I expect the next few weeks will brutally expose social care’s longstanding challenges.
It will be tempting to leave long-term reform until ‘after the crisis’. But the time to start building a new system is now.
We need a social care system that lets people live at home, or a place that feels like home, with care organisations that are part of and controlled by the local community.
What we lack and what we have in social care
In the social care sector, we are currently all too aware of what we don’t have.
We still lack adequate protective clothing for workers doing the most important jobs.
We still lack people in key roles - like the social care workers who until a few weeks ago were ‘unskilled’, but are now the heroes we applaud from our doorsteps each week.
We still lack virus tests, which means we lack the knowledge we need to keep people safe. Individually, many of us lack money because people are losing paid work. We lack social contact, freedom, green spaces, hugs. (and pasta.)
The things we lack are causing hardship and hopelessness. We are also finding some things we didn’t realise we had.
We have new friendships, and support where we weren’t expecting it, as thousands of grassroots mutual aid groups have sprung up.
We have a stronger desire to help each other than we realised: three quarters of a million people volunteered to help the NHS and social care before the programme had to be paused while the system tried to catch up.
We have more creativity than we knew: people and organisations finding a million ways to offer their help, knowledge or skills to others, often for free.
What we’ve found does not, of course, begin to balance out the devastating impact of the things we lack, let alone the people we have lost.
And those good things are no more evenly distributed than the deaths and the shortages, exacerbating already deep-rooted inequalities. But given how difficult the coming weeks (and years) will be, we must make everything we can of what we’ve found, and what people have offered to give.
This moment of people stepping forward and reaching out to each other will pass very quickly. Without action, it could be replaced by something much bleaker in the hard years to come.
PRINCIPLES FOR BUILDING A BETTER SOCIAL CARE SYSTEM
The story of the next few weeks will, I believe, be of the NHS doing better than feared.
But the challenges within social care will be brutally exposed. Particularly where three problems are found together: lack of money, lack of central planning or strategy, and buildings which house too many people in close contact.
We will rebuild our social care services after this. But surely we cannot want to reconstruct the broken systems which contributed to us being here?
I believe that building better systems should be based on three closely linked principles:
A renewed drive towards living at home, or a place which feels like home
We can no longer tolerate older people living long-term in big, impersonal institutions. ‘Home’ means small, personal and with people I’ve chosen.
It means having autonomy but it shouldn’t mean being alone. We feel we are in a place we belong when we have the right mix of independence and connection for this particular moment in our lives.
Formal support combined with community connection
Everyone using social care needs both formal support and community connection. Before Covid-19, people who lacked one of them were either unsafe or lonely.
It has proved difficult to match hundreds of thousands of volunteers with enough tasks, partly because the tasks identified and prioritised by health and social care services are not those which fit best with community action. We need support services designed to achieve and value both, and we should demand both as standard.
Care organisations controlled and run at the neighbourhood level
Community action at scale can only be delivered by locally-rooted care services.
What we call neighbourhood level care organisations can reach tens of thousands, like the famous Dutch Buurtzorg dementia support service with its self-managing community teams, or Shared Lives which reaches 14,000 disabled and older people through a family-based support model which behaves like a franchise in every way except for the fact that no one owns it, nor profits from it.
But they cannot be run remotely, nor owned offshore. No one wants to volunteer for an obscure set of corporate entities which pay minimum wage, no tax, but millions in dividends.
If we want people to continue to step up, connect and be generous, they must be offered a greater sense of ownership and real relationships in return.
New tech – its power to identify who needs or can offer support, and to connect them with each other – will play a crucial role alongside and in support of this new people power.
THE TIME TO START REBUILDING IS NOW
The crisis is still peaking and the bleakest news from the social care sector is yet to come out, as we start to understand the scale of what has happened, but not yet been counted.
Many smaller provider organisations are already staring at bankruptcy.
But we cannot wait until the crisis has passed to start building the future. We must start now.
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Alex Fox OBE is an RSA Fellow and Chief Executive of Shared Lives Plus, the UK network for Shared Lives and Homeshare. He is Vice Chair of the Think Local, Act Personal partnership and a member of the NHS Assembly. His book, A New Health and Care System: Escaping the Invisible Asylum is published by Policy Press.
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From a care point of view it does appear to be artificial (and counter-productive) to have a good national health service and a fragmented care system. Both health and care (which is often required because of an underlying health issue) are vital to the well-being of an individual. I have seen the amount of time that hospitals take trying to find appropriate post-discharge care for a patient. An integrated National Health and Care Service should be considered. Linked to this is the amount of time taken (wasted) determining whether the care should be paid for by the state or the individual. In the 2010 election, the Conservatives put forward the idea of a voluntary insurance scheme to cover the cost of care. Did this ever see the light of day?
Surely what we need is a totally new structure. What is there now is not good for purpose. We need a national care service. This should be properly funded. There should be an end to privatisation and zero hour contracts. Services should never again be run for profit. Workers need to be properly trained and properly remuniated. Hopefully the status of services and workers would rise.
I agree that we must grab the opportunity to change the social care to a system that works. Social care has undeniably been in crisis for years. Those living at home and their cares been forgotten/ignored for years. The reality for many living in their home who rely on social care is bleak, short rushed visits to the basic, because don’t have the time. We clap on Thursdays for the NHS and care staff but are people prepared to pay the real costs of an effective home care system including paying staff properLy for the skilled work they do. Politicians a little Care badge doesn’t pay the careers bills.
A very interesting article- thankyou. I totally agree that we may be in a terrible moment - but also one that represents opportunities that will pass. Yes the time to act is now- though many leaders are understandably operating in crisis mode. It is also of note that the solutions you point towards are likley to involve a collaborative approach rather than single agency or public body. A developing sense of public leadership, where the focus is a more holistic view of 'place' - the context and the unique ecosystem is required- a leadership that extends beyond more traditional boundaries and hierarchies. A leadership that must increasingly listen to the 'front-line' for real answers, solutions and workable remedies- rather than developing them in isolation and arms length.
Really interesting article and many good points made. Thanks. Running a day centre in Chatham for adults with learning disabilities and autism, I can relate to many of the points made. Incidentally, we are running a sort of "library service" while we are closed and it's working very well...delivering items from our day to our clients such as books; console games; puzzles; DVDs and musical instruments. It's all about resolve and resolve takes energy. A useful, relevant quote (not sure of source!) is "there is nothing more painful than a new idea" and this can be applied to new ways of delivering social care and supporting vulnerable people. By the way, our minibus has absolutely no writing on it...what client wants to travel around in the typical white minibus with a phone number and "Learning Disability" plastered all over it?.
Inarm Osborn FRSA