A vision for adult social care

The government's vision for adult social care in England has just been published, a week after the launch of the partnership strategy Think Personal, Act Local.

JRF will be responding formally to both documents. We will be welcoming and endorsing Think Personal, Act Local (the Partnership Strategy) which is a clear, careful and challenging statement capturing what we know about what matters to people who use services: families, carers and supporters. Our response to the government's vision will be more circumspect.

There is much to welcome in the government's vision. It builds on the past whilst rightly criticising the lack of pace and progress in some areas. Many priorities are spot on, including:

Prevention: both before and since the JRF Older People’s Inquiry into That Bit of Help, our evidence has highlighted how low-level support services are highly-valued and effective in assisting people to enjoy a better life in their own homes and communities – sustaining relationships, promoting health and well-being. This in turn brings benefits to the private and public purse by reducing or delaying the need for more costly (especially NHS) services in the future.

People: the recognition that people are often the key to quality – imaginative, creative, person-centred support that takes account of the whole of people’s lives and the relationships that are important to them. Our evidence has highlighted that good people can make the impossible possible (and of course, people can also make the possible impossible).

There is an important message running throughout the government's vision that social care is not about 'them' – it is about us all. This message has come out powerfully from our own work too. It underpins our new programme on tackling loneliness in neighbourhoods in York and Bradford; our commissioning of research into approaches based on reciprocity and mutuality; and our 2009 Viewpoint on the role of communities. However, the power of this message risks being confused by:

1. the hard realities of the spending review settlement for local authorities (despite the additional £2bn and the frequent references to this being a ‘solid settlement’ for social care);
2. the even harsher realities that many user-led, community-based and voluntary sector enterprises and organisations, who have been delivering the best of what the vision sets out, are struggling to survive. Attend any conference on social care, older people, dementia, disability and you will hear stories of good services and support disappearing.

For some, the message will be further confused by references to the Big Society and the devolution of power – and responsibility – for providing care and support to communities and local councils. The role of central government is greatly reduced: ‘facilitate, assure and support’. The expectations on local councils are extended: commissioning and developing the workforce of the future; commissioning a full range of preventative and early intervention services; developing community capacity, and so on – alongside a wholesale change in the attitudes of councils and staff. There are high expectations for local voice, user-led groups, community and voluntary sector, and providers – small and large alike.

Certainly, there is a real risk that some (many?) of the people and groups who are best placed to deliver and support it will soon have neither the capacity, back-up, infrastructure, nor the finance to do so; and that local councils will struggle – despite the government’s clear expectation – to prioritise investing in ‘that bit of help’.

It is a relief that the document refers to housing and employment and the need to start with the whole of people’s lives. However, these references feel hollow in the wider context of welfare reforms, diminishing supply of affordable housing, and uncertainties about the future jobs market. What should we read into the lack of reference to the role of the Department for Work and Pensions? More positively, the document highlights a greater leadership role for the Department for Business, Innovation and Skills in supporting, shaping and stimulating the market around care. The word ‘invest’ is barely used, but certainly that is what is required: investment that identifies different approaches and new technologies, but also – and critically – investment that sustains and builds on what we already have. And this is where funding does matter, where leadership from government matters, and where the complicated interfaces across work, welfare, care, support, housing, neighbourhoods, equalities, transport and leisure matter.

In a nutshell, this is a vision which:

• recognises the value of social care and support, the role we all have to play in this, and the importance of increasing the quality and reach of support;
• is dependent on enterprise and some untested assumptions (most notably that the universal roll-out of personal budgets, especially direct payments, will stimulate a plural vibrant market);
• should benefit significantly from the commitment expressed in the Partnership Strategy, Think Local, Act Personal; 
• could not come at a more difficult time for people who use services, for carers, for disadvantaged communities, community organisations and councils.