The Casey Commission on Adult Social Care has invited organisations and members of the public to contribute to its review of adult social care. We encourage our members to make a submission. Camphill Families and Friends has submitted the following:
Can you give up to three examples of things that work well or new ideas you have seen in adult social care?
- In well-run group and village communities such as those that operate under the Camphill banner, people with learning disabilities and/or autism are offered a sense of purpose, belonging and an opportunity to contribute. Most people, including people with learning disabilities and/or autism, want to belong to a community and to feel that they are doing something useful.
In well-run Camphill communities, carers and the cared-for live and work together. Everyone is valued for what they can offer. There is shared purpose and everyone is encouraged to feel that they are making a valuable contribution to their community, whether they are someone that draws on care or are someone offering that care.
Activities and responsibilities are shared. This includes the preparation and eating of shared meals, a key part of community life which both brings people together and which supports people to live healthy, active lives.
Housing arrangements which support shared living and promote a sense of belonging are key to successful group communities. Arrangements under which carers and the cared-for are part of the same housing provision, such as the Shared Lives model (which is used by a number of Camphill communities as well as outside of the Camphill movement) have been shown to work very well.
More information about the Camphill movement can be found at https://camphillfamiliesandfriends.com/what-is-camphill. - Proper support and meaningful opportunities to allow people with learning disabilities and/or autism to choose well, particularly in connection with choices around healthy living and purposeful activity, as is the case in well-run Camphill communities. This requires support staff to have a deep understanding of the person they are supporting, as well as clear guidance and training on how to support decision making. It also requires people with learning disabilities to be offered genuine choice in the lives they lead, including opportunities to eat well, to exercise, to connect with the outdoors, and to have purpose. If such opportunities are not offered, people with learning disabilities cannot choose them.
- In well-run Camphill communities, and elsewhere where it is offered, well-designed and thorough staff induction and training will support the development of trust between people drawing on care and support, their families, and carers. It also supports the development of a base level of community values and a sense of belonging and purpose for staff.
Can you give up to three examples of things that don’t work well in adult social care?
- The Care Quality Commission (CQC) effectively prohibits the right of people with severe learning disabilities to live in group and village communities. The CQC places unachievable requirements on existing communities and has asserted that it will not register or favourably rate new campus or congregate settings (Right Support, Right Care, Right Culture, 2020). This narrative has been used by CQC inspectors and external care providers to justify the closure of group and village communities, equating them to ‘campuses’, regardless of the quality of care provided.
For a more detailed analysis of this problem, please see the work of the Our Life Our Choice campaign – https://ourlifeourchoice.co.uk/. - Care providers often fall back on an over-reliance on the ‘right to choose’ without offering genuine support and opportunity for people with learning disabilities to choose well. Staff are not trained to support people to make decisions based on factors beyond short-term gratification. In the long term, a lack of opportunity to choose well can lead to poor physical and mental health and social isolation, compounding the health inequalities that people with learning disabilities already face.
- The recruitment, retention and training of staff is a huge problem. Many care providers, including those who offer group and village care, are increasingly reliant on agency staff, many of whom have little or no induction, training or experience of working with people with learning disabilities and/or autism. Care work is undervalued and poorly paid, and staff come and go quickly. This means people are unable to develop relationships with the people who are supporting them. High staff turnovers are particularly unsettling, even distressing, for people with learning disabilities and/or autism. Added to this is an increasing reliance on inflexible technological solutions (for example, clocking in and logging micro activities) rather than trust and shared values.
Can you give up to three examples of things that waste time, money, or effort in adult social care?
- Poorly costed projects with little thought of the future. We have seen examples of major capital expenditure for a project but without a long-term and robust budget for running costs. We have also seen initial enthusiasm for new ideas and projects which dwindle and die when the initial enthusiasm wanes or when there is a change of staff.
- Poor collection of feedback from people with learning disabilities and their families. This includes the use of badly-designed surveys. Asking people how well a local authority or service provider is doing on a scale of 1 to 10 is unlikely to identify what is working well and what improvements are needed, and may be viewed as lip service. Proper conversations, face-to-face where possible, are much more likely to yield genuine, thoughtful feedback which can in turn lead to genuine service improvements.
