Follow the road to health

As an independent roadmap for reforming adult social care is published by social care leaders’ association ADASS, Richard Humphries explains how its practical action plan could help us transform care and support in England.

Everyday inspiring stories of the many ways social care saves and transforms lives are played out throughout the country.

An isolated older woman receives help with her shopping, as well as the companionship she has missed. An adult with learning disabilities flourishes in supported housing, in a place he calls home. Carers at the end of their tether get the break they desperately needed. A patient in hospital returns home earlier because the right support is put in place for them.

The enormous contribution care and support makes to our lives as individuals and to society remains one that is less told. Every day nearly 1.5 million people are offered care and support in the UK.

Last year, around 818,000 people got publicly funded care in care homes or in the community, with just under a third of those being younger adults. The majority of care providers are rated good or outstanding by the CQC(1).

Yet despite all this, we cannot ignore that the system in England is underfunded, stretched to breaking point and badly letting us all down. We have been trying to patch up social care for decades, and that is not working. By last August, half a million people were waiting for care assessments, and around 2.6 million older people were missing out on some aspect of care(2). Patients are being admitted to A&E when health and social care in the community should have prevented that.

People are spending too long waiting to return home after hospital because the proper care and support isn't in place.

Post-Brexit, and with wages in other occupations outpacing social care, recruiting social care workers has never been more challenging, with 165,000 vacancies in the sector on any given day(3).

How can we move forward against this challenging backdrop? The good news is that there is a strong consensus among those drawing on and working in social care about the kind of system we want to build. The roadmap report, commissioned by Sarah McClinton, the departing president of the Association of Directors of Adult Social Services, sets out how we could achieve this vision. It brings together the best thinking on reforming social care over the last decade and provides a practical route through what needs to be done to achieve it over the next 10 years.

It covers 10 areas for action, placing those receiving care at the front and centre of each one. These include improving housing, harnessing the power of digital and outlining solutions to the workforce problems.

Some of the objectives require big shifts in thinking and investment, such as designing a minimum universal offer as part of a new social contract for care and support.

Others require us to put the scaffolding in place today within legislation to benefit future generations, such as ensuring the planning system supports the development of a diverse range of housing options for the future.

Some require public support to influence political change, such as calling for the right to paid carers leave – similar to parental leave – and allocating budgets for family carers who live with the individual.

But it also recognises there are things local authorities, and directors of adult social services in particular, can do now and some with limited cost. For example, councils need to make a commitment to co-production with people who draw on care and support, their families and carers, and working in partnership with local providers and community organisations.

We know this is already happening – Doncaster City Council has developed a ‘Making it Real' board, placing people receiving care at the heart of decision-making about the services it provides – but we need to go further and faster.

There is more opportunity to improve prevention by building better links between social care, public health and population health across Integrated Care Systems.

The Home First approach should be implemented and extended, to support more people to get care at home and entitlement to aids and adaptations should be more consistent across the country.

We need to give the lowest paid care workers an uplift in pay and conditions, but we also need to explore ideas such as values-based recruitment to deliver improvements in quality.

Of course, delivering the vision will require significant increases in cash for social care. We need a long-term, investment plan for England to turn around the crisis in adult social care and properly meet the needs of older and disabled people and carers in the future.

We don't need the Government to wave a magic wand, but without reliable funding for social care, we will continue to be stuck in a trap of continually making do with cash injections when we reach crisis point.

It is important to underline the word ‘investment', because a reliable social care system allows people to remain in work and in turn grow the economy, particularly beneficial to women to whom the job of caring so often falls.

There is not one answer to the social care puzzle and implementing this roadmap will look different in different places, but there are key markers along the path which need everyone who is involved in care and support to act – as policy-makers, commissioners, providers, user-led organisations, or as individuals.

We know where we want to get to. Now is the time to act – for everyone to take responsibility for those actions within their spheres of influence and make progress. By doing this we can offer hope to all of us who draw on care and support and to our families and wider communities.

Richard Humphries is a trustee of the Association of Directors of Adult Social Services

@1adass @RichardnotatKF

1 Time to Act Roadmap – p9

2 Age UK and CSA estimate, research from 2022.

3 Time to Act Roadmap – p8


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