CONCEPTS that are “not usually heard in policy discussions about care” — including flourishing, loving-kindness, empathy, trust, and justice — are among the values that should underpin England’s social-care system, the Archbishops’ Commission on Reimagining Care suggested this week.
The six proposed values, “informed by Christian theology and ethics”, were put out for consultation on Wednesday, at the launch of the Commission’s formal period of listening and engagement, which will run until Friday 10 December.
Announced in April (News, 20 April), the Commission has been tasked by the Archbishops with developing “a radical and inspiring long-term vision for care and support in England, underpinned by a renewed set of values and principles, drawing on Christian theology and ethics”. Its focus is on adults with disabilities and those with care and support needs in later life and a final report is due to be published in September 2022.
Besides seeking feedback on the values, the Commission is asking for people’s views on “what is good and what is difficult, challenging or missing about care and support currently.” Responses are invited from those who use formal services, their relatives and friends, and those who commission them, unpaid carers, those who work in the care sector, churches and other faith communities, people and groups who provide informal support.
A press release said that the values “include concepts that are not usually heard in policy discussions about care such as flourishing, loving kindness, empathy, trust and justice”. The section on the first value — flourishing — notes: “Care can sometimes be reduced to tasks, focusing on the physical needs of eating, drinking and going to the toilet. Sometimes keeping people safe from harm overrides all other considerations. This sets the bar too low.”
Among the concerns highlighted are the rationing of care and support by local authorities and “a fear and reluctance to allow people to direct their own care. People who draw on care and their carers know what matters to them and therefore know best what they need.” The Commission warns: “Many people with disability and older people face discrimination, both generally and in their experiences of care. They have to ‘fight’ to get support.”
The Commission Chair, Dr Anna Dixon, formerly Chief Executive of the Centre for Ageing Better, said: “Our draft values are not the language of policymakers or indeed professionals, but we hope that these resonate with those who draw on care, their family and friends, and those who provide care. . .
“We want to hear about where care and support is working well, but also the honest stories of where things need to change. We want to gather ideas to help shape a reimagined future of care and support, not just a reformed statutory care system, but wider changes that will enable people with disability and in later life to live a full life.”
On Thursday, the Revd Katie Tupling, Oxford diocesan disability adviser and a co-founder of Disability and Jesus, raised questions about the consultation. “I’d be interested to know why the language is person-centred throughout — ‘people with disabilities’ — and no attempt to use identity-first language — ‘disabled people’ — especially when the disabled community try so hard not to have disability perceived as an unfortunate ‘add-on’ to life,” she said.
“It’d also be interested to know what difference it will make to government policy, tabloid propaganda and an underwhelming private sector, who all perceive a d portray disabled people as costly burdens.”
She also raised questions about the accessibility of the consultation, particularly for the most vulnerable disabled people, “whose experiences need paying attention to”. Consulting the National Network of Diocesan Disability Advisers would be one way to get it “out there”, she suggested.
The Revd Dr Stacey Rand, a senior research fellow at the Personal Social Services Unit at the University of Kent, welcomed the consultation.
“In looking at the values, you may think that they do not look especially distinctive,” she said. “However, I think it reflects the way in which our society and culture has been influenced by Christian faith, but also the way in which there are shared values that bridge divides. This shared ground is vitally important, as also is the potential for Christian ethics and theology to shape and disrupt ways of thinking that are unhelpful — for example, when discussion of care is reduced to technical issues of funding and finance.”
The experience of carers, who might have care and support needs “even if they are not always visible or heard”, was important, she said. “I also wonder if there is more could be said about care workers, their working conditions and pay. Again, this comes back to the interrelatedness of care and the need for flourishing, justice, and fairness for everyone, whether the person using support, unpaid carers or care workers.”
She was conscious of a “gap in theological thinking”: “Even though churches and faith communities engage in offering both formal and informal support, they do not realise that this is what they are doing — or how it relates to the wider picture of social care. . . This is an opportunity to re-engage, both at a local and national level.”
The Commission is working against the backdrop of a care sector in crisis. Responding to the Budget on Wednesday, Richard Murray, chief executive of The King’s Fund, warned: “It is abundantly clear that the social-care system cannot continue in its current form and is failing the people who need it. While the Government’s commitment to bring forward funding reform is welcome, the sector is at breaking-point now.”
Funding reform, announced by the Government in September, includes the introduction of a health and social-care levy in April 2022, so that National Insurance contributions rise by 1.25 per cent. It is estimated that this will raise £36 billion for health and social care over the next three years, of which £5.4 billion will be invested in adult social care. The cap on maximum care costs that people are required to pay themselves, effective from October 2023, has been set at £86,000. People will not have to pay anything towards the cost of their care from their assets if they are less than £20,000 and will be required to pay the full cost only if their assets are more than £100,000.
The Local Government Association has set out its concerns. It estimates that the size of the gap between providers’ calculation of the cost of providing care and what councils pay, over the three-year Spending Review period, is £4.5 billion. It has warned of a “huge recruitment and retention crisis” in the sector. In 2019–20, there were an estimated 112,000 vacant positions. The turnover rate was 30.4 per cent, and around a quarter of the workforce was employed on a zero-hours contract. Age UK estimates that 1.4 million older people are not getting the care and support that they need.
This month’s Coronavirus: lessons learned to date report by the Health and Social Care, and Science and Technology Committees concluded that both the Government and the NHS had failed to recognise the “significant risk” to the social-care sector at the start of the pandemic, and that a lack of input from the sector, staff shortages, a lack of testing and PPE, and the design of care settings had had “devastating and preventable repercussions”.
Thousands of deaths could have been avoided, it said. Between 16 March 2020 and 30 April 2021, 41,675 care-home residents died of covid-19 — nearly a quarter of deaths from all causes among care-home residents.
The lack of priority attached to social care was “illustrative of a longstanding failure to afford social care the same attention as the NHS”, the report said. “The pandemic occurred against a backdrop of issues in social care including workforce shortages, funding pressures and provider instability which successive governments have failed to address.”
The Archbishops’ Commission’s report will join a long list of reviews. Earlier this year, the King’s Fund highlighted that, in the past 25 years, there had been “eight Green Papers, four White Papers, many independent recommendations for reform and two government-commissioned inquiries, but still a failure to fix the crisis in social care once and for all”.
Those seeking to respond to the consultation can find the form on the website, or download a printed form to be sent to:
Call for Evidence — Secretariat
Reimagining Care Commission
Lambeth Palace
London SE1 7JU