Care Homes are at the terrible centre of the Coronavirus crisis. Right now the focus has to be on helping the people living and working with them all we can. Even in the middle of this crisis we see great examples of people pulling out all the stops both to keep people safe and also maintain connections to loved ones. What of the future? This week a poll suggested 40% of people aged over 65 would now be less likely to choose the option of a care home for themselves. Pre-crisis some have been exploring the role of care homes and of different approaches in the mix of options people should have available. We have been discussing this, in the wider context of the future of social care, with Peter Hay. A long time Director of social care in Birmingham, Peter was President of ADASS when Southern Cross collapsed, has more recent provider board experience and is part of the Devolution Commission.
Anna McEwen is Executive Director of Shared Lives Plus. She tells us about how shared lives households and schemes are adapting to lockdown and very interestingly how Shared Lives are rapidly evolving new ways of providing support during the pandemic. One of these is to offer an alternative to hospital discharge to residential care – reducing risks via a non-congregate option. This has much relevance as we emerge from the current phase of the crisis. Anna also offers thoughts about how clear the pandemic makes it that relationships are core to people’s sense of what is important and that what we call social care needs to better reflect this. Indeed many of the most interesting developments that are emerging wouldn’t be called social care.
We also talk about skateboarding twins, lockdown hair and Kylie!
Apologies for slight technical hitches – bear with it!
Anna’s desert island disc
By Sarah Bedford and Jasmeet Phagoora, New Economics Foundation
Public understanding of social care is low. Many people are unsure what it is – never mind how to get it, or who pays – until they or someone close to them comes to need support beyond what friends and family can provide. A lot of care work goes on behind the closed doors of people’s homes, hidden from view. When it happens in public places, it’s unlikely to have a social care hat on: a dance workshop inclusive of disabled people or an arts club for isolated older people are not ‘social care’ to those involved – they are just a dance workshop and an arts club.
Because of this, the sheer scale of social care can be a surprising fact. The workforce is made up of 1.5 million people, bigger than the NHS. It is a major sector of the economy and a foundational sector too, essential to millions of people. By supporting them in diverse ways, social care provides the ‘invisible scaffolding’ they need to live the life they want, regardless of age or disability.
It is, nonetheless, overlooked by economic policy makers. An obsession with GDP does not favour social care: it’s hard to measure productivity in a sector where outcomes, not outputs, are what counts. The purpose and value of the service gets lost, and it’s treated as a cost rather than an investment. More fundamentally, the people who stand to benefit from public investment in social care are not wealthy. The means test restricts access to those on low incomes, while care workers themselves are generally paid close to the minimum wage. Inequalities in power are central to the undervaluing of care.
The oversight by policy makers is huge, not least because there is vast scope for improvement in social care. The system is failing on many fronts. A market approach incentivises providers to compete to win business, scrambling to undercut each other. Chain companies, whose business models are suited to short-termist, cost-driven, competitive tendering, gain market share. Care worker jobs become more precarious and care itself can resemble a ‘factory production line’, with people needing support having little say or control.
Locally, there are glimmers of hope. A small but growing number of social care commissioners are trying to shift away from the status quo. Other policymakers in local government are developing strategies to build more inclusive local economies. They should join the dots. As a sector rooted in the everyday lives of millions of people, social care has the potential to drive creative new approaches to economic development. The objective of meeting care needs is connected to a lot of other objectives: building local wealth, lifting up job quality, reducing unemployment, improving health and wellbeing, and supporting more connected, resourceful and powerful communities, to name a few.
We at the New Economics Foundation and Community Catalysts are interested in the question of how social care can become a stronger driver of inclusive economic development. Our report, published today, explores the benefits to local economies of one particular approach to care. Community micro-enterprises are small social businesses that provide support in diverse ways. In places like Somerset, where they have been promoted by the local authority, they have proliferated – with numbers jumping from around 50 to more than 450 over five years. We find that micro-enterprises can enable personalised care, by devolving decision making to people at the frontline. They also spread an accessible form of entrepreneurship, create roles that offer more autonomy and control than a typical care job, and build resilience, creativity and diversity in social care. In doing so they help to draw people into the sector and encourage them to stay. A third of the micro-entrepreneurs we surveyed doubt they would be working in social care if they hadn’t set up their micro-enterprise. Two thirds expect to continue running their micro-enterprise for five years or longer.
Local authorities have a crucial role to play in supporting the development of ventures like these. They can encourage the spread of micro-enterprises as part of a family of care models that promote inclusive economic development, such as co-operatives, social enterprises and user-led organisations. These models are often locally rooted, they are driven by social purpose, and they generally seek to be accountable to the people they support. Policymakers should not see this as a marginal endeavour: the goal should be a bottom-up rejuvenation of communities and the economies that serve them. This will require long-term public investment, along with willingness to collaborate, experiment and learn.
NEF’s report can be downloaded here
Clenton Farquharson speaks of his experience with the Birmingham and West Midlands direct payment and personal budgets network. The anxiety and stress of sometimes feeling forgotten and the hard practical issues of PPE availability, essential worker status for personal assistants, inappropriate reviewing mid-pandemic and more. He points though to places which are being very supportive and calls for others to follow their lead. Having lost people close to him Clenton is very focussed on the disproportionate impact on people from black and minority ethnic communities – the pandemic laying bare long standing societal inequalities – and calling for a better protective response. Clenton offers reflections on his activity as Think Local Act Personal chair at this time – how the underlying principles of reciprocity, inclusion, community and love come to the fore. “We have to be thinking about what a better future looks like…in these moments we have created connections. I would like to reclaim that for social care”. He is thinking about how we think about health – far beyond traditional illness services – about how our health is collectively created in our communities – the future must reflect this – love, kindness, justice, fairness, trust. “We need to bottle how councils and mutual aid have worked well”
Karyn Kirkpatrick on how Keyring has rapidly adapted to help its members, many who live alone, to keep connected. “One of the easiest and quick things to sort out was our staff response”, but “We’ve got to really re-think about the tools we equip people with…all homes should have wifi…” She offers practical and thoughtful ideas about people could grow their skills and connections. “We should try and imagine how older age will be in 20 years time..Society is running two systems – older people in care homes unable to access and see their families….that should have been happening anyway”
For the future Karyn says she will want to go back and talk to her commissioners based on what has changed in the last few months. “How could we take the new ways of working further…If you can change everything in two weeks you should do that again and again”
Thinking about the strategies that people who want to see change might use – looking for alignment with others beyond social care. “It needs a really wide movement”
An interview of two halves this one with Donna Hall, chair of the New Local Government Network and Bolton Foundation Trust, former CEO of Wigan Council.
The first half is a powerful critique of what Donna views as an ineffective over centralised approach to covid-19, “a fragmented mess at the moment”. Donna calls strongly for a shift to testing and tracking led by and making best use of local skills, resources and coordination – there to be used, not being. She ends this section by saying this shift must happen now “We’ve not got much time”
The second half is a look to the future of social care and other public services, by the leader of the biggest UK real life experiment – The Wigan Deal. Donna answers the question “What would your advice be to local leaders who don’t want to go back” with both strategic ideas and detail of practical actions and areas for focus. She says “The last few months have taught us that a lot of the things we thought we couldn’t do, we can do”
Donna’s music choices:
Kathryn, Jade and Pete tell us about an initiative that started when Sian Lockwood met a young woman with learning disabilities begging after her modest support had been withdrawn and lost her flat. The not for profit support provider Macintyre had also been noticing people “falling into the gap”. Jointly with Community Catalysts they set up Great Communities. Now operating in Warrington and Worcestershire it aims to build community inclusion with local partners and links with people with learning disabilities and autism who want to make a local contribution and become leaders. This is not a traditionally commissioned “service”. Our interviewees tell us stories of how they have been going about this and lovely developments like Kieran’s film club. An exciting extension is the connection that has been built to a number of other national charities – Choice Support, CVT, Certitude and United Response to share ideas and approaches and develop the skills of leaders to make more of this happen.