This article first appeared in slightly abridged form in Community Care magazine, Feb 2006
See also “All in the same boat”, Community Care, March 2006
The new Supporting People national strategy, unveiled for consultation in November, represents a major step forward for this complex but hugely important area of social and welfare policy. It shows that the SP programme has turned a corner, and is ready to re-build and re-position itself as one of the key social policy platforms of this government.
ODPM’s proposals in the consultation suggest that the strategy should adopt different approaches for those needing housing support alongside care services’s in-put; for those needing low-level support on an on-going basis; and for those needing crisis support services ( news, page 6, 17th November). Yet there are already signs that Health and Social Care services are again missing the significance of this new approach.
This is perhaps understandable. Health and Social care are busy, pre-occupied with their own core priorities, budgets and modernisations. Three years of hectic service and policy development in SP, followed by two years of cuts and painful retraction, does not tend to make for clear signals sent to other local agency partners about where SP is going. Those early cuts caused additional frictions between local SP, providers and community care agencies, jeopardising both the credibility of support services, and the original ambition for the SP programme to co-ordinate services at local level. Small wonder, perhaps, that Health and Social Care have tended to get on with their own affairs, disappointed at the lack of resources, but otherwise simply shrugging and leaving SP to sort itself out.
But the new strategy moves us on. The consultation document itself is thoughtful and quite clear about the dilemmas and options. It is also refreshingly frank in its dismay at the way that some local authority SP teams have interpreted their new responsibilities. (That alone should win the document some friends.) But let us consider the two aspects of the strategy that will have most impact on social care.
Firstly, we are told now that the support services of the future can cross the care-support boundary. For community care service users, support provides an invaluable new form of low-key and practical assistance, as part of a package of interventions. It makes little sense for the resources for one aspect of the service to be inflexibly and hermetically sealed from others, or to work to any artificially brief timetable – to impose, in effect, a funding-led black-and-white distinction upon a needs-led patchwork of greys.
But we had simply not heard this from ODPM before. For two years, we have instead seen attempts by local SP teams to demarcate and enforce a clear line between support services and care services. It has been argued, for example, that anything over 8-10 hrs per week, or taking more than 2 years to achieve full independence, cannot really be support; it must be care. Such finessing leads to “angels on a pin-head” decisions:- paraphrasing Lady Bracknell, one accompanied visit to the GP, or to a community centre, can count as support; but two must be seen as care.
But now, it seems, all these artificial boundaries may be crossed. In fact, that may become the norm, the expectation. As the consultation document states: “ We believe that there are opportunities to improve how these services are commissioned and provided as an integrated package” ( Summary, p.6 ) and later, “where services are commissioned by a local authority, there seems little reason why they (ie: care and support ) should be provided separately” ( para 48 ) .
This is certainly very welcome. But even this is only a prelude to what is perhaps the most radical suggestion of all. Discussing the pros and cons of retaining the SP grant as a separate funding stream, the document comments “….whilst a ring-fenced grant… has helped to manage any risk of funds being diverted to other service streams, it seems to have created a perception that this is the only public funding which can be invested in housing-related support.” ( para 87 )
The document goes on to point out that any locally held welfare budgets could in principle be funding low key preventive support, if that is the most effective way to deliver a support service to any particular client group. There is considerable talk in the document about encouraging Local Area Agreements, as a mechanism for sharing priorities and addressing shortfalls in cross-cutting programmes. If nothing else, this is certainly an imaginative way forward from the chaotic patchwork of services that Supporting People inherited in HB legacy funding.
This opens up a host of issues about the development of new services to the most vulnerable, crossing the artificial care/support divide. The strategy effectively re-opens the debate about the role of preventive support, of supported housing as a base for community care services, and an alternative to more conventional statutory services. At a stroke, this new strategy transforms Supporting People from being simply yet another beleaguered and under-funded welfare programme, restoring it to its intended role as “the glue that binds other programmes together”.
National policy statements on Supporting People had consistently emphasised an ambition to see a wider range of vulnerable individuals supported, bringing into the welfare net many client groups excluded from community care, with a greater stress on preventive services, and with local authorities playing, through SP, a key co-ordinating role at local level between disparate programmes and agencies.
There have been many sceptics who argued that the real purpose of Supporting People was simply to cap the rise in benefits spending on housing. The new strategy suggests a far wider and bolder vision. The “3 R’s” of Supporting People are:- Re-focus social and community care services on preventive work; Repatriate to local authorities their role at the centre of joined up government at locality level; and Re-position the SP programme as the broker of inter-agency partnerships to meet cross-cutting needs.
The new proposed national strategy, therefore, is bold and yet sophisticated, realistic and yet radical. It redraws the map of established silo boundaries between services and agencies, including between health and social care, and between the voluntary sector and statutory agencies. It will have a major impact on community care policies over the coming years. Inevitably, it is complex, but it deserves careful consideration and response from social and community care services, planners and managers, and service user groups.
Nevertheless, we need to bring this down to earth a little. If these are indeed the 3 R’s of grand strategy, what will this mean in practice? How will this work “on the ground”?. In next weeks’ article, “All in the same boat”, we will explore in more depth the implications for development of more integrated services, and for more integrated commissioning of services, taking for illustration one major area of community care – mental health.