Seminar on key current care issues

In terms of the context and future for adult social care, austerity was “the new real”, David Behan told Care Conversation delegates, with the recent Budget and Autumn Statement confirming that “the squeeze would stay on until 2016/17 and beyond”, coupled with an “unprecedented” reduction in public spending of £80bn over four years.

Previous recessions had lasted little more than two years, he said. “It was tough running public services but the mentality was ‘let’s batten down the hatches and get through it’. This one started in 2008 and we don’t know when it’s going to finish. The maps we previously had to navigate this stuff just don’t exist.” The economy was 4% smaller than in 2008 and productivity was a key issue, he stressed.

As was often pointed out, the aging population also presented a huge challenge. “The girl who’s going to live to be 126 is alive and living with us now, and she’s going to spend more of her life outside of work than in it –that’s the challenge of the retirement age.”

Another major issue was the question of trust, he explained. “GPs still do well in British Social Attitudes Surveys when it comes to trust, but the level of trust in politicians is lower than it’s ever been, and that goes for senior civil servants as well. So the question is how do we advance the debate about how we reform a system like social care, and a major institution like the NHS, when the people charged with doing that are not trusted.”

The Department of Health had published its vision for the adult social care sector in November 2010, he said, with the Care and Support White Paper and progress report on funding reformdue soon. The Dilnot Commission Report in July 2011, meanwhile, had warned that people were not making provision for their later years. “That’s despite the fact that 70% will need care, while 60% thought that social care would be free from the point that they needed it – it never has.The question is how do you incentivise people to make plans and provisions for their later years?”

The figures forerunning a tax-based system did not add up, he said. “The key challenge is ‘can the younger generation pay for the older generation?’ and the answer is probably no. ”The market for insurance and savings products for care had also never developed in the UK, he continued, and a much more appropriate regulatory framework for financial products was needed.

Legislation would be carried through at the earliest opportunity, he told the seminar. Prior to this, however, the Department of Health had embarked on a period of engagement to gather views. Among the findings were that there should be shared responsibility for improving the system and a shift to an approach focused on building individual and community assets. People should also be empowered with choice and control through a universal offer of national and local information, advice and care navigation. “We want to build on those strengths and assets in the community. It’s important that people get the information they need, rather than make distress purchases.”

It was also vital to rebalance the social care market to encourage innovation and preventative action, he said, while quality of care was still too poor. “We need to strengthen the social care quality framework and build a system based on quality, not cost – the whole basis of commissioning needs to shift to something based on quality and outcomes. What concerns us is that at the moment we seem to be engaged in a race to the bottom.” It was important to develop shared outcomes measures, based on the experience of users and carers, he stressed.

The department was continuing to work with stakeholders to develop policy recommendations, while feedback from the engagement process would inform policy development and decisions. Much, however, would come down to questions of behavioural economics. “Will people change their behaviour? You can implement changes, but how will people respond to them?”

There were five key influences on quality, he said – commissioning, the providers, the professionals, the regulator and the voice of the people who use services. “Regulation alone doesn’t produce quality. Let’s not forget that providers are under a moral and ethical, as well as legal, duty of care.”

It was time for a “balanced discussion about how you get quality into the system”, he told the seminar. “The smart operators recognise that their future viability is based on reputation. And reputation is something that’s easy to lose.”

About the speaker:
David was appointed Director General: Social Care in the Department of Health in June 2006. He took up post in September 2006. From November 2003 he was the first Chief Inspector of the Commission for Social Care Inspection. From 1996 to 2003 he was Director of Social Services, London Borough of Greenwich and a member of the Greenwich Primary Care Trust Board and the Professional Executive Committee. In 2003 he was the President of the Association of Directors of Social Services. David was born and brought up in Blackburn in Lancashire and graduated from Bradford University in 1978. He was awarded a CBE in 2003, and in 2004 was awarded an Honorary Doctorate in Law by Greenwich University. He is married with two sons.