Change that leads to better lives

Blog: Rethinking, rebalancing and redesigning social care

Paul Marshall, CEO of NDTi, writes about his reflections on the Archbishops’ Commission and House of Lords Adult Social Care Committee reports.

I had the opportunity to be at the launch of the report coming out of the Archbishops’ Commission on Reimagining Care yesterday. It’s a very welcome report, one which has been eagerly anticipated since work on it started in April 2021, and its launch comes hot off the 8 December heels of the House of Lords Adult Social Care Committee’s ‘A Gloriously Ordinary Life’ which also makes the case for long-term reform of the social care system.

The two reports
Front covers of the Archbishops' Commission on Reimagining Care and the House of Lords Social Care Committee's A Gloriously Ordinary Life

It sets out shared ideas of people living within a community, where they care and support each other, where society’s attitude to care and support changes, where roles and responsibilities are rebalanced, and where the social care system is redesigned. I don’t think anyone who is a carer or works in or accesses care and support would argue with that. The questions are where do you start and how do you get social care to matter to everyone?

At the launch there were lots of familiar faces in the room and they brought with them a host of collective knowledge and life experiences. People who can tell you what’s not working and why, but importantly they can also tell you what’s good, providing examples from across the UK and our society of where, in spite of the environment and circumstances services, communities and people find themselves in, progress and success is happening.

Whilst each of the Archbishops’ Commission and House of Lords Adult Social Care Committee reports are stand-alone publications separate from each other, they both highlight the social and human value and importance of care. It strikes me then that they need to be considered as accompanying each other. Both reports set the scene of where we find ourselves now, with a social care system that is beyond strained, with uneven access to care and support, people fighting to get the basic essentials, carers who are exhausted and a workforce who, with growing case loads and unbearable pressures, still strive to do the right thing at the right time in a system that’s disjointed and terminally underfunded.

Nor surprising then, that after kicking reform into the long grass for what seems like decades, there is a mounting call for change. That’s not new, it’s something that so many have been arguing for over such a long time. What feels different is that there is now a collective sense and voice about the need to rethink and reimagine care. And that reimagining is framed around what matters, people, and their lives. It’s founded on a sense of collective society desire and benefit, where we all play our part in caring and supporting people and the community we live in. It’s founded on mutuality and reciprocity – both big words describing the simple concept of giving, taking, and sharing.

It’s easy to start with the money, there’s a wealth of data and information about the levels of investment needed to ‘fix’ social care. The figures range from a drop in the ocean to eye-watering levels, and that plays into the political and financial voice who will say that it’s too expensive, particularly in the context of an economic crisis. Add in that people’s purses are stretched already and paying the extra tax to fund services and supports that you don’t need, or access (yet) will be challenging for people when they are making choices between putting food on the table, heating your home, or buying new shoes for the kids.

So, that focus on money is understandable, the fact is that social care has been hugely underfunded for decades, and that plays into the crisis we find our health and care systems in, we need to act now and provide the resources now to deal with what’s directly in front of us and building as a backlog. But the heart of the problem can only be solved with a proper long-term plan. The bill for simply treading water in providing social care is more than is available and with a limited amount of cash you can only provide a limited number of things, choice is removed, you fund what you can. The fact is people tend not to recognise the importance of social care and support until they or someone they love needs it.

So, does reform need a different starting point? It makes no sense to say here’s £10 toward your £100 bill, that’s a single sticking plaster for multiple cuts and grazes. Is it not a better starting point to ask people what they need to live a full and equal life, what is there from services and your community that helps with that, what more do you need and what are the gaps? Is it not better to be clear about where and who has responsibility for care? Is it not better to change perceptions of the value of social care and support? If we are to reform or re-design, then it needs to be about the art of the possible, what people need and want, what is right and human, not constrained by barriers of money.

Take the NHS, it may well be 114 years since people started working toward reform of the Poor Law, 111 since the setting up of the State Medical Service, 81 years since the Beveridge Report, all of which led 75 years ago to the beginning of the NHS. There were three essential values in that, firstly that the services helped everyone; secondly, healthcare was free and finally, that care would be provided based on need rather than ability to pay. This approach of being clear on what was needed and then working out the cost and how to pay for it meant we ended up with a model that worked for everyone. Surely, we need to look at social care in the same way.

This need and experience informed approach should provide an understanding of what works, what’s missing, and what are those things that people need to live a full life – and for those thinking about the money, some of this doesn’t cost anything other than a change in approach. That knowledge helps reform and re-design, and it tell us where the gaps are and where investment needs to go, it tells us who is best at providing what. This is the first step, the second is then working out the cost and the third, finding a way of meeting it, and that needs to be informed by the knowledge that prevention is cheaper (and more human) than having to intervene in a crisis. Invest in and provide support now, it reduces costs in the long term.

Collectively we know the solutions, we know what works and have some ideas of what’s needed. But we are several small voices in a very noisy room. This why both the Archbishops’ Commission and the House of Lords Adult Social Care Committee reports are so welcome and important, together they add powerful political and faith support to the voices of those accessing and providing care, hopefully building a stronger collective voice that can finally drive action and change.

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