The year 2014 was another cataclysmic one for social care. More cuts, more high-profile reports of abuse and even fewer people ensured the support they need.
But don’t just take my word for it. Former coalition care minister Paul Burstow described the homecare system as “close to crisis”. The Care Quality Commission’s chief inspector of adult social care, Andrea Sutcliffe, spoke of “too much awful care” in residential homes. The current care minister, Norman Lamb, said the wages of some care workers were “completely unacceptable and a disgrace”.
With a rhetoric-ridden but weak and ambiguous Care Act due to come into force in spring 2015, there is little sign of anything much changing for the better. Yet millions of disabled and older people and family carers know only too well that we can’t go on with such insecure and inadequate services and support – and these have to face even more draconian funding cuts. In this general election year, we’ll all have our own lists of prerequisites for improvement.
For a start, here are my top tips for change – and we should all be checking the manifestos of every party to see how they match up to what is needed.
First, the chaos that is government social work policy must end. We’ve had the Social Work Reform Board, Munro inquiry, Narey and Croisdale-Appleby reviews, yet practice, particularly for adults, is increasingly marginalised and the prospects for children and adults at risk increasingly uncertain. We now have a fragmented social work education system which includes Step Up To Social Work, Frontline, Think Ahead and underfunded, under-valued mainstream courses at colleges. What’s most needed are skilled social workers spending more time with service users. The present ideologues’ beanfeast is taking us in the opposite direction.
Policymakers must come clean about personalisation and personal budgets, the central plank of government social care policy. They must admit that its evidence base has increasingly been called into question. They must face up to the fact that the gap between the claims of enthusiasts and the experience of service users, carers and practitioners on the ground means that radical policy review is long overdue. Plans to export this initiative lock, stock and barrel to the NHS also need to be urgently re-examined.
The social care workforce must be revalued. Three key issues highlight the fundamental problems facing it, if it is to deliver reliable, high quality care at a time of greatly increasing demand through major demographic change. The terms and conditions of care stuff have to be improved; there must be a real career structure for workers and the negative stereotypes associated with care work must be challenged by improving the reality.
Reprioritising social care and getting it onto firm financial foundations is going to be a long job. But in the meantime, a start must be made on recording unmet need. It is because this hasn’t happened that “need” has come to be defined by ever narrowing “eligibility criteria” only to mean the need that is granted a service. This flies in the face of every political commitment to preventive policy. It is why ministers like Paul Burstow have been able to get away with claiming that there is “no funding gap” when some estimates put it at as large as £7bn. Every frontline practitioner, committed manager and service user in need knows that claims like Burstow’s are not true.
Integration between health and social care has become the government mantra. But what does it mean by this? If it translates as exporting the medical model to social care, it is unlikely to be helpful. If it means making the national health service more like social care by increasing privatisation and outsourcing, weakening universalism and raising charges, then it will spell the end of the NHS that people love.
Prime ministers, politicians and policymakers should no longer be allowed to talk about family carers as “heroes” or “heroic”, unless at the same time they introduce concrete provisions to improve their and service users’ circumstances and support.
The appalling large scale child sexual abuse emerging from Rotherham and elsewhere in 2014 is likely to chacterise social care in public memory for the year. If the resulting shared feeling is “never again”, then this must be the trigger for valuing and listening to, rather than ignoring, the voices and experience of the many groups facing abuse and oppression. It is this rather than more easy rhetoric about “user involvement” and “co-production” that is now needed. Social care has long been a sector whose primary purpose is to challenge imbalances of power and resources by offering advocacy and support. This is perhaps one of the reasons for its political unpopularity. We all need constantly to remind ourselves of this, its underpinning role.
Finally, 2014 has also witnessed other high profile expressions of abuse – older people assaulted and neglected in residential “care”, people with learning disabilities bullied and tormented in supposedly specialist settings. Installing intrusive cameras in service users’ rooms and homes says less about seeking solutions than increasing social control and restricting responsibility to under-resourced frontline workers.
Systemic change is essential, and all political parties (as well as the rest of us) should turn their attention to it as the general election offers a chance for change. Renewing social care has to be a long-term project, but 2015 should be the year that policymakers make a start on it.
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