The Care Act was a landmark moment for adult social care, embedding the principles of empowerment, prevention, proportionality, protection, partnership and accountability.
In 2014, I was still a Director of Adult Social Services (and Children’s Services!). I was optimistic about the potential of the Act to improve the lives of people who need care and support. I was also living the experience, organising care for my increasingly frail mum with dementia.
Despite worries about funding, I felt optimistic that we were making strides in helping people who needed care to live as independently and good a life as possible. We were supporting people to do things for themselves and choosing and organising their own care through Direct Payments. We were also increasingly aware of the need to safeguard rights and wellbeing.
So, ten years on, how do I feel? First, the positives. I genuinely believe that these principles are now fully embedded in the sector.
No one would think about care without thinking about maximising independence, looking at broader wellbeing issues, and balancing capacity to make decisions to take risks while ensuring safety.
Here in Barnsley, we’re proud of our Better Lives Programme that is built upon the principles of home first, wellbeing and co-production. We optimise our shared resource across health, local government, and communities, supporting more people to remain independent and sustain family caring while keeping costs relatively steady.
The biggest caveat to this optimism is the funding position. In 2014, 43 per cent of Barnsley’s Council’s budget was spent on adults and children’s services, now it’s 56 per cent. The explosion in costs has been in children’s social care rather than adults, but this will have knock-on effects in the future.
The local government financial system is broken, with short term one-year financial settlements for the last five years and the current government real terms spending reductions over the next five years.
Back in 2014, we were all preoccupied with ‘the graph of doom’ where more and more our funding was required to fund social care services, and unfortunately that’s what has happened. Adult social care needs more financial investment, particularly to address workforce challenges. It’s disappointing that we’re yet to see a comprehensive, long term national workforce and skills plan for adult social care. A skilled, properly rewarded and valued workforce is critical to properly delivering the ambitions of the Care Act. Yet frequently these roles are insecure and low paid.
Here in Barnsley, we’ve established a Proud to Care hub with the Prince’s Trust and Barnsley College and worked with providers to try to ensure they always pay at least £1 an hour above the national living wage. However, only funding and career pathways that provides parity with NHS roles will really make the difference we require.
We need to do more to establish in the public and politician’s minds the importance of adult social care in its own right.
Care is still too often seen as adjunct to the NHS, there to facilitate hospital discharge rather than as a sector that looks after the most vulnerable, maintains independence and supports adults to lead the fullest life they can.
Sometimes in local government we’ve had to collude with this as the only way to secure additional funding, but that hasn’t really helped us in the long term in promoting a rounded picture of what adult social contributes and needs.
An over focus on discharge has led to poor outcomes for people too, with some moving straight to high cost 24/7 care rather than being supported to regain independence and normalcy in their lives at home.
The question of who pays for care also remains unanswered. It needs to be resolved but not at the expense of funding care for people who cannot pay.
I’m also ashamed to say that there are still dark corners where the Care Act principles are not being lived. How can it be that 13 years on from the Winterbourne View scandal we still find examples of completely unacceptable treatment and care of adults with a complex learning disability? We’ve done a lot to improve the support for adults with learning disabilities in Barnsley in terms of employment, housing and support but it’s only in joining up our endeavours with our NHS partners that we can truly make sure that people are supported at the right time, in the right place and prevent admission to acute services that are both costly and at times poor quality. While the Care Act lays out local government’s duties to shape the market, financial arrangements do not always facilitate a collaborative approach.
Stepping outside of direct care support, there’s more work to do in other areas too. More co-production and real-time engagement with people with lived experience is needed and I’m still not sure we’ve got the conversation right with carers. Many people don’t see themselves as carers, desperately struggling to balance work, family and caring.
This impacts on high levels of economic inactivity where people who want to work, can’t. It’s something that we’re acutely aware of and we’re pleased to be working with our South Yorkshire partners to develop easier ways that people can access advice and support to help them with their caring role, and also back into employment if they want to.
There’s also an opportunity to see housing as key to social care reform, with a focus on reducing reliance on residential and nursing care and providing better-supported housing for younger adults with complexity in their lives. Being able to maximise access to capital across both local government and the NHS is critical if we’re able to deliver on shared ambitions for independent living.
Ten years on my reflection is that while the Care Act was a cornerstone to a brighter future it was only a down payment towards a more comprehensive, properly funded set of reforms that we’re yet to realise. The next decade will prove critical.
