We all know what it means to care and be cared for. The way we protect and empower the people around us, according to their needs and hopes, is part of what makes us human, and builds communities and society.
Yet the 2018 expression of care, in both our public services and private institutions, has become deeply inconsistent with this. We are in thrall to the technocratic and managerial provision of efficient services, the prioritising of acute ‘rescue’ interventions, and ongoing funding constraints.
If we want to effectively implement change, the social care model needs a new story fit for the 21st century. We need to elevate the system from being viewed as a secondary need to one valued as critical to society.
The current national debate about adult social care is in a poor place. And the recent Budget and events surrounding it were no exception.
NHS acute care costs eat into money for almost everything else, including social care and other parts of the NHS. A grown-up debate about funding alternatives and tax is avoided.
In his Budget, the chancellor highlighted spending on crisis interventions in mental health and on the relationship between hospitals and social care. But regions and localities are dependent on the centre to meet growing costs, in a mechanism almost unique in Europe. Underpinning all this, the government system for adult social care remains largely unchanged since the war.
The Budget showed how we have allowed social care to be defined by the dynamics it is meant to avoid. Focuses are on treatment, not prevention; medical imperatives, not social ones; top-down service, not bottom-up networks; and intervention, not support. Whilst adult social care does have to manage crises and provide care in institutions, there is more to it than that.
What the state and other institutions ‘provide’ is only the visible part of the care iceberg. Below the waterline is a complex system of interactions and relationships – some formal, some not – which are a far bigger expression of care than a care home’s Care Quality Commission ranking or the annual budget settlement for a council. We do not nurture these interactions well, if at all.
Often, they emerge despite the system, not because of it. And I fear adult social care is losing the connection between these two parts. We are panicking about what sits above the waterline and forgetting to prize what sits below.
Working with the consultancy Jericho Chambers, we conceived our project A Caring Society because the current debate about money, structures and services is not the one we or society needs. We can’t hope to assert its value and achieve real change if we continue to be defined by how efficiently we manage the ‘care superhighway’ from hospital bed to care home.
Our emerging theory of change suggests three steps any system or place needs to work through.
First is reclaiming the meaning of care. We are stuck with declining budgets and services, focusing on technical aspects of delivery. We are therefore missing the incredible level of informal care provided across the country, which greatly dwarfs that provided by the state.
We need to reshape our priorities, draw on the compassion of people and begin to prize the £60bn-£100bn of informal care recorded by the Office for National Statistics, not just the £15bn-£20bn in state-commissioned services.
Second, we need a new role for the state. Local government is hard-pressed, but it is not all about money. A new social care role for local government should emphasise its ability to convene, explore data and plan to challenge and support the complex social model.
The management revolution in Barking and Dagenham LBC, led by its chief executive Chris Naylor, is proof that we can turn local government upside-down to meet the needs of society.
Last, we need innovation that really works. It can come from anywhere: public sector commissioners, large private providers, informal carers, frontline industry staff, tech giants and small tech collaboratives.
But no matter where it originates, innovation in care often gets stuck, with few managing to successfully change the model. The Shared Lives network, led by Alex Fox, is perhaps an exception. A Caring Society is the precondition that will allow innovation to scale.
The Budget was depressing, and the green paper might be as well. But while government can help or hinder, this is about our own agency in lifting the social care model from the margins of the NHS plan to the starring role in its own story.
Alex Khaldi, partner and head of social care insights, Grant Thornton