A blog by Steve Cox
I retired in 2023 after over 40 years working in social care in both the statutory and voluntary sectors. At the outset of my career, there was little talk about funding problems or crisis in care services. There was an excitement about closing long-stay institutions, enabling people to stay in their own homes and supporting people to lead a valued life as part of their chosen community. People with additional needs were to receive the support they needed whatever that might be. People were able to make choices and have control in their lives.
There were challenges of course; communities were not always ready or welcoming. Barriers to integration and inclusion were everywhere, but there was a real sense that working together these could be overcome. I saw first-hand that organisations could work in partnership and put the person receiving support at the centre, seeing them as individuals with rights and aspirations. People were attracted to work in the sector because they could see the difference they could make in someone’s life.
Supposedly though, what we needed was more competition; that would make us better, more efficient organisations that would provide even better services.
Mistakes were made
What it turned into in reality was a drive to the bottom. The quality of care and support only went down, as organisations were forced to cut costs and lower prices and came up against recruitment difficulties both in terms of the quantity and calibre of staff. Inevitably, mistakes were made, things would go wrong more often and the perception of society was that there were real problems in social care.
Good organisations continued to put the person receiving support at the heart of what they did, continually looking for innovative ways to enable them to lead a fulfilling and valued life. Staff still managed to do amazing work but increasingly people working in the sector were not staying, as financial and job requirement pressures mounted.
Government decided that what the sector needed was to be recognised properly for what we do, so it was decided that care staff would be paid the minimum wage. Thank you very much – the people who care and support the most vulnerable in our society are seen as only worthy of the minimum pay. But organisations could pay more than this if they wanted to. Of course they did, but they get virtually all of their funding from the people who have determined that their staff are only worthy of the minimum.
Promises of an overhaul of social care came and went. Many small local organisations came and went, and staff came and went. “Give us more money” was the cry. “We’ve given it” was the response. Still services were squeezed to provide more services to more people with greater needs. Still government refused to honestly acknowledge the problem. Councils look to determine who is eligible because they now cannot afford to meet the needs of everyone, even though that is what the legislation says they should be doing.
The campaigning narrative has to change.
I think it is unrealistic to think resource issues will not determine levels and quality of care for a long time yet which is why I believe that the campaigning narrative has to change.
We hear a lot about wanting to fix a broken health service but it still feels like social care is not seen as being as important as health care. The new government likes to think it is the champion of social care but in reality offers little hope of putting things right for a long time, setting up another commission and putting off any realistic change for many years.
In the meantime we have to accept that resource issues will only become more acute. How come we have supposedly intelligent people doing the maths and yet they can’t see that the cost of the planned increase in National Insurance contributions and the National Living Wage is not matched by the additional funds given to cover cost increases faced by organisations which are just about surviving in the social care sector?
The Campaign for Real Care is admirably highlighting the blatant failure of statutory bodies to properly and fully assess the needs of disabled and vulnerable people. It calls for a new approach as in health, where need comes before resource. However, as I know through personal experience, even within health, need does not mean the resources will be provided. This could be seen as a consequence of the oxymoron organisation NICE (thank you Tony Blair ) which enables Health Boards to make decisions not to fund treatment based on monetary grounds. Another aspiration of the Campaign for Real Care is that “need precedes resource”, and it should, but it has to go further than the assessment of need.
Increased cost: Acknowledge it, accept it, demand it
In order to challenge the influence of resources on the eligibility for, the level of, and the quality of care, we have to be able to present alternative solutions that go beyond highlighting the level of need and what is a fair price (both hugely important). We have to work more with economists to show how the need can be funded and at the right level. Yes, undoubtedly this will cost more leading to tax increases but until we acknowledge this upfront it feels like we are not going to get the message across so that people will start acknowledging it, leading to accepting it, leading to demanding it. This is about getting society to be clear about what it wants for those people in that society who have additional needs.
There are still providers coming up with some great innovative services as solutions to the resource issue but it isn’t, and won’t ever be, enough.
The focus on outcomes-based commissioning is of course something no-one would argue with, but it will continue to be impossible to achieve this for many people within current resource levels.
Providers achieve some amazing outcomes for those they support despite the constraints on them and in some respects, this goes against us; it takes the eye off those people who do not receive enough support or who don’t get the right support.
I loved my time in social care; seeing people grow and develop and their lives being enriched was both humbling and uplifting. I want to see more of this, and I know it will need more money – not a recycling of existing money. We need a society that recognises that, even though it will cost everyone more, it is the right thing to do.
Steve Cox worked in social care for over 40 years. He retired in 2023 as the CEO of Perthyn, a provider of support to people with a learning disability and autistic people.
Perthyn’s primary purpose is to provide support to people with a learning disability in order that they can lead dignified and fulfilling lives within the community.
Steve is now a member of ARC England as an individual.
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