I felt increasingly angry and frustrated reading this piece by the comedian Jo Brand in the Independent this morning. It seems unlikely to have been written simply at the author’s own initiative and hence is probably connected to wider campaigns. The article has good intentions – seeking better status, pay and conditions for people who work in care and support. But, even if unthinking, by painting people who draw on support as a burden or depicting care work as intrinsically unfulfilling (‘thankless’ ‘arduous’ ‘boring’ ‘unenviable’) it seems unlikely to help. The truth of the matter is that the low status accorded to care workers derives from the low status accorded to people who draw on care and support and in turn to supporting people to live their lives. Reinforcing such thinking helps no one.
People who draw on care and support and their families, and people who work in care and support, who may also draw on it, have a shared interest in winning both an uplift in government investment and changes to the way local councils commission care. Guided by the principle of ‘reciprocal dignity’, the goal should be a win-win, not one of gaining traction for worker rights off the back of stigmatising the people who rely on care and support. I think the US campaign Caring Across Generations does it really well in this video, by centrering on relationships, love and reciprocity:
How might people who work in social care and their backers make the case for improving the pay and conditions in a way that accords with #socialcarefuture’s vision and values? I’ve had a go here:
“We all want to live in the place we call home, with the people and things that we love, in communities where we look out for each other, doing what matters to us. Social care exists to ensure that everyone can look forward to this, providing support to do so if we or someone we care about have a disability or health condition during our lives. As people who work to support others to live their lives, it is an aspiration we share for ourselves and our families, and it is what we hope our support can help people to achieve and maintain. But decades of underinvestment by successive governments and the way local councils fund social care make that harder and harder. Our pay and conditions, often the National Minimum Wage and zero hours contracts, coupled with the way councils commission social care by ‘time and task’ make it almost impossible to provide support to people in the way we would like to without it becoming impossible for us to make even a basic living. We are forced to provide only ‘life and limb’ support in very short timeframes, with little time left to attend to the things that matter most to all our wellbeing – a life with meaning, purpose and good relationships.
That’s why we all have an interest in changing this, investing in social care to ensure that we can look forward to a decent life for each other, whether we or a loved one requires support, or we are involved in offering it. Ensuring that people who work in social care enjoy fair pay and decent terms and conditions is a crucial building block towards a brighter social care future.”
Another social care conference… the big names talking… and no one who draws on social care speaking at the main sessions.
This is 2021 and still the conversations about social care, are happening without us, people with lived experience of social care (either themselves or as a family carer).
Thankfully we have progressed; to a place where if a conference on gender inequality had no female speakers, it would be criticised and probably draw protests. Or an event about tackling racism, had only white experts, rightly it would lack all credibility. And yet social care conferences are full of experts and leaders, who usually have never experienced living with the very thing they are talking about. Or we have to beg to be begrudgingly added last minute as the ‘token service user’.
Social care needs a #MeToo or #BLM moment!
Why does this matter?
– A buzz word in social care is ‘asset based’ – seeing people’s strengths- and yet deep down much of the sector still sees its role as caring for vulnerable people and that they best know what people need. When I said I wanted to be able to go out with my friends more often, I was offered a befriending service. This sense that we are vulnerable is deep in the culture and is perpetuated by the idea that we couldn’t possibly be able to contribute to discussions or at conferences. #ValuableNotVulnerable
– We are also experts. I live this every day. And I know what works well and what doesn’t. I can tell you where I have been given off the shelf options that never worked and wasted money or some simple changes that would mean I need less care long term. This doesn’t replace other experts but compliments their knowledge.
– We care too! Believe me I have a huge desire to see a strong and successful social care, my quality of life relies on it. I also care about the social care workforce because my life is intrinsically linked to theirs. We have the same goals.
– When we get added on as a last minute tokenistic gesture, frankly it’s insulting and humiliating.
– Simply because it’s the right thing to do! The fact these meetings and conferences happen without us is shocking. Or should be. But it happens all the time so the sector accepts it. #OurSocialCare
At Social Care Future we got so fed up with this normal that we have launched the Whose Social Care Is It Anyway? Inquiry, led by a group of people with lived experience. We will also hear from other experts and leaders from social care- this isn’t about removing them- but about rebalancing the voices where so often we are left out. We will also focus on what really matters to people, not get lost in the bureaucracy of the system.
So what can you do?
In recent years, I’ve had the opportunity to meet lots of social care system leaders, many of whom seem to be really genuine in their desire to see change. But most of these people still keep attending and in some cases running these events that effectively exclude us. I say now if you want to be our ally you need to personally change your behaviour. You need to make sure all of your own events are designed and delivered alongside us. And if you are invited to join events a true ally would refuse to do so unless they were similarly codesigned with equal opportunity to participate. If you, the powerful influential people don’t do this nothing will change. So I am asking you to be my ally.
You can also copy the text and use it on Facebook, Linkedin or other social media:
I pledge. If I’m asked to speak at a conference or contribute to another kind of public debate about social care I will ask organisers to ensure full & equal contribution from people who draw on social care. Share if you will pledge #OurSocialCare
We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.
For everyone, these are really important things in life. They make us who we are, give our lives meaning and make us happy. But for many, who need some support from social care, we have had to fight for support and often that support has meant losing some of these important things from our lives.
Whether you receive social care, care for a loved one, don’t qualify for support, work in social care or are someone who cares about this- your opinion and ideas are important and will help inform the findings of the inquiry.
We are offering many ways to tell us what you think, so hopefully there will be a way that works for you:
You can join a zoom session and tell Donna and Julie what you think. These will be on Friday 22nd Jan at 2.30pm, Thursday 28th Jan at 6pm and Saturday 30th Jan at 2.30pm. Please email firstname.lastname@example.org to get the zoom link.
You can phone us on 0121 474 5900 and speak to Wendy who will take down your answers for you.
We also ask that you share this with people that you know. You could hold a zoom session of people you work with or know and send us their answers or help someone who may find it difficult to respond to get their views heard. Through the diverse network of people who are part of SCF we are hoping to hear from a wide range of people, but we need your help with this.
We would be grateful if you could please complete the survey or send us your thoughts by the 28th February 2021. If you are unable to do this before then, please get in touch at email@example.com.
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.
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!
Social Care Future is working to put a vision at the heart of campaigning for social care reform. Without this, any amount of funding would fail to achieve the shifts that people need to see. We also know though that resources are required to enable this vision and that right now short term funding is needed to stabilise a terrible resource situation impacting badly on many people. For this reason we agreed to come together with a number of other organisations and groups (accepting of course that these are just some of the groups who need to be heard) to make a case to the Treasuries Comprehensive Spending Review. You can see that case in this letter. It starts from our vision and asks for urgency in bringing forward reform based upon it. Immediately it asks for stabilisation funding and early investment in change – a down payment that could immediately support action that could build towards our vision:
Priorities for the Comprehensive Spending Review
Social Care – A New Vision
Social care reform must be underpinned by a vision. There is an opportunity to transform social care so that it is sustainable, a contributor to national economic recovery and plays a key role in ensuring that all people with care & support needs are fully included in their communities. As Social Care Future put it,
We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us
This vision cannot be achieved by social care or even wider public services alone. Public service resources need to be targeted to support and supplement the efforts and activities of citizens, community groups, voluntary organisations and local businesses. Social care leaders and local support providers, working alongside other council services and the NHS, can shift their practices to enable a much-increased level of preventative activity, freeing up resources for personalised support to local people requiring long term care.
Policy on social care, including funding reform, should be guided by and tested against this vision – with a single shared ambition across health and social care which puts people’s expectations for their lives at the centre. This can be measured using TLAP’s Making It Real framework. https://www.thinklocalactpersonal.org.uk/makingitreal/
The Strategic Partners have agreed three key areas of priority for social care that the Comprehensive Spending Review should support:
Urgently bringing forward investment and reform proposals needed to ensure the sustainable long-term future of social care
Funding for short-term stabilisation
Investment in the short term to speed the process of change
The government should bring forward proposals for longer-term investment and reform as an immediate priority to create a simpler, fairer system. However, any additional funding that is made available to social care, should not simply be used for ‘more of the same’ and the pre-COVID-19 status quo. It should be targeted on action to shift towards the above vision with clear expectations and levers that drive system transformation in care and support towards a more asset-based and preventative model of care
As a first step, the government must urgently address short-term funding challenges, which have been worsened by Covid, to prevent further deterioration in the access to and quality of care. An immediate injection of funding is needed to enable short term stability and avoid serious risks to support during the next phase of the pandemic. Work by our organisations and others has identified the most serious challenges to support which will require funding during the pandemic.
Early investment in change
We have identified the following key priorities for short term investment which can speed the shift towards the vision of a social care that is both sustainable and fit for the modern age.
A targeted fund enabling councils and their partners to make a rapid shift towards prevention that current financial constraints will not allow to happen without further investment funding. It is important that councils have the resources to support the prevention assumptions of the NHS Plan otherwise that ambition will not succeed and healthcare needs will also grow faster than necessary. In advance of the bedding in of long-term reform this fund would allow all councils to make progress towards use of the best, evidence-based approaches to start to reduce demand for and unwanted dependency upon formal services. This includes short term interventions when people first look for support and broader demand reduction in long term care.
The Government should commit to and fund a new deal for the care workforce, including personal assistants and other non-traditional workforce roles. This would develop clear career progression, better recognise and value staff, invest in their training and support, professionalisation and registration where this is appropriate. This would mean that we were able to recruit and keep high quality, skilled social care staff with the right values. Early investment is also required for the expansion of the workforce in roles which enable prevention, support the growth of innovative models of support and to develop and recruit a workforce that reflects and understand the needs of communities being served. This is particularly important in the context of the inequalities and discrimination experienced by black, Asian and minority ethnic people and their communities (see below).
Funding support for action on inequalities. The disproportionate impact of Covid-19 on some communities has exposed long endured patterns of inequality and discrimination. The need to address and help tackle ingrained inequalities and challenge discrimination is a given for all concerned with responsibility for adult social care services. The principles of social justice have always underpinned both social work and social care and it is vital that targeted and specific action is funded to address inequalities and poor outcomes for those people at greater risk. This funding would be linked to and support necessary DHSC and MHCLG action to support and ensure compliance with Section 1 of the Equality Act by public authorities. Funding along with specific advice and guidance could support local authorities to take action in line with the public sector equality duty of the Equalities Act 2010 to evidence and address the inequality of outcomes. Some funding would be directed to identifying exemplars that are improving equality of outcomes for people requiring care and support from BAME communities, so that the spread of effective approaches is accelerated. This should be taken forward within council’s existing formal responsibilities. This action should align with NHS action, and minimum expectations for action.
Whilst innovation and technology are making inroads into the way care is delivered, it is generally accepted that social care has been slow to capitalise on the potential of digital technology. We have the opportunity to invest in the rapid adoption of proven technologies which can enhance outcomes, such as artificial intelligence, assistive technology, predictive analytics and apps. An innovation fund would support councils and support providers to make best use of technology. It would also support bringing evidence based but currently marginalised positive models of care and support into more mainstream use. This fund could also be used to develop and rapidly test solutions to particularly challenging care problems.
Transformation and improvement support to councils and support providers: Change happens locally but local partners need technical and practical support to learn about best practice, innovate and embed better approaches. Resources are required to ensure a new funded transformation and improvement framework for adult social care can be delivered, linked to strong independent means of assessing how well local systems work together and metrics which incentivise this. Improvement should include a complete review of how care markets work, with a much stronger emphasis on the contribution providers make to the lives of the people they support and their contribution to the communities in which they operate and to wider society. Practice change needs to be thoroughly evaluated to provide evidence of what works to incentivise change.
Anna Severwright – Social Care Future
Caroline Speirs – TLAP
Clenton Farquharson – TLAP
James Bullion – ADASS
Kathy Roberts – AMHP for the Care Providers Alliance
Kathryn Smith – Social Care Institute for Excellence
Martin Green – Care England for the Care Providers Alliance