It might well be time to stand the care debate on its head. Scary charts about the demographic drivers of care needs, sincere attempts to chart a way through paying for care, and even a rather fine piece of legislation setting out care for the 21st century, have all failed to set the debate alight. As Richard Humphries (opens new window) eloquently points out the last 19 years have seen 12 Green and White Papers and 4 independent reviews - a long and winding road heading precisely nowhere.
No amount of emotion works either. The machine has withstood rage against a 26% reduction in people receiving care over the last six years or the £5.5 billion reduction in council budgets.
It is also clear that that paying for care is a tricky public debate - taxing people’s estate was the ‘death tax’ and paying on need was the ‘dementia tax’. We’re apparently content to run the lottery of life chances as to whether we need care and then empty our coffers into the growing amount of residential care waiting to offer something to ‘self-funders’. We might get reasonably good care, but as the Competition and Markets Authority (opens new window) highlighted we are unlikely to make good decisions about that care or get a good experience as a consumer.
Even though I have spent a working life in the ‘care system’ I don’t want care on this basis. So maybe like everyone else I would rather just avoid this noisy and complex debate about care.
From a different perspective, I am interested in what makes for a ‘good life’ (not some self-sufficiency project in Surbiton!) What’s fascinating about the debate on social care is the complete absence of ambition about what it would take to live and age well or to live a good life with disabilities and multiple conditions. What would make this a fine country for old men and women?
Healthcare is of course a part of the answer - and we are mighty proud of the NHS - but healthcare on its own has limits. Lord Crisp (opens new window) suggests we need to add interdependence, independence and rights on top of medical care so that we are ‘living a life we have cause to value’. That starts with a having a sense of control over life and our environment to sustain the contact that we all need with people we value or will come to value.
At a recent South West Housing LIN Leadership Set meeting I addressed with housing, health and social care industry leaders from across the region, I learned that thinking about connectedness led St. Monica’s Trust when developing extra care and residential care at ‘The ‘Chocolate Quarter’ in Keynsham, to create a destination, a space that is shared. This applies to “attractions” (a pizza oven restaurant works for me!) and having offices as part of the space. Using space within a Hanover Housing extra care housing scheme in Tewkesbury, Gloucestershire’s community wellbeing services has created a thriving sense of connections and community.
These housing examples prove why ‘care’ is a complex thing: a ‘good life’ can be explored across homes, communities, networks and the formal ‘care sector’. Indeed, sometimes by concentrating on the sector, the skills of social work in joining up people, and systems and utilising the resources within and around people, are underplayed.
The University of Birmingham’s study of ageing well (opens new window) started a step back: the key being the retention of a personal narrative - the sense of who we are and where we come from that can keep us in control even with complex healthcare needs. For me this was best illustrated by a terminally ill man who had a visit from a volunteer to ‘just’ listen and chat every week: a simple act at one level that carried deep meaning about being interesting company and having value.
How far we still have to travel to ambition is perhaps best illustrated by the creation of a Minister with responsibility for loneliness, Tracey Crouch MP. Loneliness stems from a set of social conditions: a loosening of ties and obligations amongst us that have seen a sense of the collective weaken. It will be interesting to see if reversing this also includes consideration of the retreat of public spending and investment from the collective. Looking across all ages, the new Ministerial role seeks to find opportunities to build resilience in individuals and communities. “Resilience” implies a characteristic that we either have or lack, as opposed to the interdependence that we all require.
So, it is time for the care debate to shift to what makes for a good life, acknowledging that the context of age, disability and illness can add complexity to how we meet that aim. It also is important we hold some clear and memorable requirements. We all will want and need the three C’s of health creation (opens new window) - contact, control and confidence.