Could a more joined-up adult social care sector unlock progress on reform?

Fragmented. It turns out that when you ask 35 leaders in adult social care to sum up their sector in one word, the one they use the most is ‘fragmented’. (Close behind is ‘uncoordinated’).  

Nor do they think the sector has been effective in bringing about improvements to the social care system in the last five years. As many think it has been ineffective as effective.  

What can be done about that? 

To begin that discussion, we brought 35 of the most influential voices in social care together for two days at Cumberland Lodge in Windsor, with the support of The Rayne Foundation and Joseph Rowntree Foundation. The aim of the session was to consider whether, with the latest independent commission on social care – under the leadership of Baroness Casey – now in full swing, there was a fresh opportunity to break the logjam of reform. 

We brought together a diverse group, representing people with lived experience, local government, campaigning charities, providers, government, politics, think tanks and academia, workforce representatives and sector support bodies. Sessions were held under the Chatham House rule, so contributions can be repeated but not attributed to any one individual.  

Surprisingly it was, as far as anyone could remember, the only time that such a broad group had been together at a similar event.  

The aim was to ‘hold up a mirror’ to the sector by hearing from experts within and outside the group about how adult social care is seen by politicians, civil servants, the media and the public, and how this might affect its ability to bring about reform. We then wanted to take any challenges that emerged from that and consider how – whether – the sector should respond to them.  

The result was richer and more positive than we could reasonably have imagined, thanks in no small part to the willingness of participants to hear sometimes uncomfortable truths, challenge themselves and each other about what needed to be done, and to look hopefully to the future. 

Often, the challenges came back to that core issue of ‘fragmentation’ and what might be done about it. Politicians and civil servants in particular highlighted the difficulty of working with such a diverse and uncoordinated sector. It diluted the impact of the sector and meant that it was much harder for government to identify priorities for action. This challenge was acknowledged, though there was less consensus around a solution. Some thought a single representative body was needed while others thought this impractical given the competing interests it would have to represent. Some thought a single body to represent providers would be a start.   

We also heard that the sector’s messages were not always clear and that even where there was a degree of consensus, it could easily be drowned out by the ‘buts’: the broad agreement that higher pay for care workers is a good thing, being one case in point. Some diagnosed a need for more message discipline, and rigour in keeping disagreements behind closed doors, but for others these challenges spoke of an embattled sector that needed to be clearer and more confident in articulating its value and potential.   

What emerged were some tentative steps towards more collaborative working on specific issues, as a means of dipping a toe in the waters of larger scale collaboration. Groups discussed – and have since progressed outside the meeting – work on a small number of pressing issues where a more joined-up sector approach felt necessary. These included the sector’s response to NHS plans for neighbourhood working, and to the upcoming interim Casey Commission report and developing a clearer statement of the common problems faced by the sector.  

Potentially as important as these immediate steps, however, was the desire we unearthed to continue to work together on a wider range of critical issues, raised by external speakers and participants, which might require longer term action. These include: 

• Relationship with central government. It was striking that in thinking about previous victories, the 2014 Care Act was highlighted, not just as a good piece of legislation, but also an example of how constructive and close working between the (then) Department of Health and many parts of the sector delivered results for everyone. The question is what it would take for the sector to get back to that way of working – and to what extent it needs to more explicitly get alongside the government’s current agenda to do this. 

• Gaps in understanding. The lack of public and political interest in social care was a recurrent theme in the discussions, with the former recognised as feeding the latter, but our discussions also unpacked significant gaps in our understanding of how this could be addressed. Focusing on people not systems, having a clearer social care ‘brand’ and identity, and nailing the economic impacts were all thought to be potential routes to success, but ultimately we lack the definitive answer on what will work – and the question of how we might fill these knowledge gaps remains for another day.  

• Innovation and success. There was a sense of frustration that far more good things are happening across the social care field than even those in the sector know about – and that social care leaders are ill-equipped to tell the stories of great care and positive innovations. Filling this gap would not simply be about providing balance to negative stories but also about demonstrating that the sector is worth investing in.  

These are not issues that can be resolved overnight. However, it was encouraging that there was a strong desire among the ‘Cumberland Group’ to continue working together and sharing honest and open reflections about our effectiveness.