In 2018, the LGA launched its own green paper for adult social care and wellbeing, ‘The lives we want to lead’. Building on the title, the work deliberately started from the experience of people who drew on care and support. Their stories formed the opening substantive chapter of the publication, with one person – Vicki – stating, ‘we are human beings, not just numbers and figures’. In the rush to relay important information on funding pressures, assessment waiting lists or workforce turnover rates, we may sometimes lose sight of Vicki’s key point. Every statistic or piece of data has, at its heart, people. Whether that is the young disabled adult using a direct payment to attend their favourite gig, or an older person accessing reablement support to regain their independence in their own home they know and love, or the care worker darting between appointments to connect with those they are supporting. These are our loved ones, our friends, the people whose lives we want to see lived equally and fairly. And it may well be us at some point in the future.
In its influencing and lobbying work, the LGA continues to emphasise the importance of person-centred support and the role councils can play in supporting and improving people’s wellbeing, two key features of the legislation. We do so by centring people and what good adult social care means for them and our local communities. We work with people with lived experience directly and we highly value our ongoing relationships with organisations such as Think Local Act Personal and Social Care Future. Through this approach and related activity, we are proud to be part of work that is seeking to change the way that adult social care is perceived and thought about by the public.
We fully subscribe to the idea that public understanding of, and public support for, adult social care is a prerequisite for securing the long-term and sustainable investment needed so that everyone who has cause to draw on social care can live the life they want to lead. We are grateful to Social Care Future for the following content on the importance of shifting the narrative on care and support.
Shifting the narrative, by Neil Crowther, Co-convenor, Social Care Future
Another world is possible
The Care Act 2014 heralded a paradigm shift in how social care was to be imagined, oriented, organised and practiced. It repositioned care and support not as an end in itself but as a means to the end of promoting individual wellbeing. It shifted the focus from ‘providing services’ to ‘meeting needs’ and required councils to do so respecting each individual’s own identity, will and preferences. It also included duties to the community at large, to act to prevent the emergence of more significant needs for care or support.
This expansive and progressive reimagining of what social care should be and do was not however matched by requisite investment from central government and has been largely absent in the debate about funding social care, which has dominated public or political discourse for the past quarter century. In that imagining of social care, which predates the Care Act 2014, it is rarely more than ‘washing, dressing or feeding’ delivered either in congregate care settings or via homecare visits, and focused exclusively on older people.
The debate has centred on ameliorating the ‘catastrophic costs’ faced by some in paying for long term care and support, not on what the money buys. Rarely if ever has the question ‘what resources do we require to meet the obligations in sections 1 and 2 of the Care Act 2014?’ been asked. As a result, local councils are tasked with delivering on statutory obligations that are not only woefully under-resourced, but equally under-imagined.
It's unsurprising then that the public’s imagination of adult social care is also misaligned with that embodied in the Care Act 2014. Since 2019, #SocialCareFuture has been leading work to change the public narrative about adult social care with a view to shifting mindsets and inspiring a different imagination of the future. We began with a deep dive into how social care was represented by campaigners, in the print media, on social media and by politicians, and into what was top of mind when the public were invited to think about social care.
We found that social care was largely represented by campaigners, in the media and understood by the public as a broken system in crisis, that ‘looked after vulnerable people who can’t look after themselves’ offering help with ‘washing, dressing and feeding’. Older people were the overwhelming focus, painted both as victims and as the cause of the crisis in social care. Metaphors such as ‘demographic timebomb’ and ‘silver tsunami’ were common ways to attribute the challenges faced to rising demand, not failure to have invested in and transformed our social care system in line with predicted demographic change and trends in. People rarely saw social care as relevant to them, or as holding any wider social or economic value. It is seen ultimately as a question of money, but of money that isn’t available. The narrative possessed features that the Frameworks Institute have identified as barriers to change across a range of issue areas: othering, a failure to depict, see or understand system causes or solutions and most challenging of all, fatalism about the potential for change.
Can we change this? The answer from #SocialCareFuture’s follow up research is a resounding yes. Alongside this work, we co-produced with our movement the story we ideally want the public to hold in their heads and which we believe should guide what social care should do and how it should be organised. We then went back to the public, working with the strategic communications organisation Equally Ours and public opinion research company Survation to get further under the skin of public thinking, and to begin to test and refine our story and the messages it contained. What we found was that, when presented with a well-framed story, strongly aligned to the values and ideas embodied in the Care Act 2014, not only did we see positive shifts in people’s imagination about what social care can and should be, its relevance and value, we also saw consequent increases in support for investment and reform and in people’s optimism about the potential to build something better.
Social Care Future's story
We all want to live in a place we call home, with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.
If we or someone we care about has a disability or health condition during our life, we might need some support to do these things. That’s the role of social care.
When organised well, social care helps to weave the web of relationships and support in our local communities that we can draw on to live our lives in the way that we want to, with meaning, purpose and connection, whatever our age or stage of life.
There are already places that are thinking about and organising social care differently to achieve this. For example, by supporting facilitators who bring family, friends and neighbours together to support someone to do what matters to them, strengthening the relationships of everyone involved. Personal assistants, employed by people to provide practical support so someone can lead their life their way. And organisations that connect people with opportunities to use their skills and talents, which improves their wellbeing and benefits the local community.
We believe that this can and should be happening everywhere and for everyone.
For that to happen, the government must make good social care a priority and begin investing more in it. And more local councils need urgently to start working alongside and supporting local people and organisations to bring these ideas to life by organising and funding social care differently.’
Given the precarious state of adult social care, some people may be nervous about the prospect of unleashing such imagination. Isn’t it better to just portray the harsh reality? The point is that a relentless storyline of a broken system in crisis, letting down ‘our most vulnerable citizens’ has singularly failed to marshal public or political support for change. Evidence from other countries like Germany and Japan who have arrived at a new funding settlement for adult social care is that being able to offer a compelling vision of what people’s money would buy was fundamental in getting reform over the line. This is what we saw in our research: when we offer people a vision that taps into universal shared values, speaks to a ‘larger us’, explains how it can be achieved and sets out who is responsible, people’s support for investment and reform, and their belief it’s possible to achieve, grows.
As the Frameworks Institute have warned ‘Crisis framing has, over time, caused a decline in public engagement and eroded people’s confidence in our civic and social institutions. As a result, the greatest communications task for most advocates these days is not to convince people that a problem exists; it’s to convince them that it can be solved.’
If we want to escape the doom loop adult social care finds itself in, we have to create what Geoff Mulgan has called ‘the possibility space’ in which people can imagine a different, better future. #SocialCareFuture is now working with the Local Government Association, Association of Directors of Adult Social Services and others to do so. Another world is possible for adult social care and all who will have cause to rely on it or who work in the field, but we have to offer that different imagination to the public at large if we want to see the promise of the Care Act 2014 become a lived reality.