A national perspective on a national service
“It would be a big step forward to see something brought in that genuinely recognises the value of high quality social care and which supports people to access the services they need in the communities they live in, and which completely respects their rights and choices so that they can live life to the fullest possible.
“In my opinion any new system needs to recognise that there is high value in supportive and enabling relationships which build trust and help people to live as independently as possible, rather dealing in ‘packages of care’ which are then traded in a competitive marketplace, cutting across those relationships.
“That doesn’t mean creating unnecessary dependency but really recognising the conditions under which people thrive. Most of us, at any age, thrive best when we have loving supportive relationships, on which we can rely, surrounding us. Much of that can be delivered in communities and by giving more support to families who take on many and varied caring responsibilities and who can struggle with the tensions that unpaid caring brings.
“However, where specialist services are required, we need to tackle the practice of tendering. I don’t think any of us would like to be thought of as a ‘package’, and the current practice is highly disruptive to both supported people and the care staff working with them – it can put back progress that’s being made.
"They are highly trained, highly skilled and highly experienced. But they are low paid"
“We need to replace that competitive tendering with something which puts supported people at the heart of it, gives them as much choice and control as possible and which understands that spending on care is both a valuable investment in the life of an individual and an investment in building resilient communities where everyone can play a valuable part, rather than a drain on the economy which it has often been seen as in the past.
“Our work in CrossReach is diverse: from acute dementia care to postnatal depression counselling and working with adults with disabilities or children in care with very complex emotional behaviours. On a daily basis I am reminded that the people who are delivering these services are specialists. They are highly trained, highly skilled and highly experienced.
“But they are low paid – particularly in residential care for older people – and they often have really poor job security. It would be a huge step forward for any proposal about the future of care to fully address the principles of fair work.
“That, in turn, would ensure that those who do access services also have more security from knowing that there will be more consistency around the people supporting them. In CrossReach we have a lower than average staff turnover, but it is high in the sector as a whole and the working conditions of the staff and perception of their value all contribute to that.
“I believe it also needs to meet the aspirations of supported people who want to live as long as possible in their own communities, in their own homes or in high quality smaller group settings. And it should address something of the inequality which exists where some people have to pay a high personal premium for the care that they get or are unable to get equal access to the services that would best support them.
“This is particularly pertinent to care of older people where, in residential care, it is subject to a national care home contact which no longer covers the costs of care and which has contributed to some of the very difficult situations we have heard about throughout this pandemic where larger and larger care homes are being built in order to make them viable. Smaller homes, such as the ones CrossReach runs, may be being discussed as a preferred option but they are simply not sustainable under the current contract arrangements.
“So that’s part of my opportunity list and, for the record, I think all of this can be achieved if there is enough will for us all to sit round the table to discuss the important issues and put some of the old tensions aside – without necessarily introducing a nationalised service, although, to be fair, I have seen no firm proposals on what a national care service would mean.
"My concern is that ‘national’ means homogenous – one size fits all – which poses a real danger"
“There are things that worry me about a potentially nationalised care service – things we need to ensure we avoid doing. And the first of those is my concern that ‘national’ means homogenous – one size fits all – which poses a real danger that people’s lives and choices would be significantly impacted.
“At the moment, despite the many flaws, there is diversity, which should allow people to find the best sort of service to meet their needs at any given time. People need to be able to get the support they think is the best fit for them based on a number of factors including value, expertise, quality of what is being offered and their own faith or value system. And, to do that, they need choice.
“I also think that, if we are setting up a new care system, and if voluntary sector providers such as ourselves are part of that, then we need to be treated equitably and fairly as partners in delivering care and support.
“For example, we know that, on the whole, services in the public sector pay their own staff differently to what is passed on to voluntary sector colleagues. I don’t think we yet have the evidence to tell us whether any public sector national care service would be any higher quality or deliver at a value than the voluntary sector currently offers, but it is something which will need to be considered.
“I know that the for-profit element of provision is a much more tricky conversation but, however that is resolved, we should always try to ensure there is as much diversity as possible for the people accessing services and that everyone providing them is treated equitably and fairly, which is currently not the case.
“Another concern that I have, and I don’t know how widely shared it is, is that we might create a national care service that simply mimics or falls out of the National Health Service. I would be worried that outcomes might be more clinically driven and based on a medical rather than a social model of support.
“We have seen a wee bit of this already as integration unfolds, but most people who access services do not see themselves as ill. They see themselves as people living with a set of circumstances, on a temporary or longer-term basis, which means that they need additional support to live their life to the fullest and with as much independence as possible.
“So, for me, in any discussion of future care, social care must be seen as distinct from, although related to, health. And it should always be about improving someone’s situation, alleviating challenges, normalising people’s life experiences, putting them in the driving seat of the support that they receive – not about regarding them as patients per se.
“This is important in all care settings and has particular resonance for residential care. We strive to make sure that care settings are as homely as possible, that people who choose to come into residential care can live as if they are actually ‘at home’.
“After all, it is the only home they’ve got at that time. We don’t want that to just become a quasi-hospital ward with all of the restrictions that a clinical setting brings.
“We absolutely have to hold onto the opportunity to change things for the better, and I firmly believe positive change can happen. However. I believe that none of us should go into this with a fixed notion of how that can be achieved – or else that real opportunity might be missed.”