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Social care is a profoundly political issue. Political leaders are responsible for two critical functions;
defining society’s vision for how life should be for older and disabled people
the extent to which the vision is resourced
Political leaders need the professionals to translate their vision into reality on the ground, and to inform them of the level of funding they need to make available. Professional leaders thus serve their political leaders, who serve society.
But in Bristol we saw the exact opposite. We had the extraordinary sight of the Labour lead for social care and the Mayor proclaiming that, in the light of the responses to the consultation, the proposed Fair and Affordable policy not go ahead, yet within a matter of days, signing off on a budget prepared by their professionals that incorporated an even more draconian version of the policy (link to the paper that critiques the budget).
The Council’s officers were using their political leaders to front a wholly phoney ‘consultation’. They were simultaneously spending large amounts of public money on a management consultancy to develop the policy and on appointing a ‘hit squad’ of social workers to deliver it.
Professional control
The question arises - how could officers treat not just the public, but their political leaders, with such disdain, and how could political leaders respond so meekly and submissively?
The answer can be found in Parts One and Two of our dossier Unveiling the Truth about Social Care in England. Professionals don’t identify need to deliver a political vision. They identify need to ensure the cost of meeting it comes within whatever budget they happen to have.
In a moment of honesty, the Director and his team may well admit their consultations were a sham, their promises of ‘co-production’ phoney, and that they have manipulated and misled service users, the public and their political leaders. They may admit that to ignore the enormity of the impact on the wellbeing of a person supported at home above the cost of residential care in order for the Council to declare the spend is not cost effective is not only a breach of the law, but an abandonment of their own professional values. They may even admit that to save money by recategorizing authentic needs into mere wishes in order to deny any responsibility for meeting them is a yet further breach of the law and professional values.
But they will believe all these wrongs are justified by what they see as a greater good; to secure funding at current levels.
At the core of social care leaders’ view of the world they occupy is that they deliver a deeply unpopular service. The only reason political leaders put money into social care is under threat of legal action. Making the only needs met a legal duty to meet serves precisely this purpose. Year on year, local politicians sign off on budgets they are told are required to meet all ‘eligible’ needs.
But the politicians have not the faintest idea what an ‘eligible’ need actually is. Nobody does. Unveiling the Truth shows it means whatever each council needs it to mean in order to stay within budget.
They can claim, with full justification, that their strategy works. Last year’s spend of £28BN was similar in real terms to the £18BN in 2010. While all other local authority services have been devastated, social care has been protected.
The ‘legal needs only’ strategy is inherently built to produce stand still budgets.
But there are four arguments to counter any sense of achievement in securing standstill budgets.
The first is that pre-austerity budgets left huge swathes of needs unmet. In 2012, the Minister for Care was batting away estimates from think tanks like the Kings Fund suggesting an uplift of some £7BN - 40% - was required to address unmet need.
The second argument is that demography means demand is growing. There has been a 15% growth in the older population since 2011. The growing gap year on year between needs and resources, already large before austerity, is why Bristol feels the need to act. It is doing so in the only way it knows how.
The third is that calibrating need to resources not only means councils can never know how much money they really need, Part Three of Unveiling the Truth shows it results in chronic misuse of the available money
And the fourth argument is the irony that social care’s leaders are themselves the very source of social care’s unpopularity. They promote a public narrative of crisis. The system they have created is experienced as highly complex to navigate with a lack of transparency as to how and why decisions are made. There is a lack of trust in social work and a fear of neglect and abuse in care. No-one wants to invest in a system that isn’t valued, understood or trusted.
Political submission
We will never know whether the Mayor and his lead member for social care were aware they were being used to tell an untruth when they announced that the Fair and Affordable policy would not go ahead at the very moment officers were putting the policy into place. Whatever the level of awareness, they were complicit.
In so doing, they were merely conforming to a well established national pattern of political acceptance of professional power.
Political leaders fear social care for being a bottomless pit of demand. Professionals, by shutting the lid firmly on demand at a cost national and local political leaders are able and willing to fund, remove the fear. The professionals give politicians the easy way out.
The irony is that social care is only a bottomless pit of demand in the way its professionals deliver it. There is, indeed, no limit to dependency in a system that, as Unveiling the Truth shows, induces dependency.
But social care delivered as it should be – supporting people to make the best of their lives – is not a bottomless pit. No healthily functioning person wants any more support than the minimum they require to achieve what they need.
Summary
Bristol City Council has demonstrated exactly the same dysfunctional relationship between political and professional leaders as Part One of Unveiling the Truth shows has been the case in Barnet. Both Labour run, both leaderships defer without question or challenge to professional omnipotence. Both political leaderships have, in different ways, contorted themselves to do so;
In Barnet, the Labour leadership succumbed within days of taking power to the professional requirement to conform, despite knowing conformity to be unlawful and immoral
In Bristol, whilst the political leadership have had no counter briefing as was the case in Barnet, they were prepared for their willingness to compromise their integrity to be exposed.
The consequence is the abdication by professional leaders of their two key responsibilities for the healthy functioning of the social care system - setting a vision for how life should be and resourcing it to the best of their ability.