A Watershed Year

    For all of us, social care in 2004 will mean different things.
    For me it has especially meant the death in July of my partner’s
    much loved uncle Les. He was 86 and the support he received was a
    model of integrated services – health, housing and social care all
    in harmony – multi-disciplinary staff, working well together,
    caring and committed.

    Les had true independence right to the end. The evening before
    he died he went to the Tiger Inn with his mates. When our tears and
    grief are because someone has had a good life and now it has ended
    – perhaps that’s the most we can hope for as human beings.

    The question is how do we get the social care big picture right
    to provide such positives routinely and reliably for everyone? This
    has been the enduring problem for social care. This year has been
    important for big pictures in social care, if only because there
    has been so much change. Yet it is less than 20 years since the
    last major changes took place in child and community care.
    Demonstrably neither worked, but turning to repeated restructuring
    as a solution has been another of social care’s longstanding
    failures.

    This year saw a new Children Act, heralding a massive
    reorganisation of children’s services and a proposed green paper on
    adult social care. The new three-year qualification in social work,
    with its emphasis on practice and user involvement, in now fully
    operational. In April, the last of the new social care structures,
    the Commission for Social Care Inspection, was established. Charged
    with inspection and regulation as a route to better social care,
    CSCI is perhaps the most important piece of the organisational
    jigsaw. It stresses user involvement and putting the service user
    at the centre of social care as its first value. Then there’s the
    broader context of change. A public health white paper, a second
    Mental Health Bill, a new unified rights body pending and extended
    disability discrimination legislation, already in the House of
    Lords. Change, change, change.

    At a recent British Council seminar, David Behan, chief
    executive of the CSCI, set out to an international audience the
    facts of English social care. There are 1.2 million staff working
    with 1.6 million service users; an annual budget of £15bn,
    involving 25,000 service providers and 150 local authorities. These
    are enormous figures.

    This is truly “caring” on an industrial scale. The frequently
    experienced reality is like 19th century factory production. Sadly
    people’s lives are the product here. It is a process, whether in
    institutional settings or people’s own homes, that too often seems
    to be crude, routinised, impersonal, desensitised and mechanical. A
    common image from service users is of a procession of unknown,
    anonymous care workers trooping through their homes. Hardly
    surprising that this is how it so often feels, when we are talking
    about a labour force with terms and conditions on a par with
    supermarket check out staff and burger bar temps.

    Direct payments meanwhile demonstrate an alternative human face,
    with the potential to support people to live life on their own
    terms. But with only 15,000 service users so far using them
    (compared with 600,000 still in institutional care), there are
    worrying signs that policymakers are conceiving of direct payments
    in narrow consumerist terms. Thus direct payments are reduced
    merely to a matter of service users purchasing their own package of
    care.

    This is a long way from the liberational ideal of the disabled
    people’s movement with its vision of having whatever assistance you
    need to live on equal terms with other people. Instead, it could
    lead us straight back to dependence on the same old agency
    services.

    This year has been a watershed year for social care. Soon the
    findings will be available from the service user consultation
    carried out for the government’s vision for adult social care. This
    will offer an important indication of what service users think of
    social care now and what they want for the future.

    In 2005 we will be able to see how well the social care reality
    matches the rhetoric. It was a good fit for uncle Les. There are
    1.6 million other service users who will doubtless be hoping to be
    able to say the same.

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

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