Quietly and with little fanfare, adult social care appeared in last autumn’s pre-budget report as one of the greatchallenges now facing our country, and a Labour government committed to renewal in office. Adult social care has been for too long a ‘Cinderella’ public service, but its new status as one of our great social and political challenges results from the realities presented by a rapidly changing society. Demographic pressures, rising public expectations and perpetual technological advances are asking new questions of a system designed for a different age.
Labour’s new leader, whom I hope and expect to be Gordon Brown, should bring together the current Treasury review of the needs of over 85 year-olds, the vision promoted in the Our Health, Our Care, Our Say white paper, and the emerging lessons from the In Control initiative and individual budget programmes, to map out a vision and strategy for the future of social care. There are a number of integral elements to an adult social care reform strategy.
First, there is a need to build a consensus for a new settlement that redefines the respective responsibilities of the state, family and individual. Unlike the NHS, social care has always been means-tested, and free care is neither sustainable nor fair. A Liberal Democrat frontbencher recently expressed regret that her party had misled the electorate in their manifesto at the last election, by suggesting it was a realistic proposition. So the challenge is to define what is fair and sustainable, including the system’s responsibility to self-funders, who have a right to expect protection from exploitation, and information and advice about the nature and quality of services.
Second, carers. Brown recently announced a national consultation with carers and their representative voluntary organisations to shape the development of a new national carers strategy. We must build on our annual carers grant to local authorities, new pension rights, the right to request time off from an employer and our recently announced new deal for carers. In addition to practical and emotional support, it is important we invest in family leadership so carers have the knowledge and confidence to develop a more equal relationship with professionals.
Third, we need an integrated approach to the commissioning and provision of services. Social care is
at the heart of every community’s health and wellbeing. It is important to view all the services commissioned and provided by local government as contributing to the wellbeing of older and disabled people – not just the resources in the adult social care budget.
Exhorting local government, the local NHS and voluntary sector to develop a ‘joined-up’ approach will no longer be enough. In future, GP practices commissioning social care should become mainstream. Voluntary organisation should not only be treated in accordance with the compact principles, but also as an equal partner in identifying local needs and offering responsive services. Issues such as continuing care funding and different accountability systems for local government and the NHS must be tackled, but in themselves are not insurmountable obstacles to integration.
Fourth, we need to give power back to the people. Individual budgets, direct payments, self-directed support and person-centred planning are all means of putting those who use services at the heart of the system. To ensure this becomes a reality for all, professionals and volunteers will have to be deployed as advocates and facilitators, enabling and empowering people in ways which are relevant to their personal support needs and in accordance with their preferences.
Not everyone will want to directly employ their own care staff, but the vast majority of people requiring social care do not want to relinquish all control over their own lives. People power in social care is not new, but it is the preserve of a few pioneering local authorities, In Control, and some organisations led by service users and carers. This should move from the margins to the mainstream of the way social care is provided in this country.
As we claim the mantle of the party best equipped to be the guardians of our nations future, social care can help to transform that belief into a reality. The first 100 days of a new leadership will not answer all the difficult questions, resolve all the hard choices or transform the system. But it must be the moment when we commit to building a consensus for a new settlement, and expose the differences between Labour’s vision of a state fulfilling a new role to reflect a changing society, with David Cameron’s retreating state. In an era of personal and global insecurity, an enabling state on your side versus a state of last resort is a choice we should relish putting before the British people.