LOCAL GOVERNMENT ASSOCIATION – WRITTEN SUBMISSION (ASC0042)
1. About the Local Government Association
1.1. The Local Government Association (LGA) is the national voice of local government. We are a politically led, cross-party membership organisation, representing councils from England and Wales.
1.2. Our role is to support, promote and improve local government, and raise national awareness of the work of councils. Our ultimate ambition is to support councils to deliver local solutions to national problems.
2. Context
2.1. We welcome the Committee’s inquiry and its intention not to duplicate the broad body of work that many others have done previously in considering the future of adult social care. We therefore fully support the Committee’s three main areas of focus and believe these helpfully home in on issues that tend not to come to the fore in other similar inquiries of this nature. In considering these issues, we believe it is essential to consider the wider context adult social care is operating in, as set out below.
2.2. Councils are facing significant immediate pressures in adult social care. Of particular concern is the impact of inflation and the National Living Wage. Our initial estimates indicate that inflation increases the adult social care cost pressure by £145 million over the current SR period and pay pressure by £3.8 billion (cumulative) over the period (£3.1 billion for commissioned services, £700 million for directly employed staff). The total core cost pressures on adult social care (when including 65+ and 18-64 demand) increase by roughly 9 per cent over each of the first two years of the SR period and 7 per cent in the final year. We estimate this means adult social care will cost £5.2 billion more in 2024/25 than 2021/22. Furthermore, planned increases in core spending power will be insufficient to meet these pressures and those falling on other council services, leaving a funding gap. It is important to note that these are early estimates and subject to change
2.3. We have been clear publicly that there is much to support in the Government’s ambitions for reform as set out in the September 2021 ‘Build Back Better Plan’ and the December 2021 White Paper. However, we are increasingly concerned that the amount of funding Government has earmarked for them is insufficient. We are particularly concerned about the affordability of the proposals on fair rate of care (FROC) and application of section 18(3) of the Care Act, which seeks to tackle the issue of self-funder cross-subsidisation of care costs (ie enabling self-funders to access care at the council-commissioned rate). Councils have contacted us raising similar concerns. These areas are reporting that the numbers simply do not add up, exposing significant shortfalls which threaten to completely destabilise their council budget. For some areas, these reforms pose the biggest financial risk to local budgets and Government should not underestimate the risks to overall financial stability as a result.
2.4. In just the realm of adult social care, councils are facing an exceptionally busy period. Following two relentlessly challenging years posed by Covid-19, adult social care is emerging from the pandemic to face a period of major reform and associated implementation activity. Most notably this includes the reforms emanating from the September 2021 Build Back Better Plan and the December 2021 social care system reform White Paper. But it also includes activity linked to the Health and Care Act 2022, recent Integration White Paper, the Messenger review on health and social care leadership, and the forthcoming Health Disparities White Paper. More generally, the impacts of Covid-19 are likely to be felt for some time and will contribute to and exacerbate the consequences of system pressures. We have real concerns about the ability of councils to achieve everything the Government has proposed. That is why we are absolutely clear that the timetable for reform implementation, and its associated funding, needs to be kept under close and constant review.
3. Summary
3.1. We agree that adult social care has suffered historically from a low public profile and has made it ‘invisible’. We believe that this could be because many people do not know what adult social care is and how it operates, with many people believing it will be free at the points of use; many people do not give much thought to their possible future social care needs; and where people deliberately avoid thinking about potentially difficult future circumstances, this may well be because of the way social care is portrayed by the national media and, indeed, sometimes those organisations within the sector. Much of the national portrayal of social care, and those who access it, is negative, with the service framed as being in ‘crisis’, or ‘broken’, or facing a ‘tsunami of need’ of ‘vulnerable’ people. The care workforce is often similarly framed in negative terms, for example, ‘unskilled’, ‘poorly paid’ and ‘suffering from burn out’.
3.2. Shifting the narrative around social care to something more positive is essential to reducing the invisibility of the sector. We owe an enormous debt of gratitude to our frontline care workforce who have given so much in supporting people of all ages who depend on social care. We want to see social care presented as being about ‘all of us’, not ‘them and us’. It needs to invoke shared values, such as caring about each other, rather than, for instance, ‘looking after our most vulnerable’. Similarly, we need all voices in the debate to frame social care as an investment and an opportunity, rather than a cost and a problem to be fixed.
3.3. We believe the key issues facing people who draw on care and support are on the Government’s radar, however, we do not believe the steps which have been taken so far are adequate to address them. For example, there is not sufficient funding to sustain the current system, giving rise to issues such as growing unmet and under-met need. Similarly, a lack of action on care worker pay (as part of a lack of action on a dedicated workforce strategy for social care) will continue to have consequences on care worker recruitment and retention, with obvious impacts likely to be felt by people who draw on social care.
3.4. Relying on the national living wage (NLW) does nothing to help the adult social care sector become more competitive in the tightest labour market since 1974. NLW is a wage floor for the whole economy and the sector cannot employ people at the minimum if it is to attract the best. Investment is also needed in better career structured pay. To demonstrate the issue, sales and retail assistants earned 13 pence per hour less than care workers in 2012/13, but in 2020/21, on average, they earned 21 pence per hour more. We know workers with five years (or more) experience in the adult social care sector are paid just 6 pence (1 per cent) more per hour than care workers with less than one year of experience. In addition, The Health Foundation, in the 2019 report ‘The real cost of a fair adult social care system’ reported that there is a 7 per cent gap between the pay rates for adult social care nurses, and the rates available for nurses in the NHS. For care workers in the adult social care sector, average full-time equivalent pay in 2017/18 was £16,000. A similar role working to provide support to doctors and nurses in the NHS would pay a fifth higher (£19,300).
3.5. Hearing the views of people with lived experience of care and support is particularly important. Central to the LGA’s – and councils’ – approach is the principle that people with lived experience are an equal source of expertise and insight as other colleagues working in the system. Failing to follow through in this way runs the risk of lip service engagement, which will deter people from offering their time and expertise in the future. We also need to think of coproduction not just in terms of the two-way relationship between the person who draws on care and their social worker, but also the role of coproduction at service level in terms of designing and evaluating services.
3.6. The pandemic has meant there have been increases in unmet need. For example, surveys conducted by the Association of Directors of Adult Social Services (ADASS) have shown councils are having to take quite drastic action to manage immediate pressures. This includes, for example, prioritising assessment capacity. As a consequence, the number of people awaiting an assessment stood at 245,537 in February this year, significantly up from 70,000 in September 2021. We also know that the pandemic has led to more people becoming unpaid carers. Carers UK estimate there are 4.5 million people new to caring since the start of the pandemic, 2.8 million of whom are juggling work and care.
3.7. The strain on the care workforce caused by the pandemic has been well-documented. While they have demonstrated to the nation its enormous capacity for resilience, compassion and dedication, burn-out, low morale and the issue of care worker pay is creating serious recruitment and retention problems with an estimated turnover rate of 30.4 per cent (equivalent to approximately 430,000 leavers over the year) alongside a vacancy rate of 7.3 per cent (equivalent to approximately 112,000 vacancies at any one time).
3.8. The adult social care system could not survive without the contribution of unpaid carers who provide vital support for thousands of people every day. Many councils rely on, and fund, local carers organisations in the voluntary and community sector to communicate to carers. Funding pressures impact on that commissioned support. GPs also have an important role to play in linking carers to their local council.
3.9. Caring can place a real strain on individuals – emotionally, physically and financially. Carers are more likely to suffer depression, anxiety and stress and nearly two-thirds of carers have a long-standing health condition. The impact is often exacerbated by carers being unable to find the time for medical check-ups or treatment. Personal relationships can also suffer and carers are more likely to be socially excluded.
3.10. A recent report found that the 2014 Care Act’s strengthening of carers’ rights appears to have been limited by the requirement for local authorities to keep within budget, and as a result these rights have not led to greater access to support for carers. Every part of the care and support sector is under intense pressure due to the pandemic and councils are doing all they can to support unpaid carers and those they care for.
3.11. Enabling councils to support the increasing numbers of unpaid carers should be a crucial part of a long-term and sustainable funding solution for social care. Additional funding will allow councils to support the increasing number of carers with a range of services including to help address specific needs, such as supporting carers of people with dementia, carers from Black and ethnic minority communities and young carers.
The invisibility of adult social care and its consequences
4. One of the fundamental challenges facing adult social care is that it is ‘invisible’. Do you agree? What do you think explains this?
4.1. Given the link between ‘profile’ and ‘visibility’, we agree that adult social care has suffered historically from a low public profile. To the extent that public profile (and concern) determines political prioritisation amongst national MPs, we also know anecdotally that MPs do not receive frequent correspondence from constituents regarding the state of adult social care and the need for change. We believe there are various potential reasons which explain this:
4.1.1. Many people do not know what adult social care is and how it operates (including how it is funded), with many people believing it will be free at the points of use.
4.1.2. Many people do not give much thought to their possible future social care needs, either as a deliberate avoidance of facing up to potentially difficult future circumstances, or a genuine sense that it is not a service they will have cause to access.
4.2. More practically, much of the provision of adult social care is behind closed doors – either in people’s own homes, or residential care. This contrasts with the far more public GP surgery or hospital, which arguably helps create a stronger emotional connection to the health service and partly explains why – in the realm of the NHS and adult social care – the former tends to win hearts and minds, translating into public, and therefore political, prioritisation. This may in turn contribute to the perception that adult social care is simply an adjunct of the NHS, existing primarily to mitigate demand pressures facing the health service, rather than a vital service in its own right.
5. What are the key changes that need to be made to reduce the invisibility of adult social care?
5.1. Given the answers above, we believe that a shifting of the usual narrative around social care – to something far more compelling and positive – is essential. We want to see social care presented as being about ‘all of us’, not ‘them and us’. It needs to invoke shared values, such as caring about each other, rather than, for instance, ‘looking after our most vulnerable’. Similarly, we need all voices in the debate to frame social care as an investment and an opportunity, rather than a cost and a problem to be fixed.
5.2. Such messages came across loud and clear in a series of roundtables we held on the future of care and support last summer. At these, participants noted that the debate about social care can often be over-intellectualised, neglecting the emotional case for reform. This, participants suggested, should be the starting point; a recognition of what we all have in common, such as a desire for relationships and connections to family, friends and the communities in which we live.
5.3. In light of the above, we welcomed the way Government framed social care in its white paper – such as describing it as being “at the heart of our communities” and that it “matters to everybody”. This set a helpful tone and aligned with much of our framing of social care in our own 2018 green paper and subsequent publications. In these publications, we talked deliberately about social care being a means to the end of enabling people to live an equal life, rather than an end in itself. Or, as others have described it, social care is vehicle, rather than a destination.
5.4. Similarly, we welcomed the white paper’s ambition for social care as defined through different statements about what people can expect from social care and what the sector will do to help achieve this. However, it is problematic that the white paper offered no commentary on why previous similar ambitions for care and support have failed to be fully realised. Of chief importance is the fact that significant pressures continue to have consequences in the immediate term. Mirroring previous moments of change, this white paper – as well as the Spending Review and the Build Back Better Plan – have done very little to deal with the here and now challenges, such as funding to stabilise core services, tackling unmet and under-met need, stabilising the provider market and addressing care worker pay. Without action on these and other issues, the white paper is attempting to build a better future from seriously inadequate foundations.
6. How would you define the purpose of adult social care? How does the invisibility of adult social care get in the way of achieving this purpose?
6.1. In our own 2018 Green Paper, we set out our view that the core value of social care lies in supporting people of all ages, with a range of conditions and needs, to live with maximum opportunity, independence, connection to others, and control. In this way, we defined social care as being about supporting people to live the lives they want to lead.
6.2. We also posed the question, ‘Why does adult social care matter?’. The many responses we received defined the importance of social care in different ways. Some framed social care as a moral responsibility, a hallmark of a civilised society, and as an issue of human rights. Others noted the role it plays in enabling people to maintain or regain their independence, with a clear linked emphasis on the ability of social care to help prevent, reduce or delay the onset of needs. A clear proportion of respondents defined the importance of social care in terms of helping people enjoy the best possible quality of life, including their participation in, and contribution to, society. Some respondents noted that social care acts as a ‘universal safety net’ and others acknowledged its importance in supporting unpaid family carers. Finally, a significant number of respondents spoke of social care’s wider contribution to society, such as in economic terms and in linking to other public, private and voluntary services.
6.3. The problem, not discovered by our consultation but certainly reinforced by it, is that the value of social care is not recognised beyond the sphere who those attached to it (those who draw on it or those that work in, or alongside, it). It is not part of the national psyche in the same way that the NHS is, or other fundamental institutions in our society that we instinctively appreciate despite any shortcomings, such as schools and education. We concluded that the first step to bringing about meaningful change is building an awareness of what it is that needs changing and why. That believe that can help raise appreciation, and in turn, build momentum for a wider commitment to change.
7. To what extent does the definition of the purpose of adult social care differ for younger and for older adults? How can future reform of the adult social care system best address these differences?
7.1. The different situations people who draw on care and support may face, will of course vary across age. An 80 year old living with dementia will have different requirements to live their best life than a 30 year old with a learning disability. But at its heart, to be able to live the life you want to lead is common to everyone, irrespective of age.
7.2. Likewise, the underpinning principles that should serve as the foundation to great social care and support – quality, personalisation, choice, control and independence – transcend age brackets.
7.3. The biggest challenge we face in this respect, is addressing the common misconception (again, inadvertently reinforced in the media) that adult social care is just about supporting older people.
8. What are the key challenges that people who draw on care and support and carers will face in the future, which are not factored into current assumptions related to the social care system, for example the fact that some families will age without children to care for them? How are these challenges different for younger and for older adults who draw on care? What should be done now to address them?
8.1. We believe that most of the key issues facing people who draw on care and support are on the Government’s radar. The question is therefore whether steps will be taken to address them.
8.2. In the immediate- and short-term, there is inadequate funding to sustain the current system, giving rise to issues such as growing unmet and under-met need.
8.3. Similarly, a lack of action on care worker pay (as part of a lack of action on a dedicated workforce strategy for social care) will continue to have consequences on care worker recruitment and retention, with obvious impacts likely to be felt by people who draw on social care.
8.4. Relying on the national living wage (NLW) does nothing to help the adult social care sector become more competitive in the tightest labour market since 1974. NLW is a wage floor for the whole economy and the sector cannot employ people at the minimum if it is to attract the best. Investment is also needed in better career structured pay. To demonstrate the issue, sales and retail assistants earned 13 pence per hour less than care workers in 2012/13, but in 2020/21, on average, they earned 21 pence per hour more. We know workers with five years (or more) experience in the adult social care sector are paid just 6 pence (1 per cent) more per hour than care workers with less than one year of experience. In addition, The Health Foundation, in the 2019 report ‘The real cost of a fair adult social care system’ reported that there is a 7 per cent gap between the pay rates for adult social care nurses, and the rates available for nurses in the NHS. For care workers in the adult social care sector, average full-time equivalent pay in 2017/18 was £16,000. A similar role working to provide support to doctors and nurses in the NHS would pay a fifth higher (£19,300).
8.5. It would be helpful for more thought to be given to the ‘sandwich generation’, in other words, those people who face double caring duties in respect of their children and their parents.
8.6. Likewise, more work should be done to consider the pressures and difficulties likely to be caused by older parents of older adult children with learning disabilities. The unpaid care those parents provide is considerable and when they pass away this will leave a potentially distressing and concerning gap in support.
9. How can other public services (such as the NHS) play their part in tackling the invisibility of adult social care?
9.1. We welcome initiatives from partners that recognise the inherent value of adult social care in its own right. The Health for Care Coalition, led by NHS Confederation, is a prime example, bringing together 15 national health organisations to make the case for a sustainable social care system, backed up by a long-term funding settlement.
9.2. The development of Integrated Care Systems also provides an important opportunity for the NHS to help raise the profile of adult social care in local areas and its importance to people and communities.
10. What effect has the COVID-19 pandemic had on adult social care?
10.1. We know from surveys conducted by Association of Directors of Adult Social Services (ADASS) that councils have seen increases in unmet need as a result of the pandemic and are having to take quite drastic action to manage immediate pressures. This includes, for example, prioritising assessment capacity. As a consequence (and as of January this year), more than 217,000 people were waiting for an assessment – a 7 per cent increase on the November 2021 figure. It also includes increases in people waiting for care and support (or a direct payment to be made) following completion of a needs assessment. ADASS reported 27,406 such people in January, up from 25,468 in November.
10.2. We also know that the pandemic has led to more people becoming unpaid carers. Carers UK estimate there are 4.5 million people new to caring since the start of the pandemic, 2.8 million of whom are juggling work and care. Similarly, the pandemic has put care providers under even greater pressure and care homes are seeing reducing occupancy rates, putting a further strain on this section of the provider market.
10.3. The strain on the care workforce caused by the pandemic has been well-documented. The adult social care workforce has demonstrated to the nation its enormous capacity for resilience, compassion and dedication. Front line care workers have helped keep our loved ones safe and done all they can to support their wellbeing in the most challenging of circumstances. Yet burn-out, low morale and the issue of care worker pay is creating serious recruitment and retention problems with an estimated turnover rate of 30.4 per cent (equivalent to approximately 430,000 leavers over the year) alongside a vacancy rate of 7.3 per cent (equivalent to approximately 112,000 vacancies at any one time).
10.4. The sector also experienced high levels of staff sickness. Skills for Care’s latest annual review of the care workforce published October 2021 showed that levels of staff sickness have nearly doubled over the course of the pandemic (an average of 9.5 days lost in 2020/21 compared to 5.1 days pre-pandemic).” As Skills for Care also note, “It remains to be seen if the relaxing of rules on self-isolation…or the levels of Covid vaccinations among the workforce will help this figure return closer to pre-pandemic levels.” This issue is something to keep an eye on given the significant increase in sickness during the pandemic.
10.5. Many care workers also died during the pandemic, and many will also have experienced moral injury. We know that the adult social care workforce was affected badly by coronavirus with care workers among the highest mortality rates by occupation during the first phase of the pandemic. Care workers were at higher risk of getting the virus and of dying from it because they were older and more ethnically diverse than the general population. The psychological impacts of people’s experience of care work during the pandemic, and potential impacts on retention in particular, are yet to unfold.
10.6. There were also some positive developments. As participants in our roundtables on the future of care noted, the pandemic demonstrated the system’s ability to change at speed, challenging the validity of historic explanations of ‘We’ve always done it this way’ for why change is neither possible nor desirable. Similarly, participants commented on the powerful impact local communities had when they mobilised, for instance, volunteering and mutual aid.
Better support for unpaid carers
11. What, in addition to the support that has already been pledged by the Government, would be the most effective thing that could be done to raise the profile, as well as to improve the identification and support of unpaid carers? What examples exist to demonstrate that better identifying and supporting of carers leads to better outcomes for those for whom they care?
11.1. Many councils rely on, and fund, local carers organisations in the voluntary and community sector to communicate to carers. Funding pressures impact on that commissioned support. GPs also have an important role to play in linking carers to their local council.
11.2. Active efforts as part of a neighbourhood/place/system level prevention approach are often needed to identify ‘hidden carers’. These are people who have assumed a caring role but may not identify themselves as a ‘carer’ and are therefore missing out on the opportunity for not only potential support but also their involvement as experts by experience.
11.3. As highlighted in the LGA’s guidance and case studies on supporting carers, the work that Leeds has done in helping GPs to identify carers has proved is put forward here as an example of best practice. As well as referring carers to the service, GP surgeries are encouraged to put in place their own additional support for carers by offering things such as annual health checks and flexible appointments. The initiative has led to an increasing number of referrals from local practices.
12. How can carers who wish to do so be better enabled to stay in work or re-join the workforce? What needs to change to achieve this?
12.1. Approximately half of unpaid carers are in employment, many in their prime years of employment. But research suggests many find it difficult to balance their working life with their caring commitments.
12.2. Research from Carers UK has shown that 62 per cent of working carers have given up opportunities at work because of caring; 77 per cent of working carers feel tired at work because of their caring role; 72 per cent of working carers worry about continuing to juggle work and care; 23 per cent of working carers have left their job, reduced hours or lost business, if self employed, due to the pandemic; and 35 per cent of working carers who rely on care services are at risk of reducing their hours or leaving work if the services they used to rely on do not return.
12.3. Efforts to encourage employer-friendly practices can help. This can include, for example, setting out unpaid carers’ rights, such as asking for flexible working, time off for caring and the right not to be discriminated against. Similarly, advice to carers on how to approach their employers as well as suggestions for changing practices can be helpful. This might include, for example, shift swaps or staggered hours.
12.4. In its 2021 response to its 2020 consultation on unpaid carers leave, the Government committed to introduce a new leave entitlement for unpaid carers through legislation. This was referred to again in its adult social care white paper. However, the Government has yet to follow through on this commitment and it did not feature in the recent Queen’s Speech. Research by Carers UK shows that 56 per cent of unpaid carers need unpaid carers leave and that 1 in 7 workers who are unpaid carers are at risk of reducing their hours or giving up work completely if carers leave was not available.
13. How valued and respected are carers in the overall adult social care system and what are the consequences of failing to value and respect them?
13.1. The adult social care system could not survive without the contribution of unpaid carers who provide vital support for thousands of people every day. The amount of care provided differs greatly. Nearly a quarter of carers provide over 50 hours of unpaid care a week. The care that is provided is worth an estimated £132 billion, about the same amount that is spent on the NHS in England.
13.2. But caring can place a real strain on individuals – emotionally, physically and financially. Carers are more likely to suffer depression, anxiety and stress and nearly two-thirds of carers have a long-standing health condition. The impact is often exacerbated by carers being unable to find the time for medical check-ups or treatment. Personal relationships can also suffer and carers are more likely to be socially excluded. ONS data has highlighted how unpaid carers have been more affected by the pandemic compared to the general public on aspects of lives including healthcare, work, household finances and access to groceries, medication and essentials.
14. A recent report found that the 2014 Care Act’s strengthening of carers’ rights appears to have been limited by the requirement for local authorities to keep within budget, and as a result these rights have not led to greater access to support for carers. Every part of the care and support sector is under intense pressure due to the pandemic and councils are doing all they can to support unpaid carers and those they care for.
15. Enabling councils to support the increasing numbers of unpaid carers should be a crucial part of a long-term and sustainable funding solution for social care. Additional funding will allow councils to support the increasing number of carers with a range of services including to help address specific needs, such as supporting carers of people with dementia, carers from BAME communities and young carers.
16. What can be done to make sure that social care professionals recognise the expertise of carers and value them as full and equal partners in care, who are included as part of the whole team, so that there is greater synergy between paid and unpaid care?
16.1. Section 10 of the Care Act 2014 gives anyone over the age of 18, who is looking after another adult who is disabled, ill or elderly the right to a carer’s assessment. Young carers and parents of disabled children also have the right to an assessment by their local council under the Children and Families Act 2014. These assessments should cover topics such as carers’ mental and physical health, their ability and willingness to care, and their relationships with others.
16.2. Carers rightly want to be recognised and valued for what they do, which is why the assessment process (and the relationship that flows from that) is so important. Carers need to be seen as full and equal partners in their support and the support for the person they care for. Time should therefore be taken to fully understand the unpaid carer’s circumstances and their aspirations and ambitions for their own wellbeing.
17. Why is the current care system so difficult to access for carers? What needs to be put in place so that carers can simply understand what is available to them as a right and discretion, and the person they support? Do you know of good practice examples? How can these examples be expanded more widely across the system?
17.1. Under the Care Act, councils already have a duty to “establish and maintain a service for providing people in its area with information and advice relating to care and support”. Under the legislation’s statutory guidance, it is clear that councils are also “expected to understand, coordinate and make effective use of other high quality statutory, voluntary and/or private sector information and advice resources available to people within their areas”. To the extent this is another aspect of the legislation that has not been delivered because of funding pressures, we therefore question whether the Government’s pledge of £5 million for improving information and advice is an adequate investment and whether a three-year timeframe is commensurate with the urgency of the need.
17.2. The White Paper commits £25 million to work with the sector to identify and test a range of new and existing interventions for carers, which could include respite and breaks, peer group and wellbeing support, and new ways to combine these to maximise support. On respite, the white paper commits to working with the sector (including councils) to explore different models of respite, how they are accessed and what the barriers to access are. The white paper also sets out proposals for improving data collection and the sharing of data to help better identify unpaid carers and a commitment to ensure that the voice of unpaid carers is properly embedded in Integrated Care Systems.
17.3. We welcome the money to pilot new approaches and build on existing good practice but question whether the scale of the investment matches the scale of the ambition. Any positive outcomes emanating from the pilots must be given sustainable long-term funding. It is important that local authorities, as the key local commissioners and providers of carer services, are involved in the work to kick start new approaches. Similarly, issues pertaining to unpaid carers need to be addressed through place-level arrangements; ICSs will have a role in supporting this work but will not be the vehicle for delivery.
17.4. Anecdotally, we have heard that some unpaid carers misunderstand the term “carers assessment”, and this may put carers off from seeking help and support. The impression that some people have is that they are being assessed based on their ability to provide care, which could be anxiety provoking and stop people from accessing support they may be entitled to. A change the language used around carers assessments could be one way to make support more accessible.
Putting co-production at the heart of care
18. It is often difficult for people who draw on care and support and carers to exercise choice and control if they do not know what good support looks like or what kinds of care and support might be available. What information and support could be helpful to address this and how could it be made available more easily?
18.1. See 17.1 above.
19. How can we design care and support arrangements which work both for the person drawing on care and support and for those who care for them? How can people who draw on care and support and carers both be involved in the planning of future services?
19.1. Local government is underpinned by democratic accountability and is therefore used to engaging regularly to create a stronger two-way relationship between the council and the community.
19.2. Across many local government services, councils use an array of different mechanisms to promote opportunities for local people to share their views and experiences. These include, for instance, community forums, citizens’ panels, community mapping, crowd sourcing and focus groups.
19.3. In the realm of adult social care, hearing the views of people with lived experience of care and support is particularly important. Nationally at the LGA, we have sought to include that voice loud and clear in all of our work on care and support reform over the last few years. The experience of people who draw on care and their loved ones featured prominently in our own green paper on the future of social care and wellbeing in 2018 and at many points since. This has included: roundtables with people who draw on social care to help our own thinking about the lessons to be learned from the pandemic as we look to the future of social care; speaking invitations at our Board meetings and conferences and events; joint work with national partners including collaborative publications on the Queen’s Speech, Spending Review, and the future of the care workforce.
19.4. Central to our – and councils’ – approach is the principle that people with lived experience are an equal source of expertise and insight as other colleagues working in the system. We cannot and must not fall into the trap of subconsciously ‘ranking’ people’s contributions; everyone’s experience matters and must be reflected in the way services are designed and delivered. Failing to follow through in this way runs the risk of lip service engagement, which will deter people from offering their time and expertise in the future. Similarly, we need to think of coproduction not just in terms of the two-way relationship between the person who draws on care and their social worker, but also the role of coproduction at service level in terms of designing and evaluating services.
19.5. We are fortunate in the world of adult social care to have both passionate and persuasive national organisations – such as Healthwatch England - who advocate so effectively for those they represent, as well as other national organisations that champion and promote the voice of experts by experience, such as Think Local Act Personal (TLAP) and Social Care Future (SCF).
19.6. TLAP has been a trusted and highly respected voice of lived experience for many years and their work on ‘Making It Real’ – a framework that supports good, personalised care and support for providers, commissioners and people who draw on social care – continues to influence national policy at the highest level. One need only look at the Government’s recent adult social care white paper to see how closely aligned the Government’s vision for social care is with the markers laid down in Making It Real.
19.7. Similarly, Social Care Future has become a powerful voice over the last three to four years in arguing for a brighter future for care and support that puts people who draw on social care front and centre. Their vision (“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”) has been adopted by several councils to guide local work on the future of care and support. This is being adopted by some councils as a guiding vision that underpins local thinking about designing new models of care and how best to involve people with lived experience in that work.
19.8. At a time of such significant change in adult social care the voice of lived experience is more important than ever. First, it helps ensures that the reform agenda is grounded in what people who draw on social care want and need – what works and what does not work. And second, it helps inject a much-needed degree of positivity and optimism into the debate about the future of care and support. As set out above, coverage of adult social care can often default to talk of ‘crisis’ and ‘collapse’, ‘burden’ and ‘pressure’. This absolutely has its place and it is right to highlight the scale of the challenge councils and their partners are facing on the ground. But there is a strong argument for saying that we will never achieve the change we seek if we don’t make social care about ‘all of us’ and tell a positive story about its role in our society.
19.9. There are a number of examples of co-production which can be found online. For instance, Croydon set up the Croydon Adult Social Services User Panel (CASSUP) which brings together service users, carers of service users and Croydon residents who have a strong commitment to improving adult social services. The panel meets six times a year and works in partnership with decision makers. They represent the views of the community to improve service delivery and access to social care services.
19.10. Another example is Leicestershire County Council, which has an Adult Social Care Engagement Framework which acknowledges the importance of working with people who have used the services to make improvements.
19.11. Devon County Council highlights the number of ways they ensure service users and carers can have their say. Adult social care engagement within Devon is co-ordinated by Devon’s Involvement & Equality Team, based within the adult commissioning part of the council. They work in partnership with Living Options Devon as holders of a contract to provide local engagement activities, and undertake some activities themselves. The council also commission Healthwatch Devon, the local statutory consumer voice organisation and work with the County Council’s independent Equality Reference Group.
19.12. There are also a number of best practice examples of co-production which can be found on the Social Care Institute for Excellence website.
26 May 2022