As someone who uses social care, Anna Severwright, convener at Social Care Future, knows first-hand the urgency for health and social care to work together. Here she gives some home truths while writing on the difference integrated care would make to so many lives.
Yesterday I decorated my Christmas tree and baked my Christmas cake. So what? you may well say. But I could only do that because of support from my Personal Assistant (PA), who I employ using a direct payment, as being disabled I need assistance to live my life the way I want to. That is social care. Yes, I need and want care to be fed and clean, but only so that I can live my life, otherwise what’s the point?
For too long, myself and many others I know, have described social care as a fight to get the support needed to be able to live the life we want. That is why we are seeking social care reform.
I am also painfully aware that the NHS also sees the negative results of the current social care system – whether hospital admissions due to lack of support or adaptations, or delayed discharge as support is not in place - health and social care are interdependent.
I know my health, wellbeing and need for support are interwoven; if one is struggling it knocks everything else out of balance, often resulting in needing more care from another service. Calls for social care reform are welcome. But what should we be asking for?
Reforming social care
We need brave, radical reform. More investment is crucial but we must make sure we are not just funding more of the same: too few realistic alternatives to moving into a care home, rarely people’s goal; support to live at home that is too often short ‘life and limb’ visits, family carers paying too high a price for supporting their loved ones; where I sometimes have to choose between using my care hours to have a shower or go to the supermarket.
I want to start with the premise, articulated in #socialcarefuture’s vision, that “we all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us,” accepting the reality that many of us and the people we care about will, at some point, need some form of social care to help make this vision a reality. I want to change the way we think and talk about social care, recognising it not as a destination or place, but as a tool to support us to live the lives we want. And reimagining social care to be about weaving the web of relationships and support that we all need to live lives of meaning and purpose, instead of delivering a defined, transactional service.
Addressing health inequalitites
COVID-19 highlighted society’s many health inequalities that must no longer be tolerated as the ‘status quo’. People from BME backgrounds, living in poverty or who have a learning disability all have worse health outcomes, leading to lower quality of life for them but also increased demand on the NHS. If we call for resources to be directed towards supporting strong and connected communities, using models such as Asset Based Community Development, we shift the focus from fixing people, to tackling the social determinants of health while supporting communities to look out for one another, as demonstrated powerfully with Mutual Aid. Improving people’s wellbeing upstream reduces their reliance on formal services, relieving pressure elsewhere in the system.
By investing in social care we can create jobs, improve local economies, support more people to contribute to society, strengthen communities, reduce isolation and improves people’s wellbeing. Sharing this narrative will encourage the public to value social care as an asset worth investing in, instead of a crisis service to avoid ‘bed blockers’ (a dehumanising term I would like to ban).
As well as the injustices, we should showcase the many innovative examples of social care already helping people lead great lives and which could become the norm with investment and reform.
Interweaving health and social care
Health and social care need to work together in a more coordinated way. This does not require merging into one huge organisation, risking losing the qualities, values, and skills specific to both. Rather, the organisations, and crucially people working in them, should work together around my life; with a shared goal of me living the way I want to as well as possible. Ending the culture of ‘that’s a different team’ or budget. For example, my council won’t allow my PA to collect a prescription as that’s a ‘health need’, which is ridiculous and counterproductive: if I don’t get my medication, my health deteriorates, increasing my support needs. Organisations may be siloed but our lives are not. We need to share power so that people have genuine choice and control over their lives, including their care and support, on an equal basis with everyone else.
Ultimately to maximise people’s health and wellbeing, communities and citizens must be involved in shaping and delivering health and social care (co-production) or you miss the wealth of knowledge and skills they hold.
So I believe we should reform social care, not just because it’s the right thing to do, but because it will help the NHS to continue as our national treasure long into the future.