The state of adult social care — why is it collapsing?

The 6 million dollar question

When musing on the state of adult social care and the seemingly endless calls for reform, unheeded for decades, one has to ask why. Why is such a fundamental sector to our national happiness and wellbeing so poorly served by policy makers and political vision?

Why has my 1980’s bleeper (remember them!) been replaced by my smartphone that can do far more than I’ll ever discover? Why is the way I book a taxi, organise a holiday, manage my central heating been transformed whilst social care remains firmly organised to serve a generation whose wants and attitudes have long been superseded by a consumer generation, used to making their own choices and shaping their world?

In good old Economics (I did that once upon a time), change in markets is ideally powered by consumer sovereignty. The consumer wields their spending power to shape the goods and services that the market offers. This sovereignty appears to be wholly missing in the social care world. What you get is decided by Commissioner Sovereignty which offers little choice, little diversity and very minimal opportunity to segment the desires of consumers. So we end up with bigger and bigger care homes and shorter and shorter home care visits — Why?

There is a fundamental underlying fear of change. As the regulator, The Care Quality Commission (CQC), announces yet another change to its regulatory approach (there have been many and none are based on any evidence or evaluation of approaches). We risk further embedding the market into traditional lacklustre tired old institutional and reactionary risk averse models of care, squeezing out the consumer and shackling innovation.

Why haven’t we fully embraced a preventative and neighbourhood level social care model, offering a cornucopia of choices and options? Why isn’t there a Community Circle in every neighbourhood? There is a surfeit of willingness within communities; they just need some permission and a simple architecture. Why doesn’t every care home have intelligent systems that can warn of inactivity, anxiety, and monitoring vital signs? Wouldn’t this be a far more effective way of giving individuals, families and regulators reassurance based on real time evidence?

Why don’t we have a joined up system sharing data, safely and respectfully, that allows for best use of capacity and stops the terrible misery of being stuck in hospital because the system can’t get its act together to support you back home? Indeed, why isn’t much more utilisation of innovations in technology to support people to stay in their own homes, engaged and enriched, maintaining their relationships, neighbourhoods and self?

There are too many middlemen getting in the way. It is time to empower the consumer to make their own choices according to their risk appetite. What I can and want to do, not what I can’t and aren’t allowed to.

We can rebuild it, we have the technology!

Written by John Kennedy, an independent consultant in housing and social care.

John is the co author of ‘Power to People – Proposals to reboot adult care and support in Northern Ireland’ 2017 and ‘John Kennedy’s Care Home Inquiry’ 2014.