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What if…? A different social care

Here, John Kennedy asks, what if we’d invested in reform before it was direly needed?

Social care reform has been put on the backburner for years, and nothing has shown the damage this has done like the COVID-19 pandemic.

No doubt you are now well used to reading the litanies of pain that have accompanied social care through the coronavirus pandemic. The PPE, the testing, the abandonment.

You will no doubt have also noted the daily stories of resilience, heroism and sheer kindness and selflessness that have filled our newspapers and news broadcasts. I trust too that, like me, you haven’t been surprised.

You won’t have been surprised by the abandonment; those purporting to ensure, support and improve conspicuous by their absence. You’ve shrugged maybe, and if, like me, you occasionally fall prey to a touch of pomposity, a mutter of ‘plus ça change, plus c’est la même chose’. If not, then just a weary ‘same old, same old’.

You won’t have been surprised by the response from the people working in social care. Because you know them. Whilst others fled the field, they got stuck in for they ‘are but warriors for the working day’, despite the abandonment, despite the decades of neglect, despite the exploitative pay, despite their ‘low skill’.

No, you won’t have been surprised. Of course, the crisis and pain are not yet over and the full history is yet to be written. I don’t often quote the Queen, but her words earlier in the year, ‘I hope in the years to come everyone will be able to take pride in how they responded to this challenge,’ struck me. There is no doubt that the 1.5 million working on the ground in social care will ‘stand a tip toe when this day is named’.

Despite the heroism, the people working in care are stretched to the limit, physically, mentally and emotionally. The death and loss is starkly disproportionate for people receiving and giving care and you have to ask, has our archaic model of social care contributed? Has the system got harm designed in? What if we’d done things differently?

Dealing with the disparities

Whilst the hospitality industry is coproducing guidance on how pubs and restaurants may open safely, social care receives no such engagement.

Crucial guidance on correct use of PPE, safe hospital discharge, isolation etc is curtly issued only to be met with cries of anguish at its impracticality and ability to utterly confound. Obviously written by people with very little knowledge or understanding of the realities on the ground. ‘Please, please, involve us in the design of guidance’, cries the sector, ‘We know the reality! Let us write it!’

Whilst every other sector is able to access substantial financial support with a few clicks on Government Gateway, social care is conspicuously singled out as different.

Instead of support being swiftly allocated to the front line, financial support is channelled through the byzantine bureaucracy that is local authorities. Trickled out, richly decorated with detailed criteria, claw back clauses, caveats. Why? Why can golf clubs, bookies, tanning salons and pubs get immediate support and the care sector has to beg?

A different story?

What if, years ago, we’d recognised the true value of social care and truly put the citizen at the heart?

What if we’d recognised that ‘commissioning’ had become a straitjacket that was binding us into the creation and sustenance of service models people increasingly don’t want? A downward, spiralling race to the bottom, creating bigger and bigger care homes, pizza delivery homecare models and stifling imagination. Further entrenching poverty pay, industrialising care into piecework packages and attracting short-term, impatient profit-maximising finance.

What if we’d realised that the very best services often come from organisations with purpose, patient profit and not-for-profit? From people who get out of bed each morning with those they provide care for first on their minds.

What if we’d driven consumer sovereignty into social care? What if ‘the desires and needs of consumers controlled the output of producers’? What if we’d invested in supporting consumers to have economic power in the market?

What if we’d allowed a sector to bloom that was able to offer a wide continuum of services responding to the desires and needs of individuals? What might have been different? Would you want a stranger to do your supermarket shop? With their list? What if the power in the market was in the hands of the people receiving the care?

What if we’d invested in and celebrated neighbourhoods? What if we’d not waited for a crisis to mobilise the immense potential of volunteering? What if we’d recognised, cherished and supported carers – the bedrock of social care?

What if every neighbourhood had a navigator, connecting and empowering? What if there were no ‘service users’ but instead a network of reciprocal support? What if the first point of attention was a person, and not a criteria assessment but a conversation about what they want and what they can give?

What if we’d regulated for success and not for failure? What if we’d been inquisitive about the attributes of Outstanding services? What if we’d recognised that all Outstanding services have adequate and sufficient resources and that desperately few Outstanding services are wholly in the shoestring commissioned market? What if we’d been inquisitive about the underlying fundamentals of quality and safety? What if we’d used that to demand reform?

What if instead of nurturing a ‘critical parent – reactive child’ relationship, we’d coproduced a SMART regulatory framework? What if efficiently collected data had made random subjective ‘whack a mole’ inspections redundant? What if staff and managers in social care had been empowered by regulation and not cowed?

What if we’d actually known how many people lived in care homes, why they were there and what if the reporting of the crisis had been accurate and timely?

What if we’d banned the word ‘integration’? The magic Holy Grail forever just out of grasp. Do we really want integration? Don’t we want people to just work together? Surely, we want a medical model in our hospitals but not in our homes? What if social care had the same respect as Health? What if it was seen as just as important, but different, just as much an essential part of our societal and economic infrastructure?

What if Health knew the care providers in their patch? What if they worked together as partners? What if they met, talked, explored, planned and did things together? Perhaps then social care may have been able to really support the NHS in a way that kept both safe. The NHS may have paused and considered before it put those receiving and giving care at risk.

What if we’d acknowledged the skilled nature of social care staff? What if their pay reflected their skill and responsibility, and was complementary to and comparable with Health? What if they shared the same competencies and accreditation? What if they were professionally registered and could show an ID that was immediately recognisable and respected?

Perhaps they wouldn’t have felt panic at having to stay away from work and lose pay. Perhaps they wouldn’t have needed to work multiple sites to feed their children and pay their rent. Perhaps they wouldn’t have had to shout and plead to be recognised as essential workers.

Time for change

Despite the systemic injustice and contempt towards social care, its people have been magnificent, but they shouldn’t have been treated the way they have been.

Is it time to stop the stifling over- parenting and give social care the respect and attention it deserves? It’s a fundamental part of our lives and is of primary national strategic importance.

John Kennedy is an Independent Social Care Consultant. Email: Twitter: @JohnnyCosmos

What are your ‘what ifs’ of this crisis? How do you think things could have been different? Let us know what you think by sharing your views in the comments section below.

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J M Floyd Pattison

I am a retired executive member of a local Care Association. I fully endorse John Kennedy’s position, but would like to see local associations encouraged to develop a united position. Articles in a Care Magazine are not enough. Local associations are finding it hard to see that the ecology of care (and health) is changing – they should be forgiven for this but not let off the hook. Your magazine could pioneer this, by challenging Care Associations to consult their members for the direct purpose of evolving a way forward. Of course, there would be partisan aspects to this, so,… Read more »

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