Over the weekend, Health Secretary Matt Hancock floated the idea of pension system-type payments to fund social care, ahead of the repeatedly-delayed DHSC green paper on adult social care, still officially expected some time this autumn.
I have therefore been reflecting on potential evidence to contribute to the LGA’s green paper for adult social care and wellbeing before the deadline of 26th September. The paper poses 30 interesting and insightful consultation questions ranging from ‘in what ways, if any, is adult social care important?’ (Q2) to one asking ‘how the accountability of the health service locally could be strengthened?’ (Q28). The LGA is hoping that their collection and analysis of responses to these questions will inform the government’s version.
The 31st question I have been asking myself is . . . why is reforming adult social care so difficult? As Richard Humphries of the King’s Fund has pointed out, there have been 12 white papers, green papers and consultations in 20 years, yet no-one has actually been able to deliver a changed system. The papers and consultations were full of ideas for both small and fundamental changes to the system; there is a professional consensus that the social care system is fundamentally unsustainable. But despite that, nothing has come of these efforts.
Is it time to look at the problem differently?
At IMPOWER, when supporting councils to deliver demand-led transformation of social care, we regularly use the ADKAR framework as a model for change. ADKAR is an acronym for sequential stages: Awareness, Desire, Knowledge, Ability, Reinforcement.
If we overlay this framework to the problem of delivering a sustainable adult social care system, the green paper debate is focused on the K – what knowledge do we need of the features of a new sustainable system?
The issue with this is that a well-functioning social care system is dependent on much more than just the people who develop or implement social care policy. The beliefs and actions of those who use social care services, other professionals who affect and influence those services, and the public who pay for them are also critically important. But many of the 60 or so million interested parties are still stuck at stage A – their awareness needs to be developed. Not just awareness of the need for change, but awareness of what social care is and what the current deal is!
Unless we lay this groundwork we have zero chance of agreeing a future state, let alone delivering it.
So how about we reframe the challenge and ask the LGA to add another question into their green paper: ‘How can we reach a common and widespread understanding of the current care and support deal?’ This needs to be answered before any of the others. If we don’t start with this question, the ones that follow will sadly be pointless.