The present care system is not fit for purpose – Jenny Owens

A new approach to care and support – based on the recent green paper – will involve tough talking and some even tougher decisions, warns Jenny Owen, president of the Association of Directors of Adult Social Services

Over the next year the issues raised by the government’s green paper on care and support are going to lead to some extraordinarily hard policy and political discussions. The current blend of nice words and thoughtful options will give way to some vigorous and rigorous debate, as options are squeezed into tunnels out of which decisions will have to come.

It has been a brave decision to push this particular boat out into today’s choppy waters. Raising issues that might lead to more contributions from taxpayers at a time of monumental economic and political uncertainty took conviction and courage. But the opposition has been muted, it has not been sucked into the political maelstrom that so many feared.

If the green edges had to be greener in order to get the report published, then so be it. Even if there are fewer answers than questions, it’s out there, published, and the issues are in the open – for good and all.

Given that we are looking at an extremely complicated set of relationships between individual, family, community and state, and the financial and political balances that hold between them, it would be irresponsible to make too many judgements in advance of some of the hard thinking ADASS will be doing in the coming months.

There are clearly implications for the way very large budgets – attendance allowance, for example – are streamed and the way our broader welfare services are structured and situated. Some of those implications are pretty obviously on the face of the document, others are fairly deeply buried. Still more – the future of disabled living allowance, for example – barely make an appearance at all.

The fundamental principle that directors of adult services will be taking is simple. We have to look at these complex inter-relationships between structure, streaming, family responsibilities and the duties of central and local government, and ask “What do they mean for the people who are using these services? How will their lives be improved by adopting this, rather than that, option?”

That will mean weighing balances. Is the fairly reliable promise of a universal, national benefit to the individual, wherever he or she lives, more or less important than their right to live in a flourishing local democracy and influence its services by voting in regular local elections? Will the appeal and profile of a national care service really outweigh the truly inspiring local care services that only local authorities, at their best, can deliver?

The care sector has acknowledged that the present system is not fit for purpose, that the 1948 era’s settlement – which excluded social care – is fast coming to an end, with changed expectations, a changed economy, a totally changed social culture and massively increased expectations of longevity. It has equally acknowledged that more resources have to be put into the system. Unfortunately, the Ipsos/Mori polling figures strongly suggest that a large proportion of the public still believes that social care is free care.

What will have to be teased out in the coming months is exactly how the different ways in which it has been mooted that the additional sums should be raised will impact on those other structural debates waiting in the wings. And, to add to the burden, this complicated nexus will have to be unravelled at the same time as we examine its relationship to the way we continue to manage a vibrant and growing social care market underpinned by a transformed, personalised social care service.

It is because of these complexities that the basic reference of our debate has to be the user and carer – and balanced judgements, frankly, will have to be made as well between different users. What will be the outcomes for them? How will the quality of their lives improve?

We began our debate in ADASS with a day-long seminar with more than 100 directors attending a briefing session at the King’s Fund, aided by the Social Care Institute for Excellence. But it isn’t just the big issues that need discussion. Getting social care more fully involved with the health services still has to be accomplished irrespective of the green paper debates being resolved.

Too often we are co-located, not integrated; too often the line and broken-line management accountabilities we are building link job titles, not fellow professionals. And how strange it seems to be wondering whether we want a social care equivalent of NICE when we consider the hugely valuable work the Social Care Institute for Excellence has been producing over the past couple of years.

A few years ago when he was ADASS president, David Behan, now director general for social care local government and care partnerships, used to point out to audiences that the “tectonic plates” of social care were beginning to move, and that it was everyone’s duty to make sure they moved in the right direction, in the right sequence.

We must not forget that the green paper is only part of a continuing grinding of those plates – some the same, some different. The DWP recently produced its strategy on ageing – somewhat lost among the attention paid to the green paper. In November the social work task force will publish its long-awaited report on the workforce. Some time within the next 12 months it’s clear that the soft talking will be all but done with – the hard talk will then have to begin.