Mission critical

The new Labour government has said it will be 'mission led'. What mission might it adopt regarding adult social care? We set out some ideas here.

It’s no accident that ‘home’ takes centre stage in Social Care Future’s vision

It represents our core belief that people should be able to live in the place they call home with the support they need to do so, participating in and belonging to their community.

But it’s also because talking about home sets in train a whole way of thinking and feeling that helps to create a more fertile space for our ideas to take root. When asked to think about home, what comes to mind for most of us are family and relationships, expressing our identity and doing the things that matter to us, feeling anchored and safe and being in control of our lives.  And we recognise that these things are foundational to our wider lives.  In short talking about home centres our minds on the wellbeing principles in the Care Act without having to talk about wellbeing or the wellbeing principles in the Care Act.

Conversely when we talk about ‘social care’ we send people down a different path of understanding – most commonly to think about “vulnerable” others who need to be looked after because they can’t look after themselves.  This is arid ground for those who share our vision and values, where care is the end product and reduced to beds, visits and packages.

So a focus on home is very welcome

But what might the Labour Party mean by ‘home first’ and how can we contribute to the development of their thinking?

In 2023, Former Shadow Social Care Minister Liz Kendall MP outlined what Labour meant by ‘Home, first’, saying:

“We are always going to need residential and nursing homes, but the vast majority of people want to stay in their own homes for as long as possible, but too many people struggle to get even the basic support or home adaptations that make this possible”

She also said that:

“Labour will radically shift the focus of support towards prevention and early intervention, with a new principle of ‘home first’. We will bring together care workers, district nurses, physiotherapists and other staff into one team so people don’t have to battle their way around the system. We will also expand the use of housing options, home adaptations and technology, and work with local community groups to offer early help with things like shopping, cleaning and tackling loneliness and isolation.

Half of the budget and a third of the users of social care are working age adults with disabilities, yet they have been almost entirely excluded in recent debates. Labour will champion independence, choice and control for disabled people, ensuring their views drive change throughout the system.

Our plans are for a universal, needs-based, nationally funded, locally delivered care system”

This last point speaks to Labour’s plans for a ‘National Care Service.’  The Fabian Society think tank drew up ideas for a  ‘roadmap’ to a National Care Service.  In a piece in the New Statesman, Fabian General Secretary Andrew Harrop said ‘‘We (the Fabian Society) want to replace a service that is narrowly targeted, fragmented and starved of cash with a new set of national entitlements for everyone who needs help to live independently….Today we have a two-tier system where half arrange and pay for care themselves with no assistance, while the other half fight to access a state offer that is totally inadequate. A new social care guarantee regardless of means would be transformative.’

These are all positive noises.  But we know from recent election that social care in and of itself is not a driving mission of a Labour government.  The focus is firmly on ‘our NHS’.  Labour’s mission here is to ‘Build an NHS fit for the future by reforming health and care services to speed up treatment, harnessing life sciences and technology to reduce preventable illness, and cutting health inequalities’.  Hence one might most usefully understand ‘home, first’ as ‘prevention’.

There are though some other potentially helpful shifts being proposed by Labour, that could offer more fertile ground for our vision to take root.  Labour say that mission led government means:

1. Organising government around a shared vision

2. Focusing on real-world impact, rather than inputs and that ‘this could be done by putting citizens centre stage from the outset, making sure policy is built around meeting people’s needs’

3. Focusing on the ends, with flexibility and innovation on the means and that ‘This could mean creating the conditions for innovation to thrive and technology to be harnessed for the public good, boosted by our industrial strategy focus on data and life sciences, and reviewing the institutional landscape of how we identify innovative practice and scale it up.’

4. Devolving decision-making away from Westminster to those with the experience, knowledge and expertise…This could mean handing powers to local leaders to deliver the improvements they want to see, and letting local people make the big calls about what affects them and not leaving everything to decision-makers in Whitehall.

5. Injecting more accountability into government

6. Approaching problems with a long-term, preventative approach…. means flexibility around budgeting horizons, to enable us to plan for the long-term challenges faced by the country, in line with our fiscal rules. This includes how we incentivise preventative approaches which rightly put the emphasis on long-term, sustainable improvement rather than short-term incremental gain.

Of course, what Labour doesn’t mention here is that there is very unlikely to be lots more money made available to spend, so their approach is likely to be generally about better spending, not more spending, and where Labour does want to spend more it says it will need to be clear about where the additional money will come from. Of course, we would call for significantly more spending, well used.

The other important framework for thinking about policy is Labour’s description of the dimensions of a mission:  that it should include a measurable goal, the projects to meet that goal, the first steps that will deal with the ‘immediate crisis people face on the way to the bigger mission’ and a timeline towards the mission.

So with all that in mind, what might those of us who shared Social Care Future’s vision suggest that Labour might strive for in the short, medium, and long term?

We think in the short term it will need to be some very practical, tangible things that can easily be deployed and explained to the public.   So for example, given the disproportionate impact of the energy crisis on older and disabled people, an energy company windfall tax could be levied to raise the ringfenced funding for a ‘home first package’ which might bring together support with home energy and insulation, care and repair, aids and adaptations, technology, voluntary support and perhaps community circles facilitation & other approaches to address isolation and loneliness.  This could be via new individual home first budgets or personalised plans.

There clearly has to be an injection of cash to improve workforce pay, recruitment & retention whether homecare or personal assistance. Given in many parts of the country social care is the single largest source of employment, this would represent a clear investment in places and people, with most money returning to those often starved local economies.  But this should be coupled with a commitment to strive to expand and diversify the supply of support, and through doing so not just pay, but the quality of work available in social care and in turn greater choice, control and quality of support for people who have cause to draw on social care.  For example, Labour could seek to increase the numbers of personal assistants, small community enterprises and shared lives carers. To do so, it could promote ethical commissioning to advantage not-for-profits and community businesses.  And it could also help open up access to ‘non-regulated’ support, in particular by recommitting to and recalibrating self-directed support and direct payments, amending the Care Act 2014 to strengthen people’s right to choice and control over support and their lives.

Related to this last point, Labour could commit to putting power in people’s hands and helping take the battle out of securing care and support through a package of investment in information, advice and navigation, public legal education, and support. In line with the Care Act 2014, this would be a universal offer, available to self-funders and those eligible for publicly funded care alike.  Looking beyond this, Labour should take note of EHRC’s recent inquiry into challenging decisions about social care, and set about building stronger modes of redress and consumer protection as well as mediation support to benefit all.  It should also invest in ‘choice and control’ infrastructure, including local user led organisations, peer support and in digital technology to help and support more people to take control through direct payments, or other means, as well as people using their own resources to get the best support they can in line with their own life goals.

At present, there are few opportunities for innovative ideas to take risks and take root.  With great exceptions, few in our movement see local authority commissioning driving innovation. Capacity to think and co-design with local citizens and providers has been driven out, often leaving just procurement.  So Labour should consider a dedicated ‘home first innovation incubator’, linked not only to social care and prevention, but to its goals for growth.  A £500 million endowment would fertilise and nurture such innovation and be genuinely transformative, while helping to position Britain globally. It would span technology, social innovation, housing and product design and consider new models of interdisciplinary, person-centred working, as well as considering the enabling regulatory, legal, financial and other conditions necessary for such innovation to take root, grow and spread.

Looking beyond the first term, Labour, under the rubric of a ‘National Care Service’ should focus on the system shifts that will genuinely support people to live well in the place they call home, reorientating health and social care and growing community capacity.   A network of neighbourhood-level coordinator teams, taking a ‘strength’ and ‘asset-based’ approach, weaving together & helping to coordinate formal (health, social care, housing etc) and informal support (circles, volunteers, local opportunities) around what matters to people and communities would be a gamechanger.  This approach could draw on the shared DNA of things like Local Area Coordinator, Sure Start, the best social prescribing link workers, mutual aid, community development, family conferencing and the approaches being developed by New System Leaders.  Its animating principle would be mutuality, working with local people to strengthen places and communities. In this sense ‘co-production’ will in future be about co-creation, not simply rebadged consultation.

The longer-term shift will go even deeper, resetting the goals and the focus from ‘treatment’ and ‘care’ to health and wellbeing, and from ‘preventing’ to ‘generating’.  This is where changing the public story comes in.  Social Care Future’s vision and narrative have already been widely adopted as a ‘north star’, while its language (such as talking about ‘drawing on support’) is now firmly embedded in the sector and in government.  But as the Archbishops Commission on Reimagining Care noted, we won’t make progress without reimagining social care and the value of people who draw on, or who work in the field.  Social Care Future will do its bit, translating our vision into a mosaic of stories, told through different media, such as our upcoming animation.  We’ll continue to support greater prominence being given to the voices and expertise of people who draw on social care in public debates about the future, including in the media.  But we do not enjoy the platform of our politicians, so we hope they too can recognise the power of story to change the world, and help us to change that story from ‘looking after our most vulnerable’ to ‘with the right support and opportunities, we can all live our best lives.’

You can read more about our ideas here

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