By Simon Bottery, Director of Policy and Communications
Sadly, in the outrage over the Equalities and Human Rights
Commission's report into home care, published on Wednesday, three
critical distinctions have been missed.
1.
Between individual responsibility and systemic problems. Abuse
is always the responsibility of the individual - no one can be
excused the sorts of callous or even violent and illegal behaviour
that the EHRC report has uncovered. And everyone has a personal
responsibility to treat people with dignity and respect, without
prejudice and as individuals rather than 'old' people. This will be
tough to tackle, requiring training, and quality management and
support. Yet the EHRC report also shows that ageism is
systematic.
An older adult would typically receive less services than a
disabled, working age adult with the same level of needs. The need
for social activity - to get out of the house and meet people - was
more likely to be acknowledged and responded to in care plans of
younger people than older ones. Tackling this systemic
discrimination will be every bit as hard, possibly harder, than,
the individual prejudice that contributes to it.
2.
Between outright abuse and rushed, poor-quality care. The EHRC
report uncovers both but the social care minister, Paul Burstow,
and most media coverage focused purely on abuse. Of course Burstow
is right to say that this needs tackling with spot checks, tougher
enforcement and better training but it's the broader issue of a
system that consistently fails to deliver good-quality care that
is, in many ways, the harder part to tackle.
The EHRC rightly highlighted the role of council commissioning in
the failures of home care. It found that some councils now based
their commissioning decisions overwhelmingly on cost rather than
quality, and the practice of 'reverse e-auctions', in which
potential suppliers compete in real time to provide the lowest
possible price, is gaining ground. How can this possibly deliver
quality care?
3.
Between central government funding and actual cash spent. Can
there be anything more depressing than the sight of politicians
arguing over statistics? The Social Care Minister Paul Burstow and
his Labour shadow, Liz Kendall, spent much of Wednesday morning
trading figures.
Burstow argued that the coalition is spending £7.2bn more on
social care; Kendall argued that there has been a £1.2bn cut. They
are probably both right. Yes, the coalition has made available more
cash to councils for spending on social care. But this came against
a wider background of deep cuts in overall council budget and,
crucially the coalition failed to ringfence the money for social
care, allowing councils to spend it on whatever they want.
So in reality they are spending less, not more, on social care and
we don't just need to take Liz Kendall's word for it: The Audit
Commission last week said that in 2011/2012 local authority
spending on adult social services will fall by an average of 2.5
per cent. This is a smaller cut than on other services but it
comes, of course, as our older population is growing. So the
reality is less money being spent as demand increases. Small wonder
the system is in crisis.
If we recognise these distinctions and act on them, we will have
the basis of a fundamental reform of our social care system that
should mean that any future EHRC report records fewer problems and
much greater satisfaction. Such a care system will rightly
prioritise dignity and respect, and will step up enforcement of
standards. But it will also tackle systemic discrimination, reform
commissioning of social care, and introduce a new approach to
social care funding, based on the recommendations of the recent
Dilnot Commission.
Or we can just sit back and wait for the next report on the
failure of our social care system.
