Kim is Co-Chair of the Coalition for Personalised care and a cancer survivor with a complex history of multiple long term conditions. His experiences of treatment over almost 20 years have given him an insight and lived expertise into how health and care services can be reconfigured to provide a better quality of life for people.
Since Tony Blair set up a Royal Commission on Social Care in 1998 and, after decades of indecision, the eagerly anticipated blueprint for the overdue renewal of Social Care was always likely to be disappointing. Yet, the new White Paper does contain some positives and, perhaps because of its lack of detail, its publication does open a door to potential new opportunities to do things differently.
Pleasingly, there has been some attempt to listen to the voices of lived experience about what needs to be changed and to offer a framework based around the individual and their personalised needs and preferences. This is evident in a more sensitive and compassionate use of language. There is encouraging recognition too of the importance of tackling the non-care determinants of well-being, such as good quality, affordable housing. The need for reform of local government arrangements for the commissioning of care support is also rightly flagged-up.
But, both in response to the immediate crisis in care provision, and in terms of growing future demands, the solutions set out in the White Paper are nowhere near commensurate with the scale of the challenge. At best, they offer only partial remedies. By contrast, the Care Act, with its wider focus on well-being, remains a better approach, albeit one badly implemented so far. We have one of the most fragmented and atomised health and care systems in the developed world, but the promised thinking still to come on greater Integration, to drive both efficiency and effectiveness in both parts of the system, is unlikely to be the “magic missing piece of the puzzle”.
There is little here on the inequities and difficulties of accessing care provision, on the variable quality of what is on offer, and on the lottery of the costs borne by those in need and their families-all of which have visibly worsened over the past ten years. Similarly, there is scant mention of community-based solutions and, with an Innovation Fund of only £30 million, there is inadequate leverage for radical change.
As the key to real and lasting improvement, there is merit in the White Paper’s proposal to create a centralised workforce development fund, to improve skills and career progression so as to attract and retain desperately needed social care staff, but it’s funding equates to no more than £100 a person a year! Care will need to be taken to avoid “medicalising” social care, and losing sight of the individual around whom it needs to be wrapped. At the same time, it must be recognised that the positive growth of direct payment for personal health and care budgets, is likely to complicate the marketplace for such support in uncertain ways. And, of course, social care staff remain underpaid and undervalued, lacking parity of esteem with their health colleagues.
The White Paper lacks an holistic approach, appears naive about the required tasks ahead, and has surprisingly little new thinking to offer on alternative approaches. It is also clearly seriously underfunded. We don’t need (yet another) 10 year vision, but rather a well-funded ambitious plan of bold actions for change over the next three years, with a guarantee at the end of that period that there will be sustainable and adequate funding to embed fully a new system. Such a confident approach must enable new solutions to be tried and tested, with genuine co-production of their design, planning and delivery that fully involves all those who are or will be receiving care.
Within the Coalition, there is a great deal of experience to draw on that can help shape the future of social care. There is much to play for and we are committed to getting behind the spirit of the White Paper, by working with our partners to push open fully this door of opportunity, and to let in the light of new thinking and practice on compassionate care for all who need it! Words need to turn to action to ensure that the (increasingly impatient) public and the social care workforce at long last get the support they want and deserve.
The following of our partner organisations engaged as part of the consultation process on the social care reform White Paper and where a public response to the publication has been published, they are linked below: