‘Turning the welfare state upside down?’ Developing a new adult social care offer

For many commentators, the adult social care system is fundamentally broken. This is not the fault of current workers, managers or policy makers – but there is strong consensus that we still have a 1940s’ system which is increasingly unfit for purpose in the early twenty-first century. This was already becoming apparent before the current financial crisis – albeit that a very difficult funding environment has brought these debates to the fore and made them even more urgent.

Against this background, the Health Services Management Centre at the University of Birmingham was commissioned by Birmingham City Council Adults and Communities to produce the current policy paper to guide the Council’s thinking on the potential for a new adult social care ‘offer’ to local people. This was based on a review of Council websites (to see how other local authorities frame what they do for local people) as well as interviews with a series of leading national stakeholders and good practice examples.

From our search of local authority websites, many Councils seem to be describing what they do to the public and to potential service users in fairly traditional ways. A typical way of framing the role of adult social care seems to be as a directorate or function within the local authority which assesses individuals and then provides/arranges for the provision of formal services to those who are eligible for support. While many Councils highlight the importance of independence, choice and control and describe an ongoing process of transformation, few explicitly address issues of social capital. Although a small number include mention of building community capacity, this often co-exists alongside traditional approaches to service delivery and some websites even encourage people to go through formal Council processes before they can make their own arrangements for care and support. While some Councils provide online community directories and signpost people to a broad range of services, others do not seem to divert people away from formal services at all and do not provide wider information for local people.

In contrast, our interviewees felt that adult social care has too often adopted a deficit-based approach and either underplayed (or even in some cases ridden roughshod over) social capital and community resources. What was important for them was being clear about the need to be met – but with much greater scope even within the current system to be creative and imaginative when finding ways of meeting such needs within a challenging financial context. In many ways, they seemed to be calling for a return to pre-care management community development approaches, with workers who are based in local neighbourhoods and can work to nurture and release individual, group and community resources. They also cited examples of areas who have been working differently with their care managers to focus more fully on social capital, developing new approaches via the social work practice pilots and exploring concepts such as local area co-ordination, timebanking and support for microenterprise. This was described by one participant as ‘turning the welfare state upside down’ (the title of this paper) – starting with social capital and community resources rather than with statutory services.

However, participants were equally aware that it is easy to talk the language of social capital – but that major cultural changes might be required. At various stages, they cited the dangers of imposing top-down solutions, of such approaches being misconstrued as ‘cuts’ and of trying to rush a process that many felt needed to be small-scale, bottom up and led by communities themselves. Many cited a series of local and national organisations with significant experience of this process, and they questioned whether local authorities could make such significant shifts by themselves and without support. Of course, this raises significant challenges for local authorities facing very difficult decisions and having to consider large-scale and rapid changes. Going forward there may be a real tension between responding quickly and responding well – and doing both may require a series of carefully judged tradeoffs.

In addition to their views on social capital and community resources, participants also highlighted a broader range of issues to do with:

• The relationship between social care and wider social and economic benefits (with scope to view the reform of adult social care not as an end in itself, but as a form of social and economic investment in local communities which can create new employment and business opportunities).
• The relationship with the health service (including the need to develop a shared vision for community services, the need to make best use of scarce public resources and the need for more joint approaches to supporting people with very complex needs).
• The relationship between the local and the national (with a constructive twoway dialogue needed between current debates about a more national settlement for adult social care on the one hand and the need for innovative local solutions on the other).

Overall, there are major opportunities to refocus the adult social care system and to work much more creatively with social capital and community resources. However, the risk is that the severity of the challenges facing local government prevent the careful thinking, time and investment needed to produce a genuine, long-term solution.