SOCIAL CARE INSTITUTE FOR EXCELLENCE – WRITTEN EVIDENCE (ASC0081)

1. Introduction

1.1              The Social Care Institute for Excellence (SCIE) is delighted to submit evidence relevant to this enquiry by the House of Lords Select Committee on Adult Social Care. We are an independent charity committed to improving social care for people of all ages. Our vision is a society where care and support maximise people's choices, remove social inequality, and enable people to live fulfilling, safe and healthy lives.

1.2              Working with national policymakers and local health and care systems, we contribute to the development and implementation of better care, support and safeguarding through our research evidence and practice development support. We publish evidence-based national guidance for social care, “what works” good practice guides, research reports, eLearning tools and other resources.

1.3              For this enquiry, we are responding to a select number of questions where our evidence and good practice guides are most relevant. Should the committee wish to undertake more thorough evidence reviews, our freely available Social Care Online resource provides access to peer-reviewed and grey literature about a wide range of social care topics.[1]

2. “The Invisibility of Adult Social Care”

2.1              “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?”

2.1.1        The purpose of social care drives SCIE’s vision of a society, where care and support maximise people’s choices, remove social inequality, and enable people to live fulfilling, safe and healthy lives. In describing social care as an enabler of people’s independence and quality of life, we challenge the assumption underpinning the provocative question posed. For people who draw on adult social care and support are not themselves invisible, but in many instances are leading independent lives as active members of their local communities.  We recommend the Committee review the vision for social care from Social Care Future, which has been produced by people who draw on services.[2]

2.1.2        Perhaps the “invisibility” challenge is best understood as reflecting political priorities. Unlike the NHS, state funding for social care has never been universal, and care is largely self-funded or provided through informal carers. But the policy environment is changing, with social care issues becoming more visible because the debate has shifted to one about people and their lived experience. The Dilnot Commission[3] outlined the issues, especially problems with accessing care and the financial burden for individuals and families, and made the case for changing social care funding arrangements with a new policy framework and settlement. The report was followed by government action that eventually led to the Better Care Fund (2013), the Care Act (2014), the most recent government’s Social Care White Paper (2021) and funding changes included in the Health and Care Act (2022). These policies represent a growing consensus around an agenda for change, one we are committed to realising. Staying focused on improving real people’s lives is critical to keeping social care “visible”.

2.2              “How can other public services (such as the NHS) play their part in tackling the invisibility of adult social care?”

2.2.1        We encourage the Committee to consider the role of housing in the future of care. We believe that no decision about care and support should be made without considering where people live. Through the SCIE Commission on the Role of Housing in the Future of Care and Support (2021), we published a vision and ten-year roadmap of recommendations to expand housing options for people with social care needs.[4] At the heart of the vision is the idea that as far as is possible, people should be supported to live in their own homes. Our research confirmed that people are seeking housing choices but that options are presently limited, and the gap between supply and demand is growing.

2.2.2        The SCIE Commission called for government action to create the policy and economic conditions for increasing the availability, quality and choice of housing with care and support options, such as Extra Care and Supported Living. We produced a series of case studies to illustrate innovation in this sector.[5] The Commission identified seven key principles of excellence that reflect this vision of the future, as well as existing examples of positive practice that demonstrate that such a vision is entirely achievable. The significant role of housing was acknowledged in the recent Social Care White Paper, which proposed a Housing Transformation Fund, and the announcement for a cross-government Task Force on Housing for Older People.[6]

2.3              “What effect has the COVID-19 pandemic had on adult social care?”

2.3.1        The pandemic has had a disproportionate effect on people who draw on social care, ranging from higher mortality rates for care home residents to safety issues for people receiving care in their own homes. As part of a current research project with people with learning disabilities, we are hearing about their experiences with loneliness and mental health problems during the isolation of the lockdowns; challenges in accessing NHS and social care services, especially with virtual appointments; and unmet personal and social needs as local authority-funded community programmes ceased to operate.  We would be happy to share our unpublished research findings with the Committee.

2.3.2        SCIE undertook research for the DHSC about the effects of the government’s discharge to assess policy during the pandemic.[7] The discharge to assess model is not new, and the evidence supporting early discharge from hospital has been robust, showing clear benefits for patients. During the pandemic, however, we found that the emphasis on NHS acute bed management over people’s recovery and reablement was placing extra pressure on local social care services. The effect was to shift the burden of care from hospitals to the community, rather than reinforcing shared accountabilities. We also heard concerns about people being discharged with higher levels of need, long waits for post-discharge assessments and unmet needs at home. In some places, block purchasing of care home beds has meant care homes were becoming step-down facilities, with patients being directed to this pathway by default. During the pandemic, the government made additional funding available to local authorities for four-week packages of care. This mitigated the financial pressures and enabled collaboration across health and care partners, but the additional funding is no longer available. The discharge to assess policy has now been incorporated into statute (the Health and Care Act). The monitoring of the effects of discharge to assess on social care are ongoing. The most recent ADASS survey suggests waits for post-discharge assessments are growing in number and length, with care needs going unmet.[8]

3. “Better support for unpaid carers”

3.1              “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 carers? What examples exist to demonstrate that better identifying and supporting of carers leads to better outcomes for those for whom they care?”

3.1.1. SCIE defines a carer as a person who supports and cares for a relative or friend who is living with a disability, long-term illness or has additional daily support needs. The Care Act of 2014 strengthens the rights and recognition of carers, although these remain unfulfilled. We suggest focusing on three areas to improve support for carers: (1) improving information and advice for carers; (2) providing services and professional support to carers, starting with person-centred assessment; and (3) extending professional support through digital technology and innovation. Working with NICE, SCIE has produced a quick guide and online resources to support carers and social care professionals.[9]  Our guide makes it clear that social care practitioners should be identifying carers and informing them that they have the right to their own needs assessment. Carers should be offered information and advice, carers’ breaks, training and skills development, psychological and emotional support, and peer support.  The role of the voluntary and community sector in supporting the needs of carers cannot be underestimated, and statutory health and social care services should work hand in glove with voluntary services, encouraging seamless support and investing in innovation.

3.1.2. Recognising the diversity of carers’ needs is critical to delivering support. For instance, The Care Act 2014 requires Local Councils to identify young carers who are not receiving children’s services but who are likely to have support needs of their own as a young adult carer. SCIE’s research about young carers has highlighted their unique needs, ranging from housing and employment to education and transitioning to an adult carer.[10] 

4. “Putting co-production at the heart of care”

4.1              “To what extent are the voices of people who draw on care and support and carers shaping the design and delivery of social care, irrespective of their age or circumstances? If these voices are not sufficiently heard, what is the impact of this on those who draw on care and support and carers?”

4.1.1        We define co-production as 'people who use services and carers working with professionals in equal partnerships towards shared goals'. Co-production is a key concept in the development of public services and the provision of personalised care, but its principles are poorly understood, and its methods are applied inconsistently. SCIE previously produced a guide for how to do co-production with good practice examples.[11]

4.1.2        Rather than describing the impact of not undertaking co-production, we prefer to promote co-production’s benefits. This assists with tackling the cultural, structural and professional barriers to good practice. Case examples are useful in illustrating these benefits. For example, SCIE’s work with Oxfordshire County Council demonstrates how to embed co-production into a Council’s “business as usual”, including the role of senior leadership commitment and a co-produced handbook.[12]  The programme’s impact included a shift in culture that led to tangible improvements in people’s relationships with the Council’s services and social care providers.[13] Co-production can also be an integral component of service re-design, especially for integrated care, as our case study from NHS Camden and Islington NHS Foundation Trust illustrates.[14] An important outcome from this work included the transformation of professional practice by changing attitudes about sharing power with people who draw on care. A further example from our tool for care homes highlights how co-production with residents and families is a powerful approach for delivering personalised care and better care experiences overall.[15]

4.1.3        SCIE’s own work programmes are underpinned by a co-production strategy to ensure the lived experiences of people who draw on care and their carers inform and shape our policy positions, research priorities and approaches, practice guides and improvement tools. We believe co-production offers the chance to transform social care to a model that offers people real choice and control. SCIE’s Co-production Network is a key part of our co-production strategy, and we showcase co-production good practice on our website and annually during our National Co-production Week.[16] We will shortly be publishing an evidence review about the impact of co-production and would be pleased to share this with the Committee.

5. Additional idea for improving people’s experiences of social care: the Named Social Worker

5.1              In 2018, SCIE was part of a DHSC project looking at how people with learning disabilities, autism or mental health needs - and their families - could be in control of decisions about their own future.[17] To achieve this, it was important that people had access to a named, dedicated social care worker, i.e., someone providing the main point of contact for people and their families and the professional “voice of challenge” across the system. The project evaluation found not only did this approach greatly improve outcomes for people, but it was cost effective: every £1 invested would anticipate a saving or costs avoided of £5.14. We also found higher levels of satisfaction with care and evidence that people were better able to live the lives they wanted, including faster and smoother discharges, restrictive decisions overturned and greater stability of care placements. Now, the initiative of having a named social worker is being extended to other people who draw on care and support.[18] We would be delighted to share with the Committee the full evaluation report and related resources about the Named Social Worker model.

27 May 2022