The Minister for Communities, Health and Care, David Mowat, generated a wide-ranging debate last week when we spoke about the duty of children to look after their parents. But these comments were not in fact the most contentious things he said.
Earlier in his appearance before the Communities and Local Government committee, he was asked by Mark Prisk MP about unmet need for social care services. His response was confident to the point of bullishness. There is, he said, no evidence of unmet need. His argument was that for there to be significant unmet need, one of two things had to be occurring. Either:
- the Care Act eligibility criteria were wrong and people who needed help were not in fact entitled to it; or
- the criteria were OK but local authorities were not implementing them correctly.
“I don’t think that there is any evidence that either of those two things are in place”, he said.
Ergo, there is no unmet need for social care services.
There are so many ways of effectively countering that argument. For a start, there is a great deal of evidence that both of events he disbelieves are in fact happening. The Care and Support Alliance has consistently argued that thousands with ‘moderate’ levels of need don’t get any help. And we hear from an awful lot of people who believe their council has not assessed them properly. Indeed, it is an open secret that councils are effectively ‘rationing’ services because they do not have resources to meet the needs of all those eligible. Then there are the self-funders who often don’t get as far as assessment.
But his statement is most obviously wrong because his two questions would not in fact identify unmet ‘need’ at all. They would only identify ‘demand’, which is not the same thing.
A need is something that is necessary to me, such as water. But I can lack water – be dehydrated - and not realise it. Similarly, in social care I can be eligible for service such as help with washing but not ask for them. I have an eligible need and it may impact on my wellbeing but I do not demand help from my council.
To see if there is unmet need, at least to his own satisfaction, the Minister should ask himself a third question: do all people with needs come forward and ask for those needs to be met?
To which the answer is, of course, no. If we want the simplest demonstration that demand is lower than underlying need we should look at pension credit, where around a third of the very poorest older people do not claim the additional money which would take them out of poverty.
We have some understanding of why people do not come forward for benefits and services. It may be because they are unaware that a service exists. It may also be that they think they are not eligible. Some, though not as many as people often think, may be too ‘proud’ to claim from the state. Or they may be put off by the complexities and indignities of the application process (I vividly remember a man describing to me how he had stopped applying for help from his council because the staff were trying to defraud him. I realised after a while that he had simply become suspicious of the questions about savings asked of him as part of the financial assessment).
But to assume that there is no unmet need for social care services because we can’t easily identify it suggests not confidence but complacency. We need to demand the Minister looks a little harder.