift towards asset based community development.  This would place the strength & durability of places centre stage when thinking about the future of ‘social care’, including with an accent on ‘prevention’.  This would be the point of intersection with the NHS, aligning with the NHS 10 year-plan and its focus on addressing the social determinants of health and on investing in the opportunities that will make social prescribing and self-managed care a reality.

We would reset the debate about ‘choice and control’, starting not with the mechanisms but with the principle.  Rather than positioning direct payments as offering ‘most’ choice and control we could focus on optimising choice and control for everyone no matter how they access support.  We might focus in particular on inspiring people, building confidence, supporting people to see what their options are. For those using direct payments or other ways to direct commission support the focus will be on reducing bureaucracy and the burdens of monitoring while optimising flexibility, including and creating other models for people to pool their money.  In particular, we could focus on developing ‘choice and control architecture’ i.e. support with exercising choice and control, on and offline.   


We would think beyond and reset the ‘Resource Allocation System (RAS)’ to tip the scales again against deficit-based eligibility, assessment and budget-setting towards so called ‘strength based’ approaches.  We would challenge the terminology of ‘packages’ of support, to include ‘injections’ of support, boldly saying that not all support should be permanent, but some of it exists on to help people achieve particular goals or get past hurdles in life, beyond which we can hopefully reconnect, draw on supports in our community, find work and so on.

As with ‘Green Investment’ and the recognition that meeting the challenge of adapting to climate change is an opportunity to grow the economy and create new jobs, we would talk about the new job opportunities & opportunities for local economic development flowing from our plan as we adapt to demographic change.  We will work with economists to model and evidence this.

These are just a few ideas to get us thinking and talking.  The #socialcarefuture inquiry will be building on some of these ideas.  In the meantime though, all thoughts are welcome!   

4 Comments

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  1. Reading this is the best Christmas present I could get. In my professional role in the heritage sector I have been leading on social prescribing projects & strongly believe in the power of heritage to support health & wellbeing in preventative & early intervention. On a personal note, my youngest sister has West Syndrome & currently lives in a ‘large scale congregate care facility’ while we know she would benefit more from a compassionate & stimulating community setting. I will happily do what I can, in my own small way, to help realise this social care future vision.

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  2. I am sure all would agree that setting out ambitions for how life should be for older and disabled people without addressing the resource consequences is simply building castles in the air. Credible ambitions must be supported by credible plans for funding them.

    Neil’s blog addresses this only through a ‘re-set’ of the RAS, the concept of the up-front allocation of resources. Neil does not explain what he means by a ‘re-set’. The reality is that the concept, far from being the transformative engine it was promised to be, has not made an atom of difference.

    That much will surely be agreed. TLAP itself has recognised that it is only when direct payments are used to employ one’s own staff that anything like Independent Living happens. But that has been the case since 1996 and owes nothing to up-front allocations. Before contemplating a ‘re-set’ the lessons must be learned. Otherwise you will be clinging to a vain hope.

    The original idea of an up-front allocation as an entitlement was a well-intentioned attempt to empower. It was always questionable on practical grounds. Best plans do not start with money, they start with understanding of need. Just as the founding principle of the NHS is that need precedes resources, so should be the case in social care. But whatever merit there may have been was swept away when In Control agree with the New Labour government to relegate the up-front allocation to being ‘indicative’ only. This allowed the eligibility regime – whereby ‘need’ is determined by resources thus allowing spending to be kept to whatever budget is set and to deny the existence of unmet need – to continue its domination. The RAS allowed the government to wear its progressive laurels whilst sustaining the same old system. Councils obliged for a long time but now the RAS is scarcely mentioned.

    It is essential to let the concept go, allow it to pass into history. Too much time has been lost in sustaining it. If Social Care Futures is to put forward a credible vision, it must have a credible strategy to address the resource consequences. Peter Beresford and I have set out why we believe the UN concept of ‘progressive realisation’ of the resources required for Independent Living provides that strategy. Below is a link to a short piece on the Socialist Health Association website focussing on the recent Health and Care Select Committee report and the situation of Anna Severwright in particular. I would be pleased to engage with Social Care Futures if you feel able to engage with the realities.

    THE CONTINUED DENIAL OF COUNCIL AND POLITICAL LEADERS (sochealth.co.uk)

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  3. Fantastic ideas, things lots of us have been talking about, and know need implementation. The trick will be how, the details needeed that shows by listening to the us, we can do it better, more efficiently and cheaper.

    We instead of getting to see outside the box need to convince them there is no box, it does not exist. There are no boundaries. It’s pointless them drawing a map that only leads where they want to go.

    The legislation and money is already there its just the old structured imbedded thinking that says we must do it this way, that stops a lot of this happening. The people know what they need its the purse strings holders that need reminding that they work for us, not the other way around.

    I look forward to following this group and seeing the true pottential working with users van bring.

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