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Why we need social innovation in home care for older people

By Paula Hyde

The public debate on the issue of how we look after the older members of our society continues to rumble on with limited prospect of a solution and this week’s report from the Care Quality Commission highlighted the crisis we are facing in adult social care. At last month’s Fairer Futures conference, we examined the provision of domiciliary care for older people and launched our report entitled Why we need social innovation in home care for older people, we explain why good intentions are not enough, and that to implement real change it is necessary to think radically.

Our report provides a critique of why those responsible for commissioning care in the home have made uneven and inconsistent progress towards personalisation and outcome-based commissioning. It goes on to propose an alternative radical social innovation approach to thinking about ways in which home care can effectively and consistently deliver choice, control and independence across the board. The argument in this report is set out in three main sections:

  1. We describe the hyper active state and the centrally driven reforms in the sector and explain the disappointment which arises from thinking about home care through a narrow market citizenship lens. Personal budgets, direct payments and local authority sponsorship of competitive markets have disappointed in the case of the elderly because they are built on a limited understanding of choice, control and independence and because they accept the underlying business model and commissioning practices as given.
  2. We analyse how the activity specifics of home care intersect with the sectoral business model to create an intractable mess so that putting more state money in is a necessary but insufficient condition of reform. At an individual level, the sector consists of travelling carers performing physical maintenance tasks on unsettled rotas. At firm level, the branch retail business model sees firms choosing to pursue diverse objectives of resilience or cash generation; specifics which are often obscured by provider demands for a fair price from local authorities.
  3. We sketch a new agenda for radical social innovation that connects with a much broader notion of full citizenship which is about our duty towards carers and those who are cared for as much as their rights to a decent living. In our view, this should be led by local authority commissioners, empowered by mobilisation of a political coalition for change; engaging old people and other citizens in political debate and choices about the general form of provision for the elderly and recognising the huge social value of maintaining precarious independence in our later years.

This report draws on the CRESC research centre’s concept of the foundational economy; which delivers welfare critical goods and services – including health, care and much else – to all the population. The concept of the foundational economy is important because it challenges mainstream thinking about what economic and social progress and ‘success’ mean; and because it allows us to develop practical policies for citizen welfare. Social care is of interest to us as researchers because it provides an essential service to large numbers of citizens and, when done well, it encourages social participation and improved quality of life for cared-for people and their families. In addition the sector is a large employer which again if it acts responsibly has the potential to provide secure and properly paid jobs, while improving the capabilities of the workforce. Head along to our reports on the CRESC website and get involved in the discussion!