Upon winning the election in July, the Secretary of State for Health and Social Care commissioned Lord Darzi to conduct an immediate and independent investigation of the NHS. This aimed to provide an understanding of the current performance of the NHS across England and the challenges facing the healthcare system. We are only a few months on, and the report has already been published, determining that the health service is in ‘critical condition’ whilst outlining a roadmap to recovery.
Understandable apprehension
To date, the social care sector has not been afforded the same opportunity. Instead, there are hints of a royal commission, the approach Labour took in 1997 and largely disregarded. Although a royal commission offers an opportunity to recognise social care as a part of our national infrastructure, not just in transforming individual lives but also in strengthening local communities and the broader social fabric, there is understandable apprehension.
Not least because a royal commission will take years to produce conclusions and recommendations, with no guarantees of implementing the changes. Given the urgent nature of the issues facing the social care sector, a royal commission must be balanced against immediate action.
Many of the issues facing social care are already well understood, and numerous reports and inquiries have already identified areas for improvement. Crucially, the sector has worked hard to come together, with consensus emerging around ideas that will change lives for the better and build strong local communities.
This has been reflected across Time to act: A roadmap for reforming care and support in England from the Association of Directors of Adult Social Services (ADASS), Care and support reimagined: A National Care Covenant for England from the Archbishops of Canterbury and York, Support guaranteed: The roadmap to a National Care Service from the Fabian Society and the adoption of Think Local Act Personal’s (TLAP’s) Making It Real framework within the Care Quality Commission’s (CQC’s) single assessment framework.
Whether a royal commission will go beyond this current consensus, providing a better understanding of the issues and solutions in the sector from where we are today, is a matter to be debated, but what is clear is the amount of energy and optimism in the sector to drive forward change. The Government now needs to capitalise on this goodwill.
There is a recognition that there is no silver bullet and getting this right will take time but, repeating the 1997 commission is not something the sector can afford. Instead, a different approach is needed. The following must serve as the building blocks for the Government’s mooted royal commission.
Creating a shared vision
A royal commission is an opportunity to signal the Government’s intention to stabilise the social care sector once and for all. To do this, there must be agreement as to what the purpose of the social care system is, what the problems and challenges are and what the solutions are. This will include agreement on how care is funded, organised and delivered going forward.
We have our north star with the vision from Social Care Future, but now we need the building blocks to get there. This will include establishing a realistic timeline and actionable steps. Working back from the change we want to see, we need to take into account the current issues. As is well documented, the sector is under intense financial pressure, due in part to local authority budget cuts, with emerging issues around the quality and availability of care and support, placing more pressure on families and communities to fill gaps.
This is all against a backdrop of demographic and epidemiological transitions which are shifting the demand and profile of care and support, such as our ageing population, rising care needs and the increasing prevalence of chronic health conditions and disabilities among older and working-age adults.
A sensible starting point for the royal commission, which would help realise the vision of Social Care Future, would be to look at how it can fully implement the Care Act 2014. Although we are 10 years on, the Care Act’s ambition has remained unfulfilled because the system is fragmented, services are not personalised and many care and support needs are unmet. Current funding is unfairly and inequitably distributed on closer examination of demographic trends, whilst key issues like wellbeing and co-production require further work to embed these within the system.
Collaboration with the sector
The approach of Government to a royal commission must learn from where previous commissions have failed. Richard Humphries, in his book, Ending the Social Care Crisis, advocated for a movement away from top-down approaches to reform care and instead foster a bottom-up, citizen-led and co-produced approach. Drawing on the knowledge, ideas and experience of people who use social care, their families, carers, health and social care professionals, care providers and commissioners is central to equity and inclusion.
Co-production should not be an afterthought but rather central to policy and practice design. SCIE’s Experiences and understandings of co-production in adult social care revealed that only 59% of people with lived experience had previously had opportunities to be involved in co-producing their own care and support. Social care staff reported that time (47%), organisational culture (31%), cost (26%) and communication (25%) were the most significant barriers to implementing co-production. A tide change is required.
Such an approach will also create agreement about the key design principles needed to guide the planning of a social care system fit for the future, one which builds on the consensus and partnerships that already exist across the sector. Creating a royal commission, through which power can be shared with the full diversity of the sector, will be a powerful asset for Government.
Investing in solutions that drive change
Scaling innovation and improvement is crucial to helping social care and providing support to carers, including those who are unpaid. To do this, we must facilitate learning, overcome barriers to social innovation and identify and enable those things that support innovation.
Given the current pressures on the social care system, it can be hard to imagine a system working well. However, there are examples of good practice and innovation from around the country, and the amazing resilience and contribution of disabled and older people, carers and communities for a royal commission to build on.
For example, SCIE is providing hands-on support for the Government’s Accelerating Reform Fund, an initiative to encourage and grow innovation within the social care sector. The programme focuses on scaling and spreading social care innovation in key areas like supporting unpaid carers and delivering new care models.
Examples of projects include Shared Lives, a care and support service that matches people aged 16 and above who want to live independently in their community with Shared Lives carers. Research by SCIE found that Shared Lives can result in an average saving of £8,000 for people with mental health needs and £26,000 for people with learning disabilities.
Sustainability is fundamental
Lord Darzi’s Independent investigation of the NHS in England recognises that health and social care cannot function effectively in silos; they are interdependent. Both systems aim to enable people of all ages, not just older people, to live independently, manage long-term conditions and relieve the pressure on finite NHS and emergency services.
Without a co-ordinated approach to addressing the issues in the social care sector, as well as the NHS, people will continue to face under-met and unmet care needs, and family carers will remain overstretched. With the Government having launched a mission to fix the NHS by developing a 10-Year NHS Plan, there is a unique moment of opportunity to make the case for sustained investment in the social care system which can deliver change at pace.
The importance and value of investing in early intervention and universal services cannot be understated. By improving upstream support through investment in social care, people will be able to access the care they need, positively impacting their health and those around them. This will include expanding the social care offer through sustained investment in community rehabilitation, reablement and intermediate care, which will prevent the need for long-term care as well as unplanned hospital admissions.
We stand ready
A royal commission represents a potentially transformative moment for social care reform. It presents a unique opportunity to overhaul the current system and establish one that is not only more equitable and sustainable but also more attuned to the needs of those who depend on it.
The extensive work carried out by the sector over the past decade provides a solid foundation. Practitioners, care providers, individuals who draw on care, and organisations, including SCIE, have continued to generate a rich repository of evidence, research and insights.
The sector requires practical measures that can be implemented immediately, as well as a long-term vision that includes sustainable funding, improved care standards, and a greater focus on person-centred care. SCIE, and the wider social care sector, stand ready to work with the Government to deliver the solutions our sector requires.
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Kathryn Smith is Chief Executive at the Social Care Institute for Excellence (SCIE).
Email: [email protected] X: @SCIE_socialcare