This week, after consulting with local practitioners in Wiltshire, I sent a letter to the Health and Social Care Secretary outlining proposals to improve social care.
The obvious or ‘presenting’ problem with social care is money. But the problem goes deeper than money and if we think only about costs we will fail to solve it, and miss an opportunity to create a better society.
The fundamental problem with social care, which gives rise to the problem of finance, is that as a society we do not really respect elderly and vulnerable people and those who, paid or unpaid, look after them.
However, elderly and vulnerable people and care workers have been in the spotlight during the coronavirus crisis and I believe that a profound change could be occurring in public attitudes towards social care.
While this crisis has raised serious concerns about our social care system, it has also prompted care providers, councils and local communities to develop creative solutions which should be harnessed for the longer-term redesign of the system.
I suggested to the Health Secretary the following principles to guide our approach:
- Social care needs more money, but it should not become a single, centralised state service.
- Our focus should be on moving care ‘upstream’ from expensive professional provision, with appropriate financial support for informal care and properly-funded flexible professional care to supplement this.
- In keeping with the focus on family-led care, no-one should be forced to sell the family home to pay for professional care.
- It is not appropriate or possible for all social care to be funded from general taxation. Individuals and families should still be required to contribute if they can.
- We need a social insurance model i.e. compulsory payments into a dedicated fund, following the example of Germany and Japan. This will spread costs more fairly.
- The system should include the option of care recipients receiving cash benefits with which to compensate family members for giving up work to care for them, or to buy care themselves; as well as entitlements to professional services commissioned, using a voucher system, by recipients and families.
- Professional care, in people’s homes or residential settings, should aim to deliver quality of life not simply basic physical care.
- We must create models of care that sit between the informal and formal care economy, with more ‘semi-professional’ domiciliary care workers drawn from the local community.
- We should support - as well as properly regulate - the small private care home sector and defend the market against consolidation by large corporate providers.
I look forward to the Health Secretary’s response, and to working with individuals and organisations in Wiltshire to improve the design of the system. If you have thoughts on this vital topic do contact me at email@example.com.