In April Anna Dixon and Kate Jobling published a report commissioned by the Association of Directors of Adult Social Services (ADSS), entitled Time to Act ‘A roadmap for reforming care and support in England’.
The report is about having a shared vision and draws on a number of vision statements. In search of a better system where through the support of social care and support people will be able to live life to the full, free from abuse or neglect, and ‘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 what matters to us’.
A common understanding of outcomes
The emphasis on outcomes is to a large extent reflected in the Care Act 2014, which frames social care around a duty to promote individual wellbeing which is defined broadly.
This ultimate goal of wellbeing is reflected in other policy documents, as a shared goal across health and social care services.
The report focuses on a common understanding of outcomes that cover adult social care including care homes, domiciliary care and supported living services.
It contains eight features of a better system – which are the “destination” of the roadmap.
The first three describe the care and support experienced by people who draw on it and their carers. The second two describe features of how the system of care and support is organised. The other three are wider and relate to the system as experienced by all of us as citizens. A better system of care and support is:
1. Focused on outcomes and well-being. Care and support are promote wellbeing in all its facets – physical, mental, emotional and spiritual – and the outcomes we decide are important to us. It also promotes equity and inclusion by ensuring different groups in the population experience similar outcomes.
2. Personalised, co-created and flexible. We have a say and shape care and support both individually and at community/ local level. Care and support adapts to our needs as they change, and recognises our diversity and individual preferences, beliefs and circumstances. When we lack capacity there are advocates to represent our prior wishes and best interests.
3. Proactive and preventative. We can access support to enhance our health and wellbeing and reduce inequalities across communities. Care and support is easily available at an early stage to help slow or prevent escalation into crisis, or before we have acute care needs.
4. Integrated and coordinated. The care and support we receive is better joined up around our needs and those of our carers. Care and support links to and / or includes support around health, housing and employment.
5. Local, community-based and relational. We can access care and support near to where we live, or where our close family and friends are. Care is relational rather than transactional, recognising our interdependence and mutuality. We feel at home and are part of our local community.
6. Sustainable, efficient and effective. Whether care and support is funded by the state, or by me and my family, it offers good value for money, is of good quality and achieves the desired outcomes. To deliver this, the market for high quality care and support is stable and well-functioning.
7. Fair in what it asks of people. Who pays and how much we pay for care and support is fair with regard to both charges and where the responsibility for funding collectively through taxation falls. It is also fair in what is demanded of unpaid family carers, and of communities. Paid workers are fairly rewarded for what they do.
8. Accessible and affordable. We can all get care and support at prices we can afford and without a fight. Care is available to more people on an equal basis as eligibility is widened and there is a more generous universal offer.
We all want to see a better system of care and support that is personalised to people’s individual needs. Anna Dixon and Kate Jobling suggest that the way to achieve this is to have a system that is based on a shared vision that focuses on outcomes and wellbeing.
The report provides a roadmap to help providers of care homes, domiciliary care and supported living services to gain an understanding of what needs to be done to achieve the shared vision.
Whether or not you believe the report to be utopian in the current climate, social care needs the ADDSS and sponsored research to enable us to gain an understanding of where we have come from and ideally where we want to get to.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy