What reform of adult social care should look like

By Cath Roff | 22 November 2021

The fundamental question when considering the reform of adult social care is ‘will adults with care and support needs simply exist or will they be able to live’? At the heart of any reform must be the human rights of those who use social care.

Social Care Future set out the following in its vision [1]:

‘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’

Ask yourself, is there anything in that statement that we wouldn’t want for ourselves or the people we love?

The Association of Directors of Adult Social Services, of which I am a trustee, has set out in Adult Social Care – shaping a better future its contribution to the debate on social care reform.

If I were to focus on four key things for reform it would be:

  1. Reform home care so people can live well in their own homes and communities
  2. Invest in the workforce – make social care a good and well rewarded career choice
  3. Invest in enhancing community connection and friendship
  4. Provide a wider choice of housing and housing-with-care options

Home care: the current model of home care is no longer fit for purpose. It atomises people’s lives down to timed tasks and devalues the staff who work in it. A new model would see Community Well-being Teams of support workers created who would be co-located with social workers and community health staff in local neighbourhoods. Social workers should agree with the individual what outcomes they want from care and support, then the person would work through how that is achieved in practice with the Well-being Team. The role technology can play will automatically be considered as part of a person’s care and support plan. Community Well-being teams would work flexibly with people who draw on support, recognising that people’s needs fluctuate over time. Community Well-being workers would have enough time to do their job well and be paid for their whole shift.

Workforce: social care staff should be paid a decent wage (which should be above that paid in sectors such retail and hospitality), with improved terms and conditions of service and a proper career pathway. Ideally the starting rate for social care workers will be the equivalent to Agenda for Change Band 3. This should open the possibility of creating generic care worker roles where people could choose to then specialise, having a career path weaving in and out of health and social care as part of a national Social Care Workforce plan.

Connection: when you talk to people with care and support needs about what makes a good life for them (apart from the basics of being clean and nourished) they talk about the importance of connection with family, friends and community. It is vital that local authorities are properly resourced to retain good universal services such as community transport, libraries, sport and culture activities but also enough money to invest in Third Sector organisations. Leeds has always invested in these community bodies who played a vital part in the city’s Covid response. They include 37 Neighbourhood Networks (organisations of older people for older people) across our city offering a range of activities from social gatherings, benefits advice to practical help. They support people to make connections, keeping active in their community and so help keep people independent and healthier for longer. It is our ambition in Leeds that everyone should have at least three good friends.

Housing: there needs to be a far wider range of housing and housing-with-support options. Population modelling predicts that there is going to be a significant increase in older people in the decades to come, often living in single households. We have the sadness of couples who have been together 50+ years living separately because we don’t have models of support for people with dementia that enable them to always remain together. This is a civic challenge, and the government should produce a housing strategy for our ageing population. But good housing options are also needed for working age adults where technology and digital solutions can maximise independence.

All this must be done in a way that reduces inequalities, ensuring all our citizens can access care and be supported in an inclusive way.

So, I ask again - do we think people with care and support needs should just 'get by' or have a decent quality of life?

Cath Roff is a trustee of the Association of Directors of Adult Social Services and director of adults and health at Leeds City Council

The National Children and Adult Services Conference takes place on November 24-26. See here for full details


[1] Social Care Future is a growing movement of people with a shared commitment to bring about positive change in what is currently called 'social care'

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