Philippa Russell is Vice-President of Carers UK and a Board Member of the Think Local Act Personal Partnership
Demographic change – and a long-delayed Green Paper on the future of social care – challenge all of us to both value and to rethink what we mean by social care and the ‘care market’ which provides it.
The Care Act was the marker for change, with personalised and self- directed care and support encompassed in legislation for the first time. But there are major challenges ahead. The policy shift to personal budgets and support in family homes and communities has raised the debate (not always positive) about personalisation and the role of residential care (particularly for frail elderly people). Personalisation has created a very diverse care market – a spectrum of provision ranging from personal budgets and home-care services through to supported living and of course residential care.
Commissioning has also changed – my disabled son has a personal budget through his local authority, my husband (and mother before him) as self-funders and both in their late 80s opted for residential care. Choice and control should mean access to a range of options for meeting individual needs and maximising quality of life. As Professor Paul Burstow said when launching his Commission on Residential Care (2014)[i], ‘Rebranding residential care as part of a spectrum of housing options with care is a pre-requisite for delivering the 2lst century care system that we all want to see’.
I see ‘rebranding’ of residential care (within the wider context of social care) as the biggest opportunity – and challenge – for a quality care market. All too often residential care is seen as a mark of failure, the ending of a valued community life. TLAP (the Think Local Act Personal Partnership) and others have proved this wrong but the message about personalised group care has not gone wide enough. As Professor Paul Burstow said, we need rebranding and that means rethinking how we recruit, train and deploy our social care workforce.
CQC (2017) [ii] notes that there are 1.45 million people working in adult social care – with 460,000 people receiving care and support in 16,000 care and nursing homes and residential colleges. The care market is large but sadly staff turnover is high, vacancies multiple, and care is seldom a career choice for many young people. As the National Audit Office notes[iii] ‘social care can’t continue as a Cinderella service…and fulfil its crucial role in supporting vulnerable and other people in society.’
As TLAP has shown, personalisation is possible in residential services [iv] if we enable the staff, the community, families and friends as partners in care. I shall never forget my mother’s delight in once again playing the piano (a skill that survived her dementia) to the local playgroup which visited her care home once a week or my mother-in-law’s indignation when a friend talked about the folly of ‘putting people into care’. ‘I am not a like a dog being rehomed’ she retorted, ‘this is my home; I chose it and I am safe and happy here.’
Thinking of the future, and my own family situation, I hope we can ‘rebrand’ not only residential care but also social care itself. We need a recognition that social care across all settings can change lives and that working in the care sector is in itself a valued occupation. In the end we are talking about shared lives.