Imagine if the public felt the same ownership for social care as they do for the NHS

“Tonight on the 6 o clock news, thousands protest as local authorities in an attempt to meet Government spending plans try to slash another 5% from social care budgets. There were angry scenes up and down town halls outside the country as campaigners vowed to fight until the bitter end “my mum would be dead if it wasn’t for social care” said one man “without them she’d have given up the will to live”. Another woman agreed “I used to worry I’d have to put my daughter into a home but with social services help, she lives in her own home and has a job. They’re brilliant! I can’t praise them enough!” The leader of the “care not cuts” campaign Ms U Topia said “the Government will not win on this; social care is like a religion for the British people. Without it tens of thousands of people would live lonely and vulnerable lives, dependent on the goodwill of family and neighbours. The British people will never let this happen”

And then of course back in the real world…..

Why is it that the mere mention of a closure or downgrade of a hospital has hundreds if not thousands of local people attending protest meetings, writing letters, going on marches, lobbying and generally making it known as vociferously as possible that they will not tolerate this happening. You can guarantee that the local MP no matter from what party will appear on the regional news with a grave face saying “this must not be allowed to happen, lives depend on the ability of people in Suburban town to have their NHS care locally where they need it”

Cuts to social care however, are routinely met with maybe a few tens of protesters, possibly if it’s something big like a care home a hundred or so, and the odd letter to the local paper. Local voluntary organisations will work together with service users and meet with the local council where they will be listened to sympathetically and then ignored. The wider public will be either totally unaware or completely indifferent.

The news today from the BBC that showed just 4 out of 101 councils paythe £15.19 per hour the UK Homecare Association (UKHCA) believes is necessary to cover wages, training and travel will come as no surprise to anyone working in or with social care. It is just the latest in a string of reports highlighting poor care and bad practice in social care. In Dec 13 the BBC reported that the number of people receiving social care had dropped by a quarter, in October 13 Leonard Cheshire published a report which got widespread coverage about the iniquity of 15 minute care visits and around the same time the equality and human rights commission said that care staff face poor pay, high pressure and a lack of support.

However, I expect that the response from the general public to this report will be (if we’re lucky) an “oh isn’t it terrible?” followed by massive wave of indifference. It’s not that people don’t care about the vulnerable, the frail and the sick but there is massive public disengagement from social care. Why? Why is it that the public feel so little ownership of social care, something they fund far more directly through council tax than they do the NHS?

There are I think 5 main reasons

  1. People haven’t a clue what it actually is or how it works. They may have a vague idea that a care assistant comes in and helps with things but they don’t really know how that might actually happen in practice.
  2. It’s hidden away. They don’t see social care happening. Most of it happens in people’s own homes or in buildings euphemistically labelled “resource centres”. They don’t come into contact with it unless they actually need it.
  3. They don’t understand how it’s funded or what it costs to deliver.
  4. Users of social care are amongst the most disempowered people in country. There has been progress over the years through user led organisations and personalisation to rectify this but service users views are still routinely downgraded, ignored or just set aside as “too difficult”
  5. People don’t want to think about getting old and frail or what it’s like to have a disability or sensory impairment. There is huge ageism in our society and a dismaying rise in disablism. It has to be said though, most people don’t want to think about getting cancer either but that doesn’t stop millions being raised from the public from cancer research.

In an ideal world, social care would be integrated with the NHS and funded centrally but that is unlikely to happen. I honestly don’t know how we champion social care and change the public’s attitudes so they feel ownership of it, and pride in it, but if we don’t, we’re in danger of having a system that will collapse.


6 thoughts on “Imagine if the public felt the same ownership for social care as they do for the NHS

  1. Is part of the problem that as Social Care is mainly provided to older people it is not something we experience until mid-life when our ageing parents become service users, whereas most of us have first-hand experience of the NHS. Furthermore Social Care is also stigmatised by the association with Social Services which are often seen as intervening when families are problematic and/or dysfunctional.

  2. Great article – although I think there is some invisibility of social care in debate I’m not sure that it’s personally invisible – although we may not receive it I find I often am more aware of the social care received by family members, friends parents, etc than medical experiences which may be more private. I think the reason social care is more a background issue is institutional.

    the public faces of the NHS are medical staff who have a high level of public trust (eg doctors about 90% trusted). The public face of social services tends to be politicians rather than professionals and they’re deeply distrusted and generate public antipathy.

    Also, I do think that Councils are often better connected to local communities than the NHS but are much more constrained by national policy – they’re less able to respond to community views, even when they’re better able to listen. Because the NHS has more control over delivery debates about it are more meaningful. Decisions on social care are distributed across a range of institutions.

    The problem with social care is that it’s just one element of council delivery and so is viewed in a more crowded context. If your local politicians are being hammered over council tax, bins and streetlighting then the statements they make on social care will be framed by this. The NHS doesn’t control charges, doesn’t set or collect taxation and therefore only has to talk about the care it gives and the medical needs of the population.

  3. Hi Gareth, thanks for the comment. I think that is definitely part of the picture. Plus of course the NHS gets lots of nice programmes on TV showing how wonderful it is. Social Services for many reasons around confidentiality does not, and even when it does, like last years programme on Bristol, people find what they deal with so far removed from their own lives that it’s difficult to relate too

  4. Hi John, thanks for this. I agree with pretty much everything you say. I remember when I worked in a leafy london borough that shall remain names going to a consultation about council cuts; there was far more discussion by the public of potential cuts to the local theatre and waste collection than there was of cuts to social care. You’re right councils are much better at connecting with local communities and at working with third sector. The last line encapsulates it perfectly!

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