Service-user power

There are few areas of public policy that get quite so up close
and personal as social care. Of course medicine probes all our
bodily nooks and crannies – and doesn’t stop at the skin. But
social care is about much more besides. It may not only involve
seeing our nakedness, “toileting”, washing, wiping and cleaning us,
moving, lifting and dressing us. It can strip off our privacy in
many more ways. It can come even closer to touching our soul.

There can be few potentially intrusive questions that are not the
business of social care, whether we are talking money, sex, crime,
relationships, feelings, behaviour, becoming physically
incapacitated or growing older. Social care can be involved in
ordering where we live, what we have, who we see, if and when we
eat or go out. I long ago lost count of how many times I have heard
service users talk about being demeaned, overwhelmed and
disoriented by social care.

And here’s the problem. The thrilling part of social care is its
potential to offer support, to challenge assumptions about people’s
abilities, to keep them connected with the wider world and
challenge discrimination. It really is something special. No wonder
it has attracted so many enthusiasts and idealists. But there’s an
inevitable downside. For all its commitment to the personal and the
social, it is still just another public policy and all public
policies are ultimately political.

The personal and the political still sit badly together. This
especially hurts social care which is crucially about “the
personal”. Politics is something we human beings do badly.
Something seems to come over us, separating us from our ordinary
understanding and good sense. In politics, qualities which
everywhere else – from children’s story books to religious teaching
– are routinely despised are now celebrated. Arrogance,
ruthlessness, duplicity and dishonesty are ranked as high as
political skills and savvy.

It is difficult to know what explains this, whether it is a
structural issue, simply to do with who goes into politics or some
complex combination of the two. Politics, however, like war, is
where the basest human logic applies. We take for granted the
alienating nature of politics. Hardly surprising, then, that an
area such as social care, with its focus on the individual and
their world, commands so little priority, such limited status and
resources and that its workforce is so little valued.

Even during the party conference season, it is difficult to
distinguish party priorities for social care. In a world of
postmodern irony, where the Conservatives have tried reselling
themselves as “the party of the poor”, New Labour wants to be
“business friendly” and Liberal Democrats headline themselves as
“sensible” and “the real opposition”, the only clear fault line
between the main political parties seems to be war with Iraq.

If we look at the defining political issues for social care over
recent years, they have been who provides it (welfare pluralism and
the internal market), who finances it (an expanded role for the
City and private finance initiatives) and where it is provided
(from institution to “community”). So far these sweeping political
priorities have had only a limited impact on how it is provided,
the quality of the workforce and the adequacy, appropriateness,
reliability and quality of what is provided. Yet these are the
enduring priorities of service users and committed service

The one big political shift has come from disabled people and other
service users who have pressed for the democratisation of social
care. This has been based on a philosophy of independent living,
ensuring service users the support to live on equal terms with
other people. To make this real, disabled people developed direct
payments to put people in charge of the support they need with help
from local service user organisations. Only a few service users who
could benefit from this approach so far access it. There are
powerful pressures at work to undermine it, such as caps on
individual payment and the tendency to subvert the liberatory model
by converting it into a consumerist one.

But direct payments are now mandatory and they are beginning to
reach a wider range of service users. They offer an important
example for the future. There are also some important lessons here,
both for political parties and the politics of social care. There
is now a new player in the game – service users and their
organisations – with the potential to change everything.

Peter Beresford is professor of social policy, Brunel
University, and is actively involved in the psychiatric system
survivor movement.

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