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2021: A year of reform, hope and humanity

It’s safe to say that 2020 was not the year that anyone predicted. Ways of working had to be adapted overnight and pressures mounted, while any notion of planned change was pushed aside. With a vaccination programme underway, Vic Rayner of the National Care Forum takes a look at what we might expect from 2021.

Early indications suggest that January will feel very much like early 2020, with high levels of outbreaks, staff shortages, pressure and, very sadly, infections and deaths. Not quite the New Year everyone had hoped for, but quite possibly the beginning many would have predicted.

So, what about hope? Are we at the moment that hope is allowed? Clearly, vaccination brings promise and there is a sense that we might just begin to start counting the days towards a more positive future rather than marking up the days since the pandemic began. The impact of this shift in focus on those receiving care and support, the workforce and those operating care services will be vital. But the road to that hopeful land looks harsh and inhospitable from the cold coalface of January.

The things that need to feel very different are manifold. Let’s start with the Government definition of care. It has, of course, been very important that the Government has focused much of its attention on what is happening in care homes. However, the flipside of that is that other parts of the sector have vacillated between a position of playing heavily delayed catch up or being completely ignored. Government guidance has come late and, in many cases, has borne little resemblance to how services are run and what can be achieved within existing capacity. The lack of knowledge about what happens within care homes pales into insignificance compared to the lack of knowledge of what supported living is, how day services operate or what the role of a personal assistant is.

However, the statements made by Government talk about care, the care workforce and those receiving care as an homogenous group. This is a grave concern for the reform agenda.  Worryingly, the small amounts of attention that seem to have been focused on the longer term still cling to the notion that the big issues are linked only to older people and the costs of residential care on an individual’s wealth.

People at the heart of care

We need the year ahead to be about people. Ironically, in a pandemic that has absolutely been about people, and the impact of COVID-19 on people, the directions for social care have been firmly footed in a narrative dominated by process. The voices of people – those who receive care and support and those on the frontline – have been hard to hear above the grinding gears of guidance development. What feels almost like an industry in its own right runs the risk of dominating the very essence of care – the fact that people sit at the heart of it. We need 2021 to bring those people right back to the forefront of everything that we do, and for there to be a rebalancing in favour of independence, rights and connections.

One clear sign that we are moving in the right direction will be when we have families and loved ones back in the heart of all care settings. I know many have said it, but some of the most heart-breaking images of 2020 have been of people split asunder by screens, windows, drive-bys or some other mechanism. Of course, these approaches have been an important part of bringing people together as much as possible, within the rules and regulations, but they have sat painfully, and it has sometimes felt as if the anger and despair around the lack of visiting could rip the heart and humanity out of care. Hope for the year ahead does correlate strongly for me with the reintroduction of meaningful visits and the sound of visitors’ voices once again ringing strong within care homes. Shifting the care home anthem from Dame Vera Lynn’s
We’ll meet again – to Eurythmics’ Right by your side.

Reform and the workforce

Of course, hope for social care has often been connected to the much vaunted notion of reform. Once more, we enter a new year with the promise of transformation hot on the lips of politicians across the political landscape. We know that this discussion is progressing at pace in Scotland. But in England, we are faltering at the starting blocks (again!). We now have 18 months of promises with this Prime Minister and over 12 months of commitment within this parliament.

Whilst the pandemic continues, it seems unlikely that we will see anything substantive. However, what is clear is that when the ‘bandwidth’ opens for this debate, the inequities that have been writ large during the pandemic must be addressed.

A deal for the workforce will be key. The incredible commitment of staff across the country has been acknowledged, but little has been done by Government to change how it feels on the front line. As we finally exit the pandemic, we need to ensure that there is not a mass exodus from a mentally and physically exhausted workforce.

Anyone who has been part of managers’ and workforce calls over the last 10 months will know just what a toll this has placed on everyone on the front line. And when the pandemic lifts, the care must carry on.

The best reward for all will be a properly resourced and supported workforce plan. A plan that gives long-awaited parity with NHS staff, that provides a clear progression pathway, and that recognises social care as a valued and important career. Whilst I wonder whether we will see the full funding reform agenda that everyone hopes for, I anticipate that the extreme pressure on sustaining and recruiting a care workforce will mean that this is one key priority the long grass cannot hide for yet another year.

My hope radar runs out of steam a little when it comes to the longer-term reform of the funding of social care. One of the things that will dominate the year ahead will be the notion of economic challenge. In the midst of that, even if social care funding reform does manage to cut through, it will need to carve out a system fit for a 21st century future – in an economy with unemployment and recession vibes that bear more resemblance to the early 1980s. That is going to be tough.

The plan we land on is intended to give us a sustainable future for generations to come and the options to fund that will undoubtedly have been impacted by the massive shift in our economic projections. The downgraded Spending Review of 2020 may find itself repeated if the hoped-for ‘V-shaped’ recovery falls short of expectations. This will not be a positive backdrop against which to outline an ambitious plan for the care we all want and need to be delivered in the years ahead.

It is also extremely possible that as we exit this pandemic, there is a collective gasp from the politicians who have held the ring on social care for the last 12 months and that we find ourselves arguing the case for what the future should look like with a new group of politicians who know little about the current situation, never mind an understanding of what came before. This is all notwithstanding the gradually emerging picture of what a fully implemented Brexit Britain will look and feel like.

Finding a way forward

Finally, one of the unassailable elements of progress that has been achieved in the last year has been that of digital transformation. In many ways, for me this has brought together hope and humanity in a way that I can only expect to continue long into 2021 and beyond.

When rules and regulations would not allow people through doors, technology enabled close connection to continue. When healthcare professionals were told to stay away, technology ensured that they could stay in touch and continue to offer help and support to those most in need. When it looked as though the needs of those receiving care were to be ridden roughshod over in the drive to protect the NHS, technology enabled us to gather and share the data that showed just what a devastating effect COVID- 19 was having on those receiving care and support.

I suspect it would not garner everyone’s vote as an emblem of hope and humanity. However, in an extraordinary year, the world of digital has truly opened up to social care and has been instrumental in ensuring that never more can the needs of those receiving care be ignored.

COVID-19 has given us the opportunity to stand up and be counted, and for those who lead the country to be held to account for each and every way in which their decisions affect not just those who receive care, but the incredible people who work in it too.

Vic Rayner is Executive Director at National Care Forum. Email: Twitter: @vicrayner


About Vic Rayner

Vic joined the National Care Forum in 2016. She is a regular national and international speaker and has extensive knowledge and expertise across a wide range of care, support, housing and social policy agendas.

Vic is a trustee of Hestia as well as The Care Workers’ Charity. She was previously the independent Chair of the Brighton and Hove Fairness Commission, tackling inequalities and promoting social justice within the locality.

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