Glen Garrod, President of the Association of Directors of Adult Social Services
Welcome to you all. Welcome to NCAS 2018 and to Manchester. Conference, it is an honour to address you and be amongst such esteemed Councillors, colleagues, practitioners, people who use social care services, sponsors and exhibitors. It is truly a delight to be back here again.
As I have travelled the country, I have been privileged to meet both people working in and those receiving social care and seen quite remarkable examples of entrepreneurship, creativity, invention and practice that support local people to achieve their hopes and wishes, increase their independence and yes, allows them to give something back to society. These are not rare examples and today I pay tribute to the humanity, love and passion my colleagues have for the people they serve and support (irrespective of their job title or pay grade).
Earlier this year I visited a hospital social work team. The manager told me about a social work assistant in the team who went out and bought with her own money some clothes to help a homeless man get discharged to a hostel (the clothes he had come in with had been incinerated at admission). Then there is the social worker who walked 3 miles in heavy snow on Boxing Day last winter so that he could reach an elderly man living alone. But it's not just the great things people do in social care it's how we approach them as well – take for example the social worker who began by asking the right question – that freed someone up to say what they hadn't for 6 years whilst drugs, in-patient services and repeated visits to hospital made matters worse. The question – what are the things that are important to you and how can I help you achieve them.
As colleagues in Leeds, Kirkless, Cambridgeshire and Essex are showing us if we focus on the person rather than the form, what people want to achieve and not what we have to offer a great deal more is possible.
Then there are the two sisters – care workers that I met at a local awards ceremony. Between them they had supported countless people for over 80 years, yes 80 years. They had so much love for the job and the people they supported.
Beyond these stories are thousands more like them. However, their efforts alone cannot continue to meet the level of need that exists. We must scale up and amplify our impact. We must challenge the shortfalls in the system. We must change how we all work together. For all this we need ambition.
My ambition for (my belief in) social care is not to the exclusion of other areas of public service. I know how important it is that housing gets the recognition it deserves and I would also like to reassure Stuart that I understand the importance of Children's Services. We are all so deeply interconnected and it would be a dis-service to the people we work with and support (along with their families) if all that we did was worry about our particular piece in the jigsaw.
And, of course I am interested in health care: few people come requiring the advice or support of health or social care services – many if not all need both. Far too often we allow people to experience the complicated nature of our work. For them the distinctions are an irrelevance and yet we find it so hard to provide an integrated experience. I doubt our complicated world can be made simple but believe that the experience of those using our services can.
And yes, I would dearly like to help Simon spend his birthday present wisely. And quite some birthday present it was - £20.5bn additional funding is more than the entire budget for adult social care in one year. But I'm not bitter, I'm not twisted.
Whether we work in housing, health, social care or children's services we have a collective endeavour with each providing a distinct and valuable contribution to meeting the expectations of those we serve and the sooner that is realised the better. However, I worry that we are drifting into a country that is lowering its standards, its expectations, becoming desensitised to the impoverishment of other people, reducing our ability to support and care for each other.
Within the near future two key documents will be released: the Green Paper on the future of Adult Social Care in England and, the NHS plan – both may go some way to help us understand the answer to my question – how ambitious do we want to be. Let us take a few key facts, to see the all too familiar challenges these documents must address:
- Despite the remarkable resilience of social care providers highlighted in the recent CQC Report 'The State of Care', the last few years, indeed the last few weeks, have shown how fragile, increasingly fragile the availability and quality of social care is. Both big and small scale providers are clearly distressed and whilst many continue to survive, how many are thriving – too few. This is not a buoyant market – our annual budget survey speaks eloquently to this fact and, let's face it some areas have reached their 'tipping point'.
- The gains in one area of our collective endeavour should not be at the expense of another though all too often that is precisely what happens. As this year's ADASS Autumn survey revealed the attention given to delayed transfers of care has come at the expense of better support in the community, with more people now entering and remaining unnecessarily in residential care and, contributing to what has become an A&E crisis. How can it be right that the NHS seeks to reduce spend on Continuing Health Care when everything tells us that need is growing. Why are there fewer GPs and fewer community nurses, yet more nurses in hospitals.
- Homelessness and rough sleeping is rising. It is now a commonplace feature in our larger cities and towns, and now smaller market towns, a colleague in one London Borough told me recently that there are now in excess of 4,500 people homeless in her area and the figure is growing. I also know that 4 homeless people sleeping in shop entrances in a small market town can have an equally profound effect.
- Carers UK have clear evidence that families and friends are caring more for a disabled relative, that they are increasingly suffering from mental exhaustion, physical ill health and financial insecurity because they feel obliged to do more caring for loved ones because the state is backing away from them.
- Our prisons and the experience of being a prisoner on release seem to be an increasingly regressive exercise that does little to help ex-offenders rehabilitate back into their families and local communities or find employment.
- For the 1.5 million people who work in social care, who outnumber those in the NHS, the vast majority are at the lowest levels of the pay rung and often go un-noticed as skilled and dedicated colleagues, unheard and poorly rewarded. Many are unable to exercise the more human aspects of care at home because there is not the time (or rather the money to pay for it). Yet it is clearly what people value most from the service and what carers get most intrinsic reward from – human interaction: 'time for me'.
- There is the all-too-frequently used narrative that de-humanises people to scary levels by talking about them as 'super-stranded', bed-blockers or 'delayed discharges'. There is clear evidence that for some they would rather not ask for help for fear of being labelled a burden or nuisance.
- Loneliness and isolation are becoming a prominent feature and now very clearly on the radar of our colleagues in Public Health as a growing and pernicious cause for concern. Indeed, the Prime Minister herself described loneliness recently as 'one of the greatest public health challenges of our time'.
- In excess of 1.4 million people are struggling without support – we euphemistically call it unmet need – and the numbers according to Age UK are growing. I worry that more people will lack the support they need, leading to a more rapid deterioration in their ability to stay independent, retain social contacts, contribute to society and feel good about life.
In my view social care has a much broader offer which includes those who will purchase their own services, seek good information and advice or genuinely benefit from a conversation about what might be available to help them or plan ahead. We are being wrongly drawn into an ever narrower 'offer' to fewer and fewer people, with less opportunity to transform lives. Our ability to connect people with communities – to act as community connectors is not given sufficient prominence in such a limited role. Our credibility, our contribution to social justice, our story is increasingly being seen through the prism of the NHS and how well we perform on delayed transfers of care – NO, conference, NO!
It is easy to blame it on the money and that is certainly a big part of the picture but we must also recognise our need to continue to embrace change. To make the most of what we have, and make the case for more we must all build on the successes of colleagues who have taken some brave steps and shown there is still plenty for us to be really proud about and more that we can yet achieve.
So what will our response be to these challenges? In my view we have never been able to rely on the state to be sufficient, cohesive or responsive enough. We cannot focus on individual organisations serving communities but rather must consider how best to work together to meet the needs of local communities. Here, I can think of no-one better than to quote Sir David Behan when he said 'Once we were judged by how one ran an organisation. That is finished. Now we will be judged by how we collaborate'.
We must also recognise that once more we have a watershed moment, a chance to change the legacy that has been left to us with a better one, for the people we serve and the people who work in the sector. That will be a key test of virtue for the NHS – as it is for us. Sir Derek Wanless predicted 17 years ago that unless the NHS spent more on primary/community and prevention then bad things would happen. Well, guess what: bad things ARE happening. I worry that the increasing impoverishment of prevention and community services -evidenced in our annual budget survey - will oblige more people to have no option but expensive and traumatic solutions such as long term residential care or hospitalisation. I worry that in consequence we are being pressed to increasingly see people in bits, episodically fixing this bit, or that when people want to be seen as a whole person.
We must also observe a test of humility as organisations of state and, professions - our role and relationship with citizens has changed and will change further – as it should. We must all see people as partners, no longer the passive and grateful recipient of public goods. The ambition to be seen as true partners has been well rehearsed in the recent publication by Think Local Act Personal in their latest iteration of 'Making it Real'. The social care futures event taking place nearby pays testament to the expectations for change that the people who use and need our services have of us and yes, to be a bit more up-beat as well. We already know that for many people with a personal budget how they exercise choice often lead to creative solutions in how their needs are met and, with better outcomes for them, notably when health and social care funds are combined. One day in my opinion on-line self-service and self-assessment will be a prominent offer in how people access care and support. I hope that one day soon our integrated systems, rules and processes will be as enlightened as the principles of personalisation and, customer centric. In Hampshire, when a social worker helped Mary obtain a personal budget she used it to recruit a retired accountancy clerk to help her manage all the correspondence and money matters which had made her so anxious. Shortly after the number of medications she was taking dropped from 6 to 1 and her visits to the GP and from a Community Psychiatric Nurse dropped dramatically.
And, just look at the examples of how people have used new technology to help them lead independent lives and engage with friends and families – to be 'life-enabling'. One publication: 'TEC Stories', being launched this week gives voice to people's own experience of using technology: there is Colin who, with an acquired brain injury has used assistive technology to stay in control and, in his words 'on line my disabilities make no difference to what I can do'.
The values and function of social care have been embedded in the profession of social work but they are not limited to the role, nor is it the monopoly of local government. For example, take Joan – the parent of a young man with profound disabilities who died too young and has since dedicated herself to supporting other parents with disabled adults for over 30 years: there is Sunny who after recovering from a drug addiction has spent the last 10 years supporting others like him to get off drugs, find work and a new life. There are many more such examples representing the best in society – our communities and, the best in the profession of social work and those allied to it. All for me are illustrative of what social care is and what it can achieve.
But I am worried – very worried - that a small but growing number of colleagues are finding their role almost impossible. The role is demanding enough and as the ADASS budget survey and the recent Autumn survey revealed - my fellow Directors confidence at maintaining statutory services is becoming the exception. This is an untenable position when the lack of money means services decline, standards reduce and risks to people increase. This leaves colleagues in an invidious position. Despite the best effort by local Councils to protect adult social care, austerity has gone too far and the consequences are not sufficiently well understood. The profile given to a delayed discharge has not been matched by what it must mean to have a backlog of assessments that stretch to 4 figures and the waiting times can be counted in months not weeks, where residents in care homes are obliged to move due to a lack of funds and, our ability to protect people's liberty is severely impaired. Conference, this is just not acceptable.
Yet, we must all be ambitious for social care and the sort of country we want to live in. We have some fantastic opportunities to serve people better now with housing, digital technology, integration with partners and a rejuvenated personalisation offer – we cannot just stand by and say it's up to the Government – every one of us in this room needs to help make the case, to be ambitious for social care and embrace change. If we ourselves do not then we are part of the problem that will see yet another opportunity to leave a lasting and positive legacy slip by. Conference we cannot continue to muddle through while hoping something will turn up!
We all know that social care remains too much of an enigma, a confusing 'offer' in the public domain and that successive Governments have failed to create an environment in which social care can thrive. Unless we continue to build a stronger case for the public pound -which includes our contribution to wider economic vitality, then we will remain consigned to arguing for funding for the wrong reasons and from the side-lines.
Let me leave you with the words of one care worker: Beth, who describes her day caring for a lady living with Alzheimer's disease: 'today I was a cleaner, a cook, a hand to hold, a friendly face, a washer, a dresser, a helper, a carer, today I was human'
So, colleagues let's be ambitious for social care – why – because the people we serve and the people who work in our sector are worth it.
Thank you for listening.