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 was fascinating listening to Andrew Dilnot at yesterday’s Treasury Select Committee on social care funding, talking not only about the detail of the government’s latest proposals, but crucially about the importance of winning media, political, and public support to increase investment to a level necessary to achieve the kind of support we might have reason to value.
Dilnot noted how the government’s funding proposals, the detail of which was published on Wednesday, amounted to the first time any significant increase in spending on social care has been committed by a government for 40 years, but that this fact and the inadequacies of the proposals pointed to how ‘social care simply hasn’t attracted political, public or media support proportionate to its needs…….so I do think the proposed settlement is inadequate, but that’s a problem that implies criticism of all of our institutions and we all need to reflect on why something so important simply hasn’t had the support it needs if it’s to be done well.’
He went on to say that ‘the sector needs a different kind of profile & there are all sorts of questions about why we don’t talk about this very much.’ He reflected how surveys show that people who draw on social care find people are often happy with their lives and their support, which ran counter to the fears people who don’t draw on social care appear to expressed and perceptions of what social care is and does.
Personally, I don’t think the challenge concerns ‘the profile of the sector’. Rather, it speaks to the need to shift the debate from being one that starts with and remains exclusively about money, private assets and ‘systems’ towards one that is about the way we all imagine and think about care and support in our lives and the values needed to support change. Right now, we are missing crucial opportunities to speak to and shape values and thinking about the world we inhabit together, how we want it to be in future and the role of care therein. There is hence little moral context to the discussion, save ‘looking after the vulnerable’ which has little purchase on public salience, or protecting people against ‘catastrophic costs’ which asks nothing of the role that care should play in our lives. Other movements for sometimes complex and technical policy and practice change, and significant financial investment, such as those for climate justice, have learned how starting with these broader ‘who are we and how can we live well together?’ questions are crucial to winning support for reform. We must do too. Caring Across Generations explore this and the role of pop culture in shaping how we think about care in this excellent article.
We also need to break free of short termism. Most campaign messaging on social care is about short-term relief – to relieve current urgent pressures – even as it attaches to a debate about long-term reform. This criss-crossing of immediate term and long term means that the hard graft of shifting thinking to support long term reform never really begins. To convey urgency, messages centre only on what’s wrong, confirming rather than challenging the negative thinking Dilnot refers to.
So, in the week that the government has published detailed proposals for long-term reform, the media, many providers, charities and Trades Unions have been focused – understandably – on the immediate recruitment challenges facing the social care sector and on the feared impact of vaccine mandate. Documentaries and news programmes on both BBC and ITV on the ‘crisis’ in social care. The message, as it has been for several years, is that social care is broken and on the brink of collapse, meaning that ‘people could be left in urine soaked beds’ or ‘not fed on time’. In a bid to increase the pay and conditions of staff, we are told about how hard and unpleasant care work can be, as though this – rather than the value of the work – is what should command better pay and conditions. TV documentaries depict people drawing on social care as isolated, distressed and neglected. We rarely if ever hear directly from people that draw on social care, who are depicted as only silent victims, implying ‘social death’. In this` dominant narrative people are objects, for whom tasks of bodily functioning and everyday living – feeding, washing, dressing, going to bed and getting up – are done to them at great cost to the social care workforce, or their families.
Even the government feels compelled to frame its plans as ‘fixing’ social care or ‘getting social care done’ (echoing the language of Brexit) – as leaving something behind, not building something great for all our futures. The framing is about loss aversion (not having to sell ‘the family home’) rather than gain (having a good life because of great support). This is despite evidence from countries, such as Germany that that key to secure public support for reform is people feeling their money will buy them something that they have reason to value.
Every shred of evidence about the impact of messaging on public thinking finds that urgency absent a sense of efficacy breeds fatalism. And in a context where many of us have a view of social care as representing loss rather than gain, as something to be avoided, not something that could help us to maintain our wellbeing and life goals, these messages are just feeding the beast. They reinforce an association between social care and death – the ultimate fatalistic thought. And in the face of death we turn away for as long as we are able to.
In expert debates, ‘care’ itself – what it is and does and whether that is the right way to organise things – is not really questioned. The focus is on securing more money, but not whether more money will buy us something better. The offer therefore is that with more money, more of us can have the thing few of us want. It was also, therefore, interesting to hear Dilnot comment that ‘our best option is adequate funding & innovation…this sector hasn’t radically changed in how it delivers care.’ In the current cycle of ratcheting up urgency to win short term ‘aid’ there is little if any space – rhetorically or in reality – given for new thinking and ideas. The resultant perpetuation of institutional or time and task, life and limb care feeds harmful depictions of and attitudes towards social care, generating a negative feedback loop. In #SocialCareFuture’s assessment, a message of ‘look how it could be, if only we invested more’ is infinitely more powerful than ‘it’s terrible, give us your money before it gets worse.’ That’s why, in addition to a new narrative, we have placed so much emphasis on showcasing ‘glimpses of the future’.
We have to disentangle short term campaigns for injections of funding from the very different kind of long-term work needed to change the weather when it comes to social care. That’s why #SocialCareFuture developed a vision focused on the future we want to bring about, but we need help to develop and share it more widely and to realise its full potential in reshaping attitudes, assumptions and expectations. Some donors have been in touch to express and interest in supporting this, but we need to build a coalition of the willing, up for backing and being actively involved a long-term effort to shift thinking, build support and mobilise a movement for deep and lasting change. We plan to convene interested parties to explore this early in the new year.
Underpinning this, we need to shift from protest to proposition, pointing not just what’s wrong, but also to what’s strong, what can be built on and how we can make steady progress towards our vision. This is about growing the future, not fixing the past. There has to be a believable plan for change, going way beyond just questions of funding, which we own and deliver together, and that we can invite other people to get behind and we need to stop expecting government alone to lead this work.
As Andrew Dilnot rightly said, the way social care is depicted and how we think and feel about it is a major obstacle to the meaningful reform we all want. The only answer for those of us that want to break this deadlock is to mount a serious effort to shift mindsets through concerted strategic communications, focused on long term change. That’s why #SocialCareFuture is leading work on changing the song people hear about social care and changing the chorus line that they hear it from. Through our work, we have a produced a story of change that the public shows strong support for. But we need to tell that story in creative, engaging ways that reach large numbers of people, over and over again.
You might draw on social care, or work in the field, you might be a campaigner or movement builder, work in marketing or communications, be a journalist or work in social media. You might be in the creative industries or the arts, or be an investor of donor. If you’ve something to bring to this journey – we’d love to hear from you.
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.