By Simon Stockton and Natasha Burberry

 

Recently the CEO of a large health care provider shared a story with me which summarised why coproduction matters so well it almost felt like a ready made urban legend.

The story went something like this… A care professional is talking with a local resident describing how a smoking cessation service is aiming to help address health inequalities and raise the life expectancy of men in the area above 65 and the man, a heavy smoker, says in response ‘why would I want to live any longer than that?’

It’s a pointed rebuttal to a well intentioned offer and it raises the question – how well do we really involve people in defining the problem we are trying to solve and in designing the approaches we use to improve people’s wellbeing.

Taking Coproduction seriously enables us to focus on building a deeper understanding of what really matters to people and communities and to use that understanding to build services collaboratively as well as strengthening the capacity of people and communities to help themselves.

That may feel like a no-brainer but in the harsh financial climate which continues to plague social care it can be challenging for the leaders of Care systems to invest in Co-Production.

Exploring how best to engage people takes time and effort and isn’t always a smooth ride but some areas, Eastern England being one, are acknowledging that this just makes the challenge all the more critical.  After all, if we’re not using resources to address what matters most to local people and communities how can we really say resources are being used effectively?

Over the last few years Directors across the East of England have been developing a programme to acknowledge the importance of coproduction.  Directors across the region have signed up to the  Count Me In pledgecommitting themselves publicly to supporting and investing in coproduction. Alongside that the Count Me In Network which produced the pledge has developed a simple  RAG rated self assessment for people involved in coproduction activities to reflect on their experience and whether it felt meaningful and productive.

This month sees that work take another significant step forward in its ambitions. The East of England is now aiming to become a centre of excellence for coproduction and is holding a series of events starting on 23rd September to bring together system leaders and people involved in coproduction to design an improvement programme to fulfil those ambitions.

The network itself has also grown and is now supported by NHSEngland and  MacIntyre Charity extending its reach to the health and provider sectors. In the context of the Long Term Plan and the move to Universal Personalised Care this makes significant sense.

Our hope now is to develop a cross sector support  offer which can nurture local coproduction activities across the region, share what works and test out new ways of working in ways that feel safe and benefit everyone involved. How we do that is an open question and one we will explore together but a core part of the programme over the next year will be focussed on building capacity for people to engage in coproduction and in testing approaches which we think are scaleable.

If you’re interested in getting involved in this work, sharing your stories of coproduction with us or simply hearing what happens next you can get in touch with us by emailing simonstockton@me.com or natasha.eastsli@gmail.com

 

By Elaine James, Rob Mitchell, Hannah Morgan, Mark Harvey & Ian Burgess
You may wonder how rocket science has a role in social work. For us, rocket science is a metaphor for the new world of complex technologies, reshaping our lives and our understanding of the social world we live in. It is also a way of describing how understanding the complexity of human lives and relationships is far more complicated than being able to take apart the inner workings of a rocket ship, yet in many ways social work is so much simpler and more beautiful.
We each have over 20 years working in social care, and during our careers we have come to conclusion that social work practice isn’t technically complex, like that of a rocket scientist is, but it requires working with the complexity of human relationships.  Social work is deep in the messy stuff, the grey areas of life, which become intermingled with the social worker’s interpretation of what we think we see during our smallest snapshot of a glimpse into someone’s life during our “assessment”.
Since the 1970s successive UK policymakers have proposed a role for social workers in meeting the wider needs and aspirations of citizens by acting as a source of advice and connecting people into wider circles of support to sustain their independence and wellbeing.
However, social workers cannot meet and uphold people’s hopes, wishes and ambitions for their lives if social workers do not first have a strong understanding of the social model of disability and the blocks which prevent people living their best life.   It is almost 40 years since Mike Oliver developed the social model of disability as a way of explaining the new approach to disability.  However in 2019 we still see that power and control over how support is planned and paid for is very firmly within the hands of  professional staff within health and social care.
2011, Lord Justice Munby, at a speech given to social workers, asked the question – at what price did social workers ‘safeguard’ people by restricting their freedoms? His observation, that the local authority is a servant, not a master and that vulnerable adults do not seek to be controlled by the state, should be a mantra for all social workers.  Reminding us that we are there to uphold the inherent dignity of the people whose lives we become a part of. We are not there to displace their decision making, their control and confidence, imposing a set of outcomes which we feel good about, but which steamroll their views and ignore their rights.
People tell us they want some very simple things from the social wormers who are invited into their lives.
Home, Work, Love and Hope.
It doesn’t take a rocket scientist to get that these 4 things are the foundations of a good life. But it might take a tonne of high octane rocket fuel to inject the energy needed into social care to make these 4 things the mission of all social workers. Let’s go for main engine start and reach for the stars!

By Angela Catley, Community Catalysts

People ‘doing it for themselves’ report and stories launched by Community Catalysts

We work in a bit of a bubble – the world of health and social care. It’s a sector that is always complex and often baffling, one which on the face of it is all about people…but you don’t have to dig too deep to see that the people who are supposed to benefit are rarely in the driving seat.

I find myself challenged because I really want people – the ‘general public’ whoever they are – to understand my bubble…and get frustrated when they fail. I talk to family and friends who move in different circles and have different experiences to mine and cringe when they use language like handicapped and elderly; despair when their only view of my world is care homes, day centres and hospitals. Frustration and despair felt by someone who only works in the sector, I dread to think how it feels for someone who experiences it regularly in person.

I understand where the lack of insight comes from. A media obsessed with ageing as a ‘timebomb’, portraying older people with images of wrinkly hands and zimmer frames. An austerity driven Government viewing disability largely in terms of the impact on costly services. Both of these combined with some care and support models that have evolved very little in the last 30 or more years. The whole thing creates a kind of negative fog into which the creativity and strengths of people, organisations and the sector as a whole slides out of view.

The whole thing creates a kind of negative fog into which the creativity and strengths of people, organisations and the sector as a whole slides out of view

So where to start. All of that negative stuff has a core of reality, for some people in some places sometimes. But, and it’s a big but, it is really not how it is for everyone, everywhere. Community Catalysts has the privilege to work everyday with people, communities and organisations that want different and do different. Imaginative, energetic people who are challenging the dated stereotypes and creating a different reality for themselves and others. A quiet, and quietly satisfying, little revolution.

Imaginative, energetic people who are challenging the dated stereotypes and creating a different reality… A quiet, and quietly satisfying, little revolution.

I take heart from colleagues and peers leading this revolution within organisations. Organisations like local government, small and large businesses, charities, social enterprises and community groups. A good example is the Social Care Futures initiative, started by a ‘change agent’ or two and evolving into a multi-faceted movement made up of everyone and anyone who experiences, offers or plans social care. Another is Personalised Care, an initiative started by NHS England, picked up by local government and health organisations and now snowballing into something that might, just might result in a very different system in the future. All working together to make things different and better with people who need care and support to live their life, their way firmly in the driving seat.

But the folks whose story I really want to tell are the individuals and small groups of people who have personal experience of time in the health and care bubble. People who need care or support to live their lives. People often portrayed as being little more than wrinkly hands, wheelchairs, benefits recipients, service users…needs. People who live with challenges every day – usually placed on them by the system or society as a whole.

Community Catalysts supported by the National Lottery Community Fund developed a project to focus on these people. In particular those individuals who refuse to disappear quietly into the fog of negativity. Our project is called ‘people who are doing it for themselves’ and its whole purpose is to shine a huge spotlight on the positives. Strengths instead of needs, citizen instead of service user, can instead of can’t.

Strengths instead of needs, citizen instead of service user, can instead of can’t

We know there is real value in finding out what helps these people (and the folks around them) to value their strengths and believe in themselves. We think it might be possible to distil some of this stuff and use its essence in other areas for other people – spreading good ideas and good practice far and wide. Exciting stuff but more than a bit scary too.

We made a start by writing a list of all the people we knew who are ‘doing it for themselves’ People who are running their own enterprise or group and/or affecting change within their community. People who shine a light through the negative fog in a small, medium or huge way.

We grew the list by inviting people to get in touch, searching on line, using social media and talking to people we know about people they know. The results were amazing. 56 individual leaders running enterprises or businesses or groups in their community and another 15 run by groups of people working together. And the list keeps growing. We found people in England, Scotland and Wales; in cities and villages. Men and women, of all ages, who live with conditions like dementia or autism or epilepsy; those define themselves as disabled and others who experience challenges with their health. All of whom are actively, intentionally and gloriously leading positive change for themselves or others. Strengths at the forefront with needs still there but well out of focus.

  • We spent a good few weeks talking to people and learning from them, bringing some people together into a coproduction group to help us plan. We’ve realised there is such a lot to learn and also that we are only seeing the tip of this hugely positive iceberg as it juts jauntily clear of the fog of negativity. We then went on to distil what we’ve learnt, working with our partner Public Perspectives to write it down for sharing with anyone and everyone who might have the power and inclination to create the conditions for creative, talented citizens to shine. The result is:

We’ve realised there is such a lot to learn and also that we are only seeing the tip of this hugely positive iceberg as it juts jauntily clear of the fog of negativity

To learn more contact Project Manager, Angela Catley on 01423 503937 or email on angela.catley@communitycatalysts.co.uk

 

By Tim Cooper, United Response

Teddington Band

Most would agree that these are tricky times for those of us in social care and certainly the challenges we face don’t seem to be reducing in number or complexity. Social Care Future is a powerful stimulus to get us thinking about how we need to think and act differently.

I was talking recently to one of our longest-serving managers who is just retiring and I asked her what her parting reflections would be, and she set it out quite simply “Really, it’s about de-professionalising peoples’ lives and keeping a focus on people being included”.

We need to see people with using social care (in our case particularly people with learning disabilities) as part of whole communities and not special groups of people with particular conditions.

We need to develop ways of working out of settings that everyone can use that are not just for people using social care.

We need to focus more on what is ordinary and less on what is special.

There are numerous individuals in every community who are isolated and lonely. Belonging to a community network can help prevent individuals from reaching crisis point by offering company, a sense of worth and belonging and practical help with things like transport/ shopping etc. Should someone experience a change in need or reach a crisis point, a natural network of support has already been established with people known to that individual who can give that little extra during a particular time of need.

In one of the deprived coastal communities on the South coast, we run a community network. At its heart is a simple idea that: everyone has something of value to contribute that could help or benefit someone else, including those who often sit on the margins of society. And that everyone has something to gain from engaging with others in their community, including those who may appear most advantaged.

Through the network we encourage people to come together to share interests, hobbies, skills, ideas, concerns, aspirations and needs… People from all walks of life come together and contribute. It is fun, creative, empowering, motivating, resourceful, inclusive and non-judgemental and imbues a sense of belonging to or being a part of something.

It has a high street presence, branded as the ‘community network’ rather than specifically learning disability service. People with a learning disability are active members of the network, the point is so are older people from the local area, families, children, in fact anyone in the local area who has something to contribute and wants to draw something from it.

In the jargon of the sector it is an asset based approach. I don’t think that’s how members of the network would describe it. They see it as a place where they meet others, can help others and receive something in return.

Parts of south-west London are among some of the most affluent areas of the country, but that does not necessarily mean for some of the people who live there that there is any reduction in the loneliness, marginalisation and sense of exclusion that they feel. The idea of volunteering within local communities is not new but very often in this context it seen as people volunteering to help the more marginalised members of society, for example people learning disabilities. With the help of the National Development Team for Inclusion we are starting to look at whether we can turn this on its head. We are developing a local ‘Time Bank’. This will start small but the aim is to link people from across the community and provide an opportunity for disadvantaged people to volunteer their time to support their local community and become engaged and involved. If we can make this work people who would otherwise be seen as recipients of social care are contributing to the community well-being and reducing the demands on public services.

Teddington

A couple of years ago we joined forces with a Devon-based charity – Robert Owen Communities. One of the one of the things that really attracted us to them was their innovative ‘well-being’ services, supporting people with disabilities from local community settings. So for example, they have staff based in local leisure centres who enable disabled people to make full use of the centre’s facilities, sometimes supporting them to access the day-to-day programme of activities and sometimes supporting people one-to-one. These staff to all intents and purposes are indistinguishable from the core leisure centre team, but have the time expertise and training to support individuals’ particular needs but in the same settings as everyone else.

Our aim at United Response is to build an approach to supporting people that is based on networks of support rooted in local communities, with the back-up of a large and well-resourced organisation. The practical examples above give us the confidence that it is possible to think about social care differently and more importantly to make an impact with people.

@unitedresponse

 

 

 

By Sian Lockwood, Community Catalysts

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An important debate is taking place about how to ensure that people who need care and support get that help in a way that enables them to stay safe and well and live the life they want. This conversation has been given momentum by three recent Panorama programmes on social care – the exposé of the appalling treatment of people with learning disabilities at Whorlton Hall followed by a two-part programme about the immense care challenges in Somerset. The fact that there are two All-Party Parliamentary Groups on Social Care, each considering the challenges faced by social care and its workforce, underlines the importance of this debate.

There is no doubt that care is in crisis. Local authorities do not have the money to pay for the real cost of care provided by traditional care agencies. Agencies are struggling to recruit and retain staff, with the loss of care workers from the sector last year being over 25%. Care agencies are giving back contracts and some of the largest household names have gone into liquidation.

The All-Party Parliamentary Group on Social Care (APPG Social Care) launched earlier this year is currently considering ways to ensure the safety and quality of the social care workforce. The recent opinion piece in the Daily Express citing the two co-chairs of the APPG illustrates one important element of the debate. Should everyone working in social care be regulated, trained and qualified – and will that ensure the quality of the care that people get?

Whorlton Hall was a regulated service (with a rating of ‘good’) with trained and qualified staff. It’s clear then that while regulation and training have an important part to play in ensuring the quality of the care and support available to people, they are only part of the story.

A golden thread that has run through government strategies for health and social care for more than 10 years has been the vital importance of people getting high-quality personalised care and support tailored to their circumstances. Think Local Act Personal and the Coalition for Collaborative Care co-produced the Making it Real framework for personalised care and support with people with lived experience and their families. The framework is divided into six ‘themes’, each of which is described through ‘I’ statements.

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The first theme called Living the Life I Want, Keeping Safe and Well is self-explanatory and like most of the ‘I statements’ applies to all of us – we all want to live the life we want, to be as independent as possible, to have a place we call home, to have people we love who love us and to feel valuable. There are some though that are particularly important to people who are depending on others for their care for example – I am treated with respect and dignity; I feel safe and am supported to understand and manage any risks.

The fourth and fifth themes deal more directly with how people get the support they need to live their life Theme 4 My Support, My Own Way is summed up by the first ‘I statement’: ‘I have care and support that enables me to live as I want to, seeing me as a unique person with skills, strengths and personal goals’. Choice is vitally important: ‘I can choose who supports me, and how, when and where my care and support is provided’.

Theme 5 deals with the workforce. The focus there is on attitude as well as capability. ‘I am supported by people who see me as a unique person with strengths, abilities and aspirations’; ‘I have considerate support delivered by competent people’.

So how can we ensure that people get safe help in the way they want from considerate, empathetic and capable people?

Disabled activists have fought for many years for direct payments from local authorities that will allow them to select and employ their own personal assistants. More recently there has been a recognition that not everyone wants the burden of becoming an employer and that there are different models that can offer real choice and control to people, such as community well-being teams and community micro-enterprise.

These new models require us to think differently about how to ensure that safe support is provided by capable and empathetic people in ways and at times that work for people.

Current approaches to regulation, training and qualifications are designed for more traditional (and larger) organisations and do not fit these new models of care. Innovators are faced with the challenge of squeezing their model into a regulatory framework designed for mainstream care, with the danger that they end up compromising the heart of their offer. Some like the Community Well-Being Teams have blazed a new trail to regulation, and it is heartening that the Care Quality Commission is keen to find ways of building on this to regulate other innovative models of support like community micro-enterprise. Heartening too that Skills for Care are prepared to help organisations like Community Catalysts to design learning programmes that are appropriate to community micro-enterprise.

These new models also require a different way of thinking about ‘risk’. As a recent Kings Fund blog comments:

The word ‘risk can feel loaded in a health and care setting, often coming with negative connotations, but (councils need) staff to start seeing the positives of taking risks, of trying new approaches based on what users told them – and also to see that sticking with the status quo carried its own risks.

People who employ Personal Assistants or who buy support from innovative or mainstream providers are as keen as anyone to ensure that the help they get is provided by safe, capable and compassionate people. They understand, often from bitter personal experience, the risk of the status quo and their voice must be central to any discussion about the quality of social care and the capability of its workforce.

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I hope very much that the new APPG on social care is consulting widely with the people most affected by this issue, people needing support and their families, and will give proper weight to their recommendations. If we have learned anything from recent scandals, it is that regulation, qualification and training do not by themselves result in the safe, respectful and considerate support and services that people are asking for and deserve. We need to think differently – and together – about how to make sure everyone gets good care and support.

Sian Lockwood

CEO, Community Catalysts

23rd July 2019

by Mary Reed, Wiltshire Centre for Independent Living 

Live for Today Tattoos Mike Boddy

In 2015 Wiltshire CIL launched Make Someone Welcome, making a foray into Twitter with our hashtag campaign and getting out and about in the community asking groups to sign up to the pledge to ‘Make Someone Welcome’. It was a simple way of showing communities that all people have value and it doesn’t take much to be inclusive. Everyone is welcome to be part of Make Someone Welcome and the range of groups is vast: sports clubs, craft clubs, museums, hairdressers, tire fitters and tattooists to name but a few. We also work with organizations involved in delivering health and social care, encouraging them to think differently about the people they are working with.

We know that words can become slogans with little thought or intention behind them and this ultimately means everything stays the same, it just gets labeled differently. We didn’t want this to be the fate of ‘Make Someone Welcome’ so looked to find ways for the people we were connecting with to be able to think about what inclusion is and what it means. To that end we created an awareness raising workshop and toolkit, designed and facilitated by people with lived experience of disability. So far, we have delivered these workshops to over 300 people including professionals involved in social care (care providers and those in statutory services), voluntary sector organizations and volunteers in the community groups that had signed up to the campaign.

This isn’t training, you can’t train people to look and perceive things differently but through lots of activities and discussion you can show people that we are basically the same, we all want the same things out of life; relationships that matter, hope for the future, something to get up for in the morning.

The workshops are designed to encourage people to put aside their professional identities or preconceived ideas and see people as they see themselves. We also wanted people to see how they can unwittingly ‘other’ people they see as different to them, and that even if this ‘othering’ is done in a positive way it can still have a negative impact; assumptions are made without getting to know the person, and people remain on the outside of communities, catered for in ‘special’ ways but not seen as equal members with equal value. Our workshops are lively affairs with lots of talking points, we use press reports that show disabled people as saints, superheroes and scroungers, include insights from people in the public eye and discuss how we feel when school children support a class mate to win a race because he is disabled. We don’t do absolutes, or right and wrong answers but we do ask people to take a moment and really think about these situations. As with all issue’s worth thinking about deeply it is complicated with blurred lines and fuzzy boundaries, as the actor from the Breaking Bad TV show says; ‘I was called for audition because I was disabled but I got the part based on my acting ability’. This is all supported by facilitators with lived experience of disability and an openness which means participants are free to ask anything without fear of ‘saying the wrong thing’.

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A good example of what we do in these workshops is the exercise we call ‘What do we have in our lives’ this is designed to show the difference between what we need to function and survive and what we value in our lives. We divide the page into two; on the Left-hand side are the services we use and on the right-hand side is ‘other stuff’. Under ‘other stuff’ people can include anything in their lives that isn’t a service but which plays a part in their everyday.

People work on this in groups and the lists generally look like this: Left side is all the boring but necessary services people need, anything from bins collected to dentists, the cogs and mechanisms that help us to function but that go on in the background and don’t take up much of our daily thinking. The right side is the fun stuff and includes relationships; family, friends, food and drink, pets, holidays, work, hobbies. We then ask the group to choose a side that gives meaning to their life. No one ever chooses the left side. Our final question is: so, if the right side is what is important to you and your reason for getting up in the morning why is it that when we work with people who need our support we invariably focus on the left side? Having done this exercise with lots of groups we have learnt a couple things as to why professionals provide left side, service solutions. Firstly, services are effectively the easy offer; easy to assess for, relatively easy to sort, they can also be packaged up and costed. To use a factory analogy, they are basically your widgets; easy to produce, count, control and distribute. But more than that services are the professional’s ‘gift’; anyone involved in delivering any kind of support wants to feel that the work they do and what they can offer is of use to the person. Often all they have to offer are leaflets, or a signpost to a service, but this is enough to give a sense of job satisfaction, as a volunteer from a voluntary sector organization said to us; ‘whenever anyone rings in for advice I always set them up on attendance allowance’, this might not be what they asked for or wanted but it was something he was able to give. The result of offering an off the peg service is that well-meaning professionals, looking for ways to do their job, can often end up with preconceptions of what a person wants, limited by what services they know they can offer – so a referral to a day service is easier than supporting people to maintain and strengthen relationships with people that matter to them. However, the fundamental flaw in this is that by focusing on the widgets (services) and not the ‘other stuff’ we end up missing the point entirely, giving people the means to survive but not to live.

This exercise helps us to ask people to take a moment, step back from automatically offering the usual and notice the fundamental importance of ‘other stuff’. We ask them to work with us to find ways of supporting people to build on things that have value in their life, whilst providing the background support to enable them to do this. Abbie, one of our facilitators, will talk about how her PA helps her get her teeth brushed and hair sorted, this service is necessary, but this isn’t whey she gets up in the morning; she gets up to care for her daughter or come to work, she gets up to live her life and to get on doing the ‘other stuff’ just like all the people in all the workshops do.

@WILTSCIL

by Neil Crowther

Me and dad.jpg

Many people welcomed today’s social care report by the House of Lords Committee on Economic Affairs, which calls for an immediate injection of £8 billion to fund social care, followed by the phased introduction of free personal care over the next 5 years, to be ‘available universally by 2025/26.’ The report is significant, both given the political support it indicates but also because it comes hot-on-the-heels of reports by the left-leaning think tank IPPR and right-leaning think tank Policy Exchange (with explicit support from Jacobs Rees Mogg) both calling for free personal care paid for through general taxation. There would appear to be a definite shift towards an idea that only a few years ago seemed like a pipe-dream in England and one which seems, on the face of it, fairer and more progressive than any other funding option that has been mooted in recent times.

I absolutely support access to care and support being based on the same principle as the NHS: free at the point of need and funded through general taxation. But I have some big caveats about this and similar proposals.

‘Personal care’ is very narrowly defined

The cost of moving to the principle of free personal care appears to be to lose the principles of wellbeing on which the Care Act is founded.  Included in the definition of ‘personal care’ is:

  • Personal Hygiene: bathing, showering, hair washing, shaving, oral hygiene, nail care;
  • Continence Management: toileting, catheter/stoma care, skin care, incontinence laundry, bed changing;
  • Food and Diet: assistance with the preparation of food and assistance with the fulfilment of special dietary needs;
  • Problems with Immobility: dealing with the consequences of being immobile or substantially immobile;
  • Counselling and Support: behaviour management, psychological support, reminding devices;
  • Simple Treatments: assistance with medication (including eye drops), application of creams and lotions, simple dressings, oxygen therapy;
  • Personal Assistance: assistance with dressing, surgical appliances, prostheses, mechanical and manual aids. Assistance to get up and go to bed. Transfers including the use of a hoist.

Excluded are ‘other needs, such as housework and shopping’ according to the report. But it’s clear that a whole raft of other supports that can be instrumental to promoting the wellbeing principles in the Care Act are also missing here.  On the one hand, we might conclude that by relieving people of the costs of these elements of life and limb care, people may be better positioned to re-direct their personal resources towards achieving wider matters of personal and family wellbeing (the ‘partnership approach’ to funding talked of in the report).  I also think Caroline Abrahams makes a good point in the report when she is quoted as saying:

‘If you provide people with a bit more support, they are more inclined to want to care informally. For example, neighbours and friends are often terrified that if they start doing help for someone, they will suddenly be landed with it—they will carry all the responsibility themselves and be left holding the baby, as it were—but if they thought there was better support around them, they would be more inclined to help.’

But many people, including many adults with learning disabilities, don’t have access to such resources at all. For many others, networks of informal support are not self-executing but rely upon expert organisations sourcing and marshalling support and  making connections, such as the work of Circles, Local Area Coordination or Community Catalysts for example.  The sheer number of older people expressing loneliness as their primary concern should also be a clue to the fact that reducing social care to ‘personal care’ – even if free – could prove to be a false economy if it means other support is not funded.

Would free personal care be the only available support that people can access without payment? If so, a measure which nobly aims to protect people from the catastrophic costs of paying for life and limb care could come at a catastrophic cost to anyone who needs some support to secure or maintain a life to live. In fact it could extinguish the vision of personalised care and support to promote wellbeing in the Care Act altogether, while creating a raft of other social and economic problems.

Related to this, the report also contains another problematic (in my view) argument that appears to have become received wisdom, when it says a principle of policy should be to:

‘Reduce the disparity between entitlement to help in the National Health Service and the adult social care system, ensuring that entitlement is based on the level of need, not the diagnosis.’

This is misleading. Arbitrary and inconsistent though it may be, access to Continuing Healthcare is based neither on level of need or diagnosis, but on the nature of a persons need and whether they have an ongoing need for healthcare. Of course, if they do, then the totality of meeting the costs of their care transfer to the NHS and is free to them. But there are many people who require care and support who do not have ongoing healthcare needs. We should in my view support extending the same free at the point of need principle to social care, but arguing for parity of esteem with Continuing Healthcare as though comparing apples with apples further obscures crucial features of social care as embodied in the Care Act wellbeing principles and seems dangerously reductive.   The fact that our forthcoming research into media discourse on social care finds its recipients frequently referred to as ‘patients’ as in this recent article should give us reason to pause for thought about the impact of not distinguishing social care from healthcare in this way.

Only for those with substantial and critical needs

The proposals are also targeted only at those assessed as having substantial and critical needs, in line with the baseline eligibility threshold introduced in the Care Act.  This isn’t new of course and reflects what the majority of local councils already do.  But this generally means people have to reach crisis point before accessing free personal care, and presumably self-fund or go without up until that point. How does this support both the emphasis on prevention in the Care Act and the forthcoming Prevention Green Paper? Won’t this proposal further shift all resources – including for prevention and short term care – towards – to borrow the metaphor – placing more ambulances at the bottom of the cliff, rather than stopping people from falling over the cliff in the first place? Where is early action and invest-to-save in all of this thinking? Is focusing all public resources on personal care for people with substantial or critical needs, in the absence of wider investment, really the best use of public resources?

Make a crisis out of social care and get a crisis service

I know some will count today’s report as a success of the crisis narrative – as evidence that it has cut through. They are probably right. But as Julia Unwin has said of social housing ‘If you talk about housing in terms of desperation and need, then you can’t be surprised if it becomes an emergency service’. Likewise, if we frame policy as a response to a crisis, don’t be surprised if we just get a crisis response.

We should very much welcome the principle of free at the point of need care and support, paid for out of general taxation. Evidence shows that while the public struggles to understand what social care is, they express shared values of mutual obligation and the need to support others in society, which are foundational to any model of shared investment. Social care is in a mess and the debate on funding has gone and on. Today’s report does feel like a breakthrough, but it is set against a highly regressive vision of what social care should be and do in modern Britain.

Let’s treat the House of Lord’s report and others advocating free at the point of need care and support as valuable building blocks.  But let’s not lose sight of the vision of the future we want, where we can all: ‘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.”

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