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By Debbie le Quesne

Archive for the ‘domiciliary care’ Category

King’s Fund: Another year of challenges

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Looking to be inspired for 2017 and needing that shot in the arm to pep you up for the months ahead? Take heart (or a pill) – here’s the news from the much respected Kings Fund: “2017 promises to be another challenging year for the health and care system, with demand for care increasing faster than the supply of resources.”

The January bulletin adds: “A system already stretched to its limits will have to work even harder to maintain current standards of care and to balance budgets.

“This requires a continuing focus on operational performance and renewed efforts to transform the delivery of care at a time when frontline staff are working under intense pressure.”

I’m already wilting, even though I know it’s true.

The Fund points out that the NHS five year forward view (Forward View) will be “tested to its limits as leaders work to improve performance and transform care.” And it adds: “The NHS locally has to deliver £15 billion of the £22 billion efficiency improvements required under the Forward View, with the remaining £7 billion to be delivered nationally. It also has to provide evidence that new care models are delivering benefits. Failure to do so will raise serious questions about the assumptions on which the Forward View was based and on the ability of leaders to deliver their plans.”

The popular think tank highlights five main priorities for 2017.

Here we go and I’m summarising . . .

 

Supporting new care models centred on the needs of patients

 

  • People should be much more involved in their own health and care and be offered the information and support to manage their medical conditions
  • More care should be delivered in people’s homes or closer to home
  • Much greater priority should be given to public health and prevention through partnerships between local government, the NHS and other organisations
  • Action by government is also needed to reverse the rising tide of obesity and other major risk factors.
  • Building on the Forward View – programmes of integrated care that are sustainable.

 

Strengthening and implementing sustainability and transformation plans

 

  • Sustainability and transformation plans (STPs) are a practical expression of care that offer the best opportunity for the NHS and its partners to work together to transform the delivery of care, but there’s a need to strengthen leadership as they move from planning to implementation.

 

Improving productivity and delivering better value

 

  • As an organisation with an annual budget of more than £100 billion, the NHS has plenty of scope to be more productive. Increasing productivity has become more urgent as funding increases have fallen and deficits among NHS providers have risen. Key issues include better value, involving patients more in decision-making and reducing unwarranted variations in care and to improve care

 

Developing and strengthening leadership at all levels

 

  • Improving care depends in large part on the quality of leadership throughout the NHS and the ability of leaders to engage and support staff to improve care. There is a need for compassionate and inclusive styles of leadership
  • The success of STPs and the new care models hinges on experienced organisational leaders developing into system leaders, who are able to work across boundaries to negotiate and implement improvements in care. There is a need for leaders ‘comfortable with chaos’ to make things happen

 

 

Securing adequate funding for health and social care

 

  • In April the NHS will enter the eighth year of unprecedented constraints on funding while adult social care is rapidly becoming little more than a threadbare safety net for the poorest and most needy older and disabled people. The prospects for the remainder of this parliament remain bleak, with limited scope for raising more funds for social care and the NHS having to plan for infinitesimal growth in 2018/19 and 2019/20.
  • The government must choose between finding additional resources for health and care or being honest with the public about the consequences of continuing austerity for patients and users of publicly funded social care. Finding additional resources means being willing either to increase taxation or to reallocate funds from other areas of spending. Being honest about the consequences of continuing austerity requires acknowledgement that current performance standards and new commitments like seven-day working cannot be delivered within available funding.
  • The more important challenge is to initiate a debate about a new settlement for health and social care, building on the work of the Barker Commission.

 

I genuinely wanted some rays of sunshine in this bleak report, but the skies are still dark. Here’s hoping things will get better and we’ll see more integrated approaches between the NHS and social care. . . it surely must be the way forward.

 

 

The state we’re in – time for a reality check

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Britain’s elderly population is soaring, but there’s a big problem: Not all the latter years afforded by better care and medicinal advances are healthy.

There are one million more people over the age of 65 than five years ago, and the number of those aged 80 and over has risen by almost 10 per cent.

The demographic shift means an increasing number of extremely frail and elderly people who are unable to carry out daily tasks unaided.

And social care is in demand like never before.

In 2010, the Coalition government promised to protect the NHS from cuts and the

Conservative administration has continued to ensure that the health service receives increases in funding, with an extra £8bn a year by 2020, I read.

Despite the NHS ‘protection’ policy, just like its poor relative, social care is also in trouble.

With social care funding at an all-time low, care businesses failing weekly, reduced capacity in the private sector and a growing unwillingness among care provider survivors to take council-funded candidates, bed-blocking is now seizing the mechanics of good hospital caring.

Simply, medically fit people are being left on wards because there are no community beds available, or the necessary support care packages at home cannot be established.

Austerity measures have hit councils badly and social care has been an easy target on which to save money. It sounds harsh, but it’s the way it is.

In real terms, figures suggest budgets for social services have fallen by 11 per cent in five years, as the elderly population has surged.

We have been warning of the winter crisis for months and now we find operations are being cancelled in a bid to ease the hospital beds shortage.

I understand that ahead of Christmas there was a clamour to free up hospital beds.

But returning pensioners to their homes requires far more care to be available; from home-helps, to full-time live-in personal assistants and carers with advanced skills.

What’s more, since 2009, the number of people receiving state-funded help for care has fallen by 25 per cent. So many are struggling to pay-as-you go as self-funders.

And there’s another issue. “Social care sector roles now have turnover rates of more than 25 per cent a year, with more than 300,000 workers walking away from such work every year. It is an ageing workforce too – one in five of those in the field are approaching retirement age,” a national press report said.

Remarkably, so many of my West Midlands Care Association members and those with whom I work in other care organisations, stoically press on providing excellent standards of caring.

Yes, we do need a new architecture for care finances, but proposals are so far short-term and a realistic solution is notably missing from any political New Year goodwill message that I’ve seen.

 

 

Autumn Statement: My utter disbelief

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Like millions of others, I listened to the Chancellor’s Autumn Statement in a stunned disbelief that after unprecedented pressure he failed to deliver on social care.

Secretly, I’d been hopeful that, as ITV put it, this vital area of funding would be Philip Hammond’s “rabbit out of the hat.”

But the man, who is privileged to represent the constituents of one of the wealthiest areas in the UK, said absolutely nothing on the issue so many of us were pinning our hopes on.

As the Prime Minister pointed out in PMQ’s, local authorities have been allowed to raise council tax by 2% to help plug the funding gap. But, especially in poorer areas where council tax receipts are low, the “social care precept” has barely touched the sides.

The irony of it all I find was in the closing comment calling it a plan that “provides help to those who need it now.”

On what plant does this Chancellor live?

It was no surprise that leader of the opposition Jeremy Corbyn chose to focus on health and social care as he took on the Prime Minister in the Commons before the Autumn Statement.

But is set a stage of clear demarcation – between reality and Cloud Cuckoo Land.

Love him or hate him, Corbyn urged the Government to plug the gap and address the “stress and fear” it causes.

Unremittingly bleak, social care providers have done an amazing job in recent years without the central funding to sustain long-term credible business models.

Local authorities have also been forced to pare provision back, to in the opinion of many, dangerous levels.

For six years there have been unprecedented cuts to LA budgets, with figures suggesting those people eligible for council-funded care falling by 25 per cent.

Teresa May’s almost apologetic herald for the mini-budget of gloom was found in her comment: “We can only afford to pay for the NHS and social care if we have a strong economy”.

My life! This is another George Osborne in this key role.

Well, Mr Hammond, may I congratulate you on your sheer brilliance in ignoring perhaps the most pressing social dilemma since the introduction of the Three-day Week in 1974.

Predictions of “looming chaos” were rejected by the Chancellor.

Philip Hammond said a previously announced NHS funding commitment was in line with what its leaders had wanted.

Health and social care leaders are reeling and unanimous in their condemnation.

Now the Treasury has made its stand, with Mr Hammond confirming that ministers would be sticking with departmental spending announced last year, the official unraveling of social care can begin.

In a new briefing published ahead of the Autumn Statement on 23 November, the Health Foundation, The King’s Fund and the Nuffield Trust analysed the state of health and social care finances, concluding that cuts and rising demand will leave adult social care facing a £1.9 billion funding gap next year.

What a cynical approach to well-founded information in the care sector we have witnessed. Is this bordering on criminal neglect . . . interesting thought.

And finally (for now): For once I am in a position to sympathise with the local authorities in the West Midlands and particularly Birmingham which is £50million in the red already this year.

No lifeline, the extra burden of the living wage  . .  and effectively an abandonment of responsibility for those in need and their care providers. In the industrial West Midlands  there simply are not enough self-funders to keep the sector afloat and bolster the care of those people funded by their local councils.

A budget for the JAM people (just about managing), Mr Hammond. Not in my world, Sir.

 

 

 

 

– Debbie LeQuesne CEO

Pressure mounts on Chancellor for more cash

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Last month Theresa May’s claims that the government is putting £10bn extra into health was challenged by five MPs. led by the Conservative Dr Sarah Wollaston, the chair of the Commons health select committee.

The impact of not enough money for hospitals and access to social care are written for all to see in rising demand for A&E and missed waiting time targets.

Clearly there are complex reasons that, according to some sources, delayed transfer of care lost 192,000 hospital bed days. But the downgrading of social care in government agendas must be a primary cause.

I am led to understand some NHS number-crunchers believe the real number of people in hospital who should be being cared for in the community is probably four times as many as represented the figures here.

The pressure really is on Mr Hammond to deliver in his Autumn Statement.

Rising costs, the ageing population, difficulties recruiting staff and years of central government reducing its grant have left the service in crisis, the Local Government Association claims.

Surely, there is an unprecedented agreement that social care should be at the very top of the list of Mr Hammond’s priorities for urgent extra funding.

The triple whammy of shrinking budgets, rising demand and the cost of paying the national living wage to care workers has left many councils paring back more and more on care costs.

I’m led to believe that in Walsall last week there were 138 people waiting to leave hospital. There is enough capacity in the region to take them all, but . . . there is not the money to start the funding of new packages.

Before winter pressures kick in we understand discharge managers are looking to get all those people back in the community and free  100 beds for winter. Sadly, if all of those perceived admissions required care in the community or step-down residential beds we’re in trouble. There simply is not the capacity.

Mr Hammond is being urged by senior Tories to give the crumbling care system a double boost in his autumn statement, amid growing alarm that social care and the NHS will be unable to cope with demand this winter.

Rumours suggest that Mr Hammond is examining a plan to plough between £700m and £1.5bn extra into social care services from April to help reduce numbers of older people being admitted to hospital.

Apparently, he is also considering letting councils raise the amount they can add to council tax bills to fund social care through a precept introduced in April, currently capped at two percent.

We’ll see . . .

The LGA has made known that years of cuts to town-hall budgets have left the sector in crisis, with fewer people getting help with basics such as washing and eating at a time when need is rising.

Also, care homes are closing, partly because councils cannot afford high enough fees to allow operators – whose costs have risen because of the national living wage – to make a profit.

Putting further funds into social care, will I’m sure, indirectly relieve some of the difficulties being encountered by the NHS; not lest helping to facilitate a more efficient discharge of patients.

 

Branson wins £700m contract to run 200 care services

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There is no more burning injustice today than older and disabled people being denied the care they need to live with independence and dignity, but what is the way ahead for a cash-strapped system that is currently failing to meet needs?

Perhaps one of the answers lies in the hands of the billionaires. But will they repeat commercial history  just like the supermarket chains, which with huge buying powers, rode roughshod over the corner shop traders?

Currently, however, the national/local cost structures are very similar at the consumer end and what the big boys save on bulk buying goes on additional overheads.

I do read with interest though that Sir Richard Branson’s health firm, Virgin Care, has won a £700m contract to deliver 200 types of NHS and social care services to more than 200,000 people in Bath and north-east Somerset.

The contract has sparked new fears about private health firms expanding their role in the provision of publicly funded health services. Clearly I can understand the concerns regarding the NHS, but for the social care sector, could this be a lifeline?

Virgin Care has been handed the contract by both Bath and North East Somerset NHS clinical commissioning group. It is worth £70m a year for seven years and the contract includes an option to extend it by another three years.

It means that from 1 April Virgin Care will become the prime provider of a wide range of care for adults and children.

That will include everything from services for those with diabetes, dementia or who have suffered a stroke, as well as people with mental health conditions. It will also cover care of children with learning disabilities and frail, elderly people who are undergoing rehabilitation to enable them to go back to living at home safely after an operation.

Outsourcing, especially with the NHS, has a bad reputation and it appears the Virgin initiative is a big step towards the empire dominating the supply of community health across England.

The Mirror online newspaper reported that the Virgin deal includes dementia and end of life care and a “hospital from home” service for recently discharged patients.

Sir Richard has an impressive record of successful investments, so I’ll be monitoring this one with interest.

Certainly he is not short of the financial sleeve to bring a large fresh broom to social care provision, but if this is the future, I fear the conglomerate approach will inevitably destroy that indefinable ‘homeliness’ of some smaller residential care settings.

 

Care cuts ‘leave frail elderly fending for themselves’

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Frail old people in England are being left to fend for themselves because government-funded care is being scaled back, a review suggests.

That’s the news that recently greeted me care of the BBC.

The number of over-65s being helped by councils had fallen by a quarter in the four years to 2014, the joint King’s Fund and Nuffield Trust report claims.

Wait a minute, I’ve already read this report, I thought. But then I became aware that because of the information overload, I’d missed this crucial point.

Despite more people needing help because of the ageing population, we’re helping less and less it seems.

The BBC assured that Ministers were “taking measures to address the problems.”

The reality – highlighted in the report – means there are growing numbers left with no care or having to pay for support themselves.

The report was released on the day the BBC published an online guide to care, which details the costs people face wherever they live in the UK.

Care is means-tested, with only the poorest getting help to pay for services.

 

The Beeb reported (quote):

  • The numbers getting help from their council with care had fallen by 26% to 850,000 in the four years to 2014
  • Spending on care by councils had fallen by 25% in real terms in the five years to 2015, to £5.1bn
  • Additional money from the NHS and increased contributions from individuals had topped this up to £7.2bn, but that still represented a cut of 9%
  • Over 40% of money paid to care homes came from people paying for themselves
  • One million people with care needs now receive no formal or informal help – a rise of 10% in a year

 

The report also warned that the cuts by councils were a risk to the future of the market. I’d say so. It was noted that providers had walked away from council contracts in 59 local authority areas.

I’m not shocked – providers have walked away from contracts in all the West Midlands regions

‘Leak’ reveals a savings solution. Is this really the best we can do?

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My recent weekend off had an annoying surprise. Scanning the newspapers to check essential TV viewing, I find a story about a leaked document that allegedly reveals the government is up for motivating people to save for their care in old age.

Just great. How is that going to help us now?

The leaked memo warns of a looming crisis. Looming? Wake up, it’s already here!

Sir Andrew Dilnot offered his solutions and they’ve been shelved. It appears our current elderly population is being somewhat overlooked in these new proposals (if they’re true).

Observer policy editor Daniel Boffey writes: “Ideas include Isa-style savings accounts – known as “care Isas” – with preferential interest rates for a pot of up to £75,000, which you would be able to withdraw to fund your social care or leave, tax-free, in a will. Another plan is that tax incentives could be offered if people wished to take from their pensions to meet social care costs.”

He goes on to say the memo was written last May by the then pensions minister Baroness Altmann in which it’s claimed she says the crisis has been left too long.

Let me quote some more . . . The memo also warns of huge political risks of allowing the crisis to unfold. “There is no money set aside for social care spending by individuals or by local authorities – needs have to be funded as they arise, and if the money is not there the quality and availability of care is compromised, causing scandals and misery that could potentially rebound on policymakers at some point,” it says.

Word has it the Dilnot proposals are dead in the water and I suspect the care industry as we have known it is too.

A savings solution is for too simplistic in my opinion. Would tax breaks encourage it to work? Only for the well off, I suspect.

Newcomers, who are younger . . . would they buy into it? I doubt it. My friends’ kids are too busy surviving the present and trying to get on the property ladder to have disposable income for their care that appears to them light years away.

If this ‘leak’ is the best offering, I think I need stress counseling or maybe anger management therapy . . .

 

New working partnership to help skills shortage . . . and much more

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Creative solutions – a sound bite of the 80s – is alive and ticking with two northern employers coming together to help tackle the care industry skills shortage.

TyneMet College and Age UK North Tyneside’s EveryDay Home Care service have launched a new training programme to upskill workers in the healthcare sector and develop the next generation of industry talent.

I love it!

Health and social care staff from EveryDay Home Care’s workforce and Age UK North Tyneside Wellbeing Services will undergo a structured training programme that covers a range of disciplines including health and safety, medication awareness, customer service, food safety, nutrition and first aid. The employees will study for a health and social care apprenticeship, which will combine on-the-job work experience with classroom learning at TyneMet.

The partnership with TyneMet comes as demand for homecare services is on the rise and providers are struggling to recruit suitably skilled staff.

Alma Caldwell, group chief executive at Age UK North Tyneside and EveryDay Home Care, was reported in the media as saying: “We recognise the importance of increasing the skills base of our workforce, particularly as there is a shortage of suitably qualified workers in our industry.

“That’s why we’ve teamed up with TyneMet College to upskill our current workforce and provide an opportunity for other aspiring care staff to make their way in the sector.”

What can I say? Well, surprisingly quite a bit. . .

All care staff have to go through a structured training programme and many newcomers are signed up to apprenticeship schemes.

My West Midlands Care Association has always worked with local authorities, which have helped us to ensure that we get the right quality training and that it is easyily accessible when needed.

This year we are pushing boundaries and seeking to access training through other routes.

Our problem is that LAs are limited on what they can supply.

Currently we are working with ACCTV a company that produces interactive television training for care staff.

Previously, this has been the preserve of the Southern, well-funded areas, but we have now managed to secure a service with a realistic offer.

Our members will get a very good deal, be assured. Providers will get a taster and access to the dementia training program as September is Dementia Month.

We’ll keep you posted. This is our own creative solution.

 

 

 

Rising cost of care: Don’t shoot the providers, please

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Those people needing to go into a care home now face average fees of £30,000 a year as costs are rising ten times faster than pensioner incomes, writes The Telegraph consumer affairs editor Katie Morley.

A study by Prestige nursing, one of the UK’s biggest care agencies, found a “desperate and worsening” care crisis, with the annual cost of a care home room increasing by £1,536, or 5.2pc over the past year.

The article points out this is almost ten times more than the average £156 (1pc) income gains earned by pensioners over the same period.

Logically then, it suggests that paying for care without spending savings is becoming unaffordable even for the wealthiest pensioners.

Record low interest rates mean pensioners living off cash savings and buying guaranteed incomes in the form of annuities are struggling to generate monies which will not devalue as the price of goods and services gradually rises.

According to the Telegraph “the cost of the average single room in a full-time care home has pushed past £30,000 for the first time and is now £30,926, some £16,470 more than the average pensioner income of £14,456.

“It means pensioners are short by an average of £290 a week if they require residential care,” states the article.

Not surprisingly, the article adds: “London is the region with the most expensive care homes with the average cost now at £38,896 a year. It has overtaken the East of England as the most expensive as a result of experiencing the biggest annual rise in care costs of any UK region at 19pc.”

Before we go any further with this, I must add that every region has a different story to tell on the costs of care, often mirroring the social wealth of the area. We need to be careful how we take up this information and how it is used. For example, in the West Midlands it is more likely to be £24,000 per year, but still many try to provide quality care for less.

Nevertheless, the statistics in the media make compelling reading.

Ros Altmann, the former pensions minister, is quoted in the article, saying: “We have an increasingly desperate crisis in social care in this country. Nobody has set money aside to cover care needs for the increasing numbers of older people who cannot manage to look after themselves.”

Not a lot is made of why we are in this mess in Morley’s work, so I’ll add a nugget or two . . . Simple: Government no longer wants to fund social care in a fair and realistic way. To survive, care providers have to pass on costs. We’re not talking fat cat owners here, either; this is simple economics of survival.

In a separate article carried in the Guardian, Care England, lambasted the government for the crisis in the industry, accusing ministers of not having a strategy for older adult care and allowing local authorities to pay well below the cost of care for residents with state funding.

Martin Green, the chief executive of Care England, is quoted as saying: “I have great sympathy [for residents]. There is a dynamic in this called ageism. Why is it that when you get old and get a disease called dementia, you have to pay for it? I don’t know how in the age of the Equality Act you have older people having to pay for a service that younger people get for free.

“The government needs to have a proper approach to social care. Just pumping money into the NHS isn’t going to work. They need a clear approach, saying that this is what good social care costs. The government needs to show a bit of leadership, I am sick of them hiding behind localism and saying it is about local councils.”

Strong words., which I’d be willing to echo.

There will be those who will blame this current batch of figures on the greed of owners. Frankly, that’s rubbish. It’s just too easy to blame providers when all the facts are not present.

Some local authorities are paying just £330 a week for residents, the equivalent of less than £2 an hour.

Is that a fair rate for caring? Will that really cover hands-on care, laundry costs, food, lighting heating etc? Of course it won’t.

 

 

Social reform: Are the answers in grassroots debate?

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I recently stumbled on an article by Professor Peter Beresford in The Guardian and his comments are worth sharing in this blog.

He is emeritus professor of social policy at Brunel University London, professor of citizen participation at Essex University and co-chair of Shaping Our Lives.

He notes that 70 years on from the creation of the welfare state, social care is one of the biggest, most important and yet most neglected social policies.

“Now another new government needs to face up to the vital need for radical reform,” he adds.

Indeed, that’s so true, but also frustrating. We meet up with Ministers(as we did Paul Burstow in London) and suddenly they are gone – taking with them all the good work we have shared. Such is the political arena.

Prof Beresford’s message is clear – social care reform must come from the grassroots

I quote: “The spending cuts made in the name of austerity over the last six years have especially hit local authority social care.

“This in turn has particularly hurt the growing numbers of older and disabled people needing help, including mental health service users and people with learning difficulties. While the rhetoric surrounding social care has been all about integration, the tendency is still to treat it in isolation.”

This is someone who has a good handle on the underlying issues of funding – the root of nearly all social care ills – and the frustration we feel in trying to get joined-up thinking between the NHS and residential and domiciliary care.

He observes what he describes as the “grassroots reality which shows the human face of welfare reform like that presented by Ken Loach’s award-winning film I, Daniel Blake.”

Based on research and interviews by the screenwriter Paul Laverty, this movie tells the fictional story of Daniel Blake, a middle-aged widower in the North East who can’t work or get benefits after a near-fatal heart attack.

The internet trailer is challenging and introduced for me a broader horizon of how ‘The Cuts’ – ‘Austerity Measures’ – call it what you will – have impacted our lives and how food banks have become ‘normal’ in an increasing desensitised society.

I find myself questioning: What is social care coming to? How has this been allowed to happen and what more can I do to help educate those who handle the finances of Government and seem unable to find funds for us.

Prof Beresford is the author of a new participatory social policy text, All Our Welfare, and he highlighted that there really are alternatives, both to old-style welfare state and current “neoliberal privatising welfare” reform.

Interesting – mental note; must find out more!

David Brindle, the Guardian’s public service editor who chaired an All Our Welfare launch debate, referred to the post-war welfare state as a revolution and asked what kind of revolution we need now.

On the panel, John McDonnell, shadow chancellor, emphasised the importance of developing a new narrative for a new welfare state, reminding us that its founders not only created a new architecture, but also “won the argument” so that for years Conservative governments continued to protect it.

“It’s narrative that wins,” he said.

Significantly, this was a different kind of debate because it included the groups more often talked about than having a chance to do the talking. Representatives of Disabled People Against Cuts, Shaping Our Lives, other disabled people’s and service user organisations, campaigners and user researchers, were present in force as well as the policymakers, academics and researchers more often encountered.

Is this the way we must go?

Summing up, the professor writes: “This was one occasion that demonstrated that there are very different ideas out there about a future for social care and welfare, which come from the bottom up. But they tend to be hidden or devalued and we need foster these green shoots. This is perhaps already beginning to happen. . . .

“For me, the key question posed by writing All Our Welfare was, how should people look after each other in a 21st century society? The launch debate showed that there are already many answers in the making – if they are only allowed space to surface.”

Wish I could have been there . . .