An unexpected effect of cuts to council budgets, and the ensuing crisis in support services for adults and older people, is that the public is starting to understand for the first time what social care for adults actually is. The challenge now is for us to imagine what it could be.
In March, the government announced a green paper in response to the overwhelming evidence that the way we support older and disabled people is neither working nor affordable. Fewer people are getting support, care providers are leaving the sector and handing back contracts to councils, and hospitals are filling up with older people who have no medical reason to be there.
The green paper, alongside a welcome short-term funding boost of £2bn, was primarily framed as the latest attempt to find a sustainable funding model for social care – but optimists in the sector welcomed the potential for ambition that it signalled.
Sustainable long-term funding is vital, but it is only half the story. Social care will not be affordable – perhaps not even seen by the public as worth funding – unless it can become a service that, like the NHS or schools, is capable of renewing people’s faith in public services and the welfare state. This means it must become what people entering the profession wish it to be: the support network that enables people to live safely, purposely and well, in their own home or a place that feels like home, with people they love.
Not every form of social care can achieve that, even when delivered effectively and consistently. The models that most clearly see their goals from that human perspective – a good life lived in a good place – are currently small in scale. Shared Lives is a little-known model promoting just this kind of support, in which approved carers are matched with disabled adults or older people, and share family life with them.
An adult with a learning disability or mental health problem might move in with their Shared Lives carer, living as part of their household, sometimes for many years. One woman, for example, had a longstanding mental health condition that saw her constantly turning up at A&E. Living with a Shared Lives carer gave her the motivation as well as the support to stay well, and her use of hospitals has dropped dramatically.
Others regularly visit their chosen Shared Lives carer for short breaks, which might otherwise be taken in a care home when their family needs time off caring. This approach is now used by around 14,000 people in almost every region of the UK – but this is still only a fraction of the total numbers of adults receiving support.
Shared Lives is one of six social care innovations that have joined together to demonstrate that, collectively, they could form the core of an efficient, cost-effective long-term support system for adults (pdf). They include local area coordination networks, in which a neighbourhood coordinator supports people who might otherwise slip towards crisis, connecting them back to their friends and neighbours so they have a better chance of living well in their own homes.
Community Catalysts, meanwhile, helps ordinary people form a wide range of tiny, highly personalised health and social care enterprises. In Somerset, one coordinator has helped more than 170 enterprises to provide homecare in a rural area where traditional agencies struggle to provide cover. Community Circlesoffers a way for people to form stable, long-lasting support around an adult who might otherwise rely entirely on services with ever-changing staff rotas, at risk as a result of falling through the cracks.
These models don’t seek to replace emergency services, but they do help people to avoid many of the crises that lead to emergencies. Each on its own cannot offer people everything they need to live well, but together they start to form a different kind of social care system.
As a general election puts an unavoidable question mark over how any incoming government will approach the challenges we face, it is to be hoped that whoever forms the next government does so with a view to delivering a system that is truly sustainable – not just affordable.