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A Different Mindset for ‘The Lives We Want To Lead’

Posted: 08/08/18

NDTi’s Chief Executive, Rob Greig, discusses the recent LGA’s Social Care Green Paper

Given the perpetual delay and shifting focus of the Government’s adult social care Green Paper, the Local Government Association’s publication of its alternative green paper – ‘The lives we want to lead’ - is a highly welcome addition to the debate. 

A Different Mindset for ‘The Lives We Want To Lead’

To understand and analyse the LGA’s contribution, we need to separate out the two key questions it covers:

  1. Funding for Social Care
  2. How that funding is best spent by local authorities.

‘The Lives We Want To Lead’ provides a sound and pretty comprehensive coverage of the first point. By running through the various options and, importantly, breathing new life into the Dilnot Commission proposals, the LGA make a clear case for additional investment and articulates the importance of the social care sector to both the national economy and the jobs market. Society must decide whether it wants a properly funded social care system and this document clearly describes how the current precept system discriminates against the most socially deprived areas.

The report’s consideration of the second question is more concerning. It starts out excellently, telling short stories of people’s need and how they benefit from social care – thus grounding us firmly in the reality of people’s lives. It also makes important statements about needing a greater focus on connecting communities and the role of local government as a whole (not just social services) in delivering the social care agenda. However, after that, it rather loses the plot.

There is one underpinning fault-line in the document. Despite placing emphasis on prevention and early intervention, it makes no reference to children and young people. From a philosophical and outcome perspective, social care has to take a life-course approach if it is to succeed. From an economic perspective, it is often early decisions taken by children’s services (such as to send children to residential schools) that create financial demands on the adult sector. Social care reform has to take a whole life perspective. Yet, ‘The lives we want to lead’ does not.

The biggest issue for me though is this document’s lack of critical self-analysis. The responsibility for social care’s problems is put down, almost totally, to a lack of government funding. ‘The lives we want to lead’ trumpets how well local government has managed austerity. In many ways that is true. Councils have taken difficult decisions to balance the books – but balancing the books has been the prime focus, along with reducing delayed hospital discharges. Few authorities have used these challenges to fundamentally review, and improve, their approach to social care. The LGA list a range of indicators to illustrate social care’s crisis – more people having identified unmet need, increased mental-ill-health amongst carers, escalating staff turnover rates. Yes, these are partly caused by cuts and austerity, but they are also a function of the way local government has decided to address austerity.

Yet the overwhelming message in ‘The Lives We Want To Lead’ is that local government can and should be trusted to just get on with things - having first been given additional money. Sorry, but rigorous self-analysis would also conclude that local government needs to change how it operates and be more open to external influences. In our work we often come across examples of this:

  • The Care Act is rightly lauded as a sound legal foundation for care and support. However, many LAs are ignoring key Care Act requirements. The wellbeing duty requires LA’s to support disabled people into paid work – but, despite evidence that they are a cost-effective intervention, many LA’s have cut employment support services. The document also cites the new rights available to unpaid carers, but NDTi’s work on carers has found that few Council’s are actually taking this seriously.

 

  • The LGA argues against national delivery support programmes and in favour of ‘sector led reform’. It quotes incomparable costs to support this and confuses cheapness with being cost effective.  Yet, the most discernible local progress in the last fifteen years has come as a result of having national support programmes such as the Valuing People Support Team and National Institute for Mental Health. More recently, the Community Led Support initiative is delivering real improvements because it creates a framework for taking innovative practice from one area, and then shares and adapts the learning across the UK.

 

  • The document also explicitly rejects CQC inspections of commissioning in favour of sector-led peer review. Putting to one side the assistant director who assured me last month that all peer review teams go easy on neighbours because they know they too will be subject to peer review in the near future, this rejection of CQC inspection conflicts with the same document lauding provider improvements as evidenced through CQC inspection. Is LGA saying inspection is good for providers but not for themselves?
     
  • The LGA urge more community connectedness with a focus on life outcomes. Yet our ‘Time to Connect’ initiative has found that a major reason why providers are not investing in such approaches is because their LA commissioners are not expecting to see life outcomes beyond the walls of a care home.

I’m conscious this sounds highly critical of local government – so I must be clear that, across the country, innovative and creative practice can be found across a range of issues. However, many LAs, driven by austerity, have used neither people’s expressed wishes nor the available evidence base as the rationale for their decisions.  If Local Government is to be taken seriously in its absolutely justified pleas to be given more money, and not to find itself handed over to an NHS led decision making structure as a cloak for integration, then it must also show a greater degree of honest self-analysis about its own recent performance. Without a genuine willingness and desire to do things differently in the future, we will just be throwing more money at the same people to repeat the same mistakes as before.