If we are to ‘do care differently’, then perhaps the first crucial step is to start thinking about it differently. Let me explain what I mean.
For years now social care has been starved of resources. Policymakers have repeatedly expressed the fear that major changes in demographics, with many more older and disabled people, mean that the financial cost of social care has created new, perhaps insuperable problems in the way of funding it. The simple truth is that social care has been conceived of as a costly, financially burdensome policy, taking money which even a supposedly rich Western society like the UK cannot afford.
New thinking on social care
It really is time to rewind that argument and think afresh. To do so is not even such a radical step. After all, it was the very opposite way of thinking that led to the creation of the National Health Service in the impoverished 1940s. But then policymakers based their calculations on a very different kind of number crunching. What they realised was that an unhealthy population was one of the most costly drains on any exchequer. The cost of ill-health resulting from poor housing, inadequate medical care and social and economic insecurity wasn’t just a society blemished by low levels of well-being. It was also a society scarred by early mortality, high levels of morbidity, the perpetuation of illnesses and conditions that could be prevented and lowered levels of production, efficiency and social cohesion. All these cost money.
And similarly now, the disastrous state of social care costs money as well as disproportionate suffering and disadvantage. If we recognise that a good social care system can be an economic contributor, rather than a burden, then a very different vision begins to take shape. This is of a key social policy which ups the well-being, skill and contribution levels of groups like disabled people, mental health service users, people with learning difficulties and long term conditions – young and of working age. Also a policy which makes it possible for growing numbers of older and very old people and their loved ones to live the best lives possible, without constant wasteful and unnecessary reliance on costly crisis interventions and constrained lives and breakdowns for ‘family carers’.
It makes possible the development of a positive, creative workforce, with high quality jobs, with conditions commensurate with the crucial role they play in society, offering good training, supervision and a career structure. We need to see social care as at the heart of a new sustainable economy, a model for future employment, based on ‘looking after each other’, that can be exported, committed to supporting positive social reproduction, rather than based on environmentally damaging production and economistic ‘growth’.
Involvement of service users
This kind of vision of support (and it is support not ‘caring’ we should be talking about) is one that has been advanced by service users, disabled people and our organisations for a generation now. It is based on a social model and independent living approach which understands independence not in old-style terms of people having to ‘stand on their own two feet’, but instead having the support they need to live their lives on as equal terms as possible as non-disabled people. That’s why it is so important to involve service users and user led organisations (ULOs) in shaping the future of social care. We have had most of the truly ground-breaking ideas in recent years!
The evidence, accumulated by service users and others indicates that two major changes will be needed if social care is to become the sustainable and effective policy that is essential for any civilised society committed to social justice and inclusion. These are changes in social care funding and changes in culture. Either one on its own won’t be enough.
Social care service users have repeatedly stressed the importance of putting social care on the same financial footing as the NHS if it is to meet the needs of the UK’s new demography which includes much greater numbers and proportions of older and disabled people A diverse range of service users were brought together by Shaping Our Lives, the ULO, by the Joseph Rowntree Foundation in 2009, to explore proposals for funding social care for the future. They felt that a false divide between social care and health care was perpetuated by conflicting funding arrangements. Almost all thought general taxation was the best way to fund social care, with support free at the point of delivery.
A social approach to social care
But this is only the beginning of the story. Second, as the largest independent research and development project on person-centred support highlighted, carried out by a team of service users, practitioners and researchers, a changed culture is needed, committed to supporting the independence, rather than dependence and institutionalisation of service users. Service users all stress that a much more social approach to social care (and welfare benefits too) is needed, which gets beyond individual medical conditions and sees beyond pathologising the individual for what they can’t do, to support them to do all that they may be able to. Our health and social care systems don’t currently do this. However, here lies the way forward to truly doing care differently in an inclusive way, addressing diversity with the equality it demands.
The views expressed in this blog are those of the blog’s author alone and do not necessarily represent those of Independent Age. Independent Age is not responsible for the accuracy of the information supplied in blogs by external contributors.