There was policy among the politics in Wednesday’s Queen’s speech, although not all of it was necessarily pulling in the same direction. For political consumption the Government is offering a new clamp down on the rights of non-UK nationals to access our NHS services. Let’s see if it proves more consequential, or electorally satisfying, than the many clamp downs that have preceded it. On the policy side, the government is taking important steps to reform social care, capping individual liability for some costs, introducing new rights and prioritising early intervention support. The social care sector will need to grow and change radically in order to meet the aspirations behind the proposals. Whether this will be helped or hindered by restricting the ability of migrant social care workers – on whom the sector has been highly dependent - to access health services while in the UK has yet to be seen.
The kindest interpretation of events is that the Coalition is deliberately underlining that the way we’ve expanded our caring capacity as a society in recent years is unsustainable, fiscally and socially. We cannot continue to rely on professional services, often offering low-pay, low-prestige jobs, intervening at points of crisis or severe infirmity and offering relationships between carer and cared-for that are so tightly rationed that care itself struggles to keep a foothold. A high-quality care sector can only be part of the solution to living well in a silver society. A much larger role needs to be played in future by softer interventions that maintain wellbeing, respect independence and nurture social-interdependence across the life-course. With its stress on reducing people’s dependency on formal care services through earlier intervention, the Care Bill is a useful step in the right direction. But as a pamphlet we published this week argues, its attachment to needs rather than strengths may ultimately perpetuate a system in which rationing around individual thresholds distorts our overall social investment and can create perverse individual incentives and unfair outcomes.
We believe that the Bill should go further. At the same time, we believe that the onus for change doesn’t rest exclusively with the Government, or even local government. How we function as a society will need to change as who we are as a society changes. Work in support of the National Dementia Strategy is instructive and important in this respect, reframing a medical condition as a social challenge with implications for communities and employers, as well as health professionals and care services. In a paper that we published last year, Craig Berry struck some important cautionary notes; yet many of the opportunities for improving the lives of our older citizens lie outside of traditional services. For example, we are currently working with Asda to explore how they could operate in ways that generate greater social value. The amount of store space that will be needed for retail is falling, so what other functions could the store spaces provide? How could stores like Asda, in partnership with community groups or mainstream public services, create opportunities for isolated older people to come together, share skills with each other or with younger people, perhaps learning how to pool personal budgets in order to access care that they would value? We have also been working with the Scottish Environment Protection Agency and Scottish Natural Heritage to look at the role of access to high quality natural environments in supporting health and wellbeing throughout the life course. The importance of green space for healthy childhoods is now widely recognised, but designing healthy green space for active older communities is just as important, yet receives relatively little practical attention.
It’s unfortunate to see our older population routinely referred to as a burden, a timebomb or – more recently – the sharpest teeth in the LGA’s jaws of doom, threatening imminent financial breakdown. A whole-place, strengths-based approach doesn’t substitute fantasy for reality, but it is useful because it puts all of us in the frame.
Paul Buddery is Partner at RSA 2020 Public Services. He tweets at @buddypb