by Jeremy Porteus, Managing Director of the Housing Learning and Improvement Network

The tenth anniversary of the publication of Putting People First slipped by as the festive season got underway last month. It was a ‘landmark’ moment that could secure independent living for all adults. It was also supposed to usher in a care system that offered people personal choice and control, alongside active participation in community life.

I had the privilege of working in the Putting People First team at the time and, since then, the Housing LIN has been championing the role housing can play in helping to deliver those aspirations.

Over the last decade, we’ve seen many targets set for the building of new homes. However, we don’t just need to physically build more homes, we need to build the social capital that underpins the communities in which those new homes will sit.

Indeed, whether we’re building starter homes, family homes, specialist or supported housing, we need to ensure that the social architecture is in place to support those who will live in that housing. This means building neighbourhoods that promote and support wellbeing and healthy living for people of all ages. It is, after all, also ten years since the publication of another document we could still learn from; Lifetime Homes, Lifetime Neighbourhoods – a ground-breaking housing strategy for an ageing population.

Specialist housing can be about more than supporting the most vulnerable. It can promote links between the generations and provide educational and employment opportunities for a community’s young people.

But we also need to be clear about the types of housing that we’re talking about. Innovative and collaborative organisations or groups of friends have in recent years pioneered a range of new citizen-led housing models including:

  • ‘Care ready’ housing
  • Co-housing
  • Community-led housing
  • Land trusts
  • Mutuals
  • Co-living
  • Intergenerational housing and
  • Home-sharing

They have much in common and all are vehicles for giving people greater choice and voicing the opportunity to manage their own care and support. However, by their very nature, these projects are largely micro-commissioned and small-scale.  In my view, these need to come in from the margins and be mainstreamed so that they can become an essential component in providing different solutions to fix our broken housing and care markets.

It’s sad to have to acknowledge that such repair work is still needed nearly four years after the Care Act came into force – complete with the duties it placed on local authorities to shape local markets and to cooperate with ‘relevant partners’. Ministers now have another opportunity in the coming months to foster the growth of community and cooperative specialist housing via the social care green paper and social housing green paper, both planned for this spring.

However, we are beyond the days when a passing reference in such documents to the role of housing in preventing demand for social and health care is sufficient. And, as some of the small-scale innovative schemes show, housing can be the foundation of a social care system that puts people first when meeting their needs and aspirations. Let’s hope that it isn’t another ten years before we see this become a reality.

by Alicia Wood, Dimensions

Martin Routledge challenged me to blog about social care as part of a quest to get a range of views from people in the social care field. Follow them on #socialcarefuture. I have so much to say about what is needed for a good social care so for the sake of brevity, I have condensed a wide range of thoughts down into my #socialcarefuture wish list…

1. Money can’t buy you love.

I’m going to get this one out of the way quickly, we need more money to pay for care and support. Local authorities do not have enough money to pay for the care and support needed in their communities and they need more. Providers are facing a broad onslaught of issues and regulatory changes that mean that care costs more. What we don’t need however is any more money being spent on care and support that doesn’t enhance people’s lives. We need social care that helps give people something to get up for every morning and recognises people as valuable human beings that happen to need a bit more help than most of us, not a drain on our economy.

No doubt that times are tough but I’ve also been through times when there has been a lot of money sloshing around and people were still not getting the care and support they wanted and needed. More money does not automatically equate to better services, we need a BIG rethink on what social care is and does that makes it something that we are all invested in for our own futures.

I want to see a care and support system that enables the people that use it to experience love, friendships and relationships, have meaning in their lives and be valued and contributing members of their communities. I don’t want to keep paying for what doesn’t work.

2. Put our brands and egos away and put our money into enabling disabled people and families to speak truth to power.

 

The social care narrative and debate often feels very paternalistic. That’s because it usually comes from professionals and organisations that represent professionals and organisations. A narrative peppered with beds, crises, the vulnerable, the disabled….blah blah blah. When if you listen to people that need social care, their families and those (often small and not well funded) organisations doing brilliant stuff you will hear the kind of narrative and debate that connects with people, and not just people involved in social care.

Please, please, please can those people and organisations that have power, money and the ear of those in power get behind these more authentic voices so that they can be heard and we have a chance of changing this sorry situation.

3. Communicate better about what social care is – no-one cares about ‘social care’.

I rarely use the term social care in my work or home life. It somehow feels so broad it is a bit meaningless to me. It is used to describe such a wide area of care, support and funding; social work, personal budgets, direct payments, community services, personal assistants, home care residential care, supported living…the list goes on.

If you ask the average person what social care is, most people don’t really know how broad it is and what it does. As an (unscientific) experiment, I just asked the person sitting next to me on the train what they thought social care was. Answer: social workers for children and carers that come to old people’s houses to look after them.

Yet we have conversations about ‘social care’ as if it is one thing. We talk about the needs of a wide group of people under one banner when the reality is that the needs of children and families is vastly different from disabled adults which are also very different from those of older people.

If we want to understand what we are really taking about ourselves, let alone the media, general public and politicians, we really need to start understanding and communicating much better about what social care really is.

It also doesn’t help that we have adopted industry jargon that is meaningless even to most people that use social care. It’s no wonder that most people don’t care about social care.

4. Personal budgets are not an evil way of privatising public services, nor are they the magic solution to making social care better.

 

Personal budgets and direct payments really work for some people and not for others. There I said it. I was one of the people that was evangelistic about them and I genuinely believed that they were THE solution for social care and continuing healthcare. I still think that they are great but I think that they are a small part of reforms that are needed. I want to see more focus on reforming commissioning so that people have a real say in local services and it is transparent, regulated and accountable. It is scandalous that so much crap is still being commissioned and we need local mechanisms to stop this, of which a part of is personal budgets.

If we stop commissioning the crap we may end up with a regulator that can regulate more effectively instead of constantly fire fighting.

5. Stop investing everything in ‘the next big thing/programme/pilot/vanguard and work on the basics to getting care and support right.

Don’t know about you but I can barely make myself read about THE NEXT BIG THING. It’s usually good stuff so don’t take this as a criticism friends and colleagues, but it is exhausting to see another reorganisation, integration, programme, initiative, set of standards etc. when there are so many basic things that need tending to.

Like how to make sure that disabled and older people are getting the support they need to live the lives they want and;

How to make sure that we pay those in care and support roles a wage they deserve for one of the most important jobs in our society and;

How we make sure that no one is getting substandard or dangerous care and support.

If there is going to be A NEXT BIG THING could it be that we stop tinkering with systems (that are flawed and will always be flawed) and just form relationships, talk to each other locally, have good conversations, listen to what the people who use social care and their families want and do what you can. If you can’t do what people want, tell them and ask for their help to find solutions as they will usually have some answers.

Lastly 6. People who need care and support also have a lot to give.

We need to stop framing people who use social care as simply vulnerable and needy as not only are we feeding perceptions that a whole group of people are a drain on our society but it simply isn’t true. Whether you are 105 years old and living in a care home or have profound learning disabilities and don’t use words to communicate, everyone has something to give. Who wasn’t inspired by the care homes that are working with nurseries? Or the examples of people with learning disabilities that help their older neighbours by picking up groceries and walking the dog, or volunteer in their local nursery or school to look after children.

My wish would be for housing, care and support providers to come out of their silos and shift their focus towards becoming community builders, community connectors and rights activists alongside the people they house or support to deal with some of our social problems such as rising mental ill health and loneliness. To enable the people they support to help their communities, get jobs, give and receive education and demonstrate that the value of human beings is much more than just economic productivity. We need older and disabled people to be central to our communities so that all our children grow up with people that are too often hidden from them, and our communities don’t miss out on what disabled and older people bring.

@AliciaWood___

by Neil Crowther

 

Corporal Jones

 

Understanding means finding a story you already know and saying, ‘Oh yeah, that one.’ Once we have found (the) story, we stop processing.”

Roger Schank, Tell Me A Story, 1998

One of mankind’s most incredible recent success stories – vastly increased life expectancy – is now most often described using metaphors of impending catastrophe such as ‘silver Tsunami’ and ‘demographic timebomb.’   More recently, a polarising discourse which pitches old against young has taken hold and begun to shape debate.  As a result, our ageing society is increasingly framed as a problem and a threat, rather than as a success and an opportunity.  Like debates around immigration, discourse around ageing casts it as creating ‘pressure’ on public services, the economy and communities.  In short, it is overwhelmingly positioned in public discourse as a growing crisis.

Debates about the future of health and social care are contributing to and being shaped by this narrative. ‘Integration’ of health and social care is positioned as a solution to the crisis in the NHS, with older people ‘bed-blocking’.  At the same time, debates concerning funding of care in later life have centered on individuals drawing on the equity in their homes, ideas that are quickly dismissed as ‘taxes’ upon death or dementia.   Younger people who require care and support feature barely at all in this debate, a fact that appears to be behind the governments’ decision to address its incoming Green Paper exclusively to older people.   The following paragraph from a piece by Rachel Sylvester in the Times Newspaper on 16 January 2018 exemplifies these themes:

‘The NHS crisis is really a social care crisis, created by an ageing population and exacerbated by government cuts.  Although health budgets have been ringfenced since 2010, there has been a £6 Billion cut in spending on social care and an entirely related 50% rise in the number of older people stuck on hospital because there is nowhere for them to go in the community.’

The debate around the future of health and social care is hence dominated by the language of death, bed-blocking, tax, unfairness between young and old, losing our homes, unaffordability and crisis, which together is likely to encourage fatalistic thinking about the future.  It is little wonder then that governments since the mid 1990s have struggled to command public engagement and support for a long term funding settlement.   The December 2017 Ipsos-MORI  ‘Issues index’, which maps public priorities, found only 2% of the public listed ‘ageing population/social care for the elderly’ as the most important issue facing the country today, and only 12% highlighting as an ‘other important issue’.   The challenge is both that the issue lacks public salience (or the public are reluctant to express it) and insofar as it enjoys public salience, the salience it does enjoy is deeply unhelpful.

Have those advocates striving to seek a new settlement for social care challenged or helped reinforce these narratives?  The Frameworks Institute, a US-based organisation increasingly working with social partners in the UK, lists the features of poor communications practice as follows:

  • Employing crisis communications and highlighting problems, rather than solutions, encouraging fatalistic thinking.
  • Leading with unframed facts and evidence, and professional jargon, rather than values and frames which appeal to people’s feelings and aid understanding, or employing unproductive or unhelpful values and frames.
  • Telling individual stories without explaining the systemic factors lying behind them, which encourages people to see the problem as residing with the individual.
  • Engaging in myth-busting, which often reinforces, rather than challenges the myths by repeating them.

Conversely, effective communications:

  • Combines urgency with efficacy – people must feel a problem can be solved.  Set out the solution and avoid crisis language.
  • Leads with values and employs ‘metaphors’ or ‘simplifying models’ that engage with productive feelings about an issue and that create ‘pictures in our minds’ to aid understanding.
  • Uses thematic stories, not individual stories to foreground the systemic factors shaping outcomes.
  • Connects outcomes to society as a whole – explain how the positive or negative outcomes related to social care affect everyone.
  • Contextualises numbers – don’t expect them to speak for themselves.
  • Avoids myth busting – it tends to affirm the myths, not overcome them.

A quick look at recent communications around social care by a selection of public-facing organisations in the field suggests that they are contributing to the problematic way social care is framed.   Almost all of the large NGOs in the field, spanning older people, disabled people are carers are leading on ‘social care crisis’ in their communications.  None posit solutions other than ‘more funding.’  Most use unframed statistics about the situation facing their client group to convey a sense of urgency.

Research by IPPR and Price Waterhouse Coopers for the Labour government in 2009 found ‘Low awareness and uncertainty: confusion about the nature of social care services.’  Yet insofar as organisations attempt to describe what social care is in their headline communications, little attempt is made to convey any ambition beyond basic ‘life and limb’ services. Even within those limited ambitions communications fail to convey the value to individuals, families and wider society of social care, nor do they employ any ‘metaphors’ or ‘simplifying models’ to aid understanding.

The story of social care needs to be told within broader human narratives around relationships, family and community, in the way TV shows like 24 hours in A&E, One Born Every Minute or Educating Essex have done so for the NHS and education for example.  We need to learn from the way other policy issues have been framed.  For example, the benefit of ‘flexible working’ is not found within the workplace, but in having time to spend outside the workplace with and on family life.  Hence the most effective ‘frame’ through which to communicate the benefits of flexible working is the family, not the workplace.  Where does social care have meaning and value to people?  We also need to overcome the ‘othering’ that can infect perceptions of social welfare, particularly ‘needs- based’ social welfare that is targeted on particular groups, as social care is.  Again, this suggests that more effective communications might foreground stories of family life and use the voices of wider family members, such as grandchildren, to convey the universal importance and value of social care.   There are also major lessons from the reframing of ‘gay marriage’ to ‘equal marriage’ which consciously shifted from invoking the ‘civil rights’ of a minority to emphasising the universal desire for love, relationships, family and stability and so on (i.e. the things people commonly value about getting married, which for the most part isn’t their civil rights).   What is it that people commonly value and which social care helps to protect or extend?  How far are these values embedded in our communications and the frames we employ when talking about social care?

The fact that social care enjoys low public awareness and understanding is, perversely, a major opportunity to define and articulate a new story of change, especially as evidence also suggests there is at the same time a strong desire for more information and debate about its future.

We require a new narrative, employing values and frames to enlist support for and building understanding of the crucial role that social care can play in creating a better society for all.

Communicating effectively is an empirical question, requiring research, development, testing and refinement.  There are a number of initiatives underway in the UK presently to strive to reframe debates, such as work by to reframe poverty, work on immigration, criminal justice, children in care, child protection, climate change and human rights.   There is no equivalent work on social care.

It involves work to clarify the communications goals and current practices of communicators in the field and the values and frames embedded in these, to map current discourse and public attitudes and the values and frames embedded in them and to explore the impact of the above on what people think, feel and are prepared to do about an issue such as social care.  It then involves work to identify values and frames that might affect more productive attitudes and understanding and hence enlist stronger support for our goals and to begin to construct narratives and messages in which these are embedded.  Finally, it involves the dissemination of these new values-based frames, including via guidance, training spokespeople, coordinated communications activity and proactive campaigns.

The process can be a challenging one for those in the field, confronting their own practices and beliefs.  It needs, by design, to be iterative and to bring people on a journey, otherwise it is likely to be rejected.   It requires expert support and funding.

Who’s on board?

@neilmcrowther

By Martin Routledge

Right now, around the country, there are glimpses of a better, brighter future for what we now call ‘social care’, in places, groups and organisations – some very small scale, some bigger – where people are making better things happen and pointing towards how things could be. But these examples are the exception, the minority. Even when better ways of doing things have proven themselves, they often stay small scale with major barriers to growing or spreading and with strong forces limiting them.

While our focus will not be primarily on resources, we know that social care and the people that use it have been badly damaged by long-term under-investment and more recent cuts and that this damage needs to be repaired to have any kind of positive future. We are very supportive of those pressuring and negotiating with government to secure sustainable investment for the future and many of those involved with #socialcarefuture will be part of such efforts.

The role of this, initiative, however, is to complement action on resources by taking collective action to bring about major change to what social care does and how it does it. We start from a strong concern that even when the financial situation was better, systems, practices and “services” for disabled and older people and for people with long-term health conditions, powerfully reflected their institutional roots and have not substantially changed in decades. They have recently been referred to as “The Invisible Asylum.” We are concerned also that the prominent discussions about social care amongst national and local government are stuck on how to “ease the crisis” or provide funding for existing service models, ownership approaches and professional practices. They are limited to who will pay and how, rather than how public resources can be used more effectively.  At the same time, in so far as the public is aware of social care, it is something people see as a last resort, for people who are desperate and mostly to be avoided.

#socialcarefuture is for people who don’t want us to be stuck here.  

@mroutled