Martin Routledge, Social Care Future

This article forms part of the LGA's Re-thinking local think piece series.

We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.

Doesn’t seem too much to ask for in 2020 does it?

This vision emerged from Social Care Future gatherings which had people with lived experience at their heart, alongside their allies who work in, deliver, manage and commission social care. We believe reform should start from asking how it might happen.

Understandably there has been a lot of frustration with central government on social care, in particular around finding the funding that is so badly needed. I think though that we must go beyond producing evidence of the impact of this underfunding and do better than bid for money to deliver more of the existing ways of doing things. The LGA’s The Lives We Want to Lead series is a good start to this that needs to be built upon.

A new persuasive story of change and possibility

Three key things we need to do are:

  1. Develop and share a compelling vision of something much better than the way we currently offer social care which is attractive to the public and politicians and which the Treasury can find persuasive in terms of value and sustainability. This can create sustained political and policy prioritisation for big change beyond short term fixes or marginal adaption
  2. Paint a picture of how it would work at a local level, adapting to local contexts - an inspiring and persuasive roadmap for national and local politicians and organisational leaders. This would underpin the development of enabling elements of policy
  3. Show it in action, with results, via exemplar-led change. It is unrealistic to expect a kind of light switch, policy-led simultaneous transformation. But it should be possible to generate waves of research-supported change via investment in pioneer places with varying contexts and geographies

Recently Kate Sibthorpe and myself, via the Social Care Innovation Network (SCIN), worked with commissioners, citizens and support providers to look at the role for commissioning in bringing about a better future. We concluded that great social care needs to be relevant and important to everyone in a locality by contributing to local wellbeing and prosperity. It can’t be seen as “that thing over there for desperate people, that we hope we never need and are not involved with”

Social Care Future and others have been harvesting “glimpses of the future” - the jigsaw pieces already in place in some areas but not yet brought together as the picture on the box. Together they offer an ecosystem of support:

  • Helping many people right from the start by connecting us with self-help or community-based opportunities and solutions and avoiding the need for formal services
  • Promoting independence at key points in people’s lives when we might fall into unwanted dependency on public services such as when we have had a stay in hospital or find ourselves disconnected from others
  • Where people do need more significant support, offering this in ways which enable people to stay connected and contributing to their communities, including economically – blending and using formal support resources with a much wider range of local opportunities
  • Support which is self-directed, where people’s expertise in themselves and their situations alongside their exercise of choice and control facilitate efficient personalised design enabling the best, good value results
  • A shift in the balance of longer-term support to a diversity of options and choices with a bias towards human sized and shaped, community-embedded approaches, making full use of enabling technology and local resources and ingenuity

Great social care needs to be relevant and important to everyone in a locality by contributing to local wellbeing and prosperity.

Exemplar led change

Many of these elements are in place somewhere in the UK. But they don’t yet come fully together in a way that support for disabled and older people to live good lives is seen as a collective public service and community endeavour rather than as a set of fixed service offers from the local state.

In our work for SCIN we identified four things that we think are needed to make this kind of shift locally:

  1. Establishing a clear strategic direction starting from the key goal of improving lives and communities
  2. A determination to release and use all local assets
  3. A starting aim to use public service resources to support, enable, build from and add to citizen and community initiative and action - not parallel or replace them.
  4. Co-produce and deliver a range of activity to support wellbeing and sustainability with people and communities

We have gathered many approaches and examples of how places are doing some of these things. They include key practical and technical issues like contracting, growing a new kind of workforce, use of technology as well as the effective and creative means of building local coproduction and relationships to release all assets.

The right ask – a down payment on reform

We believe that we can now put the jigsaw together, at least well enough to support pioneers to become exemplars. It’s very clear that the kind of win-win transformational change we need requires significant additional resources, but these will be better used than just putting more into our current unsustainable system. The extra money needs to underpin a new sustainable approach to social care.

So, one firm ask that LGA and others should make of central government is for a down payment on reform. This would support these pioneers to point the way for their peers by resourcing their key shifts of investment and practice. A well supported programme like this could then ripple out to succeeding waves of places to result in big change in just a few years.

If we want to persuade a sceptical Treasury we need to set out where this investment would be focussed and how impact would be evidenced. For decades leaders have been saying they can’t shift funding to help people avoid unnecessary use of expensive long-term care and hence make social care sustainable. A significant part of a new fund should be focussed there.

Currently many say there is no alternative to the large scale residential care and life and limb, time and task “home care” approaches that are not working well enough for the people that use them or those who support them. An investment is clearly needed but this should be used to build something better. So, a new fund should also support pioneers shifting the balance on residential care and modelling support for people at home that helps people pursue wellbeing with the support of neighbours, friends, family and communities and uses technology more.

It will be vital that creative and robust research supports this programme. In speaking to Professor Martin Knapp, Director of the School for Social Care research recently about this he was clear that such a research design could be developed.

This can be done. It would make our country better. We all deserve it.