Joseph Carter and Joe Allen argue that Welsh policy makes should be brave in coming up with solutions to our growing problems around social care
From November 2009 to February 2010, the Welsh Government consulted on its long awaited Green Paper on Social Care, Paying for Care in Wales: Creating a Fair and Sustainable System, following a similar Green Paper in England. The paper sets out a range of different options for funding social care in the future, including compulsory and optional insurance models, and taxation. However the funding of social care is only one piece of a larger puzzle, and it is time for society to reconsider what social care is actually designed to do.
When the foundations of the modern welfare state were laid by William Beveridge in ‘Social Insurance and Allied Services‘, published in 1942, social care did not feature. His five ‘giant evils’ of the day were “want, disease, ignorance, squalor and idleness”. If this document were written today, an evil as great as any of these would be ‘lack of care’. In 1942, shorter life expectancy and contemporary social concerns meant that supporting older people and disabled people did not figure to anything like the same degree as applies today.
If you were involved in a sudden accident or developed a serious medical condition, you would expect the NHS to look after you and nurse you back to health. Regardless of whether you were living in Bangor or Barry, Pembrokeshire or Prestatyn, you would expect the NHS to be free and for professionals to do everything they can to make you better.
But, what if you are not going to recover? What if you develop a long-term chronic condition or are elderly and need help at home? In these circumstances it is a local authority, rather than the NHS, who could provide you with a package of care, but it can be extremely difficult to know what you are entitled to. The level of charges varies between each local authority and depending on where you live, you might be assessed differently. Someone could be judged to have moderate care needs and be given a care package in one local authority, whilst in another the same person might not be given anything.
We believe that Wales needs a Social Care Constitution to set out the rights and responsibilities of people receiving care and those who are providing it. The current system needs to be reviewed and simplified so people can have an understanding and a realistic expectation of what support they could receive if they were sick and needed long term help.
The Welsh Government has started to tackle the inequalities of the current social care system through the ‘Social Care Charges (Wales) Measure’, which it plans on using to cap weekly charges at £50. This is a positive step, but it only makes minor changes. The modern Social Care System has developed piecemeal over the last 60 years and a future Welsh Government needs to review the whole system to determine what sort of help people need in the 21st century.
But if a future government wants to review the entire social care system, where would you start to rebuild it? We believe the system needs to be based on clear values and would propose the following:
1. Citizenship: Everyone has the right to live a full and active life. This means being in control of one’s life, and having the opportunity to participate fully in family, community, cultural, political, social and economic activities.
2. Equality: Everyone should have the right to a sufficient level of support and care that gives them the opportunity to live this life, whether those needs are temporary or permanent.
3. Access and eligibility: No one will be denied this opportunity because they can not afford to pay for the support they need.
4. Friends and family: It is right that friends and family support each other when needed, but not to compromise their own full and active lives because they have chosen to support someone.
5. Equity across the country: People’s right to live a full and active life will not depend on where they live geographically or whether they live at home or in an institutional setting.
6. Choice and control: Those who require social care support, together with their friends and family, have the right to control how their needs are met, and to decide how that support is managed and delivered.
7. Independence: Social care should enable individuals to live a full and active life.
8. Meeting people’s needs: Everyone’s needs are different and the aim of the social care should not be to provide a set service, but to achieve positive improvements in people’s lives, however that is best achieved.
9. Openness: Social care is a public service and is accountable to the public, communities and the people who use its services. It is open and transparent in every aspect of its work.
10. Responsibility: Leading a full and active life also depends in part on people playing an active role in making it happen, by making the best use of the resources they are given, and where possible sharing what they have learned with others.
Throughout these 10 principles there is a recurring theme of the individual as playing an important role in the development of their own care package. The vast majority of people like to have control of their lives and would not want a care package presented to them by a local authority. We live in a world of 24 hour shopping, where choice is everywhere. The vast majority of people who are disabled or living with a long term chronic condition wants to remain in control of their lives, and this needs to be built into any new care system.
The Welsh Green Paper on Social Care has helped to put social care reform back on the political agenda. However funding is not the only issue and Wales needs an open debate as to what sort of social care system we need.