Over the last few years, people have often expressed to me their shock, distress or anger because they’ve come up against the social care system. The only reassurance I have to hand is that their experience is the norm – that the whole system really is in crisis. As a social worker of 35 years’ experience, I pride myself on navigating complex systems to access help and support for people in need, but the truth is that the system is now so dysfunctional, so fragmented, so utterly incomprehensible, that no one knows how to make sense of it.
The miracle to me is that the show stays on the road at all, and that’s tribute to the many dedicated people who work in social care across all kinds of provision. They do their very best, against the odds, to support and care for those vulnerable people for whom they find themselves responsible.
Until recently, this human crisis has felt invisible – but coronavirus has changed that. For the first time ever, social care has taken centre stage in public awareness. Concerns are focused on older people in care homes and the death toll there, while those supported in their own homes remain under the radar. However, the whole notion of shielding people who are vulnerable, of noticing those in most need or at most risk, is a powerful new phenomenon.
The upsurge in community action, volunteers helping those who need support, food distribution, creative measures put in place to support the homeless or those escaping from domestic abuse – all unthinkable as recently as February. This presents a massive opportunity to make the changes needed in the provision of social and community care. More funding is only part of the answer. The system itself needs to change radically and fundamentally.
Labour’s 2019 manifesto policy proposals received only a cautious welcome from key stakeholders in the social care industry. Radical social care campaigners have long argued for more community-based services, localised support, cooperative business models, and ongoing involvement of service users and frontline staff in the development of these services. Their approach is based on valuing independence, enabling people to retain self-respect and control where possible, a rights-based approach that offers independent advocacy and real choice.
Labour wasn’t able to capture the vision needed to inspire change. Improving the pay and working conditions of care workers, moving away from the profit motive for personal care service providers, and introducing free personal care for older people are important but limited objectives. The policies represent a perspective that sees personal care as an extension of health care, and fails to see the wider picture of social and community care. Even from this limited perspective, Labour didn’t address the costs of personal care for disabled working age adults, nor the costs of residential care.
The policies also depended entirely on the election of a Labour government, which is unlikely now for at least four years. What should Labour councils do in the meantime to mitigate the very real crisis in adult social care? How can policies be developed in partnership with people using and delivering services? How can Labour campaign effectively in this sensitive and complex area of public policy?
A broader vision for adult social care
Social care is much broader in the real world than is commonly recognised. It encompasses family and community caring activities where interdependence is the significant factor. It is integral to the way in which other public and community services are delivered, including public space, housing, transport, anti-discriminatory action and measures to reduce poverty.
There needs to be a wider vision of what we’re working towards – how do we as a society want to provide care and support for vulnerable people? How far do we go with dementia-friendly communities, or the social model of disability, or supporting independence and choice wherever possible? How much are we going to listen, or are we going to default to the tramlines of traditional care models that too often reinforce dependency, social isolation and institutionalisation?
The coronavirus pandemic has focused our minds on those who are vulnerable for reasons of ill health, disability, age, mental capacity, poverty, abuse and homelessness. Although the private sector remains involved in the form of care homes and domiciliary care agencies, most social care services are now provided by local or national charities, often using volunteers, with underpaid and under-trained staff, dependent on the contract culture and largely non-unionised.
What about funding?
In its 2018 report on funding for social care support, the King’s Fund found that public understanding of the means testing system and the low threshold of savings that are taken into account was very limited. When they found out how the system worked, people were opposed and even angry, and felt it should be changed. Research tells us that most people believe that social care is funded like the NHS, until they experience it directly. This creates a significant political problem.
Trust is so low in politicians, the King’s Fund concluded, that a movement for social care is needed independently of political parties, with the aims of informing the wider public about social care funding. The current coronavirus crisis has brutally exposed the problems for some parts of the adult social care system, and there will be more hidden scandals emerging over the next few months. While social care is squarely in the public eye, the opportunity for such a movement is here and now, and Labour should be playing a leading role.
Imagining the future
The alternative vision is to imagine a strategic role for local authorities, working with other agencies, to shape and develop the social care market built on different principles. The very real shortage of resources – even more so as the economic impact of the pandemic starts to bite – means Labour must engage with local communities to find viable ways to protect, support and enable those most in need.
The really radical connections are being made with strategies to rebuild local economies despite continuing austerity. The Centre for Local Economic Strategies has worked in recent years with local authorities such as Preston, Salford and Wigan to develop community wealth-building strategies that include a key focus on the economy of social and community care.
In May this year, the New Economics Foundation and Community Catalysts published a report on community micro-enterprise as a driver for local economic development, and a more creative responsive approach to the social care needs of older and disabled people.
We need a more holistic view of how different kinds of services in the social care market are struggling, what hopes, strengths and skills they bring. The groundwork must be laid for building an alliance or movement for change that values the contributions of those delivering services and demands due recognition in terms of working conditions.
The community response to the pandemic has opened up new opportunities. Mutual aid groups have been very successful in many areas, as activist volunteers have quickly adapted technological aids for fast communication and collective organisational structures.
Action from Labour cannot wait until 2024. Labour councils must draw on the very real energy, creativity, enterprise and spirit of diverse communities. As the full impact of coronavirus on the most vulnerable in our communities becomes starkly exposed in the months to come, national leadership will be needed to support Labour councils in building a genuinely radical and transformative approach to what threatens to become a real humanitarian crisis.