Presentation for Reclaim Social Care Conference, Birmingham 17 November 12018, Health Campaigns Together
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Social care is the worst and most dishonest social policy we have – it is at least as bad as welfare reform if not worse. You can at least successfully appeal hostile decisions on benefit cuts to an independent tribunal system. You get nowhere generally doing that with social care.
Social care is the absolute opposite of all that people love about the NHS. The NHS is still largely true to its founding principles. It is still mostly paid for out of general taxation so that most things are free at the point of delivery. Mostly getting its help is based on clinical decisions, not money ones. When you go to hospital with a broken leg they don’t say no it’s not really broken, you don’t qualify. They get on with it in a way that private systems like the US can’t hope to do. And they do this with great expertise, commitment and kindness generally.
But social care, although most people don’t realize it until something goes wrong is a very different kettle of fish. It is the worst kind of what people call a residual or safety net system. It’s only there for you if you qualify as the absolute worst case scenario. It’s no safety net at all in fact. Age UK estimated that last year more than a million older people who had social care needs got no support. The system is means and needs tested. That is exactly the same as the victorian poor law. The creation of the welfare state has passed it by and the efforts to destroy the welfare state have driven it down into even deeper failure.
What this all means is that you don’t qualify to get free social care unless you are on really low income. You also don’t qualify unless you are seen as eligible for it; that is to say that your needs because you are frail, or have an impairment or long term condition as seen as qualifying you for its help. But here it is based on a really nasty little conjuring trick. Because your needs only qualify even if you’ve got them, if there is enough money to pay. And of course we know that for the last eight years of austerity that budget from central government has been cut and cut. So it isn’t like the NHS where an emergency is an emergency; a broken leg is a broken leg. If there is less money, then suddenly your needs don’t qualify and you and your family and loved ones” are left out in the cold.
That’s because the legal requirement for local authorities to stay within budget legally will always trump them meeting people’s genuine needs and needs are instead more and more redefined down to keep within budget.
Given that we live in an age where the numbers of disabled and older people are greatly rising, the result can only be human disaster. We know that as social and economic conditions have improved as cultures have changed as medical advances have continued the number of disabled children, disabled people living into adulthood, people surviving catastrophic injuries, people reaching older and very old age and people experiencing distress in their life course have increased significantly. People living and having a life who wouldn’t before is something to celebrate not to see as our policymakers do as a problem, a burden, and yes a fraud. We need to support people with social care needs to live the fullest life they/we can – not see them as a costly impossibility. Hitler showed us where that road leads.
We owe where we are to Mrs Thatcher to be truthful. She wanted to make people pay for their care and as she saw it stand on their own two feet. Not by having the support to live truly independent and fulfilling lives, but by cutting back state support, making them pay for help themselves and providing new markets and customers for her beloved for profit sector. No matter it provides poor quality institutionalizing services from another age too often. Here was another source of profit for people like her and her mates. Well it may work for them, but not for millions like us.
It is the biggest domestic policy disaster we face. It is spoiling the lives of millions, yes millions. It is damaging the NHS because there is no proper support for people outside hospital. It is spoiling our economy and wearing out family members left without support to look after loved ones.
Instead we must invest in social care and social care needs. Just as we have realized it works to invest in health needs – and reduces human costs, human misery and economic loss through having an unhealthy workforce and population.
There’s a load of talk about integrating health and social care. But it will never happen properly so long as they are based on different principles and values. This government wants to drag the NHS down to the level of social care by privatizing it to make money for itself and its friends. We must say clearly and loudly on and on, NO this has not and will not work. Instead we must have an integrated social care system accessible and equal for all, in all our diversity, based on social models, which is paid for like the NHS out of general taxation and is free at the point of delivery. That alone will work, is sustainable and will address the changing needs and crucial rights of our changing population.
And it needs to be based on a different approach to support. Not the failing policy of so-called personalization this government is still desperately pursuing and all its other workarounds which promise better for less and don’t deliver. But a policy of person-centred support, based on social models of disability and distress that challenge the barriers and discrimination social care service users face and which isn’t based on the assumption there is something deficit about people – something lacking – but which is committed through an independent living philosophy and strategy to put in that help that people need to live on equal terms to others in the mainstream. And key to this new approach will be the role of a national network of disabled people’s and service users user led organisations, small, human scale organisations, which are evidenced to be particularly valued by people as service users and which are currently at great risk.
And if we take this approach, guess what, we will discover that in an age of artificial intelligence and automation which replaces the multitude of dreary mechanistic jobs no human being should be forced to do, there will be a whole range of valuable and satisfying learning, jobs, careers and opportunities, supporting each other as part of a new vision of social care alongside health care, not as a financial burden, a cost, but an economic generator that can widen and increase people’s opportunities, quality of life and life chances as both workers and service users and often as both at the same time. This must be a truly participatory and co-productive policy, creating new forms of support suppliers, organisations and collective enterprise and co-production – advancing empowerment, involvement and progressive change.
This is the way to go. Decent support, proper social care isn’t unattainable. It is crucial for a modern civilized society as part of a truly sustainable and egalitarian and inclusive approach to human beings and the needs of our planet.
- Beresford, P. (2016), All Our Welfare: Towards participatory social policy, Bristol, Policy Press.
Beresford, P. and Harrison, M. (2017), Social Care Is Broken Beyond Repair, so what should replace it? Labour Briefing, November 24, http://labourbriefing.squarespace.com/home/2017/11/24/ayugootu1ts3hj752d342uv1wn9778
Peter Beresford is Co-Chair of Shaping Our Lives, the national disabled people’s and service user organisation and network and works at Essex University.