Dr Alison Tarrant argues that a re-think of adult social care shouldn’t solely focus on funding – it needs to look again at its fundamental purpose.
Among the most pressing challenges for the new Welsh Government is the increasingly urgent need to reform social care, which is now perhaps ‘at breaking point’ in Wales, as it is in other parts of the UK.
Reform is well overdue. A recent report has revealed that while some people have good experiences of social care, all too often people are unable to access assistance, or receive inadequate support, or have to fight for provision.
Wales is also heavily reliant on informal carers, with the vast bulk of support provided by family, friends and neighbours – usually women.
When you add the pressures that the pandemic has placed on this already creaking system, we see more clearly than ever that we are faced in Wales with structures that are in urgent need of both financial investment and renewal.
The pandemic has revealed not just the fragility and instability of the current system, but its inability to protect the most basic human rights when under pressure.
“People want to live rather than to survive; and to have their own life; rather than the life that the state makes available to them.”
Yet within days of resuming his position as First Minister, Mark Drakeford announced that the Welsh Government would act on social care only if the UK Government does not take action on a UK-wide basis.
Given the repeated postponement of a green paper on social care at Westminster and the lack of anything substantive in the recent Queen’s Speech, that is unlikely to happen any time soon.
Social care reform is certainly complicated for a devolved nation. It is funded by intricate combinations of monies from local authorities, health boards, and private individuals – the latter of which are typically intertwined in complex relationships with national benefits over which the Welsh Government has no jurisdiction.
Eluned Morgan, the new Minister for Health and Social Services has also pointed out the difficulties that arise from cross-border retirement into Wales.
But the focus on funding – while clearly of huge significance – is overshadowing an equally important debate that we also need to take forward.
That debate is around the purpose of social care. We need to think about what social care is for and what we want to achieve with it.
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The UK is home to an activist disabled people’s movement which has been making very clear representations on this theme for decades.
It argues that the purpose of social care is to enable people to lead lives that are – quite simply – equal to those of their non-disabled peers in terms of opportunity and control.
In my experience, most older people who need support in daily living (the main demographic group of social care recipients) have also wanted assistance that enables them to lead their own life in the way they want.
In short, people want to live rather than to survive; and to have their own life; rather than the life that the state makes available to them.
When we need assistance in daily life, social care is fundamental to us seeing our friends, going to the park or the shops or the cinema, getting around, working, parenting our children and supporting our parents as they age, relaxing however we choose, cooking, eating, voting.
I say ‘we’ because very many of us will need social care support at some time during our lives, although we cannot necessarily predict who.
If we fast-forward 60 years, it is safe to say that this is not what social care in Wales – or other parts of the UK – is achieving.
“There is still a pervasive narrative that ‘dependence’ on social care is undesirable.”
The Social Services and Well-being (Wales) Act 2014 certainly contains new ideas – such as the wellbeing duty, a focus on outcomes, and references to international human rights law. It also has important distinctions from its English counterpart (the Care Act 2014).
Overall, however, much of the 2014 Act was about consolidating existing legal duties. Some of that pre-existing legislation dated back as far as 1948, although it had been adjusted and added to many times since then.
As a result, many of the underlying assumptions around the law and the people who use social care have tended to persist. We still typically think of social care being about ‘looking after’ people. In particular, there is still a pervasive narrative that ‘dependence’ on social care is undesirable.
Instead we should consider social care use as a positive, and as a means for people to live their lives in the way they choose.
The pandemic may have brutally exposed the problems in social care in Wales, but as the (former) Deputy Minister noted in February, it has also raised awareness about it.
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We need to take this opportunity. Rather than endlessly tweaking the existing system we need to use the impetus of the pandemic to think in different terms.
We need to start from the question of what we want to achieve with social care in Wales, instead of applying this question to what we currently have.
Wales is in a unique position to drive forward discussion on the purpose of social care and explore a new vision.
Forty-four of the 60 MSs now in the Senedd come from three parties which have previously – in various permutations – worked together in coalition governments, suggesting that there may be more opportunities in the Senedd than in Westminster for constructive discussion.
Wales is also distinguished by a current interest across the political spectrum in developing new human rights legislation. There is widespread interest in the Senedd in legislating to incorporate the UN Convention on the Rights of Persons with Disabilities (CRPD), and both Welsh Labour and the Welsh Liberal Democrats committed to this in their 2021 manifestos.
If this is achieved, we will certainly need to reconsider social care. The CRPD states that disabled people (and that includes older disabled people) have a right to lives that are equal to their non-disabled peers. It follows that social care will need to be crafted around enabling people to live such lives.
“Welsh Labour has been returned to power with an increased presence in the Senedd… there will rarely be a better opportunity to act.”
The manifestos of all the major parties demonstrate that there is already some overlap in discussion around social care.
However, it is focused on matters such as funding, sustainability, the workforce and support to informal carers rather than the overall purpose of support. In other words, how to ‘fix’ what we have.
Instead, we need to consider what social care should achieve in a modern world and what narratives we want to create around those in our communities who use it.
Do we want stories of otherness and separation, a struggle to get support, and lives restricted by poverty of ambition in the social care system, or stories of equality and social justice?
If it is the latter, we need to start from that vision and work backwards to work out what we need, rather than forwards from the system we have.
The challenges facing the Welsh Government when it comes to social care policy are formidable and have been hugely amplified by the pandemic. But the Welsh Government is in a secure position.
Welsh Labour has been returned to power with an increased presence in the Senedd, endorsement for Mark Drakeford’s leadership and a four-year mandate.
There will rarely be a better opportunity to act.
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