Vision validated

Gerald Wistow is a part-time research professor in
health and social care at the University of Leeds and a visiting
professor of social policy at the London School of Economics. He is
working with the Social Care Institute for Excellence as a
consultant on its Looking to the Future project.

Richard Wistow is a senior research associate at the
centre for public mental health, University of
Durham.   

Earlier this year, community care minister Stephen Ladyman
launched a debate about the future of adult social care. Speaking
to social services directors in April, he announced that he wished
to develop a vision and framework to provide greater clarity for
service users about the purpose and role of such care.

The green paper Every Child Matters had set out a vision
and direction for children’s services when it was published in
autumn 2003. Ladyman envisaged making a parallel statement in the
summer of 2004 about the future of services for older people and
adults of working age.

He already had several ideas about that vision, but wished to
engage the wider social care community in a national debate. In a
subsequent speech to Community Care Live in May 2004,
Ladyman urged his audience to respond to a brief questionnaire
about his emerging thinking.

Ladyman’s starting point was the need for adult social care to move
into the 21st century. His vision is firmly located in the
government’s wider principles for public service reform, especially
choice, diversity and person-centredness. Thus, he advocated an
approach to social care “that puts the person needing care at its
centre rather than the institutions providing that support; one
that promotes inclusion and diversity and supports people in their
choices and aspirations rather than cares for them once all choice
and hope is gone”.

He has also criticised services in which both users and providers
are trapped in a “culture of dependence”. Most fundamentally, he
questioned whether the balance between individual, family and
statutory responsibilities has tilted too far towards the
state.

Against this background, Ladyman proposed that adult social care
should be: person-centred so it is tailored to the individual’s
circumstances and so allowing them to fulfil their potential;
proactive, so services intervene in time to prevent problems and
help maintain independence; and seamless, working with partners to
eliminate gaps and improve access.

Respondents overwhelmingly agreed that change was needed and should
be broadly on the lines suggested by Ladyman. They showed little
defensiveness about his critique of social care or his suggested
ways forward, except perhaps in the relatively low priority
apparently accorded to direct payments. Few respondents
specifically identified the latter as a tool for implementing
Ladyman’s approach.

More generally, the results show that respondents not only shared
the ministerial vision, but also appreciated the measures that
would be needed to implement it. Hence they emphasised:

• The need for resources to be adequate and more flexibly
  deployed.
• The importance of cultural change.
• The need for learning and training to support the kinds of
  early intervention and low-level support necessary to realise
  person-centred care.

Ladyman decided not to issue a further statement in the summer
after all, but instead summarised the main responses to the
questions he had posed in the Social Care Institute for Excellence
(Scie) report.¹ In a personal foreword, he explained
that the results of the survey had made him think about other ways
of “encouraging new and radical and stimulating debate”. Meanwhile,
to allow further responses up until the end of September, Scie was
asked to reopen its website featuring the original questions.

Ladyman also emphasised that he wanted to “maximise the
contribution that older and disabled people can make to the next
vital stage” of policy development. Too much policy in the past had
been developed “top down” and he was determined that this time it
should be different.

Partly as a contribution to this process, Scie has organised
consultations with service users, carers, voluntary organisations,
the private sector and local authority members, as well as social
services staff at all levels in their departments.

In his introduction to the survey report, Ladyman commended
respondents who had put social care in a wider context. He
recognises the links between his vision and deputy prime minister
John Prescott’s wider vision for local government and local public
services.

This wider concept echoes Association of Directors of Social
Services president Andrew Cozens’ vision of social care working in
the mainstream of local services. It is also supported by survey
respondents who highlighted the need for social care to be
connected to mainstream services such as housing, education,
leisure, employment and public health, as well as community
resources.

To implement this wider concept, different and more fully developed
skills are needed, and this was also recognised by respondents. To
reach this point, we need education and training to deliver such
skills and competencies, and not only in social care but also in
mainstream services. Perhaps the next stage of the debate should
focus as much on the tools for the job as on the grand design.

The adult social care survey   

Community care minister Stephen Ladyman said in May that he had
asked the Social Care Institute for Excellence (Scie) to
co-ordinate a survey of how far others agreed with his vision for
social care.   Three questions focused on the overall direction of
adult social care: 

• Whether the balance was right between “positive intervention
  and unnecessary interference in people’s lives”. 
• Whether “some models of care can lead to increased
  dependency”. 
• Whether respondents agreed services should be “person-centred,
  proactive and seamless”. 

The remaining four questions dealt with the support necessary
for individuals, families, communities and the social care
workforce. 

Scie received 178 questionnaires. Most (79 per cent) respondents
worked in the public sector: 41 per cent in social services
departments, 21 per cent in the NHS, and 9 per cent in housing. The
other responses were private and voluntary sector. 

Few users and carers responded directly but several voluntary
sector responses came from organisations representing the interests
of service users.  

The survey attracted a more broadly based response than formal
consultations often do: 40 per cent were operational managers; 25
per cent were front-line staff; and 23 per cent were senior
managers. 

Ladyman’s vision was shared and endorsed by most
respondents: 

• Eighty-one per cent agreed that some models of care can lead to
  increased dependency. 
• Ninety-three per cent agreed that services should in future be
  person-centred, proactive and seamless. 

But, they were equally clear that a wide range of resources and
support were necessary for social services staff to make this
vision into a reality (see main article).

Abstract 

This article summarises findings and conclusions from a survey
of views about ministerial proposals for a new vision for social
care. The survey was co-ordinated by the Social Care Institute for
Excellence and found widespread support for the new vision. This
was qualified by recognition that appropriate support and resources
would be needed if the delivery of social care was to become
person-centred, proactive and seamless.

References 

1 G Wistow, R Wistow and J Simmons, The New Vision for Social
Care: a report on the results of a survey undertaken by Scie
between 18 April and 30 June, Department of Health and Social Care
Institute for Excellence, 2004

Further information

• L Kendall and L Harker (eds) From Welfare to Wellbeing: The
  Future of Social Care, IPPR, 2002 
• C Leadbetter, Personalisation through Participation, Demos,
  2004 
• Department for Education and Skills, Every Child Matters, DfES,
  2003 
• Department of Health, Tackling Health Inequalities: A Programme
  for Action, DoH, 2003 
• Office of Public Services Reform, Reforming our Public
  Services: Principles into Practice, OPSR, 2002 
• J Rankin and S Regan, Meeting Complex Needs: The Future of
  Social Care, IPPR, 2004

Contact the author 

Gerald Wistow, consultant, Social Care Institute for Excellence,
1st Floor, Goldings House, 2 Hay’s Lane, London SE1 2HB, tel 020
7089 6840. gerald.wistow@btinternet.com