John Burton has been working in and with social care, mostly residential care, since the mid-1960s. He has worked at all levels with all client groups and ages, and is currently consulting to therapeutic children’s homes. His most recent book is Leading Good Care (JKP 2015) and he is now writing a new book on children’s homes. Readers may also be interested in his What’s wrong with CQC? published by The Centre for Welfare Reform. (1003 words)
When designing anything it’s crucial to understand what its purpose is. When redesigning something that isn’t working as well as it should, we must study the operation of what currently exists to identify how it falls short of its purpose. To study effectively, we must get to know it in detail from the inside, look at it as a whole and make no assumptions.
So it is with what we call social care. We start and end life dependent on others, but in between the beginning and end we remain dependent to a greater or lesser extent. We are social beings and we are never fully independent. When we need more support than our family, friends and neighbours can give, we require an organised system of support which will include paid people and is likely to include supplies, buildings, equipment etc. We all need and give support, some more than others and at different times. It’s simply part of being human.
Such a social care system may start with just a little bit of help and develop into a place to live, supporting us with almost everything we need for survival. It’s likely that the sooner the little bit of help is given, the later the help with everything will be needed, if it ever is.
To work well for us, that little bit of help should be provided quickly, reliably and locally. (If it’s not local, it’s very difficult to make it quick and reliable.) We establish a relationship with the people who help us: a relationship in which we are active and equal participants. (Another reason for social care to be local.) As we need more help, it is most effectively given by the same reliable, local social care system. (They know me; I know them and I have a voice in how it’s run.)
Our current system
The system we have now is a huge conglomeration of competing providers complaining that they’ve got insufficient money to pay their staff properly, even when some are paying fat dividends to shareholders and stashing profits away in overseas tax havens. Some—mostly local—are very good and some, often not local, are not good at all. To survive they are compelled to spend a disproportionate amount of time and effort trying to prove—not to their users but to a national regulator—that they are good. When something goes wrong, they try to show—to another organization—that it wasn’t their fault. Most are short of staff. After many years of input from another expensive national organisation, training and staff development remain abysmal. Indeed, much of the management time in care homes is spent on failure demand, investigating or trying to justify, correct, or prevent errors that are built in to the system.
So, attempting to correct separate faults in this system won’t work. The whole creaking, unresponsive system is unsuited to its declared purpose. It is a product of muddled, ignorant, risk-averse, blinkered, blame-shifting, top-down tinkering, layer upon layer of attempts to prevent errors without understanding what the root of the error is.
A new system
The new system of care should be built from a positive and energetic approach to the task itself and that may—and probably should—mean that it’s differently organised in different localities. While small self-managing care co-ops work very well in some places, small private care homes have provided the backbone of excellent local care for many years. Good social care should be a matter of civic and community pride and achievement whether it is privately, charitably or publicly run. Working in social care should be something to be proud of, and receiving social care should be an ordinary part of community life. We should build on new and long-established local social care initiatives.
In my view, we should start with the same levels of funding (from all sources) used better: spent on care rather than on all the obstructive and diversionary trappings. Government must provide capital investment in social care as it does for education; accommodation costs (fair rents) should, of course, be paid for by the people who live in it, and care should be prescribed by GP and social worker together, and therefore free at the point of use. Anyone wanting to have care either at home or in a care home as a choice rather than as a necessity should fund themselves. (Fair care and accommodation costs—allowing for a return on investment—are quite easily calculated.)
The discussion of social care is centred on money . . . we just need more of it and we don’t know how to raise it. We have an old diesel vehicle: tax, insurance, fuel and maintenance costs are mounting; it breaks down constantly and pollutes the atmosphere; it’s now banned from city centres. Yes, it’s pretty useless, yet we still go on pouring resources into it, when we could invest in a clean, efficient, reliable, low maintenance, vehicle which will do the job for a fraction of the cost. But who will pay for our new vehicle?
Our current government is borrowing to invest in new hospitals and schools, but the running costs will be paid through taxation—of course. And—of course—how to raise the running costs of a new free, effective, local social care system through taxation is a real issue. But it should not be the central issue because the money is already being raised (through often unfair means) to run ineffective social care that is very poor value for money. If we make money the central problem of social care, we will continue to patch up and tinker around with a failing system. We’ll simply make matters worse and pay more for it.
Building on what works now locally, removing unnecessary costs and obstructions, and finding the same money from fairer taxation should not be beyond the capabilities of any government. It’s what they are elected to do.
John Burton has been working in and with social care, mostly residential care, since the mid-1960s. He has worked at all levels with all client groups and ages, and is currently consulting to therapeutic children’s homes. His most recent book is Leading Good Care (JKP 2015) and he is now writing a new book on children’s homes. Readers may also be interested in his What’s wrong with CQC? published by The Centre for Welfare Reform.