Alex Fox, Chief Executive at Shared Lives Plus, writes for the ResPublica fringe magazine
There’s no doubt that we can’t afford
social care as we know it. We can’t afford to provide care to the people, who
receive it now, nor to the people who need it, but are judged not ‘vulnerable’
enough to be eligible, let alone to the growing numbers of older people who
will need care in future.
So it is not surprising that the
debate about social care often focuses on how to cut costs, increase
efficiencies and scale up effective interventions. But social care, even less
than health care, refuses to conform to the economics of mass production.
UK health policy makers are learning
from ‘the Henry Ford of heart surgery’, Dr Devi Shetty, whose 1,000-bed
hospital in Bangalor last year carried out 6,000 operations. Performing surgery
at high volumes has not only driven down the price of an operation to as low as
$1,500 (through making constant use of expensive equipment, for instance), but
has driven up quality: doctors performing many more surgeries a week can become
more practiced.
Scaling up makes sense for surgery,
but can be disastrous in social care. Southern Cross provided residential care
to around 30,000 older people, with a half-billion turnover, before collapsing
last year. Successive reports into home care have found large providers being
commissioned for 15 minute slots and in one case a woman recorded
106 different care workers sent to support her husband with dementia, who
needed consistency above all.
Whilst advances in mobility
equipment, telecare and online technology can help streamline some areas of
social care, social care’s key interactions - one person assisting, listening to or
talking with another person - resist automation and standardisation. The
‘personalisation’ of social care reflects this, embedding facilitated
choice-making and individual tailoring of services. Service users are
increasingly recognised as experts in their own lives. In the development of
choice and control within social care, the desire to improve ‘customer’ relations
and experience reflect the private sector’s recognition that, whilst a large
offshore call centre may have a cheaper unit cost, customers are more likely to
be loyal to a company which offers personal customer relations and personalised
services.
Good customer relations, whilst an
improvement on a ‘take what you’re given’ philosophy, still do not capture,
however, the kinds of interactions we look for when we need social care
support. Social care professionals are not only called upon to meet basic needs
with warmth, professionalism and dignity. We also need social care
interventions which can tackle an older person’s isolation, a care leaver’s
lack of confidence and the barriers someone with a learning disability can face
to employment. Supportive relationships which can hope to achieve those goals
cannot be one-way. If the root cause of an older person’s increasing support
needs is their isolation, even an expensive package of professional support is
unlikely to replace their need for friendships with people not paid to be with
them.
A raft of emerging micro-scale and
mutuality-influenced approaches are creating two-way relationships in which
people have the opportunity to contribute as well as to receive: in other words
to have friends as well as volunteers and to be citizens rather than service
users. These include Shared Lives (in which a registered Shared Lives carer
shares their family home and community life with an older or disabled person);
Time-banking; Local Area Coordination (coordinators with an intimate knowledge
of their small locale, help people to navigate systems and connect with or
build informal community resources); Homeshare (in which a young person who
lacks affordable housing moves into the spare room of an older person who needs
some companionship or a little help) and very small social care
‘micro-enterprises’, some of which are set up or jointly owned by people who
use services themselves. These approaches find economies in being small (low
overheads, no back offices) and bring in voluntary and informal contributions
which would not be offered to large organisations with weaker links with local
people.
But if the best and most sustainable
social care is small and mutual, how does that help us tackle the macro-scale
challenges of public service cuts and an ageing population? Small and personal
initiatives can’t be scaled-up without destroying what made them valuable in
the first place. But they can be ‘scaled out’: creating the conditions in which
many more people are able and motivated to do similar things. Thousands of
people are members of time banks and there are attempts to create a national
‘care bank’ which would see us all encouraged to deposit hours of care now,
which we could cash in, in later life. Shared Lives is used by 15,000 people
and is growing whilst other service sectors shrink. There are tens of thousands
of micro-enterprises, many unknown to councils.
For micro solutions to social care to
become as common as, say, small independent hairdressers, there is a role for
local and national government, but a different role from that of central
planner and purchaser.
It lies in bringing new providers,
including micro-providers, into the market place and bringing them together
with people who hold personal budgets or wish to spend their own money.
Councils need to nurture support
systems for people to make all kinds of contributions, from unpaid family
carers to volunteers and community groups. Regulators need to be pragmatic in
the application of regulations often designed with large systems and providers
in mind.
This new approach to social care,
which gets to know individuals and seeks to build on their gifts, skills and
relationships with those around them, could be described as a ‘networked’ model
of care. It is an approach which has learned from the innovations of social
networking, but retains a belief in the primacy of ‘real world’ interactions
and relationships. We are some way from seeing it become the norm, but it is
the only affordable way in which we will be able to construct a society in
which everyone, including those with long term conditions and support needs,
can live well, as fully responsible citizens.
This article has been published in the
ResPublica Fringe magazine, a collection of articles and essays from our party
conference partners.
Alex Fox will be
speaking at ‘Making care and support personal’, a ResPublica public fringe series
at
Liberal Democrat Party conference: Tuesday 25th September, 12.30pm –
1.45pm, Holiday Inn Brighton, and at Conservative Party conference: Monday 8th
October, 12.30pm - 1.45pm, the ResPublica Marquee, the ICC Birmingham
(secure zone).