I was asked by a colleague the other day what I thought the future of social care in England would be. This got me really mulling and musing with the text below as the result.
My instinct is that we are currently heading for at least two futures.
The ‘personalised’ future Will be the future for those with some or all of the following: money; capacity; connections; influence; strong advocates; the motivation and ability to fight for what they want. The people heading for this future are likely to have at least one of the following elements at the core of their experience of social care: self funding; direct payments; ISFs (battled for); employing own support staff and directing how they operate; imaginative services and supports that don’t necessarily have to cost the earth
People who need care and support to live their lives are joined in this future by imaginative and high quality service providers, community organisations, personal assistants, motivated and value driven families and carers. Sadly they are probably also joined by some abusers and people who can’t get a job in a more traditional care environment (but recent scandals within regulated care services make me wonder if this is always as it is perceived).
People in this future will expect support that helps them live lives (rather than just meets their personal care needs) and will ‘buck the system’ wherever they can to achieve this. To this end providers and people who need care services will find ways to avoid care regulation which is often seen as not contributing to quality and only contributing to cost and bureaucracy They look instead for ways to measure and check the things that matter to them.
In this future the assets and resources of everyone involved are maximised and distinctions between providers, service users, carers and others are beginning to be less and less relevant. In the same vein distinctions between sectors (health, care, housing, justice) and client groups (learning disability, mental health) are blurring.
Things are more vibrant and personalised with better outcomes for many.
Things are also much more risky. If people’s needs change or they lose capacity, motivation or resources could quickly find themselves in the other future. Each time money is squeezed or pinned to ‘agreed rate for defined personal care task’ ; each time someone decides ‘regulated is safer’ or ‘council knows best’ there is a risk to the imaginative arrangements already in place that don’t conform to these rules.
In this future the Local Authority is less and less influential (but some will be unable to see that until it is too late). The public and media will not understand why something that goes wrong, a PA arrangement for example isn’t regulated. LAs and regulators will be blamed for stuff that they have little or no control over and councils will have to pick up the pieces (and costs!) when things don’t work out well.
The ‘managed’ future The managed future is the preserve of those who lack some or all of the elements that will allow them to claim a ‘personalised’ future. They are the people with no money or resources, who lack capacity or strong advocates and who are unable or unwilling to fight. People will tend to be seen as the sum of their personal care needs rather than people with personal strengths and assets who need help to live real lives
In the controlled future people are only able to use services approved by local councils either directly contracted by councils or as self funders. Limited resources will mean that council will want to contract with as few providers as possible so a handful of big regulated players will eventually be the only option. (this in itself is risky for councils – look at what happened with Southern Cross). Over time the services that are approved in this way will tend to be those that are happy to deliver ‘value’ (for example 15 minute home visits) and to compromise quality. There will be good service providers in this future but they may be questioning the quality of what they offer for the money available (and doing much more than they are paid to) and may be pulling out of the sector or moving to work in a more personalised way. There will be good councils and council staff but they will struggle to marry up the two futures and keep motivated.
Everything will be regulated and monitored but this may not make a huge amount of difference to outcomes for people. The personalised future will be viewed as dodgy and unsafe or not part of the real ‘social care’ sector.
We already have elements of all of this happening now in some places in some small ways and it feels to me like we are at a bit of a crossroads. Many councils are trying hard to deliver a more personalised approach whilst grappling with massively decreasing budgets and the loss of key people. There are good things happening but we are not learning fast enough or sharing the learning. Very real cultural, procedural, attitudinal and legal barriers get in the way. If we can find a way to procure and monitor the quality of the personalised future (without killing it by viewing it through the lens of the managed future) we can probably merge the two and create some kind of excellent hybrid. That said I don’t envy the people in local councils who are expected to make that happen.
Angela Catly – Director of Operations