In England, adult social care affects the lives of over 10 million adults at any one time. For most of them, one or more members of the family are also involved in providing unpaid care. The paid social care workforce, for its part, represents another 1.65 million jobs – more than
the NHS, construction, transport and the food and drink service industries.
If numbers don’t speak loudly enough, there remains the fact that almost every single one of us will draw on the social care system at some point in the future, as new care needs inevitably develop with old age. The importance of adult care is unquestionable. So why is it so invisible?
The House of Lords Adult Social Care Select Committee has just launched a major new inquiry asking that question.
We are focusing on this question because, over the past few weeks, we have listened to colleagues, academics, policy makers and most of all, people with lived experience of the social care system. The message that came across was not surprising: social care, in most instances, does not work for those who need it. It is notoriously under-funded, but also difficult to access and fragmented. It fails to listen to people
and to provide them with a fulfilling life, or to recognise the expertise of those who provide care and support. At times, it appears to be even cruel.
Therefore, we have been prompted to think about the reasons for these shortcomings. Why has successful wide-ranging reform not happened yet? Do these issues receive the attention that they deserve? In most cases, the answer is no.
Despite its immense place within our society, adult social care is not recognised or acknowledged as much as it should be – particularly in
comparison with its much better-known sibling, the NHS. The social care system is barely portrayed in the arts and culture; often inaccurately depicted in the mainstream media; and until recently, quasi-absent from the political agenda.
We believe that while the adult social care system remains trapped in invisibility, meaningful reform is impossible. To unlock real change, we
will need to transform the way that social care is perceived. Only then will the value of successful reform of the system be understood. Above all else, this means lifting those who are at the heart of care out of invisibility: the people who draw on care services, but also those who, whether they are family members or friends, provide unpaid care and support.
Too often, we have heard from people with care needs and from carers that they are fighting against a system that does not acknowledge or value their expertise and contribution. They are not seen as people with aspirations and ambitions, but as a problem to be solved, a burden on society. The services they receive often reflect this deep misunderstanding of who social care is for.
People with care needs and carers are contributors to our society, and they should be valued as such. This means listening to their individual
ambitions and aspirations, regardless of their age, condition or personal circumstances, and taking this as a starting point to the care journey – the purpose of which should be to enable people to live an ‘ordinary’ life; one that they find fulfilling, and in which they are equal citizens.
Many aspects of our social care system are problematic because for too long, the voices of people who draw on care and of carers have been
ignored. It should not be expected, for example, that family and friends are always available to provide care for their loved ones; nor should it be assumed that people with care needs want their parents, siblings or friends to become an unpaid carer. Yet, there is little scope in the current system for people to exercise this degree of choice and control over their own lives. Services have been designed for people to adapt themselves to, rather than the other way around.
In the next few months, our committee will be looking at what needs to change to enable people who draw on adult social care and carers
to come first. This will require listening to them, recognising their place and their contributions and lifting them out of invisibility.
Adult social care has always been about the people it is here to serve. While they remain misunderstood and alienated, the system cannot
meaningfully deliver. It is time to give a voice to those who are at the heart of care; this is the only way to create a system that truly works, both for those who have care needs and for carers.