2013 in adult social care has been one of stark contrast and rapid change; of disconnection and connection; of fear and hope. I can’t recall such a volatile 12 months. The model of social care that has operated post-war from the National Assistance Act onwards is coming to a close as the Care and Support Bill moves closer to becoming law. A new and challenging future lies ahead.
The care system has experienced some disturbing lows across the last twelve months. Many adult protection incidents highlighted communication breakdown; such as the Serious Case Review into the death of Mrs. Gloria Foster, a lady who went without vital care and support for nine days when her care agency closed. Despite the Winterbourne View abuse and subsequent Report, referral levels to Assessment and Treatment centres have remained consistent since 2010. Chris Hatton’s careful and considered analysis focuses on why many of the key issues in the report remain outstanding If It Looks Like a Duck
Camcorders in several bedrooms documented appalling abuse and exploitation of people without a voice or means of protecting themselves. Institutions, from hospitals to care homes have been scrutinised and found wanting about the ability to deliver the basics: dignity, respect and compassion. These issues cannot be justified in terms of resources. Some of these examples are about the decisions taken by those entrusted to care not to do so, often compounded by the subsequent failure of organisations and systems to identify and address such failure and abuse. These examples have rightly received widespread condemnation; as professionals we have a collective duty to act; learn from the past and ensure decency and better care- this cannot be compromised whatever the wider context.
Resources are of course playing a key role in shaping the future. The biggest sting in the tale of the Comprehensive Spending Review was the planned reduction of Revenue Support Grant to Councils from now until 2017-18; for many authorities the single largest source of income from government. The Leader of Birmingham City Council Albert Bore has already publicly stated that the Council may not be able to deliver all of the statutory duties with the decreased resources available. It is not just about Local Government, parallel pressures exist across other statutory bodies (especially CCGs and the NHS,) voluntary and private sectors. The impact on people who use care and support services, carers and all providers of social care is already significant. By means of illustration a recent LSE report suggested that nearly 500,000 fewer people (primarily with moderate needs) are receiving local government funded domiciliary care; the era of rationing is sadly now well established.
Welfare Benefit Reform is another factor and many unplanned consequences are emerging. There has, for instance, been a rise in “sofa surfing” (kipping at a mate’s house when you can) amongst people aged 16-25 in many areas. People impacted do not appear on either homelessness statistics or the housing register. Anyone declaring a surplus bedroom in social housing is susceptible to decreased housing benefit. In some areas three bedroom properties are now proving harder for social landlords to let despite underlying demand increasing.
2013 was not by any means all about failure and cuts. I do not mean to trivialise the experiences of anyone impacted by the preceding issues by focusing on the many positives I also experienced during the year. Hope is essential and standing still and passively accepting defeat benefits no-one. Adapting to uncertainty and fear (i.e. what you do about it) has been a common theme that knits together many of my conversations, blogs and tweets. As Leonard Cohen puts it: “There is a crack in everything. That’s how the light gets in.”
Hope and encouragement lies in human connection. The time and skill to understand the whole person, working out a new approach that makes a radical difference to someone’s life, rediscovery of a lost skill, increased confidence and improved self-esteem and finally the ability to exercise true control and choice, irrespective of the complexity of disability, illness or age. These are but a few of the skills and qualities that contribute to great quality care. Whatever the context, these values will hold as encapsulated in Making It Real
Other inspiration comes in the form of volunteers who do without expectation of anything by return, the selflessness shown by carers for the people they put ahead of themselves day in day out and the professionals who doggedly battle on for the people and communities they serve.
I am surrounded by people who are motivated by driving positive change. Positive stories about care do not dominate the headlines. So I have decided to name a few of the folk who have inspired me over the past year:
Mike Hands (@mdhsupport) runs a micro provider organisation based in Brierley Hill called MDH Support. Mike offers a different model of support to people with learning disabilities, autism and older people; including taking one individual to London for the first time in two decades.
Jayne Leeson (@jayneleeson) from Changing Our Lives has just been awarded an MBE in the New Years Honours list. Jayne is a long-standing advocate for people with learning disabilities and has supported a vast range of activity that genuinely changed people’s lives. It is absolutely superb that her contribution has been acknowledged
The relentless enthusiasm, passion and leadership shown by Eileen Fielding (@DudleyVols) and her army of Dudley Volunteers both inspires and humbles me.
A very biased mention for my friend Mick Ward at Leeds City Council (@mickmodern) who continues to motivate, create and build new partnerships
Think Local Act Personal (@tlap1) continues to punch well above its’ weight and consistently publishes practical and useful tools to support the personalisation of care. Co-production runs through the core of the organisation. I would like to pay special tribute to Clenton Farquharson (@clentonF) who has offered his warm and considered approach to Making It Real both locally and nationally.
The Carer (I don’t have permission to name her) who supported my 90 year old Nan on Christmas morning (her 11th year of working Christmas morning to help other people enjoy the day.)
All of the people who attended (and especially organised) @socialcarecurry. Folk have participated in droves on a voluntary basis; shared experiences ideas and built connections and it has been a blast. The simplicity of the format and commitment of all concerned to make it work is something I really enjoy.
Looking back there are times this year when I have allowed the scale of the challenges and extent of failures to overwhelm me. The title of the blog is a corruption of a Bob Mould lyric “I’m on the centre line, right between two states of mind.” My resolution for 2014 is to spend less time on the centre line and more time on positive change and learning from the mistakes and successes of the past (see “Beyond the Brontosaurus” a previous blog if interested in amateur musings about what works in leadership.)
Happy 2014 everyone @mattbowsher1