State of Care in Britain today – we need a revolution

I would welcome today’s Care Quality Commission's (CQC) State of Care report. No doubt another frenzy of judgemental headlines will follow. Who will get the blame this time?

The findings of this report really shouldn’t be a surprise to anyone.

What do we now know? The complexity of need amongst users of health and social care is rising, co-morbidities, complex conditions, a rising number of older people and the consequent increase in those living with dementia. The needs of the population are changing at a rapid rate and the Health/Social care complex is struggling to cope.

The NHS in particular, already facing the challenges of increases in medical options and pressures on budgets, simply doesn’t look sustainable in the future when our ageing society is added to the mix.

Social care has suffered from 20 years of poor commissioning and lack of vision, and is now in a dysfunctional state. As local authorities struggle to balance their budgets, an increasing divide is appearing between those who can pay for their care and those who can’t – increasingly obvious in the north\south divide. In some parts of the UK it is now almost impossible to get a domiciliary service as no one is able to provide under the prevailing market structure.

The care home stock is increasingly unsuitable and dilapidating as fee rates outside richer areas still fail to reflect the increases in complexity of need.

But we all know this. Why are we shocked and surprised?

The report talks of ‘cultures in which unacceptable care becomes the norm’. Although CQC is referring to individual ‘cultures’ within settings or organisations, I would argue that in fact our collective societal culture is the root cause of the malaise.

The future needs to see a radical reassessment of our values if we are to have any hope of securing good services in health and social care for our future.

The system is crisis-driven, with far too little investment in preventative support, and the consequent high cost is the result of increased use of health services – health, housing and social care work in separate universes, only occasionally touching.

There needs to be a radical shift of resources from hospital care to social and community care. Instead of spending billions of pounds fixing crisis we should spend the billions on preventing crisis. This will not only improve the wellbeing of us all but will also protect the NHS for us all.

The findings of My Home Life exposed the unsustainable pressure on the social care sector to continue to manage the dishonest expectations of society that demands quality, kindness, compassion but that is unwilling to extend the same respect to those who are on the front line, be this in terms of pay, status or respect.

It’s about time we really faced up to the challenge.

We hope to bring some more evidence to the debate with our new programme of work on Risk and Relationships. Our hope is to help make a shift away from CQC’s ‘An attitude to care that is ‘task-based’, not person centred’ by looking at how things could be done in a way that promotes real relationship-centred care and moves away from risk-obsessed, blame-petrified and task-focused care.

Time for a revolution.

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