Monday, February 04, 2008

Crisis? What crisis?

Our social care system is in crisis, according to the annual review published by the Commission for Social Care Inspection this week. Disabled people and the frail elderly face a postcode lottery as local authorities tighten the screws ever further on the provision of social care. The report revealed that councils are implementing increasingly strict eligibility criteria, excluding many vulnerable adults who would previously have been eligible for support.

Fewer frail elderly people are being supported in their own homes, despite a 3% increase in those over 75. Shockingly, some local councils are excluding those who are unable to either wash or dress themselves independently. The burden of care is falling on female relatives families who are under increasing pressure to provide both social and personal care for their elderly relatives.

The social care minister, Ivan Lewis, has made loud noises about the system being both ‘unfair and inconsistent’ and has announced a government investigation into the findings. You might even be convinced that the government was unaware of the shambolic way we support those with social care needs, although personally I think he doth protest a little too much. Try a little experiment. Google ‘social care crisis’ and you will see similar reports going back at least a decade. Or ask a social worker.

Why are we failing so spectacularly to support those members of our communities with high care needs?

As an ex-social worker I have heard many, many (and then some more) complaints and back-of-a-fag-packet explanations from people who are appalled to find that they fail to meet the eligibility criteria for support. A small selection:

  • This bloody tory council doesn’t give a toss about disabled/elderly people.
  • This bloody labour council is too busy giving its money to lesbian basket-weaving classes.
  • This bloody lib-dem council couldn’t organise a piss up in a brewery.
  • Various explanations involving anyone in possession of a foreign accent or dark skin.

I suspect the real reason is more complex, and one that we all ultimately have to take responsibility for.

Anyone over 40 may remember a quaint old thing called consensus politics. Between 1945 and 1979 the major political parties had a tacit consensus regarding the role of the state and its responsibilities. The welfare state and the national health service were born, and subsequent governments understood that the state would provide social and health care to all its citizens, to be paid for through direct taxation and national insurance contributions.

In 1979 we voted overwhelmingly for a woman who sought to abandon the political consensus with her zealous commitment to free-market monetarism. ‘There is no such thing as society’ declared Thatcher, and then proceeded to dismantle the mechanisms which supported it. Rampant individualism replaced the concept of a co-operative society in which the economically active members support the needs of those who are vulnerable through frailty or disability. Apparently we were only interested in government's ability to run an efficient economy. Apparently, we still are.

The simple truth is that as a society we appear to not want to pay the taxes required to maintain a half decent standard of social care. We complain bitterly at increases in our council tax, and vote according to who will give us the lowest tax burden and maintain an efficient economy. We just don’t seem to care about the frail elderly or disabled people, and local government becomes the scapegoat as it struggles to manage with increasingly tough settlements from the centre.

Social care has been in crisis since case law established that local authorities have the right to meet the needs of vulnerable adults within available resources. This was roughly 16 years ago. Perhaps it is time for us to have a full and frank debate as to whether we are genuinely willing to pay for a decent social care system. And if we aren’t, please let's be honest and quit the disingenuous whingeing.


Reading the Signs said...

I'm with you all the way about tax-whingeing, Ms M, but there is always the question of how the money is actually spent. Never enough of it on social care.

We are going to be facing this issue increasingly, I think. My feeling is that it's an issue most of us don't want to look at because it's too uncomfortable. A small crack into the otherworld of the frail elderly opened up when I was trying to find residential care for my mother-in-law. The places I saw - if I hadn't seen I would hardly have believed - and did not want to believe.

B said...

I'm glad you're posting again (I only started reading just before you stopped). I have nothing to add, but just wanted to comment to encourage you :)

Ms Melancholy said...

Hey Ms Signs, yes, agreed. I despair that we don't seem to be able to make the link between the paucity of social care and our unwillingness to fund it. You have my sympathy regarding the residential home search. Introducing free market principles to social care has been an unmitigated disaster in so many ways, but not least the quality of care provided in so many homes. It's good to see you back here.

Hi b, thanks so much! I shan't be taking such a big break again....and do come and visit us at Chasing Sheep.

Böbø said...

Of course Council Tax (which is really Council, Fire and Ambulance Tax) gets artificially inflated when central government sneaks in low grants, or gives extra responsibilities without extra resources.

Council Tax accounts for only a small part of local government spending, so it has to have big increases to cover any shortfall in government money.

This allows central government to stigmatise local government as spendthrift and irresponsible with their money, and position themselves as the protectors of ordinary people but capping "outrageous" Council Tax increases.

It also allows central government to increase the tax burden while claiming that they didn't do it.

There is a Thatcherite paralysis around income tax: you must always be shown to want to decrease it, and never suggest it might need to rise. Hence "creative" (aka dishonest) attempts to raise tax by indirect means. Ooooo those sneaky Antisocial politicians.

My hope is that some way will be found to mobilise the political muscle of the elderly. But I suspect that'll only come about when we "Me" generation babyboomers suddenly realise that 70 isn't the new 50, and that actually we've become old and need extra care.

Los Angelista said...

It'll be interesting to see how this gets addressed as the US moves toward universal coverage. I especially think about this as my parents get older and I live 2000 miles away.

Los Angelista said...

Oh, and I'm glad you're back! :)

Absolute Vanilla (& Atyllah) said...

Thatcherism has a shitload to answer for - as someone who's planning on moving to the UK - yes, please shove over and make some room, if you don't mind - I have some seriously serious concerns about what is happening on numerous fronts. The reality though is, as is the case anywhere, unless the populace is willing to stand up and shout, government will get away with whatever they can - it's true of any place and any government. As I said to another blogger a while back - and best it's our generation who do the shouting because it will be us who'll be elderly later - so even if there are those unwilling to do it for old folks now, they/we should at least think to the future. But will they/we?

Boris said...

You are right Ms M, as I have said in the past, I DO think we need to have a rethink about what kind of society we want to live in. If we want to maintain all the things we now pay for and have more of some of those things then it is clear that we MUST pay more tax. And personally I think it should be a tax on income/wealth, not a tax on spending as the latter penalises the less well off.

However, RTS has hit the nail on the head - where does OUR money go?

Do we really need an "independent" nuclear deterrant for example, or could this cash be beter spent on social care. If our leaders at least bought British then at least the money would circulate back into the economy.

Nice to see the serious stuff back again.

Boris x

That's So Pants said...

Hi Ms M

Good to have you back. You KNOW I agree with you.



Ms Melancholy said...

Hi Bobo, I really share your distaste for the antisocial way that central government raises taxes by stealth - hitting the whole population rather than those who can most afford it - and then creates a whipping boy out of local government whose job it is to provide comprehensive local services. Perhaps there should be psychometric testing for would be politicians, with only certain personality types getting the thumbs up? Not sure which adaptation would suit best though!

Hi Los Angelista I was watching the coverage of Super Tuesday this week on the BBC, who said that voters are solely concerned with who will run the most efficient economy. I wonder when the principle of fostering a healthy and successful society dropped off the agenda? It will be very interesting to see how the US approaches universal coverage, and what lessons we might take from that over here. Our system is certainly in crisis, and something new has to happen.

Thanks for the welcome back!

Hi there absolute vanilla, I think the bit that I despair about is that folks don't seem to be able to make the link between their voting patterns and lack of public services. The number of elderly people I used to work with who would tell me in one breath that Thatcher was the best thing that ever happened to this country, and in the next breath blame the local labour council for the fact that they had to pay for their own residential care! We weren't supposed to engage in political debate with clients, but sometimes I just couldn't hold myself back. I fear this is the discussion we need to have in a much more open way, as ordinary voters just don't seem to make the link that when we pull public services, one day it will be they who are in need of them.


Of course we will make room for you, by the way. There is still a bit of room up here in rural Yorkshire, and we are are very fond of hens so Atyllah can come too.

Hi there Boris, do you think if we could make a choice about where a proportion of our tax is spent, enough of us would choose social care? I just wonder if not enough people care anymore, as this discourse has so long dropped off the political agenda? Young people seem to consider it quite archaic to think collectively......or am I just encountering a particular kind of young person do you think? Oh dear. I appear to have depressed myself again!

Hey lovely Ms Pants, you have escaped!! Well done. Enjoying catching up with you on your travels.....

trousers said...

One of your characteristically eloquent posts with a fine balance of reason and passion. As such I've nothing I feel I can add (or argue against) but it's good to see you back on the case with such matters.

Absolute Vanilla (& Atyllah) said...

Atyllah says thank you and would you mind if she brought Granny Were along with her. She feels Granny might enjoy chasing sheep with Ruby.

Ms Melancholy said...

Hey trousers, you flatter me, but I do love you for it!

Hi again absolute vanilla, Granny Were is very, very welcome. Ruby would love the company, although the local farmer has taken to travelling armed with shotgun so they do have to be extra careful.

Political Umpire said...

"Perhaps it is time for us to have a full and frank debate as to whether we are genuinely willing to pay for a decent social care system."

That's the point, I think, isn't it - people simply are not. Far too many have huge personal credit problems, and they can't blame Thatcher for that (many do, but it wasn't her who told them to buy a designer outfit last week when they couldn't afford it). Ironic given that public spending in 1945 only took place at all because we got in hock to the Americans big time (the buggers having shafted us during the war, quite deliberately, to pave the way to them becoming a superpower).

Second problem that occurred since 1945 was that the population aged: life expectancy increased enormously. That put a strain on the NHS and pensions that no-one foresaw at the time.

What's the answer? Not a clue, of course.

PS like your other blog, promise I'm reading even if not yet commenting ...

Ms Melancholy said...

Hey Pumpy, good to see you back here again.

Personally, I think I could probably construct a half decent argument holding Thatch responsible for global warming, Amy Winehouse's drug problem and my missing bank statements (where the hell arethey?) but I take your point. I do think we need to be clearer about our abandonment of consensus politics, however, particularly given the demographic changes that you mention.

It seems like we want to keep putting sticking plasters on the NHS and just ignoring the fact that social care - for all vulnerable adults, not just the elderly - is in a state of utter crisis and has been for some time now. We can't keep pretending that we have a social welfare system when it is clearly on its knees.

If we are not willing to fund it through direct taxation, then so be it. But let's be honest about it rather than come over all shocked every time it is brought to our attention.

Glad you are enjoying the new blog x

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