If we build back local, we can put people at the heart of a new, reformed approach to social care.
COVID-19 highlighted just how essential adult social care is in supporting people to be as independent as possible.
While the Government has acknowledged the value of social care and praised its workforce, it has yet to publish its proposals for the future funding and reform of care and support.
The issues facing social care – particularly the scale of funding pressures – are just as pressing now as they were before COVID-19, with many having been exacerbated by the pandemic.
While funding challenges do need to be addressed urgently, at its heart, social care is first and foremost about human relationships.
It is impossible to support someone to live the life they want to lead if you do not understand what gives that person’s life meaning (see case studies below).
‘Doing with’ rather than ‘doing to’ is, therefore, a prerequisite for an approach to social care that is rooted in putting people first and understanding what matters to them. This is about genuine co-production and supporting people as early as possible to prevent, reduce or delay the development of higher-level needs.
As the Government develops its proposals for the future of care and support, it should ensure its accompanying vision reflects this.
We also need to put ‘local’ at the heart of social care reforms. Councils are best placed to convene partnerships to bring together health and care services in a locally focused and democratically led way.
Government should work with councils and their many partners as equals in helping to build resilient communities that are geared towards prevention, wellbeing and public health.
We also need help to enable local areas to retain the positive changes they made at the height of the pandemic and build on what we know works, such as prevention, reablement, technology, and more person-centred care and support.
We believe the future reform of social care and support needs to start with the most urgent priorities: sustainable long-term funding; more funding to tackle unmet need; a person-centred approach; a new deal for the care workforce; and strong relationships with the NHS and other partners.
We recognise the value of preventing people from suffering catastrophic care costs and welcome the commitment to tackle this problem. But plans to introduce these funding reforms must also embrace the challenges above if social care is really to fulfil its potential.
‘A life with meaning’
Isaac Samuels lives with mental and physical health challenges, and is Co-Chair of the National Co-production Advisory Group. They receive a direct payment, and self-direct their own care and support from their home.
“I’m really passionate about social care because it’s made a massive difference in my life, but it’s been a mixed experience – more negative than positive.
“Often, I feel like people don’t really want to listen to me and want to provide solutions that don’t make sense. I believe that people should always be included in any decision-making, because, ultimately – as a person with disabilities – I know what’s best for me and what’s important to me.
“It’s about a good life, not a service. It’s about being connected to people who are important to me, and being able to work, to connect with my local community, stay safe and well, and have good information advice and guidance.
“It’s a bit of a challenge all the time; your social care is forever changing and, often, I’m excluded from conversations that are about me. That makes me feel powerless; it has affected my self-esteem – it’s affected my whole care.
“People have a lot of skills and they’re able to do a lot of things by themselves. If you work with an individual to identify what they can do and what support they need, they don’t become dependent on social care – they use social care to do the things that make sense, and a bit of support goes a long way.
“So, I think good social care is where every single person who has care and support needs is able to live a life with meaning – and that will be different for different groups.
“Everybody should be able to live in a place they call home, and feel they’re doing the things that are important to them, including maintaining family and social connections.
“It is really important, going forward, that we try to address and minimise the inequalities resulting from COVID-19.
“Regardless of your particular characteristics – you might be someone with a learning disability, or from a black or minority ethnic background – you have the right to the same care and support, and to the same opportunities to live a good ordinary life.
“If we have social care that’s responsive, supportive and, ultimately, compassionate, I think we will have a good society, where people with disabilities are fully included, and we are able to live independently, or interdependently, and be part of our communities.”
‘Passionate about social care reform’
Sally Percival is Co-Chair of the National Co-production Advisory Group and of the All-Party Parliamentary Group for Adult Social Care’s Working Group. She lives in Cumbria and cares for her son Alex, who has a learning disability and autism, and for her step-daughter Hannah, who has a profound learning disability and autism.
“Some bits of the care system have been great, but when my son was given a service and they tried to fit him in a box that didn’t say ‘Alex’, it worked really badly.
“Once we started managing our own social care budget with a direct payment, it was transformative. Alex went from being a bored, lonely, angry person to having a much more fulfilled life.
“His whole life is World War II enactments – it puts a smile on his face. With a personalised budget, we were able to employ people from the re-enacting community, which was where I found two carers, so they immediately had that connection with him.
“I feel passionately about adult social care reform because it affects everybody at some point. I have seen so much money wasted, and yet social care is so badly funded. With reform, that funding could be better used to serve people and give them better lives, and that’s what it’s about.
“It’s about making sure disabled people, carers, and people who just need that extra bit of support have the best life they can have, and the opportunities everyone else has.
“The only way reform can happen is by working with people. Co-designing the system is the only way that it will be done right. For me, good social care is all about the person who’s being supported – about bringing back that absolute ethos of choice and control, rather than being very prescriptive about how social care funding is used.
“It’s about giving people a menu they can choose from. I would like to see a blossoming of micro-providers or bespoke providers, so you do have choice of how to spend your budget.
“It’s also about commissioning properly. So many commissioned services work for the provider, not for the people accessing them.”