A Caring Society - What role for the state?

Many good things are happening in social care. There is innovation, inspiring leadership at a local level and examples of empowered communities making a real difference. However, if this is to meet the challenge the current system is facing, we need to find a way to make these the norm rather than the exceptions. In line with this, the theme of Grant Thornton’s latest roundtable debate – led by Donna Hall (Chief Executive of Wigan Council) and Andrew Haldenby (Director of Reform) – in our caring society programme, was to consider what is the new role for the state?

More money isn’t the only answer

Too often the social care debate comes back to money, but there is a real risk that just focusing on funding misses the opportunities to drive change. There is a clear lesson from the NHS, which saw significant additional funding in the noughties, but where the extra money had little impact on the outcomes that matter to patients.  

While austerity has presented real challenges to social care, it has also prompted new thinking and approaches and this could stall if funding constraints are suddenly removed. What is important is that there is enough money and discretion for local authorities to make choices based on local need and not just end up paring everything down to delivering core statutory services.  

Getting partnership and collaboration right

All those involved need to work together to respond to local need. That can range from social care departments working with social housing, to cross-authority initiatives, to joint public and private sector projects.

This collaboration, though, cannot be imposed from the top or driven by the NHS. The experience of the Sustainable Transformation Plans (STPs) in health shows how expecting the NHS to lead integration and effectively enforce partnership is an unworkable model. The NHS is simply too centralised and bureaucratic to respond to local needs. Instead, local leadership should be focused on empowering individual communities to create networked, collaborative ways of working.

Empowering communities

There is a real danger that new initiatives in social care just end up as another version of the state doing things to people. To avoid that, a different mindset is needed where local authorities learn to follow and respond to community-led approaches rather than just commissioning what they think people want. That will require a real willingness to hand over both resources and power.

The Wigan Deal is one model of how spending time in communities talking to people and finding out what they need can drive better services. That kind of approach can shift the question from, “What’s the new role for state?”to “What's the new role for communities?” That can then stimulate new grassroots approaches from community support for people with dementia, to involving schools, to using care homes as local hubs.

A different approach to risk

Achieving this will require greater trust between the state and communities and a move away from the current approach where councils can spend more money on monitoring people than providing the service. We are seeing how this can happen.  Wigan adopted light touch monitoring of their £10 million investment in community projects, and of the 500 schemes they supported only two failed to deliver. This more hands off approach will require a willingness to tear up the rule book and say, “We're going to do things differently”.

It will also be important to get the language right to make sure that empowering communities is not seen as the state simply passing on its responsibilities to the individual. It needs to be presented as a positive vision about enhancing lives rather than a patronising or paternalistic imposition, with a real commitment to making communities believe they will be heard.

Engaging the workforce

None of this can happen without a workforce that is committed to a new approach. Giving people permission to innovate on the front line will be the single biggest driver of change but some people will be uncomfortable with that and be unwilling to build real relationships with residents. That might mean taking some tough decisions about removing people who do not have the right attitudes and behaviour.

Market shaping

The private sector also needs to be brought into this debate and local authorities should be trying to understand the market better and what drives its investment decisions. Too often providers find it hard to have conversation with councils yet they can be part of the solution. There are real opportunities to work together to develop more imaginative options and funding models. The challenge will be balancing the state’s need to shape and manage the market to avoid a two tier system while working closely with good quality providers to develop effective partnerships.

A brighter future

It is clear that the role of the state in social care has to change. There is too much commissioning of the same type of service, a focus on just managing decline with less money and excessive bureaucracy. But places like Wigan are doing things differently and show local government can be the engine of change. The role of the state can then become one of empowering communities and individuals to take more responsibility for their own care and so drive real change for the better.