Social care: putting people back at the heart of the conversation

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'.