Richard Banks shares some ideas being considered by the Residential Forum for a neighbourhood approach to designing models of residential and supported living.
How did social care get to be in such a difficult place? The quick answer is that successive governments in England have perpetuated a policy vacuum for social care. This is a vacuum about purpose, finance, the nature of services and the workforce. The debates, such as they have been, have missed the core purpose of social care – yes, it is part of an effective health service – but success should be about lives supported and enhanced not reductions on stressed parts of the NHS.
The longer answer is to examine how we by coping and doing our best, which of course we must, have found ourselves in a strange and unwelcome place.
People should have emotionally intelligent support when they need assistance with caring for themselves and their family. Be those needs associated to issues of adolescence, mental health, disability or ageing. Unfortunately, the response that people get when they need support tends to be about service qualification thresholds and the waiting lists for distant services. In other words, people are asked to understand the difficulties of the administrative system rather than have their own family needs addressed.
This is a perversion of what people want. Instead of getting personalised support they find themselves embroiled in a maze of policy and procedures that define them in terms of services that are available not what might assist. The services probably do not relate to their needs and are operating to timetables that become an additional set of problems. As a result, we have some very dull standardised care provision that struggles to respond to individual needs. The regulator acts to distinguish between good dull care and poor or abusive dull care. This may be the best they can do in the circumstances but is not the vibrant and responsive set of options we need.
For the general public, this has contributed to a wider lack of trust in ‘experts’ and certainly in official bodies that appear to be protective of their power and position. This is dangerous since there is genuine expertise that people need at these pressure points in their lives. Sadly, they may well not even know such knowledge exists or to access it. Examples will include the people’s struggles to get support related to eating disorders, depression, disability and dementia.
Consequently, there is a common thread of dismay in the stories of people experiencing mental health problems, disability and those dealing with aging at the difficulty of just being heard. They struggle to get organisations, that should support them, to listen to them and respond. We know that much of this to do with cuts and underfunding. It is also to do with the ways that organisations attempt to apply a rational and defendable process to their rationing. Additionally, it reflects narrow thinking and slow recognition of evidence about improving practice. One of the effects of cuts has been that many organisations rather than seek and support community assets have withdrawn behind quasi-professional and bureaucratic barriers. Staff in these organisations are often in an invidious position of defending tawdry services. At its worst, this has created an ‘us and them’ attitude from state organisation staff who behave as if under siege and communicate distain to citizens. (The treatment of residents before and after the Grenfell Tower tragedy being an example). This sets up a vicious cycle of mutual distrust with elements of class, disability and racial discrimination. A strange and most unwelcome place for people who work in social care.
We are unlikely to see anything effective in the short term from our governments in the UK. They appear short on ideas and even shorter on capacity to think things through. We must look much closer to home to move things forward. Part of that will be to avoid just coping and muddling through. Social care does have to cope for the sake of people who need support now but we must find a better way to engage neighbourhoods, communities and the families to create access and agency in locating information and support. There are many examples from peer-led organisations and other community based organisations that show some of the ways forward. Unfortunately, many of these organisations are struggling to survive.
The Residential Forum is developing a project to bring the knowledge, skills and experience of neighbourhood people and community members to bear on planning, organisation and provision of care and support. The view is that social care would be both more creative and effective if planning was local and drew on the real assets of people, neighbourhoods and communities. This would be inter-generational because part of the unhelpful legacy of existing systems is that people are divided into categories that immediately separate them from their communities. This project will not set out to fix funding problems but it does intend to develop ways to ensure that what is available is more likely to be what people want. In part, the idea is taken from the work of neighbourhood plans – these are being used to think about the housing, business, environmental and infrastructure needs of an area.
In a similar way, the Residential Forum want to investigate the means for local people to contribute to planning for the sort of care and support facilities they need now, in the next few years and for the kind of community they will want to be part of in the future. The belief is that people, given the chance, are innovative and more likely to have plans that will provide better results for people in their community. This plan would then be the focus of collaborative commissioning and more confident developments by organisations providing services; encouraging flexible and more responsive ways in which people can have care and support. The plan will need to think about the people who will provide care and support. The skills and knowledge of the people in the workforce (paid and not) are the core of successful support. So, we are looking for creative ways to do this that will likely be unique to local areas. The project is being developed and feasibility funding being sought.
About the Author
Richard Banks is an expert in strategy and management of workforce in adult social care. Richard was writing on the Residential Forum Blog - an independent body of thinkers seeking to promote supported accommodation and residential living as a positive choice for people of all ages and thereby make a contribution to public life in the UK.
If you or your organisation are interested in being part of this project then either submit your thoughts via a post or just get in touch with the Forum via their contact page.