Beyond the soundbite
The ‘care crunch’ is likely to affect everyone at some stage in their life. At its foundation is the simple fact that we all want our loved ones to receive the best support to live as happily and healthily as possible. We are not ‘health’ or ‘social care’ but human beings with a range of interconnected needs and we want coordinated services that meet them. But, as our society ages, the number of people with long-term conditions grows and budgetary belts get tightened, we find that this basic everyday support is not universally available.
These simple messages can often get lost as the debate enters the policy arena.
Money is always a key focus in the debate but also a key sticking point. Long-term decisions on funding reform have proved to be too much of a jagged pill for successive governments to swallow. A poll conducted in July this year showed that 89 per cent of English adults believe that people shouldn’t have to bear all the costs for support with everyday tasks, even if they have a small amount of savings. Dilnot, while not a panacea, is a necessary first step in ensuring long-term clarity on funding and sharing costs fairly between the taxpayer and the people who pay for their own care.
It’s not only a question of money, but also what we do with it. It goes without saying that the changing needs in care and support necessitate a new kind of model. From National Voices’ perspective, the key question is how we are listening and responding to needs, both those of the individual and of the wider community.
In the first instance, we support a bigger focus on preventing care needs developing, intervening early, and acknowledging a wider definition of wellbeing to improve people’s quality of life and promote continued independence. The Health and Social Care Act 2012 and the draft care and support bill have laid some foundations to support this shift. However, the latter will need amendments to include the provision of advice, information and advocacy services, and the regulations and guidance will need to clarify how charging would not act as a disincentive to usage and how progress will be measured and monitored.
When considering how to meet existing needs, National Voices sees the realisation of the personalisation agenda as critical in ensuring that resources are targeted effectively at what people really need and want. All too often, tangible tools get the glory and the fundamentals that underpin them are neglected or given lip service at best.
Telecare, for example, can support better self-management and improve access to continued professional support. But it is not the ‘kit’ that delivers better care; it is the way it is planned into service redesign and encourages more supportive approaches. Also, personal budgets can enable people to choose more tailored services, when supported by useful discussions with professionals. But it must be remembered that it is the flexibility – and not the upfront allocation of resources – that adds most value.
If the end point is better outcomes for a given individual, the starting point should be a discussion between a professional and the individual about their needs and goals and the options for achieving them. Personalised care planning promotes independence, confidence and control, and more integrated working and supports patient activation and improved self-management. But, despite years of policy commitments, implementation on the ground remains patchy.
National Voices advocates that people who need care in the longer term need a new delivery system, such as the Year of Care approach. This combines support for self-management and high-quality health and social care, in a coordinated and personalised service. It acknowledges that only through partnership working and responsive commissioning and by engaging and informing the end users will we be able to rise to the challenges of the future.
It doesn’t take a genius to recognise the senselessness of doing the same thing over and over and expecting different results. We know which approaches work – the evidence is there. In many places we have the policy buy-in to boot. Going forward, let’s keep the person at the centre of the picture.
Laura Robinson is policy and communications adviser at National Voices. National Voices is the national coalition of health and social care charities in England. We work together to strengthen the voice of patients, service users, carers, their families and the voluntary organisations that work for them
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Care, carers, Dilnot commission, social care