The Care Act may not be perfect, but it was widely heralded as an important step forward for social care and more importantly for disabled and older people, including myself, who draw on some form of care and support to live our lives.
The Act put duties on councils to ‘promote an individual’s wellbeing’, to reduce or delay the need for future support (often called prevention), to provide information and advice and a provision for unpaid carers.
As the Social Care Future movement vision says, “We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us”. There are many aspects of our lives that contribute to our well-being, and these will look different to everyone, but it felt hopeful that well-being was named in the Act.
However, it is widely recognised that the Care Act has not been fully enacted.
I hear often from people who draw on support and their families, about the fear, fight and challenges they face to get the right support.
Indeed, the House of Lords Adult Social Care Select Committee in 2022 stated in their report, ‘Gloriously Ordinary Lives’, “The tragedy of the situation facing adult social care is that the right prescription for many changes have been nearly to hand for eight years in the shape of the Care Act 2014.” I am sure others will look at why this has failed, but I want to look instead at how we can change things moving forward.
Currently people must wait until things get so bad, often a crisis, that they meet the high threshold for support. This is the opposite of the prevention that the Care Act aspired to, and while distressing for the person is also counter-productive to the wider system. We need to shift money away from responding to crises and move it to places and activities that promote health and wellbeing. This may include community groups, VCSE organisations, community centres along with models such as Local Area Coordination and Circles of Support. Of course some people will still need care but a thriving community that mutually supports each other will often delay or reduce the need for more formal support.
For this to work there needs to be a shift in commissioning, away from lowest cost tendering of block services, focussed on the number of tasks done, to commissioning for outcomes. Local people should be involved in the commissioning decisions because they know best what their community needs. They also know what is already happening; don’t start a new service but support what is already there.
But when someone does need some more support, we need to get back to the heart of self-directed support. The Care Act talks about, “the importance of beginning with the assumption that the individual is best-placed to judge the individual’s well-being” and that this should be based on the individual’s views, wishes, feelings and beliefs.
Instead of assessments focussing on people’s challenges and care needs, the conversation should start with the outcomes the person wants.
This could be long term aims like getting a job or more immediate like being able to get out with their dog again. Support can then be shaped to enable these outcomes in the way that works for the person. Like I often say, in my 20s I was fed, clean and watered, but utterly miserable as I wasn’t living a life.
We need easier and better ways for people to be able to have choice and control over their support. This may be via a personal budget but not always. People often know what will work best, so we need to work with them, allowing flexibility and creativity. Currently lots of money is wasted on expensive services that people don’t really want. For example, I used my direct payment to purchase a supermarket delivery pass, saving 2 hours with a PA to drive me to the shop, do the shopping, get home and put the shopping away, much cheaper but until recently was not allowed.
To enable the changes above, both in communities and for individuals, will require a culture change. We still have a system where those working in it are seen as the professionals (and by implication experts) and they hold the power. Instead, power should be shared, trusting people and families as the experts in their own lives. We also need to co-production at all levels of the system, national and local, so that services are designed in ways that work for people and communities.
I deliberately haven’t mentioned until now the need for more funding. Of course, social care needs more sustainable, long-term funding that recognises the needs of our changing demographics. However, if we use the extra money to buy more of the same services we do now, the aspirations of the Care Act will never be achieved.
Finally, we must tell a better story about social care, so the public better understand and value it, and to get wider political support. People don’t currently value social care or want to work in it because it is relatively hidden or only represented as a broken, failing system. But a sector that enables everyone to be a part of society, employs more people than the NHS and will be there for us or our family is a much more attractive prospect for people to support.
So, I have to keep hope, that by working together, over the next 10 years we will make progress and more people will be able to live the gloriously, ordinary life.
