Reimagining social care – where would we start?
David Walden CBE is the Editor of RiPfA’s newly launched Evidence Review: Reimagining Adult Social Care.
With extensive experience in both policy and service provision across central government, national agencies and delivery organisations, he is well-placed to give an overview of the issues facing social care, and how we could start again, using the evidence we have available in order to build a new system of care from scratch.
In this article - the first of a week-long series of blogs giving an insight into the topics covered by the review - he introduces the challenges and discusses some of the potential solutions.
When grappling with the day-to-day issues of care and support, it is all too easy not to step back for a moment and consider why the current system is as it is.
We tend not to reflect on what evidence has driven certain policies and what we still need to research, understand – and implement. That’s why I am delighted that Research in Practice for Adults has commissioned this fascinating review of critical issues in adult social care.
Using four academic experts in adult social care to look at current knowledge in key areas - and then asking four further experts to comment on their findings – the review paints a rich and complex picture of a system seeking to implement policies mainly drawn from evidence (broadly defined to include user views) but often mired in difficulties such as funding, workforce capacity, organisational politics and power struggles. When we look at it in its entirety, we see that the resultant picture is inevitably messy, complex and sometimes contentious.
Yet by reflecting on the journey we have made over recent years, we can see more clearly both our progress and the distance still to travel. This review helpfully looks both backwards and forwards – reminding us of how far we have come and what more is to be done to truly reflect what people want from care and support. So the review’s authors and commentators look at four key areas, decided on after consultation with senior stakeholders from social care, that we believe represent the foundations of social care.
These four topics are:
- safeguarding adults from abuse
- promoting prevention and independence
- involving people, co-production and advocacy
- the adult social care workforce.
In each case the authors look carefully at what we know from the evidence and compare it with current practice. Overall, there seems little doubt that the evidence base has strengthened considerably over recent years, including the Randomised Control Trial into Individual Budgets, the wide-ranging Partnerships for Older People Projects on prevention, substantial work on co-production with people using services and emerging findings on the effectiveness of Making Safeguarding Personal.
Often the challenge is not so much drawing out the messages from research and other forms of evidence, including user experiences, as the consistent implementation of those messages at a time of significant financial pressure. That pressure is, in turn, exacerbated to some extent by the consequences of success - an ageing population living longer, often with complex or multiple long-term conditions such as diabetes and dementia, and a growth in disabled children surviving into adulthood.
Of course some policies are either not soundly based on evidence, such as the Health and Social Care Act 2012 which restructured the NHS from a highly political perspective, or have exaggerated claims made for them, such as the savings possible from closer integration of health and social care. This is probably inevitable given the Government’s interests in such large, mainly taxpayer-funded systems as health and adult social care.
Yet the review shows how in significant areas policy stretches back across several Governments and fashions. The details of how to implement policy may change, not least as the delivery mechanisms themselves change, but what needs to be done displays a remarkable degree of continuity. For example, there has been a pretty firm consensus for several decades around promoting independence and preventing care needs from developing or worsening, coupled with a growing evidence base about what works and its cost effectiveness.
The challenge is as perennial as the policy consensus, however. It’s how to design and invest in long-term programmes which can, if properly designed and targeted, produce both a financial payback and a better quality of life for users but which will not do so for several years. Meanwhile, pressures to find savings and to deal with the most acute needs make it all too logical to cut such preventative programmes to secure short-term survival. Recent cuts to the “Supporting People” preventative grant are a good case in point. Evidence and practice can sometimes conflict, therefore.
Other areas of social care have their own developing evidence bases, whether in safeguarding adults from abuse, or seeking to recruit, retain and motivate staff in ways which mean they can support people accessing services in the way the latter prefer. Whilst resources obviously matter, the critical issue here is often how to care and support people in a consistent manner, day after day, regardless of setting and in ways that enhance users’ dignity and self-respect. This is as much an implementation as a policy challenge - which affects both well and poorly-resourced services - and the review sets out many ideas for improving the user experience.
So as well as trying to think about how social care might look if we started wholly from the evidence, the review also teases out many of the barriers to success. It affords us an opportunity to pause from the daily hurly-burly and consider what progress has been made and what is still to do. Overall, it’s a positive story, despite the gloom around at present, though no-one should be complacent. And it sets out some crucial issues if we are to reimagine social care and enable it to meet the challenges of the future.
Look out for further articles on this blog by some of the authors and commentators, who will each explore their specialist area in more depth.