For those of us toiling away at WLLG Towers there is never – never – a nicer moment than when an e-mail pings into our inbox starting with a phrase along the lines of "I’ve got a guest post for you…" Those are the moments when we can sit back and be happy that people know they can send them to us (and you can too, you know), safe in the knowledge that they will see the light of day. With that in mind, here’s a brilliant piece for you to read through about a pretty serious topic; social care…
I will ease you in with a simple thought- the way we care for one another matters most about society. We all have a right to equality, dignity and fairness
Happily this thought underpins the new Care Act; as it did in 1947 when the National Assistance Act was written.
Our systems are not perfect. They do not always adapt to meet the needs of the individual. Appalling abuse, neglect and system failure has a relentless place in every Serious Case Review. When things go wrong, they go spectacularly wrong and people experience inequality, degradation and unfairness. Systems must be held to account by the people they serve. This failure must power a relentless drive for improvement; the status quo can never be accepted.
This article is not a passionate defence for the system but for social care itself. The Association of Directors of Adult Social Care has recently stated that social care in England is fast becoming “unsustainable.” Gone is the era of moderate needs and discretionary spending. Half a million people who received care pre-2009 order no longer do so. £3.53 billion has been taken out of Local Authority budgets (a circa 26% cut) and yet political expectations continue to ratchet up. Social Care is to achieve: fewer hospital admissions, integrated health and social care, a living wage for domiciliary care workers, increased choice of care provision and personalised care and health. There is also a new range of statutory duties: support for Carers, preventative services, a cap for social care spend and many other (formerly discretionary) facets of social care that are now law. The public is therefore entitled to align expectations accordingly.
On the demand side there is significantly more demand for primary and secondary mental health services (poverty and poor mental health are clearly related); increasing number of people aged 85+ with dementia and people with learning disabilities.
Nothing (worsening mental health aside) above should be viewed negatively. The Care Act is a modern take on equality, dignity and fairness. Carers deserve to be paid properly for the increasingly complex and skillful jobs they deliver. Hospitals should be a place of last resort. The problem is that the gap between political expectation and reality is widening at pace and the electorate aren’t yet at the party.
The majority of people (myself included) don’t think about social care until they need it for themselves or a loved one. You may need a hospital at any point in time but the idea of relying on others for care; especially professional care; is too much for most of us to get our heads around. Elections tend to be won and lost about wars, immigration, taxation, crime, unemployment and mortgage rates. A Prime Minister is unlikely to be swept to power on the crest of a radically new approach to dementia care. Social Care isn’t Top of the Pops and it is being treated like a bad tribute act accordingly.
Councils must take some responsibility. Too much defaulting to positive on efficiency surveys and equality impact assessments. Too much bidding for integration initiatives with undeliverable performance targets and the allure of “pathfinder” status. It all smacks being alone for the last two minutes of speed dating, wild and desperate.
There should be more painting the picture of local impact; articulating the story of people who are socially isolated, not ill enough yet to pass threshold: crises waiting to happen.
The case for Health and Social Care is not helped by very high profile instances of misused resources; the scandal of £3,500+ per week beds in assessment and treatment units for one example. This does not mean the system is adequately resourced.
There is a wider context alongside the stick social care is regularly battered with. A few observations:
· Real money is better than virtual or recycled money. Real money can be spent on the care and support people need. You can waste a lot of time and energy with partner agencies arguing about how to make virtual money real and much like magic beans the success ratios are limited.
· Social capital doesn’t mean every neighbour opts to deliver complex care overnight
· If you want to achieve integration you can’t give the NHS (a monopoly provider with tariffs/payment by activity targets) an effective right of veto. I reckon they’ll use it.
· Taking 26% out of any system, saddling it with swinging cuts until at least 2020 and raising public expectation at the same time isn’t cricket.
· Promising people free care, then a cap on care, then a policy that means the typical homeowner has to live for 4 years after death to quality for state assistance isn’t entirely transparent
Let’s dispense with the magic beans and speed dating. It isn’t working for anyone. I want equality, dignity and fairness for social care. Granted this won’t put anyone in No.10 but the millions of people who use and work in social care would love it and maybe it is just the right thing to do.