Social care remains high up the political agenda.
Last week, Boris Johnson and Jeremy Hunt set out their ideas as to how they will address the apparent crisis and the Lords Economic Affairs Committee proposed its own plan.
But the narrative on social care hasn’t changed much for a number of years.
Social care is about more than just funding
Whether it’s about the underfunding of social care or how austerity has led to cuts to services for older people and those with disabilities, the central theme is: if we get more money and address where this is coming from then things will be better.
Few would argue that more money wouldn’t help. Local authorities face a huge challenge in delivering a social care system that meets the needs of their local population. But what that system looks like and how it meets the needs of recipients of care and staff is just as crucial as how much money it has. Otherwise, we risk shovelling money into a system that is not what anyone wants or needs.
Radically increasing funding may enable services to keep going as they are, however, there is a fundamental issue that is not being addressed.
Social care can feel like a factory production line
The traditional method of providing home care has not changed for over twenty years.
It is the model of providing home care that most people recognise and (to some degree) expect if they are linked with the social care system. But this system has begun to resemble a factory production line.
With a piecework model of pay and service delivery for staff and a time and task experience for those who receive the service, you’d be excused for thinking this was a factory production line as opposed to the frontline of care and support services.
Recipients of care talk about a lack of consistency, a revolving door of staff who don’t know who they are, what they like or want, and who are too rushed to be able to learn. Support is often heavily task focussed and doesn’t look at the wider needs of an individual.
The idea of a person-centred support plan provided by a skilled workforce with high morale seems far from the real experiences of those on the frontline.
Changing the social care system
There are groups of small organisations, self-advocates, carers and smaller service providers who are trying to change how we think about care.
Social Care Future is trying to shift the narrative to look at how services can truly deliver whole family working. This is a step beyond person-centred, that supports people to be connected to their community, enabled to live a life they want, a life which is more than being washed, dressed and fed.
Care Cooperatives are an example of the shift in how care can be provided with those who are “recipients” in control, and those who are employed having a better experience.
There is evidence that working in this way can reduce costs in the long-term. As people become enabled to be more independent, they can become linked with their wider community, who may be able to fulfil tasks currently provided by social services. It also sees better staff retention and better morale among better trained staff who deliver a more consistent service.
The challenge facing these more innovative providers is that the commissioning landscape doesn’t allow the flexibility required to enable them to deliver a person-centred support plan (let alone start to explore the wider needs and wants of a family).
Giving care workers more responsibility: the self-management model
Helen Sanderson FRSA, who leads Wellbeing Teams, is one of the people that is trying to change the home care model so that staff and care recipients have a better experience and a better life.
Many conventional organisations will talk about person-centred care and putting people at the heart of service delivery. But this often excludes their own staff. Wellbeing Teams is actively working to promote the self-management model.
The idea of ‘self-management’ isn’t new to Fellows of the RSA. Jos de Blok and Frederic LaLoux have both spoken at the RSA about the difference self-managing (or self-organising teams) can make both for staff and for those they are working with. Many Fellows are exploring and developing self-management models or Burrtzorg inspired models specifically. There are Fellows like Toby Lowe who are also working on developing more innovative models of commissioning.
Wellbeing Teams operate in a radical way (not hollow words, they’re actually one of Nesta's New Radical organisations) to change how social care is delivered. This includes enabling staff to organise themselves, plan their own working week and rotas, co-produce support plans with clients, support each other all in a values-led, self-organising and person-centred service.
This approach includes making sure staff are paid appropriately, have opportunities to learn, and develop. The idea of enabling staff to be paid to attend meetings and training may not seem radical to some of us, but in relation to home care this can be.
Read the RSA Briefing Paper 'Radical Home Care: how self-management could save social care'.
Making sure people are the centre of the social care conversation
There is little disagreement that the current model of social care doesn’t enable or provide for fulfilled lives for anyone. We have an opportunity in the current conversation to ensure that both recipients of social care, and the staff who provide it aren’t forgotten.
The (still delayed) social care green paper must take into account the wishes of those who are recipients of care and those who are frontline workers and presents an opportunity to ensure they aren’t forgotten.
The call for change in social care is growing stronger. There’s a need for radical change. Risk-taking and self-management presents an opportunity to put the power back in the hands of those who really need it: the recipients of care and frontline care workers.
Self-management presents an opportunity to make that change for good if those who currently hold the power are willing to be bold.
Read the RSA Briefing Paper 'Radical Home Care: how self-management could save social care'.
4 social care challenges we can tackle with self-management
The social care system isn't working. The public doesn't understand it. It's bureaucratic. It's placing a huge burden on workers. We can start to address these problems by trusting care workers.
Finding Purpose and Skin in the Game: Helen Sanderson on Transformational Health and Social Care
We interviewed Helen Sanderson, Founder of Wellbeing Teams and one of Nesta's New Radicals in 2018, about the challenges of running a 'next-stage' organisation and her vision for the future of health and social care.
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I had an interesting meeting with my local MP recently. I got the most definite impression that Care is a politicl football of sorts. Any ideas mooted by one party are deliberately and systematically denigrated by the others to ensure that they score political power points! Not a happy picture.
I have been surveying the Care business for two years. I have read every report I can lay my hands on and have interviewed at least one hundred of my fellow 60 plussers. As a result I have developed a new approach to care and retirement that embraces flexible and inexpensive housing that is eco-friendly and has low running costs, with integrated care services, income generating opportunities and community services. The idea met with the approval and interest of a city council on the south coast (they didn't get the land they wanted to build on) and experienced care consultants. So - does anyone, anywhere want to talk to me about it?
We have worked for over 5 years to #flipthenarrative around social care health and education approaches. Essentially the three need to focus heavily on their ability to joint commission and work well together. Often central services require local services to do something twice or three times. Early intervention and strong links to education and health both reduce likelihood of poor outcomes for people. We have managed to take an entirely fractured situation and turn it on its head with a community focused and values lead approach.
We need a radical reboot to shape services and pathways through life that are humanised and effective. The onus is firmly on those providing to improve and be consistently threaded together with other parties.
The evidence from teams that are doing this is staggering. In our team, allowing front line staff to make the decision on what to actually do when faced with a new demand, allows them to actually solve the problems they are confronted with. Usually they are less about health treatment, and more about environmental, family, mental, and situational issues; with loneliness being very high on the list.
The team also have compared what they would have done in the old way with their new approach, and 9o% of all their demands on the service are different once the staff can discover the real problem and its cause.
The method to this is surprisingly simple; allow staff when in contact with patients, to put aside their assessment mentality and service provision head, and simply truly listen to the patient and ask open questions.
Then, working as a self managed team, they can take ownership or refer on to others in a way that transfers that rich knowledge.
Great value in your article that is born out for evidence.
Thanks for this John, that's really positive to hear. I'd be interested to know where your team is working and possibly discuss your experiences in my detail if that's possible please let me know.