What we want

The Social Care Institute for Excellence has been canvassing
service users and practitioners about their views of the adult
social care green paper. Amanda Edwards looks at their visions of
future services.

The social care sector should take credit for the greater
opportunities for independent living that have occurred since the
NHS and Community Care Act 1990.

The adult care green paper identifies a consensus about what people
want from adult social care. Also, the values and principles
underlying people’s visions are consistent with that of the
government’s vision in the green paper. Now the vision has to
be put into practice.

This week, the Social Care Institute for Excellence launched a
report looking at the future of social care based upon the views of
almost 1,000 service users and practitioners.

Service users ideas about the future of social care in the report
include:

• Involve greater support from wider society rather than
  over-reliance on families and friends.
• Transcend disability and include education, training and
  support.
• Provide help in an understanding manner.
• Enable people to lead more fulfilling lives.
• Give people choice and control, helping them to lead their
  lives in the way that they choose.

These new visions for adult social care will need more effective
partnerships across a range of activities. Users and carers said
they wanted to experience services as though they were seamless,
while service commissioners and providers need to integrate
separate services.

A survey carried out for the report found that progress in joining
up services has been uneven. Much of the evidence about the
effectiveness of joined-up services focuses on interagency
relationships rather than on outcomes for service users.
Participants in the consultations said that rather than pursuing
seamless services, stronger bonds were needed between services, so
people experience services as being joined up.

Participants did not want structural change, which they believed
would distract from service improvement and be undermined by
“change fatigue”. They believed that better outcomes
could be delivered within the current structure if systems and
processes were improved, for example by streamlining the assessment
process.

Respondents said society has increasingly expected professionals to
take and manage risk. But the extension of choice and
person-centred care transferred risk to individuals and their
carers. Participants questioned whether service users possessed
enough information to make informed decisions about the risk they
face.

Service users said direct payments had boosted their self-esteem,
ended their feelings of isolation and secured a better standard of
care. But they also reported difficulties in obtaining direct
payments and in finding well-trained staff to help.

For individuals, direct payments and other forms of personalised
budgets are key to giving them greater control and choice, and more
influence over design and priorities of services.

There was considerable interest in extending self-assessments, and
participants believed that a case-management model like that being
developed for long-term illnesses in the NHS might have some merit.
But they said it should be built on a social model rather than a
medical model. As well as provided through domiciliary care,
attention must be given to people’s emotional and
psychological needs for companionship, friendship and
intimacy.

Services users talked about lacking self-confidence and feeling
guilty about asking for services despite independence and rights
being key to the social model. One person said: “A culture of
dependency and gratitude is everywhere.” Many respondents
suggested that social care, its staff, and service users, needed to
be revalued. Service users also believed that the design of
services and the practice of staff should focus on improving the
self-image of service users.

Participants said that individuals see themselves as belonging to
different kinds of community, defined by geography, employment,
interest, belief, ethnicity and kinship. They argued that a
community approach promotes social well-being by focusing on
generic risk factors such as those associated with safety,
transport, employment, education, leisure and isolation.

Using mainstream services was seen as important as a means of
helping people to live fuller lives in communities, strengthening
citizenship and delaying or removing the need for individual
services. Families and other sources of informal care, such as
volunteering, should also be supported and developed to help
involvement in communities.

Social inclusion recognises that fulfilling lives are rooted in
interdependence relationships. So, for example, although many older
people may wish to remain in their own homes for as long as
possible and to live alone rather than with others, almost none
would choose to live in isolation. Older people have also
identified as crucial to well-being other factors such as good
quality housing, safe neighbourhoods and getting out and about, as
well as having useful, enjoyable ways of contributing to
neighbourhoods.

Putting people at the centre of social care requires shifting power
and influence to service users, to their carers and to community
interests. This new vision implies a shift from “choice and
independence” for some service users and carers towards
“control and interdependence” as an expression of what
most citizens expect.

But converting the vision into lasting reality requires
“making it happen and making it stick” – using
change-management programme to support the transition to new ways
of working and then embedding these new approaches in social
care’s culture and practice.

Training and learning
The author has provided questions about this article to
guide discussion in teams. These can be viewed at www.communitycare.co.uk/prtl
and individuals’ learning from the discussion can be
registered on a free, password-protected training log held on the
site. This is a service from Community Care for all GSCC-registered
professionals.

Abstract
The Social Care Institute for Excellence launched a
position paper this week based on the views of service users and
practitioners, looking at the future of adult social care. Scie is
keen for the sector to use this paper to help inform their
responses to the government green paper “Independence,
well-being and choice”. It draws on almost 1,000
people’s views.

Further information
Social Care Institute for Excellence, Developing Social
Care: the Past, the Present and the Future. To order call 020 7089
6840 or download from www.scie.org.uk/publications.
Go to the website to contribute to Scie’s green paper
consultation.

Contact the author
By e-mail: info@scie.org.uk

Amanda Edwards is head of knowledge services at Scie.
She has responsibility for managing Scie’s work programme, which
includes reviewing the evidence, the production and dissemination
of practice guides and the development of the electronic library
for social care. She has experience in policy, practice and service
delivery.