Imagining a better future for adult social care beyond COVID-19

Principle of subsidiarity

A common theme that emerged from the essays and podcasts is the need for us to preserve a care system which is led, commissioned and delivered close to local communities. As one contributor put it, we need a system which is ‘local by default.’

We are pleased that many of the decisions we take about funding are taken with local people – so we commission what really matters to people.

Commissioner involved in a SCIE’s COVID-19 DHSC-funded meetup

Good social care, it was argued, is locally based, and community-centred, building on local community connections and resources; something the LGA recently expounded in its seven principles for reform.

Social care plays a key role in making connections in our local communities between a wide range of public, private, voluntary and community organisations that all work together in supporting people to be well, safe and independent.

In an envisioned future for social care, locally owned and run organisations – rather than distant national organisations – created personalised care through close collaboration with communities.

Unsurprisingly, given this view, there was little support for the NHS becoming more involved in the funding, commissioning and delivery of care, something that has been mooted in some press stories as a viable option for social care.

Top-down solutions don’t always meet local needs.

Georgia Gould, Leader, London Borough of Camden

There was less agreement across those we have engaged about the role of central government. Most of those who contributed felt that it was the role of the Government to set out the vision for care, and the expectations it has for the sector on standards, similar to the role it took with the Care Act. There was less consensus about whether the Government should go further than this, and intervene much more in redressing variations in performance between local authorities or intervening when there are perceived failures.

What it was seen to have a role to play in was in identifying and backing innovation. Much as the Department for Education has done in children’s social care through its Innovation Programme, the DHSC could create some form of innovation fund to support the growth of proven and innovative models of care.

At play here is a paradox of scale – great care often happens at a small scale but struggles to deal with the challenges of a large population and big problems.

Alex Fox, Chief Executive, Shared Lives Plus

Creating asset-based areas

There was broad support amongst those involved in the essays and roundtable, for a vision of an asset-based care system – one which starts with, and builds on, people’s strengths and assets, rather than their problems or deficits.

Several of those we interviewed for the podcasts talked about the post COVID world as being the right climate in which to build asset-based care, as we could use this period to build on the ground swell of people already keen to help within local communities.

Others pointed to the growing evidence, including SCIE’s own research, which shows that these approaches to care and support, have the potential to enhance health, wellbeing and resilience; reduce long-term pressures on higher-cost health, care and support services and enable more people to participate in and benefit from community resources and activities.

Taking shared responsibility for population health means the NHS, local government and voluntary sectors working together as partners to make the best possible use of their reach, resources and assets to innovate and tackle the causes of ill health.

Paul Burstow, Chair, SCIE

For this to happen, we needed to encourage and invest in a whole-systems approach, which requires sustained action at three main areas.

• Co-production, partnership and power sharing: building and valuing community capacity and community organisations, tackling inequalities.
• A strategic approach: a clear story translated into shared outcomes, asset-based commissioning, grant-giving, and provider market development.
• Diversifying workforces and building local enterprise: investing in volunteers and social entrepreneurs, valuing lived experience, growing mutuals and cooperative organisations.

Collaborative and outcome-focused commissioning

Across all of the insights we received for this report, it was clear that we need a new approach to commissioning; one which is focused on community strengths and assets, is collaborative with providers and the community, and which seeks to achieve whole-person outcomes.

This is the vision we call for in Commissioning during COVID-19 and beyond, a guide we co-produced with the sector to assist commissioners and providers during COVID-19:

Building on the strength of communities is a vital pillar for good commissioning. There is so much to learn from the impact of and response to COVID-19. Equality of access, relevant accessible information, and visibility of people all have impacts on people’s life chances. For people to retain, and in many cases regain, control over their lives, they need to be able to connect with the things and people that are important to them and to participate in their communities.

Innovations are enabled to thrive

Although we have a growing body of evidence about what works in terms of community-centred, personalised care and support – and in terms of new technologies which can transform care experience – we continue to struggle to bring these to scale. The future vision for social care will be one that sees innovative models much more commonplace, central to commissioning intentions, and demanded by citizens who will be much more active in shaping how we design services.

Social care workers’ pay and conditions improve

For too long, the pay, working conditions and level of recognition received by care staff has lagged behind those of their colleagues in the NHS and other public services. In many of the conversations we have had with people in social care to shape the DHSC-funded guidance we have produced, we were told that the low status of care work holds back efforts to improve the quality of care and improve access.

I felt that I was battling alone without Government and public acknowledgement.

Care home manager involved in SCIE’s DHSC-funded COVID-19 programme

In several essays and podcasts, contributors told us that it was time for radical action on low pay and poor conditions in the sector. In the future, we need a workforce which is better paid, receives high-quality training and career development, and experiences good working conditions.

First off, we need to tackle long-term issues with the social care workforce. Care work is highly demanding, physical, skilled work and yet it has always been poorly paid with few opportunities for progression. It is also often insecure work with a quarter of staff on zero-hour contracts.

Deborah Alsina MBE, Chief Executive, Independent Age

Promoting equality

Contributors to this report spoke about the need for social care to do more to tackle deep-rooted social inequalities and social injustices in society. Whilst there was recognition that many of the principles and training in social care are strongly focused on tacking injustice, it was felt that in too many parts of the sector not enough is being done to address inequality within the workplace, promote inclusive working practices, and ensure that there is fair access to good-quality care.

As social workers we need to re-affirm our commitment and ambition to tackle racism, celebrate diversity and tackle prejudice.

Fran Leddra, Chief Social Worker, Joint Chief Social Worker for Adults at the Department of Health and Social Care

In the future, social care will be driven by a strong and clear vision for a more equal society. In this new reality, we will be able to demonstrate that people with protected characteristics are equally able to access high-quality care; care workers consistently seek to challenge discrimination; people with protected characteristics are much more involved in decisions about local care services and their own care, and that people working in social care with protected characteristics are equally able to progress into management and leadership roles.

Growth in housing with care options

Good-quality housing needs to be at the heart of future plans for social care, echoing the Association of Directors of Social Services call for a ‘Home First’ principle. Whilst there will always be some need for residential care, most of those we involved in the essays and the roundtable were of the view that now was the time to invest in a broader range of housing with care options, including extra care, supported living and home share models.

Budgets are devolved to local areas and individuals

In a transformed care system, budgets will be devolved as far as possible down to neighbourhoods, families and individuals, maximising choice and control over how money is spent on people’s care.

In the future, more money will be devolved to the neighbourhood level, and through collaboration with communities, allocated to services which matter most to local people.

As part of this vision, the level of bureaucracy which currently gets in the way in some places of people with direct payments spending their budgets, will also be scaled back.

We measure what matters

As we reform services, we need to put in place a different approach to measuring the impact of care and support. Plans are already underway to update the national adult social care measures, but we need to put in place different measures for contracted services so that we understand their true impact on wellbeing and independence.

In a recent article, Alex Fox, Chief Executive of Shared Lives Plus argued for the creation of key human indicators, instead of traditional key performance indicators which tend to focus on narrow outputs:

Many areas and organisations have key performance indicators (KPIs). Perhaps every area needs key human indicators. Are people achieving wellbeing? That usually means that people who need support are able to experience the right balance of independence and connection for them, which will change at different times in their lives.

A vibrant voluntary and community sector

Reading all of the insights that we have included for this report, there is consistent call from stakeholders for us to shift more investment into the voluntary, community and social enterprise (VCSE) sector, so that it becomes a thriving part of a local social care ecosystem. Investing in the VCSE, it was argued, will help us to create a care and support sector which is better placed to create person-centred, co-produced forms of care and tackle inequalities.

The VCSE is better placed than any service, to connect to people who for reasons of inequality and discrimination, cannot access normal services.

Social worker involved in SCIE’s COVID-19 meetup