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

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.

Are we too focused on service user involvement?

Are we too focused on service user involvement in care services?

I know that is a controversial question but make no apologies for it because I think it is a debate worth having because while we  focus  on that we may be missing some of the essential ingredients to  truly personalised  care and support provision.

The idea of service user involvement is a natural extension of the theory of Social Role Valorization (or normalisation or an ‘ordinary life’ which ever term you choose to use). The idea behind this is that all people with disabilities should have the same conditions in life as are offered to the general public and that they should have the same should have the same opportunities in housing, education, health and freedom of choice. It does not mean that we should try to make everyone ‘normal’ but it does mean the same conditions of life should allowed to occur.

So why could we be too focused on service user involvement? Let’s take two areas where it is touted as a good thing for users to be involved in, recruitment and supervision.

The aim is to create an ordinary life, the same as the general population but at what point do the general public get involved in the recruitment and supervision of people in the services that they use? When was the last time you were given the opportunity to sit in on the recruitment process of your bank, your G.P. or your local NHS Trust or, indeed, have the opportunity to sit in a supervision session at your local council, supermarket or energy supplier?

The fact of the matter is we are all service users in one way or another, the principle difference being the majority do not use care services but if people are to be given the opportunity of an ordinary life then, surely, care services (in this sense) should be treated the same as any other service.

This is where the true difference occurs and where social care fails in providing the opportunity for an ordinary life. What do the general population do if they are really unhappy with a service they receive? Simple, they change the suppliers if they are able to or, if not (as in NHS services), they will challenge the quality of the service.

What many service users lack is the opportunity of freedom of choice in the service they receive and it is the denial of freedom of choice that needs to be addressed.

How much choice to service users get in the social worker ‘allocated’ to them to assist them in sorting out their care package? An unfair question because we would not expect any other service to give us the choice yet if we were unhappy we would be able to move to a different provider, something not available to care service users or we would be able to make a specific request about the type of person we wanted to help us – how many service users are given that choice?

And what about the choice of actual care services? Is there a real choice or are service users again ‘allocated’ the approved local authority contractor? Given that we are talking about vulnerable adults, is there really an adequate mechanism for challenging the quality of the service and a choice of care provider available?

Service users should be involved in their care but rather than the somewhat tokenistic concept of involvement in recruitment, supervisions etc. the real involvement should be in the choice of services they receive in order that they can have the ordinary life opportunities available to the rest of us.