Demos Daily: The Commission on Residential Care

The social care crisis has been one of the greatest challenges of our generation. Successive Governments have come close to coming up with a long term plan but never reached the finishing line – in practice little has changed. Meanwhile, the coronavirus pandemic has given the social care crisis a whole new meaning: shining a light on hardworking carers up and down the country whilst exposing the cracks in the system even further. Once this is over, we can hope that politicians from all sides can come to a consensus in the need for urgent plans to reform the care system. Back in 2014, our Commission on Residential Care put together a series of proposals for putting housing with care at the heart of the care system.

Read the findings and recommendations from the Commission here, and the foreword from the Chair of the Commission – former MP Paul Burstow – below.

Foreword

Over 450,000 older and working-age disabled people live in residential care, yet the many acts of hospitality, human kindness and great care are drowned out by stories of shocking abuse.

This report starts with a simple proposition: residential care has a future; it is an essential part of our health and social care system. At its best it has lessons to teach the NHS about the care and support of frail older people.

Over the past 12 months our Commission has taken a long hard look at the state of residential care and its potential future. There are some tough messages. The brand of residential care is fatally damaged. Unloved, even feared, for most people residential care is not a positive choice. Linked in the public mind to a loss of independence, residential care is seen as a place of last resort.

We are optimistic about the potential of residential care to change. During the course of our inquiry we have witnessed great care: we have seen what the future can look like, because it already exists in the present.

For most people, going into residential care is synonymous with an end to independence, of loss. Personal independence is wrongly linked in the public mind with remaining in one’s own home. In the UK and around the world we have seen great examples of how residential care can reinvent itself. It is no longer a last resort, but a respected part of a continuum of ‘housing with care’, which is enabling people to lead bigger and more fulfilling lives.

Rebranding residential care as a part of a spectrum of housing options with care is a prerequisite of delivering the twenty-first-century care system we want to see. Housing with care separates the decisions about the ‘what’ of care from the ‘where’ we live. It starts with the goal of maintaining the everyday rhythms and routines of life; it recognises that feeling included and purposeful matter.

At Lasell retirement village in Boston MA I eavesdropped on a conversation between residents. The village is part of the campus of Lasell College and residents must take 150 hours of education a year. The conversation was all about their courses and the future, not their ailments and age.

In the Netherlands I visited De Hogeweyk, where people live in ‘houses’ with a small number of others who share similar tastes and outlooks on life. It is intended that people lead as normal lives as possible. Hospitality is at the heart of the training and behaviour of staff and volunteers. Supporting people to lead everyday lives was ‘on stage’ while the nursing care was seen as ‘back stage’.

At Humanitas Bergweg in Rotterdam I met the inspirational Hans Becker, the founder of Humanitas, who described his philosophy as moving from a focus on cure and care, which create ‘islands of misery’, to a focus on happiness. He believes there are two elements to happiness: the individual and the communal.

At Florence Leonard Centre for Living in Boston, I met Steve, who has motor neurone disease (MND). When the idea of building a green house scheme for MND first surfaced, Steve helped to design automation systems that give him and fellow residents of the MND and multiple sclerosis houses control over their environment.

In all my visits for the Commission I found a shared philosophy of supporting the self-determination, self-reliance, fun and community bonding among residents, employees and families.

These ideas are not new, nor exclusively from abroad. The communal dimension has been central to the mission of the Whitely Village in Surrey since it was founded in 1917. Glendale Lodge in Kent also demonstrated the importance of bonding between residents and staff as part of its ethos and practice.

As one of the authors of the Care Act I believe it offers an opportunity for the reinvention or rebranding of residential care that this report calls for. By placing the promotion of individual wellbeing at the heart of the care system it challenges regulators, commissioners and providers alike to look afresh at what they are doing.

However, chronic underfunding of social care is undermining the best endeavours of those who would reform and reinvent residential care. Without a fair funding settlement for social care the trend towards a two-tier system of residential care will accelerate, with those who cannot afford the cost of care condemned to a mediocre, life-limiting experience in the poorest quality homes, staffed by the lowest paid, least qualified staff.

Westminster, Whitehall and town hall leaders can create the conditions for a better kind of residential care, which starts by recognising the importance we attach to home and social connectedness. It involves breaking the false link between the ‘what’ of care and ‘where’ we live. Breaking this arbitrary link will enable much more innovation and greater transparency and clarity between the costs of care, accommodation and services.

Such a change would end anomalies in the way care is commissioned, regulated and inspected depending on where the care is provided. It challenges the idea that a frail or disabled person should have less security of tenure simply because of where they live. Much can be achieved with the existing stock of residential care to realise this vision. As this report demonstrates, technology is opening up many new possibilities to make better use of existing bricks and mortar and deliver great care.

Whether it is in new or old bricks and mortar the workforce is critical to delivering the Commission’s vision. Too often working in care is seen as a ‘job’ that is temporary and low skilled. There is little career progression; society attaches a low value and low pay to the work, unlike the value it attaches to those working in the NHS.

We are under no illusions about the difficulties of moving away from a low wage to a living-wage sector, but we believe that government, local and national, cannot stand by and do nothing. I want to thank Claudia Wood and Jo Salter from Demos, and Natasha Kutchinsky from my office. This report would not have been possible without them. Above all I want to thank my fellow Commissioners for their time and commitment to this project.

We share a common belief that great care can liberate people, enabling them to maintain, even regain, their sense of worth, purpose and connection. Housing with care can offer a life and laughter, fun and friendship.

Much has been said and written about residential care, but less has been done. Through this report, therefore, we have sought to create a powerful case for change and an action plan to deliver it – identifying what needs to be done and who needs to be responsible for these actions. Our aim is to inspire a joint effort. I am confident that, with this effort, housing with care can claim its rightful place in a twenty-first-century care system.

Rt Hon Paul Burstow MP
Chair of the Commission on Residential Care

September 2014