The popular notion of a ‘settlement’ for adult social care concerns its funding and associated risk pooling. This is understandable given the inexorable pressure of an ageing population and long-term health conditions.
But the urgency of money has overshadowed the debate about the fundamental system of institutions and roles. Yet most of those who experience social care, whether from lived experience (receiving or giving care), as providers and commissioners, or as activists and advocates, know there are issues that money alone cannot fix.
Continued evolution or an opportunity for reinvention?
Local authorities can thank the National Assistance Act of 1948 and other related post-war legislation for enshrining their role in supporting older adults (and adults with disabilities more generally) with what we now call social care. This was an era-defining change which marked the end of the poor laws and the development of a social democracy. We have had plenty of legislation and change of other kinds since, but the council’s role to support those without means and, crucially, other local organisations (namely charities) has been constant. Within this context, at key points (every 15 or so years) over the past 70 years, adult social care as a system has undergone phases of major change or reinvention, whether modernisation of professions, the introduction of independent inspection, moving people out of institutions or latterly introducing personalisation.
I am not wholly sure whether the adult social care system needs another epoch-defining change or reinvention; the gap between reform and revolution can be in the eye of the beholder. But I am in no doubt that a funding change, while necessary, would be wholly insufficient and an opportunity horribly missed, given the forces shaping social care for the future and the inadequacies of our current ‘system’.
Meeting the needs of a changing population
As I set out ina discussion of how we define care, we are now, as a society, well beyond the simple provision of a service to a defined group without financial means. The breakdown of extended family, greater gender equality, increased longevity and our own expectations of a good life (for others and ourselves) mean that more care is needed, in more forms, than ever before. We increasingly want that care, not from institutions or services, but from networks, products and people that allow us to lead our lives as fully as possible. Care is no longer defined solely as a bed in a home, a hot meal and a 30-minute visit by a care worker. It may be all of those things and none, but what matters to people is arguably beyond the role of the state. The state may provide, commission, fund, convene, intervene and facilitate, but it cannot love.
A new vision for the state: Creating a caring society
This recognition – that we should never conflate the job of councils in social care with care and kindness itself – is what can liberate us to imagine a new role for the state. Personally I believe local authorities are well placed, perhaps even best placed, to commission adult social care. But more important than this is a potentially new mission, to create ‘a caring society’ in each and every place. If this role were developed and enacted, we would see:
a vision not just for services but for deep care and kindness in a place
a new deal for carers, in recognition that they are a far bigger and more important component of care than formal care services
a new role for councils as both local regulators and quality champions – when currently councils are far too removed from lived experience
leadership of collaboration in the local system – austerity has combined with the marketisation of care to inhibit local organisations working collectively for public good
regional care market collectives (of councils), stabilising the inequities that arise from both scarcity and over-supply in key care segments, and kick starting a new era of investment in asset based care, replacing many homes, centres and services
councils as data insight hubs, working to gather and interpret data in ways that help grow collective intelligence and address the prevention of social need, not just to make economies or account for performance (critical here is the word collective – the council’s job is not to know everything first but to enable others to use the insight)
Buurtzorg-style social care practices – the Dutch model of neighbourhood care – where overheads and bureaucracy are relegated in favour of closeness to people and doing the right thing
a role in incubating and accelerating innovation, whether democratic, product or service, that benefits the system and local people.
Redefining the role of local government
These are jobs for the state that, arguably, only the state can and should do. Jobs that are collectively much more important to a care in an area than the efficient disbursement of a shrinking budget. In most places there are parts of these jobs done to a degree, but at nothing like the intensity and priority we need. So it is time to ask ourselves what the state is for in social care, and perhaps even to consider whether a settlement that has lasted 70 years should now make way for something new. A new role for councils would sit at the heart of a new settlement, but everything should be on the table, including central government, regulation, workforce and the role of local partners, especially the NHS. Far from being unsettling, this would see a new narrative emerge for adult social care, not as an NHS dependency or a council funding risk, but as an integral part of a caring society.
A caring society
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