A View from the Top
Sara Livadeas

Sara Livadeas is Strategy Director for The Orders of St John Care Trust (OSJCT).

Reflections on the last decade

Since I started my career in social care over 20 years ago, I have seen a huge improvement in the support available to people. We have moved from a one-size-fits-all approach, with the majority of services delivered by councils, to a vibrant care market underpinned by notions of individual entitlements and choice.

While I still see variability, the progress we have made in creating a more person-centred approach to care is a real success. We need care homes to become smaller and more intimate, perhaps along the lines of the Greenhouse model. What older people really need is love and intimacy – and that can’t be delivered in a large institution, however hard we try.

Projections for the next decade

We aren’t doing enough to help individuals plan for the challenges that come with ageing. By the time people accept they need care, it’s often too late to influence the type of services that are available to them personally.

There is a surprising lack of debate about the sort of help people should receive when they are old. It seems that politicians are just as likely to stick their heads in the sand when it comes to planning for an ageing society. The fact that people with dementia, which is an illness, have to pay for their own care, is a national scandal. I wonder if the fear of dementia itself stops us from having the debate.

I hope housing with care on-site will play a bigger role in the future. Someone needs to bang heads together to make more land available for retirement housing in the locations where people want to live. I’m thinking of the size of the NHS estate and other institutions like the Church and universities where they own land. This generation of older people has benefitted hugely from policies that favour home ownership. If we can make equity release easier so people can fund their own care and downsize, releasing family housing for the next generation, then everyone is a winner. Making the UK a great place to live when you are old is not the responsibility of any one agency.


During my time working as a commissioner for Oxfordshire, I saw local authorities making a lot of efficiencies and they rightly expect providers to do the same. I hear a lot about underfunding in the sector, but less about cutting costs. I know commissioners are busy people but, since changing roles, I am surprised by how difficult it is to get them to talk to you about anything other than their own concerns. If only they realised that providers hold the solution to many of the challenges facing health and social care.


I’ve recently met Muir Gray, Director of the NHS National Knowledge Service, who is raising awareness of the influence we have over our own health and wellbeing as we age. His basic message is ‘don’t mistake loss of fitness for ageing’. In essence, it’s so empowering. Small changes make all the difference.


The real joy in this job is that I am learning all the time and I find that so exciting.

I felt pretty daunted when I took on the development role at The Orders of St John Care Trust as I had never even directly managed a capital project. However, now I can confidently talk to you about any aspect of healthcare development, from the return on investment for a new-build care home to the price of bricks.


My advice is to keep trying new things. I’ve recently taken on the role of non-executive Trustee on the Board of the Disabilities Trust – another great organisation.

I think that voluntary trustees do an amazing job running these big charities. Knowing that you are improving people’s day-to-day experience is so motivating, and I challenge anyone to find a more rewarding occupation.

Login to read about Sara’s typical day. Subscription required.

This content is for registered users only. Please login.
Notify of
Inline Feedbacks
View all comments

Caring for Care Workers. Donate to The Care Workers’ Charity and make a difference Donate