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Social-care system needs a clear vision, says report from Archbishops’ Commission

24 January 2023

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Archbishop Welby visits MHA Bradbury Grange — a residential care home in Whitstable in Canterbury diocese — where he recorded his New Year message (News, 6 January), in which he described the care system as “broken”

Archbishop Welby visits MHA Bradbury Grange — a residential care home in Whitstable in Canterbury diocese — where he recorded his New Year message (News, 6 January), in which he described the care system as “broken”

THE Archbishops’ Commission on Reimagining Care has called for a clear Christian vision to mend the broken social care system: a plan of action that would give equal dignity to everyone and find its expression in a National Care Covenant for England.

A report by the Commission, Care and Support Reimagined, published on Tuesday after 18 months of engagement with the sector, invites a broad coalition of politicians, faith communities, charities, and user-led organisations to collaborate in a sustained programme of public dialogue and engagement, leading to a revolution in attitudes.

This commission follows an equivalent one on housing (News, 26 February 2021), and another on the diversity of families and households in modern Britain (News, 19 March 2021), all arising from the Archbishop of Canterbury’s book Reimagining Britain, in 2018 (Books, 16 March 2018).

The King’s Fund reported in 2021 that, despite eight Green Papers, four White Papers, two government-commissioned inquiries, and many independent recommendations for reform of social care, there had been no fix.

In a foreword to the report, the Archbishops say that the vision “requires a fundamental reorientation of our priorities and direction. . . While changes are proposed to the social care system, with the long term-aim to make social care a universal entitlement, reform alone cannot bring about the change we seek.

“At the heart of this report is a deeply Christian understanding of what it looks like to live together in community, with people caring for and supporting one another in relationships characterised by mutuality and interdependence.”

While promoting independence is rightly held up as a positive goal of care and support, the best examples of care are based on interdependence and reciprocity, the report says. Councils remain responsible for assessing and arranging care and support, but are now dependent on others to provide it, to the extent that more than 90 per cent of regulated care is provided by private and voluntary organisations.

Needs and costs have grown much faster than funding, and public awareness has not kept up with current trends, it says: “Few realise how high are the odds that they or a relative will need care, how much it will cost and that NHS will not pick up the bill. . . We heard repeatedly how confusing and complex social care is to understand and navigate. All of these problems were laid bare by COVID-19. The human toll has been immense.”

Too often, respondents described having to “fight” to get the current support they needed. Carers were “exhausted, expected to do more with less support”. People wanted “fair and affordable access to care, to live in connected communities, to have a greater involvement in their care planning, and to see a shift in public attitudes, giving greater value to those who draw on care and support and those caring”.

The focus of care should be on keeping people well and able to do as much as possible for as long as possible, the Commission says. It was co-chaired by Dr Anna Dixon, a former chief executive of the Centre for Ageing Better and adviser to the Feeley Review of Adult Social Care in Scotland, and the Bishop of Carlisle, the Rt Revd James Newcome (Features, 17 June 2022).

Society will not be able to realise the vision of care and support without changing the attitudes which underpin the current system, the report says. “A major reason why we do not value care and support is because of underlying social attitudes towards age, disability and mental illness.

“There is need for a visible and broad coalition across England — including people with lived experience of care, politicians of all stripes, civic institutions, and faith communities — to run a campaign that starts with values, takes a long-term perspective, and promotes a positive vision for care and support and makes the case for why change is needed.”

There is a strong emphasis on rebalancing roles and responsibilities, on the grounds that social care “has become everybody’s business. There is no clear agreement or public understanding on who is supposed to do what. There is no clarity about what should reasonably be expected from families, or how the costs of care are shared between individuals, families, and the state.

“Many believe that the NHS will take care of all their care needs at no cost to themselves. This fog of confusion runs the risk that all solutions are laid at the door of the government to sort out; conversely it could become too easy for the state to dump its responsibilities on the shoulders of those those of us who support our families and communities.”

The proposed National Care Covenant would clearly and simply set out the mutual rights and responsibilities, making clear the part played by citizens, families, and the state, both in providing support and paying for it. Developing such a covenant would require a “major and sustained programme” of public dialogue and engagement, the report says.

“There is need for a more nuanced approach that recognises the role that communities already play and could play in supporting individuals and families to stay well and to remain connected when they need more support. There needs to be a rebalancing of roles so that the potential of communities in care and support is fully realised. . .

“Communities play an enormously important role not only in addressing practical needs, but combating loneliness and social isolation and fostering physical and mental well-being, which can delay the onset of the need for care and support. . . All aspects of the community should be welcoming to disabled people and older people.”

It warns, however: “We must guard against communities being seen as a substitute for the support provided by the state, because there will always be disabled people or older people who require more care and support, including professional skills, than could be reasonably provided, or that they want to be provided, in the community.

“Local authorities should redouble their efforts to work in partnership with voluntary and community organisations, including faith organisations, to coordinate and collaborate in providing a network of community-based support for everyone, including disabled people and older people.”

And, when people look at the Church, the Commission says, “they should see tender-heartedness; places where the deep love of God for the world is revealed and people discover the importance of community, and worship for their flourishing.” It is key that churches “look outward and join up with what is already going on”.

The focus of the report, which refers to examples of good practice, is on values: it does not delve into finances. Paid carers would be “valued, reflected in better pay and conditions, and recruited as much based on values and attitudes as on qualifications and experience.”

It does make clear, however, “Based on our values, fairness and justice, we would wish to see funding that is progressive, that taxes both wealth and income, and shares the responsibility fairly between individuals, households and businesses.”

Tinkering round the edges, it says, is no longer an option. “We believe that a National Care Covenant would make it clear that care and support is about more than contractual obligations and statutory duties but rather a deeply profound set of relationships in which we are bound to one another.”

In an article published on the Church Times website, Bishop Newcome elaborates: “We need to redesign the system to make it simple, consistent, and person-centred, with the long-term aspiration of making access to care and support a universal entitlement, free at the point of need.

“In order to move towards this, the Commission proposes simplifying and separating the care assessment and planning process so that people have more say over the care and support they draw on, as well as independent advocacy to understand where to go for extra support. We emphasise the importance of community as the setting in which people are able to build relationships and flourish together, but supportive communities need nurture and investment.”

Archbishop Welby said that the report gave him “hope that we can rise to the challenge of fixing our broken social care system”. The Archbishop of York said that it outlined “a new vision for our society, where we learn to be interdependent with one another; where I thrive because you do, and together we live in a country where we serve one another and flourish together”.

At a press conference before the launch, Dr Dixon said: “All of us, we suggest, are going to need care or to be a provider of it. . . We think [the Covenant] would lead to the empowering of our communities and a greater sense of community.”

Bishop Newcome reflected on the theology underpinning the report that secular partners and organisations readily accepted the three fundamental points it made: everyone being of equal value in the world; loving your neighbour; and the notion of interdependence.

“A lot of people in society would accept these as important, whatever their religious background,” he said. Many in secular life acknowledged the different contributions that faith communities could make, particularly in such things as social prescribing, but also as listeners, “enabling those who might otherwise have to be in hospital or care to be able to go on living in the community, because there are people prepared to listen to them — a rare commodity”.

Responding to the publication of the report, the chief executive of Methodist Homes (MHA), Sam Monaghan, said that the Commission’s findings “yet again highlight the need for urgent reform of the adult care sector”.

He continued: “The Commission recognises that without this reform, we will continue to have a fragmented system. Report after report over decades have highlighted how reform is needed yet, when we thought reform was starting in 2021, the Government halted it with no plans on when it might start again. It is time for the Government to engage with care providers and find out from them exactly what is needed.”

The chief executive of the Carers Trust, Kirsty McHugh, described the report as “yet another vital call for reforming social care and providing a sorely needed new deal for the UK’s millions of unpaid family carers”.

She welcomed the idea of a National Care Covenant as “a welcome contribution to the debate”, and praised the Commission for recommending “crucial changes”, such as “access to breaks for carers, paid leave, and an urgent review of Carer’s Allowance”.

Read more on the story from the Bishop of Carlisle and in this week’s Leader

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