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What do we really mean by 'care'?

Alex Khaldi Alex Khaldi

Care. A small, familiar word, yet nonetheless laden with assumptions, connotations and emotions. Yet it is a notion fundamental to social care provision.

To meet the challenges faced by the adult social care system and grasp the opportunities ahead we need to understand what we mean by ‘care’ and its application – from individual relationships, state provision and markets through to policy. This topic formed the basis for the latest round table debate in our caring society programme.

Care can be something we’d rather ignore

The need for social care touches every family and is arguably as important to our infrastructure as broadband or roads. Yet, as a society, we find it hard to talk about and care often becomes something for ‘them’, not for ‘me’.

“We find it easier to take out insurance against the unlikely event of a domestic burglary than against a very likely need for care in the future.” Julia Unwin

Why we need to be brave enough to talk about care

To change the care system, we need to talk about it. By having this conversation as a sector and as a society we can get a better understanding of the outcomes we want and the value good care can bring. In doing so, the conversation can shift care provision from a bureaucratic process about managing demand and supporting survival, to one that focuses on how it can support people to enjoy their lives and thrive.

“In families, care is not a toxic word. It's something that people value. Most people experience some element of good care and it's not social care or health care - It's care." 
Emily Holzhausen, Director of Policy and Public Affairs, Carers UK

Care is intrinsically personal 

At the simplest level, care is one individual helping to meet the need of another. Considering care at the point of delivery, the focus on processes and ticking boxes rather than an individual’s needs can lead to both very poor care and frustration for those working in the sector.

We need to find ways to liberate the workforce, volunteers, family and friends so they can build real relationships with individuals and give them the freedom to empathise and innovate and the support to sustain deep care. Across the sector this can be energising and it was voiced at the roundtable that many feel worn down by the immediate pressures and the gloom of austerity.

“We have huge turnover of care workers and we constrain their kindness in terms of how we require them to work. But if we can employ them for the same amount of time but give them more scope to be kind I think that can bring a wholly different perspective." 
Bruce Moore, Chief Executive, Housing 21

Building a holistic approach to local care provision

It can be argued there is an intrinsic kindness in public sector care as the proportion of total council spend is high, yet it benefits a small proportion of the population. While social care priorities must not be lost in clinical NHS concerns, a more holistic approach would be experienced as more caring.

For local authorities, this is about cross-departmental working, including housing and children’s services, as well as working with public health to understand the wider population needs. From a local perspective the holistic approach includes collaboration between charities, local government and other services. The end goal would be more coherent and early support, leading to more efficient and better care, and innovation; the system bending to the needs for the person, not the other way around.

“The voluntary sector has the skills and expertise, but also needs to make the bold transition to working more collaboratively.”  
George McNamara, Director of Policy and Influencing, Independent Age

A rallying call for the market

Private providers and investors play a significant role in the system but we need more debate about whether, in Professor Michael Sandel’s words, we have moved from a “market economy to having a market society” and the way in which the aim for a healthy mix of public/private provision has become distorted in some cases.

“We need to talk about ownership not just the workforce when considering care. 25% of the market is nationals, multinationals and hedge funds.”
Bob Hudson, Professor, Centre for Health Services Studies at Kent University

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How can we build kindness into public policy?

At the policy level, the challenge is to set a direction that allows people to build and sustain kindness into the system. This does not mean considering kindness as providing a free or cheap alternative to a budgeting issue. It must recognise that not all carers want to care; many are trapped through a sense of duty.

Such a policy would recognise the value of relationships. It would also create an ethical framework that promotes equality among society, removing the sense of ‘them and us’, and provide foundational principles around which the public, private and third sector can unite.

“We need a framework that allows a complex system of organisations to work together, not having to fight their own corner."
Emily Holzhausen, Director of Policy and Public Affairs, Carers UK

What needs to happen to drive change?

  • Public policy language must move away from transactional terms and instead provide a link into personal concerns and emotional needs that care can and must provide
  • Applying the concept of human rights to envision new social care approaches. It is already used by some care homes, to consider kind and compassionate relationships and take into account all people involved in experience of delivering and receiving care. Similar lessons can be drawn from international experience such as Germany’s charter of care which formalises people’s rights to dignity, respect and control over their care
  • Develop new approaches to monitoring and measuring the quality of care. The current approach is focused on ticking boxes and compliance and we need to find ways to measure the value of relationships and explore the link between kindness and productivity
  • Promote local leaders that value kindness and generosity and set a tone which is less about ‘services’ and more about values and behaviours of everyone involved in the system

Seizing the opportunity

We have allowed social care to be defined as a set of services and institutions. As funding pressure has grown, so the meaning of care has shrunk. If local leaders and people with lived experience can reclaim the meaning of care, we have a real chance of delivering change. Building an ethical foundation must underpin any notion of a caring society, but then putting this morality into practice in the 21st century comes next – by rethinking the role of the state, accelerating innovation and ultimately  making the paradigm shift to a new care system.

“We need to prove that kindness can be more productive compared to the current system, otherwise change will not happen.” 
Sam Newman, Director, Partners4Change

To get involved in our caring society project, please contact Alex Khaldi, or join the conversation on Twitter at #ACaringSociety.

A caring society

Discover more about our programme to build a caring society  - bringing together a community who are committed to shaping the future of adult social care

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