The Promise of Social Care Reform

Comprehensive social care reform has been a rallying cry for the sector since well before the pandemic. But the extraordinary events of the past nine months have raised these voices to a crescendo. However, whilst awareness of the importance of social care has never been higher, the impetus for reform seems more lacklustre.

We all remember, of course, Boris Johnson boldly promised to ‘fix the crises in social care once and for all with a clear plan we have prepared,’ in his opening address as Prime Minister. And yet this ambitious goal is no closer to being achieved. An issue that becomes more pressing as the 2021 budget draws closer.

A Culture of Uncertainty

 Few in the sector are optimistic about timescales, including Karolina Gerlich, Director of the Care Workers Charity.
“From the reform point of view there’ll be conversations next year but I’m not sure it’s going to be finished next year,” she told us.

Even these fledgeling ‘conversations’ have proved faltering. The government has repeatedly had to reverse its position over the past year. This has spread uncertainty about social care’s precarious present, let alone its fragile future. David Smallacombe, Chief Executive Officer of Care and Support West, spells out the cost of this uncertainty:

“One of the things that concerns me greatly is that it seems entirely evident to me the people in central government… have either very little or no understanding of the complexity of running a care company,” he laments. “Never mind there being any COVID around. But particularly in the context of pandemics like this. And so for example, you get central diktats via the news and newspapers and so on, saying, ‘we’ll do this by Tuesday’, and there’s no thought given to what doing it by Tuesday means.”

Money Talks

Confusion rarely mixes well with a crisis. And yet despite the frustrations around infrastructure, care providers across the country have been able to step up and support their service users. However, this impressive feat has become more and more difficult as the pandemic pushes carers and service users into isolation. The Care Workers Charity recently shared the shocking statistic that care workers are twice as likely to live in poverty as the general population. In many cases forcing carers into impossible choices due to their financial situation.

Kathryn Smith, Chief Executive of the Social Care Institute for Excellence, explains that when looking ahead to reform in 2021, an injection of cash would be life saving:
“The pandemic has shone a light on massive inequalities and challenges that exist in care and support; but it has also seen communities coming together in a fantastic way. Early on in the first lockdown we talked to the sector about what’s needed in the future. We’ve concluded that next year and beyond we need sustainable funding, a focus on preventative services and better workforce pay and conditions. We also say there should be parity of esteem for social care with the NHS.”

The Social Care Institute for Excellence goes into more specific detail on potential reforms in their excellent Beyond Covid-19 report.

National Care Service

Money plays a large role in comprehensive reform, but without change on an infrastructural level, it would only go so far. One frequently heard call for reform suggests creating a ‘national care service’ as a potential solution. You may remember that this was part of the Labour Party manifesto at the last election, and First Minister for Scotland Nicola Sturgeon has initiated a national review of social care with the aim of creating such a service north of the border.

Despite the attractions of such an idea, Dr Donald Macaskill, Chief Executive of Scottish Care, has reservations about the approach:
“The SNP want the equivalent to some sort of nationalised model of social care. The romantic image of a national care service as being the legacy of the trauma of the pandemic – in the same way that the National Health Service was the legacy after the trauma of the Second World War – is very appealing to our rhetorical politicians. But the how of that is the challenge. To effectively create a nationalised care service would bankrupt Scotland in its present form even before the pandemic, never mind because of the pandemic.”

Whether reform of social care comes via a replication of the NHS model, or through other means, the conversation keeps coming back to money. Even without a national care service, the government already helps pay for a lot of social care services, in many cases perpetuating the failures of the existing system.
“The financial issues – [such as the] continued need for PPE – aren’t going away any time soon,” says David Smallacombe. “So the central and local governments are going to have to think differently about how they fund care that they commission.”

Moving away from the idea of government funding social care, we are faced with a complicated question. One that Dr Macaskill posed during our conversation:
“How do you attract inward investment in a sector which is absolutely crying out for a financial investment from somewhere?”

Social Care as a Motor for Recovery

Social care is the victim of many assumptions, often made by those who are yet to experience it directly. In some cases social care is seen as a drain on society’s resources.

Dr Macaskill believes this is a backward perception of the situation:
“I think there’s a collective failure both in Scotland and in England to see social care as an economic driver and contributor and to see social care as it should be: as the baseline for a regenerated economy.”

Social care is far more than just ‘end of life’ care. Reforming social care, both in purpose and perception, to be more preventative, brings with it a wealth of benefits. Including reducing the burden on the ever-stretched NHS

Katie Furey, Operations Director for Cera Care, shared the change she would like to see with us:
“Society wants to be cared for at home, and we should be enhancing everyone’s ageing journey to be a positive continuation of their lives to date. We can achieve this by using the best technology and gleaning insights from AI to truly prevent ongoing health concerns that put immense amounts of pressure on the NHS.”

Becca Young, Policy & Research Manager at Scottish Care, agrees:
“I think the NHS more than ever will be valued for what it’s done. But it’s not sustainable without a social care system that’s sustainable, and able to develop and innovate. And so I think there’s discussions in Scotland about how we become more of a wellbeing economy, that social care is critical to.”

Wellbeing Economics

The idea of developing a ‘wellbeing economy’ is one that has been gaining support over the past few years. At its core is the ideal that the economy focusses on maximising the ‘wellbeing’ of its citizens and their environment. This may sound revolutionary, but in practice this largely means moving towards better integrations amongst institutions. As well as better consideration of the larger impact of industrial actions. And who doesn’t love ‘joined up’ services?

David Smallacombe sees the pandemic as having encouraged these alignments already:
“[The pandemic] made the relationship between commissioning authorities and the Services Commission, and the Care Association, a much closer relationship. So the care associations have been quite fundamental to helping local authorities do what they need to do during this dreadful period.”

While money will always be the limiting factor of reform, it is possible to change the wider perceptions of social care’s relationship with funding. Through preventative care, closer working relationships with other institutions and better communication, it is possible to reform social care a myriad of ways. The crucial part is adopting a different perspective on finance, and recognising the influential role social care can play in the economy.

Next week we will be exploring the role technology has played in social care. And what it can still do to improve the sector.