Today is a really exciting day, as the ‘Whose Social Care is it Anyway?’ Inquiry group issue our first findings.
The powerful thing about this inquiry is that is has been led by us, people who draw on social care to lead our lives or who support loved ones to do so. We got tired of being left out of the discussions about reform or being the ‘tick box service-user’ so we took matters into our own hands and started the Whose Social Care is it Anyway? Inquiry.
But we knew we didn’t know everything so we asked people whether they currently experience our vision (below) in their lives and their ideas for change.
We heard from over 500 people (thank you!) and from what people told us and our own experiences we have identified 5 key changes to bring our vision about.
1. Communities where everyone belongs
2. Living in the place we call home
3. Leading the lives we want to live
4. More resources, better used
5. Sharing power as equals
As we move into the next stage of the inquiry over the coming months, we will be looking into these 5 key changes in more detail and starting to craft the solutions that can make our vision a reality. Please share the report and look at the asks to see what you can do in your live or work to start making these changes happen.
It is looking increasingly likely that the government’s long awaited ‘solution’ for social care will consist of little more than tweaking with the floor and the cap of individuals’ contributions to their own care costs. If so, this will be a missed opportunity, but it will not end the campaign for a much broader rethink about how social care can improve people’s lives. In my new book Clients, Consumers or Citizens? The Privatisation of Adult Social Care I identify three essential steps to changing the conversation.
Reframing the Debate
The first step is to stop thinking about adult social care as being primarily about removing the fear of selling a house to pay for care in older age or of being a drain on the NHS. The more important question is one of what care and support should do and of how it needs to work. In this respect Social Care Futures itself has done much to shift the terms of debate with its emphasis on people of equal worth leading lives of value that they choose to lead as part of a reciprocal web of community-based support.
What this in turn raises is the question of how the reframing of an issue comes about. Johnson et al identify four stages in the process: innovation; local validation; diffusion; and general validation. It is hard to say exactly where the reframing of the adult social care discourse has reached in terms of these four stages. Research suggests public discourse is still narrow in understanding with representations of ageing, for example, largely negative. There is certainly much evidence of pockets of innovation and in some cases of local validation, but there remains much still to do before the final two stages could be said to have been reached.
Practical Improvement Support
Reframing the narrative needs practical support, some means of improvement capability among commissioners and providers. There is a great deal more of this capability in the NHS (especially the hospital sector) than in adult social care, which has never benefited from a fully developed programme to identify and share best practice. Fledgling bodies such as the Care Services Improvement Partnership, the Change Agent Team and the Integrated Care Network became early casualties of the Coalition Government’s ‘quango cull’ following the 2010 General Election.
Meanwhile the Care Quality Commission sees its role as primarily one of inspecting and regulating rather than supporting improvement through local relationship-building. This is a missed opportunity. A review of the impact of the CQC on provider performanceemphasised the need for support, not just inspection and regulation. It urged the CQC to draw on its intelligence and insight to support providers, foster improvement and prioritise its use of resources. However, this conflation of inspecting and improvement roles is inherently contradictory and it is likely that improvement support is best delivered by a more trusted ‘critical friend’ along the lines of the Joint Improvement Team in Scotland.
Implicit in all of this is the idea that change needs to happen locally and at micro-level. The role at national level is to promote and facilitate local change, whereas currently local change movements are often fighting against the grain of national policy. Too often the problem is not so much a lack of innovation as finding ways for such approaches to take root more deeply in more places. Time, space and resources will be needed to breathe more life into better ways of thinking about service design and delivery, otherwise the established narrative around access, eligibility and service models will continue to dominate.
Challenging Established Power Bases
Change will ultimately, be dependent upon shifts around the social-structural context within which policy functions. This in turn requires thinking about where power lies in the policy-making process. In his classic analysis, Power: A Radical View, Steven Lukes distinguishes between ‘three faces of power’: issue, agenda and manipulation.
Issue: This is the ‘open face’ of power – the ability of one person or group to achieve compliance by openly making decisions that must be observed. In the case of parliamentary legislation there is at least some basis for this in implied democratic consent. It is here that the marketisation of adult social care has been built up through key policy landmarks such as the Griffiths’ Report of 1988 and the1990 NHS and Community Care Act. Any serious attempt to shift power towards people who need support, along with promoting alternative modes of sustaining people’s independence and wellbeing would require fresh legislation, not just discretionary ‘toolkits’..
Agenda: This is Lukes’ ‘secretive face’ – the power to set the agenda and make decisions behind closed doors; a situation where it is unclear who is making decisions and on what basis. This has increasingly become the modus operandi of adult social care decision-making where critical judgements are made without taking into account the needs, views and wishes of those most affected by them. This includes organisational decisions such as tightening eligibility criteria for accessing support; professional decisions, where front-line staff exercise discretion in how rules are interpreted and implemented; and business decisions where judgements on the terms and conditions of care workers, on loading a company with debt in order to extract dividends, and on whether or not to terminate market activity are decided in distant boardrooms. A new approach to adult social care would be based upon an ‘open’ not a ‘secret’ face.
Manipulation: This is the ‘deceptive face’ – the power to shape and shift values in such a way that the decisions that create benefit and advantage to the powerful party are accepted without serious questioning. In the case of adult social care there have been three decades to promote the concepts of markets, competition, choice and consumerism as self-evident virtues that require no further justification. Where defects in the model become apparent, these are then interpreted as failures of policy implementation rather than of misconceived policy design. The fact that the most heated policy debates are around funding by individual users of care rather than the model of commissioning and provision bears testimony to the force of manipulative power.
The most immediate way to bring about change is through the commissioning process. Many options exist; none of them are easy but all are achievable to some degree. Commissioning from local suppliers would redirect resources from national and transnational companies to local suppliers and populations. Commissioning small would give preferment to community businesses, not-for-profit organisations, to agencies with local roots, local presence and local accountability. Commissioning holistically would challenge the orthodoxy of separate organisations pursuing different and distinct objectives and place primacy on the importance of ‘place’ and belonging in people’s lives. Commissioning personally would replace the restrictive interpretation of a personal budget with a wider understanding based upon personal outcomes and supported, inclusive communities. And commissioning ethically would offer the opportunity to prioritise non-market values in decision making to support the social, economic and environmental wellbeing of an area.
The current mixed model is fundamentally flawed. Markets will go where there is money to be made; voluntary endeavour thrives most where people have the time and inclination to contribute; local authorities are commissioning hand-to-mouth; and communities are struggling to find the wherewithal to strengthen local bonds. Addressing this complexity will require political determination and excellence in statecraft, neither of which has been much in evidence for over fifty years. We are still in the foothills of change; tweaks to caps and floors are only a first step, but the journey continues.
Professor Bob Hudson, Visiting Professor in Public Policy, University of Kent
We hope you find it interesting and useful. Could you share it with anyone you think might be interested? Get in touch if you want to be involved in any of the activity.
It’s great to see our vision being taken up in many places. Next we need to focus on making it a reality in places and lives.
As you will see below its been a very busy few months! The group of convenors, who co-ordinate activity on an unpaid basis will be taking a break over the summer and re-charging the batteries to go again in the autumn.
It also makes a number of “First Asks” to particular groups as well as to all of us:
Following the launch we wrote to all Directors of Adult Social Care to ask if they would consider using the SCF vision and Think Local Act Personal’s Making it Real to steer local strategy and action. Already quite a few have answered in support, including some local councillors responsible for social care. We will be bringing them and others who respond together in the autumn to plan what they can do and what help might be available. The letter is here if you want to talk to your local DASS or others about signing up Will your local area adopt the Social Care Future Vision to transform social care?
Plans are now underway for phase two which will start in the autumn. This will combine going deeper into the five key changes in order to steer action for change. From September lots of discussions will take place with movement members and partners about how this will happen and roles people and organisations can play. Steered by the inquiry group’s work we need to be able to describe in detail what needs to be in place to make the vision a reality in places and lives and then work as a movement and with others to focus action on making progress towards it.
As part of phase two there will be a series of public gatherings for the movement and beyond, starting in the autumn to focus, steer and act
You will remember that Anna Severwright has led calls for people to say “enough is enough” to conferences and events about social care with no or only token presence of people who draw on social care themselves #oursocialcare – Social Care Future. Positively we can now start to point to significant national leaders and organisations showing a lead on this. First Oonagh Smyth, the Chief Executive of Skills for Care set out her commitment Our pledge supporting full and equal contribution at events from people who draw on social care. (skillsforcare.org.uk). This week Kate Terroni the Chief Inspector of Adult Social Care at the Care Quality Commission made her own commitment in a podcast discussion with Anna which also involved CQC expert by experience and athlete Selina Litt. You can listen here @cqcconnect | Linktree and see the blog here: Empowering the voice of people who draw on social care | by Care Quality Commission | Jun, 2021 | Medium Positively both Oonagh and Kate have told us of recent examples where using the pledge practically has influenced both their own organisations’ behaviour and also had an impact on the design, participation and organisation of events they have agreed to speak at. We are in discussion with other national organisations about how they will use the pledge, including the Association of Directors of Adult Social Care and Local Government Association
As you know every two weeks we meet informally with a “Strategic Leaders” group to ensure that our movement’s issues are heard by the most senior statutory, provider umbrella body, and other national leadership groups. This offers an opportunity to meet also with senior government officials. There have been a few developments from these meetings and more generally recently:
Following this Anna Severwright was interviewed on Sky News – her interview was so different from the usual kind of “expert” discussion – reflecting much more what people who draw on social care say is important – watch the inteview here.
We met with Department of Health and Social Care representatives working on social care reform to make the case for reform based on our movement vision and make practical suggestions around the “assurance” process proposed in the new Bill, for stronger co-production in policy development and for a ringfenced fund for progressive change
These practical two-part online workshops will begin by equipping communicators and campaigners with the knowledge and skills to use strategic communications and framing as a lever for social change. Based on the insights from #SocialCareFuture’s research, participants will then have the opportunity to work on their own framing and messaging.
Part 1: Tues 21/9, 10-12
Part 2: Thurs 23/9, 10-12
Part 1: Tues 5/10, 10-12
Part 2: Thurs 7/10, 10-12
There will be between 15-20 places available for each workshop. If demand is high we will run more later in the year. If you would like to attend, please email email@example.com. We will then contact you with instructions on how to book a place.
We are asking organisations to pay a minimum of £100 per place at these workshops. This allows us to cover the cost of their development, administration, and delivery, and to cross-subsidise some places for people that do not belong to organisations and who might be unable to afford to attend. If your organisation is able to contribute more than £100, this would be welcome, as it will support the work of #socialcarefuture, which is volunteer-led and has no core funding.
If you would like to attend, but are unable to pay, please indicate this in your email to us. We welcome everyone’s participation and will try and offer some free places at each session if our finances allow.
Watch out for more detail about activity and action to come out in September – virtual, via email updates and maybe…some face to face:
Sharing approaches and practices that can help build towards the future vision
Updates on movement action and opportunities to get involved
Key debates on issues identified by the Whose Social Care Future is it Anyway inquiry group
Work in partnership with others that helps progress towards the vision
Challenges to unacceptable practice, with solutions
Keeping in touch
We are currently building a new website (thanks Gaynor from In Control) which will be up and running from the autumn, with more functions to help us build and sustain the movement, share ideas and plan action. We also plan to start a short regular update email as well as these longer quarterly newsletters
A reminder on funding and support
Social Care Future receives no core funding in order to act independently. Some initiatives are sponsored by movement members “without strings”. Income from events will be used to sustain our movement activity – in particular co-production, movement building and administration. All programmes are run on a “pay if you can” basis in order to ensure no financial barriers to participation. Donations from groups able to support the movement are very welcome. Thanks so much for the funding and in kind support offered so far
Best wishes for the rest of the summer
The Social Care Future Convenor Team: Anna, Martin, Neil and Julie
94% of English local councillors surveyed by Survation for #SocialCareFuture and the Local Government Association agree with the vision and purpose for social care articulated by #SocialCareFuture, while 92% agree with how we describe what social care should do and how it should work. Over 9 out of 10 councillors believe the government must prioritise investment and reform in social care now.
These latest findings build on the work we published earlier this year, showing how a new narrative, articulating our vision and approach, shifted public mindsets about what social care should be and do, and through doing so could command greater support for investment and reform.
The Whose Social Care Is It Anyway? Inquiry has since surveyed the experiences and views of people who draw on social care to live their lives to begin exploring how the vision and approach can be implemented. In June it published its initial findings ‘From Permanent Lockdown to an Equal Life’ which set out 5 key changes needed to get us there.
We are inviting councils to sign up to the vision, as some have already done, and to harness the Think Local Act Personal Making it Real Framework to implement it.
Already a number of Directors of Adult Social Care have responded positively. Alongside TLAP we plan to gather supportive councils together in the autumn to offer advice & consider appropriate support.
This might be something you might want to explore in your own local area. If so, please read or promote this letter which was recently sent to all Directors of Adult Social Services in England:
We are pleased to share the first findings of the Whose social care is it anyway? inquiry. You will be aware that this inquiry is being led by a diverse group of people who draw on social care, directly or as a family member. Its goal is to help the Social Care Future Movement and others to be clear how best to pursue the SCF Vision, starting from the views and experiences of people directly affected. It also aims to make a contribution to wider reform debates and activity, making sure that the voice of people is directly heard. The group has identified 5 key changes to steer action and is inviting action in these areas. We would appreciate your sharing the findings with colleagues and partners.
The inquiry group and wider Social Care Future movement are keen to ally with you and your colleagues in bringing about a better future. At national level we are engaged with ADASS and LGA to do this via the National Strategic Leaders Group.
We have agreed with TLAP that for those councils expressing an interest in this, we will offer a joint initial opportunity in the autumn to pull places together to explore and advise on this. Please do get in touch on this. We would be pleased to recognise councils making such a public commitment.
Dear Prime Minister, Boris Johnson MP, Chancellor of the Exchequer, Rishi Sunak MP and Secretary of State for Health & Social Care, Matt Hancock MP
SOCIAL CARE REFORM
We are writing as leaders of organisations that represent adult social care nationally to urge the Government to act now on reform of England’s social care system and publish its proposals before the Summer Recess. In common with all people who draw on care and support, and colleagues working across social care, we are clear that the time to deliver reform is now. Reform must be underpinned by a positive vision: ‘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’, as Social Care Future put it.
Transforming social care so that it is sustainable and helps enable people with care and support needs to be fully included in their communities matters in its own right. More broadly, as we look to recover from the pandemic, we need to see social care as a key part of the solution and a key part of our infrastructure.
The vision we share cannot be achieved by social care or even wider public services alone. Public resources need to be targeted to support and supplement the efforts and activities of citizens, community groups, voluntary organisations and local businesses, building on the best of what we’ve seen in our local communities over the last fifteen months. The social care sector, working alongside other council services and the NHS, can shift its 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.
Addressing longer term funding and co-producing a ten-year plan for social care will help enable successful implementation of the forthcoming Health and Social Care Bill and the revision of the Mental Health Act. We recognise that helping people to avoid catastrophic care costs and selling their home to pay for care are important dimensions of the reform debate. But action on these issues alone will not suffice. We have collectively agreed that the priority areas for action are therefore as follows:
Funding for short-term stabilisation
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 and beyond. Work by our organisations and others has identified the most serious challenges to support which will require funding.
Urgently bringing forward investment and reform proposals needed to ensure the sustainable long-term future of social care
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, such as more home, housing and community focused, asset-based, inclusive and preventative models of care.
3. Investment in the short term to speed the shift towards a system of 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.
A new deal for the care workforce, including personal assistants and other non-traditional workforce roles.
Funding support for action on inequalities and levelling up.
An innovation fund to enable local authorities to harness the true potential of technology.
Transformation and improvement support to councils and providers and to ensure a new funded transformation and improvement framework for adult social care.
Each of these actions is essential for creating the conditions in which social care can be a full and equal partner with the NHS and enable more people to remain independent, living in their own home or in their community.
We would welcome the opportunity to discuss our concerns with you and stand ready to work with the Government to ensure that our future social care system is best able to support people to live their best lives.
Anna Severwright – Social Care Future
Clenton Farquharson – TLAP
Councillor David Fothergill, Chairman, LGA Community Wellbeing Board
Kathryn Smith – CEO Social Care Institute for Excellence
Kathy Roberts – CEO AMHP for the Care Providers Alliance
Martin Green – CEO Care England for the Care Providers Alliance
Martin Routledge – Social Care Future
Stephen Chandler – President ADASS
Cc Rt Hon Boris Johnson – Prime Minister
Cc Rt Hon Rishi Sunak – Chancellor of the Exchequer