What Does It Mean to Care?

What does it mean to care?

Right across the UK, everyone from decision-makers and lawmakers to venture capitalists, children and parents is asking this deceptively simple question. With an ageing population, more people living longer with life-limiting conditions and more families and councillors struggling to make budgets add up, the question of care is one of those that will define Bristol’s future.

Today, in 2023, there are 61,000 older people living in Bristol, and 8,400 people aged over 85 – although not all are in need of care. More than 750 children are in the care system, and at the end of 2021/2022, there were 2,253 working-age adults in receipt of some form of social care. If Bristol follows national trends, those numbers are set to go up and up.

Their life experiences, their chances of a happy and healthy future, depend on city leaders, citizens and families answering the question: what does it mean to care?

But while the numbers of those in need of care are rising, the amount of money councils have to spend on care has fallen. This has resulted in what some experts call ‘the graph of doom’, where the net expenditure on care is becoming further and further removed from funding available. Exacerbated by more than a decade of austerity – where grants from central to local government were almost halved on average – the gap between spend and need has continued to widen.

‘There is a perfect storm when it comes to social care,’ explains Councillor Helen Holland. As the cabinet member with responsibility for Adult Social Care and the Integrated Care System, Holland has an excellent insight into the needs, pressures and solutions for care in the city. ‘There are more people in need of care, sometimes very expensive care. There are cost pressures, rising costs across the board means care providers are asking for more. And there are workforce shortages.’

Care providers are seeing a widening gap between the money offered per person from the council and the day-to-day running costs of running a residential care home or care service. Sometimes that gap can be as much as £200 per person.

Another storm brewing is linked to the crisis in the health service.

More and more people are living with conditions for longer before getting treated, requiring more complex care for longer. Then there’s the ‘bed blocking’ issue, where people have no choice but to stay in hospital for longer after an incident – be that an injury or illness – due to a lack of social care places to move patients into. The longer someone remains in hospital, the more complex the recovery. Some trusts are resorting to extreme measures, moving patients into temporary hotel placements to relieve the pressure on wards and ease the ‘bed blocking’.

The result of this perfect storm of pressure, Holland warns, is that local authorities can end up doing things wrong, because they don’t have the resources to innovate and improve.

The doom graph may be the focus of local and central governments, but Holland is keen to emphasise that the outlook on social care does not have to be gloomy. She is keen to promote innovation and inclusion across the sector, to ensure more people with complex needs can get the most out of life.

One example of innovation in adult social care in the West of England is the We Work For Everyone campaign, which supports learning disabled people into the workforce. The initiative also supports employers to make the necessary adaptations to support their new staff member.

A combination of practical barriers as well as longstanding discrimination means that Disabled adults, and learning disabled adults in particular, are locked out of employment. They may be eager to work and have the skills to work, but stigma means doors are closed in their faces. The We Work For Everyone campaign breaks down those barriers.

It may sound unrelated, but supporting people who want to work into work is a form of care. It recognises that every person has different needs, skills and aspirations for their life, within the care system and outside of it. While not everyone living with complex needs can work, or indeed wants to, some do, and their ambitions deserve support and respect.

‘The response has been fantastic,’ explains Holland. ‘With people being able to live independently, feeling that they’re contributing to society.’

Work is one thing. But building a city that has care at its heart requires a broader approach that recognises our shared civic responsibility to the most vulnerable in society.

This means investing in open and accessible city infrastructure that supports a wide range of people’s needs, from the parent negotiating a buggy on the bus to get their child to the local library, to local parks where older people can enjoy a sit-down in the fresh air, and community centres offering classes and social sessions. Care does not need to happen in a residential home or a hospital bed. It can happen in every corner of our city.

The idea that care can be central to a city and its infrastructure is something that drives Geoff Crocker. It’s now more than 20 years since Crocker set up Bristol Care Homes, which are dedicated to providing affordable social care for older people.

‘We need to be engaging the care home community – and that means residents, relatives, and staff – into civic society,’ says Crocker. Rather than seeing care as something that happens to specific people in discrete areas, there is a need to bring care into society, making it something we are all engaged in.

In common with the whole sector, Bristol Care Homes is facing many challenges. The ongoing impact of the Covid-19 pandemic along with the cost-of-living crisis and workforce shortages have all put pressure on the business. And providing care is, in itself, a challenging space to operate in.

‘There are a number of people in the community who are elderly and have lost capacity to some degree,’ says Crocker. ‘This could be mobility, it could be to do with incontinence, it could be to do with loss of intellectual capacity and dementia. Caring for people in those situations is fairly challenging, because unlike a hospital, a care home is providing long-term care, usually for the rest of a person’s life. That is both holistic and clinical care.’

In the face of these pressures, Bristol Care Homes has committed to innovation, so it can meet both its residents’ needs and the needs of their wider families, all while helping to build a Bristol that puts care at its heart.

Driving that spirit of innovation is the understanding that older people today are not the same older people as of our childhoods. Today’s pensioners are not the stereotypes of days gone by – they require different entertainment, engagement and activities than previous generations.

‘We don’t patronise the elderly person, we don’t stereotype the elderly person and we don’t project our own preferences onto the elderly person,’ explains Crocker. In practice, this means devising an activities programme that meets older people where they are, offering art classes, music sessions (with the playlist ranging from classical harpists to The Rolling Stones) and trips on long boats and to falconry centres, as well as regular visits to the garden centre. One memorable occasion, which Crocker hopes will become an annual event, was an immersive Aurora Orchestra concert in Bristol Cathedral that brought the city and care residents together.

Such on-the-ground innovations help to keep residents active and engaged, help staff enjoy their time at work and offer relatives peace of mind. But there is a need, Crocker and Holland agree, for more structural innovations that meet the graph of doom head on and ensure that an ageing population, and a rising number of adults and children in care, get the support they need to live happy, healthy and fulfilled lives.

Such structural reform can start with tackling a seemingly unrelated issue: socioeconomic inequality. Bristol remains a deeply divided city, with council wards struggling with extreme deprivation set cheek-by-jowl with wards where incomes and house prices soar.

Healthy life expectancy for men and women in Bristol is below the national average, and people living in the most deprived areas have a lower healthy life expectancy than those in wealthier wards. The gap in healthy life expectancy between the most deprived ten per cent and the least deprived ten per cent within Bristol is 16.3 years for males and 16.7 years for females, and there are five areas where male healthy life expectancy is in the lowest five per cent in England. These are Knowle West, Barton Hill, Withywood, Upper Easton and Hartcliffe. For women, there are three areas that fall within the lowest five per cent: Withywood, Hartcliffe and Barton Hill.

The gap in healthy life expectancy is a warning. The longer people live with complex long-term health conditions, the more care they need. To build a caring future for Bristol depends on us building a more equal one.

This article appears in Bristol 650: Essays on the Future of Bristol, a book bringing together essays from over 30 contributors, addressing some of the challenges the city faces and sharing ideas about how we might meet them. From dealing with the past, the future of social care, culture and housing to building a city of aspiration, the book looks to promote learning about the future of Bristol and encourage new ideas to come forward.

Free copies of Bristol 650: Essays on the Future of Bristol will be available at selected Festival of the Future City events in October 2023, or you can find articles featured in the book at bristolideas.co.uk/bristol650book.