Community care needs investment and reform to become a key pillar of social welfare

The Covid-19 pandemic has taken a grim toll on community social care across Europe. Previous lack of adequate investment had already left the sector without the necessary equipment to manage the crisis, which also raises questions about future funding.

Outcomes have been covered by the media in terms of an unacceptable number of excess deaths in care homes and staff, raising serious ethical concerns. Indeed, a key challenge has been to ensure the safety and support of the workforce within a fragmented system of provision. Accessing real-time data using digital technology on what happens across community-based services is therefore vital in terms of future crises preparedness.

The 28th edition of the European Social Services Conference on 30 June-1 July saw the participation of more than 250 social services leaders from 32 countries coming together to discuss how care in the community needs rethinking to better support its workforce, be effectively resourced, lead through a set of ethics principles and use technology to better support people using services and practitioners.

Community care has seen a shift in recent years towards more personalised and individualised care, whilst public authorities have been increasingly outsourcing care to non-public providers, making oversight and regulation of the sector more difficult. These issues were further exacerbated as the Covid-19 pandemic took hold and the workforce faced a lack of protective equipment to be able to do their job. Speakers highlighted that staff do not feel secure about their working conditions which in turn impacts the attractiveness of a sector already contending with a significant recruitment gap. Covid-19 put social care and social services, as well as carers and social workers, back on the political agenda. But there is a difference between being aware and taking action to mitigate the circumstances, for which more fundamental changes in terms of job quality improvement and funding are needed.

There is a need for funding in community care but there is a risk that this funding might be used to reform facilities and re-institutionalise people using social services. Community care costs are high and much of the time these costs are hidden because the development of community care involves resources from different budgets, not just social services. Meaningful reform requires political commitment, transferring resources from institutional to community care and incentivising care in the community. Incentives necessitate developing a narrative that highlights how community care investment can impact others; e.g. the employability of people in support services. Likewise, there is a need to promote new ways of contracting providers, not by the number of beds or places filled but based on outcomes such as how community services delay accessing residential care.

The case for community care cannot just be made by looking at costs. We must also look at the benefits. A human rights approach has become central to this debate and now more than ever in the wake of Covid-19. On average, the number of excess deaths in residential care accounted for almost 50% of all Covid deaths in many European countries. Banning of visits and restrictions of liberty of people living in these support services with no access to local communities or a lack of inspections meant that the sector was confronted with serious moral dilemmas. Therefore, trying to uphold human rights, the need for regulatory reform as well as transparency and the promotion of autonomy have been more widely recognised crucial for future reform.

That said, the pandemic helped deliver in a matter of weeks some technological changes that otherwise would have possibly taken years. Conference speakers referred to the adaptation of telecare services, online access of benefits, e-vouchers, the extension of rental assistance through cloud enabled platforms to prevent evictions, remote monitoring, or the use of data for predictions. These developments should be both resilient and available. Crucially, the public should be assured that they are developed in the right way. For example, a critical uptake of these technologies, the kinds of data being drawn on and ensuring that social services professionals are involved in decision-making. Another issue is how to ensure that ‘contactless’ does not mean devoid of human interaction. While support might be virtual, there still needs to be a human touch.

The use of technology in community care may have accelerated in recent months but its use must be cemented to build a better prepared sector, particularly when it comes to the use of digital tools in a preventive manner.

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