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Social care: a work in progress

23 June 2023

Anna Dixon, co-chair of the Reimagining Care Commission, talks to Christine Miles about its recommendations on social care

THE interim report of the Archbishops’ Reimagining Care Commission (Feature, 17 June 2022) was followed by the Commission’s final report, Care and Support Reimagined, delayed until 24 January (News, 27 January), after the death of Queen Elizabeth II. The Commission recommended three areas of action: rethinking attitudes; rebalancing roles and responsibilities; and redesigning the system.

The first is an acknowledgement that all may need care and support at different times in their lives, and an understanding of the importance of mutuality in relationships — to counter the often negative attitudes towards old age and disability.

The second introduces the idea of the need for a National Care Covenant, setting out the clear responsibilities of the State, as well as of the part that citizens and communities — including faith communities — should be willing to play in a publicly defined agreement.

The third calls for a better, simpler, universal care-and-support experience, which would allow people greater autonomy and independence, and value the contribution of family members and community organisations alongside paid carers.

Six months on, a co-chair of the Archbishops’ Commission, Anna Dixon, spoke to Christine Miles. . .


CM: What has been the response to the report?

Alastair FyfeDr Anna DixonAD: Because it was delayed, it gave us longer to work with partners on building support for implementation. So, the response was very positive from a wide range of stakeholders, the Church itself, and other faith communities.

Before the launch, we had a session with leaders of other faith communities, and that was very positive. The principles had fairly universal resonance, not just with Christianity. They also recognised that their local faith communities were dealing with these issues: trying to support people with disabilities and older people, and similarly didn’t feel that they were well equipped to do so.

It also resonated with the social-care sector, from directors of adult social services, through community organisations, to providers — particularly some of the not-for-profits who have faith origins.


What do you hope will happen next?

I think there was a real sense that it did set out a radical vision that used different language from that which has often been framing the debate. So, I think we really helped to reframe the discussion. It’s got very stuck on funding [and] on some of the technicalities around that.

I think our report was very human. We really made an effort to listen to people who draw on care, and carers, and that really came through. And it also came through in how we did our launch: we had videos from people from Livability, one of the organisations that helped us to engage directly with people who draw on care.

I think it was . . . galvanising, saying: There is a really strong moral reason why we need to do something about this, that we got backing for.

On specifics, obviously our report wasn’t the only report: the House of Lords Adult Social Care Committee report came out at about the same time. Most recently, the Fabian Society has just put out a report, commissioned by UNISON, looking at a National Care Service. That could have gone down a very different route, if you look at the proposals in Scotland for a National Care Service. But, interestingly, again, really recognising the part played by family, and the community.

I guess the other reason why our report is going to have impact is because many of the recommendations are similar to some of the other reports: seeing this as more than just about what Government does, but also about seeing this as something where families and communities play a big part.

Some of the recommendations are Church-facing, but a lot of our recommendations were facing politicians; facing the sector. So, what we’ve done is to have a series of follow-up sessions, to try and get others to take ownership of taking those recommendations forward.


Whom, do you hope, will the report change most?

Ultimately, we’ve got to reach the wider public; but, obviously, we as a commission don’t think our report is directly doing that.

Social Care Future is a user-led campaigning group, and we organised a follow-on session with them, where we invited people from Caring Across Generations, in the United States (mentioned in the report), and they are taking that forward: looking for philanthropic funding to put money behind something that could be public-facing.

It has happened in other areas, if you think about mental health and changing public attitudes towards mental health, and reducing stigma. But they are long-term attitudinal changes, and they need a sustained campaign to do that.


What else can you look at, on the need for rethinking attitudes?

In terms of what we mean by social care, the Archbishops have taken a position of leadership on that. The Archbishop of Canterbury used his New Year message to talk about this. And they both did a lot of media around [the launch]. It’s not every week you get Ed Balls interviewing the Archbishop of York on Good Morning Britain.

The other aspect is that social care is often framed very much about older people, and we were keen to make sure that people were aware of how our recommendations can help people living with disability to also live a good life. And I think something we’re seeing is how leaders — whether it’s national or local policy-makers, or voluntary organisations — are starting to change how they talk about care and support.

On attitudes to age and disability, we didn’t pull our punches, and we did say that this is an area where the Church needs to look at itself. So, it was pleasing to have the Synod commitment around affirming inclusion of disabled people within the ministry and within Church, and this was obviously going on during the Commission, not as a consequence directly.

But we want local churches, not just national leadership, to be looking at doing things to change attitudes both to age — sometimes there is an emphasis on wanting to attract young people rather than on cherishing and valuing the contribution of older members — and to inclusivity. There tends to be a focus on the physical — so, ramps for people with wheelchairs, that sort of inclusion — rather than thinking about someone with a learning disability or dementia, and how they can participate in worship or wider community life.

We’ve set a challenge to keep these issues front-of-mind, in making sure that the Church does look at how its attitudes to age and disability might need to change.


What proposals do you have for local and national government?

These wider attitudes about how we talk about care — the language we use, and doing things in consultation with people who draw on care and doing things with people who care — I hope would be true of policymaking nationally, and also commissioning locally. It’s more in the rebalancing roles and responsibilities where we get into what are looking for from national Government.

It’s this second area of recommendations, about rebalancing roles and responsibilities, where we were looking at trying to build cross-party support ahead of a General Election: thinking about manifestos, as well as where local authorities can do things — even recognising the limited resources that they have — that they should begin to do.

One of the big ideas was the National Care Covenant, and we have been talking to all political parties about that.

The Fabian Society, in thinking about a National Care Service, interestingly, talked about the idea of a constitution, which is not a million miles away from a covenant. I guess it doesn’t have the same theological connotations as a covenant, but the idea that they are recommending to the Labour Party that there should be something which clearly sets out devolved responsibilities for people feels positive.

The Fabian Society also had in their report things like stronger legal entitlements, proposing a move towards greater universalism, and a more generous entitlement over time.

We [also] put in a new deal for carers. I think if you look at the House of Lords report, and the debate that followed, in which, again, Archbishop Welby spoke very powerfully and passionately about this issue, it really recognised the amazing contribution that unpaid family carers make, often without recognition, often without support.

Obviously, Carers UK have been campaigning around this very effectively for a long time. But, again, it feels like there is growing political recognition and consensus that social care, like childcare, is part of our social infrastructure and important to our wider economy.


How do your recommendations differ from proposals for a National Care Service?

At the moment, people don’t know what they’re entitled to: there’s lots of confusion; things are very unclear. We feel, as a result, families are picking up a lot. Communities are doing their best to support people.

If we could make it clearer that, yes, as families we do take on these responsibilities, but . . . in return we want a bit of support. And, as faith communities and voluntary organisations, we do want to provide for people to live well in community, but we need a bit of funding, or we need things that are going to enable us to do it. So, it’s about setting out clearly, and documenting, a mutual agreement about our responsibility and the role we’ll play, but in return what we need.

That was our idea: that a National Care Covenant would bring clarity to people. It would also make much clearer the things you can expect in return for discharging certain responsibilities and roles, whether that be as communities, or as families . . . making clear the rights and entitlements that people can expect from the state. We think that is what a covenant does.

In the same way that there’s a National Health Service, an organisation you go to to get health care, sitting behind it is an NHS constitution, which sets out what you can expect. There are different policies and legal documents which effectively give those rights to people in terms of what you can expect (free at the point of use, and when you have to pay charges for prescriptions); so that’s all there.

It’s having something equivalent [for social care] that is visible and clear, but, I suppose, is not creating a new structure, a new organisation, which, I think, a National Care Service — certainly as it’s been proposed and implemented in Scotland — is much more like, much more a centralised state-run organisation.

We’re saying that Covenant would be developed through public dialogue, potentially led by Government, in the sense that they would support the process, and it would need to be backed up by some sort of legislation.


The report identifies the need for greater investment by local authorities in community groups and infrastructure.

Some local authorities but not everywhere, recognise the role that communities, including faith communities, play in supporting people who may, or may not, be in touch with statutory services — so they’re supporting some people, and preventing them from needing statutory support, and they are complementing statutory support by providing much more rounded opportunities for people to live well, and be supported.

In some places, there has been a suspicion — or an ignoring — of faith groups. So I think that is the first thing, and then, hopefully, providing some funding for those types of activity that support people with disability and older people to live well, independently, in their communities.

We have social prescribers in the NHS; in the social care they are sometimes called local area co-ordinators, but, basically you have people whose business it is to map all of the things going on in a place and to signpost people to access those.

The point is, there’s no point having a social prescriber if the things that they need to signpost people to are falling over because they don’t have any funding, or there just isn’t something in that area to support people with dementia, or whatever it is.

Local authorities are not exactly flush. But there is some money in public health if they join up with partners in the NHS. There’s a wider prevention agenda. So, we are saying, yes, this is small amounts of money, and it would be good for local authorities to see the benefits of investing in this.


You suggest a ‘new deal’ for carers in the report. What do you mean by that?

A much more generous deal: at a minimum, a review, and an uprating of carer’s allowance from a financial point of view, giving them stronger entitlement to have paid breaks. These are people who effectively take on the care and are therefore saving the state thousands, sometimes giving up their jobs if they’re of working age. In those instances, they should be getting much more financial and practical support to do that job.

Carers should go back to being able to give care voluntarily. We heard from a lot of people that the lack of support from local authorities meant that they had no choice but to provide care, and at that point, sometimes, the relationship of being husband, wife, daughter, gets lost in this relationship of care — especially when you don’t get a break from it, when you have very little support.

We’re trying to convey that we need to put this on a completely new level. It’s totally undervalued, unrecognised for a lot of people; and the levels of financial and practical support need to be of a different order, particularly for those who give many hours of care.


When the report sets out a need for flexible working arrangements for carers, you mean protected legal rights if you’re having to care for somebody?

Yes, exactly; but also, if you’re applying for a job, that that flexibility is from day one, because otherwise you won’t take a job. And, with caring, often it changes; so you want support from your employer at that point, to maybe change your hours on a temporary basis; maybe to have some paid, or a mix of paid and unpaid leave at critical stages — at end of life, for example.

Like we have with maternity and the right to return to jobs, we would be looking for much stronger rights in that way.


You talk about a means of collective funding and a tariff of care charges established on a national basis. Can you explain?

Depending on where you live, you get a very different level of support, and very different levels of charges. So disabled people, even if they’ve passed the means test, are subjected to large charges in some places, and they vary hugely: you get councils, like Hammersmith and Fulham, that have abolished their charges [for home care for elderly and disabled people]; then you get other places taking a huge chunk of people’s benefits to pay charges.

We were making a principled point that that doesn’t seem fair. So there should be a review of those. Set some national charges; over time, again, as the economy allows, potentially phase out those charges; and certainly have something that would be a more universal way of funding care.


Finally, the report calls for “redesigning the system”. . .

The final recommendation was that there should be a radical redesign of the whole system — not just incremental changes, or tinkering around the edges, but something pretty fundamental. For so many people, the system is complex, bureaucratic, and confusing. So we propose that there should be a much simpler assessment process; that people should be able to receive a fixed budget relative to their needs, and should be given much greater flexibility to spend this in a way they feel will help them live a better life.

One area where the Government are taking some action is around housing. They set up the older people’s housing task force, but it was needed years ago, and we need to accelerate building much more accessible housing and much greater diversity of options for older people.

They are also putting a lot of emphasis on data and technology. We need to harness technology so that it helps people to live a better life.

The last area we make recommendations about is the need for changes to the workforce. This isn’t just about pay, although that is really important; it’s also about dignity: being valued in the workplace; and knowing that there are opportunities that bring out the skills and strengths of the fantastic people in the workforce.

Dr Anna Dixon co-chaired the Archbishops’ Commission on Reimagining Care with the Bishop of Carlisle, the Rt Revd James Newcome.

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