Quality of life aspirations

We all know what the NHS does, but ask a hundred people what Social Care does and you will get a hundred different answers, many of which will be wide of the mark.   But without a common view of what Social Care is all about, how can we expect our society to value or prioritise it?  Our starting point must be to articulate and agree the purpose of Social Care.

This purpose should surely be expressed in terms of what it supports those in receipt of care and support services to achieve.  But those we serve are a broad church, from young to old, with all sorts of needs, wants and aspirations, so whilst some outcomes are universal, others will specific to the individual.  In general, though, it seems reasonable to differentiate between Social Care for working age adults and older people.  The former might aspire to achieve a good quality of life through progression and development, whilst the latter might see enduring quality of life as most important.

After much discussion and word-smithing we conclude that the purpose of Social Care is:

1. Enabling all people to enjoy rich, purposeful and happy lives.
2. Enabling working-age adults to develop skills, progress positively through life, achieve long term aspirations and live more independently.
3. Providing dignified care to enable older people to maintain capabilities, prolong independence, preserve individuality and build quality of life in the place they want to call home.

Our definitions might not suit all, but let us work together to achieve a common view.  Without this, we are lost before we start.

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Valuing Social Care

Social Care will only ever receive the support it needs if it is held in high esteem by the public and those charged with developing and delivering policy. The current position appears to be mixed. Many people still see Social Care as a simplistic sector doing basic, unskilled work. Others have a more positive view based on the selfless commitment shown by our staff through the pandemic. But even where viewed positively, this does not necessarily translate to a desire to fund appropriately.

Social Care can only have a bright future if it is valued both by the public and policy-makers as a vital and important part of the fabric of our society. But do people really have an understanding of the value of Social Care beyond a vague notion? Probably not.

We would like to see the value of Social Care defined and articulated clearly, and understood by all. This starts with the value generated by supporting people to transform their lives, and extends to the value which the sector contributes to our wider society, financial and otherwise.

But it requires more than just articulating and understand value – it requires people to internalise, embrace and prioritise Social Care based on that understanding. It requires an aspiration to see Social Care as important, a measure of the quality of our society as whole.

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People who access Social Care services struggle to find solutions in a self-serving system which they often feel is stacked against them. This is because they have no power. We propose a structural change to introduce a new rights-based entity at the heart of the system (an Independence Board, perhaps) which will uphold people’s rights and give them the control and ownership of care and support processes that they rightly should have. Activities could include conducting independent assessments, supporting choice of service, assisting with care planning and review processes, advocacy and arbitration.

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Enhanced market-shaping and commissioning

Social Care is a dysfunctional market in which demand does not shape supply, so market intervention is essential to promote the development of services which meet people’s needs, wants and aspirations. Market-shaping, itself shaped by the views of the new Independence Board, must become reality rather than the myth, whilst Commissioning needs to up its game to implement innovative practices which incentivise best practice, quality, progression and positive outcomes.

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Reform of Social Care changes the roles of those working in it. Gone is the old medical model in which people were fed, watered, medicated and cleaned. New, emerging models are more progressive and holistic, focusing on social, psychological, developmental and self-actualisation needs and wants as well as medical wellbeing. Staff roles are becoming more complex, with the range of skills and attributes required increasing too.

The redefinition of the role should be accompanied by re-naming to align with what people actually do. Stephen Hawking called his carers Care Technicians. We like this, and Care Practitioner, too.

If society values Social Care, then it follows that it will wish to value to the people who deliver it for the skilled and challenging role they perform. We would like to see this value reflected in the implementation of a National Minimum Care Wage £2-3/hour higher than NLW. This would be fair reward for our staff.

We also support accreditation of the Care Technician/Practitioner role. We see this a mark of recognition which will drive professionalism.

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In comparison to the NHS, the Social Care sector’s investment in training and developing our staff is woeful. Yet training and development is vital both to drive quality of service and as a marker of the value we place in the role and the people doing it. We need a radical shift in our approach.

The emergence of a redefined role should be accompanied by a new and valued qualification. This will both support the development of skills and reflect the value our society is attaching to the role.

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Reforming Social Care will require a significant injection of funding at the outset, but this requirement will diminish as new models and innovation support people to live more independently.

In the past, funding has been limited from the top down, so eligibility criteria have increased, and real-term wages have been driven to the floor. It has been a painful dynamic. But in Social Care, our people are everything. If the sector is to be sustainable then funding must be zero-based, set at levels at which people can be paid above the National Minimum Care Wage. This will enable providers to attract and retain valued staff.

Funding must also promote Social Care to be innovative and progressive, so must allow organisations to continue to invest in quality and development.

This is particularly important here and now, as the White Paper requires Councils to define the cost of care. This must be a cost which is sustainable in the long term, not a cost based on current services driven to pay the National Living Wage.

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Social Care cannot be static. We cannot continue to do things in the future as we have in the past.

As a sector we must continue to innovate. We should, for example, develop new models to support working age adults to progress to live more independently, and we should support older people to maintain their functionality so that they can build quality of life as they age, not give up on it. We should be bold and ambitious, building on advances in technology.

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Social Care for people with disabilities and other working age adults has been hamstrung by a medical model which has prevented them living like everyone else. People are severely disadvantaged in all walks of life.

There is a need for a landmark programme to close the gap. People need encouragement to articulate their aspiration and ambitions, support to develop the requisite skills and capabilities, and pathways along which they can progress. It will require a change of social policy too, for example by encouraging and incentivising employment. This will provide a big win for all – for people who live better lives, for staff who become teachers and enablers, and society, as people need less support.

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Social Care is distinct from the NHS and other agencies in its breadth, giving care and support in all areas of life at all stages in life. And the care and support it provides is so much more than medical. It makes sense for Social Care to remain independent.

But the services provided by Social Care alongside other agencies should be seamless and efficient, driven by exemplary collaboration.

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