Turning the welfare state upside down? .. not just yet

The Health Services Management Centre has produced an interesting report that questions the fundamentals of the ‘social care offer’ that people receive today.

Glasby et al say “It should come as no surprise to anyone that there is a growing crisis in adult social care. Policymakers, practitioners and people using services alike all argue that the current system is fundamentally “broken”. This is not the fault of current managers or front-line professionals – we just have a 1940s system designed with 1940s aspirations and society in mind, which feels increasingly unfit for purpose in terms of how we live other aspects of our life in the early 21st century.” They argue for “a new approach that starts in a more positive place with what people can do for themselves, any natural supports they have from their family, friends and communities, and any additional resources available locally.”

We have to ask, though, whether the proposals in their report represent a radical departure from the current model of welfare. Looking at the conclusions, it’s more about testing out asset-based approaches to social care and seeing where this takes us.

It is a very helpful document, particularly in the examples it provides of projects that make good use of ‘social capital’. But it doesn’t give us confidence that there’s a viable alternative to what many people see as solid and reliable state services. It does its best to talk up some innovative approaches to community support and the potential for making more of small enterprises, which they call ‘micro services’. However, there is no ‘consumer view’ of the merits of ‘traditional’ versus ‘alternative’ approaches and there is no account of the strengths of what we already have. It would have been helpful if the potential of ‘co-production’ between the state and informal sectors had been explored, for example, in the case of local authority Shared Lives services. It would also have been interesting to have heard some discussion of why there are plenty of the customers of social care still who express high levels of satisfaction with ‘traditional’ services and who have no enthusiasm to ‘change the culture’ of social care. For some of these people, services offer a liberating break from a community that offers them social isolation, discrimination and few opportunities for self-expression.

The concern of the report is strongest for those people who fall outside increasingly restrictive eligibility criteria, and with building on the community and family assets that those people have available to them. This is entirely valid, but we are still left with the impression that the solution to scaling up some very imaginative community projects to solve some of the the problems caused by tight service rationing and increasing demand remains as elusive as before.

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