Reframing in the here and now

By Neil Crowther

 

It’s true that #SocialCareFuture’s vision was developed to offer a compelling sense of future direction, rather than only to describe the current state of affairs.  As we’ve previously explained, this was deliberate and the decision to do so rooted in well-developed evidence on how to motivate people to support social change.
 
Simply repeating that a system is broken and in crisis gives no sense of possibility and generates despondency when repeated over time.  But the vision and narrative were also developed to shift how people understand the current systemic failures of our ‘social care system’ and the injustices this generates.  How we frame current problems matters a great deal in helping to build a bridge to the future we want to see.
 
Take, for example the current focus on how to solve the existing and anticipated shortfalls in the ‘social care workforce.’  Thinking has been inching, by stealth, towards the idea of a single workforce, equivalent to the NHS, with national pay-scales attached to recognised qualifications, routes for career progression and a ‘national register’, modelled on nursing.  Yet all of these ideas, if allowed to grow and to calcify, would, in my view, shift us further away, not only from #SocialCareFuture’s vision, but from the existing legal duties to which local authorities are already bound.
 
It often seems to have passed many by that the Care Act 2014, despite its name, actually made the general duty of councils to promote individual wellbeing, by both preventing the need for care or support emerging, and by meeting eligible needs. This is not the same as, or limited to “providing services”.  As the Care Act 2014 statutory guidance explains ‘The concept of meeting needs recognises that everyone’s needs are different and personal to them.’ (1.10).[1]  The guidance goes on to say that: ‘Care and support should put people in control of their care, with the support that they need to enhance their wellbeing and improve their connections to family, friends and community.’ (10.1)[2] 
 
Attempts to turn social care into something like the standardised monolith of the NHS are antithetical to achieving this.  It requires openness, innovation, enterprise and diversity, driven by the preferences and imaginations of people with cause to draw on support, in partnership with social entrepreneurs focused on how we can all live life well. It requires commissioning suited to help with building lives, not just buying services or using models more suited to delivering parcels and takeaways.  And it demands a new model of regulation, focused on generating wellbeing, not ‘care provision’.
 
If we start here – which is effectively what #SocialCareFuture’s vision is about – then the challenge we face can first and foremost be framed as one concerning the supply of support and its effectiveness in connecting people with the things that sustain their wellbeing, not simply one about the workforce of current service provision.  That’s an important but secondary concern, which has become primary only because for too long we have failed to grow and diversify local support (including standing in the way of visionary providers who want to do more but who can’t because we focus only on funding life and limb, time and task personal care).  Of course, the past decade of austerity has proved a huge factor in stymying the ability of councils and other public services to make this shift, but let’s not fall into the trap of saying it’s the only factor.  At a recent meeting we organised, one provider, keen to radically shift how they support people to be part of their local communities, told us how across the 70 local areas they work, not one commissioner met with the people they support to decide what and how to commission.  By contrast there are councils that have invested in such diversification, not as a luxury, but out of necessity, and who are striving to embrace ‘co-production’ as a much-needed solution.
 
Right now we should be building bridges, not walls.  Rather than striving to create a single defined ‘care workforce’ with its badges, qualifications and registers, we should be thinking about all of the different roles and ways people might be involved in supporting one another to live great lives.  Rather than care as a ‘career’ why not being a Personal Assistant or a support worker as something you do during your working life, to which you bring valuable skills and experience and from which you gain valuable skills and experience you then take to other fields?  Rather than focusing only on the workforces of traditional service models and organisations, why not focus on growing community businesses, micro-enterprises and coops. Instead of imagining the answer to the current challenges of avoidable hospital admissions and people becoming stranded and unable to be discharged rests only with funding more 15-minute care visits, why not invest in the ‘connectors’ and ‘coordinators’ who help to stitch people together with blended formal and informal local support, drawing on all of the abundant local assets available beyond those directly funded by councils or the NHS?  And why not frame all of this as an opportunity rather than simply a challenge, to create great new jobs for the future, building the infrastructure that will help us all to thrive through our longer lives?
 
There is undoubtedly a workforce crisis faced by existing providers and failure to resolve it risks causing incalculable harm to many people and families.  But the harm it could cause is as much a product of a failure of imagination in how we commission as it is one of finance.  Many of the providers involved in #SocialCareFuture want to break free of this death spiral, as I know do many Directors of Adult Social Services.  By focusing first on supply rather than workforce, and by focusing on growing and diversifying sustainable sources of support to promote wellbeing, not ‘delivering care’, we can turn challenge into opportunity.

[1] Care and Support Statutory Guidance (Updated January 2022) Department for Health and Social Care  https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance

[1] Ibid

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