Shaping care for our futures

By Kathryn Smith | 09 June 2020

There have been a lot of stories to emerge during the lockdown era, from drive-through care home discos, to virtual haircuts and funny Whatsapp videos. For me it’s been strange because I’ve never met most of the people I work with, particularly as I’m currently trying hard to lead them through an organisational response to the pandemic, a restructure and a strategy refresh – all from my kitchen table.

You see, I became the Social Care Institute for Excellence (SCIE) chief executive right in the middle of the current crisis. I was finishing off my role as chief operating officer at the Alzheimer’s Society and being interviewed at the SCIE just as the pandemic hit.

Policy erupts and confidence is lost

I’ve worked in social care since I was 13 and never really heard it mentioned prominently on the media before; but suddenly it has been high-profile during lockdown. I have commented regularly for various media outlets as the care crisis has become evident. Normally the word ‘policy’ summons up quite dreary images of nameless people thinking things up on behalf of others, but the pandemic has seen policy issues erupt onto the scene.

In particular, the crisis in care homes reveals to the country what we’ve known for years: Social care is the poor relation. This care home crisis, which saw significant impact and many deaths – not least that of my own aunt – came about through inappropriate hospital discharges, a lack of protective equipment and a lack of consistent testing. Of course, it isn’t just about care homes. It was good to see the Government contact all UK home care providers, alerting them to new advice on caring for people living at home during the pandemic.

But it is in care homes that a crisis of trust has developed. Last week, at the start of June, we heard that the number of COVID-19-related deaths in care homes has dropped by a third. However, the damage has already been done – a recent survey said that a third of people are less likely to seek residential social care for their relatives as a result of the crisis. We need to reassure the public but we should also fully consider the future of residential care, so that we take on board what people are telling us they want in the future – and then we can start to rebuild the trust that has been lost.

A chance to really change things

Before the crisis hit we were making some progress on the integration of health and care, with a focus on coordinating how we support people in local ‘places’. Local government can play a vital role in this vision. In a recent report for the NHS Confederation on place-based working, we argued that place-based partnerships need to start with a ‘coalition of the willing’, with local authorities playing an important leadership role and galvanising local people around a plan for better care.

And we need to try harder to tackle variation. The responses to the pandemic have varied enormously across the country, and best practice has been seen in patches. This is why the SCIE has been commissioned by the Department of Health and Social Care to create a COVID-19 hub, which seeks to highlight and share good practice so that it becomes more commonplace.

Supermarkets and libraries

There are of course many aspects of social care that need to be considered, including how it is funded and how we professionalise, and pay a wage, that recognises just how crucial this sector is. Also, if one thing has come out of COVID-19, it is how vital other facilities such as supermarkets, parks, libraries and neighbours are to social care. Personally, I believe the intention has always been there to let people spend personal budgets as they wish, but perhaps bureaucracy has often gotten in the way of common sense.

New policy issues are occurring on a daily basis. All are very urgent, for instance the recent news on the high incidence of deaths from COVID-19 for people with learning disabilities; or the heightened risk of domestic abuse. At least these issues are making the news, but everyone involved needs to work in an integrated way to grasp the nettle; not shove the issues back into the bushes. Any change of policy needs to be steered well, with the co-production of people who use services and carers at the heart of policy direction.

Challenging conversations

Today I’m pondering how I can consider our role in shaping other policy and practice issues in social care from a remote perspective, such as the very real issues raised in the Black Lives Matters conversations. Of course, we’ll start by getting our own house in order and having those difficult conversations internally to recognise and address our own unconscious bias. And I’ll test our comfort around technology by holding workshops and training sessions over video conferencing to make a plan that we’re all signed up to. This will surely then help us to support the social care world to better tackle this issue too.

Let’s hope that by the time I hold my first actual meeting in our office, some decent headway has been made in the national conversation about how care and support should be shaped for the years to come.

Kathryn Smith is chief executive of the SCIE

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