The future of social care in a post-COVID-19 world
Appreciation of our carers is at an all time high – let’s seize the moment to reimagine and reshape the future of social care in the UK
INNOVATION & IMPROVEMENT
Image: Istock
Paul Rackham
Independent Consultant and former Head of Adult Social Care Commissioning at Westminster and Kensington & Chelsea councils
What will social care look like after the global coronavirus pandemic? I have 25 years’ experience across all aspects of adult social care, yet I am still not qualified to answer this question. The failure of successive governments to set out and deliver improvements suggests I am not alone.
However, with millions affected by COVID-19, and many more grieving we must make sure we build on the response to the current pandemic to reframe the future. That starts with asking some different questions.
Funding, technology, workforce and Brexit continue to shape our thinking, but in its manifesto Campbell Tickell has challenged itself to “reimagine” and that’s what I have tried to do here across four key areas.
1
How do we make the future of social care about us, not “them”?
Social care has been operating without a widely understood, clear purpose for as long as I can remember. However, more people than ever are now aware of the fragile arrangements for providing care and support and Clap for our Carers showed there is a lot of love and appreciation for people who work in the care sector. Even at the same time as we are fundamentally questioning the business models on which most care provision is based, wider UK society is only just tuning in.
We must steer the debate and build on the current interests and strengths of our society and communities, rather than describing the future needs of specific groups. If we believe we are like the people we are investing in, then we are happier to invest.
If not, social care risks being defined by the deficits and issues it faces. It will continue to be seen as a transactional relationship, where care is a commodity to be restricted.
Although there is anecdotal evidence of green shoots of kindness, compassion and relationships within the business of social care, we still use a plethora of numbers to assure ourselves we are doing the right thing and are doing it properly. There may be some science behind, but it often spectacularly misses the point.
1. How do we make the future of social care about us, not “them”?
Social care has been operating without a widely understood, clear purpose for as long as I can remember. However, more people than ever are now aware of the fragile arrangements for providing care and support and Clap for our Carers showed there is a lot of love and appreciation for people who work in the care sector. Even at the same time as we are fundamentally questioning the business models on which most care provision is based, wider UK society is only just tuning in.
We must steer the debate and build on the current interests and strengths of our society and communities, rather than describing the future needs of specific groups. If we believe we are like the people we are investing in, then we are happier to invest.
If not, social care risks being defined by the deficits and issues it faces. It will continue to be seen as a transactional relationship, where care is a commodity to be restricted.
Although there is anecdotal evidence of green shoots of kindness, compassion and relationships within the business of social care, we still use a plethora of numbers to assure ourselves we are doing the right thing and are doing it properly. There may be some science behind, but it often spectacularly misses the point.
2
Does size matter?
Where does the balance of responsibility lie for individual, community and population health, welfare and happiness?
I have seen that people react far more positively when presented with a human-sized issue. Local and regional efforts have been more effective and more appreciated than central coordination and there are vast local networks of informal and organised voluntary and community sector responses.
For the complex social care issues, there is also growing interest in place-based and smaller-scale interventions and less value attached to the institutional-sized responses, such as large nursing and residential care homes. That means continued, or even more involvement of local government but also a redefinition of the scale of issues we face.
2. Does size matter?
Where does the balance of responsibility lie for individual, community and population health, welfare and happiness?
I have seen that people react far more positively when presented with a human-sized issue. Local and regional efforts have been more effective and more appreciated than central coordination and there are vast local networks of informal and organised voluntary and community sector responses.
For the complex social care issues, there is also growing interest in place-based and smaller-scale interventions and less value attached to the institutional-sized responses, such as large nursing and residential care homes. That means continued, or even more involvement of local government but also a redefinition of the scale of issues we face.
3
Better together – surely?
“The NHS and social care have been in a constant state of change and struggling to settle on an identity as providers or commissioners of services”
No question on the future of social care can be asked without reference to the NHS. For as long as I have worked in this area, there have been national and local programmes to integrate health and social care. Structural and process-driven change only succeeds when key people form trusting relationships.
The fact that the NHS and social care have been in a constant state of change and struggling to settle on an identity as providers or commissioners of services has not helped. Also, the involvement of people, communities and the voluntary sector has been patchy.
Are we looking at a National Care and Health Service combined with regional and hyper-local delivery? We need to ensure strong local coordination whatever structures are in fashion.
3. Better together – surely?
“The NHS and social care have been in a constant state of change and struggling to settle on an identity as providers or commissioners of services”
No question on the future of social care can be asked without reference to the NHS. For as long as I have worked in this area, there have been national and local programmes to integrate health and social care. Structural and process-driven change only succeeds when key people form trusting relationships.
The fact that the NHS and social care have been in a constant state of change and struggling to settle on an identity as providers or commissioners of services has not helped. Also, the involvement of people, communities and the voluntary sector has been patchy.
Are we looking at a National Care and Health Service combined with regional and hyper-local delivery? We need to ensure strong local coordination whatever structures are in fashion.
4
How to enjoy an infinite journey?
Ensuring that people who need it have timely care and support, at the same time as preventing or delaying people needing care and support, and dealing with health or well-being crises and emergencies, is always going to be our task. So, the social care journey is not something to be endured – it must be judged by the successes and failure along the way.
For me that means finding new leaders for this conversation, people with a personal interest and passion, people with a long-term view and a handle on what is important today.
National and local government and all the large and small organisations involved have to work with these new leaders and wider society to fundamentally shift, not only how the debate is framed, but what success looks like along the way – not just in some distant future.
It can’t be led by the bean counters like me. That risks it all boiling down to a question of what people are worth and how much are we prepared to pay.
This bean counter wants the future of social care to be expressed as a feeling, not a number.
4. How to enjoy an infinite journey?
Ensuring that people who need it have timely care and support, at the same time as preventing or delaying people needing care and support, and dealing with health or well-being crises and emergencies, is always going to be our task. So, the social care journey is not something to be endured – it must be judged by the successes and failure along the way.
For me that means finding new leaders for this conversation, people with a personal interest and passion, people with a long-term view and a handle on what is important today.
National and local government and all the large and small organisations involved have to work with these new leaders and wider society to fundamentally shift, not only how the debate is framed, but what success looks like along the way – not just in some distant future.
It can’t be led by the bean counters like me. That risks it all boiling down to a question of what people are worth and how much are we prepared to pay.
This bean counter wants the future of social care to be expressed as a feeling, not a number.
