2 December workshop: summary

The fourth workshop brought together the Caring for our future engagement discussion leaders and reference group members. Its aim was to provide an opportunity for participants to articulate their vision for care and support in 2025 and identify the practical steps required to achieve that vision.

This note summarises discussions during the workshop. It does not represent a statement of Government policy.

Through group discussions and plenary sessions, participants considered:
•    What should care and support look like in 2025?
•    Why does it need to look like this?
•    What would need to be done differently to realise that vision?

In considering what would need to be done differently to achieve the vision, participants discussed what practical steps would be required, in particular:
•    What do we need to stop?
•    What do we need to start?
•    What should we continue to do more of?

Finally, participants considered whether, if brought together, these practical steps would deliver the vision articulated at the beginning of the session, and what further action might need to be taken.

Main points from discussion

Discussion 1: in summarising discussions over the last three workshops, co-leads explained that without losing the work they had done so far on the short and medium term, they wanted to use this workshop to look at where we want to be for care and support in 2025, and specifically, what should it feel like for the service user, the carer and the citizen. This will mean delivering differently, not just more or less, and taking a whole society view, not just focusing on those ’eligible‘ for social care.

On their individual tables, co-leads and reference groups took stock of the priorities identified across the engagement workstreams to consider:
•    What should care and support look like in 2025?
•    Why does it need to look like this?
•    What would need to be done differently to realise that vision?

Plenary feedback from these discussions reflected the following key themes:

What should care and support look like in 2025?
•    An outcome-focused system
•    Individuals in control – individuals feel responsible but not overburdened, they should not be defined by their care need, they are supported and able to contribute to society
•    Information available to empower people – the system is understandable, people know where to go even before they have a care need, there is good quality information, advice and brokerage
•    Social care is everyone’s business – we celebrate longevity and disability, the whole community provides support
•    Clear roles and responsibilities – people know what to expect and are not frightened, there is financial advice and products they can trust
•    Prevention, early intervention and life planning are part of the focus throughout the system
•    Change demand for care – a shift in resources to prevention and early intervention, this will also promote choice and control
•    Integration is about more than health and social care
•    Maximising the benefits of technology – to keep people safe and connected
•    More flexible workforce – including improved workforce skills, support and education for carers, less distinction between formal and informal care.

Why does it need to look like this?
•    The system is not delivering what users want
•    It is unsustainable, wasteful and too expensive
•    The quality and experience of care is not good enough
•    The system perpetuates dependency and there are some perverse incentives for staff
•    It sometimes focuses on those who are most vocal rather than those who may have the greatest needs
•    Health, care and housing provision needs to be more joined up.

What would need to be done differently to realise that vision?
•    Implement capped cost model, this will also bring about greater clarity and enable risk pooling
•    Implement Law Commission recommendations
•    Leadership and commitment from the top, make health and social care the responsibility of all government departments and the whole community
•    Make local authorities an enabling force
•    Shift from acute and residential to community support
•    Remove perverse incentives that stop people working together and prevent person-centred approaches
•    Inform and empower users and carers, shared decision-making and self management.
•    Individuals and families prompted to plan at key life stages.

Discussion 2: with the case for change and vision for change as context, attendees then considered in mixed groups the practical steps that might be required to effect that change. In particular:
•    What do we need to stop?
•    What do we need to start?
•    What should we continue to do more of?

Plenary feedback from these discussions reflected the following key themes (these are not exhaustive, rather they build on priorities and practical steps identified in earlier workshops):

What do we need to stop?
•    Health payment systems based on process rather than outcome;
•    Duplication of assessment and information
•    Trying to eradicate risk rather than empowering people
•    Distinction between state supported users and self funders, rather we should support everyone to plan and make choices
•    Focus only on minimum standards rather than what constitutes quality
•    Lack of clarity about the future funding model.

What do we need to start?
•    Implement Dilnot Commission recommendations for a capped cost model to give greater clarity and enable people to plan
•    Implement Law Commission recommendations
•    Mainstream preventative services, integrated neighbourhood planning
•    Move resources from health to social care, housing and community
•    Core universal information offer, accessible at an earlier stage
•    Better information on provider quality, especially user experience;
•    Navigation and life planning at key transition points
•    Intelligent commissioning with longer-term outlook, working in positive partnership
•    Stimulate more technology and adaptations
•    Valuing social care as a career with progression
•    Involving social care in local planning decisions.

What should we continue to do more of?
•    Deliver personal budgets
•    More proven preventative measures such as community budgeting
•    Incentivise communities to tackle isolation
•    Integrated workforce across health, social care and housing
•    Default joint commissioning, pooling and aligning of budgets
•    Universal focus on reablement
•    More volunteering opportunities for older people
•    Involvement and connectedness with users/carers.

Other issues reflected upon:
•    Need to continue to focus on sequencing of priorities and what are the most important things to do first
•    It shouldn’t just be central government who plays a role in beginning things. Capable communities and sector leadership will be key
•    On the other hand, we cannot simply rely on change from the bottom up – some change currently occurs in spite of legislative barriers.

Discussion 3: finally, co-leads reflected upon whether these actions (stop, start and continue) would deliver the vision identified in the first part of the workshop. Key points from this discussion included:

•    To be meaningful, the case for change needs to be connected to what it will mean for people in 2025.
•    Some of these measures will be more short term, some transitional and some longer term to achieve the vision for 2025. We also need to think about how we respond to more immediate financial pressures.
•    For the longer term, we need to consider what are the key game changers that will make the big difference. For example the greater clarity associated with the Dilnot Commission’s recommendations on funding, a broadening of focus beyond the social care system and greater emphasis on life planning.
•    One of the key questions is how we shift the pattern of demand. Prevention needs to be interdepartmental at both national and local level. Could GP practice populations be a hub for local planning for example? How can we capitalise on the work already done in housing to bring about better outcomes in health and social care?

Overall reflections

•    Co-leads welcomed the spirit in which the engagement was undertaken and there was general agreement that working in co-production in this way should continue beyond this particular focused period of engagement.
•    Also welcomed was the degree of consensus about what needs to change and how we go about it. We need to ensure we retain this sense of shared leadership across the sector as we go forward.
•    We can’t change everything at once, so we need to be clear about what the vision is and what are the key steps for getting there.
•    We need to use the passion that people working in social care have for improvement, to motivate and inspire people so that change comes from within.
•    We need to continue to articulate the case for change in terms of what it means for people and for staff.

Attendees:
Here are the details of the people who attended the workshop, supported by DH facilitation and secretariat.

  • Alan Rosenbach, Special Policy Lead, Care Quality Commission
  • Andrew Kerslake, Director of Institute of Public Care, Oxford Brookes University
  • Andrew McCulloch, Chief Executive, Mental Health Foundation
  • Anne Netten, Director of PSSRU, University of Kent
  • Bridget Warr, Chief Executive, United Kingdom Homecare Association Limited (UKHCA)
  • Dan Wellings, Director of Public Health, Ipsos Mori
  • David Rogers, Chair of Community Wellbeing Board,    Local Government Association
  • Des Kelly, Executive Director, National Care Forum
  • Geoff Alltimes, Ex-Chief Executive of Hammersmith and Fulham Council, Co-chair of the Future Forum integration workstream
  • Gordon Morris, Managing Director of Commercial Services, Age UK Enterprises
  • Helena Herklots, Services Director, Age UK
  • Imelda Redmond, Chief Executive, Marie Curie Cancer Care
  • Jeremy Hughes, Chief Executive, Alzheimer’s Society
  • Julienne Meyer, Professor of Nursing, Care for Older Adults, City University London
  • Lisa Christensen, Director of Children’s Services, Norfolk County Council
  • Lizzie Feltoe, Policy lead for Care and Support, Age UK
  • Miranda Wixon, Managing Director, Home Care Partnership
  • Peter Hay, President, ADASS
  • Philippa Russell, Chair, Standing Commission on Carers
  • Sharon Allen, Chief Executive, Skills for Care
  • Sheila Bremner, Chief Executive, Mid Essex Primary Care Trust
  • Sian Lockwood, Chief Executive, Community Catalysts
  • Steve Smith, Public Affairs Officer, WRVS
  • Sue Adams, Director, Care and Repair England
  • Paul Burstow MP, Minister for Care Services, Department of Health
  • David Behan, Director General of Social Care, Local Government and Care Partnerships, Department of Health
  • Glen Mason, Director of Social Care Leadership and Performance, Department of Health
  • Luisa Stewart, Deputy Director, Dignity and Safety, Department of Health
  • Nichola Yorke, Deputy Director of NHS Communications, Department of Health
  • Sally Warren, Deputy Director, Social Care Strategic Policy & Finance, Department of Health
  • Shaun Gallagher, Director of Social Care Policy, Department of Health
  • William Vineall, Deputy Director, Policy and Legislation, Department of Health

(See the ‘Who’s who‘ page for more details of the non-Department of Health attendees listed above)

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