Social care: a positive option

By Amanda Deeks, for DHI's Vision Project

An item on the radio about social care:

• Cue sad piano music, presenter’s gloomy voice and a story of service failure, loneliness and isolation.

Cut to real life:

• My neighbours’ twin teenage sons with severe learning difficulties. I’ve watched them grow through school, college and into supported living in a home shared with friends. They have busy days, a great social life and holidays abroad. They are happy, healthy young men living without being dependent on my now ageing neighbours.

• A recently visited elderly friend who was being supported to die at home. Not much money in the family, but a warm, clean and welcoming home as always. Family able to drop by and a constant stream of friends and neighbours. All made possible by a fantastic district nurse working with two great home care workers, supported by the GP and palliative care services. My last memory of him was lots of love and laughter.

• A friend whose grandson who was born prematurely and has severe physical and learning difficulties. He lives at the heart of a loving home, adapted for his needs, surrounded by his boisterous siblings. He attends an amazing school with the help of specialist transport and support. A happy and loving little boy.

• A close relative’s mother has a degenerative illness and her husband of 64 years was struggling to cope. She is now happily settled in a local care home a short bus ride from her husband. He can visit every day and they spend the afternoon together, still holding hands.

Lovely stories of social care at its best. So, what’s the problem? When I asked these families, the issue always comes back to funding and the often complex, confusing and sometime adversarial process of securing the services needed.

Amazing advances in healthcare mean that many more people can now survive for longer with increasingly complex conditions. Our current system does not adequately recognise these changes in demographics, nor does it recognise the changing social context.

Institutional care is no longer an acceptable model. Quality care must recognise the needs of the individual and that the burden of care and cost should no longer fall on the family.

The majority would agree with this, but there has been no recognition of the costs involved. So, what are the implications of an underfunded social care system? There are a number of factors which are in themselves problems, but together can sometimes lead to disaster.

Costs have been driven out of the care system to a point where pay rates are no longer competitive and some care home and home care providers sometimes struggle to maintain staffing levels. Society rightly expects quality services, but a drive to the bottom can only result in service failure and failures in quality. Often employers rely on agency staff, this can be a positive, filling short term gaps and sometimes bringing in experienced staff.

Agency work can also offer the freedom to the individual worker, which may mean the difference between keeping good colleagues in the sector or losing their skills and expertise. However, if overused and badly managed, use of too many agency staff can lead to situations which may be sub-optimal and occasionally unsafe for the customer.

Often, low pay is synonymous with jobs that are seen as low value and lead to negative perceptions of care work, which has its challenges but can be some of the most rewarding work going. There is a wider issue than just pay rates. Lack of investment often leads to a lack of training and development, the very issue which will attract and retain a care workforce in the longer term. Indeed, the lowest paid in the sector are often expected to pay for, or contribute to, their own training and development.

The implications for professional working in the system have also been significant, leading to a potentially damaging change in emphasis which has contributed to less job satisfaction for those working across the system. Individuals aspire to become social workers or occupational therapists or any of the professional and caring roles within the system because of a desire to support the most vulnerable in our society, to make a difference and to add value.

Increasingly their roles are as gatekeepers to resources which has led to already stressful jobs becoming harder and less satisfying. Work feels more adversarial and about denying care rather than the creative, supportive and sustaining roles individuals joined for. This must contribute to burnout and staff looking for other ways to take back control, of which agency work must be a prime example. The serious risk lies in staff becoming negative about already difficult roles when cost becomes the driving factor. This can lead to untold damage to staff and the very individuals they joined the professions to support.

The best care happens where there is trust and a shared commitment to the same vision and values for all players in the system. Social Care, wider Council services, the NHS, education and the voluntary sector working together in an integrated system can wrap support around the individual and their family, to maximise independence and choice.

Financial pressures across the system cause disagreements around funding thresholds and can be the cause of deteriorating relationships and a lack of trust between staff and organisations, potentially contributing to a dysfunctional system. In children’s services this may lead to unfair pressure on schools unable to support children with additional needs; and in adults’ services, perverse decisions about care settings, which can lead to additional costs in the longer term. A particular example may be a reluctance to fund early intervention and prevention, with mental health services and services for vulnerable adolescents being particularly vulnerable.

Current thinking recognises the vital role of the community and voluntary sector in keeping individuals in their own home and providing vital support to parents or carers. Funding specific services is not enough. Councils and the NHS must invest in voluntary sector infrastructure and consider their shared commissioning strategies if they expect the voluntary sector to be available when needed.

One of the most distressing impacts of a lack of funding is the way parents or carers have to fight, sometimes for years, to get the services and support their child or loved one needs and deserves. This sometimes leads to a destructive and adversarial relationship between parents or carers and the very staff who are there to provide services and support. This is a terrible consequence for all concerned, valuable time, money and energy is wasted, when it should be focused on the individual who should be at the heart of all our care.

So, our request to have a properly funded social care system is about preventing the frustrating consequences of underfunding that reduce the effectiveness of the resources already available. More funding will have a major and beneficial impact. That the system functions as it does, is testament to the parents, carers and staff who work so hard, in spite of the circumstances, to provide safe and high quality care for so many. But we can do so much better for the most vulnerable in our community.

This article was written for The Vision Project by Amanda Deeks. Amanda is the retiring Chief Executive of South Gloucestershire Council, a role she has held for the last 14 years.

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DHI has invited the author to write the above article. The views and opinions expressed in this article are those of the author and do not necessarily reflect the views, opinions, policies or otherwise of DHI.

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