Thoughts for the Department of Health and Social Care

Most debates about social care and its reform start from current systems and “services”. The main focus is on funding reform and beyond that most ambitions are about more of the same types of services with modest adaptions. These services are mostly of the transactional type with social care being seen as a destination that people head towards rather than one that supports them to live their lives. The debates are mostly very gloomy about anything beyond this being possible.

We think differently both about what “social care” should be for and what is possible. We share the view that more money is needed but we think it should be used differently and if it is, it can make social care both better and more sustainable. Our goal for disabled and older people and others who need some support, is for that support to help achieve an equal life. One where people can simply do what other people do and whatever age or stage of your life you can still have purpose and control and relationships. This vision should drive policy and practice.

We are gloomy sometimes too, but for different reasons. Most people are not currently supported by social care to have an equal life – many are denied this badly. But we also have hope, because we know, from what we have seen and sometimes experienced, that something much better is possible. For all the poor, limited ways of supporting people we have seen, we also have seen examples of it being done differently. So we know it can be better. The challenge is to understand why the best examples are not happening everywhere and do something about that.

We don’t think that this is all down to the DHSC or even central government, but there are definitely things that central govt can do to help local people make good change. Many of us were involved in different ways in helping develop the Care Act and we’re disappointed that the development of policy currently has not been inclusive or co-productive like that. We know you can’t sort that out in this hour and we can’t give you all our thoughts and ideas now but we do invite you from here to develop things more with us and the 000s of people we are connected to.

In our discussions for this meeting we came up with some big areas for you to consider and a few specific examples of things you might include in policy and implementation.

First a few things about the basics of how social care should be in terms of the relationship between managers, professionals, workers and us, the people that draw on social care or support family members

·??????Social care isn’t driven from a vision about the lives people should have – without that its hard to design something that will offer people what they need

·??????Relationships are like those between gatekeepers and people at the gate. Lack of trust, lack of belief we are the experts in ourselves, about deficits not our qualities, fighting not support, someone else’s idea of risk, not ours – The professional gift model

·??????Support is transactional and service based, too rigid and over specified with very little choice and control. The end point is seen as to be “in” somewhere or allocated something. Not to help us work out the things that are important and help us get them with support and resources flexibly used and directed by us. We are discriminated against through ableist or ageist ideas of us and some of us face multiple discrimination due for example to our ethnicity

·??????Most support comes after crisis and leads to very expensive service type responses when if it came earlier, often from non-statutory or service sources, it could reduce or delay crisis and lead to better, cost-effective results. Really important here are good information and advice, advocacy and peer support – often best via “user led organisations”.

·??????Commissioning, the way big decisions are made and implemented about how resources get used, excludes us and hence often bad decisions are made about what we need and how our needs should be met

What can be done? A few practical ideas

·??????DHSC action to help councils deliver the Care Act and especially the parts about wellbeing and self-directed support. Set out a vision like the SCF vision which starts from what is important to people and can be used as a test

·??????Use the leverage of the proposal for CQC to assure commissioning – make sure this is designed in co-production, starts from what is important to people, involves local people in judgements, is not monitored just via numbers (use Making it Real I statements). See Commissioning for a better future: A starter for ten (scie.org.uk) Making it Real - Think Local Act Personal

·??????Set expectations around self-directed support (Personal Budgets/Direct Payments) that require use of the best practice seen in a minority of councils around, for example, support to use DPs, maximising flexible use and reducing unnecessary rules and audit. See Direct payments.indd (thinklocalactpersonal.org.uk)

·??????Provide (probably targeted at first) funding for “prevention” and ensure it is used to fund some of the great existing approaches (often non-service/statutory) and use best implementation examples. Ensure some ￡ targeted at information, peer support and advocacy

·??????Help councils and their staff to make change in key areas. Don’t underestimate how “hollowed out” council capacity for development has become and how far backwards progressive practice has drifted in most places. Help is needed in a range of areas including co-commissioning; use and spread of innovation; professional practice and culture change, action on equalities issues removal of key barriers (e.gs, restrictive procurement approaches, risk aversive policy/bureacracy), elected member development. Need to look at approaches to “improvement and development” across the sector that supports these shifts – including co-produced development approaches and delivery including people who draw on social care. See

·??????Provide independent funding for evidence-based innovation to spread itself and to grow the evidence base around earlier stage promising approaches. A “New Models” fund – allocated in co-production with people who draw on social care and communities

·??????Assist the development of workforce and regulatory approaches that support the vision – rather than simply project forward from existing models. Avoid over-regulation, unhelpful registration of parts of the flexible “workforce” that is needed

See:

From permanent lockdown to an equal life (socialcarefuture.blog)

Martin Routledge, Social Care Future | Local Government Association

A long-term framework to transform social care? (socialcarefuture.blog)

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