In the first of a series of articles focusing on social care in 2017, I want to start at the beginning and ask the question of what is the purpose of social care? In all the many discussions I have seen since before the Care Act have never asked or answered this fundamental question, which I believe as added the current problems we are facing.
I fear most people see the purpose of social care as simply ‘looking after the vulnerable’, which is quite a disheartening viewpoint as the term vulnerable shows a lack of respect for people with impairments that includes older people. On a policy level, the purpose can no longer afford to be that simple and ad-hoc. It worked when social care was a smaller concern but with demographic and other issues, social care has now grown to a point it is having an existential crisis.
I would like to propose that there are two main goals in social care; preventing people from going backwards in their general wellness, and supporting people to move forward with their own goals. It is inevitable that financially the first goal of not going backwards will take priority and can be agreed upon in every context. The bottom line is social care is there to prevent people with relevant impairments from physical and emotional neglect that could result in poor health, injury, harm and ultimately death.
While this goal is often criticised for not being founded in the realms of compassion and dignity, it is what it is. The big question is what exactly constitutes social care as opposed as any other solution in preventing people from experiencing harm. Everyone needs food to stay alive and it is easy to see this is a welfare issue as oppose to social care. We can see if someone needs help with feeding physically than this is social care, but what about if someone refuses to eat as their main condition? It is currently very hard to establish what makes social care social care.
I feel as my personal assistant pointed out to me once, the notion of impact is important to determine whether a request for social care is financially sustainable, a concept that has to be applied to be fair in a world of limited resources. I had a discussion with someone who believed it was awful that people who could not do up buttons had to where tracksuits as it was an issue of dignity. My opinion is that unless wearing garments with buttons is a requirement of your employment that could therefore be at risk, we live in an era where buttonless clothing is the norm in a informal setting. A difficulty in doing up buttons in isolation to any other difficulty is not going to cause harm and could result in a call for people who can not open jars to receive personal assistance!
The second goal is more in the realms of independent living and one that is harder to define. I believe that we all have ‘next steps’ to reaching our full potential and that people’s impairments can add difficulties that social care solutions can overcome. I believe in deciding what is reasonable additional assistance in terms of social care, it is important to compare a person with impairments with a peer without impairments in terms of socially and culturally relevant opportunities and experiences. An example would be I believe it is reasonable to assist someone in their 20s to go backpacking across Europe or the World because their peers are likely to be doing the same.
This is just a brief start to what is a complex issue that requires exploring as part of any reform to the social care system. I believe if we are able to properly define and universally agree on this and other questions, then we can go some way to solving the social care crisis.