Social care reform: time to re-focus on what people want from care services
By: Deborah Alsina, Chief Executive, Independent Age
2020 is a year in which social care has flown up the political, media and public agenda. Few of us can remember a time when issues in this sector were such a constant feature of daily headlines and news bulletins.
This has had some important consequences. The vital, highly skilled work of professional social care workers has been more widely recognised than ever before. The domiciliary care sector may still lack the attention it deserves, but the many challenges in the care home sector are now certainly better understood. There’s also a greater appreciation of the gulf between the ways our health and care systems operate and the challenges that lack of parity brings.
With social care firmly in the spotlight, many of us feel there is reason to be cautiously optimistic that we will finally see some action on reform of social care in 2021. But there are still unanswered questions about what this agenda will look like. Will it stick closely to the Prime Minister’s standard playbook of protecting people from selling their homes? Or will it go beyond this and seriously engage with the whole range of social care issues?
One of the problems with the way social care has played out over the last decade is that political considerations have taken centre stage. The seemingly never-ending sequence of announcements, delays, U turns and so on become a sort of drama where it is easy to get caught up in speculating about the next installment in the story and lose sight of the basic but crucial question: what people want and rightly expect from social care.
It’s helpful I think to take a step back and reflect on what people tell us is important to them. Here are just a few of the common themes we hear in the course of our work with people in later life at Independent Age:
People want a clearer understanding of their entitlements and costs the they might face
It often comes as a shock to people to discover that they are liable for very high levels of social care costs. Many assume the state plays a much greater role, similar to the model of services free at the point of use in the NHS. With no limit on individual liabilities, it is incredibly hard for people to plan ahead and care choices become a topic no-one wants to think about until it becomes unavoidable. Reform must tackle this by pooling risk of high costs and establishing a clear set of universal entitlements that people easily understand.
People want a genuine sense of choice in the care they receive
While the Care Act made great strides in terms of bringing choice and personalisation to the fore, too often it is still the case that people feel like they are having to fit their lives around services rather than care services being designed to fit around them. One of our campaigners told us that her husband’s carers could turn up anytime between 3pm and 10pm to put him to bed. As she put it, ‘you can’t even have a life because they can come at any time’. A sustainable funding settlement, putting an end to decades of cuts, would give the opportunity for the Care Act to finally move from aspiration to reality.
People want to experience care as a relationship not a transaction
It’s so important that people have the opportunity to get to know and trust the people caring for them. But this is undermined if carers change so frequently they feel like strangers. Most people are realistic about the fact that they will receive care from a number of different people. But poor retention and high churn, along with the use of agencies, can make it impossible to feel like there is any chance to build up a relationship at all. One family carer based in Scotland told us: “during one period of 14 days recently we had 16 different carers. My partner has PTSD and gets very anxious about who is coming to give him personal care”. If there is to be any chance of people receiving better continuity of care, reform must tackle systemic issues with the social care workforce so that is can both attract, and crucially retain, people with great skills.
Of course, we cannot be naïve: tactical thinking about how we negotiate the politics of reform will always be necessary. But social care is more than a political headache to solve. It is about how people can be supported to live the lives they want to live. As we move into this next phase of reform – one that we all hope will be more decisive – let’s keep its real purpose, and the changes it could mean for people, right at the centre.
Deborah will be chairing a session titled “Who cares? Fixing social care for today’s and tomorrow’s old” with Sir Andrew Dilnot (Warden, Nuffield College, Oxford) and James Bullion (President, ADASS) at this year’s Future of Ageing conference.
Find out more about Future of Ageing 2020 and register on our conference website.
Deborah Alsina MBE
Chief Executive, Independent Age
Deborah Alsina MBE joined Independent Age as Chief Executive in October 2019 and brings extensive experience of voluntary sector strategic leadership. Deborah began her career in publishing and has subsequently worked in the voluntary sector for over 25 years. She has worked with a broad range of organisations from academic think tanks to charities working on international refugee and human rights issues.
Prior to joining Independent Age, Deborah worked for Bowel Cancer UK for eleven years, including ten as the Chief Executive. In 2017, Deborah played a leading role in merging Bowel Cancer UK and Beating Bowel Cancer, becoming Chief Executive of the new merged charity on the 1st January 2018.
She was awarded an MBE in the Queen’s 90th Birthday Honours list 2016 in recognition of her service to bowel cancer patients. She was named Charity Chief Executive of the Year at the Third Sector Excellence Awards 2017,Charity Principal of the Year in the Charity Times Awards 2018, and one of the 25 most influential leaders in the voluntary sector by the Charity Times in 2019.