November 30, 2023 • 42 mins
Dr Duncan Fisher hosts Richard Humphries in another edition of our CARE MATTERS mini-series, ‘Authors of Care’. Duncan asks Richard about his recent publication, ‘Ending the Social Care Crisis: A New Road to Reform’, exploring the themes of the book, the background and personal challenges which helped shape it, Richard’s recommendations for reform and much more.
Richard's book, ‘Ending the Social Care Crisis: A New Road to Reform’, was published in Autumn 2022 and can be purchased on Amazon and from Bristol University Policy Press. In the book, Richard considers the route to meaningful and enduring positive change for adult social care in England and what we can learn from history and other contexts in this regard.
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(00:05):
The Care Matters podcast is
brought to youby the ESRC Centre for Care and CIRCLE,
the Centre for International Researchon Care, Labour
and Equalities.
In this series, our researcherswelcome experts in the field
and to those giving or receiving careto discuss crucial issues in social care
(00:27):
as we collectively attemptto make a positive difference to how care
is experienced and provided.
Hello
and welcome to Care Matters, The podcast
from the Economic and Social ResearchCouncil, Centre for Care
(00:48):
and the University of SheffieldSerco Research Centre.
My name is Duncan Fisherand I am a research
associate at the Centre for Care.
We are delighted towelcome Richard Humphries as our guest.
And in this episodewe will discuss Richard's new book,
Ending the Social Care Crisis.
This is part of our ongoing serieslooking at New Literature on care
(01:12):
in the book.
Richard considers the report a meaningfuland enduring positive
change for adult social care in England
and what we can learn from historyand other contexts in this regard.
Richard Humphries is a recognisednational commentator
on social care and healthpolicy is current roles
include senior policy adviserto the Health Foundation and Newton Europe
(01:36):
and visiting professorat the University of Worcester.
He was senior fellow at the King's Fund
from 2009 to 2021,
covering social care and integrated care
between 2021 and this year.
He was a member of the Reimagining CareCommission established by the Archbishop
(01:57):
of Canterbury in Yorkand a special advisor
to the House of Lords Economic AffairsCommittee.
Inquiry into Social Care from 2017 2019.
Building on a career in social workover the past 46 years,
he has worked in a variety of roles,including as Director
of Social Serviceand Health Authority Chief Executive,
(02:22):
England's first
joint appointment and in senior rolesin the Department of Health,
working with ministers and senior civilservants.
Richard's new book, Ending the Social CareCrisis.
The subject of this episodewas published in autumn 2022.
Welcome to Care Matters, Richard.Thank you.
(02:42):
So, Richard, could you please
introduce the book to our audienceand tell us what the book's about?
Sure.
And thanks, Duncan,for inviting me to do this.
It's a great pleasureto be doing it with you, and I hope that
listeners will find this helpfuland maybe a bit educational as well.
So so the book
was really bornout of a mixture of motivations, really.
(03:06):
First of all, I was a bit frustratedthat there's lots of stuff
written about adult social care,but none of it in one place.
There's lots of pieces,really good pieces of work
as articles or research papers, blogsand so on about different aspects of the
problems in social care, like workforceor the nature of care services.
(03:29):
The need for users to be more involved.
But nothing reallythat pulls it all together in one place.
So I've been mulling this overfor some time that a need to do something.
Also frustratedthat successive governments over 25 years
have been trying to sort outsocial care and have generally failed.
(03:49):
But we don't seem to be learningfrom that,
and we just seem to be repeatingthe same kind of approaches and processes.
And a lot of the thinkingas well as has been very superficial.
But above all, the debate about socialcare has really been all about negatives,
about
the so-called burden of care,the costs of care,
(04:12):
people stuck in hospitalcare, homes closing,
and nothing about the goodthat social care can do.
And it seems to methe more I've thought about this,
that needs to be the starting point,not the
all the difficult stuff and the problem.
So the book reallyis an attempt to set out, first of all,
(04:32):
what is social care,What do we mean by it?
What does it consist of?
And I've tried to illustrate thatthrough the voices and experience
of people that have hadsocial care needs and use services.
And how has it evolved over the years.
And that throws up some surpriseconclusions
about the causes of the current problems.
(04:54):
What can we learn from other countriesabout how they have gone about it?
But above all, what can we doand how do we need to go about the process
of really sorting out social care
that avoids the mistakes of the past andreally can lead to some enduring change.
So that's in a in a nutshell.
Duncan Okay.
(05:15):
Thank you very much.
And I think that that kind of your finalyour key point there to the question
of what can we do?
Certainly something that willwe can come back to later
in the conversation as and as something
stick in of emphasise and discuss further.
So just in terms ofjust to come back on your
your answer there, you worked inthe social care for a long time.
(05:37):
You've been thinking about these ideas,
but in terms of the actual processof writing the book
and even the opportunity,how did that more practical side
of writing a book for you?
How did that kind of come. To the IT?
So as I say,I've been thinking about it for some time
and and I've written all sorts of stuff.
I've written articles,the journals, peer review stuff,
(06:00):
lots of stuff I
published when I was with The King's Son,but never in a book.
So I made this was a personal developmentchallenge as well.
And then, of course, COVID came.
So lockdown was a great opportunityto kind of to spend the time on it.
But but actually, the actual triggerthat finally kind of
(06:22):
caused me to beginthe process was the personal experience
I had in sorting outcare for my late father,
which I talk about in the book.
But it illustrated for meboth the best and the worst in our current
social care systemand the worst aspects and the
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the nature of, say, of the struggle
to get to get good care for him
was was profoundly affecting for me.
Actually, he is me a so-called expert, and
I felt like I was an expertby an experience.
But the good news is that my
we got there in the end and my dadhad superb person centred care in the last
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four years of his life and goodsocial care gave him his life back.
So that's that's the good news.
But getting that,that's a different story.
So that was that was the personal processthat caused me to write the book.
And I think that's, you know, it'sa very interesting point a bit that what
navigating the system, because I thinkone of the many things that your book
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does well
is as can capture and conveythe complexity of the
the social care system on so many levels
from funding to legalitiesand the organisation it.
I'm conscious of your answerto my opening question about
so much of what we hear about social care,focusing on the negatives on your unit
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to think maybe more positively and more,
I guess proactively, but just want toyou know,
you obviously the title of your bookis Ending the Social Care Crisis.
We know that that word isis banded about a lot
and a lot of people are quite criticalof the use of that term
crisis for you, What what are the most
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what are the most urgent issuesand social care in England?
I think if you asked many peoplethat question, they would
they would refer to thingslike the workforce.
The fact that this over hundred 60,000vacancies, the lack of money,
austerity, the impact that's had,the impact of COVID,
people stuck in hospital,in the market, in the care that they need,
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younger disabled
people not getting choice and control,that sort of thing.
And those are all valid issues, but
I think they are symptoms.
And it seems to me that theythe underlying cause of those symptoms
is the failureto bring social care up to date.
So the in responseto the great sweep of change
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we've seen in this countryover the last 75 years.
I mean, interestingly,I think a lot of the problems in the NHS
are caused by a failureto address the new realities of life
as it is 75 years onfrom when it was in 1948.
And and I think the fundamental problemwith social care
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is that we're still stuck in this 1948mindset.
The former minister once talked aboutsocial care as dirty little secret,
which is that in fact it's not likethe NHS is not universal.
It's actually a very minimal safety net
for the poorest peoplewith the greatest needs.
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And that's become more accentuatedin recent years.
And that is the fundamentaloperating model
for social care thatunless you're relatively poor
and unless you have very highneeds, you're on your own.
Actually,there have been some attempts to kind of
shift
that over the years, that creationof Social services department
(10:09):
in the seventies and that we havethe community care reforms
and the CARE Acthas tried to make it a bit more universal,
but I think it's tried itbecause of lack of investment.
So the basic trajectory of social care,which is a minimal safety net
for a relatively small number of people,hasn't really changed very much.
We still have means testing, for example,in a way
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that would be unthinkableif we applied that to the NHS.
So we and because because we're allbetter off or many of us are better off,
that has become a live issue.
The issue of peoplehaving to sell their homes
to today again, wasn't an issue in 1948.
Most people didn't own homes.
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Most people didn't live long enough
to meet a need for more care,and if they did, they
didn't get it from their familiesor from the NHS.
Know in a long stay ward or whatever.
So we had all these changes over 75 yearsand we're still operating
the tramlinesfor social care of a 1948 settlement.
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That is the fundamental underlyingcause of why we have got so many
so many symptoms and pressuresbubbling up.
Thank you very much.
So there's there's so much in this book
that is is very informativeand nuanced that your point there
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about the sum of the differencesbetween the social care and the NHS.
You mentioned about the social care
being means testedand you kind of pointed that out.
You know, the idea of that
and that being the case for the NHSis sort of unfathomable.
And one point quite early in the bookyou state that there's a different,
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a different political or moral calculusto entitlements
for social care compared with health care.
Can you say a little bit about that?
Why? It'sone of the things about social care
that interests mea lot about I'm interested to think about
and what about why that may be the caseand why you think that may be the case?
Sure.
So I think it's back to this issueof universality in part
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that that back in 1948,when it was all set up
and the NHS was created to great fanfare,
that wonderful leaflet that everybodypushed through the letterbox
explaining what this new servicewas, that everybody could use it.
It would be free at points of use,it would be paid for through taxes,
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and because at that point
virtually everybody would needhealth care at some point in their lives.
This created a huge reliefthat was no longer
the fear of a doctor or, you know,
getting the health care you need.
So so, you know, that that kind of
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began the country's long love affair
with the NHS,
which continues to this day
despite the current travails.
And and the point isthat the NHS gives people
that a huge peace of mind,knowing that whatever happens
to the health liesand worry about the bill.
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Now, the same thinking, I think, wasn'tapplied to social care then.
We didn't talk.
Nobody talked about social care. In 1948.
The opening words of thethe equivalent legislation, social care,
which was the National Assistance Act,basically said not to eliminate the poor.
So that was as good as itThat was good as it got.
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And then, of course,life expectancy was much lower.
We didn't see the levels of chronicillness and disease that we have now.
So the the incidence of socialkind of need in the general populace
was very low and people just didn'tdidn't see it as an issue.
And it wasn't for reasons previously
explained.
And that that has persisted
(14:07):
even though all these years later that
the demographic positionhas fundamentally changed.
Most of us now will have some kind ofkind of need at some point in our lives.
We don't know when, we don't knowfor how long we might be end of life.
It might be much earlier in our livesbecause of a disability road accident,
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injuries acquired in military servicecould be any reason
or it is just personal misfortune.
So most of us will have a kind of need.
One in seven of us will need carethat costs at least £200,000.
So this isthis is a huge change since 1948.
So I thinkwe'll probably come onto this later.
(14:53):
But I think the public as a wholegenerally don't appreciate
the significance of it
and the fact that social careis now as universal
a need as as is health care.
That wasn't the case in 48,
but we're still operatingwith this kind of twin trap, rather
schizoid attitude that the NHSmust be free at the point of view.
(15:16):
Suarez Social care.
Let's have a debate about
how much people have got to payand what carers have got to do.
And you know, politicians can openly state
that they think that a family
should, should be the primary,should have primary responsibility
for care and all sorts of statementswhich if they were applied
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to the NHS, would be greeted with outrage.
Can you imagine anybody having to sella house, pay for their cancer treatment?
You know?
I mean, noother politician would get away with that.
So so I think we do need to exposethis kind of almost hypocrisy, actually,
not much, because need is need,whether it's health care need or it's
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for carers at all.
Yeah, And I think that that
final pointyou make there about how often debate
about funding and reform of social careseems to boil down
to propertyand wealth and things like that.
And I think that's
a very important point.
And how can we get beyond that?
(16:22):
How do you think we canwe can get beyond that discussion?
So I think the traditional approachto the social care reform is
essentially consisted of various
kind of reformers and lobbyistsand campaigners,
essentially shouting at the governmentto do something about social care,
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to demand that the government is somethingwhich the government of the day
thinks will be poorly understoodby the public,
will be politically unpopular,will cost them votes
and actually they've gotthey've got some cause to believe in that
you look at what happened with so-calleddeath tax, right in the 2010 election
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and then Theresa may had the same issuewith her
dementia tax debacle in the 20002017 election.
So it's very easy, particularly electiontime for politicians
to kind of weaponisesocial care and use their opponents
commitmentsas a as a kind of stick to beat them with.
So so I think fundamentone of the fundamental changes
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we've got to adopt is actually takingthe arguments to the public
and be
very influenced by the workof an American political scientist,
Joseph Overton, who said that instead of
campaigners, policy makers,instead of trying
to persuade politiciansto do unpopular things,
we've got to persuade the publicto support popular policies.
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You've got to get the policyin that Overton window where changes is
is supportable.
And so that's whatI think we've got to do.
We've got to raise public awarenessthat social care is a universal need.
It's important for our peace of mind.
It's important that that carerscan go out to work, that disabled
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people can get jobs through the rightsocial care support.
And we don't have to worry about itin some way,
that we don't have to worryabout health care costs.
So that that means turning the policy,
making process on its ownand starting with the public.
Okay. Thank you.
Thank you very much, Richard.
And I was interested in your point
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and your opening answerabout the idea of having a book in
and having a lot of these important issuesand ideas in one place.
And I think the book acts as a know,as a great resource for that.
And to that end, aims.
So in chapter two of the book,you discuss the history of social care,
adult social care in England, and you'veobviously touched on quite a lot of
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some of these policy changes already,and you've also kind of linked that
and with some of the kind of widersocietal demographic changes.
I just wanted to ask
if there's anything you think that we canlearn from the sort of history,
the historical trajectorythat would help improve things today?
(19:11):
I think the most significant learningpoint
is not not to overestimatethe impact of policy, the policy process.
So, you know, in and when in the last,
I don't know, 25 years
we've seen a procession of white papers,green papers, consultation
(19:31):
documents full of great ambitionsand laudable intent.
But in practiceI haven't really made that much difference
to the lives of people with social careneeds.
So, I mean,there have been some improvements
and some breakthroughs,but generally speaking,
they have failed deliver reformat the scale that we need to to to meet
(19:55):
all those challengesthat have developed over the last
75 years.
The second thing I think we can learnis, is is the importance of unintended
consequences of things that happen thatnobody planned or make explicit decisions.
And there are two thingsthat I regard out in the in the book.
(20:15):
One is about how we ended upwith this huge private market whereby over
90% of social careservices are provided by private
and independent sector organisations.
Nobody ever said,Let's have this big private market.
It came about wayback in the in the 1980s.
And so really this relatively obscuredecision
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of a local Social Security office iswho decided, faced with pressure
from local voluntary organisationsand charities running residential services
that Social Security should pay a boardand lodging allowance for their residents
because they were under the coshfinancially and in one of two offices
agreed that it became a national policy.
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And that was the
that was the blue light reallyfor all sorts of people piling in
and setting up care homesbecause they could get bulk of the cost
paid for through Social Securitywithout any assessment of need.
And that marked the beginningof a rapid explosion
in the number of private care places
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and the emergence of this vast
state funded but privately run industry.
And that's why we have got the
so-called market in social care
that we have today.
Governments tried to try to regulate that.
They brought in the community carereforms.
They cut Social Security budget,
(21:47):
transferred it to councils,and expected them to assess people's needs
for the first time and ration the carewhich they did very effectively.
But of coursethere was the money transfer.
It wasn't enough and it wasn't enough tokeep up with demographic demand and costs.
And that helps to explainwhy so many councils have been struggling
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and why providers complainthat councils are not paying them enough.
So that's that's a little bit of history,which most people don't
when a lot of peopledon't fully appreciate that it wasn't
an explicit policy choice to do itthat way.
The other developments,I think, which is enormously shaped
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the way social care operatestoday, is changes in the NHS.
And what we've seen over the last 30 yearsor so is a massive offloading
of both costs and activityfrom the NHS on social care.
And although the debate currentlyis about the pressures
that social care creates for the NHS,but actually it's it's two way traffic.
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So the NHS has closeda lot of, of its long stay provision.
I mean a lot of these developments
are positive in the sensethat nobody would oppose them.
So they closed a lot of their longstay provision, they transferred
some of that provision for mental healthand then disability
so that to the private sector
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they've reduced the number of acutehospital beds,
which is now kind of coming back to two
and they've reducedlength of stay in hospitals
and they do more treatmentson a daily case basis.
But the effectof those little group of changes is to
is to shift their recuperativeto kind of the convalescent
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part of a person's hospital journey
onto the onto the shoulders of familiesin the social care system.
So people are discharged from hospitalmuch sooner.
That's usually that's a good thing.
Nobody needs to be in hospital and
unless they aren't,they are acutely unwell.
But again, that wasn't planned and nobodysaid, well, we're going to do this,
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but this is going to have an impactall on social care
and on some community health serviceslike district nurses, for example.
Nobody said let's let's kind of planto ship some resource across.
It just happened.
Not any planning, any sort of estimatesof the resource requirements.
So that means that the volume of work,
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the amount, what the social caresystem has to do is much greater.
But also I think it means that the acuity
and the complexity of people'sneeds is much greater.
And if you talk to anybodythat's in home care services
over the over the next few yearsand they will say now that they're
dealing with needsthat people have in their own homes,
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that previously district nurseswould have done
people in care homes
would say that that thatthat a lot of their residents
now years ago would have been in ain a nursing home.
And people in nursing homeswould say a lot of
their residents would have beenin a hospice or in a hospital.
But so there has been this big shiftin acuity
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of need over a number of years.
And that means thatbecause of the resource constraints,
fewer people are getting more care,
they're getting more intensive carepackages of care and support.
And it's also got big implicationsfor the nature of the workforce.
You need to deliver thatat the skill levels, which is why these
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absolutely absurdto suggest a someday that such care
is not a skilled occupationpatently is not the case anymore.
If you ever if it ever was.
So those are
those are the two of the biggestkind of factors we can only think of that
we can learn from historyabout unintended consequences.
(25:44):
And don't overestimate whatthe latest Green Paper white paper is.
It's not going to change the worldpublicly.
Thank you very much.
And in termsof thinking about another context
or moving from the historical contextto the I guess, to the
the geographic of the political context
in chapter five, if you look abroad.
(26:06):
And so can you can you briefly seewhat what we could learn from
from other countries?
Maybe maybe give an example?
Yeah.
So I spent a lot of timeactually looking at other countries
and, you know,
there's different approaches.
And I think the one obvious learning point
is that there is no magic bullet herethat we that we you could say, well, if,
(26:28):
if we do, Australia did or whatwe have done, everything will be okay.
And so there is no one set of solutionsthat can easily be replicated
in another country because it's all very
context specific.
Every country's got its own unique
context and culturewhich shapes the way it does things.
(26:51):
And I think this stories call itpath dependency so that when Germany,
for example,
was reforming itsits approach to social care,
it adopted a long term careinsurance doctor.
It went down a social insurance. Right.
And that'sbecause there is a long tradition
in Germany, particularly through healthcare of social insurance.
(27:12):
It began with Bismarck in the 19thcentury with unemployment
insurance.
So Germany went down that road.
Scandinavianshave opted more for general taxation
as a as a as a as a funding method.
So every every country is differentin that sense.
(27:33):
But I think I think on a positive note,I mean,
we can take hope from the factthat many countries
have introduced long term reforms,
you know, a whole range of countries
across the world have done this.
I don't think anybody has really crackedthe problem.
It's a bitlike painting the fourth bridge.
(27:56):
So what most countries tend to find
is they introduce changesto make that care better.
And whenever you do thatas a learning point,
the costs go upbecause more people come forward
and needs needs help rebuild.
So there's that debate about, well,how do we make this sustainable?
And then they they arejust as they go along.
(28:18):
So even countries with social insuranceschemes find that they have to look
at kind of
subsidising it with moneyfrom general taxation
countries,even countries like Sweden or Netherlands,
Scandinavian countries generally
(28:38):
rely on some personal payments to top up
relativelyhigh levels of state expenditure.
So so I think the lesson isthat you can do this.
It is possible to introduce change,
but you then have to kind of adjust itas you go along
and not expect, not expect itto kind of improve things all at once.
(29:01):
And and that's the third point actually.
It takes time.
And if you look at if you look at Japan
and Germany, which is to the examplesthat are often quoted,
I mean, they took over a decadeto kind of launch the process
to get people on
(29:21):
board, raise awareness of the issues.
And it was not that methodical,
planned approach, preparing around
instead of doing whatwe've tended to do over the years,
which is plunge straight into let'slet's have a levy on people's estates
to pay for social care, never mindstarting with engaging with the public
(29:43):
about what is social care,why is this important?
How much does it cost?
These are some of the wayswe could pay for it.
What do you think we go straight in with?
You know, let'shave this new tax to pay for social care,
which immediatelyfrightens the horses and talks.
You finance the whole issue.
So I think there's a lot we can learnfrom other countries about the process.
(30:05):
I've been particularly impressed inin the United States with the came
across Generations movement,which is a very broad alliance campaigning
groups trying to get improved careand support for carers of all ages
and both for children and for adultsand for younger disabled people
who I think have had some success
(30:27):
in creating public support for change.
That what I talked about earlier,that the public realisation
good care is something we need
to live
our lives, to live a good, a good,a good life.
So there's lots of movements like that
I think we can learn from in Australiaand I have every Australian counts.
(30:47):
We're in some really, really good work on
breaking beyond, breakingout of the shackles of the traditional
policymaking processwhereby the government issues
a Green paper,the statutory consultation period.
You have to write here, this is muchmore fresh and much more engaging.
Thanks very much, Richard.
That's really interesting
(31:08):
how these insightsfrom from different, different places.
So as you said in your opening answer,you know, one of the things
you're trying to think aboutis that big question or what can we do?
And so you save your most deepest
and most developed ideas for reformthrough the final chapter of your book.
But yeah, you make suggestionsand recommendations throughout the book.
(31:32):
Maybe for the potential readers,
can you maybe briefly summarisesome of your your kind of key proposals
for reforms or some of the
key things that you thinkit would would make a difference?
So first of all,I think it's it's important to
distinguish between process and outcomes.
(31:54):
I think
a lot of the debatein England has been quite technical.
It's been about policy options,funding methods
and so on, and it's been quite,quite narrow
and we haven't really thought
very much about the process of change.
You can have all these wonderful ideas,but how do you actually get them
(32:18):
and implement it?
So, so I think this is three,I call it a different road to reform.
And there's three things that have gotto be fundamentally different.
So the first is, is a is a new focus
on building public supportfor for better social care.
And I talked about that earlier,so I won't repeat it,
(32:40):
but it's just kind of making people awarethat the social care is really,
really important for usto have a good life, to enjoy
the peace of mind that we havewith healthcare through the NHS.
So so, you know,I think we need a whole load of
public
conversations, probably locally,then builds up into a
to a national debate and dialogueand to get social care
(33:04):
into the Overton windowof, of of realistic change.
Second thing we've got to do differentand it's it's part of the
process of buildingpublic support is to really get
into some of the toolsand techniques of deliberative democracy
and co-production of involving peoplewith lived experience in social care,
much more of engaging with local groups
(33:28):
and citizens about this.
There was some some recent examples
of focus groups of citizen assemblies
and so on, participatory budgeting
to to really get alongside
people and work up some ideas
and then get people on boardthe issues that need to be tackled.
(33:53):
The third thingI think we've got to do is,
is to shift from short term fixes,
which I think has been a real problemto social capital in the last
7 to 10 years that
government has actually put more money in,but it's done it in the least effective,
efficient way is short term last minutehand-to-mouth funding.
(34:15):
That's all going to be spentwithin months.
And, you know,
and actuallyit almost perpetuates a broken system.
It it props it up.
Instead of building a bridgeto a better system, those kind of short
term bulks of moneyjust prop up a failing system
and and and everybody that works in suchgot no
(34:39):
that the problemsare not going to be fixed overnight
they're going to they're going to needa long term approach.
So so a shift from shortterm fixes to long term planning.
So those are the three process thingswhich I think need to be different
in terms of policy ideas.
I mean, I could talk for England on thisin terms of the outcomes that we want,
(35:00):
but it seems to me
there are some really three big thingswe should be looking to achieve.
The first is a new social contractfor care,
a new kind of dealthat really clarifies and sets out
what people
can reasonably expect from the state
in terms of not only care delivery,but who pays for it as well.
(35:23):
But but also people's sense of obligationand responsive abilities
that we have towards each other.
And I've been very influencedby New Shafiq's book
on the new new social contract.
What we are each other,
because as I said earlier,we're still operating in tramlines of a
(35:45):
1948 social contract when the expectation
was actually that in return for
family allowances for free education,
universal health care and full employment,that basically women would stay at home
and look after the kids and and relativesneeding cash but never written down.
(36:06):
But that was basically the deal.
And of coursethat's gone now, totally unsustainable
and inequitable,but we don't have anything to replace it.
So I think we do need to.
A new social contractthat also would make social
got much more intelligibleand easier to understand and navigate.
(36:28):
The second big change I think we need tolook towards is really turning upside down
the very traditional model of carethat we have at the moment,
which isvery much based on professional discretion
and eligibilityand what's around in your area.
And I think we need to shift the balancefundamentally towards
(36:49):
giving people the opportunityto direct parents support,
not just through relatively crudemechanisms like personal budgets,
but actually giving them rightsthat can be enforced
when they can't get their direct paymentsor whatever.
And really make it possiblefor individuals
(37:09):
to shape their own care and supportand try and recapture
some of the promise of the directpayments movement so that 30 years ago.
And the third outcome,I think this is the final one
and it's crucial and that is a new fundingsettlement, a new poll,
probably part of the new social contractabout what is reasonable
(37:33):
to expect from private contributorsas opposed to the public purse.
And that might be anything from free,completely free personal care
towards, you know, modest contributionsfor the accommodation costs or whatever.
That's where we need to have the debates,I think.
But as I emphasised earlier, we need tothat needs to come at the end
(37:56):
when we're clear about what is social care
that we need and what is itwe're trying to fund in the first place.
But we can't we can't fudge that.
And in the book I talk aboutall sorts of ways that we can raise money.
These are essentially political choices.
I personally feel that
(38:18):
where social
care suffers at the momentis that our tax system in
England is heavily skewed towardstaxes on work rather than taxes on wealth.
And actually we have vast sums of propertywealth, in particular in pension wealth.
Much of it is unearned.
And we ought to be thinkingmuch more imaginatively
(38:38):
about how we broaden the base of that up.
That perhaps gets us into a different,different kind of discussion.
But the point isthat social care is affordable.
You know,it's about our relative priorities.
And I think if we were stuckand went back to 1948, knowing
then what we know now,we wouldn't end up with 170 billion.
(39:03):
And in just budgetand a 22 billion in social care,
but it would probably be muchmore equally balanced.
Thank you very much.
And I think that I am givesa great kind of introduction to to the
those points that obviously in the bookyou develop those a lot more
and I'd certainly recommendto people to go and engage
(39:25):
with those more more in the book.
So just finally,I just wanted to ask you about the,
I guess, the life of the book or whatyour you know, you talked in the style.
LBB Some of your motivations
and the idea of having youryour ideas in one place,
the experience, your personal experiencewith your,
(39:45):
with your father, even the opportunity,I guess a little bit and
you hadthrough, through lockdown in that time.
But what were your hopes for the book?
Yes, I mean, the interestingI decided to write from the word
go that I wasn't goingto write a traditional textbook.
I wanted this to be of interestand relevance to a wide range of people,
(40:07):
kind of reassured by commentsfrom from friends and relatives
that actually they they thought theythey thought it was much more readable
than they thought it was going to be.
I'll take Grace wherever it comesfrom, really.
So. So it was yeah,
it was aimed to be accessible.
(40:27):
So, you know, I hope that
it will be read by a wide range of people.
I suspect
at the moment that it's
I'm preaching to the converted,to be honest.
In terms of current readership.
And, you know,
I'm not I'm not sure how you youhow you you break out of that.
(40:49):
But you know I just wanted to kind of,
you know, just help stimulate the
the debate there, really.
And I think one of the problemswith the social sector,
if I can use that term,is that it tends to be same
people having the same conversationswith each other.
(41:10):
And I do feel that we've
we've got to get the great strength
of social care and the enormous potentialit has to as a force of good in society,
that we need to get that out therein the wider public so that people
can realise just how important this isand what a great thing it is, that it's
(41:31):
somethingthat's that is worthy of investigating,
whether that's through our taxesor whatever other resources.
Through. All that said,thanks very much for that, Richard.
And can I just ask you,
can you just share with listenershow they can get a hold of the book?
Well, gosh, yeah.
So, I mean,I think you can you can get it through.
(41:53):
You can get
it through Amazon, obviously,and other online sellers.
You can order it directly from the policypress at the University of Bristol.
Thank you.
For more episodesin the Care Matters series
and to learn more about the Centrefor Care, please
follow the link in the episode descriptionfor a website and social media channels.
(42:16):
All that remains for me to dois to thank our guest, Richard Humphries.
So thank you very much, Richard.
Thank you.Thank you for listening. Thank you.
The Care Matters podcast is
brought to youby the ESRC Centre for Care and CIRCLE,
the Centre for International Researchon Care, Labour
and Equalities.
In this series, our researcherswelcome experts in the field
and to those giving or receiving careto discuss crucial issues in social care
(00:27):
as we collectively attemptto make a positive difference to how care
is experienced and provided.
Hello
and welcome to Care Matters, The podcast
from the Economic and Social ResearchCouncil, Centre for Care
(00:48):
and the University of SheffieldSerco Research Centre.
My name is Duncan Fisherand I am a research
associate at the Centre for Care.
We are delighted towelcome Richard Humphries as our guest.
And in this episodewe will discuss Richard's new book,
Ending the Social Care Crisis.
This is part of our ongoing serieslooking at New Literature on care
(01:12):
in the book.
Richard considers the report a meaningfuland enduring positive
change for adult social care in England
and what we can learn from historyand other contexts in this regard.
Richard Humphries is a recognisednational commentator
on social care and healthpolicy is current roles
include senior policy adviserto the Health Foundation and Newton Europe
(01:36):
and visiting professorat the University of Worcester.
He was senior fellow at the King's Fund
from 2009 to 2021,
covering social care and integrated care
between 2021 and this year.
He was a member of the Reimagining CareCommission established by the Archbishop
(01:57):
of Canterbury in Yorkand a special advisor
to the House of Lords Economic AffairsCommittee.
Inquiry into Social Care from 2017 2019.
Building on a career in social workover the past 46 years,
he has worked in a variety of roles,including as Director
of Social Serviceand Health Authority Chief Executive,
(02:22):
England's first
joint appointment and in senior rolesin the Department of Health,
working with ministers and senior civilservants.
Richard's new book, Ending the Social CareCrisis.
The subject of this episodewas published in autumn 2022.
Welcome to Care Matters, Richard.Thank you.
(02:42):
So, Richard, could you please
introduce the book to our audienceand tell us what the book's about?
Sure.
And thanks, Duncan,for inviting me to do this.
It's a great pleasureto be doing it with you, and I hope that
listeners will find this helpfuland maybe a bit educational as well.
So so the book
was really bornout of a mixture of motivations, really.
(03:06):
First of all, I was a bit frustratedthat there's lots of stuff
written about adult social care,but none of it in one place.
There's lots of pieces,really good pieces of work
as articles or research papers, blogsand so on about different aspects of the
problems in social care, like workforceor the nature of care services.
(03:29):
The need for users to be more involved.
But nothing reallythat pulls it all together in one place.
So I've been mulling this overfor some time that a need to do something.
Also frustratedthat successive governments over 25 years
have been trying to sort outsocial care and have generally failed.
(03:49):
But we don't seem to be learningfrom that,
and we just seem to be repeatingthe same kind of approaches and processes.
And a lot of the thinkingas well as has been very superficial.
But above all, the debate about socialcare has really been all about negatives,
about
the so-called burden of care,the costs of care,
(04:12):
people stuck in hospitalcare, homes closing,
and nothing about the goodthat social care can do.
And it seems to methe more I've thought about this,
that needs to be the starting point,not the
all the difficult stuff and the problem.
So the book reallyis an attempt to set out, first of all,
(04:32):
what is social care,What do we mean by it?
What does it consist of?
And I've tried to illustrate thatthrough the voices and experience
of people that have hadsocial care needs and use services.
And how has it evolved over the years.
And that throws up some surpriseconclusions
about the causes of the current problems.
(04:54):
What can we learn from other countriesabout how they have gone about it?
But above all, what can we doand how do we need to go about the process
of really sorting out social care
that avoids the mistakes of the past andreally can lead to some enduring change.
So that's in a in a nutshell.
Duncan Okay.
(05:15):
Thank you very much.
And I think that that kind of your finalyour key point there to the question
of what can we do?
Certainly something that willwe can come back to later
in the conversation as and as something
stick in of emphasise and discuss further.
So just in terms ofjust to come back on your
your answer there, you worked inthe social care for a long time.
(05:37):
You've been thinking about these ideas,
but in terms of the actual processof writing the book
and even the opportunity,how did that more practical side
of writing a book for you?
How did that kind of come. To the IT?
So as I say,I've been thinking about it for some time
and and I've written all sorts of stuff.
I've written articles,the journals, peer review stuff,
(06:00):
lots of stuff I
published when I was with The King's Son,but never in a book.
So I made this was a personal developmentchallenge as well.
And then, of course, COVID came.
So lockdown was a great opportunityto kind of to spend the time on it.
But but actually, the actual triggerthat finally kind of
(06:22):
caused me to beginthe process was the personal experience
I had in sorting outcare for my late father,
which I talk about in the book.
But it illustrated for meboth the best and the worst in our current
social care systemand the worst aspects and the
(06:44):
the nature of, say, of the struggle
to get to get good care for him
was was profoundly affecting for me.
Actually, he is me a so-called expert, and
I felt like I was an expertby an experience.
But the good news is that my
we got there in the end and my dadhad superb person centred care in the last
(07:08):
four years of his life and goodsocial care gave him his life back.
So that's that's the good news.
But getting that,that's a different story.
So that was that was the personal processthat caused me to write the book.
And I think that's, you know, it'sa very interesting point a bit that what
navigating the system, because I thinkone of the many things that your book
(07:33):
does well
is as can capture and conveythe complexity of the
the social care system on so many levels
from funding to legalitiesand the organisation it.
I'm conscious of your answerto my opening question about
so much of what we hear about social care,focusing on the negatives on your unit
(07:55):
to think maybe more positively and more,
I guess proactively, but just want toyou know,
you obviously the title of your bookis Ending the Social Care Crisis.
We know that that word isis banded about a lot
and a lot of people are quite criticalof the use of that term
crisis for you, What what are the most
(08:16):
what are the most urgent issuesand social care in England?
I think if you asked many peoplethat question, they would
they would refer to thingslike the workforce.
The fact that this over hundred 60,000vacancies, the lack of money,
austerity, the impact that's had,the impact of COVID,
people stuck in hospital,in the market, in the care that they need,
(08:40):
younger disabled
people not getting choice and control,that sort of thing.
And those are all valid issues, but
I think they are symptoms.
And it seems to me that theythe underlying cause of those symptoms
is the failureto bring social care up to date.
So the in responseto the great sweep of change
(09:04):
we've seen in this countryover the last 75 years.
I mean, interestingly,I think a lot of the problems in the NHS
are caused by a failureto address the new realities of life
as it is 75 years onfrom when it was in 1948.
And and I think the fundamental problemwith social care
(09:26):
is that we're still stuck in this 1948mindset.
The former minister once talked aboutsocial care as dirty little secret,
which is that in fact it's not likethe NHS is not universal.
It's actually a very minimal safety net
for the poorest peoplewith the greatest needs.
(09:46):
And that's become more accentuatedin recent years.
And that is the fundamentaloperating model
for social care thatunless you're relatively poor
and unless you have very highneeds, you're on your own.
Actually,there have been some attempts to kind of
shift
that over the years, that creationof Social services department
(10:09):
in the seventies and that we havethe community care reforms
and the CARE Acthas tried to make it a bit more universal,
but I think it's tried itbecause of lack of investment.
So the basic trajectory of social care,which is a minimal safety net
for a relatively small number of people,hasn't really changed very much.
We still have means testing, for example,in a way
(10:32):
that would be unthinkableif we applied that to the NHS.
So we and because because we're allbetter off or many of us are better off,
that has become a live issue.
The issue of peoplehaving to sell their homes
to today again, wasn't an issue in 1948.
Most people didn't own homes.
(10:52):
Most people didn't live long enough
to meet a need for more care,and if they did, they
didn't get it from their familiesor from the NHS.
Know in a long stay ward or whatever.
So we had all these changes over 75 yearsand we're still operating
the tramlinesfor social care of a 1948 settlement.
(11:15):
That is the fundamental underlyingcause of why we have got so many
so many symptoms and pressuresbubbling up.
Thank you very much.
So there's there's so much in this book
that is is very informativeand nuanced that your point there
(11:35):
about the sum of the differencesbetween the social care and the NHS.
You mentioned about the social care
being means testedand you kind of pointed that out.
You know, the idea of that
and that being the case for the NHSis sort of unfathomable.
And one point quite early in the bookyou state that there's a different,
(11:57):
a different political or moral calculusto entitlements
for social care compared with health care.
Can you say a little bit about that?
Why? It'sone of the things about social care
that interests mea lot about I'm interested to think about
and what about why that may be the caseand why you think that may be the case?
Sure.
So I think it's back to this issueof universality in part
(12:22):
that that back in 1948,when it was all set up
and the NHS was created to great fanfare,
that wonderful leaflet that everybodypushed through the letterbox
explaining what this new servicewas, that everybody could use it.
It would be free at points of use,it would be paid for through taxes,
(12:43):
and because at that point
virtually everybody would needhealth care at some point in their lives.
This created a huge reliefthat was no longer
the fear of a doctor or, you know,
getting the health care you need.
So so, you know, that that kind of
(13:03):
began the country's long love affair
with the NHS,
which continues to this day
despite the current travails.
And and the point isthat the NHS gives people
that a huge peace of mind,knowing that whatever happens
to the health liesand worry about the bill.
(13:25):
Now, the same thinking, I think, wasn'tapplied to social care then.
We didn't talk.
Nobody talked about social care. In 1948.
The opening words of thethe equivalent legislation, social care,
which was the National Assistance Act,basically said not to eliminate the poor.
So that was as good as itThat was good as it got.
(13:45):
And then, of course,life expectancy was much lower.
We didn't see the levels of chronicillness and disease that we have now.
So the the incidence of socialkind of need in the general populace
was very low and people just didn'tdidn't see it as an issue.
And it wasn't for reasons previously
explained.
And that that has persisted
(14:07):
even though all these years later that
the demographic positionhas fundamentally changed.
Most of us now will have some kind ofkind of need at some point in our lives.
We don't know when, we don't knowfor how long we might be end of life.
It might be much earlier in our livesbecause of a disability road accident,
(14:30):
injuries acquired in military servicecould be any reason
or it is just personal misfortune.
So most of us will have a kind of need.
One in seven of us will need carethat costs at least £200,000.
So this isthis is a huge change since 1948.
So I thinkwe'll probably come onto this later.
(14:53):
But I think the public as a wholegenerally don't appreciate
the significance of it
and the fact that social careis now as universal
a need as as is health care.
That wasn't the case in 48,
but we're still operatingwith this kind of twin trap, rather
schizoid attitude that the NHSmust be free at the point of view.
(15:16):
Suarez Social care.
Let's have a debate about
how much people have got to payand what carers have got to do.
And you know, politicians can openly state
that they think that a family
should, should be the primary,should have primary responsibility
for care and all sorts of statementswhich if they were applied
(15:38):
to the NHS, would be greeted with outrage.
Can you imagine anybody having to sella house, pay for their cancer treatment?
You know?
I mean, noother politician would get away with that.
So so I think we do need to exposethis kind of almost hypocrisy, actually,
not much, because need is need,whether it's health care need or it's
(16:00):
for carers at all.
Yeah, And I think that that
final pointyou make there about how often debate
about funding and reform of social careseems to boil down
to propertyand wealth and things like that.
And I think that's
a very important point.
And how can we get beyond that?
(16:22):
How do you think we canwe can get beyond that discussion?
So I think the traditional approachto the social care reform is
essentially consisted of various
kind of reformers and lobbyistsand campaigners,
essentially shouting at the governmentto do something about social care,
(16:42):
to demand that the government is somethingwhich the government of the day
thinks will be poorly understoodby the public,
will be politically unpopular,will cost them votes
and actually they've gotthey've got some cause to believe in that
you look at what happened with so-calleddeath tax, right in the 2010 election
(17:03):
and then Theresa may had the same issuewith her
dementia tax debacle in the 20002017 election.
So it's very easy, particularly electiontime for politicians
to kind of weaponisesocial care and use their opponents
commitmentsas a as a kind of stick to beat them with.
So so I think fundamentone of the fundamental changes
(17:25):
we've got to adopt is actually takingthe arguments to the public
and be
very influenced by the workof an American political scientist,
Joseph Overton, who said that instead of
campaigners, policy makers,instead of trying
to persuade politiciansto do unpopular things,
we've got to persuade the publicto support popular policies.
(17:47):
You've got to get the policyin that Overton window where changes is
is supportable.
And so that's whatI think we've got to do.
We've got to raise public awarenessthat social care is a universal need.
It's important for our peace of mind.
It's important that that carerscan go out to work, that disabled
(18:08):
people can get jobs through the rightsocial care support.
And we don't have to worry about itin some way,
that we don't have to worryabout health care costs.
So that that means turning the policy,
making process on its ownand starting with the public.
Okay. Thank you.
Thank you very much, Richard.
And I was interested in your point
(18:28):
and your opening answerabout the idea of having a book in
and having a lot of these important issuesand ideas in one place.
And I think the book acts as a know,as a great resource for that.
And to that end, aims.
So in chapter two of the book,you discuss the history of social care,
adult social care in England, and you'veobviously touched on quite a lot of
(18:50):
some of these policy changes already,and you've also kind of linked that
and with some of the kind of widersocietal demographic changes.
I just wanted to ask
if there's anything you think that we canlearn from the sort of history,
the historical trajectorythat would help improve things today?
(19:11):
I think the most significant learningpoint
is not not to overestimatethe impact of policy, the policy process.
So, you know, in and when in the last,
I don't know, 25 years
we've seen a procession of white papers,green papers, consultation
(19:31):
documents full of great ambitionsand laudable intent.
But in practiceI haven't really made that much difference
to the lives of people with social careneeds.
So, I mean,there have been some improvements
and some breakthroughs,but generally speaking,
they have failed deliver reformat the scale that we need to to to meet
(19:55):
all those challengesthat have developed over the last
75 years.
The second thing I think we can learnis, is is the importance of unintended
consequences of things that happen thatnobody planned or make explicit decisions.
And there are two thingsthat I regard out in the in the book.
(20:15):
One is about how we ended upwith this huge private market whereby over
90% of social careservices are provided by private
and independent sector organisations.
Nobody ever said,Let's have this big private market.
It came about wayback in the in the 1980s.
And so really this relatively obscuredecision
(20:37):
of a local Social Security office iswho decided, faced with pressure
from local voluntary organisationsand charities running residential services
that Social Security should pay a boardand lodging allowance for their residents
because they were under the coshfinancially and in one of two offices
agreed that it became a national policy.
(21:01):
And that was the
that was the blue light reallyfor all sorts of people piling in
and setting up care homesbecause they could get bulk of the cost
paid for through Social Securitywithout any assessment of need.
And that marked the beginningof a rapid explosion
in the number of private care places
(21:25):
and the emergence of this vast
state funded but privately run industry.
And that's why we have got the
so-called market in social care
that we have today.
Governments tried to try to regulate that.
They brought in the community carereforms.
They cut Social Security budget,
(21:47):
transferred it to councils,and expected them to assess people's needs
for the first time and ration the carewhich they did very effectively.
But of coursethere was the money transfer.
It wasn't enough and it wasn't enough tokeep up with demographic demand and costs.
And that helps to explainwhy so many councils have been struggling
(22:08):
and why providers complainthat councils are not paying them enough.
So that's that's a little bit of history,which most people don't
when a lot of peopledon't fully appreciate that it wasn't
an explicit policy choice to do itthat way.
The other developments,I think, which is enormously shaped
(22:29):
the way social care operatestoday, is changes in the NHS.
And what we've seen over the last 30 yearsor so is a massive offloading
of both costs and activityfrom the NHS on social care.
And although the debate currentlyis about the pressures
that social care creates for the NHS,but actually it's it's two way traffic.
(22:49):
So the NHS has closeda lot of, of its long stay provision.
I mean a lot of these developments
are positive in the sensethat nobody would oppose them.
So they closed a lot of their longstay provision, they transferred
some of that provision for mental healthand then disability
so that to the private sector
(23:10):
they've reduced the number of acutehospital beds,
which is now kind of coming back to two
and they've reducedlength of stay in hospitals
and they do more treatmentson a daily case basis.
But the effectof those little group of changes is to
is to shift their recuperativeto kind of the convalescent
(23:30):
part of a person's hospital journey
onto the onto the shoulders of familiesin the social care system.
So people are discharged from hospitalmuch sooner.
That's usually that's a good thing.
Nobody needs to be in hospital and
unless they aren't,they are acutely unwell.
But again, that wasn't planned and nobodysaid, well, we're going to do this,
(23:52):
but this is going to have an impactall on social care
and on some community health serviceslike district nurses, for example.
Nobody said let's let's kind of planto ship some resource across.
It just happened.
Not any planning, any sort of estimatesof the resource requirements.
So that means that the volume of work,
(24:14):
the amount, what the social caresystem has to do is much greater.
But also I think it means that the acuity
and the complexity of people'sneeds is much greater.
And if you talk to anybodythat's in home care services
over the over the next few yearsand they will say now that they're
dealing with needsthat people have in their own homes,
(24:37):
that previously district nurseswould have done
people in care homes
would say that that thatthat a lot of their residents
now years ago would have been in ain a nursing home.
And people in nursing homeswould say a lot of
their residents would have beenin a hospice or in a hospital.
But so there has been this big shiftin acuity
(25:01):
of need over a number of years.
And that means thatbecause of the resource constraints,
fewer people are getting more care,
they're getting more intensive carepackages of care and support.
And it's also got big implicationsfor the nature of the workforce.
You need to deliver thatat the skill levels, which is why these
(25:23):
absolutely absurdto suggest a someday that such care
is not a skilled occupationpatently is not the case anymore.
If you ever if it ever was.
So those are
those are the two of the biggestkind of factors we can only think of that
we can learn from historyabout unintended consequences.
(25:44):
And don't overestimate whatthe latest Green Paper white paper is.
It's not going to change the worldpublicly.
Thank you very much.
And in termsof thinking about another context
or moving from the historical contextto the I guess, to the
the geographic of the political context
in chapter five, if you look abroad.
(26:06):
And so can you can you briefly seewhat what we could learn from
from other countries?
Maybe maybe give an example?
Yeah.
So I spent a lot of timeactually looking at other countries
and, you know,
there's different approaches.
And I think the one obvious learning point
is that there is no magic bullet herethat we that we you could say, well, if,
(26:28):
if we do, Australia did or whatwe have done, everything will be okay.
And so there is no one set of solutionsthat can easily be replicated
in another country because it's all very
context specific.
Every country's got its own unique
context and culturewhich shapes the way it does things.
(26:51):
And I think this stories call itpath dependency so that when Germany,
for example,
was reforming itsits approach to social care,
it adopted a long term careinsurance doctor.
It went down a social insurance. Right.
And that'sbecause there is a long tradition
in Germany, particularly through healthcare of social insurance.
(27:12):
It began with Bismarck in the 19thcentury with unemployment
insurance.
So Germany went down that road.
Scandinavianshave opted more for general taxation
as a as a as a as a funding method.
So every every country is differentin that sense.
(27:33):
But I think I think on a positive note,I mean,
we can take hope from the factthat many countries
have introduced long term reforms,
you know, a whole range of countries
across the world have done this.
I don't think anybody has really crackedthe problem.
It's a bitlike painting the fourth bridge.
(27:56):
So what most countries tend to find
is they introduce changesto make that care better.
And whenever you do thatas a learning point,
the costs go upbecause more people come forward
and needs needs help rebuild.
So there's that debate about, well,how do we make this sustainable?
And then they they arejust as they go along.
(28:18):
So even countries with social insuranceschemes find that they have to look
at kind of
subsidising it with moneyfrom general taxation
countries,even countries like Sweden or Netherlands,
Scandinavian countries generally
(28:38):
rely on some personal payments to top up
relativelyhigh levels of state expenditure.
So so I think the lesson isthat you can do this.
It is possible to introduce change,
but you then have to kind of adjust itas you go along
and not expect, not expect itto kind of improve things all at once.
(29:01):
And and that's the third point actually.
It takes time.
And if you look at if you look at Japan
and Germany, which is to the examplesthat are often quoted,
I mean, they took over a decadeto kind of launch the process
to get people on
(29:21):
board, raise awareness of the issues.
And it was not that methodical,
planned approach, preparing around
instead of doing whatwe've tended to do over the years,
which is plunge straight into let'slet's have a levy on people's estates
to pay for social care, never mindstarting with engaging with the public
(29:43):
about what is social care,why is this important?
How much does it cost?
These are some of the wayswe could pay for it.
What do you think we go straight in with?
You know, let'shave this new tax to pay for social care,
which immediatelyfrightens the horses and talks.
You finance the whole issue.
So I think there's a lot we can learnfrom other countries about the process.
(30:05):
I've been particularly impressed inin the United States with the came
across Generations movement,which is a very broad alliance campaigning
groups trying to get improved careand support for carers of all ages
and both for children and for adultsand for younger disabled people
who I think have had some success
(30:27):
in creating public support for change.
That what I talked about earlier,that the public realisation
good care is something we need
to live
our lives, to live a good, a good,a good life.
So there's lots of movements like that
I think we can learn from in Australiaand I have every Australian counts.
(30:47):
We're in some really, really good work on
breaking beyond, breakingout of the shackles of the traditional
policymaking processwhereby the government issues
a Green paper,the statutory consultation period.
You have to write here, this is muchmore fresh and much more engaging.
Thanks very much, Richard.
That's really interesting
(31:08):
how these insightsfrom from different, different places.
So as you said in your opening answer,you know, one of the things
you're trying to think aboutis that big question or what can we do?
And so you save your most deepest
and most developed ideas for reformthrough the final chapter of your book.
But yeah, you make suggestionsand recommendations throughout the book.
(31:32):
Maybe for the potential readers,
can you maybe briefly summarisesome of your your kind of key proposals
for reforms or some of the
key things that you thinkit would would make a difference?
So first of all,I think it's it's important to
distinguish between process and outcomes.
(31:54):
I think
a lot of the debatein England has been quite technical.
It's been about policy options,funding methods
and so on, and it's been quite,quite narrow
and we haven't really thought
very much about the process of change.
You can have all these wonderful ideas,but how do you actually get them
(32:18):
and implement it?
So, so I think this is three,I call it a different road to reform.
And there's three things that have gotto be fundamentally different.
So the first is, is a is a new focus
on building public supportfor for better social care.
And I talked about that earlier,so I won't repeat it,
(32:40):
but it's just kind of making people awarethat the social care is really,
really important for usto have a good life, to enjoy
the peace of mind that we havewith healthcare through the NHS.
So so, you know,I think we need a whole load of
public
conversations, probably locally,then builds up into a
to a national debate and dialogueand to get social care
(33:04):
into the Overton windowof, of of realistic change.
Second thing we've got to do differentand it's it's part of the
process of buildingpublic support is to really get
into some of the toolsand techniques of deliberative democracy
and co-production of involving peoplewith lived experience in social care,
much more of engaging with local groups
(33:28):
and citizens about this.
There was some some recent examples
of focus groups of citizen assemblies
and so on, participatory budgeting
to to really get alongside
people and work up some ideas
and then get people on boardthe issues that need to be tackled.
(33:53):
The third thingI think we've got to do is,
is to shift from short term fixes,
which I think has been a real problemto social capital in the last
7 to 10 years that
government has actually put more money in,but it's done it in the least effective,
efficient way is short term last minutehand-to-mouth funding.
(34:15):
That's all going to be spentwithin months.
And, you know,
and actuallyit almost perpetuates a broken system.
It it props it up.
Instead of building a bridgeto a better system, those kind of short
term bulks of moneyjust prop up a failing system
and and and everybody that works in suchgot no
(34:39):
that the problemsare not going to be fixed overnight
they're going to they're going to needa long term approach.
So so a shift from shortterm fixes to long term planning.
So those are the three process thingswhich I think need to be different
in terms of policy ideas.
I mean, I could talk for England on thisin terms of the outcomes that we want,
(35:00):
but it seems to me
there are some really three big thingswe should be looking to achieve.
The first is a new social contractfor care,
a new kind of dealthat really clarifies and sets out
what people
can reasonably expect from the state
in terms of not only care delivery,but who pays for it as well.
(35:23):
But but also people's sense of obligationand responsive abilities
that we have towards each other.
And I've been very influencedby New Shafiq's book
on the new new social contract.
What we are each other,
because as I said earlier,we're still operating in tramlines of a
(35:45):
1948 social contract when the expectation
was actually that in return for
family allowances for free education,
universal health care and full employment,that basically women would stay at home
and look after the kids and and relativesneeding cash but never written down.
(36:06):
But that was basically the deal.
And of coursethat's gone now, totally unsustainable
and inequitable,but we don't have anything to replace it.
So I think we do need to.
A new social contractthat also would make social
got much more intelligibleand easier to understand and navigate.
(36:28):
The second big change I think we need tolook towards is really turning upside down
the very traditional model of carethat we have at the moment,
which isvery much based on professional discretion
and eligibilityand what's around in your area.
And I think we need to shift the balancefundamentally towards
(36:49):
giving people the opportunityto direct parents support,
not just through relatively crudemechanisms like personal budgets,
but actually giving them rightsthat can be enforced
when they can't get their direct paymentsor whatever.
And really make it possiblefor individuals
(37:09):
to shape their own care and supportand try and recapture
some of the promise of the directpayments movement so that 30 years ago.
And the third outcome,I think this is the final one
and it's crucial and that is a new fundingsettlement, a new poll,
probably part of the new social contractabout what is reasonable
(37:33):
to expect from private contributorsas opposed to the public purse.
And that might be anything from free,completely free personal care
towards, you know, modest contributionsfor the accommodation costs or whatever.
That's where we need to have the debates,I think.
But as I emphasised earlier, we need tothat needs to come at the end
(37:56):
when we're clear about what is social care
that we need and what is itwe're trying to fund in the first place.
But we can't we can't fudge that.
And in the book I talk aboutall sorts of ways that we can raise money.
These are essentially political choices.
I personally feel that
(38:18):
where social
care suffers at the momentis that our tax system in
England is heavily skewed towardstaxes on work rather than taxes on wealth.
And actually we have vast sums of propertywealth, in particular in pension wealth.
Much of it is unearned.
And we ought to be thinkingmuch more imaginatively
(38:38):
about how we broaden the base of that up.
That perhaps gets us into a different,different kind of discussion.
But the point isthat social care is affordable.
You know,it's about our relative priorities.
And I think if we were stuckand went back to 1948, knowing
then what we know now,we wouldn't end up with 170 billion.
(39:03):
And in just budgetand a 22 billion in social care,
but it would probably be muchmore equally balanced.
Thank you very much.
And I think that I am givesa great kind of introduction to to the
those points that obviously in the bookyou develop those a lot more
and I'd certainly recommendto people to go and engage
(39:25):
with those more more in the book.
So just finally,I just wanted to ask you about the,
I guess, the life of the book or whatyour you know, you talked in the style.
LBB Some of your motivations
and the idea of having youryour ideas in one place,
the experience, your personal experiencewith your,
(39:45):
with your father, even the opportunity,I guess a little bit and
you hadthrough, through lockdown in that time.
But what were your hopes for the book?
Yes, I mean, the interestingI decided to write from the word
go that I wasn't goingto write a traditional textbook.
I wanted this to be of interestand relevance to a wide range of people,
(40:07):
kind of reassured by commentsfrom from friends and relatives
that actually they they thought theythey thought it was much more readable
than they thought it was going to be.
I'll take Grace wherever it comesfrom, really.
So. So it was yeah,
it was aimed to be accessible.
(40:27):
So, you know, I hope that
it will be read by a wide range of people.
I suspect
at the moment that it's
I'm preaching to the converted,to be honest.
In terms of current readership.
And, you know,
I'm not I'm not sure how you youhow you you break out of that.
(40:49):
But you know I just wanted to kind of,
you know, just help stimulate the
the debate there, really.
And I think one of the problemswith the social sector,
if I can use that term,is that it tends to be same
people having the same conversationswith each other.
(41:10):
And I do feel that we've
we've got to get the great strength
of social care and the enormous potentialit has to as a force of good in society,
that we need to get that out therein the wider public so that people
can realise just how important this isand what a great thing it is, that it's
(41:31):
somethingthat's that is worthy of investigating,
whether that's through our taxesor whatever other resources.
Through. All that said,thanks very much for that, Richard.
And can I just ask you,
can you just share with listenershow they can get a hold of the book?
Well, gosh, yeah.
So, I mean,I think you can you can get it through.
(41:53):
You can get
it through Amazon, obviously,and other online sellers.
You can order it directly from the policypress at the University of Bristol.
Thank you.
For more episodesin the Care Matters series
and to learn more about the Centrefor Care, please
follow the link in the episode descriptionfor a website and social media channels.
(42:16):
All that remains for me to dois to thank our guest, Richard Humphries.
So thank you very much, Richard.
Thank you.Thank you for listening. Thank you.
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