CM: What attracted you to the idea of chairing the Archbishops’ Reimagining Care Commission?
AD: Before founding and heading up the Centre for Ageing Better, I’d been working on health and social-care policy and research for over 20 years. When I first started, the Royal Commission on Long Term Care for the Elderly was reporting. So, the frustration for me was that here we were, 20-plus years later, and still health and social care are not working together; and care and support not being available and properly funded.
I’ve most recently been an adviser on the Independent Review of Adult Social Care in Scotland, which reported in January last year. I was approached about the Commission hot on the heels of that; government had promised a White Paper, and there was no action in England. So, it just felt like a really great opportunity for the Church of England to try and cut through other reviews and so much government inaction.
The other is that I am a person of faith. It was really the first time I could see an opportunity to bring my personal faith and my professional work together.
There have been countless reviews of social care. And the Health and Care Act received Royal Assent in April. Why was the commission announced when it was, in April 2021?
Ever since the Archbishop of Canterbury’s book Reimagining Britain, in 2018, there has been interest in setting up commissions to look at these issues. The Care Commission is one of a series of commissions that, as I understand it, is an initiative of the Archbishops to really make sure the C of E is contributing to big policy questions, society questions.
What will the commission contribute to the debate about the future of social care that is unique?
For the past decade, the work of Andrew Dilnot and his review was very much focused on the narrow but important issue of how to fund social care. We started with a very different perspective, which is a much more values-based starting point.
When the founding of the NHS happened, and other pillars of the welfare state, social care wasn’t part of that, then. Here we are, 70 or 80 years later, and a very different demographic: more people living longer, many more people surviving with disabilities, and living longer with disabilities. A lot has changed and, therefore, there is a need for a radical and long-term look at this.
How do you put values into the system?
Current policy has been about implementing some of the Dilnot proposals, albeit significantly watered down. It’s also been about some structural changes to try and make health and social care work better together.
istockWhat could social care look like in the future?
Coming at this from a values-based perspective is first about trying to get these values [the Commission proposed, theologically, that: flourishing; loving kindness; empathy; trust and mutuality; universal and inclusive; fairness and justice should be the foundation of social care] embedded in a culture change that is really going back to first principles, and using these principles and values to think about how to design the whole system.
A good example of one of those values is: what should the goal of care and support be? Different terms get used: living a good life, living an ordinary life, living an equal life. . . Coming at this from a theological perspective, we talk about an abundant life. So, this idea that care and support should enable people to “flourish” and have a full life is really critical.
At the moment, we have a system that’s barely providing a very basic safety net: helping people get up, washed, dressed, and fed. It is not about a full life. If you start with a value like “flourishing”, it leads to some quite different thinking about what is care and support.
We’ve also got mutuality as a value. Care and support systems often talk about. . . recipients or users. But, actually, we want to have a care and support system that enables people to contribute, . . . recognising that those social relationships are so important to us.
Again, it leads to quite different ideas on everything such as: how do you make sure that people who are living in more specialist settings are still able to be part of their community? I’ve gone to see examples, like the Esk Valley Camphill Community, where adults with leaning disabilities were helping with the cooking and washing up when I was there for a meal; they work the land, they have real meaning and purpose in their lives, and there is mutual care and relationship.
The commission has been gathering evidence of people’s lived experience. What are the main insights you’ve discovered?
We published the interim report [on 27 April]. I think it’s pretty clear there’s some quite challenging things about what people are currently experiencing, in terms of not getting the care that they need, and the consequences of that for people who draw on care.
We hear a lot in the news about workforce issues, and, obviously, there’s a clear shortage there; there’s also burnout. But the consequences for people who draw on care of the lack of staffing is very real.
So, if you’re trying to recruit a personal assistant and you can’t find a personal assistant, you’re not able to function and live your life. If you’re in a more residential setting, that might mean very limited social activity.
We have heard a lot about lack of support for unpaid carers. I think through the pandemic, partly through the withdrawal of care, we’ve seen a real increase in the number of people doing unpaid care, and the feeling that they don’t have the information or support to do that comes through quite strongly.
We did also ask people about good things, and people were very positive about the community support that they could access — some really good examples were community cafés, and places they could go for peer support if they were carers, or people living with disability.
We tried to ask people to reimagine care. People found that quite difficult. But they did start to articulate some of their hopes.
We heard things about really valuing social care; about wanting a system that was fairer, that was more affordable, where people could get easier access to services. And we heard ideas around innovative examples of where new housing developments, or use of technology, support people to live in different ways — more involved in their community.
What were your findings regarding ageism?
People feel that the reason why care and caring are not valued is that there’s a sort of underlying attitude to ageing and disability, where older people are not valued. We have to challenge that very fundamental view. We are all created by God, and that sense of equality should be the basis on which we think of care and support.
Commission members at a meeting last month in Birmingham (minus Professor John Swinton, who joined on Zoom) including the Bishop of Carlisle, the Rt Revd James Newcome, and Dr Anna Dixon, together with three of the Commission’s expert advisers: the Revd Dr Al Barrett, Sara Livadeas, and Sian Lockwood
We’ve also had discussions about some of the attitudes in the Church itself, in the way there tends to be quite a lot of focus on attracting younger people rather than recognising the value of older people. We have seen some good examples with things like Anna Chaplaincy, where ministry to older people is developing, but it’s still underdeveloped.
What is left of the process before the final report, in September?
This is an independent report. But we’ve worked closely to engage policymakers and politicians throughout the process, and part of what we’ve been doing has been to work with stakeholders, so that when we recommend, there will be support for implementation already; it won’t be a surprise to what it is we’re proposing.
How should churches think about responding?
Clearly, there is a lot already happening in the Church’s social-action space, and it’s really about making sure that that is done in co-ordination with other organisations in the community and building good relationships with the local authority.
And the other is doing that in a way . . . that empowers and recognises the contribution of people.
Then there is how to enable people who draw on care and support into old age, to continue to participate and have spiritual care. So, I think there is something there about supporting inclusive worship and offering spiritual care to people . . . whether they are in a care home, supported living, or retirement living setting.
I guess the other is about using the assets of the Church — the buildings, the people — to host other organisations who may be providing that sort of care and support.
How radical will your final report be?
It’s treading the line between being radical and visionary, and something that can be implemented in the real world. So, I think we’re trying to set out a long-term radical vision, but also offer some really quite practical things that organisations, Church, and government, could do in the shorter term.
Despite all the problems in the system, a lot of providers — particularly in the not-for-profit sector — have their origins in some sort of a faith-led or Christian organisation; so I think those values are there in quite a lot of provider organisations.
The sad thing is they are there in the care workers. And yet, if you pay so little, and, in a way undervalue them, people are so stretched that they can’t do that bit of the care that they want to do — the loving bit, the relational bit.
The interim report of the Archbishops’ Reimagining Care Commission can be read here