This report by Robin Jackson offers a powerful and positive vision for reforming social care and it makes it absolutely clear that there is no case for continuing to pretend that the integration of health care is either possible or helpful.
Jackson challenges the ongoing and unjustified assumption by government, and so many in the current system, that reforming social care means integrating it into the healthcare system. This is a fallacy, and it is a fallacy that reflects both general ignorance of what social care is, and a tendency to avoid the real policy questions facing social care: how to fund it; how to organise it and how to regulate it. These are the questions that need to be answered so that people who need extra assistance can live good lives with freedom, citizenship and community.
The report describes how the social care crisis has been driven, not just by austerity, but also by a system which is profit-driven, and laden with debt. Private companies have forced their way into the provision of care – the so-called market – and have been surprised and shocked to see the collapse in public funding which began in 2009. Today they have no interest in sustaining support once profit-levels drop and there is a real risk of further bankruptcies and unsustainable services being handed back to local government.
And, while the care system has become increasingly detached from public and community life, the leadership of the care system has merely increasingly centralised regulatory controls in ways that are completely ineffective. Overall the social care system has been undermined by a series of factors:
- Depersonalisation – the action of divesting individuals of their human characteristics or individuality (e.g. through the misapplication of assistive technology)
- Marketisation – the exposure of an industry or service to market forces where precedence is accorded to financial and not human benefits (e.g. the prevalent notion of the ‘care industry’)
- Centralisation – the concentration of control of an activity or organisation within a single authority (e.g. Department of Health)
- Commodification – the action or process which treats an individual as a mere commodity (e.g. the development of care ‘packages’)
- Deprofessionalisation – the reduction in workers’ professional discretion and autonomy so that they are limited in their capacity to act in the best interests of their client (e.g. the current culture of management and regulation for social workers and social care workers)
- Academicisation – where an undue emphasis is placed on the acquisition of formal academic qualifications at the expense of developing an individual’s personal, social and cultural aptitudes and skills; the corollary being the attachment of low status to the development of vocational and social skills
- Politicisation – where a policy, procedure or practice has become politicised (e.g. the uncritical adoption of an ideology)
- Bureaucratisation – where systems are governed by unnecessarily complicated administrative procedures (e.g. where protocols and procedures take precedence over human-to-human exchange)
Today abuse and institutionalisation is rife, but instead of confronting the real issues policy-makers pretend that integration with healthcare will solve every problem. There is no evidence for this belief and the fact that it has been a policy imperative for over 30 years suggests it’s a bad policy, distracting us from the real task – radical reform.
Robin Jackson offer a series of clear and practical proposals for reforming social care and ends by considering the positive role that eco-villages, a new movement to create cooperative forms of living in harmony with the natural world, might offer.