Sharon: Firstly, I want to say a huge congratulations to CMM on its 20-year anniversary. My involvement with CMM/Care Choices spans the 20 years and more! It’s a privilege and a joy to have been part of the journey, which has seen the organisation make such a huge contribution to the sector.
CMM: Hi Sharon, it’s so good to catch up! Can you start by telling us what social care in England was like 20 years ago and how it was to work in the sector then?
So much has changed and yet strangely the same issues exist and are talked about. However, there’s now a different depth and breadth to the context of these issues. 20 years ago, health, social care and housing were operating in silos (some would say they still are). Those using and working in social care (including those beyond care providers) were trying hard to get the voice of the person using services front and centre, to help people understand the contribution and value of social care.
The general image of the sector was negative and this was not helped by national or local media. The relationship between the sector and the media was very different compared to how it is now. Care homes in particular were seen in a poor light and the impact of this was huge in terms of how the public saw the sector. Social care wasn’t understood. In health, outputs and outcomes for people using services were more tangible and evidence based. Social care (in my opinion) could not consistently evidence this.
The workforce, their skills and expertise were not valued, even though a lot of the change and innovation we see now was led (out of necessity) by providers themselves. Registered nurses working in social care were often perceived as having a lower skillset than their colleagues in health settings.
When Dilnot’s Fairer Care Funding was published it enabled a different conversation about social care generally. The sector and those outside of it began to articulate the economic value of informal carers and social care, we started to see a wider understanding develop of the sector’s role and importance.
CMM: What do you think the biggest shifts have been since then? What has been the most unexpected change?
The voice of people using/engaging with services as well as their significant others – and what matters to them – has become ever more respected and observed. Seeing their influence and contribution to policy and service development is fantastic – there is still more to do but much has been achieved. From a care home perspective, the Enhanced Health in Care Homes work done by NHS England in collaboration with the sector delivered some tangible outcomes, recognising that people who live in care homes should expect and benefit from the same level of support as if they were living in their own homes.
There have also been significant changes to how the sector is perceived; I have witnessed a positive shift in the way the media engages with and reports on social care. In general terms there appears to be an increased awareness and understanding of the complexities of the system and how it impacts people, and the move away from solely uncovering and reporting on exposés has offered a different balance and perspective for the public and helped positively raise the profile of social care.
The visibility and value of the workforce has improved, too, but the work must continue so they get the recognition that is deserved. Data from Skills for Care actively informs and contributes to the dialogue now, providing opportunity for informed decisions to be made to support this.
The introduction of robust, independent regulation has been so important. Views regarding regulators and how they operate will always vary. However, the role of the regulator, alongside the introduction and use of technology, means that providers are better able to evidence and quantify the quality of life and quality of care they provide.
There’s something in me – ever the optimist and glass-half-full – that would have hoped Government would have got their act together by now as far as social care is concerned. That they haven’t is not an unexpected change, but it is a disappointing one.
During COVID-19, membership associations and providers gave voice to that which Government did not wish to acknowledge regarding social care. Whilst the impact on people needing and using services – and on staff in caring roles – was immense, the opportunity that social care utilised to communicate key messages was evident. Providers were put in an impossible position, but social care leaders and the workforce went above and beyond to do what they could to protect and support people.
Finally, the imperative for integration is not new – it has been talked about for three decades, not just the two we are covering here – making it a reality is long overdue.
How does the current landscape in England compare to what is happening in Australia?
Over the last 20 to 30 years, England has seen around 20 to 30 reports on reform, the state of social care, funding, integration…The list could go on. I have now lived and worked in Australia for four years and, when I first arrived, the Royal Commission into Aged Care Quality and Safety was taking place. The report was published in March 2021. Both past and present governments responded to this one report and have taken decisive action, recognising that older Australians deserve better from the systems that support them.
The present Government is making a huge investment in the sector; wholescale change is underway, including new legislation and reforms for funding and assessments. I know the pay increase for certain categories of workers has made the headlines in the UK. This will see a 15% uplift in pay for defined roles/categories of staff, which will be funded by Government. A concern which may not have made the headlines is that it does not cover all staff, so providers need to decide what to do for those who aren’t included. However, it does demonstrate that there is a government that is willing to act and not park the issue in the ‘too difficult’ parking lot!
As in the UK, we are seeing a shift towards submitting more data to enable transparency and accountability. Whilst the sector does not negate the intent, the impact of the administrative burden is huge. It must be remembered that change management needs to be factored in when wholescale change is taking place.
In the last 20 years in England, in my opinion, whilst there may have been good intent, the reality is that successive governments have probably wasted more money than they have saved by not implementing change. The cost to people using services has been immense.
In your opinion, what should social care look like in another 20 years’ time?
A really good starting point is Social Care Futures’ vision – ‘We all want to live in the place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us’.
People should have choice and control over how their care is planned and co-ordinated. A strengths-based approach will help them to live their best lives and deliver the outcomes they want. Living with purpose on purpose. Health, social care, and housing should help people achieve that. Let’s use technology for what it can be used for but never forget that we work with people, and relationships are important.
If integration happens, then utilising the resources we have (including people) appropriately must be a priority. Wellness, prevention, public health must be more prominent so that care stays closer to home. I want to see support to improve health literacy, to enable not disable, to empower not control.
People who use services expect services and systems to talk to each other and we should make that a reality. We need more partnership if we are to improve integration. Working together can ensure that outcomes for people happen and greater effectiveness and efficiencies can be achieved – where there is a will, there is a way!
Lastly, Government should utilise the umpteen reports and the skills and knowledge available to it to make reform a reality. We don’t need to keep reinventing the wheel.
What should we focus on in order to see transformational change happen in
social care?
We need leadership at Government level who are bold, informed, courageous, and accountable and know how to make decisions. Government already has the evidence it needs to implement changes but continues to avoid doing so. Social care must be seen as an equal partner with health. Reform is long overdue. Get it right and it will benefit people using services, the workforce, society, the economy now and in the years to come, and ensure a secure future for health, social care and housing. I can dream!
We also need to make integration a reality. Systems change, people move within the system; the intent is good but so often people who are using services do not see or experience tangible outcomes for themselves and for what matters to them. This needs to be our focus and priority when designing for the future. And we need to invest in change management, processes and systems that are sustainable and scalable – otherwise there will be causalities.
I do reflect and wonder what future generations will make of our progress or lack of it.
Finally, providers, in my view, have always and will continue to lead the way. I may be biased but that is where I have experienced transformational change and innovation that makes a difference to the lives of people. Ultimately, social care isn’t about ‘them’; this is about all of us. With the right people doing the right thing in the right way we can achieve the right outcomes for everyone.