Turning the welfare state upside down? A new approach to adult social care
Professor Jon Glasby
In recent years there has been a growing sense of crisis in adult social care, with policy makers, practitioners and people using services all arguing that the current system is fundamentally ‘broken.’ This is not the fault of current managers or front-line professionals – we just have a 1940s’ system designed with 1940s’ aspirations and society in mind, which feels increasingly unfit for purpose in terms of how we live other aspects of our life in the early twenty-first century. With massive cuts in services and ever rising demand, adult social care has effectively become a ‘poverty’ service – provided only to people with very low incomes and with very high needs. Anyone else simply has to manage by themselves as best they can. To older people and other members of the public who thought the welfare state would support them ‘from the cradle to the grave’, these harsh realities feel like a major betrayal.
Part of the problem is that the current system is based on identifying what people can’t do for themselves and then providing services or funding from the state to make up any shortfall. This is an inherently negative way of working, and people in need feel they have to highlight their deficits and problems – only to find that they often aren’t eligible for any support at all. Even worse than this, such an approach means that formal services often ignore – and sometimes even ride roughshod over - the natural supports and community resources that people may have (possibly making things worse rather than better).
Instead, a major new policy paper published today in conjunction with Birmingham City Council argues for a new approach that starts in a more positive place with what people can do for themselves, any natural supports they have from their family, friends and communities, and any additional resources available locally. Rather than formal ‘services’ the latter could be a café where local people meet, a library that has a mobile lending service, a leisure centre that runs exercise classes or a local voluntary group that runs a ‘good neighbours’ scheme. Rather than being ‘care managers’ (as at present), social workers would once again be community development workers, based in local communities and working alongside individuals, groups and communities to find new ways of meeting need. If we started here then any formal services that might be needed would build on and enhance local resources – rather than replacing them. People would also be less segregated and more fully connected to their friends, families and communities.
Interestingly, a number of Councils are exploring ways of trying to do this – partly because they can’t afford not to in the current financial climate but mainly because it is the right thing to do. Ironically, while several previous social care reforms have attempted similar changes, the current financial problems facing Councils might mean that more radical change is finally possible (with necessity being the mother of invention). Whatever happens, there only really seem three options:
1) Increasing services to meet rising demand (with no extra money)
2) Managing demand as best we can (which might mean longer waiting times, reduced quality and/or fewer people being eligible for support)
3) Reducing demand by meeting needs in new, more positive and creative ways
Of these only the final option feels credible in practice, and the University’s new policy paper: Turning the welfare state upside down? Developing a new adult social care offer (PDF - 238Kb) explores what this might look like if we really did decide to go for it (and if we really mean it when we say it this time).
Professor Jon Glasby
Professor Jon Glasby is Director of the Health Services Management Centre at the University of Birmingham. In the run up to the 2010 general election he was lead author of a study for Downing Street and the Department of Health on the reform and future funding of adult social care (PDF - 777Kb).
Turning the welfare state upside down? (PDF - 238Kb) is a new policy paper by Jon Glasby, Robin Miller and Jennifer Lynch at the Health Services Management Centre, University of Birmingham, published in conjunction with Birmingham City Council Adults and Communities directorate.