National Care Service Forum 2024: report

What you told us – embedding rights and equalities

1. An integrated health and social care service that understands rights and responsibilities can help us drive consistency.

People said geography must be considered, but services should not vary in standards. This would help services to move with people, so they don’t have to start again. People discussed the challenges of consistency when so many services are provided by the independent sector. They highlighted the need for regulation, inspection and grading of private sector providers to be consistent with local authorities. They also discussed the unequal treatment of unpaid carers across the country.

Other points raised around this included:

• the suggestion of introducing interactive, user-friendly mandatory training for organisations, developed with those with lived experience
• that people should be able to share good practice and involve those with lived experience in solution-focused discussions
• different attitudes in different professions with different priorities could be a barrier to embedding rights

2. People need a better understanding of their rights to be able to advocate for themselves.

We heard about the difficulty of holding services to account if people don’t know their rights or what to do if things go wrong. At the same time, some people questioned if the NCS can meet the demand that wider awareness of people’s rights could create.

Other points raised around this included:

• the need for a consistent pathway into independent advocacy, particularly for vulnerable groups
• the importance of GDPR issues within this context
• concerns that independent advocacy is not embedded in local communities, and that making it part of primary legislation could ensure strong provision
• advocacy has to be relationship-based and take account of the Equality Act 2010 to include people with complex needs

3. People want better accountability from decision makers on social care delivery and access.

We heard about the importance of accountability and joined-up work. People said a strong NCS Board would be key to monitoring performance and upholding rights at national and local levels.

Other points people raised around this included:

• a complaints service is a good thing, but there should be better access to legal recourse too
• vulnerable people may need reassurance that there won’t be penalties from making a complaint
• people on the ground often don’t care about governance; they care about performance and effectiveness
• we should differentiate complaints about the system from complaints about workers – too often the focus now is on workers
• unwell people may find the current system too complex – it focuses too much on process, not outcomes.

4. There are concerns over service providers’ ability to focus on human rights, access, and non-discrimination alongside decreasing budgets.

Groups discussed shortages of vital staff and how the time pressure on care staff impacts capacity to train. People said budgets are not meeting support needs. It was also highlighted that workers don’t have time for lengthy consultations, so it may be an unrealistic way to involve industry.

Other points around this included:

• the view that there’s a lack of consistency and transparency regarding funding policies
• the feeling that means-testing care for those on benefits is leaving people in poverty, and that removing non-residential charges sooner could help
• the importance of getting more men into working in care, and for people to better understand the variety of care-supporting roles
• that technology is often overlooked but investment could help people to live independently – for example, using smart homes instead of visits to open and close curtains
• the importance of flexibility – for example, sharing Self-Directed Support (SDS) packages for those who can and want to do so
• a feeling that there’s a lack of fairness, as private care home providers can choose how many local-authority-funded places to offer

5. We need a preventative and a less reactive system, with more shared power and organisations working together like they did during Covid.

Groups discussed the need for a long-term vision – beyond parliamentary cycles – involving people with lived experience. They said it would be useful to have longer-term funding, and said people with lived experience should be equal partners, directing change. This would allow for longer-term contracts with providers and longer-term planning. It could then be possible to recruit for more permanent posts, meaning greater job security and easier recruitment.

Other points people raised around this included:

• the sense of a gap between how services are talked about at a strategic level, and the reality on the ground
• the importance of hearing from the third and independent sector and from people, their friends and family – not just local authorities and health boards
• that the NCS Board should have the right representation, and staff should be included, as well people receiving care and support