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Social care faces tough times, but its transformation is still possible

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Every day, Ewan King’s colleagues gather news cuttings referencing issues affecting the social care sector and his organisation, the Social Care Institute for Excellence (SCIE). On Tuesday 13 December, they were more eye catching than usual…

Ewan King: 'The narrative is changing - there’s a will within society to do something about [social care].'
Ewan King, Director of Business Development and Delivery: 'The narrative is changing - there’s a will within society to do something about [social care].'
I nearly dropped my spoon in my cornflakes! Social care was national front page news – a sector facing very challenging times. I wondered if today’s cuttings would be seen as an important moment in time.

For years, people inside and outside government have been racking their brains about how to fund adult social care.

Most commentators acknowledge that huge efficiency gains have been made and that councils have reduced purchasing and operating costs significantly.

Commissions and enquiries have been conducted, all pointing to a divergence over the coming years between levels of demand, which keep rising, and levels of funding, which are falling.

And this does not even take into account the pressures on the NHS, which have negative ramifications for social care.

But now it seems as if the narrative is changing, whereby there’s a will within society to do something about it. Recently, we’ve had headlines such as ‘Council mulls referendum on 16 percent tax rise’ and ‘Ministers consider council tax rise to cover social care funding’. So maybe circumstances will improve?

Social care has waited before for circumstances to improve, only to be disappointed. So what to do? Firstly there are big issues coming over the hill, not least to do with Brexit; and our work on the social care workforce of the future looks to three different scenarios about how we can cope with the need for more workers at a time of potential political and economic challenge.

In the paper, amongst several proposals, we argue for service users to be more directly involved in recruitment and retention of workers so that we reach people with the right values, and show how rewarding care work can be.

Whatever happens with the funding for social care, what is absolutely certain is that we will need to think very differently about how services are delivered; we just can’t afford the current model and nor are the outcomes it produces necessarily good enough. We believe we need something akin to NHS England’s Five Year Forward View - but for social care. This is laid out in our paper on the total transformation of social care.

Working with Alex Fox, Chief Executive of Shared Lives, and Birmingham City Council, we asked the question: ‘What does a good life look like for people in this geographical area and what are we willing to do achieve it?’ Through engagement with national and local stakeholders, this question led us to identify five main areas where we needed to see care transformed.

These are:

  • Helping everyone to stay well, to stay connected and to stay strong;
  • supporting people who need help to carry on living at home;
  • enabling people to do enjoyable and meaningful things during the day;
  • developing new models of care for adults and older people who need support;
  • equipping people to regain independence following times in hospital.

From this starting point, we than used economic modelling to scale up good models of practice which showed that if we could do this, not only could significant amounts of money be saved, but outcomes could improve too. It’s a small piece of work, but we think it shows that real transformation can be possible.

The news on social care is rarely positive these days, but I do hope that this time next year, when I receive the cuttings from my colleagues, they talk about a sector that is truly being transformed.

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  1. Comment by Dr Jo Tulloch posted on

    Dear Ewan

    I'm interested in the idea put forward in your blog that home care service users could be involved in the selection of care staff so as to ensure people with the right values are recruited to these jobs.

    Having been a social and community worker for 50 years I'm always in favour of real user involvement. However, as manager of an established voluntary sector scheme to monitor users' experience of home care, I'm aware that roughly 80-85% are satisfied with the quality of their care. Their main complaints are about lack of consistency and punctuality, inaccessibility of supervisors, and unhelpfulness of office staff, i.e. the organisational systems and management, which they experience as significant stressors. So while care providers are exercised about the "bad apples" for a variety of reasons, these have rarely figured in our surveys.

    In local authorities' present financial situation, with rapidly rising need and a failing national care environment, commissioners are barely able to find enough private agencies to cover their statutory obligations, let alone impose high service standards on agencies' operation - a deplorable situation but one that even the best authority would currently find unavoidable.

    So while user participation is certainly worthwhile, it will not improve the management and market situation of home care agencies. Only large funding increases from central government can do that.

  2. Comment by Ellie posted on

    As one of the care service users mentioned above I view the issue from a different angle.

    The assumption that an agency should be used is antiquated thinking. Many care users are quite capable ( with minimum support) of recruiting and managing their own carers...aconcept which not only promotes independence but also puts the control into directly into the service users hands and eliminates the need for privately owned agencies to profit from running a service which is in many cases throughly inadequate.

    However, while recommended on paper it remains just that, a concept as many decision makers simply do not seriously factor this posibility into their thinking.

    The present system, Direct Payments, is a clumsy system which is designed from an autocratic, burocratic mindset.
    It is the only benefit which requires the user to justify how the benefit is spent...why do we treat the most vulnerable in this way? All other benefits (which eminate via DWP) do not impose this monitoring of spend. Is it because care funding eminates from local government rather than from DWP?
    Should we remove all aspects of care away from local government and ensure we treat vulnerable people in the same way other benefit claimed are treated?

    In my view we need to move away from assuming all care needs to be purchased via agencies and realign our thinking to encompass promoting independence for those living in their own homes.

    Please. Let's change the present mindset.
    It does not work

  3. Comment by John Hogan posted on

    I would like to say that I come from three interconnecting points of view. Firstly, I am a service user with a serious mental health diagnosis. Secondly, I am a qualified psychiatric nurse, and lastly I am currently a student studying for an MSC Leadership in health and social care. I am constantly reminded of the stigma associated with mental illness on a personal level.I also understand how difficult it is to navigate a system that is dysfunctional in offering services mainly due to the dislocation of resources available, and the consequences of poor communication. As a psychiatric nurse I have observed vast inequalities and discrimination of service users, and sadly, because of disjointed services many people end up either homeless or at worst, in serious danger of loss of life. I have come into leadership to hopefully make a difference to the plight of disadvantaged people. Recent governmental policy that advocates a renewed interest in involving service users in the development of services is wonderful.

  4. Comment by Susanna Thorndyke posted on

    Seems like funding will come from yet another increase in council tax
    this government yet again is penalising the most vulnerable who are most likely to to be on the receiving end of care services. as a student social worker with two adults in my household both working on low incomes we are just about struggling to get by. Our council tax is unaffordable
    unfortunately my student status does not make me exempt.

  5. Comment by Dan Midwinter posted on

    Funding has been the key issue for social care for many years now. I know providers would rather concentrate on quality of care rather than reducing costs.

    The increase in the living wage will make that issue far more difficult in the future.

    It seems there is money available for public works, large scale building development, new rail infrastructure, garden bridges and smart bombs.

    Maybe we need to prioritise our vulnerable people more highly as well now...

    Dan Midwinter
    Completely Care Ltd