What are we going to do about Social Care?

Written by Ron Brown – Managing Director at HSN Care Limited

Published on 9th December 2021

Lately we have seen how the state has taken more and more of a role in telling us what to do and how to do it. Given that we are in the middle of a public health crisis like most of us have never witnessed before, we have, in the large, borne the restrictions on our liberty with good grace despite some level of frustration at perceived inconsistencies or errors of judgment. In this light, we as a nation have generally been vociferous but relatively charitable in our assessment of HMG efforts on our behalf. However, we must be alert to the danger of the current necessity for ratcheted-up big government morphing into any form of stasis in our approach to Social Care.

The approach to the sector which has been in place for a good while now and the influencing role of the state is – and has become to my mind – completely disproportionate and overbearing. The issues in relation to Social Care fall essentially into two categories

  1. Funding or how it is paid for, which I will cover in a subsequent post and;
  2. How the Sector or Market is set and governed i.e., what are the rules of engagement for all stakeholders.

How the sector or market is set and governed has, to my mind, become increasingly driven by an overreaching state which, prior to any public health emergency, had become increasingly hard to swallow for anyone of a liberal democratic persuasion. Let us not forget that services delivered by the state itself have – at very best interpretation – a patchy record probably best illustrated by old long-stay hospitals for people with Learning Disabilities. These accommodations were often rife with infection and abuse, delivering shocking lives and appalling life experiences to service users/patients who could have justifiably been described as little more than inmates. Ditto long-stay psychiatric hospitals or what CPN colleagues used to refer to euphemistically as “Bins”. The reality is that the state should be humble when it comes to its track record of delivery and tread carefully in the Social Care Sector.

What then of the much-vaunted Care Act? I am no lawyer but, as someone who operates near the ground in terms of actual implementation, I would be hard pushed to see it as anything other than chaos. Indeed, the increasing LG Ombudsman’s findings against Local Authorities in relation to Statutory Duties failings would surely point to the increasingly impossible situation they find themselves in. Many Local Authority practitioners are de facto forced to operate unlawfully across a whole manner of areas from assessments of eligibility. Social Workers have found themselves increasingly the handmaidens of a system that demands they profess to be implementing the Care Act but in reality, they are the face of a cruel trick whereby various methods of “resource allocation” systems that are not needs-based are given a veneer of professional respectability.

What then is at the heart of this and why is the sector/market so dysfunctional? There is no doubt that many of the high ideals and much of the lauded virtue signalling about “personalisation”, “independence”, “dignity” etc. is both well-intentioned and sincere but often actually very far from the reality in most areas of the sector/market be it older people’s care, children’s services or working-age adults. The state has overreached and, as history has shown us, an overly powerful state – even if it claims to be acting in our best interests – is generally a bad thing for freedom and independence particularly for vulnerable, poor or marginalized citizens.

It is time for the state to wind its neck in, be more humble and more focused on what it realistically can and should do. How come people and their families cannot choose the care arrangements that suit them if the state, in whatever way it sees fit, has determined the options available are safe and do not represent an excessive risk? Why is it the business of the state how I determine what are the best care arrangements for me? Why is the menu of care arrangements available to me so heavily screened by the state that we end up in a situation where effectively I can have “any colour as long as it’s black”? I have been in several discussions with well-meaning professionals who genuinely think they are better equipped to decide what is best for Service Users over and above those service users themselves and their loving family members. How can that be right? The system with all its well-intentioned narratives provides ample support for such intrusion and overreach by the state. It’s seen to be quite alarming and potentially sinister from a family viewpoint. Up and down the country perfectly well-supported care options are being wound down because they do not suit the current narrative even though they are endorsed by families and service users themselves. Care options are being brought forward that do fit the government narrative which creates incredibly lucrative profit machines at the taxpayers’ expense but delivers poor care outcomes via models that are only supported because other options do not exist.

There is a two-tier element to this dynamic whereby if a Service User or their family has the means to instruct a specialist lawyer, they are likely to get a fair hearing but families without means basically have an even more stark “take it or leave it predicament”

The almost complete and wholesale employment of Social Care social workers by the state or its agencies makes the system even more skewed against the end-user choice as increasingly sound independent professional judgment is almost entirely mitigated by the plethora of “panels” and “nonprofessionally” trained or accountable governance that social workers must literally battle with if they have the professional resilience and heart to do so.

The current market that is entirely designed and governed by the state is inefficient, dysfunctional and in some instances cruel. Let people choose the care model and delivery they want. The state does not know best and frankly never did and should confine itself to:

  1. A significant and primary protection role
  2. Designating, regulating and monitoring safety
  3. Creating the market conditions where the maximum diversity and variety of choice is available to end-users and their families subject to 1) and 2)
  4. Ensuring fairness, transparency and equity in operating arrangements and delivery
  5. Setting out in clear and transparent terms what the state is prepared to fund i.e., what is eligible and what it is not.
  6. What socio-economic and financial circumstances qualify people for enhanced state funding or free social care

In principle surely state involvement in matters other than this should be approached with extreme caution and humility given the track record the state tends to have in delivering to vulnerable people and in setting overly prescriptive policy objectives. As a sector, we need to be vigilant and vociferous in our advocacy for choice!

Original Source: LinkedIn Article by Ron Brown