London Catalyst’s Director, Victor Willmott, writes about our 2017 AGM on the topical theme of social care…
At the recent London Catalyst Annual General Meeting on the 6th July, representatives of London’s voluntary and community sector gathered with our members and trustees to hear from Holly Holder, Fellow in Health Policy at the Nuffield Trust. Holly offered an authoritative review of what the future might hold for users, carers and providers. There were also reports from the ground up by Simona Florio, co-ordinator of the Healthy Living Club a dementia-centred community project and Emily Clarke, Head of Development at South London Cares and North London Cares, a network of young professionals and older neighbours.
Social care – the oxymoron of our time
‘Social care’ is the oxymoron of our time. A term commonly used, but one that yokes together the mutually antagonistic concept of policy with the reality of provision. It means different things to carers, providers, residential homes, the NHS, the cared for and the uncared.
Defining it as ‘the provision of care and support to enable people to live full and independent lives’ echoes the painting of the proverbial rail bridge, by the time we finish the description, to appreciate what it entails, we must begin again.
Commanding insights from Holly Holder
Holly provided a commanding view from the bridge (opens PDF of her presentation) pointing out who organises and pays for social care and the current state of play. The money going into social care has reduced and there is less public provision as eligibility is restricted. Inevitably, more of the share of caring has fallen on unpaid carers and those with no care for whom the path leads, eventually, to the door of the NHS.
Holly highlighted the growing inequality in care provision as availability and choice is largely determined by where you live. Private care providers are identifying these growth markets and investing in the areas where people can pay. Alternatively many local authority funded providers struggle, suffering difficulties of recruitment and retention, low pay and, despite a committed workforce, lacking a full capacity for innovation and quality assurance.
Local authorities prioritise within a declining market and the first things to go are preventative services. There is little scope for increasing contract fee levels and re-tendering contracts force many voluntary sector providers to reduce services or leave the market altogether. This in effect reduces the availability of suitable local provision and choice, resulting in an increase in the rate of delayed transfer of care between NHS and social care providers. This creates cost and service pressures elsewhere in the care system, leaves need unmet and ratchets up the pressure on carers and voluntary services.
A desolate panorama unfolds although there are glimpses of nocturnal hope. It would require £2.4bn to get back to the pre-austerity levels of social care funding and extra funding has been announced – although it is unclear if and how this will fill the gap and, fundamentally, what kind of provision we can expect and how it will be paid for.
Will it be a fully tax-funded public sector provision, free at the point of need – unlikely – or a ‘save and insure’ system transparent in its cost and benefits? Or elements of both? Many people believe social care is akin to the NHS and the state will step in and support us when we need it – which is not the case. Whatever the funding mechanism, we must be clear about what it is and what to expect.
Holly challenged us all to further the debate. We should understand what social care means and not let the debate be lost behind political posturing and the vacuity of slogans such as a ‘death tax’; two things of which we can be absolutely certain.
It was noted that some local authorities are now looking at an asset-based approach to care which includes all our personal, financial, family and community resources. This will bring a radical review of what is involved, by whom and how it’s delivered.
Despite funding constraints and political meddling, positive change is happening, as resources are pooled and walls come down between services (e.g. integration with local NHS hospitals of domiciliary and residential services). Working together we care better.
“Respecting the wishes of the individual”
For the members of the Healthy Living Club, a unique dementia-centered community in Lambeth, South London (opens PDF), it’s all about creating a community that lives well with dementia and that offers respite from being ‘cared for’ to the benefit of all. North and South London Cares (opens PDF) adopt a preventive approach, building a neighbourhood network of young and old to bridge divides, thereby mobilising people to challenge social isolation. The prevailing ethos of both organisations is that whatever the question, listening to and respecting the wishes of the individual is the start of the solution.
This in theory is what should underpin social care policy. People, we are told, are at the centre of the process. In practice control often lies elsewhere. Choice is limited and elusive and for many the hierarchy of entitlement proves insurmountable. There is much to be done before we can begin to reduce the inequalities in social care.
Wave a magic wand
At the end of the presentations, we took up Holly’s suggestion and asked our audience to begin a discussion and respond to a simple question:
‘If you could wave a magic wand and transform social care provision in your neighbourhood, what would you change?’
And this is what we were told:
‘Local resources including buildings and expertise would be willingly shared. Local care providers to share under used space with community groups’
‘There would be clear and unambiguous pathways of care and support’
‘All care workers and carers would have an increased income. Employed staff would have full terms of employment, career development training options, terms of employment, choice and a proper salary above the LLW, possibly with LLW + social care precept. This would be recognised in all care contracts as a minimum income guarantee to staff’
‘We would have more and better conversations about social care from the ground up rather than just an application of policy. Perhaps holding listening events in community venues supermarkets, schools, places of worship’
‘There would be more care and more time available for that care to be more than a brief intervention’
‘Availability and access to supported housing for people with mental ill-health’
‘An integrated budget would ensure a seamless continuum of support for care and carers across the NHS, LA, social care providers and community groups’
‘There would be a local neighbourhood social care action group even if it was just on WhatsApp’
‘There would be a commitment to support local academic research and data collection’
‘Day centres would not be seen as warehouses but as attractive solutions offering choice, independence, and purposeful and evolving activities’
‘We would have a range of community services with health specialists/isms such as SLT for stroke survivors’
‘Best practice would be standard and shared through local networks’
‘The impact of changes to social welfare provision and growing inequalities would be recognised as major factors in the increase demand for social care’
‘There would be a removal of the implicit and artificial segregation and stigma between healthcare and social care’
‘There would be a social worker routinely available in your local GP surgery and A & E’
‘The politics of social care would be removed and people would come together regularly to seek improvements in how best to work across services and with each other’
‘The role of volunteers would be fully supported and seen as integral to social care support and include supported volunteers, people that have dementia but are happy to see themselves as volunteers and attend events , but may require help’
‘There would be a no unpaid or unrecognised carers and respite would be freely available’
‘Funding on healthcare use for community projects and the voluntary sector would be ring fenced, benchmarked and long term, reporting would be minimal and proactively increase to meet demand’
‘Information on and seed funding for social support projects would be readily available’
‘Social services would develop with the community sector the skill to help carers feel they belong’
‘A simple, flexible, improved social prescribing process with GPs and there would be long term funding for this to ensure continuity and create confidence for people to access new events/activities’
‘It would be easier to identify the right people, build trust and networks within and across the communities where people live and the respective cultures’
‘People embedded in these communities enabled to be entrepreneurs taking risks/proven model’
‘Social care would be returned to the local authority as a public service and there would be a full integration of health and social care’
‘We would enable local people to identify own needs adopting a whole community approach and be clear about what a healthy community looks like’
‘Community organisers would champion engagement and help people to operate outside the respective service silos’
‘There would be more people able to deliver face-to-face social care provision’
‘Better clarity for which organisation or person is responsible for different areas of support’
‘Shorter waiting times for referrals’
‘There’s a need for more joined up thinking, more investment in “cultural care” as that helps to maintain or even improve mental and physical health potentially leading to reduced pressure on health and social care’
‘Carers are treated as co experts with professionals’
Thank you to the facilitators who led the discussions, and to everyone for coming. See you next year!