John Dixon, Association of Directors of Social Services’ disabilities committee
“Many social care developments over the past 10 years have caused concern to service users and dismay among staff.
They include:
· Eligibility criteria used as a rationing device to attempt financial management as much as to demonstrate entitlement to service.
· Average care packages have become ever more intensive which has reduced the overall numbers of people served.
· Perversity of many performance indicators which drive services away from national and local policy direction, including prevention and plurality of provision.
They have also served to obscure the advances in professionalism that have taken place in the services provided. We now need to use the green paper to reverse that trend.
The ADSS is committed to working with colleagues in the public and independent sectors, and with the government, to make this process a reality.
Especially important will be the chance to work with the voluntary and community sector (VCS) within a different framework. The green paper proposes a different compact between the state and its citizens. We should be looking for this to be matched by a change in the relationship between the public sector and the VCS.
Driven by the move towards ever greater intensity of services, local authorities have tended to see the VCS increasingly as a provider of services, and less in its other role as an advocate both for individuals and for policy principles. The new roles suggested in the green paper (navigators, brokers) and the shifts of control anticipated indicate a reliance on the VCS to come forward in that other role.
If this partnership is to develop, local authorities need to see themselves increasingly as enablers of others. The VCS has to spend too much on survival. If we provide a more conducive environment, it can devote attention to those low-intensity services that make for real service improvements”.
Jeni Bremner, programme director, education and social policy, Local Government Association
“What does prevention mean in the context of adult social care? The simple answer is actions taken now that prevent the need for intensive or intrusive interventions later, and strategies to promote quality of life and engagement with communities. But this is a simple answer to a complex question. When we deliver social care services we aim to sustain a person’s independence by building “interdependence” through networks and coalitions of individual, family, carers and community capacity.
Promoting prevention means tackling social exclusion. And this requires us to tackle social stigma, including ageism, to build community capacity and to support communities of interest, as well as geographical communities, to look after and manage their own affairs. Local authorities have a critical role working with partners - often in the voluntary and community sectors - to build community capacity.
This agenda is much broader than the statutory sector. The voluntary and community sectors are major contributors. They are major direct service providers, but their role expands beyond service provision. They are active in community capacity building at a local level, representing the needs and aspirations of different parts of our communities. Not least, they often act as a ‘critical friend’ - challenging existing models of service provision and leading innovation.
At the heart of prevention is the belief that investment in services which promote well-being will both improve a person’s quality of life and reduce or delay the need for intrusive and often expensive interventions later in life.
This does mean, however, that there will be a need for some double-running of services over a period of time. We hope the review led by Derek Wanless for the King’s Fund will provide useful evidence to support greater investment
in prevention”.
Jo Webber, policy manager, NHS Confederation
“The challenge for all of us as we refocus on preventive health and social care is to ensure services are maintained while this shift is happening. This won’t just happen automatically, and there is a danger that the day-to-day challenges of ‘getting the job done’ and ‘firefighting’ will continue to dominate the agenda. Investment needs to focus on ensuring that preventive work is not squeezed out.
The voluntary and community sector is already an important part of service provision, but this involvement needs to be strengthened through genuine partnership working.
The NHS Confederation is part of the Inter-Agency Group on Adult Social Care, a coalition of 14 organisations representing service users, carers, communities and staff who are all calling for a shift of focus from acute care to prevention in social care services.
This is a valuable forum for discussing our common ground and exploring our differences.
Statutory organisations need to be smarter in working with voluntary and community organisations - and vice versa - so that we can develop a better understanding of our different cultures and ways of working. That is a cultural shift just as great as the shift from firefighting to prevention, but it is crucial for us to achieve”.
Heléna Herklots, head of policy, Age Concern England
“If the green paper failed to bring about the full range of changes it proposes, but succeeded in ensuring preventive services are available to all who need them, we would count it as a success. But there are some caveats.
Prevention must not be defined narrowly as ‘preventing the need for more intensive services’. It is equally about promoting quality of life and well-being. It can delay or prevent the need for more costly services, but it is also good in itself because it improves people’s quality of life. It means provision of practical support. It is also about social contact and involvement. It works best if it addresses all the elements of well-being.
So what needs to happen to achieve this? Can it happen, as the green paper suggests, on a cost- neutral basis? Thousands of people develop and provide preventive services, and many work in the voluntary sector. Although recent years have seen welcome government grants and initiatives, prevention has received no sustained resourcing.
A preventive approach should produce savings down the line. But, initially, additional funding must be provided or support for the more vulnerable could be compromised. The government should ‘invest to save’.
The voluntary sector, working in partnership with others, is crucial in a shift to prevention. However, we need support from national and local government to play our part. The voluntary sector compact should be honoured so we can become equal partners in working to improve the quality of life of all those who need social care”.
Angela Greatley, chief executive, Sainsbury Centre for Mental Health
“Mental health and well-being are influenced by many factors, from family relationships to the wider community. Promotion of good health has to encompass the needs of everyone, including those who have sought help from mental health services or their GP and those who have never sought that help.
The green paper does not show any great ambition to tackle these vital questions. A short paragraph on preventive services suggests the new connected care centres will have a vital role in promoting social inclusion. Work with community and voluntary sectors will also play a part.
But none of these ideas are spelled out with any radical vision about how to tackle current mental health problems. And there is no mention of the pound signs or the commitment of people’s time and expertise that would have to go with any programme.
Discrimination against people with mental health problems and the stigma they feel create massive barriers to health and well-being. The headlines are full of negative stories that discourage people from seeking support early on. Employers and work colleagues can be wary, preventing people with mental health problems from finding and keeping work. Housing is difficult to get if you have a mental health problem.
The green paper offers little original thinking on how to tackle these problems, or on the leadership that is required to address these challenges. Overall, it offers a disappointing agenda for action to promote health and well-being. It needs much more work to ensure social care plays its part in implementing the Choosing Health white paper and tackling discrimination against people with mental health problems”.
Independent View
Jon Glasby, senior lecturer and head of health and social care partnerships, Health Services Management Centre, University of Birmingham
“One thing everybody seems to agree on in social care is the need for more prevention. With tightening eligibility criteria and financial shortages, workers often have to concentrate on those in crisis, leaving people with lower-level needs to deteriorate until they qualify for services. This cannot be the right outcome for service users and is not a sensible use of public money.
Against this background, it is to the government’s credit that it has charged local authorities with developing preventive services. Working within existing resources, councils will have to take a corporate approach. By itself, social care can never tackle the problems its service users face. Working with other services, it could achieve a whole that is greater than the sum of its parts.
One way to do this might be to make current health and social care grants available to a wider range of local authority departments, and to develop a smaller number of joined-up targets - in effect, making the whole system responsible for the various community care user groups rather than just social care”.
