There were lots of fictional references at last week’s national conference of social care leaders. ‘Why are we always the Cinderella service,’ asked one speaker. ‘We can’t always be Oliver, asking for more,’ said another. ‘The Treasury is not going to play Santa Claus for us,’ said another (though technically that’s not a fictional reference since, as we know, Santa Claus is real).
Yes: money, or lack of it, was the common theme, as it has been at many previous events. But perhaps the most telling contribution was from shadow care minister Barbara Keeley, who observed that lack of cash for social care, particularly in comparison to health, has been a feature of all recent governments, of all political persuasions yet it does not seem to bother voters. ‘Why,’ she said, ‘doesn’t the state of social care give more concern to the public?’
It’s a question that has been taken up by another former care minister, Paul Burstow, who is trying to get off the ground the idea of a ‘social movement’ for social care. There is plenty of interest, from charities (including Independent Age) as well as bodies like ADASS, though not yet clarity on what form such a movement might take. To help that debate along, let’s try and answer Barbara Keeley’s question: why doesn’t the public care about social care?
- We insist on using a term hardly anyone understands. Before the introduction of the Care Act’s now long-grassed cap reforms, the Department of Health did extensive research to understand how best to explain them to the public. They concluded that the term ‘social care’ was largely unknown and so instead used ‘care and support’ because, they found, the public broadly understood what it meant. If we wanted to be even clearer we would add ‘for the elderly and disabled’, identifying for the public the groups that needs that care and support. Yet we avoid these terms and continue to talk about ‘social care’. In the absence of terms that everyone understand, we have instead resorted to dictionaries to help the public translate them.
- Care happens in private. The greatest irony about using ‘social care’ is that the care and support provided is anything but ‘social’ – in the sense of public, shared, collective, visible. Rather it goes on behind millions of front doors, whether private houses or care homes. That means it is all too easy to miss. And the efforts by some in the care sector – the admirable ‘Care Home Open Day’ for example – to ‘open up’ care and create stronger links into communities are adopted by too few.
- It makes us think of something we don’t want to think about. We might as well accept that most people don’t want to think about old age and death. We spend a fair proportion of time as a society trying to fend off the more visible effects of ageing so is it any wonder that we try to avoid services that help people cope with it? Again, we have made life more difficult for ourselves by flirting with ‘age does not matter’ movement, which glosses over the conditions and disabilities that become more prevalent with age in favour of a life-affirming, future positive view of the world in which it is hard to believe that anyone older is ill, disabled or, indeed, ever dies.
- Care pales in comparison to the NHS. In the world of zoos, they talk about the importance of ‘charismatic mammals’ – lions, tigers, elephants; the animals that people will pay to see. In our world, acute services and those for lethal diseases like cancer are the ‘charismatic services’, the ones people will pay to fund. In this analogy (making this up as I go), GP services would be oxen and antelope: you can’t imagine a zoo without them but they’re not what sells postcards. Social care (‘care and support’) would, I’m afraid, be the lemurs and mongooses – they have a dedicated, loyal following (and they’re vital to the ecosystem) but it’s easier to get the pubic to sponsor a lion than a lemur.
- We don’t talk enough about self-funded care. Most of us will not need to go into a care home but, if we do, many of us will end up paying for it ourselves. Many of us will need some form of support and care we age but most of us will probably get it from family and friends, perhaps paying for a bit of additional care or putting in grab rails or a stairlift ourselves. Relatively few of us will need to use state-funding social care (just as well, you might think, the way it is going). Means testing makes state-funded social care closer in concept to the benefits system than to the health system, yet that is the part of social care to which we draw most attention. Where are the campaigns about sky-high care home fees or the poor quality of privately provided home care? Who speaks up for self-funders and why don’t we hear more about them?
These are big, long-term issues and problems, not easily resolved. But here’s a few things we could do (one for each reason):
- Stop using the term ‘social care’, expect among ourselves. Rehabilitate the word ‘elderly’ as a shorthand for ‘frail elderly’.
- Insist on all care homes having an open day at least once a year and do everything possible to encourage more links with school, colleges and the wider community
- Take advantage of our obsession with youth: Slap a 15% tax on anti-ageing products to help pay for care and support services.
- Talk about the whole care ‘ecosystem’, not just the ‘charismatic services’ in the NHS, and talk about how it all works together
- Campaign for improved social care for everyone rather than focusing just on the state-funded part of it.