It is common for social care to see itself as the poor relation of public policy – a sort-of Cinders-like appendage of the health service that tends to be easily forgotten. But with no fairy godmother to help, it is perhaps time to reject this victim status. It may make more sense instead to start thinking of social care as an unsolved mystery. How is it that this enormous elephant sitting in the corner can so readily pass unnoticed? What is it about a service that employs 1.6 million people, works with 1.7 million adult service users, with an estimated annual budget of more than £17bn – the numbers are regularly trotted out –that it can have such little political priority and have gained so little public support and understanding? This surely is the big question about social care.
If anything, the white paper Our Health, Our Care, Our Say, reinforces these concerns rather than answers them. First, why didn’t social care for adults warrant a white paper of its own in the same way that social care for children quite clearly was seen to? How do we make sure that this doesn’t end up signifying a lower status in our society for older and disabled people? And second, going on the publicity that both trailed and followed the white paper’s publication, you might not have realised that its remit included social care at all. There was minimal mention of it in media reporting. Only one of the major dailies, predictably The Guardian, discussed social care. Nor is there any direct mention of it in the prime minister’s introduction. He doesn’t skate over big issues like health inequalities, prevention and postcode lottery. But while there’s recognition of the role of doctors and nurses, there’s no mention of social care workers.
Yet there is a lot about social care in the white paper – if you look for it. A national director of social care is to be appointed. A positive approach to risk management is to be developed. Mental health isn’t forgotten. Individual budgets and a greater emphasis on direct payments are still in there. There are new pilots to support people back into the mainstream. But the worry is that the manner of publicising the white paper will also be the way in which it is taken forward, with the emphasis on the NHS to the detriment of social care. What effect is this likely to have on already uncertain workforce morale? And given that we still await reassurance on social care funding and commentators are already highlighting the need not to reshuffle care services minister Liam Byrne, worries for the future still persist.
So what to do? Surely the message is now clear for social care. It can no longer just wait for policymakers to deliver on its behalf. This just won’t happen. So it falls to social care leaders to make it happen. They must develop greater solidarity as a basis for planning and working together much more. Social care must fight for its values and principles. It must speak out for its unique contribution. The leadership needs to unite around this. Face to face practitioners and service users must be drawn into this activity much more than they have been. It is their first-hand experience and accounts that give real power and meaning to social care.
It is not enough to be grateful for small gains. It is time to campaign for social care as a key human service. As I read now about social services that tried to split up a couple married for 65 years because they said they had no suitable service to keep them together, I feel this even more strongly. No one is saying we shouldn’t be polite and businesslike (although one failing noted of social workers is that they can be just a little too polite). What social care actually gains from the white paper is still up for grabs. Those committed to social care, with leadership roles and responsibilities, have to be a force for change and seize the opportunities on offer.
Peter Beresford is professor of social policy, Brunel University, and is involved with the psychiatric system survivor movement