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The national care picture looks bleak – but locally the story is different

Andrew Cozens
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Is it possible to be positive about the future of social care in England at the moment?

A number of recent experiences have given me hope.

At a national level, the evidence continues to mount that the current models of health and social care are overwhelmed by immediate demand and that social care is being rationed, delayed or denied to help manage the growing crisis. The May government has been worryingly silent on addressing this.

My gentle optimism comes from the national dialogue about delayed discharges and the risks of market collapse. It is drawn from observing grassroots thinking and activity, much of which focuses on prevention, recovery and building on individual and community strengths. In it, I hear echoes of the ‘small is beautiful’ arguments about economic and environmental sustainability.

At the heart of this analysis is the recognition that social care is not a single entity but an umbrella term for activities, interventions and services, short- and long-term, that address basic human needs for support. Most policy has focused on the formal response to demand, funded and regulated by the state, and how eligibility should be determined. We have hung onto the Poor Law premise of personal responsibility first and of assessing need and means at the point of entry to services.

New approaches to prevention look for the tipping points when the ability to cope or to organise your own support networks is weakest, by virtue of crisis, capacity or opportunity. They look for new ways of giving people back control through advice, signposting and networking, often at no or low cost.

Models drawn from public and community health, community development, and social work are being tested as part of a strengthened focus on assets, wellbeing and quality of life for those who might otherwise have tried unsuccessfully to get through the eligibility barriers. Interestingly these are based on different business models - social enterprises, cooperatives and entrepreneurial endeavors - alongside more traditional charity and company models.

There is also a consistent challenge to the inevitability of losing independence if the crisis requires a hospital stay. People are likely to be at a low ebb at this point and need organising and motivating to return to full function. Recognising this, the pressure to make life-changing decisions is being tempered by finding space and time to recover and regain confidence and control.

Finally, I am always buoyed by meeting staff who tell me they love their job and show me how they are making a difference. For them we should keep clearing the jungle of despair and cynicism that currently surrounds social care.

Andrew Cozens, independent social care and health specialist

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