Last Tuesday the nation might be forgiven for thinking that the news of the day was the royal marriage announcement. Only the sharp-eyed will have caught the news about the Department of Health’s ‘vision for social care’ and outcomes framework.
The Department of Health steers the tricky course between the nightmare icebergs: over-regulation leading to a stunted, over-bureaucratic, box-ticking system where the service user is a long way down the list of priorities; or under-regulation where the service user is left to arrange care with no confidence about the services available, relying on their personal tenacity and energy of family and friends to check that services are going OK.
This is a tricky balance – Government is keen to avoid the scandal of council-provision that is mediocre or negligent but neither, in this era of localism, does it want to micromanage or be seen to be dictatorial towards councils.
The calls of social care users, families and stakeholder groups have been for many years to focus on the outcomes scored by the service provided, rather than providing a service and assuming job done. Critically, outcomes for the service user are the imperative, rather than outcomes for the service or the commissioner.
This proposed outcomes framework is an attempt to match more closely the future provision of care and support and the way it is monitored. Personal budgets and self-directed support do not sit easily with a rigid safety net which counts hours, type of provision and money.
The new proposals in essence offer service users a minimum level of safety and quality that will continue to be monitored by the Care Quality Commission at a council and service provider level. Secondly, minimum standards are removed, and replaced by outcomes standards. Not monitored, benchmarked, published in a league table, but available to those who want to know, or are aware that the information exists. The idea is that services will realign themselves to take more account of the views and reaction of service users to their care package and to the sector on the front line of this provision. The market will prevail, and service users will make sensible, informed choices when they purchase services in their area.
In theory, the outcomes framework is a positive move forward, not least because anything that supports providers and service users to access services which work is brilliant.
But there are a few issues to navigate before this vision becomes a reality. Firstly, regulation and monitoring has been changed frequently over the last few years alone. There are hints within the consultation document that councils may want to check on the services provided locally, coming back almost full circle to council-based inspections. Can the sector cope with any more change?
Secondly, this vision relies heavily on people in the local area who know about social care, take an interest, are active lobbyists and are confident in their ability to challenge. This is localism at its best, but what happens if there are no local people checking up on the quality of services and holding the council to account? We’re not talking about the state of the local pavements or library services which are more obvious and easy to check. CQC will pick up on areas where there are considerable concerns, but where will average or mediocre performance be highlighted?
Thirdly, there are many descriptions and references to the ‘sector’. However, there are many parts to the social care sector, and not all have the same opinion about social care. Achieving consensus and therefore influencing local councils effectively will be a great challenge.
Fourthly, I remain concerned about the ability of the market to arrange itself so that only the best care is provided. There is insufficient evidence that the care market is developed enough to be able to rely on this alone as a net to fish out the poor performers.
We will wait and see. This is the first step towards a much more flexible way to inspect and regulate. However, there will be some that remain unconvinced that a hands off approach protects the most vulnerable and steps in to protect and ensure that care works.