Social justice and care reform?
A joint ADASS / TLAP blog by James Bullion and Clenton Farquharson discussing the values of equality, diversity and social justice and how these should guide our actions for reform.
It looks as if the prospect of social care reform might be closer than we think. The prime minister and the secretary of state recently confirmed a commitment to publish proposals later this month. In our vision for social care, we expect social justice to remain core to the mission.
We state as our mission that we all of us want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.
That’s about people living well, with well met needs, protection, participation, contribution, and crucially with fairness and justice. But the way some things are organised now makes social justice more, not less difficult.
What needs to change to make social care fair for everyone?
We, the sector? need to discuss the key underlying concepts of equality, diversity and social justice and show how these values should guide our actions. We need to argue that we cannot understand discrimination and oppression without first having a good understanding of the issues below:
Poverty and economic inequality.
The past year has shown that outcomes for poor people have been worse compared with people who are economically secure. Pandemic case numbers have been highest in the 30% of the most deprived areas Many local authorities have seen a significant number of people coming forward for emergency assistance because of their underlying economic disadvantage, made worse by COVID. Social Care should be about people at risk of exploitation, marginalisation, homelessness, domestic abuse, or offending and imprisonment. People cannot live well unless councils and communities tackle these issues.
We have seen a fundamental shift in favour of digital affecting how we live, shop, work, access health, and relate. At the same time isolation has risen. Of course, public health measures to combat the pandemic have increased our isolation. People who access social care are at greater risk of digital exclusion, and it is our job to address this.
Think what we have achieved with school kids to enable them to participate in education. We need a rapid and comprehensive expansion of accessible technology for people to put everyone on a level footing.
Fairness and Transparency.
You cannot improve social justice when some people face catastrophic costs for care and some people do not, where some needs are counted as free health care and some needs are means tested. We surely must pool the risks between all of us in some way.
The social care charging system needs urgent reform to make it simpler and transparent. Councils have had to increase charges because of real terms funding reductions. The welfare benefits system - started in 1948 alongside the NHS and Social Care – has drifted further and further apart from social care and is now less generous for disabled people and carers. This has meant complex interplay between benefits and charging, and greater discretion and uncertainty over costs. We surely need a new alignment between welfare benefits, and social care so that improvements in one area of reform are not able to be made worse by change in health or benefits.
More of a rights-based approach.
The past year has really thrown into sharp relief the balance of power between individuals and their rights. Of course, public health measures have meant that change has been unavoidable, but how change is done, how it feels, and how much say you have, really matters.
In the post COVID world we cannot create a situation where people drawing on social care become second class citizens with their environments tightly controlled with rule, where they have no say in the risks. We are all adults. We get to say how the risks apply to us. We must surely strengthen these rights in social care reform. Can it be right that you can be prevented from return to your home (a care home) just because your needs have grown or changed, or just because the care provider has gone bust or decided to sell? For other types of landlord that would be unlawful eviction. Shouldn’t everyone have the right to live at home? Should we not build or adapt more houses to be capable of the technology we need and the care we need. That is better for people, better for the environment (and more jobs). Should we not have a stronger set of rights around how personal budgets are created and managed? We have the technology to do it very differently with the ability to have full transparency to that all of us can be clear on how public and personal money is spent, and we can counter scams and financial insecurity. Self-Direction should be a right. Financial and Debt Advice should be built into the system, with social workers and advice workers working together to protect people’s interests, and the regulate consumer rights in the care market.
We may all need protection at some point in our life. sometimes. This can be because we face a specific risk, or we are in a vulnerable situation. We might be protecting ourselves, or at the receiving end of hate crime, abuse or in a bullying relationships. The past year’s situation on shielding has taught us all that this is just as much about equal access to what we need, or health care or work. That does not mean that everyone with a similar situation is in the same position. It does not mean that we want safety to replace all risks. But we do surely want equal access, and to be heard, and to drive the decision-taking where we can.
A more professional service.
The care market has some fundamental injustices in it that need urgent correction. It cannot be right that we have allowed 40% turnover of social care staff each year, with entry wage levels meaning that there is always about 10% vacancies, and where we have a permanent and persistent quality and safeguarding problem against registration standards. All services should be supported to be good or outstanding. The money spent on training is exceptionally low compared with similar jobs. Low and minimum pay are endemic in a mainly female workforce, alongside family carers who are predominantly women and therefore we have a gender imbalance of task and fairness. We need to value social care work by creating greater fairness and justice at work. We also need to value social work and occupational therapy in a similar way. Too often these roles are seen as administrative rather than the important statutory roles that are helping with relationships, with rights, and important freedoms. We need to make sure there are enough social workers so that councils keep on top of assessments, offer a review every year, and provide a named and consistent social worker to those people with a long-term relationship with the council. Why in social care have we accepted putting up with the bare minimum, when we have not in other areas such as health? Workforce has got to be an early priority for reform.
Equality and anti-discrimination.
We should celebrate that anti-discriminatory work is at the heart of social care. Then we need to make it a reality. This means calling out racism and challenging institutional discrimination. COVID has shown how racial discrimination translates into poorer outcomes. We must hold to a commitment to target and tackle the underlying causes through social care reform, and Integrated Care Systems. Health Inequalities should be the top priority for improvement for local authorities, communities and the NHS.
We all believe in a social model of disability and yet we still exclude and allow disadvantage to disabled people. Think of the number of disabled people who are still in hospitals or institutions because we have not yet moved the resources and support into community settings (compounded by the workforce problems). Mental health needs are rising, and the likelihood is that the COVID experience will accelerate these needs.
Social Justice and Criminal Justice.
There was a time when social work and probation work was a lot closer and the links between offending behaviour, unfair justice, exclusion and imprisonment. Think of the numbers of people with disabilities in our prisons who have a disability or social care need, which has been made worse. The work undertaken between community groups, the NHS, the Prison Service, the Prison Reform Trust, and the Adass Care and Justice network ahs profiled time and again how often race discrimination and disadvantage, families where children are accommodated in care, learning disability and autism, and poverty – all this situation lead to disproportionately great risks of imprisonment. Perhaps 30% of prisoners have a level of social care need where prevention could have intervened. Don’t we want reform to encompass a wider ambition for social care that will break cycles of discrimination?
All this means that we do not just have to ‘fix’ social care – we have to expand, repair, rebuild, and renew its reach too, and this will improve the situation for all of us. There is no ‘them’. It is all of us. Our brothers, sisters, fathers and mothers, and our children. We live in important times, where there is much to do. The pandemic has been a strong collective experience. It shows us that we are connected, calling for changes, and building it together. Show up. Be seen. Answer the call.
James Bullion is the Executive Director Adult Social Services, Norfolk County Council and Clenton Farquharson is the Chair of TLAP.
The longer version of this blog appears on the ADASS website.
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