Guilty as Charged

Stephen Ladyman seems to be one of that rare breed – a
politician who commands public and professional respect for his
genuine commitment to his brief. At a King’s Fund breakfast seminar
last month, where he launched his green paper on adult social care,
Independence, Well-being and Choice, he made his position on
charging clear. He was scathing about what he called the
“mechanistic” approach to social care in Scotland, which he said
followed from it being free at the point of delivery. As he put it,
you stay at home until it costs more than residential provision.
Then, when residential provision costs more than nursing home care,
you are moved there and when that costs more than long-term
hospital, you are moved on again.

There is certainly no question now of a Labour government after
the general election extending the Scottish model to the whole of
the UK. Only the Liberal Democrats of the three main political
parties have committed themselves to abolishing social care
charges. The Conservatives’ proposal of free long-term care after
three years neatly sidesteps the issue, since it is in these first
three years that most service users are likely to be around to need
free care.

Why is the political response to free personal care so lukewarm
when, as Community Care’s own recent survey found, most
professionals want to see it; big charities like Age Concern and
Help the Aged are strongly behind it and service users are emphatic
about its importance? Service users consulted on the development of
the green paper identified charging as one of the three main
problems of social care, alongside underfunding and poor quality
provision.

Charges adversely affect thousands of service users. The largest
group are older people who have become disabled. Only those on the
lowest incomes can expect to be exempt from charges. People on
disability benefits – disability living allowance if aged under 65,
attendance allowance if older – are liable to have these whittled
away. The crucial buffer zone such benefits offer, keeping people
above the poverty line, is taken from them.

No wonder that so many people who need support at home
desperately try to avoid getting it because of the cost. They
struggle to keep washing and dressing themselves when it is too
much of a strain. They have falls trying to do things without help
that they can no longer manage. Unable to go out unassisted, they
become increasingly isolated – a form of house arrest that has
prompted no national outcry. They are more likely to become ill and
have to go into hospital. How this is supposed to square with any
economic argument for charging remains a mystery. Finding the logic
in getting the district nurse for free and paying for care
assistance must beat some of the finest brains in the land.

But charging for social care is worse than this. It is a
national scandal. How can a society which from December 2006
imposes a duty on the public sector, including councils and
government departments, to eliminate unlawful disability
discrimination and promote disability equality at the same time
impose a tax on disabled people by charging them for the essential
support they need?

No less important, how will we ever outlaw ageism in our society
if one of the pillars of social policy, the provision of social
care, is itself inherently ageist?

Charging for social care treats the frailty that ageing often
brings as a source of income generation, rather than ensuring
people their entitlement, paid for over a lifetime spent working,
contributing and paying taxes.
Elections are not perhaps the best time to expect reason, decency
and honesty to shine through in politics. Artificial election
agendas focusing on travellers, asylum seekers and hospital waiting
times bear witness to this.

But if the contribution that younger disabled people can make
and that older disabled people have already made to society is to
be recognised and valued, then some brave member of government is
going to have to put their head above the parapet and lead the
charge for free social care in Britain. That rare bird, the
politician with principles, is going to have to be at a very high
premium if we are to see this happen.

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