Public Health Articles

Forgotten Communities

by .

COVID has shown that the time is ripe for a collaborative commitment for Social and Primary Care

‘Collaborative commitments’ were defined by the former Prime Minister Gordon Brown’s Prime Minister’s Council on Social Action as “agreements made voluntarily between individuals and organisations from business, public sector and civil society, to achieve positive social impacts which would not be possible for one sector acting alone, to obtain.”

The idea is that different partners pledge to do more, conditional on others delivering other, additional benefits. GAVI – (originally the Global Alliance for Vaccines and Immunization) – would be a powerful, international example of Collaborative Commitments in action.
Could the time be ripe for a Collaborative Commitment for Social Care? Certainly, politicians outside government, from across the political spectrum seem to be agreed that action is urgently needed. The present Prime Minister promised a plan in his first speech in office; a pledge repeated in the Conservative manifesto for the December 2019 election. Think-tanks of different hues are touting different funding solutions.
Successive Westminster Governments have failed to grasp the nettle of how to fund social care. The Blair Government appointed the Sutherland Commission in 1997. Since then, there have been 12 White Papers, Green Papers and other consultations about social care in England, but very little progress. The Coalition Government established the Dilnot Commission. The Dilnot commission recommended a partnership model with a much more generous means test and a lifetime ‘cap’ of between £25,000 and £50,000 on social care costs.

It’s clear that after the COVID-19 crisis, social care cannot continue to be delivered in its current form. Radical change is needed to address unmet need, ensuring that both older people and disabled adults of working age get the care they need. Social care is massively under-funded. The charity Age UK estimated that the number of older people in England with some level of unmet need stood at 1.5 million in 2019. There is no substitute for the long-promised, cross-party agreement on long-term funding of Social Care. The sector needs more money. A lot more money. Now. No argument.

Only Government can deliver this in co-operation with the other political parties and industry stakeholders. Better long-term funding should, however, be linked to other elements of a radical change agenda: hence the idea of Collaborative Commitment. Care-work is not currently seen as an attractive career option. Yet caring for the elderly, infirm and vulnerable in our society should be one of the most prestigious, honoured and appreciated professions. Care-workers require significant technical skills, compassion, empathy and high Emotional Intelligence to do their jobs well.

“It’s clear that after the COVID-19 crisis, social care cannot continue to be delivered in its current form.”

Care providers – public, private and not-for-profit – need to be able to commit to pay at least Living Wage (rather than just minimum wage) and to honour the Living Hours pledge of the Living Wage Foundation. This, in turn, should be linked to union and staff commitments to upskill. We need to capitalise on current investigations into the Care Worker of the Future and how vocational training can be provided effectively, combining on-the-job training and blended-learning, supported by further and higher education. Here the active engagement of Skills for Care will be crucial.

We also need to expand the talent pool coming into social care. Teaching, policing, even the prison service are now benefitting from graduate recruitment via prestigious programmes modelled on Teach First. Might there be lessons here for care-work too? Much of the current debate focuses on how to fund and how to organise from the government side. Consideration is needed just as much about how social care is staffed and also how it is provided: namely the market of providers of residential and domiciliary care.

There is a strong argument that increased public and service user funding should stimulate more of a mixed economy of care. Local authority commissioners, for example, might give more emphasis to the enhanced Social Value Act and more weight to the wider sectoral benefits of having a multiplicity of care-providers with a variety of ownership models (PE and other privately-owned chains; but also individual for-profit care businesses, social enterprises, local, self-organising co-operatives modelled on the widely acclaimed Dutch Buurtzorg model and charities).

A further component of a putative Collaborative Commitment on Social Care, should be to tackle the so-called “Care Deserts” – parts of the country where older people can’t access residential or home care, regardless of whether they can pay for it or not. Entrepreneurial programmes like the Tribe Platform, developed by Artificial Intelligence entrepreneur Richard Howell and his Bronze Labs, demonstrate how AI can positively disrupt and bring much needed innovation and “make markets” between local providers and customers of care services.

Most people want to “age in place” and be cared for in their own home – which is why improving the quality and ease of access to domiciliary care is so important. Indeed, polling by Hanbury Strategy for IPPR and Policy Exchange (respectively leading progressive and centre-right think tanks, which have come together to seek a long-term solution to Social Care), in the early stages of the pandemic, suggest – unsurprisingly – that care homes are now a less attractive option. Hanbury found both families and the over-65s themselves far less interested now in a care home option. Hence, the importance of radially improving both the quality and availability of home care. In his recent report for DEMOS, the Tory MP Danny Kruger suggested that family members might be paid to provide care services. This is the case, for example, in Sweden. This is not, however, the right choice for all and improving information for older people and their families about their care options is also critical. Hence the value of new services like Legal & General’s Care Concierge.

A new think-piece also from L&G: Caring for Britain (December 2020) highlights a range of other exciting innovations already happening in the care sector. Several of these are technology-based and there is no doubt that a range of technological solutions could positively disrupt the sector.

“Most people want to “age in place” and be cared for in their own home – which is why improving the quality and ease of access to domiciliary care is so important.”

Finally, the bulk of caring is – and likely will remain – informal and unpaid i.e. provided by family and friends. Most of us want to care for our loved ones: partner/sibling/disabled son or daughter etc. if we can, but such caregiving should be because we want to – not because we feel we have to or because there is no alternative. Caring should be based on love – not because of a sense of obligation. So, here I have reservations about Danny Kruger’s Demos paper where he argues families must take more responsibility. Apart from the morality of forcing individuals to care for others, it begs several questions. What happens to the increasing numbers ageing without children? To those whose families live far away/abroad or who are estranged?

A comprehensive approach to care reform, must respect, value and support the role of unpaid carers. This includes better access to Advice & Information; peer-to-peer emotional support and encouragement; fair financial support for carers who give up work to care for a loved one (substantially higher Carer’s Allowance or alternative); legal protection for working carers including right to request flexible working, working from home etc; and better help for ex-carers to re-enter the labour market. COVID19 pandemic and lockdowns have pushed many carers to breaking point – and sadly, a few beyond.

If #BuildBackBetter #LevellingUp and #JustTransition are to be more than empty slogans, there needs to be a comprehensive settlement of social care. How much better if it can produce a Collaborative Commitment to improve care radically and to put those cared for, at the heart of reforms.


Sign up to be kept up to date