What can England learn about social care reform by looking to our neighbours?

By Anna Dixon
As Chair of the Archbishops’ Commission on Reimagining Care I have the privilege of hearing directly from people who draw on care and support and their carers. These stories are powerful and are shaping my thinking and that of the other commission members as we reimagine what the future of care in England could look like. Through our listening and engagement exercise, we have spent the last few months hearing people’s views on what is good and not so good about their current experience of care and support and inviting them to share ideas of what care and support would look like if it was just the way they wanted it to be. We have held a number of engagement events and I have also been able to do visits. I really enjoyed coffee and conversation with residents of the Moor Allerton MHA Extra care housing scheme in North Leeds recently. They enthusiastically shared their views about the benefits of the community they live in and the peace of mind they get from knowing care is available as and when they need it. We will be sharing the themes of what we heard soon.
 
We took our lead from other reviews of adult social care in both Scotland and Northern Ireland which grounded their recommendations in what they heard directly from people who draw on care and support and their carers. I served on the Advisory Group to the Independent Review of Adult Social Care in Scotland chaired by Derek Feeley. The Review had a very strong element of engagement with people who draw on care and support. This was coordinated by the Health and Social Care Alliance Scotland. Given the strong focus on lived experience it is perhaps useful to have a look at what these reviews recommended as the Archbishops’ Commission now turns its focus towards making a reality of the vision of care.
 
In Scotland, it was clear that despite progress on integration, self-directed support and carers’ rights there remained a huge implementation gap between policy intention and implementation. While there were examples of good care there was also too much unwarranted local variation, a focus on inputs rather than outcomes, a lack of prevention with interventions only in a crisis, and an undervalued workforce.
 
The Review recommended creating a National Care Service to put care and support on an equal footing with the NHS, ensure more consistency of standards and greater portability of care packages. It proposed ending all non-residential charges and improving the pay and conditions of care workers. The Review argued that a shift is needed in the narrative to focus on investment not burden, relationships not transactions, and prevention not crisis. It also advocated for a stronger rights-based approach to care and support.
 
The Scottish government commissioned the Feeley Review ahead of the parliamentary elections. There was broad consensus and support to implement the Review findings and the formal consultation on implementation has just finished.
In Northern Ireland John Kennedy and Des Kelly undertook a review back in 2016. John came to speak to the Commission about their report Power to People recently. It had a strong focus on empowering users of services to exercise consumer sovereignty with support to drive changes in the market and ensure new services were created to better meet their needs and wants. They firmly recognised the vital role that family carers played as the ‘bedrock’ of the care system. They also acknowledged the importance of resilient communities to support people to live well.  Unfortunately, the report landed at a difficult time politically and nothing progressed for several years. Very recently the government in NI has launched a consultation on reform proposals which mirror very closely the proposals made by the review.
 
Finally, turning to our neighbours in Wales. As part of the co-operation agreement between Plaid Cymru and the Welsh Government, there is a commitment to creating a National Care Service that is free at the point of need. They have recently announced an Expert Group that will look at the options for this. They are signalling a desire to increase the proportion of provision that is a public service either through local government ownership or cooperatives, and are looking at parity for health and care workers in terms of pay and conditions like Scotland.
 
The Commission has been fortunate to hear from other experts too. Natasha Curry, Deputy Director of Policy at the Nuffield Trust has been looking at other countries’ reforms of social care. She shared some fascinating insights about why Japan and Germany were both able to implement major and far-reaching reforms to social care. Both countries have a generous public entitlement to long term care. In Germany, reform followed reunification when the country had been through a major upheaval. A bit like after WWII here when the NHS was founded, could the pandemic be one of those moments? In Japan, this was understood as a major strategic issue which affects whole of society and the wider economic and social impacts of inaction. Should we make a stronger social and economic case for reform as well as the moral one?
 
As the Commission continues its work we are keen to make sure our proposals for reform influence the direction not only of government reform, but how we all see and view care and support. We all need to make the wider arguments for change. To frame this as everybody’s issues – a universal concern that needs a societal response, including by the church and other faith communities.
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