The coronavirus pandemic has revealed social care to be fragmented, battered and lacking investment. It has also exposed a lack of understanding of social care itself.
Successive governments have struggled to address social care’s most pressing problem: how to build a valued, recognised and inclusive system for people in need.
Creating a National Care Service (NCS) could be the solution to the questions the government is struggling to answer. It would be a new organisation imbued with the values and ambition of the sector: localised services with people at its heart, inclusive at every stage of care and, most importantly, community-focused.
Care workers and people in need of social care cannot continue to wait and be grateful for any short-term ring-fenced funding, which is little more than a sticking plaster on a situation in need of major surgery. Social care needs to see substantial changes, urgently – something the coronavirus crisis has thrown this into even sharper relief.
Funded centrally from government, the NCS would be autonomous and legally independent. It would work with partners including local authorities, Care England and the National Care Forum, as well as large and small voluntary providers, to commission, contract and set standards for the sector.
This NCS would provide nationally coordinated leadership, recognition and the identity the sector desperately needs. It would establish national pay and conditions structure, and the training and education programmes so crucial for career progression.
Social care is distinguished from healthcare by the social connections at the heart of services. Evidence shows that putting finances, decision-making and service delivery in the hands of individuals and communities can achieve much better outcomes for those who need care. This is the cornerstone of a good care system.
One of the concerns highlighted in debates on social care is that a separate care service would complicate support for people and lead to a lack of clarity about who is responsible for providing what.
Determining whether a person’s complex needs are health or social care-related often becomes challenging. But difficult circumstances require the government and health and social care professionals to stop, pause and think. Why, after more than 50 years of policy and legislative initiatives, does the government keep pursuing the integration of health and social care, and what has it achieved?
There truly are pockets of excellence, but research suggests that the current system is too focused on health and hospital-based care and should look at the whole system including primary, community and social care. There is also evidence to show that perspectives of people and communities aren’t considered enough.
As a solution, let’s build up social care by understanding it as a set of social networks and connections. Let’s be confident in our communities and fund them to support and deliver care that places people, families and communities at the centre.
The NCS would lead this process with a national plan for social care. It would be shaped by local community needs, not measured by the drivers of profit and the need to build national large-scale organisations that offer cost savings. Community-led services and local people know those they serve well, can often support them through difficult times and prevent their lives deteriorating further.
Covid-19 has shown many examples of this in the positive community-spirit stories we all try to focus on right now. Cooking for the person living alone next door isn’t just providing a meal, it’s building social connections and adding meaning to everyone’s life, which often results in less need for formal services – but activities like this need to be funded.
Most importantly, it would aim to ensure public, statutory services are only required in the most pressing of situations.
When someone finds a parent’s dementia too difficult to cope with, when their teenage daughter who has autism wants to live independently, or when a family finds the pressure of poverty too much and needs support to help raise their children, statutory services would be available, alongside community-led support.
If the government can release billions of pounds to prevent economic collapse and invest billions in the NHS to prevent the further deterioration of the health of the population, it must also be possible to find funding to establish a National Care Service. If not, one must ask why.
• Samantha Baron is a professor in social work at Manchester Metropolitan University