Sir William Beveridge Foundation
Working on Health & Social Care; Women Empowerment; Training & Education; Research & Dementia Friendly Care Village
The Beveridge Society Lecture 9 March 2010 – Institution of Civil Engineers, London
Funding Social Care: Getting it Right for the Next Generation Speech by Professor Peter Beresford OBE
The Sir William Beveridge Foundation hosted a lecture and debate on the future of UK social care funding in London in March 2010. It took the form of a panel discussion involving six key spokespeople from political parties and from social care and carers organisations. The panel was chaired by Julia Unwin CBE, Chief Executive of the Joseph Rowntree Foundation.
The panel members were:
Stephen Burke, Chief Executive, Counsel and Care
Julie Charles, Chief Executive, Equalities National Council
Martin Green, Chief Executive, English Community Care Association
Norman Lamb MP, Liberal Democrat Shadow Secretary of State for Health
Alan Wheatley, Green Party Spokesperson on Disability and Social Care
Professor Peter Beresford OBE, Centre for Citizen Participation, Brunel University
Welcome and introductions were made by Professor Alan Lee Williams OBE, Chair of the Beveridge Foundation, followed by a short Beveridge lecture by Professor Peter Beresford OBE, Director of the Centre for Citizen Participation at Brunel University UK (see transcript below). After each panel member had made a short address, questions were invited from the audience of around 200 people representing organisations in the UK charitable and voluntary sectors plus service user groups. The event was rounded off by a Vote of Thanks given by Rahman Jilani, Executive Director and Founder of the Beveridge Foundation and presentations were made to each of the main participants on the stage.
(Photograph at the left Professor Peter Beresford OBE presenting his lecture) We have come here today to talk about the future of social care funding. But in doing so of course, we have really come to talk about something much, much bigger, of even greater significance to us – how we as a society help each other when we need extra support – as we grow older or through the onset of ill health or impairment in our life from birth or later.
There can be few things more important than how we look after each other in a society. Here we see at work the core values of a society, how it sees itself and its people, its ethos and aspirations. Yet it is only recently here in England that the matter has become headline news and then only as political parties in the face of a general election have wrangled with each other over their different proposals.
Looking after each other – the provision of support – or social care as it has come to be called, unhelpfully, I believe – has long had low political and media priority in our society. It has been separated from ordinary understanding, so that policymakers say there is little public recognition of social care. What can this mean? Little public recognition of people’s needs for support? Or perhaps a confused and incomprehensible policy? And recently, sadly, politicians in their disputes and reluctance to talk to and negotiate seriously with each other about it, have shown how far our party politics are from our lives, from being able to address such a key issue for us as human beings, in an appropriately serious and mature way. We must begin to change this.
I say that we must now engage with this issue with all our determination, all our skills, all our commitment – and all our political force. Some commentators say we must do this because what was laid down by the creation of the welfare state is no longer fit for purpose. But I believe that the task is even greater than that, because this is one issue that the creators of the welfare state did not recognize and failed to grapple with.
Sadly the welfare state was not a cure-all. It did not get everything right. It failed to address social care. Perhaps its founders assumed, as they did with poverty, that social care issues would wither away. Of course they didn’t. instead it was one arena for public policy and provision where the poor law was not truly abolished. Instead, it has lingered on till the twenty-first century, until now. And now it is our task at last to address it, impelled by our growing recognition that the safeguarding of people’s rights require it, impelled also by the growing strength, voice and authority of the disabled people’s and service user and carer movements, that have grown up around this concern. It is this critical task that we must now take hold of. It is our job both to reconceive social care and to develop a proper funding basis for it. But this is about needing to revisit the workings and limitations of the welfare state. To meet unaddressed issues and changed circumstances. It is not about seeing its visionary principles proved wrong or rejecting them – and returning to the inequalities that preceded them. It is not about discounting visionary principles of equity, equality, citizenship, entitlement, shared responsibility, social, human and civil rights, shared ownership, universality and, support intended to be free at the point of delivery.
So to understand current social care and to plan for the future, we must first understand the past. This is a journey through war and peace because it takes us back to the war that gave rise to the welfare state, the second world war.
We have now reached an age when there is a much larger proportion and number of old and very old people in our society. Now many more people are able to live long enough not only to see and be part of the lives of their grandchildren, but also of their great grandchildren. But this has been presented in the Government’s Green Paper on future social care funding as a negative. They have been constructed as a burden.
The Green Paper rejects the idea of paying for social care out of general taxation so that it is a free and universal services, saying that: ‘This is ruled out because it places a heavy burden on people of working age’.Thus older people are a burden. That is how we must think of them – and indeed of service users of working age too – a burden. How does this fit with current rhetoric of dignity, choice and control?
Let us go back a moment to remember who these older people are. These are the people – the older and very old people of our age – whose better lives were to be what made up for all the suffering of the Great War, all the want and misery brought by inter-war economic depression and most of all all the grief and loss of the second world war.
These are the children who look out at us from posters of the time as the reason to keep going – the inspiration for the future. These are the children whose parents and families toiled for, suffered and died for, in the hope they would have a better life. These are the children that people created the welfare state for, to make possible a fairer, more equal and secure society.
And now policymakers have framed these people as a burden, a ‘demographic time bomb’ and talked about them in terms of an epidemic of Alzheimer’s and dementia, an avalanche of dependency and need.
The truth is that this emphasis on negativity, this refusal to recognize the contribution older people make to our society, to acknowledge their rights and entitlements, is the problem, the real problem. It actually demonstrates a reluctance to face up to fundamental change in our society which we must address rather than seek to reject or deny. Put simply, we must now expect many more people living in an advanced western society will need support. This is likely to be the global pattern for the future. It is no accident that leaders of two of our main political parties have both had disabled children, as the Director of the Joseph Rowntree Foundation observed to me. Societies must learn to include age and impairment as parts of the whole with growing importance.
Once before such demographic change was observed and attacked by a backward looking order. Then it was framed in terms of: ‘The number of people with hereditary disorders is growing disproportionately. In five years time, there will be one hereditary disorder to every four.’ The same divisive language of burden and difference.
Then it featured in a 1937 Nazi Propaganda film, Victims Of The Past. And it was to put an end to such thinking that this country fought a war against fascism and created the welfare state.
And as Britain waged this war for a better and more equal future, it stressed the ‘we’.
It emphasised the importance of doing things together. ‘We’ was a key word. We would go forward together. We would all help, We would be able to do great things together.
Here was not the divisive language of the present Green Paper, setting groups and generations against each other, presenting one as a drain on the other, rather than admitting and celebrating the inter-dependence of all and the contribution all can and do make to society and each other, over time.
Masquerading as a new realism is an un-evidenced narrow individualistic economics rooted in the kind of selfishness that people recently highlighted to the Joseph Rowntree Foundation as what they saw as one of the new social evils of our age, taking over from the earlier giant evils Beveridge identified.
This all dressed up as the need for a financial partnership between individual, family and state – which is actually often about double-paying for support. This a phoney presentation of partnership which takes no account of other enormous institutions in our lives and the part they may have to play in forging fair, responsible and equitable ways of ensuring mutual aid and social support for the future. Yes, the individual, yes, the modern complex family and the state, yes, certainly, but also the local community – increasingly under attack in our individualizing, centralizing world, and the market, which has been granted an increasingly important impact on all our lives.
But let’s go back to the government’s social care green paper. The green paper did not provide detailed costings or an adequate evidence base to support the three funding options it offered, to convince of their equity or feasibility. Similarly, subsequent proposals both from government, for free domiciliary care for those identified as having the highest needs, and from Conservative opposition, to provide free residential provision, are neither convincingly costed nor offer a coherent response to funding issues, each creating its own perverse incentives.
While itself saying that paying for social care out of general taxation would have the advantages of being universal and would probably be ‘the simplest and most easily understood way of funding care and support’, as we have seen the government green paper ruled it out.
But the issue here and the importance of including funding through general taxation is not just about the need to move to a more viable funding system for social care, but about the need for radical reappraisal of what funding is for. This must relate to the shift in our society to social from narrowly medical needs. This makes even more crucial the reconciliation of health and social care. To achieve this, demands the reconciliation of their funding systems.
This brings us to the key issue of the separation of health and social care. It is increasingly key because the balance of need is changing as for a range of reasons what were acute medical issues are becoming instead increasingly long term support ones in our society.
The roles and relations of medical/health care and social care have and are changing. The assumption that the two can be meaningfully separated is increasingly untenable. The meeting of changed needs can only be successfully achieved if the two are reunified. How, though, can this ever be possible when they rest on fundamentally different, even opposed funding systems? One, social care, is a needs and means tested residual service. The other, the NHS, in core principle, is still a universal and free service at the point of delivery. The two funding systems have to be brought in line. There may be some ideological die-hards who see this as an opportunity to attack the funding system of the NHS. That can carry little clout either politically or on the evidence, least of all when looked at in relation to developments in the United States. This means that what we really have to do is examine much more carefully and determinedly funding a social care system from general taxation.
But this does not and must not mean everything being the same still. This requires a fundamental reappraisal of both social care and health policy on the basis of principles of participation, rights, needs, entitlements and addressing diversity. This is where the recent suggestion of Professor Allan Walker of Sheffield University, becomes so important. He argues for joining up the recommendations of the 2010 Marmot Report for reducing health inequalities, with social care reform, to transform the debate. As he says, ‘There is enough robust evidence already to inform such a strategy. This should be a national crusade to prolong healthy lives’.
This will mean fundamental change in the NHS as well as social care – away from the over-managerialist, bureaucratized, centralist structures we have increasingly acquired, towards truly personalized provision, which values patients’ and practitioners’ experiential knowledge, that is accountable, based on social models, the values of independent living, and people’s participatory control.
The search must be for sustainability of support for future generations. I have stressed today the responsibility we all owe to those who came before us and were the inspiration for all that is best in welfare state-based collectivity and mutual aid in our society. But the enduring task, the continuing task, is to take on that same responsibility for each other, our children and generations of children to come that we may all have an ever greater hope to see.