A radical shift in thinking is needed to tackle the adult social care crisis
Open the newspapers or turn on the TV, and it’s clear that the adult social care system is in crisis, writes the Director of the Health Services Management Centre at the University of Birmingham.
In recent months we’ve seen stories about the impact of massive cuts, debates about the appropriateness of 15-minute home care visits, a series of care scandals and ongoing concerns about how best to fund long-term care for older people.
With the exception of the austerity agenda, none of this is new – and pressures on adult social care have been growing for decades as the population ages, public expectations rise and available funding increasingly falls behind the scale of the task in hand.
None of this is the fault of people currently working in or managing current services – we simply have a very 1940s’ system designed with 1940s’ society and aspirations in mind that now no longer feels fit for purpose.
While the current Care Bill may help to tidy up the underlying legal framework, it seems unlikely to provide a long-term solution.
One of the key challenges is that the current system is based on identifying and remedying deficits – things that people can’t do for themselves. This is fundamentally negative and forces people in need to try to prove that they are sufficiently vulnerable and dependent to be eligible for support.
Instead, a more positive place to start might be with what people can already do for themselves and the natural supports they already draw on at home and in their local communities.
In the jargon, this might be a more ‘assets-based’ approach or one that draws more fully on existing social capital.
Where people still need formal services, this could supplement existing supports, rather than ignoring – or sometimes even riding roughshod over – people’s existing assets and coping mechanisms.
Of course, some people needing adult social care may not have much pre-existing social capital or many community resources to draw on.
Thus, the role of the social worker would shift from being primarily an individual care manager who assesses and provides services for a person in need to being more of a community development worker who identifies the needs, assets and aspirations of individuals, groups and local communities.
These were always key social work skills prior to the community care reforms of the 1990s, and it may be that such approaches provide an opportunity for social work as a whole to reclaim some of its professional identity and value base.
Around the country, a number of councils are already exploring ways to develop more assets-based approaches.
Some are promoting timebanks to encourage mutual aid and reciprocity, while others are supporting people using services to set up their own very small businesses to help others in similar situations.
Some are creating user-led citizens’ hubs in high street locations to provide practical and peer support in more neutral, everyday spaces, while others are helping people to recover from a stay in hospital through a system of peer rather than professional support.
Others are providing grants to the voluntary sector to encourage experiments with new ways of promoting social connectedness, while some are supporting key local people who can signpost neighbours to sources of support and identify unmet need in the local area.
As is often the case, the current financial crisis is both a threat and an opportunity to do something fundamentally different.
Professor Jon Glasby is a qualified social worker by background and is now Director of the Health Services Management Centre at the University of Birmingham.
‘Turning the welfare state upside down?’ is a new policy paper on more assets-based approaches to adult social care by Jon Glasby, Robin Miller and Jennifer Lynch published in conjunction with Birmingham City Council Adults and Communities directorate. A full copy of the policy paper can be found here.
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