Dear Jeremy Hunt, Focus on People with Dementia not just the Cost

Today the Government announced a G8 Summit on Dementia.

https://www.gov.uk/government/news/uk-to-host-g8-dementia-summit

While every effort to raise awareness of dementia has to be welcome, the tone of the press release announcing the event shows that the Government is more interested in cutting the cost of dementia rather than helping those who suffer from the condition.

The press release quotes Health Secretary Jeremy Hunt saying,

“Dementia requires long-term health and social care support that can be hugely expensive. Currently 70 per cent of the global cost is incurred in medically advanced nations like Western Europe and North America. But nearly 60 per cent of people with the condition live in developing countries. As their populations grow and age, the pressure on their services and budgets will inevitably increase.” &

“The G8 today have a unique chance to come together to help people manage dementia better, lead healthier lives and deliver real improvements in care and substantial economic savings.”

Yes the increase of the numbers of people with dementia will put pressure on budgets but, surely, the primary focus has to be how to give people with the condition the best possible quality of life as the disease takes hold.

Yes we need to find ways to eradicate dementia but we also need to help people NOW rather than solely focus on cures that could be many decades down the line.

Yes there are still economic troubles yet to focus on the cost of dementia rather than improving care and support for those who need it now is a shameful way for a Government to act. Social care funding has decreased year on year for at least the last five years and the costs of providing social care have spiked – food and energy inflation have a huge impact on care provision – and the Government has done little to redress this issue.

The press release today effectively labels those with dementia as a cost burden to the State and I hope action will be taken immediately to apologise and redress this.

Social Care - It's Not Rocket Science

How long has the debate around integrated care been going on? It’s a constant theme running through the social care debate yet one that remains fully unresolved and one that seems difficult to achieve but why?

It’s not rocket science!

Take, for example, the space shuttle. That feat of engineering consisted of 2.5 million component parts, including more than 200 miles of wiring! Thousands of scientists, designers, engineers and manufacturers managed to come together to create a single machine that enabled regular space travel. Even so that would not have happened without the thousands of others who also played a role. The astronauts who flew the shuttle were also products of a system that selected, trained and developed them to ensure they were capable of operating such a complex machine. Then there were those on the ground who made sure the launch and landing were successfully achieved.

Yet we struggle to give individuals the integrated care and support they need!

The component parts of providing integrated care are considerably less than those needed for space travel and the cost considerably less!

Yet bringing together social care, health, housing, benefits and employment for the benefit of an individual seem to be an impossible task for the bureaucracy of the U.K.

Obviously because social care is so low on the bureaucratic pecking order it means that the other elements needed for integrated care tend to take precedent. Social care is a small part of the Department of Health and Housing and Benefits sit within in two other Whitehall departments. At the level of the Whitehall bureaucracy focus is on departmental achievement and policy formation with little or no consideration to the individual yet by changing focus to achieving integrated care for the individual departmental achievement and policy formation could actually improve.

With the space shuttle, the goal was achieving manned space travel that could benefit the space programme by being reusable. All those thousands of people involved in the project came together to achieve that goal, integrating their role into that single achievement. Obviously there were disasters yet overall that particular programme was a success.

Those in Government should learn that if the goal of social care is the life of the individual we can begin to make social care the Primary service under which all other elements needed to provide effective integration are mustered and directed by social care services.

Completely effective social care means having a fully integrated service whose goal is the needs of the individual, why is it so hard after all it’s not rocket science.

Winterbourne View Report: Smoke & Mirrors?

Any action to improve the lives of those with learning disabilities has to be welcome and many of the proposals in the Governments Winterbourne View Final Report are good yet that does not mean the report should go unchallenged especially as there are some inconsistencies where it appears the Government may be trying to deflect responsibility introducing ideas that, actually, really already exist.

Norman Lamb and others have focused a lot on corporate responsibility. Norman Lamb said “This case has revealed weaknesses in the system’s ability to hold the leaders of care organisations to account. This is a gap in the care regulatory framework, and we intend to close it”.

In fact the Health and Social Act 2008 made care organisations accountable and open to prosecution if they fail to meet the regulations, and Castlebeck certainly failed on a number of them. The Care Quality Commission also has the power to cancel a providers registration. In addition there are also the legal requirements under the Health & Safety Act 1974, the HSE’s guidance states:

“Recent case law has confirmed that directors cannot avoid a charge of neglect under section 37 by arranging their organisation’s business so as to leave them ignorant of circumstances which would trigger their obligation to address health and safety breaches.
Those found guilty are liable for fines and, in some cases, imprisonment.”

As the abuse at Winterbourne View clearly breaches the Health & Safety requirement to keep everyone in the place of business safe, surely Castlebeck should have been prosecuted.

Rather than taking time to draft new legislation surely it would make more sense to ensure existing legislation is being used effectively.

We also need to take care over how the Government frames the action which it proposes to take, for example in its timetable for action we have:

From June 2012 – CQC will take enforcement action against providers who do not operate effective processes to ensure they have sufficient numbers of properly trained staff, &;

From April 2013 – CQC will assess whether providers are delivering care consistent with the statement of purpose made at the time of registration
Although welcome moves the real question, unanswered by the report, is why were these not already happening? Both are required by the Health & Social Care Act regulations and, as such, form part of the requirements of registration. Yes there has been a change of leadership at the CQC and things have improved but it does not mean that such things should be omitted from the report nor does it excuse the absence of any action to ensure such things do not happen again.

The report also fails to answer the question of Government inaction on social care, particularly in terms of those with Learning Disabilities where the principles of Valuing People seemed to have faded in to dim memory. Much of what is being proposed should already have been in place and it is the Governments neglect of social care that means they are now only acting because they are forced to.

There is also a serious omission from the report that is equally important to the Winterbourne View case and that is Whistleblowing. Action could have been taken much sooner if the reports to Castlebeck and CQC were acted upon and some of the abuse witnessed in the Panorama film would not have happened. Yet nowhere in the list of action to be taken is a review of existing Public Interest Disclosure law, the responsibilities of statutory bodies to act or even report when abuse is alleged.

For all the effort to prevent abuse it is still down to people reporting it before it can be truly uncovered, I doubt very much if regulatory bodies have uncovered abuse through annual inspections, and therefore there has to be much more done in the way of encouraging people to disclose abuse along with a much more robust response when such reports are made that reports all allegations not just those that make it to safeguarding referral stage.

It would be wrong throw out the baby with the bath water and there are some very positive proposals in the report. It is right to end the existence of these pseudo-hospitals and it is right to move all people with learning disabilities toward person centred support.

We need more action on learning disability services and not just for those who find themselves confined in so called hospitals. Abuse happens in other places to and we need equal action to eradicate hate crime in the community where life is not regulated by the CQC.

This report should just be a start, let's have a new white paper on how the Government and society will support those with Learning Disabilities to lead fuller and safer lives.

Cabinet Minister for Social Care: Business Focus

Yesterday the Daily Telegraph revealed that the big care companies have a total debt of £5 billion (http://www.telegraph.co.uk/health/elderhealth/9655229/Britains-biggest-care-home-owners-have-5-billion-debts.html), also yesterday Ed Miliband declared support for the ‘Living Wage’ saying “there are almost five million people in Britain who aren’t earning the living wage” (http://www.labour.org.uk/ed-miliband-speech-on-the-living-wage).

It is probably fair to say that at least one in five of these people are frontline social care workers who are on, or just above, the national minimum wage.

The current minimum wage is £6.19 per hour and the touted living wage is £7.20 per hour, the average pay for a care worker sits neatly in between at £6.65 an hour. So to reach the living wage employers need to find 55p per hour per employee working, on average 40 hours a week for 52 weeks (inc holiday pay) a year. With this applying to over a million people the cost will be around £1.1 billion a year, add into this employers NI contribution etc. and the cost gets higher.

I totally and whole-heartedly agree with the living wage and the benefits of it to social care will be enormous, particularly in terms of recruitment and retention but the real issue is where will the money come from. Most agree that social care funding is in crisis and without promises of extra money to fund the living wage the only place it can come from is existing care services and as noted earlier the debt situation of the bigger care providers hardly suggests that they can afford the living wage whilst maintaining care standards.

Many people easily and comfortably slip in to the idea that social care is a Government run and funded thing yet the reality is, of course quite different. There is no homogenous entity such as the NHS as social care is provided by, according to Skills for Care, approximately 22,100 organisations over 49,700 establishments. Just to put this number in some sort of perspective, the total number of high street bank branches across the UK is just 11,000. This vast, complex myriad of care providers range from the smallest micro-providers to the huge debt-ridden big companies, from not-for-profit voluntary organisations to those owned by offshore parent.

Social care is big business, around 20% of local authority spending in England goes on social care equating to around £21billion per year, so it is no wonder some offshore companies feel there is money to be made, and, of course, this does not include the money paid by those not entitled to local authority support or those who have to pay ‘top-up’ fees to providers.

Yet, despite this seemingly high amount, the payments by local authorities have declined in real terms over the past few years, with eligibility criteria also tightening, and many professionals agreeing that social care needs an urgent injection of real cash to prevent and halt the constant cut back in services.

The business of social care can be as complex as meeting the needs of many individuals who need care services yet everything is the responsibility of a junior minister within the Department of Health.

I truly and honestly believe this needs to change and I would ask you to support my epetition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

New Ministerial Team MUST Act on Social Care Now

The latest figures from the NHS on council funded care services show, one again, that there has been an overall fall in the numbers of people receiving services. 110,395 less people received services in 2011/2012 a drop of 7%.

At the same time the Royal College of Physicians warn that acute hospital services are on the brink of collapse because of the increasing number of elderly patients, particularly those with dementia, they claim that many feel that older people ‘shouldn’t be there’ and are calling for a redesign of services to better meet patients need (click here for RCP press release).

In other words it appears we are seeing a reduction in community care services resulting in increased pressure on the NHS and this is an issue that needs to be tackled immediately.

This situation is one that can only get worse if left unchecked by the new Ministerial team at the Department of Health.

Kent County Council, for example, are proposing (in their 2013/14 budget consultation) to reduce spending on adult social care by £18m, a cut of 5% and while they claim to be able to do this without harming care services it certainly seems the reduction in council led services is only increasing those in the NHS. Undoubtedly other councils are proposing similar cuts in the adult social care budgets which will lead to more elderly people entering hospital.

The popular press has lead the campaign on who should pay for social care and it seems likely that the Dilnot proposals will be introduced. However this does not solve the issue of how much social care costs and, it seems now, we have some evidence that lack of funding in social care simply transfers the issue to the NHS and, undoubtedly costs the state more in the process.

Care for older people in England, particularly those with dementia, needs to be examined properly and the costs of providing the best possible care acknowledged.

It is only by properly assessing the cost of social care that the issue of who actually pays for it can be sorted.

We have a new Ministerial team in the Department of Health and they must put the care of the most vulnerable in society at the top of the list otherwise the crisis in care will only continue and lead to a greater crisis in health provision.

Raise the Social Value of Social Care

“Why is it you need a degree to get a job in fashion, but when it comes to looking after our most vulnerable members of society any one with no qualifications can get a job as a support worker?” (Guest Blogger, Whose Shoes: http://wp.me/p1enjT-tu )

The above quote highlights one of the intrinsic issues facing social care in today’s society and that is the social value of care services. Whilst the Government will focus on than who actually pays for social care, rather than the actual cost of care services and others focus on the quality of care services provided, yet perhaps where we need to start is changing the view of the wider population to view social care as an essential service, as essential as health given the demographic trends, and a view that social care is there to enhance life rather than be the beginning of the end of life process.

Social Care is not a highly rated career choice. Be honest and ask yourself would you encourage your son or daughter to pursue a career in social care? While many people, when asked, will state that they admire care workers and the work that they do, I suspect that many parents would not be encouraging their children to undertake such a low-paid, low esteem job role. This is, perhaps, reflected in the demographics of social care workers with those aged between 18 & 24 making up around 14% of the workforce and even if we include those up to the age of 34 we still only get to 36% of the workforce. In other words, two-thirds of care workers are aged 35 or above.

This rather suggests, although I can find no research to back it up, that social care work is a career of opportunity, i.e. a matter of what is available when needing a job in later life, rather than a deliberate career choice.

Yet, surely, caring for those in most need in society should be a job that is celebrated and regarded as an important role in our society, one that is rewarded appropriately in accordance with the gravitas associated with the work role.

Another, yet highly connected, issue in terms of valuing social care is that the seeming denial of many people when it comes to their own future and the potential need for care services in the future. Naturally none of us like to think about the possibility of getting old or suffering from some form of dementia and that denial leads to people ignoring the idea of social care until such time that it touches their lives. People do not want to think about being reliant on others to help them through their daily lives and, subsequently, do not think about the type of person they would want to deliver that care.

The same type of denial applies to other types of social care. If it does not directly impact on the life of a person they tend to ignore the issues of those with learning disabilities or mental health issues.

The forthcoming White Paper needs to do more than make technical changes to the current system, it needs to reach out to those not yet affected by the need for social care services and highlight that social care is about everyone’s future not just about those who need services now.

Raising the social value of social care is vitally important and needs to be the priority of Government Policy

Let's Get Social Care Out of the Darkened Corner

The Health & Social Care Act 2008 received Royal Assent on 22^nd July 2008 but the bulk of the provisions relating to social care where not put in force until 1^st October 2010. So, in essence, there was a two year gap between the final stage of the Parliament and the implementation of the Act. Of course, this is just the end of the process, a bill has to travel through the parliamentary process. For example, the controversial Health & Social Care Act 2012 had its first reading in Parliament on 19 Jan 2011 and received Royal Assent on 27 Mar 2012, probably an extreme example but it highlights the length the process can take.

What’s the point of that little tour of the Parliamentary process?

Simply speaking, the current Government has three years, at the most, left and unless they take action soon on social care there will not be any changes to the current system while this Government is in power, if they do, eventually, legislate it will be left to the next Government, whoever they are, to implement any changes made. And, more importantly, it could be close to three years to see any substantive change in the social care system (always assuming the Government put any substantive changes in a bill!).

To most of us in the sector such prevarication on social care is not unusual and not just limited to the Government in power at present. I won’t repeat the gist of my previous blog (Politicians Seem Clueless About Social Care) but suggest what we need is a radical approach to reforming social care at the very top.

When Ivan Lewis was named care minister in 2006 he promised a radical review of social care, unfortunately that never happened and the first announcement of a consultation on social care came only once Alan Johnson took over the role of Health Secretary from Patricia Hewitt a year later. This suggests that any real action on social care is decided by the senior minister who sits on the cabinet.

Obviously the Health Minister is generally more concerned about Health Care rather than Social Care as evidenced by this Governments pushing through the 2012 Act despite opposition from many health professional organisations. Social Care seems to occupy a tiny corner within the Department of Health thinking.

But why does social care sit in the Department of Health?

Social Care is not a minor area of public policy to be handily attached to what appears to be the most appropriate Ministry.

The number of people receiving local authority funded services in 2010/2011 was 1.6 million and this excludes people who pay for their own care and people deemed by social services as not having sufficient need level to qualify for support and who are cared for by unpaid family members etc., so true figure of those who may need social care services is considerably higher.

Skills for Care estimate that the social care workforce also numbers 1.6 million. So, at a minimum, 3.2 million people are involved in social care services. Add to this the fact that Skills for Care also “work closely with the 40,600 organisations that offer social care people who use services, carers and with other key stakeholders” and it is hard to see why social care does not get much more attention than say the Department of Culture, Media & Sport which has a Cabinet Minister in Charge.

It is also important to remember that social care is not just about health, although that may play a significant part in end of life care etc. the role of social care is to support and care for individuals in their day to day living and health remains the responsibility of health professionals. The public often only connect social care with elderly care but it goes beyond this and beyond the remit of health.

For adults below the age of 65 who need social care services much of the focus is on appropriate housing, employment opportunities and living independently. The latter of which is also a focus of social care for the elderly. Social care is about maintaining links with society and maintaining social well-being in addition to health well-being.

We need action on social care and we need political consensus rather than political paralysis. Let’s start by achieving consensus that social care should not sit in a darkened corner of the Department of Health and it deserves its own Ministry with its own Minister who sits on the Cabinet and has the opportunity to bring forward legislation but more importantly to show that Westminster is truly serious about working for the millions in the country who receive or are involved in delivering, social care services.

Personalisation: Structure and Agency

A basic common debate within social sciences is the question of structure versus agency, how the social structures of society impact on us as individuals and how our individual choices and freedoms are constrained by those social structures.

These arguments need to be considered in relation to social care, particularly personalisation.

The Social Care Institute for Excellence give us the following definition for personalisation;

"Personalisation means thinking about care and support services in an entirely different way. It means starting with the person as an individual with strengths, preferences and aspirations, and putting them at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives. It requires a significant transformation of adult social care so that all systems, processes, staff and services are geared up to put people first"

This shows the intrinsic link between structure and agency within delivering personalisation. It could also be argued that it demonstrates why personalisation has been difficult to achieve and why personalisation will never be truly personal unless there is a major change in the way social care is structured.

The SCIE definition describes the individual as being at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives.

In other words, the person is at the centre of the structure! But, how much is their individual agency constrained by that structure.

Unfortunately that structure is one that limits those choices available for personalised care and support and it is a multi-layered structure, each layer filled with bureaucracy and each layer with, at times, competing agendas.

The big, over-arching layer of structure in social care is, of course, Westminster. Parliament set out the laws and regulations under which social care is practiced in England, it sets out how social care is funded and it sets the structure under which personalisation can operate. This is all administered by the Department of Health who, as is its name suggests, has a primary focus on health and while many aspects of social care may overlap with health there are many other areas, such as housing and welfare, that do not.

The next layer in the structure is the most diverse and, perhaps, Weberian in its nature and that is the delegated bureaucracy. The role of implementing and enforcing the dictates of Westminster is handed down to a myriad of Quango’s (e.g. CQC, NICE etc) who have their own structures for implementing the written law handed down to them and of course, 152 local authorities with responsibility for commissioning state funded care and again with their own structures and political leadership which may vary from that sitting in Westminster.

The next layer surrounding the individual is the providers of care services. This is not just care homes or home carers, it also includes Social Workers who provide a service on behalf of the local authorities, providers of advocacy services, services which provide employment opportunities etc.

Eventually we reach the person needing care and support services.

Whichever way you look at it, as a top down structure or a circle with the individual at the centre, the layers of structure hamper the ideals of personalisation.

Those who provide services can only do so in controlled circumstances, they must be appropriately registered or have an appropriate contract and the services must be provided within the budget available. For those who need to choose services the choice becomes limited by these structural constraints, even those who have personal budgets or direct payments have the budgetary implications to consider. Whatever an individual’s strengths, preferences and aspiration, services can only operate within the structure dictated by the layers that surround care provision and the rules and regulations imposed on them.

This is not to argue that such constraints should be removed but that the structure should be revisited if we are to improve social care services and increase the opportunities for greater personalisation.

We are trying to move from a top down structure to one that has the individual at the centre yet the actual structure remains the same and has the same constraints on agency. If we want to change the outcomes for individuals we need to take a real look at the structure within which social care operates.

Social Care - What's that then?

What is social care?

To those of us who work in the sector that is probably an easy question to answer, although I suspect many of those answers will actually be slightly different, but what does it mean to the general public and the mainstream media?

It is perhaps the vaguest of all social policy areas after all most social policy is easily understood. Housing refers to where people live and the links between poor housing, welfare and deprivation are fairly easy to see to the average person (obviously to specialists things are much more complicated than that). Education means teaching our children to learn and, while there may be arguments on the best way to do this, when politicians talk about education the general public knows it is about schools, colleges and universities. Employment is about getting people to work and ensuring that the conditions of work protect employers and workers. Welfare is about the State supporting those in need, yes they is a debate about how you define that need but we all understand what is meant by welfare.

Health is also an easy issue to understand, it is about our physical and mental well-being. If we are ill we see a doctor, the type of doctor we see depends on what is wrong with us. We would expect our G.P. to refer us to the appropriate specialist in either physical or psychological issues and then expect to be treated by them, and that the system that the general public expect social policy to support. One of the reasons for the animosity toward the Health & Social Care Bill is the worry that changes may make this system different and more difficult to achieve the best possible results for our own health.

But what about social care? How easy is it for the average person to understand what social care means when politicians and professionals talk about it?

In 2006 the Department of Health described social care as “the wide range of services designed to support people to maintain their independence, enable them to play a fuller part in society, protect them in vulnerable situations and manage complex relationships” (DH (2006) Our health, our care, our say: a new direction for community services.)

Yet does that really mean anything to the average person?

Take, for example, services to support people to “enable them to play a fuller part in society”. The majority of people tend to think of social care as services for the elderly, something not helped by politicians who insist on focusing on how elderly care is paid for, and would find it hard to see what playing a fuller part in society would actually mean. After all for most people life does not involve “society”, it just revolves around work and home life (yes I know that is society but how many people think of it like that).

Social care does, naturally, support people to play a part in society, beyond supporting older people, support for people with disabilities involves trying to enable people to getting employment and if that is not possible ensuring that they receive their full entitlement of benefits (but, says the average person, isn’t that employment & welfare policy?)

Social is, or should be, about promoting and maintaining independence and enabling people to live where they want to live and ensure they are living in accommodation that is most appropriate to their needs. It is about ensuring that people have the adaptations and support in their home or, if their needs are greater that they can find accommodation in a home that will allow them to be as independent as possible whilst minimising potential risk (but, says the average person, isn’t that housing policy?)

Perhaps the mainstay of social care is providing personal support for people who are no longer able to support themselves. The reason for not being able to support themselves is generally down to physical or mental deterioration, age related conditions can be physically disabling and diseases, such as dementia, impact on the mind. The role of social care is to ensure that these people have support in maintaining their physical and mental well-being (but, says the average person, isn’t that health policy?)

There has been a lot of talk about integration in social care but the real fact is that social care is the integrating service.

Social care should be about bringing all other policy areas together for the benefit of those who need them. Social care should be seen as the umbrella under which all other policy areas sit because all of the areas could may need social care intervention. This is especially true if we include children’s as well as adult services in our overall definition, education, housing, welfare, employment and health all have an impact on the “social” and where they fail it is down to social care to step in to aid the individual, whether vulnerable child or adult, and support them to achieve the best possible outcome.

To raise awareness of social care we need to be able to define it in a way that the general population can understand and that definition should be one that shows the importance of social care as a policy area that embraces and sits above m

The Voice of the Vulnerable

The Guardian’s Social Care Network has recently asked the question “How do we give service users a voice?” yet the fact that the question needs to be asked does, perhaps, highlight what is wrong with the current social care system and why we need wholesale reform to achieve social care that meets the needs of those who need it.

The most obvious answer to the question is, simply, that we ask those who use the services and, more importantly listen to what they say. But, unfortunately we have such a fragmented and somewhat territorialised system that any messages have to pass, in the manner of Chinese Whispers, upwards towards those who make policy decisions via the agendas of the various parties involved.

If we start with the individual the person who will listen to them the most and who probably has the best rapport with them is the frontline care worker. There may be occasional contact with a social worker but my general experience this will only happen once or twice a year at reviews, obviously families will probably also be involved in listening to what the individual thinks about their care package.

The route for the care worker is obviously their own line management but that would require the care worker be given the time (and be paid for it!) to sit down with the manager to outline their discussions with the care user, how things could be done differently to meet their needs and how the care service an improve their overall care delivery.

From there the route upwards means the care provider talking to the local authority funding the care to pass on the individual’s views and what they want from their care package. Yet there are probably very few opportunities to do this except where reviews take place and there is almost certainly not enough time to discuss everything the user may have said over the intervening period and be more focused on the care plan in place. It is also at this point the Chinese Whispers can begin with the agenda of the provider being set.

For example a care user might have said they would prefer to have their care at a particular time and the care worker would have passed this on, but if the care provider was unable to facilitate this because of staffing levels etc then would they necessarily pass this on to the local authority, especially if they feared the contract could be passed to another company who could accommodate that.

Once the care provider has passed on the views of the care user to the social worker then it will get passed along the upward line of the local authority where, to be brutally frank, it is likely to get lost or transform from the voice of an individual into a statistic aimed at proving why the authority should get more money from central Government. Of course the message may have to go through the NHS route and that is equally convoluted.

So by the time that the voice of the care service user gets to the Department of Health it has changed beyond recognition ceasing to be a voice and just one of many numbers that are processed by the bureaucracy of Westminster.

How do we stop this? Well the simply way is to ensure that all user comments about their care service are written down. This may seem a little old fashioned but it achieves one thing – the original message retains its value, unadulterated, on the way to the top. Yes it would generate a lot of paperwork (or e-paperwork!) but at least in Westminster they would have access to the qualitative data in addition to just the quantitative stuff!

In reality the problem is a fundamental one, the distance between the person using a service and the policy makers deciding what is best for individuals is an immense chasm with a rickety bridge connecting the two. The change in social care needs to address this, it needs to ensure there is a smoother, undistorted route for the users of care service to move up the line towards those who make the policy and hold the cash.

Not easy by any means but worthwhile it we are to achieve the best social care for those who need it.

Building Social Care

Social care is full of concepts and the problem with concepts is that there are difficult to get across to the wider population as it is difficult to grasp what something actually means, especially when those espousing the concepts of put different interpretations on what they mean.

Take for instance the Social Care Institute of  Excellence   definition: "Personalisation means thinking about public services and social care in a different way – starting with the person and their individual circumstances rather than the service" 

Compared with the Department of Health version: "every person who receives support, whether provided by statutory services or funded by themselves, will have choice and control over the shape of that support in all care settings" 

Broadly similar but the first takes personalisation as being outside the care service where the latter stresses that personalisation occurs within the care settings.

That is, of course, pure semantics but it serves to illustrate how talking about social care is open to interpretation both by the organisations delivering the message and those listening to it and why listeners may simply switch off if they cannot fully understand the message being delivered.

To add to the general woolliness of social care speak many of the more recent concepts, such as personalisation, are being inserted into a system established 20 odd years ago and may not always be totally compatible without significant change to the system.

To illustrate in more, literally, concrete terms.

Most people agree that personalisation needs to underpin social care (and other public services), it needs to be the foundation on which such services are built. Yet if you can imagine social care as being a house exactly how easy is it to change the foundations without tearing the house down and rebuilding it? But, I hear some people cry, surely personalisation could be used to underpin the subsiding house of social care that is sinking rapidly yet is this a wise move using personalisation to simply prop up a house that is no longer fit for the ever growing family that is needs to accommodate.

We can extend the metaphor to the forthcoming white paper. Will it be an instrument that simply attempts to paper of the cracks in the social care house? One that replaces the odd rotten beam rather than tackle the endemic rot in the system, maybe it will knock through a few walls to allow for more space to accommodate prevention or even add an extension out the back to allow room for the ever growing number of people who will need social care over the next few years.

Or will it be a white paper that recognises that the house is no longer fit for purpose and tear the whole thing down in order to build a bigger   higher   social care house with firm foundations on personalisation and one that has personalisation insulating all the walls. A new,   desirable,   house that has more than enough capacity for social care to grow, has wide corridors making it easier for those who live in it to move from one room to another and, perhaps, even adjoin the Health Services house with a single door through which people can move with ease.

To  engage   the public in the importance of social care and   build   public awareness we need to ensure that the language we use is accessible to all and that the message being sent is consistent, whether we undertake extensive repairs to the social care house or rebuild a shining new ‘des res’ the important thing is to get the planning permission through with the support of the general population and the millions who will need to live in the house in the future.