Our opening post this week is by Dennis Holmes, Deputy Director of Adult Social Care.
His second ‘deputy blog’ post looks at the changing health and social care environment in Leeds and what it might mean.
Deputy Blog March 2014
Dennis Holmes, Deputy Director of Adult Social Care
And so it’s on to that tricky second post! Firstly I’d like to say thanks to everyone who took the trouble to read the first one and the more so to those people who left comments. I think it’s really helpful that we have a discussion, a debate even, about adult social care at such an important point in our history. I suppose the second thing that was brought to my attention by people of a particular generation was my reference to Clean Bandit, for which I make no apology!!
My first post was pretty much about looking backwards to a time when social care developed under a very different set of societal attitudes and concerns from those that exist today. It seems to me* that there are a few important things that have happened to change the environment in which we operate and therefore the way that people think about social care and the way we need to think about ourselves.
These are in no particular order of importance by the way, but first up I thought about expectations. I wrote last time about people with care needs being obliged to live together in big institutions. That was regarded as the norm by the people who designed the facilities and, importantly, by many if not most of the people who lived there. That is most definitely not the case now. People rightly expect that the care they are afforded will respect their dignity and be provided to a standard that is acceptable, in an environment that is appropriate (usually their own home).
The second thing that occurred was the amount of control we have for doing things for ourselves. Here’s one example to illustrate the point. Not too many years ago, to avoid shopping in a department store and to spread the payments for what you bought without using a credit card (which virtually nobody had!), you’d get a catalogue (Universal Stores, Kaye’s and Grattan were all big I believe). You’d place your order by post and several days (possibly weeks) later something like what you ordered would turn up. The internet has changed all that: the range of choice, specifics of sizing, delivery and payment methods and speed of delivery have ensured that catalogues are virtually extinct. My point is that people who have grown up with the expectations created by this kind of ‘remote control’ over aspects of their lives will increasingly apply it to their health and social care needs.
The other thing the internet has provided us all with is access to information on just about everything, including ourselves. Largely this makes us far better informed about what we should expect from the health and care system, what redress we have if our expectations aren’t met, what information is held about us (and how much of it we’re happy to share – and with whom) and importantly, what we can do to take better care of ourselves.
It’s also pretty certain that there will be many more of us too. When I was a youngster, it really was remarkable when someone turned 100, now it’s commonplace. That’s not the whole story though, while we might want to believe that longer life means longer healthy life, it’s by no means always the case. While many people will live for longer, they are likely to experience at least one and possibly several limiting medical conditions.
If you add all of this (and a few other considerations like money and equality) together, you can begin to see not only why our environment is very different now, but how much different again it is going to be in the future. People, me included, will definitely expect care to be provided on their own terms, will be more assertive in defining how and what care they want and will take the lead in securing it. People will expect to access services online and will expect to come to their own view about if or how much they want to pay for it. People with more specialist needs will expect to be supported to get the help that is most appropriate to their needs by people who are highly skilled in offering that support. People, especially carers, will expect it to be easier to understand not only how to access support, care and health services, but what they might be able to achieve.
The continuing difficult financial climate will also dictate that increasing numbers of people will ask themselves what they can do as individuals and communities to help themselves.
So what might that mean for us? Well, I think it’s logical to assume that there will need to be more support and care made available to people. It will need to be available in their own homes or very close by: some of it will need to be technical (accessed through a computer or similar device) as well as practical (offered by a human!). There will be a wider variety of care provided by a wider variety of organisations and individuals, it will be paid for in a wider variety of ways, with individuals buying more – and the state buying on their behalf less.
There is likely to be a different emphasis in relation to eligibility, particularly as lines between healthcare, social care and support get increasingly blurred.
The fact remains though that social care values fit absolutely in this new environment: advocating with people, promoting their rights to dignity and self-determination, networking in communities, co-designing creative and innovative solutions to meet care needs and supporting people directly through difficult stages in their lives. All of this will continue to be at the core of what we do as it has been since the inception of social care!
So, in terms of change and how we should respond to it. Personally, I tend to go with Benjamin Disraeli, who said: ‘Hope for the best, expect the worst and take what comes’!!
* I have come to realise that the deep joy of a blog is that it is ALL ‘as it seems to me’!!! I will really try to make these blogs ‘evidence informed’, but I can’t guarantee that I won’t make the odd assertion in and amongst …