Here’s how we could fix social care and support

We need a National Care, Support and Independent Living Service

Social care and support is in crisis – that is agreed across the political spectrum. The Casey Commission is Labour’s response. Its timescale may be too long, but we still need to ensure that it takes a holistic and radical approach. This is the transformation in social care we need, based on the programme drawn up by the End Social Care Disgrace campaign.

The country needs a National Care, Support, Independent Living Service (NaCSILS) which is funded through Government investment and progressive taxation and free at the point of use. It should be publicly provided and accountable, and nationally mandated but locally provided. It is essential that it be radically re-imagined and co-produced with disabled people, carers, sector workers and local communities, offering choice, control, dignity and independence. It would provide a range of practical and financial support to carers and value their expertise, while ensuring that staff pay and conditions reflect their high value and skills.

Let’s look at these in more detail.

The Government shall have responsibility for and duty to provide a National Care, Support and Independent Living Service, adopting into English law Articles from the United Nations Convention on the rights of disabled people that establish choice and control, dignity and respect at the heart of person-centred planning. The rights as understood within the UNCRPD transfer across to older people as well.

This will be fully funded through government investment and progressive taxation, free at the point of need and fully available to everyone living in this country.

Publicly provided and publicly accountable

The NaCSILS will have overall responsibility for publicly provided residential homes and service providers and, where appropriate, for the supervision of not-for-profit organisations and user- led cooperatives funded through grants allocated by the NaCSILS. We no longer want to see the current situation where the 784 small to medium sized care home providers have a leakage rate in profits disguised as rent payments and management fees of £7 out of every £100 of income, and £13 out of every £100 for the largest 26 providers, equating to £1.5 billion a year taken out of the care system.

A long-term strategy would place an emphasis on de-institutionalisation and community- based independent living. All provision will deliver to NaCSILS national standards. There will be no place for profiteering and the market in social care will be brought to an end.

Mandated nationally, locally delivered

The Government will be responsible for developing within the principles of co-production, a nationally mandated set of services that will be democratically run, designed and delivered locally. Local partnerships would be led by stakeholders who are delivering, monitoring, referring to or receiving supported services or budgets, eg. organisations representing disabled people, older people, people who use other services and care and support workers, in partnership with Local Authorities and the NHS.

Identify and address needs of informal carers, family and friends providing personal support

The NaCSILS will ensure that there is a comprehensive level of support freeing up familymembers from personal and/or social support tasks so that the needs of those offering informal support, eg. family and friends, are acknowledged in ways which value each person’s  lifestyles, interests, and contributions.

National NaCSILS employee strategy fit for purpose

The NaCSILS’ standards for independent and supported living will be underpinned by care and support staff or personal assistants who have appropriate training, qualifications, career structure, pay and conditions to reflect the skills required to provide support services worthy of a decent society. This in contrast to current low pay, huge turnover, workforce gaps and the exploitation of migrant labour.

Support the formation of a taskforce on independent and supported living 

This should have a meaningful influence, and be led by user controlled groups of people who require independent living support, from all demographic backgrounds and regions. This would also make recommendations to address wider changes in public policy.

The NaCSILS should be independent from the NHS

Many people needing social care /support are disabled by the barriers they face in negotiating a social world which is not inclusive.

Looking at disability through a medical lens rather than a social model encourages a view of people as bundles of largely physical needs e.g. for food, toileting etc. which can be timed and ticked off on a task sheet.

It also reinforces the historically pervasive notion that medical and managerial “experts” know what is best for people and should provide for them, rather than seeing people who use support, as well as families and local neighbourhoods, as not just experts in what is needed but also potential providers.

On a more practical level, organisational integration would mean that social care and support is likely to be swallowed up by the NHS and Integrated Care Boards and its priorities shaped to meet the needs of our struggling, underfunded, health system.

Being independent from the NHS in no way minimises the need for effective co-ordination and streamlining of support to individuals when appropriate.

The economic argument for this plan can be found here. We hope to explore this further in a forthcoming paper.

In summary, this approach to social care and support would be transformational and with hugely popular with the public. We are at a time that is similar to a pre-NHS health service, where GPs had to be paid by patients and hospitals were a patchwork of privatised and semi-privatised organisations.

It could be transformed then – let’s do the same now!

Dr Brian Fisher is a member of the End Social Care Disgrace campaign