Our response to 'People at the Heart of Care': the adult social care reform white paper
Reinventing Social Care
Review of ASC Reform White Paper
What we like
- At the top level, the articulation of the vision includes some positive objectives. Social Care should support people to have choice and control, and promote independence. Care provision should be of high quality and tailored to peoples’ needs and wants. Social Care should be fair and accessible.
- Many of the concepts promoted by the White Paper and the language used to describe them are a step in the right direction. Examples include the focus of independance, prevention, building on strengths and people achieving outcomes that matter to them.
- Integration and collaboration. The Social Care system is part of a wider system which supports people in our society in different ways. It is self-evident that the wider system should work in a joined-up and mutually-supportive way to deliver the excellent services seamlessly to people accessing them. The White Paper makes much of this.
- Focus on technology. The White Paper recognises the importance of technology in Social Care to support independence and save cost. It promotes the use of assistive technology at individual level, care management software at provider level and better use of data and information at system level. It sets up an ambitious digital transformation programme with a technology blueprint at its core.
- Promoting innovation. The White Paper promotes the development and sharing of innovative models of care.
- Professionalising the workforce. The White Paper recognises the need for the Social Care workforce to be valued for the professional work it does, and promotes several of the elements required to achieve this. These include training and development, qualifications and certification.
- Regulating and inspecting commissioning. Providers have long thought it inconsistent that provision should be regulated and inspected, but that other functions withing the wider Social Care system should not. After all, the quality of provision is a function of the wider system just as much as it is the endeavours of any particular provider. It is therefore logical that other functions are regulated and inspected too.
- Scale of ambition. Whilst the White Paper generally takes us in a positive direction, it is not bold or ambitious and will not dramatically impact the lives of people receiving care and support or those delivering it. We would like to see a much greater ambition to transform Social Care so that all people can live rich, progressive and purposeful lives with support from outstanding staff who are truly valued. It feels like a missed opportunity.
- No definition of the purpose, ethos or underlying principles of Social Care. This feels like a significant omission, because it is ethos and principles which underpin the entire social Care system. They represent a base, or point of reference, against which everything else should be measured.
- Not enough focus on people leading their services. The White Paper is titled ‘People at the Heart of Care’, but there is little of substance behind these words. We would like to see radical thinking about how people can choose, shape and influence their services, and how consumer sovereignty can be unleashed to drive quality into the care market.
- The structure stays the same. It is not evident that there has been any creative thinking about the structure of the Social Care system, so there are no recommendations for change. We would like consideration to be given to the need for an objective and independent entity at the heart of the system which safeguards the interest of people accessing services and counterbalances the interest-led behaviour of Local Authorities. Such an entity could bring objectivity to assessments, support people to make choices and arbitrate in the event of disputes.
- The funding gap is not addressed. It is widely acknowledged that Social Care is underfunded by several billion pounds. However, the bulk of new money specified in the White Paper goes to stop people spending their children’s inheritance, rather than benefitting those who deliver Social Care and wish to receive it. Staff will remain underpaid and undervalued, and people’s needs will remain unmet. We would like to see the required cash injected directly to benefit care and support staff and those people with unmet needs and wants.
- Immediate workforce issues are not given the required urgency. Social Care is in the midst of a workforce crisis, with vacancy rates escalating and services being scaled back. This is because funding constraints have forced wages to the floor and overseas supply channels have been cut. Radical and immediate solutions are required to increase Social Care pay and open recruitment from abroad.
- Working age adults are overlooked. A significant share of Social Care spending goes on working age adults, but they are largely overlooked. In particular, there is little about the vital need for an enablement strategy to upskill people with disabilities so that they can live full and purposeful lives in the community, and move from being a draw on the state to a contributor. The White Paper fails to recognise that the best Social Care is progressive in nature.
- Little focus on person-owned technology. At individual level, the White Paper highlights technology which primarily assists older people at home, such as smart alert systems. However, there is a little about how person-owned technology can enhance lives more broadly. This might be as simple as promoting the use of smartphones to using applications for social connectivity, information, personal development and entertainment, or using applications which support the definition and achievement of long-term aspirations.
- Residential and nursing care is not the end of the line. It is right and proper to support people to stay in their home whilst it is in their best interests to do so. For many people, however, residential and nursing care can provide a different but equally positive home environment in which a whole range of needs and wants can be met. Nursing homes also represent very good value when compared to hospital alternatives, and deliver a societal benefit by freeing up property to meet the housing needs of others.
- Nothing to win the hearts and minds of the public. Public support is a pre-requisite for Social Care to survive and prosper in the long term. People need to value services and aspire to work in them. The White Paper doesn’t do enough to excite.