Peter Hay

By Peter Hay

One of my favourite quotes is from Dickens’ ‘Bleak House’ where the worn down and enraged Mr. Gridley erupts with “the system! I am told, at all hands, it’s the system. I mustn’t look to individuals. It’s the system.” Dickens’ landscapes are blotted out by a pervasive fog. Mr. Gridley blew up over a legal matter that had gone on for so long no one could remember what it was about as it disappeared in the fog of opaque Victorian systems. Today, the mechanisms for our twenty first century social care system are shrouded in such complexity that a Coroner in the death of Richard Hadley concluded that he couldn’t find neglect. We have got to the point where the need for a proper diet, a poo and a relationship which supports people with living independently is hidden by the ‘complex.’ This has a broader resonance: the Competition and Markets Authority find that our reticence to face frailty means that we make decisions about a complex care system at crisis points in our lives. Complexity cannot be a fog covering the social care system in the 21st century.

The case for change won’t be made by talking about big and complex systems which Mr Gridley found so dangerous to his health. That doesn’t negate the need for ‘big’ or system reform. However, starting the debate about a social care system often overlooks that it is a broad, inclusive sector that has a huge number of component parts.   I am not sure there is an agreed definition of the words ‘social care’ albeit its purpose in supporting great lives has become more unified. Social care is therefore one mighty big system, but as it is also made up of lots of smaller systems, it’s not surprising people find it complex. Bluntly, it is fog. It’s not just the British system either; a recent tweet from Dr Judith Smith about the complexities of navigating the care system was joined by people with similar experiences in Australia and Germany – and I’ll add Northern Ireland to the mix, which is supposedly a single system.

We have to start by putting a stop to seeing people as passive beneficiaries of what comes off the end of system design. When a Coroner or the Competition and Markets Authority find these systems complex, then it must be axiomatic that leaving people in charge of navigating and buying their own care is also doomed. These debates can become locked into language about client, customer or citizen. It needs unlocking by a recognition that none of us have faced a world so populated by older people before. No one has unique skills and knowledge to design responses to the welcome but unprecedented demographics and health services that we now live with. The green paper would do well to start by being clear that government cannot know the unknown and commit it to navigating with us through these unchartered waters of human development. Knowledge and resources are maximised when they are shared. The system needs all the resources, skills, insights and talents that people bring with them. The system and the individual need to look to each other.

Mr Gridley failed to see that systems start with the individual. I found in social work a profession that offers care and support to people whilst recognising that our lives are shaped by the systems around us – families, friends and communities to name a few. Social work is about the individual and the collective, just as it is also about the head (evidence, methods, models and knowing ‘stuff,’ like the law) and the heart – ‘empathy’, friendships and love.

As a social worker, one of my favourite ‘tools’ was to get people to draw how they saw themselves in their system. When asked what makes for a good life, people talk about housing, transport, companionship and a multiplicity of barriers, like the benefits system, that they face in staying connected to communities. People in later life also talk about faith, belief, loss and a living with new timelines for life.

These are our own set of systems, which as people live interdependent lives, nestle within each other like Russian dolls. These matter deeply to us as part of who we are and how we see ourselves, and where they have broken completely, the resulting loneliness now represents a major threat to health. A lack of company kills. We all have networks of connections which might need repair or restoration at points in our lives. Evidence on ageing suggests that wellness is promoted even for people with complex multiple conditions, where people hold on to a sense of their personal narrative and their connections to others. Working with people’s systems and stories promotes better lives.

The green paper is a chance to take approaches that define the system as starting with the personal, but to also recognise that this needs a collective, civic, framework. To support our systems, we sometimes need fearless advocates, champions for rights and those who can hold a laser like focus on what needs to be changed to make lives better. We used to talk about social work in these ways, and perhaps need to revisit its role in making systems personal and clearing complexity. The experience of those self-funding their care is proof that we cannot just leave individuals and markets to somehow work things out. Reverting to the Russian doll analogy, we need as people to be both at the precious centre of everything, but also have the individual as the layer we see first.

The green paper is an opportunity to set out some ambition to be a country that makes ageing and living well possible by harnessing the combination of individual and state power to work with the grain of what life has made us. Quality Matters asked us to aim for ‘a seamless service for the person not the system.’ We need to reset an approach around what we need to grow old well, or to live well with disability. We can build upwards from what we need to maintain and thrive within our personal system to address the many parts of a ‘whole systems’ approach.

Mr Gridley was trying to work out how to hold the system to account for overwhelming him. He would still rage today, particularly about failures for those who were held in the trust of the ‘care system.’ A poo, or the companionship of others, doesn’t seem like too much to ask, but our current system hasn’t delivered them. It’s not just the social care system that is hiding individual need behind the fog of complexity: health systems are also part of this – an indeterminate trolley wait in a corridor is not compatible with an aim to be a great country to grow old in.   We could go on and talk about transport…but this is where systems reform is endless, too big and too complex and overwhelming, so requires the switch in focus back to people and individuals and to systems as constructs in the lives of people.

I want system reform, based upon a guarantee that systems will work with me and mine. I want to be assured that systems will treasure the individual at the centre and the front of the Russian Doll. I want some assurance about a fundamental set of rights and how these would be upheld if I become frail. I want to hear how the system will support the uniqueness of my world (its systems), not replace them, and build the best life possible. The green paper is a chance to make start by making commitments to always and everywhere working together, so that we blend systems and individuals. Given the sorry history of failures to reform social care, the green paper needs to lift the fog by spreading belief that reform is possible. If it does that, it will save a few modern day Gridley’s and more importantly start to make it possible to be more certain about how our care would be delivered should our present or future frailty need us to trust the system.

This can be done. The #socialcarefuture initiative is about growing the future out from the glimpses of it that we see right now. I see examples some of these in:

  • the way the older people can build communities and networks of support around an infra-structure of housing support
  • some of the really great personalised care planning that really understands  what people like and need. My favourite example is when getting beyond why x was the person’s favourite support worker, we found out that there was right way and a good time for serving a frothy coffee. It’s those little details shown in the control of daily life that are the expression of individuality.
  • the contribution made by faith groups and others who, without state funding, work tirelessly at the connections between people. I am watching now in my own community some amazing support around a terminally ill man

We need a system that facilitates these kinds of things, not hinders them

By Andy Tilden, Skills for Care

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There are good thought pieces coming out of #socialcarefutures about the sort of social care system we will require now and in the future.

Much of the focus has rightly been directed at how social care could be funded, organised, how current behaviours can be challenged and crucially how the system enables people to live the life they want. Continuing to do (or in many cases failing or struggling to do) more of the same does not appear to be an option.

Crucially, we also have to think differently and more dynamically about the sort of workforce we require. Social care will require people, people to provide care, to support, to advocate, to look after, to assist, to train, to manage, to lead and to commission. No matter what social care looks like in the future it will still require a workforce. Irrespective of the system that we eventually end up with many people will still require care and support in their own home and if that’s not possible or desirable then in some form of other accommodation.

There are currently 1.58 million social care jobs in England in 2016. With current vacancy rates at approximately 90,000. Skills for Care estimates that if the adult social care workforce grows proportionally to the projected number of people aged 65 and over in the population then the number of adult social care jobs will increase by 31% (500,000 jobs) to around 2 million jobs by 2030.

In response to the projected growth of social care as well as the long standing vacancy rates the obvious question to ask is where will this workforce come from and what more can ‘social care’ do to attract people with the right values and behaviours to work in social care?

Of course there are employers who through their own efforts are offering ‘glimpses of the future’ in the methods they use to get workers with the right values, how they keep workers and also how they offer support with appropriate learning and development. Many of these examples can be found on the Skills for Care website https://www.skillsforcare.org.uk/Getting-involved/Accolades-awards/Accolades-awards.aspx

Despite the best efforts of many the competition for workers is fierce and in order to compete effectively with other sectors many would argue that a more combined effort is required across the breadth of social care to elevate the status of social care.

I am not sure there will be too much argument about the need to raise the status, value, recognition and (for some) the quality of the adult social care workforce, as well as developing a clear career framework that would mean that social care becomes a sector of choice to work in for the many and not just the few. Good social care, undertaken well is first and foremost about enabling people to live the lives they want and as an inevitable consequence it is also about giving those workers that want it a fantastic, enriching career that is of real worth.

We have an opportunity – ‘Facing the facts, shaping the future’, the Department for Health and Social Care and Skills for Care consultation on the strategy for adult social care workforce closed on the 9th April. The consultation is currently being analysed and the results will inform how the current great work that takes place in social care is further recognised, supported and rewarded and how social care as a sector can achieve parity with other sectors as we seek to attract workers for the future.

Andy Tilden is Director of Sector Development – Skills L & M and EE – at Skills for Care

@andytildensfc 

by Lynne Elwell, Partners in Policymaking

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This year marks twenty two years since I ran the first Partners in Policymakingcourse in the UK. This is a leadership training programme for self-advocates and parents and relatives of disabled children.

As you might expect, I am reflecting on what has happened over those years – how making this kind of investment in people and families has worked out and what has changed for disabled people and families. When I started running the courses the aim was to help families access service systems more efficiently – over time this has changed. The courses now aim to help families access life. For many this has happened, with lots of people, for example, gaining paid employment or getting their own home. The expectations from people and families over these years have changed massively – we have hundreds of good examples of achievements in all areas of life.

Initially, I hoped that by spending time with many other families and sharing their experiences would answer a question that I have been trying to understand for a long time. That is, why is it that some people are actively kept out of the mainstream of life simply because of their differences?. The investment we managed to make in families didn’t answer this question, but it has shown how people can be brought in from the periphery into the heart of their communities – with a huge impact on lives. I’m delighted that our national network is active and supportive with over 2,500 people ready to share strategies and solutions on all the issues that affect disabled people, and their families – often responding to calls for support and advice

When I reflect on what seems to have made this difference I think it is that this investment in them helps families to see their children’s gifts, while service systems concentrate on people’s deficiencies. Support systems change over time, while the families are there for the long haul. We welcome people in, and come up with creative solutions. We are working hard to create a world that works for everyone.

Some of the most rewarding times have been spent with young people, many of whom have experienced the care system and have been let down by the education system. They are now successfully attending mainstream schools, college and university, part of apprenticeship schemes or working as advisers to ensure other young people have a good experience. People have also become leaders – although many would be uncomfortable with this description. Dignity, humanity and justice are at the heart of what they do to help their own families and others.

This kind of investment in families helps to lead change, through visioning, inspiring building relationships, working in much more effective partnership with professionals and local managers.

As I reflect, I am very proud that families in our network are not driven by personal ambition, but by a desire for social justice. We are ‘walking on the shoulders of giants’ – families who refused to have their children locked away, individuals who questioned what was on offer. But our struggles to be included are far from over and new self-advocate and family leaders need to be connected to our experience and learning as they carve their own path.

To help with this I have tried to capture the key experiences and practical approaches and solutions we have been building over the decades in a book called Rights of Passage, a soon to be published resource that contains the things we have learned, that we will continue to build on and that we hope will be helpful to the next generation.

By Shaun Webster, CHANGE

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I want to share with you some thoughts about how I would like to see people with learning disabilities contributing as paid employees in the field of social care. I think about people with learning disabilities not just as service users, but also as paid professionals working for our rights.

Professionals, have you thought about working together with us? We have invaluable skills and experience that could be a major contribution. At the end, we are the experts about our lives! What about if all of us share power and work together?

I know that many people with learning disabilities feel that we have no power and no confidence in ourselves, and that we are isolated. But this needs to change. The society needs to look at us as equals, and from the perspective of what we can do, and not thinking about what we can’t do.

In the future I would like you, professionals, to see us, people with learning disabilities as your working partners. We can learn from each other and share power. Real power sharing means that all of us are paid the same wage! At CHANGE, we work with a co-working model. This means that people with learning disabilities, and without learning disabilities, work together.

At CHANGE, we also believe in peer to peer support. This is why we are working alongside the University of Leeds (and other partners) on a project that aims to create paid job roles for people with learning disabilities as peer support workers. This project is funded by DRILL (Disability Research on Independent Living and Learning).

For example, I would like to see us being paid to work in communities as community peer to peer support workers, supporting our peers with learning disabilities to build their confidence, start looking for jobs and joining in with their community. We can support each other to become less isolated and not so lonely.

Some good examples of co-working and peer to peer support come from my work at CHANGE. For example, I am a person with a learning disability and I am employed as the volunteer coordinator. This means that I am employed to support and involve other people with learning disabilities who come to CHANGE as volunteers. This means that people with learning disabilities have support from another employed person with a learning disability.

Another person with a learning disability called Craig, has better reading and writing skills that me, so he sometimes supports me as my personal assistant.

A different example is when Catherine and Ana co-work on the DRILL project at CHANGE. Catherine has learning disabilities and Ana does not. But they are equals. Catherine and Ana are contributing to this project with their unique set of skills and experience.

This is my dream for a new social care future in terms of jobs…..to develop paid job roles for people with learning disabilities, including as peer support workers. My dream is to see people with learning disabilities working with others on an equal basis and values. People with learning disabilities must have the opportunity to be paid to use our skills to make things better.

If this happens, successful stories like mine will not be an exception in our society… They will be the norm!

 

@changepeople_

By Sam Sly

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I’ve read all the great blogs written so far for #socialcarefuture and every one of them says a little bit of what I would have wanted to write about, so I thought I best get this blog out quick, before there is nothing more to say!

On contemplating my initial thought that it has all already been said, I realised that the first point I would want to make about the future of social care would be that we really don’t need to re-invent what citizens need to look out for and look after each other – it’s probably already out there. We shouldn’t be wasting time and money on the next big transformation or reform, but instead should focus on all the things we already have as a society and build on those.

One of my sadly held beliefs, is that ‘care’ ‘support’; whatever it is that people want to call it, became an industry a long time ago – inextricably linked to and driven by profit. It has largely become “serviceland” – somewhere no one particularly wants to be and where, though the language used to describe it changes, what is done to people mostly doesn’t. The saving grace is when I come across a person, group or an organisation bucking the trend and getting great lives for people. These are the “glimpses of the future” that happen because they have fought hard not to be sucked into serviceland and usually despite, not because of the dominant system.

Serviceland is governed by gatekeepers and rationers whose roles have been shaped by care becoming an industry. But in my experience there has never been enough money in health and social care to give people all that they think, or others decide they need. In fact, I would say that even if there was that magic ‘money tree’ that politicians taunt each other about – it still would not significantly change the futures for the people I work alongside because their future happiness isn’t going to be found in serviceland – it will only be found in the real world.

So, if you are with me, I have an idea. Not a radical idea, not a new idea, but one we can all act on for free to start to shape a good future for social care and to start to demolish serviceland. Let’s each of us pledge that from now on in everything we say and do and everything we are, we will act with humanity towards each other. It sounds so simple, and the results would be so great. If we do this we can really challenge serviceland.

In my job as a life planner every day I already see where acts of humanity have made a difference to people’s lives, both in the moment that someone is humane and, in the weeks and years after. My job involves planning good futures with people who are in the most distressing, depressing and horrendous of situations – incarcerated in specialist hospitals. Part of the planning is to recount their life so far, so we can learn from the past. Despite the horror and pain they have often experienced it is other people’s (professionals and loved ones) acts of humanity that they remember vividly and that have given them strength, helped build resilience, and nurtured the hopes and dreams that keep them motivated in what could be seen, at times, as quite hopeless situations. The life planning process is also facilitated in as humane a way as possible – seeking out people’s strengths, skills, resilience, hopes and dreams and building on these rather than risks and fears.

These acts of humanity are simple person to person things – like the teacher remembered 20 years on because they were kind and gentle to the social worker who kept in touch when the person moved area – these are the things that make a difference. People remember someone who has shown kindness, compassion, empathy, generosity, understanding or magnanimity. Like a ripple effect it can make everyone involved more inclined to act with humanity towards others. People stuck in serviceland remember the professionals who acted with humanity even if they still had to deliver bad news.

Acts of humanity give people hope. So, if you take away one thought after reading my blog I would like it to be that each and every one of us is the future of social care and has the capacity to make it a good one. If we decided individually and collectively to root everything we do in humanity, then we are well and truly sorted. A dream? Possibly. Achievable? Definitely.

Sam Sly

Enough is Enough Time4Change!

www.enoughisenough.org.uk

Sam.sly@enoughisenough.org.uk

By Ewan King

John Birdsall
For all the problems it faces, the social care sector has always shown that it can innovate. From personal budgets, which were pioneered in social care, through to shared lives schemes around the country, it’s a sector which can produce innovations.

The same cannot be said about its ability to grow these innovations – to bring them to scale, to use the jargon. Instead, innovative models have tended so stay small scale – at the margins rather than being core business. Forever trapped, it would seem, in a pilot phase.

It’s a longstanding issue. In 2010 the CQC wrote that ‘many councils are still at an early stage in transforming social care and developments are patchy, varying between different groups of people’. Even further back, in 2005, the adult social care Green Paper of the time acknowledged that whilst there were pockets of innovative practice, more effort was needed to ‘ensure that existing good practice is spread right across the system.’

Jeremy Hunt has also acknowledged this lack of progress in his recent speech on social care. He said that Government was duty bound to ‘encourage new models of care provision to expand at scale’.  This was, for me, the best part of his speech.

Luckily, there are no shortage of excellent models of care, which with support could be encouraged to grow.

John Birdsall
Local Area Coordination (LAC), a person-centred approach focused on prevention and co-production to help individuals lead better lives, has demonstrated that it can transform lives whilst reducing costs, most recently delivering ‘statistically significant improvements in health status, health confidence and personal wellbeing’ on the Isle of Wight. In Somerset, a group of locally based staff, working as Village Agents, have helped to reduce social isolation and support people to live independently by helping to connect people to one another and to community services.

People who need accommodation as well as support in their community have often borne the brunt of low quality care. For people who need this kind of support, Shared Lives –  a service that provides family-based support for older people and people with disabilities – continues to deliver high quality support, with 87% of all shared lives services in England rated good and 4% outstanding.

There is huge scope too, to invest in ways which support disabled people to live where they choose and receive the kind support they want. One example is award winning Bradbury Place, developed by the charity Enham Trust through co-production with residents and families, which provides 8 one and two bedroom wheelchair accessible apartments, catering for live-in care, couples and single occupancy.

For those just out of hospital who need support, new models of care like British Red Cross’s First Call, a 12-week volunteer led home support service, have shown that they can help people regain their confidence and community connections whilst saving the state money.

These examples point a way to the future, but we are yet to see the seismic shift necessary to take these models to scale. In our recent paper with Shared Lives, PPL and Nesta, we argue for a concerted and far reaching strategy to bring about the necessary change. We call for the Government to introduce an innovation scaling fund to test new approaches to scaling across local areas and support capacity building and coaching for social entrepreneurs and change-makers, including disabled entrepreneurs.

Locally, we call for a greater commitment from systems leaders to shift resources away from traditional models of services which deliver low quality care towards more innovative, community-orientated, high quality ways of delivering care. More money to support this transformation will be necessary, but as places which are delivering innovations at scale like Wigan, Bradford and Nottinghamshire have shown – it is by no means impossible to make progress.

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This year should mark the turning point for social care, where the disappointments about progress expressed in past Government policies become a thing of the past. In his speech on social care Jeremy Hunt quoted Ronald Reagan. I will quote another American President, Barack Obama who said:

“If you’re walking down the right path and you’re willing to keep walking, eventually you’ll make progress”
Ewan King is Director of Business Development and Delivery at the Social Care Institute for Excellence

@ewandking 

By Julie Stansfield

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We can be forgiven for feeling pretty gloomy when, as a society, we are in effect seeing it as a problem that older people are living longer and younger people with complex health needs are surviving….effectively blaming people for being a burden to the public purse instead of celebrating life. Our systems are frequently said to be cracking under the pressure – it’s true, but of course they haven’t been the right systems for decades. 15 years ago we at In Control argued the system was broken, unfit for the future – but fast forward to 2018 and now, on its knees, the same system tries to maintain or “stablise” itself. A positive social care future doesn’t really need new ideas – they have been there for years now – rather we need to get on with making them a reality.

Last week a senior manager said to me “oh we used to do that “In Control social work” but we now have to do “austerity social work“……seriously! Has self-directed support gone out of fashion without even getting to a first base in reality? I wanted to respond that it was never a fad, but rather the right way forward for people using social care and the only serious contender that makes economic sense too. But I took a deep breath and sympathised with his dilemma & impossible goal of trying run the same system with dramatically less resources and suggested shifting to a mindset not seen enough in public services, one that prizes resourcefulness.

John Baldoni in his Harvard review states “Resourcefulness is not a means of coping with deprivation; it can be a virtue that opens the door to greater accomplishment”. So as I wander round the country between 10 Any Street with people and families and 10 Downing Street. I look for the leaders with this mindset. Without doubt the group who show the mindset more than any other I have found is those in the national network of people involved in Partners in Policymaking https://goo.gl/FDHFkW. And this is where I shift from gloom to optimism about a possible future for what we currently call social care.

Sherrie Campbell highlights 6 characteristics of the resourceful mindset….. being open-minded, self- assured, imaginative, proactive, persistent & hopeful. None of us who are part of this network lack imagination or resourcefulness. We simply can’t afford to. We can’t allow ourselves to say “It can’t be done” “they won’t let us” “there’s no money”. We can’t do that because it’s our lives and those of the people that we love that are on the line. We are disabled people, family members of older and disabled people, committed supporters of people society too-often excludes. Lynne Elwell who leads the network, has recently been capturing the tools, tips and stories that reflect and can help us build our resourcefulness. Watch out for Rights of Passage – the product of decades of learning and experience – being published soon.

I could list thousands of stories where partners resourcefulness created success but I will offer you just one, very simple but quite profound. A young man Jack, labelled as having a learning disability wants a job. The system response is an employment scheme. This scheme offers to teach him how to fill in an application form and interview skills. It also offers work experience in a specialist part of the garden centre or collecting trollies at the local supermarket. Jack isn’t interested in gardening nor working in a supermarket. He wants to work in a local pub where he can mix with other young people of his age. Partners set up an advert on a facebook community notice board, “Jack dreams of having a job in the Anchor Inn if anyone is willing to help us make his dream come true get in touch”. Within minutes two people have responded who know the landlord. His trial as a glass collector started within a week. Jack is now a waiter, still at the Anchor Inn and is reported to be the most meticulous table setter.
John Waters often tells the story of the “Gordian Knot” which always rings true to me, as systems fiddle with the knot in attempts to untie it, taking forever, Resourcefulness tells us to simply slash the knot to get to what matters. A great #socialcarefuture needs the folk who will slash that knot and bring together networks & leaders with the right mindset to build a sound future where people belong to each other not to the state. Yes it’s truly terrible what cuts have done to social care. But in the future, as money comes back in as it surely must – let’s spend it on supporting people’s resourcefulness.

Julie Stansfield is Chief Executive of In Control

@Juestanny