Social Care – a public service or a commodity

On Monday I attended an event organised by LINKS, the Local Involvement Network which the government says have been launched “to give communities a stronger voice in how their health and social care services are delivered”. The subject of the meeting was ‘The Big Care Debate’, a government consultation on the future of social care. The consultation is premised on the idea that given the rising age profile of the population ‘something must be done’ or else ‘we’ won’t be able to afford to provide it.

We are told there will be a projected 8.6 million disabled people (the older the population the greater the numbers disabled) in 2041 as compared with 2.9 million in 2007.

The government is proposing three ‘options’:

1) ‘Partnership’ – the government will share the cost with us. They will pay 25-33% of the cost of care (but not accommodation) and we would pay the rest.

2) ‘Insurance’ – the government would pay 25-33% of the cost and ‘make it easier’ for people to take out insurance to cover the rest.

3) ‘Comprehensive’ – everybody would get ‘free’ cares in return for a state insurance scheme ‘if people can afford it’.

In the manner of government consultations you are supposed to express your support for the best (or the least worse) of the options the government has chosen. What if you don’t agree with the options? What about progressive taxation and an end to means testing? The government has ruled out paying through the tax system.

On a show of hands the audience ‘voted’:

  • 4 for option 1

  • 1 for option 2

  • 26 for option 3

    Twelve of us were counted as ‘abstaining’ or opposed to all three options.

I could not say for sure but I would guess that the majority who put their hand up for option 3 shows that the idea of a comprehensive service open to all (free at the point of use) still has wide support. Although it would only be free for the poor. But it also reflects the idea that the country is short of money, an idea which, excuse the pun, has much currency.

Jo Osario, introducing the opening session inadvertently put his finger on a key problem with this sector. He realised what he had said when he referred to “the market” (assisted by a scowl from me), saying he had slipped into ‘the Martin Wicks trap’. Jokes aside the key question in relation to Health and Social Services is precisely whether it is a public service or a commodity. Since ‘Care in The Community’ was introduced social care has to a large degree been commodified, with the privatisation of much provision and the growth of a low paid and exploited workforce. In the first 10 years of the Tory government Councils’ bill for private residential care rose from £10 million a year to £1 billion.

The “Third Sector”

One of the dangers in the current government policy in regards to the so-called “Third Sector” is that it will be used as a means of providing care service on the cheap. One of the people present told me that they could use the “Third Sector” more – it would be cheaper and some of them would not even want to be paid!

Another issue which was discussed was the question of Personal Budgets and ‘personalised care’. If my memory serves me well the justification for Personal Budgets was that it ’empowered’ people. These budgets can be used for a range of purposes but these include employing your own carer. This gives power to the individual over their employee but disempowers the latter who is reduced to an isolated individual worker with all the potential consequences. I was told that the holder of the budget was given the necessary ‘management training’ but it is not clear if the situation is policed so that there is no abuse of the employee.

I wasn’t aware that this facility had been available for the last 12 years. Yet the take-up has been minuscule. There are only 200 budget holders in Swindon, half of whom apparently use care agency staff. The Borough Council has employed a Director of ‘Personalisation’. It would be interesting to know how much the Council paid for this resource to concentrate on such a small group of people.

Choice”

In this field as in others the government mantra is ‘choice’, as if service users were taking advantage of choice in the marketplace. In the Health Service there has been a positive change from the situation where consultants used to rule the roost and tell patients what was best for them (those of a certain age may remember the picture of James Robertson Justice, the autocratic consultant in Carry on Doctor). Today, most often you will be told what options you have in terms of treatment and the choice will be yours, if you want it. They call this ‘co-production’ of health. Instead of a patient being a passive recipient of treatment determined by a doctor, it’s a relationship in which the diagnosis is dependent on what the patient tells the doctor and the responsibility for determining what to do rests with the patient (obviously they will depend on the advice and expertise of the doctor).

The same should apply to social care. But the concept of choice as applied by this government is based on ‘competition’ between different providers. In the NHS most people do not want the choice of travelling to a hospital miles away. They want to be treated in their local hospital, if possible, or the nearest one in which a particular treatment is available.

Disabled or frail ageing people should have the choice of ‘independent living’ (of being able to stay in their home) if they prefer it to sheltered accommodation or a care home. But this should be provided as a public service rather than a commodity (an opportunity for a private company to make a profit) which they might not in any case be able to afford.

Personal Budgets are a gimmick. The overwhelming majority of people would like some choice in relation to the services available to them but they will not want to become employers of their carers, as the figures after 12 years show. So long as care is a commodity then those who cannot afford it will not receive it.

Postscript

Today’s Guardian reports on the ‘Big Care Debate’. Those of us at the above session were not told what the cost of insurance was likely to be. According to the Guardian the ‘insurance model’ would involve a one-off payment of £20-25,000. The one-off payment for the ‘comprehensive’ model is likely to be £17-20,000. I suspect that if we had been told that then the numbers supporting option 3 would have fallen considerably.

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