A powerful case for real change in social care

BASW’s Position Statement on the forthcoming Green Paper could lay foundations for a system based on independent living as the purpose of promoting wellbeing, writes Colin Slasberg

The headlines that accompanied the recent report of a parliamentary inquiry into the funding of social care focused on the idea that taxes on the over 40s should be raised to increase funding.

The merits of this and other approaches will be debated for some time. But this must not be allowed to obscure other messages from the Inquiry. Perhaps chief amongst them is the belief that ‘funding should be sufficient to meet the aims of social care’. If the right connections are now made, this idea and BASW’s Position Statement on the Green Paper will create a powerful force that will lead to positive and exciting change.

Everyone working within - and all those reliant - on the system will welcome the above statement. But for it to become a serious political proposition, society can be expected to want to know two things - what exactly are these aims and how much will it cost to meet them? The parliamentary inquiry report, not necessarily through any fault of its own, is found wanting on both counts.

The unanswered question

The report says social care should exist to ‘promote wellbeing, independence and dignity’. This, of course, reflects the Care Act’s wellbeing principle. But it leaves a key question unanswered -  to what extent should wellbeing independence and dignity be promoted? Without knowing that, how can we claim to know what the aim of the service actually is? A person might be a mile away from the wellbeing, independence and dignity that would make their life worth living. If the system improves their wellbeing by just an inch, has the system done its job?

Whilst the legislature through parliament created the wellbeing principle, it left the question of the level of wellbeing people should expect to the executive – national and local governments. It is for the executive to weigh ambition and cost.

A standard of wellbeing

In effect, what is called for is a standard of wellbeing to which all should be allowed to aspire. Government has yet to rise to the challenge. BASW, however, has declared what it should be in its Green Paper position statement – independent living, as defined by the United Nations. It is a concept ready made for the purpose.

Independent living is neither the obscure or outlandishly costly idea some believe. One of its core concepts is that people should have choices equal to others. For an older person, this might mean nothing more than going to bed at a time of their choosing or having a meal of their choice. A second core concept is to be able to participate in society. For a younger person this might mean being able to offer their talents to wider society, while for an older person it can mean just being able to continue as a valued family member.

Independent living is nothing more than a reasonable expectation for quality of life in a modern and diverse society. It is the level of wellbeing that enables all its citizens to contribute to their family, community and society. How can we aim for anything less for our older and disabled fellow citizens and claim to be true to our Code of Ethics?

Government did, of course, consider adopting independent living as a matter of policy. It rejected it on the grounds that the wellbeing principle was superior to what it called the ‘abstract’ concept of independent living. It presented wellbeing as an alternative to independent living. But this is not the case. Independent living describes a state of wellbeing, an end point. They are thus complementary concepts, not alternatives. Once understood in this way, independent living would become the recognisable and valued aim of social care, with the Care Act the vehicle for its delivery. 

Costs

Cost, of course, is a serious consideration. It may well be that fear of the cost of independent living is the real reason government rejected it. BASW is very aware of this conundrum. It is committed to working on it over the coming months. The key challenge is how to reconcile sufficiency of resource with affordability. Professor Beresford and I put forward a proposal in last May’s PSW centred on replacing eligibility of need with affordability of need as the means to control spending.

The national conversation about social care has to change. It must stop being seen as a place of no hope where only bad things happen, a drain on a reluctant society willing to fund it only just enough for it to do the jobs no-one else wants to do and stops being a nuisance to hospitals.

Social care should be seen as the place where older and disabled people are supported to be the people they are capable of being. Once social care is seen as a good place the parliamentary Inquiry’s belief that social care should join health in being free at the point of delivery will surely begin to attract the public affection for this idea to become a serious political option.

Merely promoting wellbeing is not enough. It’s the end point that determines if the aim has been achieved and the aim that defines the end point. It is to be hoped BASW will come up with a proposal to reconcile needs for independent living and cost to put before government that is compelling and persuasive. It could well be the key to ensuring the Inquiry is not just the latest well-intentioned, but doomed, intervention by political leaders.

Colin Slasberg is an independent consultant in social care