It has become a cliche to say that our social care system is broken. But now, it’s time to start thinking differently about care. In 2019, just minutes after becoming Prime Minister, Boris Johnson stood outside of Downing Street and promised to ‘fix social care’, however, nearly two years later we are no closer to a solution. In this morning’s Queen’s Speech, social care merited a single line, with no detail: it’s certainly not the radical action needed to ensure everyone is able to get the care they need.
The social care system is currently not a system, it is a ‘guddle’ – a wonderful Scottish term meaning a ‘mess’ or ‘confusion’. I learnt this when serving as a member of the Advisory Group to the Independent Review of Adult Social Care in Scotland last year.
This guddle works for no one. For people with care and support needs, accessing services is a struggle, one that often ends in the discovery that those services are unavailable or unaffordable. For family members, it often means having to take on heavy responsibilities for caring. Some try and juggle this alongside a job, many are forced to give up work, putting themselves into a precarious financial position. For staff who are working in the system, it can lead to burnout from the constant stress of having to respond to crises, and feeling that whatever you do is not enough. Instead, we need a system that acknowledges the vital role that communities of friends, family, faith or neighbourhood play in caring for us throughout our lives, and one that supports these communities, rather than leaving them to pick up the pieces.
The solution is not piecemeal change, but a fundamental shift in the paradigm of care. One that moves from seeing care as a burden to an investment; from support that is only available in a crisis to support that is preventative and anticipatory. Cuts to social care have meant that only those with the most severe need are able to access it. A holistic view of care and support has been all but lost. We need to reverse this trend.
On the way, we need two crucial things: a cash injection, and a better joining-up of health and social care services. The current lack of funding must be addressed urgently. In the short term, we need investment to stabilise the current providers, many of whom are on a financial knife-edge; in the long-term, we need a solution to extend publicly funded care to protect more people from, at a minimum, the catastrophic costs of care.
Services also need to be better joined-up between health and care for the many people who have both medical and support needs. We would, however, be naïve to think that health and social care can work seamlessly together when the fundamental foundations on which they stand are completely at odds. The NHS is free at the point of need, funded through general taxation and available to all. Social care is only available to those with the highest levels of need and is heavily means-tested, meaning it is only available to those on low incomes and with few assets. Unless these fault lines are fixed, services will stagger from crisis to crisis and those who need care and those who care for them will continue to bear the brunt of the consequences.
We need a fundamental reimagining of care – its purpose, its value, and the principles which underpin it. This is the task of the Archbishops’ Commission on Reimagining Care which I will be chairing. The Commission, which was inspired by Archbishop Justin Welby’s 2018 book Reimagining Britain, aims to articulate the enduring values and principles which should underpin care and caring. It will seek to shape how we respond to ageing and disability in our society, challenging existing attitudes and models of care, where appropriate, while highlighting the positive. The work of the Commission will start in the summer and will be engaging widely in order to contribute to the national debate on the purpose and provision of care and support.
We have a system in crisis that responds to people in a crisis. I have been deeply moved by the many stories I have heard about the devastating impact this has on those who need care. We need to shift to a vision of care that puts people and relationships at its heart, redefining the status of caregivers, both paid and unpaid, and those who need care and support. A vision that looks beyond the statutory system of care and recognises the wider role of communities including the church and other faith communities. A vision for the future, now.
Fixing social care is a big task, and there needs to be radical and long-term action if we are to all get the care and support we need to live our lives to the fullest, whatever our age or ability.
Find out more about the Centre for Ageing Better on their official website.