The House of Lords Economic Affairs committee has called for free personal care in England, on lines similar to the system in Scotland. “Under free personal care individuals would therefore only receive funding for support with these basic activities of daily living, based on the minimum threshold of eligible needs as defined by the Care Act.” They are recommending a major increase in the funding for social care, so that care can be delivered on much the same terms as health care. However, they accept that people should pay accommodation costs themselves, with means-tested support, and they recognise that this might entail “catastrophic accommodation costs” which might have to be subject to a cap.
This has been welcomed as a radical proposal, but it doesn’t touch on most of the problems that go with social care. We’re still thinking of social care as a set of needs which can be satisfied by specific cash payments. The Lords report explains:
“Personal care means essential help with basic activities of daily living, such as washing and bathing, dressing, continence, mobility and help with eating and drinking. It does not include other areas where support might be needed, such as assistance with housework, laundry or shopping.”
I don’t believe that a system based on this approach can ever deliver what people want to see. I don’t believe people want, or are comfortable with, successive 15 minute visits from a team of people who bathe them, or dress them, or help them to bed. I don’t believe that what most people really want in life is to manage a rota. I think that providing for a series of events, sold as if they were commodities, meets people’s human needs. What we should be allocating is time with a person, and that calls for a different approach to assessing needs from one that focuses on whether or not someone needs help with brushing their teeth.