Time for change: the language of social care reform

“Change is needed, and it is needed now, to protect some of the most vulnerable members of society.”

Care England^[1]

In his final speech as Prime Minister, Boris Johnson listed “reforming social care” among his achievements^[2], a claim quickly and widely disputed and derided.

‘Social care reform’ means different things to different people, and “the right ‘fix’ depends on your interpretation of the system’s problems”^[3]. However, I think most people would agree that whatever reform looks like, it is much needed, and it hasn’t happened yet.

In this latest blog in my series on ‘time’ I’ll explore the language of social care reform adopted by much of the media, ‘sector leaders’ and campaigning organisations – a catastrophizing, deficit-based narrative of ticking timebombs and the rising cost of care, screaming with urgency and demands for immediate reform, and as such firmly rooted in Chronos time. And then, in my final blog in this series, I’ll explore a different narrative of change, which sits firmly in Kairos time.

Britain facing social care ‘time bomb’^[4]

“Medical leaders are warning that we are facing a ‘ticking time bomb’ in social care as chronic underfunding, severe staffing shortages and a growing elderly population means that many in the future will not get the care and support they need.”

British Medical Association^[5]

References to ‘ticking time bombs’ in reports and articles about the need for social care reform are common.

The ‘rapidly ageing population’ is often cited as a key pressure, and this ‘demographic timebomb’ narrative drips with othering and blame.

“An ageing population as well as a growing number of disabled people of working age, means problems are escalating.”^[6]

“London is facing a “social care time bomb” due to its ageing population.”^[7]

“the issue of coping with our rapidly ageing population is not going to go away.”^[8]

Older people “are portrayed as a homogeneous group to be managed or mollycoddled rather than a group of diverse and active citizens with equal rights to people of other ages.”^[9] Instead of celebrating longer lifetimes, this narrative blames people for living longer, growing older. The burden of an ageing population. Longevity as a threat. More ‘demand’ to manage. How will we cope? Where shall we put them? “Where are these people going to go?”^[10]

The ‘workforce timebomb’ is another pressure, with articles calling for reform getting tangled in a contradictory ‘care work is hugely demanding, arduous, sometimes repetitive, often boring, thankless, challenging and emotionally and physically draining’^[11] vs ‘we need to attract more people to work in social care’ spiral.

And the ‘financial timebomb’ narrative threatens that “people’s homes will be sold and their lifetime’s savings raided to cover their care costs” while also managing to blame people once again as “millions ignore future costs entirely” and “almost no one has made other plans” to cover the cost of care.^[12] There are warnings too that “a bankrupt care system will undermine the NHS^“[13] and that “widespread care home closures” due to the government “seriously underestimating” the cost of reform “could leave councils struggling to find beds for those who require care.”^[14]

The emphasis is firmly on the cost of ageing and the cost of care, rather than the benefits of longer lives, and the value of great care and support.

Social care: a sector now in perpetual crisis^[15]

“A sector in perpetual crisis”.

“A threadbare safety net”.

“A system on its knees”.

“Deeply flawed”.

“Ravaged”.

“Fragile”.

“Broken”.

It’s a little bit ironic that while ‘strengths-based’ working is promoted throughout social care practice, the narrative around social care reform is overwhelmingly deficit-based.

There’s no mention of opportunities and possibilities. Just a dreary ‘social care is broken’ rhetoric on repeat. This narrative presents a pleading ‘fund a damaged system to prevent things getting worse for the vulnerable / the elderly / those who need care / the workforce / care providers / local authorities / the NHS [delete as appropriate]’ instead of painting an appealing picture of a brighter future for all of us, that’s worth investing in.

Next PM must overhaul social care^[16]

“Adult social care can only survive with the necessary support from central Government, without which it will face total collapse”.

Professor Martin Green OBE^[17]

In this dominant narrative of reform, only the government can ‘fix’ social care. Talking about a fix is inevitable when the rhetoric focuses on how broken social care is, but there are numerous problems with this framing (aside from the former Prime Minister proclaiming he’d ticked social care reform off his ‘to do’ list.)

In this narrative, the fix is more money, and the reason it’s needed is to “reduce the burden on the NHS” / “prevent further deterioration of services” / “address the fundamental unfairness of the current system” / “alleviate the burden from local authorities” / “prevent people from having to sell their home to pay for the cost of care” / “drive down future demands on the health service” / “prevent widespread market collapse” / “reduce waiting times” / “close the gulf between demand and capacity” / “prevent further deterioration in access to care” / “reduce workforce shortages” / “protect some of the most vulnerable members of society” / “prevent a widespread catastrophe within adult social care”. It’s a narrative with a confused/confusing message, focusing on what investment will prevent, not create. There’s rarely any mention in this narrative of equality or inclusion. Of good lives and human rights. Of wellbeing and independence. Of choice and control. In fact, there’s little mention of people who draw on social care at all, beyond references to ‘the elderly’ and ‘the most vulnerable’. ‘Those who need care’.

In no way am I disputing the need for significant investment, but this narrative also suggests that more money is the only reform required. However, without much broader and deeper change, any increase in funding will quickly be swallowed up in maintaining the bureaucracy of the current system and lining the pockets of a few beneficiaries, with little impact on the experiences and lives of people seeking and drawing on support.

In addition, this narrative presents social care as a single entity – a ‘sector’, a ‘system’, a ‘body’, an ‘industry’. Care as a noun, not a verb. Care that can be delivered in a package and fixed like a car, rather than care as the connections and relationships that we can all demonstrate and feel and benefit from.

And claims that ‘only the Prime Minister can fix this’ places all the agency with the government. Like the superhero ‘professional’ swooping in as the expert to protect ‘the vulnerable’, we’re waiting (still) for the prime minister to take charge and rescue the helpless, broken sector from the brink. Not only does this overlook the value of collaboration and coproduction and the way we can all influence change, but it also absolves us all from any responsibility to play our part.

“I don’t feel the emphasis on fixing it is right. We need to think of cherishing, supporting, caring and enabling social care with the attitudes and behaviours of what’s needed. It’s a constant steer not a one off fix!”

Iggy Patel^[18]

Social care ‘timebomb’ means reform is urgent^[19]

“There is a demographic timebomb set to go off in Herefordshire in just five years time – and action is urgently needed to ensure it does not blow up in the faces of the most vulnerable”.

Hereford Times^[20]

“There is a real feeling in the industry that we are at the cusp of a devastating wave that is about to crush the lives of thousands of vulnerable people.”

Ross Kneller^[21]

Collapse is imminent.

Devastation looms.

Reform is urgent.

Immediate action is needed.

FIX SOCIAL CARE NOW.

The threat of impending doom is clearly articulated by local authority adult social care directors, medical leaders, care providers and campaigning organisations in increasingly desperate attempts to convey the need for investment.

However, aside from the problems discussed above, if we continue to frame social care as broken and in need of urgent help, we invite a crisis response. An amplification of the familiar reactive approach of statutory social care – a short term quick fix sticking plaster solution to keep people/’the sector’ alive but paying little attention to strengths or aspirations or possibilities, and unlikely to support individuals and communities to thrive.

The suggestion that social care can be fixed ‘once and for all’ also gives the impression that a one-off wave of a magic wand (or a single shake of the magic money tree) is all that is needed, and all will be well.

Not only that, but the sense of necessity dissipates somewhat when reform has been described as ‘urgent’ for so many years. There’s a real danger that “where messages rely on crisis and urgency… the impact on public thinking over time can be fatalism. In summary, public sentiment can shift from the sense that ‘something must be done’ to a resigned view that ‘nothing can be done’.^[22]

“As we all know, social care has been in need of urgent reform for a decade or more…”

Lord Bichard^[23]

Time to shift the narrative

“To be truly radical is to make hope possible, rather than despair convincing.”

Raymond Williams^[24]

We need to tell a different story about social care reform. The dominant narrative is exhausting, and exhausted. It lacks vision and coherence – a confused and contradictory rhetoric where older people are simultaneously blamed as the cause of the crisis and presented as the victims, and where younger adults have no presence at all. Where campaigns to encourage more people to work in social care vie with commentary about how arduous and challenging ‘care work’ is. Where we emphasise how bad things are, rather than how good things could be. Where we claim only the government can fix this, with no conviction that they will, and with no agency of our own. Where the goal of reform is more money, with little mention of better, more equal lives.

We need to tell a different story about social care reform. A story of hope and opportunity rather than crisis and despair. Of the value of great support instead of the growing cost of care. Of the agency we all have and the part we can all play. Of us, not ‘them and us’.

And we need to recognise that yes, it’s time for change, but that lasting change takes time. The substantial and sustainable reform we need doesn’t have a set timeline or a fixed implementation date. It can’t be planned using a calendar or measured with a clock. It can’t be scheduled or, indeed, delayed.

In contrast to the Chronos time urgency of the dominant narrative of reform, this is fluid, organic, Kairos time change.

This is the change we need to see, and this is the way we need to see change.

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References

[1] It’s time to fulfil the promise to ‘fix social care’, Press release, Care England, 7 September 2022

[2] Boris Johnson’s final speech as Prime Minister: 6 September 2022, Speech, Prime Minister’s Office, 10 Downing Street and The Rt Hon Boris Johnson MP, 6 September 2022

[3] What should be done to fix the crisis in social care? Hugh Alderwick, Charles Tallack, and Toby Watt, The Health Foundation, 30 August 2019

[4] Britain facing social care ‘time bomb’, Rebecca Clifford, PM Live, 22 March 2016

[5] BMA warns of social care crisis as current system is ‘deeply flawed’ and in need of ‘urgent reform’, Press release, British Medical Association, 8 June 2022

[6] Incoming PM needs to act fast, says Care and Support Alliance, as new analysis finds 2.6m aged 50+ now have some unmet need for social care, Press release, Age UK, 2 September 2022

[7] London faces ‘social care time bomb’ with ageing population and Brexit immigration rules, new research suggests, Naomi Ackerman, London Evening Standard, 17 July 2020

[8] Timebomb of care for the elderly? Mark Andrews, Shropshire Star, 12 October 2017

[9] The coronavirus epidemic shows why it’s so important to get it right when we talk about ageing, Anna Dixon, Centre for Ageing Better, 31 March 2020

[10] Timebomb of care for the elderly? Mark Andrews, Shropshire Star, 12 October 2017

[11] I have been a care worker and know what the job involves – they deserve a real living wage, Jo Brand, The Independent, 12 February 2021
A national care service is the only way to prevent more deaths, Unison, 24 June 2020
Fixing social care, TUC, 7 September 2020

[12] Social care “time bomb” set to explode as millions ignore future costs entirely, James Andrews, Mirror, 25 June 2019

[13] Britain facing social care ‘time bomb’, Rebecca Clifford, PM Live, 22 March 2016

[14] New analysis warns government has ‘seriously underestimated’ the costs of adult social care charging reforms, County Councils Network, 18 March 2022

[15] Social care: a sector now in perpetual crisis, Rusheen Bansal, Integrated Care Journal, 6 September 2022

[16] Social care: Next PM must overhaul care amid astonishing level of unmet need, say charities, Jane Dalton, The Independent, 2 September 2022

[17] It’s time to fulfil the promise to ‘fix social care’, Press release, Care England, 7 September 2022

[18] “I don’t feel the emphasis on fixing is right…”, Iggy Patel, Twitter, 7 September 2022

[19] Social care timebomb means reform is urgent, London Councils, 12 June 2009

[20] Herefordshire’s ticking social care timebomb, Hereford Times, 24 April 2020

[21] Harrogate social care a ‘ticking time bomb’, care boss warns, Jacob Webster, The Stray Ferret, 16 June 2021

[22] Talking about a brighter social care future, #SocialCareFuture, 31 October 2019

[23] Social Care in England – Volume 814: debated on Thursday 14 October 2021, Hansard, UK Parliament

[24] To be truly radical, Raymond Williams, Goodreads

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Although I haven’t included many direct quotes, this blog is informed and influenced by conversations with – and the work of – Neil Crowther and #SocialCareFuture. Much more here… By changing the story of social care, we can build public support to transform it for future generations – here’s how.