Does it pay to design one social care system from cradle to grave?

The government announced yesterday that a (nother – groan) Green Paper on social care will be published by Spring 2018.  However, it says quite clearly that the Green Paper will set out ‘its proposals to reform care and support for older people.’  It goes on to explain the chief rationale for the Green Paper Reform as being that ‘the realities of an ageing society mean that we must reach a sustainable settlement for the long-term.’  However, the announcement also says:

Whilst the Green Paper will focus on care for older people, the Government recognises both the challenges faced by people of working age with care needs and the many common questions about the sustainability of the care system… ensure that issues for working-age adults with care needs are considered in their own right, the Government will take forward a parallel programme of work, led jointly by the Department of Health and the Department for Communities and Local Government…’

My Twitter feed suggests many providers and disability organisations are viewing this extremely negatively.  The looming crisis in funding connected to pay for overnight care may be behind this – it appears the government is allowing political imperatives to dictate its focus and to relegate younger disabled people in order of priority.

BUT…. (and its a big but because I am hedging), the debate on the long-term funding of social care has not served the interests of younger disabled people at all well for as long as I can remember.  The principal driver is the ageing population and in particular the growth in the population of over 85s.  The chief policy questions have been either how to avoid older people prematurely requiring the NHS or ‘bed-blocking’ in hospitals when they can’t go home, pushing policy inexorably towards transforming social care into ‘healthcare in the community’ under the rubric of integration and on how much of people’s assets they should be required to use up to pay for social care either before or after they die.  These issues have framed the debate about both the form social care should take and how it should be paid for in future.  Yet these are largely irrelevant questions when it comes to younger disabled people.  In fact, the questions surrounding how to ensure a sustainable system of support for younger people have been rarely discussed, it at all in recent years.

So, perhaps a cautious welcome would be wise, on the proviso that these will genuinely be parallel processes, and not a case of kicking funding of social care for younger disabled people into the long grass.

The opportunity and challenge right now is arguably not to bemoan this separation but to take advantage of it by striving to frame the debate concerning younger disabled people.  I was struck in particular by this in the government’s announcement:

‘To achieve reform where previous attempts have failed, we must look more broadly than social care services alone, and not focus narrowly on questions of means-testing, important though these are. Our vision for care must also incorporate the wider networks of support and services which help older people to live independently, including the crucial role of housing and the interaction with other public services’

There are many blogposts on this site encouraging the same approach when it comes to younger disabled people.  To really make this new process count, we might wish therefore to say with one voice to government that social care should not be our starting point – independent living should be.   More specifically, to turn the government’s analysis on its head, the question isn’t how to brigade wider supports to the ends of ‘social care’ but rather to think about how what we now call social care can be integrated into a single system of personalised support, spanning personal care, employment, education, health (potentially some benefits) and so on and how social inclusion can be achieved through people’s increased participation in the common domains of associational life (work, education, leisure, politics, religion, family life, online etc).

And of course, we have to get serious on the question of finance.  I fail to see how social insurance, equity release or asset-based funding options offer anything practical or fair for younger people.  Paying via general taxation has to be on the table and I would argue that pushing for this in order to invest in a fully integrated system of support, drawing together existing services and benefits (already paid for by general taxation) would be more successful than trying only to argue for a major uplift in public spending on social care as it is presently understood.

As a starting point, the government likes to tell us that it spends £50 billion of public resources a year for a range of different benefits and services for disabled people.   As my good friend Rich Watts suggests: hand it over, hand it over, hand it over.
















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