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January 11, 2017

Care from within the community

No one seriously disputes that unless we completely rethink our approach to social care within the next few years, the system will collapse. With demand increasing and budgets being squeezed ever tighter, that collapse may come sooner than we think. Even if we could afford it, some estimates suggest that if future demand is to be met, every school leaver would have to enter the care industry. What’s clear is that radically different approaches are required – and quickly.  Martin Sime at SCVO offers some thoughts on where the future direction might lie.


Martin Sime SCVO

BARELY a day goes by without new revelations about the crisis in social care. Across the UK, national and local governments are struggling to cope with growing demand and rising costs at a time of budget cuts and public sector austerity. Something has to give.

Here in Scotland, care is big business. Billions of pounds are spent on adult social care and many thousands of staff are employed by local authorities, charities and private companies to deliver services to people who need help to live as independently as possible. Social care services are a lifeline for many people.

The case for reform is urgent. Each year more people are assessed as needing social care support, at least in part because we are all living longer and our population is ageing. But the debate about what to do for the future has hardly started since crisis management is the order of the day. Finding more money for social care may sound like an answer but raising taxes and charges is unlikely ever to be enough.

Over the next decade our demography and rising life expectancy will outstrip what any government or taxpayers could reasonably offer. Estimates suggest that soon every school leaver would be needed for the care industry. That was before Brexit threatened to reduce the workforce. It’s clear that more of the same won’t do.

A good starting point for the future is that care is personal. It’s what people feel they need that matters most. There is a growing coalition that believes that personalised, person-centred and self-directed are the principles which ought to prevail in the future. The nanny state needs to retreat.

Care is also social. We could build a rather different system from the bottom up which enhances and supports the role friends, relatives and neighbours could play. A stronger society will be better equipped to cope with the future of social care and, one way or another, we will all have to take some responsibility for that. More needs to be done at the prevention end of social care, helping people to stay active and independent for as long as possible.

An entire generation of recently retired people could be encouraged to help with community transport, lunch clubs, care and repair projects, befriending schemes and much else. These need to become the bedrock of our future system rather than the afterthought they are at present.

Of course, some people will still need professional support and formal social care services. Reform is needed elsewhere so these vital services are not jeopardised. A new slimmed-down bureaucracy based on a single assessment formula and aligned with social security would also help.

At the very least it would be fairer and transparent; people who need social care might even understand their rights rather better than at present. The biggest challenge to more self-directed social care is psychological. People will need to be convinced that taking personal responsibility is right and doable for them, their families and their friends.

They will need trusted support and access to information and independent advocacy. Various vested interests will need to be convinced that jobs and budgets cannot be guaranteed. Politicians and regulators will need to recognise that all human interactions involve degrees of risk but enabling people to make judgments for themselves is the right thing to do.

The big message is that helping ourselves and helping each other are two sides of the same coin. We know from pioneering work by people with long-term conditions that self and mutual help really does work.

With modest investment, these community networks reduce demand on formal services, including the NHS. If more people can come together to meet their social care needs in a similar way then everybody wins.

Our public services need to adapt to the demands of a much changed world, including a greater expectation that people want more control over their own lives and more say over what is done for them.

As a country we surely want to live within our means. A more personal and sustainable approach to social care needs to be at the front and centre of that ambition. There is no Plan B.