Third sector care and support: building a different future

[This blog first appeared in Third Force News, 28th April 2020]

We’re into our sixth week of Covid-19 lockdown, and the hot topic is when – and how – it’s all going to end.

The first minister wants to have an “adult conversation” with us. Praise be for that.

Many third sector care and support organisations are still heads down, firefighting/troubleshooting (delete where applicable) and trying to sort out continuing difficulties with PPE, testing and other urgent issues.

But there’s a growing sense that we need to find time to look beyond, and to focus on what, if any, good can come of it. What are we learning about ourselves and our organisations; about the care and support we provide; about the way our system works? How can we capture that, and use it to forge a better future?

There have been some very thoughtful pieces published in the last couple of weeks on how we might approach the “recovery”. Donald Macaskill (Scottish Care), Robert Macintosh (chair of Turning Point Scotland), the IPPR and others have made important contributions setting out how Covid-19 has changed us, and how we can (and should) change in response.

Most compelling of all, in my view, was Chris Creegan’s piece in Holyrood, proposing a crisis recovery commission in which “citizens, including those who started this crisis most disadvantaged and who have paid the highest price, must be front and centre.”

Many of these citizens will be people who rely on third sector care and support. We would have a lot to contribute to such a commission; we were thinking hard about a better future, even before Covid-19 knocked us all sideways.

The Scottish Government’s Adult Social Care Reform Programme was already well under way; the Scottish Parliament Health & Sport Committee had launched its own inquiry into the future of social care; similar initiatives were either planned, or up and running, in other areas of care and support.

It’s an engrossing exercise – if you have time – to read the written evidence to the parliamentary inquiry in the context of Covid-19. If we’d known then what we know now, all our submissions might look different. But far from rendering the core issues irrelevant, the crisis has served to amplify them.

We all had things to say about changing the way we provide support by making better use of digital and other technology. Before Covid-19, a lot of our thinking was driven by acute funding realities in which one-to-one, face-to-face support was becoming unaffordable for many.

The driver has changed but the pace of innovation has, if anything, accelerated. In areas such as mental health and family support, our sector is adapting quickly to the challenges and finding ways to keep connected and continue support.

It’s not the same for everyone. A group of disabled people’s organisations led by Inclusion Scotland has uncovered disturbing evidence of people having their entire support packages removed, at a stroke, almost overnight. For those who need intimate personal care just to live their lives, this is catastrophic. Blithe assumptions that family members will “step in” have nothing to do with innovation. Surely, we have the collective wit to do better than this?

Equally disturbing is the impact of self-isolation and social distancing on people with dementia in care homes. Donald Macaskill wrote eloquently about this last week. Care homes are by definition communal spaces, that’s how they function. Like many others, my own family is directly affected by what’s happening, and it’s absolutely heartbreaking. Over the years we’ve talked a lot about “risk enablement” in social care. But we don’t seem to be able to apply it. Now we’re encountering possibly the biggest risk that anyone living in a care home will ever face.

Care homes, of course, are also the area of social care where the biggest profits are still to be made. For the avoidance of doubt – I am not suggesting that what’s happening in care homes right now is driven by the profit motive. People are also dying in third sector and local authority homes. Each death a personal tragedy.

But as we emerge from this, we should take a harder look at whether we really want businesses to be generating private profit from the care of people who are – by any measure – now exposed as extraordinarily vulnerable.

This matters because the commissioning and procurement system that has been developed over the last two decades is based almost entirely on the premise that providing care and support to people who need it is nothing more, in effect, than a business opportunity.

My organisation and its membership have railed against this for years. Now everyone is finding out the hard way just how inappropriate it is. Our colleagues at Cosla have issued some very useful guidance on commissioning, and we were pleased to have been able to contribute to it.

But it brings you up a little short to realise that public authorities have to be reminded, at this time, to treat us as valued partners. That the care and support we provide is critical, so we must be supported if we are to continue to provide it. And that there is a serious risk some of us may not last the course.

I’m happy to say that many (indeed most) of our partner authorities are fully on board. The care and support tenders that we’ve been told for years were unavoidable and unpostponable are, yes, being avoided and postponed. Contracts that couldn’t possibly be extended six months ago are now, as if by magic, extended. Long may it last.

Yet we’re still coming up against some attitudes that are hard to shift. Seriously, *nobody* in our sector is exploiting this crisis as an opportunity to feather their nest. If we can be trusted to provide intimate and/or unobserved personal support to people in respect of whose wellbeing public authorities bear serious and direct statutory responsibilities, surely we can be trusted to apply a 3.3% funding uplift appropriately?

Two more positives before I sign off. First: our workforce. The cabinet secretary and the first minister (and everyone else, for that matter) are taking very great care to ensure that the social care workforce is recognised with and alongside the NHS. We are no longer just “and social care”. Public and media recognition, too, are getting to where we have long wanted them to be.

Accordingly, the case for rewarding this workforce with more than warm words and applause on a Thursday night is now unanswerable. And it needs to be for the long term, not just the standard 15 minutes of fame.

We’ve always wanted parity of pay, terms and conditions with local government (indeed we used to have it). The IPPR has gone one further, and recommended parity for all social care workers with the NHS. Now *that’s* what I call integration.

And that won’t mean everything being taken back in-house. In a mixed economy without pay competition, we’ll all be able to focus on quality. Our sector can certainly hold its own in that regard.

Finally – most critically – the people we support. It has taken Covid-19 to make these, our fellow citizens, visible. It has taken the blanket issuing of DNR certification requests to put on the front pages people who have long been ignored and overlooked. It has taken this crisis for society to understand that, unchecked, the system as we know it renders certain people’s lives not worth saving.

These are the people our sector is here for. They’re the people who are – or should be – fully engaged with their own support, and with the organisations that provide it.

Chris Creegan’s Holyrood article ends with a plea: “We need to build a bridge to the future which hardwires community assets into whole-system change.” For community assets, in this context, read the experience of receiving – and providing – social care support.

The future we want and need must be based on trust; on real partnership, not the contractual kind; on integrity; on principle; on quality; and on equality. Or it won’t be built at all.