Usually when I get asked to speak, it is on a specialist subject. Yesterday, for example I had a great time delivering the Edward Boyle Memorial Lecture, on twenty first century enlightenment, to Fellows and some non Fellows in Leeds. It is still more challenging when I am asked to speak on a topic which goes beyond my current (limited) expertise. As the date of the event approaches I get into a spin and rely heavily on the ‘idiot’s guides’ churned out by Ben Dellot from our Projects team, who doubles up as my occasional research assistant. But it also means I have to become reasonably informed about a new topic and, sometimes, it spurs me into thinking about whether there is any scope for a wider RSA intervention.
Tonight I am speaking at the National Care Forum annual review and this has got me doing some thinking about the future of care. I won’t bore readers with my whole argument but I thought there might be some interest in one key point.
I am going to argue that we need many kinds of innovation if we are to close the care gap (between what individuals and the state can afford and what is needed). The gap is already widening as local authorities withdraw all but essential care and the Centre for Social Justice said this week it will grow by an additional £6 billion over the next two decades.
The areas of invention which most interests me tend to be at the intersection of three trends. First, the growth in personal and community based commissioning (Turning Point are doing some great work on the latter). Second, the search for ways of bridging and smoothing the divide between paid and unpaid care. Third, new ways of thinking about the economics of care, utilising not just money but other commodities such as time and housing.
There is a danger the audience will have heard of all of these but I am going to describe three ideas which I think are particularly powerful pointers to the direction we need to take if we are better to tap into the ‘hidden wealth’ of people’s willingness to share, care and connect.
The basic unit of account is an hour of service to an elderly person. Sometimes seniors help each other and earn the credits, other times family members in other communities earn credits and transfer them to their parents who live elsewhere. For example, an elderly woman who no longer has a driver’s license; if you shop for her, you get credit for that, based on the kind of service and the number of hours. These credits accumulate- users may keep them for when they become sick or elderly themselves, then use the credits in exchange for services. Alternatively, the users may transfer credits to someone else.
An interesting lesson from the project has been that the elderly tend to prefer the services provided by people paid in the tickets over those paid in yen.To convert this community service to yen would seem to dilute the community ethic.
Closer to home there is Southwark Circles of Care, the flagship in a network of ‘Circles’ that extends to Hammersmith & Fulham in West London and just last month to Suffolk County Council. The concept and business model has been co-designed and developed over three years with over 1,000 older people and their families, in conjunction with the cutting edge service design consultancy, Participle.
The service is delivered by a distributed network of people called Neighbourhood Helpers. These are people of all ages who share their talents and skills; many are also members and some are paid the London Living wage for their time. Each Circle is designed to be self-sustaining within a three-year launch period, and is supported by the Local Authority as it grows towards this milestone.
Third, Shared Lives and Homeshare which are both initiatives developed and supported by NAAPS. Shared Lives is where an individual or a family chooses to include an isolated or under-supported older or disabled person in their family and community life. In many cases that person becomes a permanent part of a supportive family.
There are around 10,000 SL carers in the UK, of which 3,800 are NAAPS members. Shared Lives is unique in adult support, in that Shared Lives carers are paid a flat rate (like a foster carer) rather than by the hour, are expected to form two-way relationships including mutual links to family and social networks (as opposed to the highly boundaried, one-way “professional” support relationship), and because Shared Lives is based on matching individuals who need support with compatible Shared Lives carers and families.
Homeshare involves someone who needs some help to live independently in their own home being matched with someone who has a housing need and can provide a little support. “Householders” are often older people who own or are tenants in their own home but have developed some support needs or have become isolated or anxious about living alone. “Homesharers” are often younger people, students, or key public service workers who cannot afford housing where they work.
Sometimes ideas like the Big Society, hidden wealth and socially productive public services seem abstract but in these examples we can see a clear outline of the services of the future.
PS Because the splendid Clifford Longley is trapped in the snow I have just had an emergency call to join the panel for Moral Maze. The topic – should we be trying to live forever? Having prepared for my speech tonight the prospect of a long old age seems just a bit less daunting.
Fabian Wallace-Stephens (Foresight Lead)
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