People need to be at the heart of decision-making on the future of social care.

Kathryn Smith, Chief Executive, Social Care Institute for Excellence
John Evans OBE

John Evans OBE, Disability Consultant and Chair of the Co-production Steering Group at the Social Care Institute for Excellence (SCIE). And Kathryn Smith, Chief Executive, SCIE.

We can all agree that social care is in desperate need of repair. It was struggling with rising demand and reduced budgets; and then Covid-19 came along, totally exposing many of its flaws. Deaths in care homes earlier this year were a tragedy but just one of many examples of things going wrong. A radical reform needs to be achieved; and at pace.

There are many views on how to make the reforms needed, not least from SCIE, who are asking for three shifts in the way that social care is delivered; and a long-term plan like the NHS. You can see the report here


One of SCIE’s big unique selling points is that it understands co-production. If you’re not familiar with the term, it means that people with lived experience, like me, work together with social care professionals and government policy-makers in planning and designing the care and support that’s right for them. It’s about doing things in partnership rather than ‘being done to’.

We’re glad to see that a co-productive approach has been introduced with the recently formed Social Care Task Force, which was set up by Department of Health and Social Care, following Covid-19. And we on SCIE’s Co-production Steering Group strongly believe that as and when these reforms are seriously worked out, they should ensure that co-production is at the centre of this.

It’s about the money

The big ask for social care is funding. There have been many attempts at solving this, including the Dilnot Commission Report in 2011. Sadly we still have to say, and especially now following the aftermath of the worst of the Covid-19 pandemic, the time is ripe for a new kind of funding approach. Recently, there have been a few public polls, asking people if they would contribute more to social care. In these polls, people have categorically said that they would like to contribute to help improve the situation following Covid-19. The chair of SCIE, Paul Burstow, has also put forward a proposal, suggesting that people over 40 contribute more for potential future care needs.

Not just residential care

It is important to stress that social care is not just care home provision – important though that is – but represents a wide variety of different practices like domiciliary care, safeguarding, strength-based approaches, community day centres and the ever-important independent living and direct payment schemes. And so much of this has co-production at its heart.

What is interesting following the first wave of Covid-19 is that those people who organised their own personal support in their own homes often ended up being far healthier and safer than people in residential homes. Lockdown has, in some situations, stimulated more co-production.

Any new social care reform should have the individual with all their needs at the centre of all decisions about their lives. They must have control and choice over any transformation regarding their lives. Now, that would be real reform.

SCIE: Beyond COVID: New thinking on the future of adult social care

Extra Reflections by John:

In my 37 years’ experience of living independently and employing my PA’s for my support on a day-to-day basis 24/7, the lockdown has been one of the biggest challenges. I realised we had to move fast to minimise all risks. We immediately raised the standards of hygiene even further, stopped having guests, lengthened my PA’s shifts and began self-isolating together. Myself, my wife and my PA’s began shielding before it became official. We sought the help of a local Covid-19 support group to do our shopping and other tasks until we secured online supermarket deliveries; after the initial panic was over and slots were available again. The emergence of these support groups was co-production in action at a local level and was one of the inspiring features of people coming up with their own solutions.

This has made me realise the importance of being in control of my support more than ever. Thankfully, the decisions we made together enabled us to survive the lockdown. I have had control over the situation, unlike those disabled residents in care homes, who often could not control the coming and going of the staff. This is the uniqueness of independent living, whose outcomes can be good health and wellbeing as individuals.

I personally feel strongly that social care cannot completely merge as part of the NHS. In fact I think this would be a disaster, as it would be in danger of being swallowed up by the NHS. The NHS and social care have two entirely different functions. The NHS is hospital-based and health-conditions based. Social care is about meeting the needs of a diverse group of people living in the community. The NHS is based on a Medical Model approach, focussing on specific health issues and systems. Social care is more expansive and based on the Social Model, which is about improving the lives of people in local communities.



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