United we stand. Divided we fall.

From Aesop’s ancient Greek fables, Christianity’s earliest days, the US civil war, the fight for independence for India, to World War Two, leaders across history have understood that it is only through strong alliances and collective action that real success can be achieved.  However powerful the cause may be, time and again history has shown that individuals and groups working alone, rather than as a unified team, are doomed to failure.  This imperative for strong, collaborative leadership could not be clearer cut for the social care sector.

The challenges facing the social care sector could not be more stark.  Indeed, the breadth and scale of these challenges is chilling: chronic under-funding, an exodus of burnt-out staff, public antagonism following pandemic visiting restrictions, quality failings, public mis-understandings, regulatory failings, providers quitting the sector or going under…  And so the list goes on.  This is compounded by a mainstream media all too ready to put the boot in to the sector; and, Governments that appear neither to properly understand the sector nor to have the political will to deliver the change required to deliver a social care sector worthy of a first world economy.

Post-pandemic, it is undeniable that the public’s appreciation of the social care sector has improved but this has not translated in to the political will to deliver the changes required or the funding necessary to deliver social care adequately.  That campaigning to withdraw the hard-fought Health and Social Care Levy (however imperfect) by the contenders for the Conservative Party leadership was seen as a vote-winner is a sad indictment not just of the candidates themselves but of the sector’s ability to represent itself effectively to those in power or to the public.

The sector is blessed with many fantastic leaders, representatives and public voices.  The individuals in such roles, many of whom I am genuinely proud to work with, are eloquent, deeply knowledgeable and powerful advocates for the sector.  They and their organisations work tirelessly to persuade Ministers, civil servants and the general public of the need to properly support and fund the social care sector.  But, I fear that the blunt truth is that none of us have really done a good enough job.  Can any of us, hand on heart, say that we have done much more than knock off the roughest of very rough edges of social care policy and funding?

Compare this with the NHS.  The NHS is, quite rightly, beloved by the public.  Whilst we all ‘clapped for carers’ during the pandemic, I would suggest that the vast majority of the public clapped for NHS workers in their local hospitals and GP surgeries not for the care professionals in their local care services.  Turn back to the London 2012 Olympics and it was Danny Boyle’s moving homage to NHS that was front and centre of the opening ceremony’s celebration of all that is great about the UK – not social care.

This matters.  This is not a popularity contest but it is about ensuring that the country and its people are properly supported through an effective, efficient and high-quality social care system.

The NHS is, of course, very differently structured than social care, but its leaders’ ability to represent its interests to Government and the general public is deeply impressive.  The NHS and social care are, of course, inextricably linked and working together better is vital; but equality of arms is crucial for effective partnership.  At the moment, the NHS Goliath is up against myriad social care Davids all fighting for their narrow interests – and without a slingshot in sight!

As we move in to a world of Integrated Care Systems, there is a massive risk that social care’s interests will be trumped by the NHS at each and every battle for ever-constrained budgets.  And, at a national level, ensuring long-term adequate funding for social care alongside the NHS’ demands will remain equally precarious.

Earlier in my career, I was a Senior Civil Servant (I saw the light some years back though!).  I was lucky enough to serve in a range of different government departments dealing with a range of different sectors.  A truth that ministers and Civil Servants do not usually share is that delivering policy change in sectors with weak, diffuse representative bodies and leaders is much easier.  Not better.  But definitely easier.  In the absence of strong, well-resourced and unified representative bodies, it is simply more straightforward to push through change without effective scrutiny.  If those in civil society aren’t able to counter poorly-thought through policies, weak supporting evidence, uninformed views of the reality of delivery structures, then Governments won’t deliver substantive positive change.  Governments and ministers may get some nice headlines in such circumstances – but they won’t tackle the issues effectively. 

The social care sector, as a whole, employs some 1.6M people – more than the NHS.  The sector employs 5% of the country’s entire workforce, twice the size of the agricultural sector. The heft of the sector should mean that we are listened to by decision-makers.  But I don’t see any prospect of Social Care Today replacing Farming Today on Radio 4! 

The social care sector is, by design, a patchwork quilt of provision.  The sector spans local authority providers, for-profit operators, charities and social enterprises, ranging in size from the very smallest of local providers to significant international organisations.  The sector covers provision for the elderly, those with learning and physical disabilities, specialist education, support services and so much more.  And the modes of care – residential, domiciliary, housing provision, etc – are varied.  Whilst the general public tends to equate social care solely with elderly care, we know that the sector supports children and adults of all ages.  Despite this all being a result of statutory design, all of this complexity sometimes seems to come as a surprise to Westminster and Whitehall…!

But the complexity of the wiring underneath the social care sector really shouldn’t be replicated in our representative bodies.  I never cease to be surprised at just how little interaction – or career progression – there is between different constituent elements of the sector.  And it seems that we have felt the need to establish an alphabet soup of representative bodies for each of these elements.  Whilst this specialist knowledge and understanding is vital, when it comes to ‘big picture’ politics we are shooting ourselves in our many feet!

As I note above, the sector is blessed with many great leaders and organisations.  Diversity not division is vital to effective integration.  We must come together now if we are collectively going to be taken seriously and force Governments and Ministers to properly grasp the social care nettle.  And to ensure that the social care sector as a whole can argue its case powerfully at local levels in new integrated decision-making structures.    It is fine to have effective interest groups to build communities of interest and contribute to the debate, but these need to feed in to a single national representative body.  Unless we develop effective, unified leadership for the social care sector – all of the sector – the sector will continue to be under-valued and starved of the political direction it needs.  The sector’s long-term health depends on collective and unified representation, advocating clearly and powerfully for all of us.  How else can we expose the laughable claim that ‘we’ve fixed social care’?

First published in Caring Times