Government must deliver urgent adult social care reform after years of failure and broken promises
A few weeks on from the Autumn Statement which brought a two-year delay to the implementation of the social care cap, there is no better time to be talking about adult social care.
The figures of failure are haunting: 165,000 unfilled posts in social care. 2.2m hours of care lost in the first three months of this year. Several millions of disabled adults and older people living with some form of unmet need.
Adult social care cannot be easily “fixed”. The title of our report, A gloriously ordinary life, expresses in the words of one of the many experts that we heard, our ambitions for sustainable change after years of failure and broken promises. Adult social care must be recognised as a truly national service capable of transforming lives by delivering greater independence and respect, reflecting ambitions for a life well-lived.
We must create a more resilient social care system that is not based on the assumption that families should and can provide care
We are far from that. To quote the Chancellor Jeremy Hunt, former chair of the Health and Social Care Committee, the invisibility of adult social care is “deeply entrenched”. In this report we reveal what that means for the lives of those who draw on care or provide unpaid care, the millions of carers who save the country an estimated £132bn, and yet continue to live at risk every day of financial, emotional and physical breakdown.
The relationship between the people who draw on care and those who, unpaid, provide care and support, is at the heart of this report. What improves the life of one will make a better life for the other. Furthermore, we must create a more resilient social care system that is not based on the assumption that families should and can provide care and support for each other - a model that will be unlikely to hold for the future as two million or more people age without children in the next decade.
What will make the real difference, inevitably, is a realistic, sustainable and predictable funding settlement across the whole of adult social care, together with a national workforce plan for the sector.
But our report argues for other changes. Critically, assumptions and attitudes must change, replacing the usual language of “burden”, “crisis” and “dependence” with a more positive narrative that celebrates and invests in the transformational power of adult social care. Not just as the essential component of a world class health service, but a national service in its own right which strengthens people, families and communities.
In our report, we show that co-producing care with those who draw on it, providing more choice and control, and understanding what is meant by “independent living” – thanks to better ways of delivering personal assistance, alongside overdue housing and technology solutions – can lay the foundations for a more resilient and efficient service for everyone.
To do more, and to make better policy, we need to know more. We simply don’t know enough about the scale, conditions and impact of adult social care. Without that, we cannot universalise best practice, introduce better systems of navigation, or design better care.
And to raise the profile of social care, we recommend creating more national focus to give greater voice and agency to the sector in the form of a commissioner for care and support. This new role, held by or shared with someone who has lived experience of social care, will raise status, challenge failure, and be the national champion that so many witnesses urgently asked for.
All this and many more detailed recommendations, including better financial support for unpaid carers, and ranging from facilitating employment, greater respect for their expertise, to stronger partnership and recognition, will enable the friends and families of those who draw on care to choose for themselves how best to manage their caring responsibilities – and look after themselves too. We continue to expect too much of them while giving them too little, even though they face higher costs and barriers while receiving the lowest benefits. That must change.
Our focus has invariably been to create an adult social care service that is more sustainable, kinder, more equitable and more efficient. We were poignantly asked: “When is the help coming?” To which our answer is: “If not now – when?”
Baroness Andrews, Labour peer and chair of the House of Lords Adult Social Care Committee.
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