England & Wales, Global Communities and society, Health and social care

Reforming social care is a ‘whole society problem’

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One of the encouraging developments of the last few years has been the increased prevalence of a strengths-based approach to social care. That is, an approach that sees individuals – not just as a set of needs or deficits to be met by the service provider, but which recognises the strengths and capacities that people have, – as individuals and as part of a community, and which works collaboratively to build on those strengths to achieve positive outcomes.

The 2014 Care Act places a duty on local authorities to ‘consider the person’s own strengths and capabilities, and what support might be available from their wider support network or within the community to help’ when planning care, and there have been fantastic examples of this approach in Greater Manchester, Leeds and many other places.

This is all to the good, but it is not to detract from that fine work to consider; precisely because the strengths-based approach is so powerful, what might be its limitations, what are its learning edges and, most importantly of all, what factors do we need to consider when we think about extending it?

The first point is obvious – we cannot get away entirely from a needs-based approach. We all die. Most of us get old and most of us deteriorate along the way. At some point in that journey needs will outweigh strengths. Deficit is, in this sense, built in to the human condition.

Equally obviously, a strengths-based approach is a feature of a functional and well-funded care system, not a substitute for it. Delivering on strengths-based approaches still requires commissioning and care services that are fit for purpose. Moreover, doing strengths-based care properly requires resource, sometimes significant resource. Some individuals or communities have very obvious strengths; others may need more discovery or nurturing. That may be a better way to spend your money, you might get better outcomes for your money, but you still need to spend the money. We currently face a three billion pound funding gap in social care. A strengths-based approach can never fulfil its potential in that context.

There are also issues of scale. An ageing population means social care will only grow as a social, political and economic challenge. The Office of National Statistics predicts that by 2066 there will be 5.1 million people over-85, three times as many as in 2016. Put bluntly, this will put intolerable pressure on an adult care system that is already under severe strain.

That means we need to rethink completely how we care for older people. While strength-based approaches are clearly an important part of that, there’s a risk that if they concentrate too much on the granularity of individuals and their relationship to care providers, they may actually obscure the sort of systemic change we need.

Moreover, while reforming social care may start with government, local and national, it clearly doesn’t end there. This is not a public service problem it’s a whole society problem and will require us to rethink how we function as families and as broader communities to look after each other.

Part of the challenge here is that many of the contributing factors to our social care crisis are in themselves good things: people living longer, greater participation of women in the workplace, more flexible family structures, social and geographic mobility. Most of us welcome these things and will not wish to reverse them, but it does pose a serious challenge as to how we can evolve socially to provide the care we need.

Again, strengths-based approaches are clearly part of the solution, but we must ensure that as they develop they do not just mediate between care users and care providers but create capacity within communities such that care services are no longer needed by as many of our fellow citizens.

Jonathan Carr-West is Chief Executive of the LGIU. This article first appeared in The MJ.

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