Fixing the adult social care crisis is about more than money
Updated: Sep 9, 2021
Adult social care has hit the headlines – not before time – with the Government’s plan to ‘fix the crisis for a generation’ by putting care for older people and disabled people on a surer footing.
The discourse around the Prime Minister's recent announcement, however, has been notable for its narrowness, focusing predominantly on money. No-one doubts that more funding is a vital part of any fix, but it won’t work on its own. Tax changes won’t solve the old question of how to reform a service into one that works for people and communities.
As Twitter users pointed out after the PM’s big announcement, we heard nothing much about local government. This is odd given responsibility for care services sits with town halls, who commission care for vulnerable adults from a local care providers.
The adult care marketplace is a mixture of organisations but, over recent years, has trended towards large operators as austerity measures hit budgets. Among the residential homes sector, for example, the top four companies have around a 20% of beds. The sector is fragile and the collapse of Southern Cross in 2011, which had 9% of the care home market nationally, still haunts the sector. The regulator, the CQC, is constantly on high alert.
These problems predate the COVID-19 crisis. But it has taken the pandemic to lay bare the weaknesses of the current model. No-room-for-manoeuvre budgets, high levels of staffing vacancies and turnover, underdeveloped relationships with families, limited development opportunities for the workforce and low wages, all add up to service that fails too many people.
It is these issues that the government need to address, alongside the promise of more funding.
My advice? I think we have part of the answer already: smaller providers, rooted in their community, with strong links to families and carers. One example is Heywood-based learning disability service PossAbilities. The service was ‘spun out’ of Rochdale Council in 2014 as a public service mutual, constituted as a Community Interest Company with its staff as members. Strong links with the community and families is central to how it works. A service-user forum, run by a non-executive board member, helps it to constantly adapt its services. It recruits locally and staff are encouraged to try new things using their professional judgement. None of its employees have far to travel to work. When you visit, the effect of these things is tangible: to its services users, families and staff it is a community of people, all with a stake in success and that are there to look after each other. Success has brought contracts in neighbouring areas but at heart it remains a community organisation.
The government has long-promised a more substantial answer to some the questions around social care in a much-delayed White Paper. Yesterday the Prime Minister said he would ‘integrate health and social care in England so that all elderly and disabled people are looked after with the dignity they deserve’, but gave no more detail.
What I think is needed from central government now is something more ambitious than just more cash. It needs to work with local authorities to create an environment that encourages entrants to the adult social care market, funds innovative models, gives new providers scope to build viable business models, and facilitates access to finance. Without that, our crumbling system won’t change.
To learn more about our work in adult social care and how we could help you contact John Copps on email@example.com.