‘Social care reform is long overdue’

An Essex expert on the UK social care system has told a House of Commons inquiry that the way people's needs are assessed and care resources allocated needs fundamental reform.

Professor Peter Beresford says the approach used by local councils to allocate social care resources is fundamentally flawed, resulting in a postcode lottery of care levels around the country and a disempowering and depersonalising service for people.

He has submitted evidence to a House of Commons inquiry into social care provision, which will inform a forthcoming government Green Paper on improving care for older people and tackling the challenges of an ageing population.

Professor Beresford explains: “The problem is that the eligibility process is circular – councils develop categories of needs they will fund based on what they can afford. The role of the social worker is to test each person against those categories, rather than assessing and costing all their needs.

“It’s the opposite of how healthcare is organised, where clinical need exists if a person has something wrong with them and there’s an approved treatment for it. If healthcare were arranged in the same way as social care, you’d go to casualty with a broken leg and, due to budget limits, the doctor would either say there’s nothing wrong or tell you that alleviating your symptoms is a personal wish for which you are responsible, not the NHS.”

Professor Beresford and co-author social care consultant Colin Slasberg argue the current system causes several problems, including:

1. no data being available on unmet needs as all ‘eligible needs’ are being met
2. being assessed for care is a depersonalising, ‘box-ticking’ experience 
3. resources aren’t used efficiently – a survey found little relationship between the extent to which needs were met and individual wellbeing, and needs being met in ways which undermined peoples’ independence 

They propose a system where needs assessments record all the experiences of an individual, and care decisions are made on a case-by-case basis, based on what can be afforded. This would expose currently unrecognised gaps between needs and resources.

Professor Beresford hopes to see real change in the Green Paper: “The Care Act 2014 has been described as a Rolls Royce without any petrol. The Act created the conditions for people to have the life that is right for them be fully acknowledged, whether or not it can be afforded. However, the car is going nowhere as current policy maintains the old resource-led, circular definition of need. This denies the potential of the Act. 

“Social care reform is long overdue and policymakers seem to be in denial of how dysfunctional the system now is. If the Green Paper recognises this, truly replaces the eligibility of need process, and begins to record ‘unmet need’, the petrol would start to flow into the tank.”