The Greens make the progressive case on funding, but no one else offers a radical vision of a system fit for the twenty-first century
ocial care has become a bigger issue in this election than many political pundits could ever have expected, judging by the attention now being paid to the different party manifesto commitments.
Yet their focus on funding, however important, obscures the day-to-day realities that make good social care so vital. We have become so preoccupied with money that we are losing sight of the complex issues that create the need for policy in the first place. Most important of all, the need for a fundamental reappraisal of attitudes and services is falling off the agenda. This is the key point to keep in mind if we are truly committed to developing proposals for a sustainable, integrated health and social care system.
While the main party manifestos are different in many ways, they all ultimately have something in common. Each harks back to the Dilnot Commission report of 2011, which was preoccupied with short term politics and prioritising wealthier voters. When forced into a U-turnover the so-called “dementia tax”, the Conservatives also reverted to a Dilnot-type cap on costs. Only the Green party has made the progressive case for a universal social care policy paid for out of general taxation. This, ultimately, is the only long term approach to funding social care that is likely to work – however unpalatable it may be to some politicians in the short term.
None of the other parties has offered any kind of radical reappraisal of what the care system should look like or how it would work in a time of unprecedented social change.
Yet this is needed more than ever before, when the proportion of disabled and older people in our society is dramatically increasing. Instead, the Conservative manifesto focuses on “the old”, with little to say about rising numbers of disabled children, disabled parents and disabled people of working age. We come closest to some serious reconsideration of “care” in the Labour manifesto commitment[pdf] to the social model of disability and inclusive education.
This is the real social care issue: investigating what it means to be a disabled parent, or have disabled children, or be affected by Alzheimer’s, and working out what support will best maximise everyone’s wellbeing and life chances. Social care must be subjected to radical review, after which policymakers can make a meaningful commitment to funding it properly.
Social care is still disproportionately reliant on institutionalisation and twentieth-century thinking, The past failure to address funding has obscured the scale of the problems people face every day, struggling to look after each other as they work longer hours and families live further apart. When is there going to be proper recognition that it is just too much to expect of families to be the main source of care and support for people with dementia? Policymakers’ assumptions that loving relationships naturally morph into caring ones is simplistic, unworkable and often damaging. As the retirement age recedes for people in their sixties, how can they be expected to look after their parents as well as offering more and more support to their children and grandchildren? When are politicians going to stop talking about family carers as “heroic” and do something more substantial to help?
Healthcare innovations mean we have keyhole surgery, unprecedented cancer survival rates and successful operations on babies still in the womb. Social care, meanwhile, is still disproportionately reliant on institutionalisation and 20th-century thinking. Community policy has got to involve more than branding areas “dementia friendly” while public services and civic support are whittled away, leaving people struggling without help while complex and difficult changes take place in those they love. Talking up the benefits of “early diagnosis” is little help so long as there is minimal follow-up support.
The picture is the same with child protection. All the complex and terrible problems involved are obscured by endless difficulties securing adequate funding, political goodwill and appropriate organisational structures to address them. These issues only surface briefly following the most high profile cases, such as Baby Peter, the Rochdale sex ring and Winterbourne View. No wonder we make such a poor job of addressing them.
The disabled people’s movement has long argued [pdf] about the importance of changing the culture of social care. Funding is only one of the elements required to achieve this. More and more problems are forcing themselves on to the social care agenda: mate crime, hate crime, elder abuse, increasing financial and food poverty, malnutrition, loneliness and social isolation. New approaches to organising and providing support for these issues are urgently needed to take us beyond traditional models of state, for-profit, charitable and family care. When there is a real partnership between service users and providers we may at last have real hope of a social care system fit for the 21st century.