A new vision to fix the ‘broken’ social care system has been proposed by the Archbishops’ Commission on Reimagining Care, which aims to rethink attitudes to care and support by investing in communities and giving unpaid carers a better deal.
The report, Care and Support Reimagined, calls for a system that enables people with a learning disability “to live the best lives they can”, not just meet basic requirements. It says that people should have a choice about who cares for them and who provides care.
The Archbishop of Canterbury Justin Welby and Archbishop of York Stephen Cottrell said they wanted to “rebuild something broken”. They added that this vision requires a fundamental reorientation of priorities and direction to strive for a society in which no one is held back or disregarded, or treated as surplus and ‘just a burden’ because of their age or ability. The goal is to enable all humans to flourish.
The report argues that tackling negative attitudes to ageing and disability must be the starting point to reimagining care and support. Furthermore, the report makes radical recommendations for redesigning the care system, with a long-term aspiration of making care and support a universal entitlement, including:
The report said that the term “disability” is primarily a way of marking out difference. Difference can be marked out positively, and it can be marked out negatively. Sadly, the latter is more often the case when it comes to disability, but it is not a problem to be solved but a way of life to be lived well.
The review concluded that social care must become a “universal entitlement on a par with the NHS” rather than rationed by the “meanest of means tests”. It proposes that the extra £15bn a year cost would be funded through taxes.
The report is based on 18 months of listening and engaging with people who draw on care and support, unpaid carers, care workers, and organisations that provide and commission care, as well as experts.
The Voluntary Organisations Disability Group (VODG) was amongst those that provided input and said that the work and recommendations of the Archbishops Commission are welcome at such a critical time for social care, in particular the call for a National Care Covenant.
Dr Rhidian Hughes, Chief Executive said: “Every day disabled people and their families continue to experience gaps in support, and with rising levels of unmet need, people are left in vulnerable circumstances. The new deal for unpaid carers, alongside a universal entitlement to care and support on par with the NHS, are all urgently required if we are to ensure disabled people’s care and support is not left behind.
“Current funding and the lack of investment in social care workers pay by central government is depleting the numbers of people and their skills and experience prepared to work in social care. Without concerted action in the Spring Budget to uplift care workers’ pay, the risks to the sustainability of services, and the provision of high quality and safe care will remain real and ever present.”
The report said that care can sometimes be reduced to tasks, focusing on our physical needs of eating, drinking and going to the toilet. Sometimes safety from harm overrides all other considerations, but this sets the bar too low.
It added that few people realise how high are the odds that they or a relative will need care, how much it will cost or that the NHS will not pick up the bill.
Most of us will need some kind of care and support at some point in our lives. Longer lives and medical advances mean that social care has become a universal need, no longer confined to a minority of people who too often have been marginalised and invisible. Providing care and support and paying for it, therefore, should involve a shared responsibility across society
The report also addressed the current burden on unpaid carers and said that the level of financial support for carers should reflect the hours and intensity of their care. Currently, Carer’s Allowance is £69.70 per week if you care for someone for at least 35 hours a week so there is a need for this to be urgently reviewed.
It added that when so many unpaid carers are forced to reduce their hours or even quit their jobs, we need to make it easier for carers who are working to manage to continue working. The government needs to legislate to require employers to provide Carer’s Leave, including paid leave and rights to request flexibility from day one of hire.
Other recommended actions include the opportunity for rest through the availability of different types of breaks to suit people’s caring circumstances and greater recognition of unpaid carers, together with provision of proactive advice and support from voluntary and statutory agencies.
Carers UK said it was clear in the evidence provided to the Commission that many carers are exhausted, overlooked and stretched to the limit.
“Emily Holzhausen OBE, Director of Policy and Public Affairs at Carers UK said: “The proposed New Deal recognises these challenges, and how restorative breaks, better funding and a change in approach could support unpaid carers, especially those with demanding roles, to take time out to look after their own health and wellbeing. Many carers feel that Carer’s Allowance does not come anywhere close to helping them manage financially while caring for 35 hours or more a week, and we would welcome a review of the benefit.
“We look forward to shining a light on the best practice for supporting carers in England and we urge the government to implement the elements of this New Deal so that unpaid carers have the fulfilling life that they need and deserve.”
The Commission said to achieve this, there needs to be an immediate increase in funding to enable local authorities to meet unmet critical needs and/or wrongly met needs, some moderate needs and a universal offer of early intervention and community-based support. There also needs to be new and stronger mechanisms to ensure existing rights to care and support are upheld.
The report has also been welcomed by social care charities who say that it highlights a key fault in foundations of social care, that it is largely commissioned by hours and not by outcomes.
Ali Gunn, Public Affairs and Policy Led of national disability charity United Response said: “The rigid allocation of hours without the focus on the wide ranging benefit they can deliver fails to give scope to social care providers, whose goal is not having people depend on us but to work alongside the people who draw on support to achieve fulfilling lives.
“This is not just about a change in language but a call for systemic change, and one that is co-produced with people drawing on social care. As the report rightly points out, tinkering around the edges is no longer an option.”
Hft also welcomed the report and said it would like to see a shift in attitudes away from existing disability stigma alongside long-term government reform to ensure the sustainability of the care sector, both for social care staff and those who receive support.
CEO Kirsty Matthews said: “At Hft, With a social care system currently at breaking point, facing a perfect storm of growing demand and severe staffing shortages, we welcome the long-term vision of Care and Support Reimagined.
“Whilst the government has attempted social care reform in the short-term, most recently with its announcement of an extra £250m to pay for care home beds, there has been little to no meaningful reform that adequately addresses the long-term challenges facing our sector. The Archbishops’ Commission’s long-term vision is therefore both refreshing and necessary to ensure the sustainability of our sector.
“The report highlights the significant 55% increase in vacancies in our sector in just one year – a statistic that will likely only improve with funding to cover a wage which accurately reflects the complexity and skill of work in our sector. Currently, care providers are caught in the middle because they are beholden to cash-strapped local authorities for funding, making any competitive rise in staff pay almost impossible.”
