It’s time to change course

The main theme of this year’s Labour Party conference, besides
Iraq, was public service modernisation. The critical role public
services play in delivering a more socially just society and the
need to be ambitious about plans for investment and reform were
emphasised in countless speeches and fringe meetings. But there was
a glaring gap in the discussions: social care was hardly mentioned.
Despite its central role in improving social well-being, the work
of the social care sector barely featured in conference
debates.

Unfortunately, the conference debate is not an isolated case. The
perception – and often reality – is that social care does not have
a strong voice in national debates or contribute as much as it
could to key policy initiatives on the ground. So while the
government has made clear its commitment to tackling social
exclusion and to investing in and modernising public services, the
focus is on the NHS, education, transport and crime. Social care is
comparatively overlooked.

The Institute for Public Policy Research’s New Visions for Social
Care project was prompted by a determination to ensure that social
care takes its rightful position in such discussions and debates.
We have sought to develop a vision for social care in 2020 that
demonstrates the way in which the sector could make a more
significant contribution to achieving a more socially just society.
From Welfare to Wellbeing: the Future of Social Care (see
panel below), published this week, does not seek to provide a
detailed blueprint for reform but is intended to stimulate
debate.

The first element of our 2020 vision is that social care will meet
universal needs and have universal support, even if its services
are not universally experienced. This is vital if social care is to
secure the extra investment it needs in the years ahead. We do
envisage that more people will have contact with social care in
future, partly because of demographic changes but also because
services should become more preventive and community based.

Currently, however, too many people aspire not to need social care.
Changing this means increasing public understanding about what
social care is trying to achieve and getting greater “buy-in”,
particularly from the middle classes.

As Anne Davies has already argued (“If Whitehall could just let
go,” 10 October), if we want people to accept and value social
care, they are more likely to do so if they have a sense of common
ownership and benefit. This presents a strong argument in favour of
local government remaining the appropriate framework in which to
deliver social care, although this must be seen within the context
of wider debates about re-invigorating public participation in the
democratic process, particularly at the local level.

Building greater support for social care also means delivering high
quality, user-focused services. Social care, like many of our
public services, has been poor at focusing on outcomes. Services
have too often been dominated by concerns about processes and
structures, not by what they are seeking to achieve. The challenge
of making social care more outcome-oriented has already been
acknowledged through developments such as Quality Protects, the
National Service Framework for Older People and the strategy of the
children and young people’s unit.

However, outcome-oriented services have yet to be adequately
defined, let alone made a reality, across many parts of the system.
Nuffield Institute for Health director Gerald Wistow argues in his
chapter of From Welfare to Wellbeing that delivering high quality,
outcome-oriented care means understanding the holistic nature of
people’s needs and recognising the interdependence of outcomes
being sought at the individual and community level. Social care
commentator John McTernan suggests it also means seeing people not
simply as recipients or consumers of services but as a resource or
co-producer of their own well-being.

Delivering high quality outcomes involves shifting the focus of
social care away from the last-minute crisis point interventions
that too often characterise today’s service provision.

Liam Hughes, chief executive of East Leeds Primary Care Trust,
describes the vicious circle where a lack of investment in
preventive services has forced social work into reactive mode,
narrowing its focus to casework with an emphasis on assessment and
care management rather than on providing direct therapeutic
interventions. The fear of making mistakes and being publicly
pilloried has reinforced this trend. Thus the wider community and
groupwork approaches that are vital to empowering individuals and
promoting well-being are increasingly being pursued not through
social work but through new services such as Sure Start.

More investment in prevention and a greater focus on community
involvement – including a substantially enhanced role for the
voluntary sector – will be crucial in the years ahead. Three
questions now require urgent attention.

First, how can we address the gap in service provision for
vulnerable groups, as opposed to those who are already in acute
need? Alongside more resources for prevention, other public
services, including education and health, could do more to help
identify those who would benefit from early interventions.

Second, how can we find a more appropriate balance between the
focus on children’s and adults’ services? Despite periodic bouts of
attention on children’s services, the overwhelming focus is still
on older people, not least because concerns about the NHS dominate
politicians’ minds, particularly the need to free up beds occupied
by older people in order to reduce waiting lists.

Third, how can we address the huge challenges facing child
protection that tend to skew the focus of debate, drawing in
attention and resources which are clearly vital but which
ultimately help perpetuate the lack of investment in preventive
work? This raises the question of whether a dedicated child
protection service might enable the rest of the sector to shift its
focus more towards prevention.

By 2020, social care’s focus must be on empowering individuals to
maximise their abilities and opportunities, to lead lives that are
as independent and autonomous as possible, and to participate in
lifestyles that are valued by their wider society. This vision can
be achieved only within and through strong communities. It implies
that social care must play a central role in delivering quality of
life agendas, shifting its framework from one based essentially on
concepts of welfare to those of well-being.

This vision has major implications for the future role of central
and local government. National politicians must pull back from
micro-managing public services and instead focus on setting
strategic objectives and goals. Social care practitioners have
often struggled to deliver against ill-defined and often
conflicting social policy objectives with levels of resources which
cannot be readily challenged because the product of social care has
not been identified.

In future, the government must define the level of well-being it is
willing to underwrite over and above that provided by the basic
social security net. It must also create mechanisms for local
initiatives, for example allowing voters to opt to pay more taxes
at a regional or local level. This will be important in managing
public expectations of what it is reasonable for the state to
provide and what individuals, their families and local communities
should be expected to provide for themselves.

Our vision suggests that government needs to be far less concerned
about the so-called postcode lottery of care. One of the main
reasons for decentralising power is to give people the freedom to
do things differently. However, debates about which variations
might be considered acceptable have not had the same prominence as
calls for an end to Whitehall control. Such debates are vital if
the rhetoric of devolving power is to become a reality and if
public support is to be built throughout the process. In future,
decentralisation must be political as well as managerial.

Our 2020 vision also presents major challenges for those working in
social care. Liam Hughes suggests that social work as we now know
it will cease to exist in 15 years, replaced by new professions
focusing on key age groups. This scenario implies significant
changes in the training of the future social care workforce with
the current emphasis on generic skills and practice being replaced
by a more specialised focus around age-related groups. While some
may see these changes as threatening, they present a huge
opportunity for social work to ensure its values are finally
enshrined across traditional professional divides.

Care trusts represent the government’s preferred model of working
across health and social care for adult services. But so far the
evidence about their effectiveness is lacking and in the absence of
such evidence they should not be rolled out across the
country.

An alternative scenario for 2020, proposed by Anne Davies, is that
local government should be responsible for commissioning health and
social care, ensuring services are locally accountable and deliver
genuinely holistic care.

The future of children’s services is currently the focus of intense
debate. The government has already made clear its belief in the
need for structural change, announcing the piloting of children’s
trusts bringing together the agencies involved in providing
services to children at the local level. The results of the
Victoria Climbi’ inquiry and the government’s response are
anxiously awaited. Many fear the worst: yet more staff-bashing in
the media and yet another bout of structural change.

In this uncertain climate, three things are clear. First, that the
most important change that needs to take place in children’s
services is greater investment in prevention. Without this, other
changes are doomed to fail. Second, a knee-jerk response from
government to any proposals for reform would be disastrous,
lowering staff morale further and entrenching recruitment and
retention problems. Third, while structural reform does not provide
a panacea, options for change must be considered if the sector is
to deliver the vision of social care set out above.

The IPPR believes one option that needs serious consideration is
the creation of a separate, dedicated service focusing on child
protection. This could help deliver the seamless, multi-agency
approach which successive inquiries and studies have called for, by
bringing together staff from social services, education, health and
the police into a single body. It could help emphasise the
specialist skills and expertise required to safeguard children
effectively. It could help remove families’ uncertainties about
whether staff are investigating or supporting them, which is often
a major barrier to effective working with families. It might also
enable staff outside the dedicated child protection service to
concentrate on the preventive, community-focused work that is often
overlooked.

Local ownership of the new service would be critical in meeting
local needs and building local support. However, there is a strong
case for a national body that enables lessons to be learned across
the country and to remove unacceptable variations in
provision.

Creating a separate, dedicated child protection service raises a
number of questions which need further exploration. For example,
how would the national body have sufficient “bite” while at the
same time allow sufficient local ownership and control? How would
the separate service avoid staff burn-out? The IPPR will conduct
further research on these issues in the months ahead.

These are, without doubt, challenging times for social care. From
Welfare to Wellbeing outlines a vision for the sector in 2020 which
will require fundamental changes in the roles of practitioners,
politicians, users and the public. The scale of change should not
be underestimated, but neither should the prize: a world where
individuals are empowered to meet their full potential and enabled
to participate in and contribute to a more socially just and
tolerant society. This is a world social care can, and must,
win.

Liz Kendall is senior research fellow at the institute
for Public Policy Research.

The big debate

The report From Welfare to Wellbeing: the Future of Social
Care is to be launched at this week’s National Social
Services Conference in Cardiff. The book is edited by Liz Kendall
and Lisa Harker and published by the Institute for Public Policy
Research. Copies can be obtained from Central books, tel: 08454 589
911 or fax: 08454 589 912, £9.95. The project was commissioned
from the IPPR by the Association of Directors of Social Services
and Community Care. This article is the fifth and final
part of a series based on chapters from the report.