Current Issues & Problems

Tier 1 – Government

Tasked with the setting of policy, funding from general tax and regulatory framework assessments via quango’s (such as the CQC) the current government remit is vast and overarching, covering many departments. Social Care does not sit isolated in one department but is heavily affected by others such as Department for Work and Pensions, Department for Levelling Up, Housing and Communities and the Department for Work and Pensions. This level of fragmentation demands co-ordination to deliver on policy – surely a a recipe for disaster.

Whilst there may be some agreement that the ‘making’ of legislation (whether the content is agreed or not!) and its processes are satisfactory overall, the collaboration, communication and implementation of legislation is, at times, beyond comprehension. Legislative guidance is also unhelpful as it leaves ‘grey’ areas which are challenging to implement.

The legislative and regulatory frameworks which interface with Local Authorities simply do not work and there is a gap (and disconnect) here.

There is also concern around the way the government consults with stakeholders and the public.  How is this embraced to capture the unification of voice – or is it closed to challenge?

Tier 2 – Local Authorities (LAs)

Nationally, the form of LAs varies – some being unitary and others having two tiers.  A collective push-pull system at County Council level is common. Fragmentation is a big problem.

Tasked with a statutory responsibility of the delivery of social care, LAs are not inspected by CQC and are therefore never scrutinised or criticised.

Consultation with the delivery of the care is often lacking in external engagement and too often, the tendering and procurement processes are used to block the path to success.

There is often a reluctance to engage fully. To truly engage and understand the pressures of the people they serve invariably would lead to additional drains on already stretched budgets. The inability to raise funds to cover this leads to the conflict.

A cultural narrative from the outset prevails. Historically, LAs sought places only in residential settings. A lack of team culture prevails today which is mirroring this. A move away from intervention and prevention due to a lack of quantifiable measurements and austerity has led to increases in the eligibility criteria.

How can we reconcile the conflicted role of the Local Authority which has a statutory duty to serve its population but little freedom to raise taxes?

Structure Circles

What happens between legislation and policy making processes? At Tier 1, Ministers and civil servants shape the policy making process. The way this works will vary depending upon the party, the Minister, the environment, the timing of events and so on.  Policy constantly evolves, with each new administration keen to implement its policy objectives. This leads to a reinventing of the wheel and further disconnect with the other tiers (examples include the CCGs and ICSs).

Historically, LAs were tasked with inspection of providers. Whilst this process lacked a national framework and there were some quality issues, the connectivity between the LA and service providers was inevitably far greater than with CQC inspection today. LAs were able to understand locality and what was happening in the local sector to feed back to Tier 1.  Today this is fragmented.

A great failing of the Social Care system is the lack of system-level decision-making.  No-one has an holistic, overarching view.  People make decisions in their box, or silo, without understanding the impact elsewhere.

Why does housing sit in a different place to management of care and support, when environment is central a holistic support solution? Why are key decisions about workers coming from overseas made in the Home Office in tier one without reference to the impact on service delivery and organisational viability in tier four?

Providers

It can be argued that providers are the most important element of the Social Care structure since it it here that the overall structure interfaces with the person accessing the service.

It can also be argued that it is her that the continuity and system knowledge sits.  Whilst governments, councils, civil servants and officers come and go, providers remain, often for decades, sometimes for generations.

Yet providers are rarely treated as equals in the system.  Their experience and knowledge is seldom sought or applied in change processes.  They are often the first point of blame when something goes wrong.  The provider’s lot is not a happy one.

People accessing services

We are describing the structure of Social Care in terms of tiers, but should we even be talking about tiers at all?  This suggests a structure which places the recipient of the service is at the bottom of the food chain.  

As with providers, the voice of people accessing services is often unheard.  What people want and need form Social Care is often assumed without reference or consultation.  And as we explore elsewhere, people are often disenfranchised and objectified by Social Care – it is something done to to people, not driven by them.