‘Cavendish Review’ – does the NHS nut fit the social care bolt?

Richard Banks, senior associate at CPEA Ltd, considers the remit of the Cavendish review of health and social care settings and offers some personal notes and thoughts.

Jeremy Hunt, the Secretary of State for Health, has asked Camilla Cavendish, Associate Editor and columnist at the Sunday Times, to lead a review looking at both NHS and social settings. The review will consider:

• recruitment
• training and development
• leadership, management and supervision
• engagement and support
• public confidence and assurance

The remit of the review does cover care staff in social care as well as those described as Health Care Assistants – but as is often the way, the Department of Health managed to appear to add social care as bolt-on to an NHS project. There are, of course, some shared issues but some important differences in particular that most social care staff work in private, voluntary or direct employment settings and not in the NHS. There are also differences in how you might go about communicating with the 1.7 million people working in more than 49,700 different adult social care settings in England.
Care and support are about values

Issues about the social care workforce are closely linked to the overall policies toward the provision of support to people who have disabilities or needs related to being older. The Government in England have avoided tackling the fundamental funding and policy issues of the aging population or the growth in the numbers of people with disabilities. Despite occasional protestations to the contrary government clearly see the aging population as a burden not as evidence of a successful welfare system or as an exciting opportunity to reconfigure attitudes toward older people as an active part of society. Attitudes toward adults with disabilities have become distinctly nasty, as they have been caught up in the government’s attempts to smear anybody using benefits. When looking for failures in values in a service a start at the top of a hierarchy is a reasonable place to begin. The government has not taken any action that communicates its value of people who require social care support. The last few years have seen an increase in the confused and overlapping requirements and initiatives from government and government funded agencies for and about adult social care. It is clear that most of these are political activities designed to give the impression that something is being done while avoiding any real commitment. The effect is an increasing state of confusion and risk of individuals and organisations being driven into cynicism.

Really good social care is often almost invisible.

The purpose is to care and support a person to live their life as they choose. So a really skilled social care professional should not ‘stand out in front’ of the work they do. This particular social care attitude and related behaviour will be alien to our self-aggrandising politicians. Rather than bombard the social care workforce with ill-considered attempts to manage them from Whitehall might it not be better invest in them as professionals? Registration of social care staff would go some way to start that change. I hope the Cavendish review will examine the progress being made in other parts of the UK on this and use that experience to inform English policy. Not surprisingly given the poor conditions they work under, individual social care staff often appear to have low self-esteem. When asked about their work the response is generally prefaced with ‘Well I just…’ they then go on to describe a complex mix of psychological insight, knowledge, practical creativity and skill. This low self-esteem may well suit those who continue to underfund and apportion blame but it does nothing to sustain or learn from good creative care. The National Institute for Health and Care Excellence (NICE) and the Collaborating Centre for Social Care has hopefully been set up to do this. The centre needs to find a way to set its own agenda with the social care sector; rather than be pushed by short term Government directives. The big tasks will be to create a coherent set of messages about excellent practice and find ways to get that information to the sector. The test of effectiveness will be use by carers, social care staff and their organisation.

Does Cavendish remit avoid strategic questions about resources?

It would be unfair to view the Cavendish Review yet another attempt to divert attention away from the woeful failure of government to provide leadership and get some integrated policy across departments. However the remit does avoid strategic questions about workforce policy and resources. The questions asked by Cavendish are important but have been answered before (in the Sector Skills Agreement and related work from Skills for Care) what is required is concerted action to provide coherent government policy with intelligently managed resources to match. Hopefully that is where the recommendations of the review will focus.

Richard Banks April 2013

Contact: CPEA Ltd 07947 680 588