Time and laterally the crushing impact of Coronavirus have destroyed any illusion that resolution of the social care crisis in England can be delayed. Proposed solutions must meet ethical tests around the essential value of all people – and also be just for adults of working age who need adult social care.
People of working age who need social care are faced with a system that financial pressure has optimised to barely meet the statutory obligations that Local Authority have to older people. For the working age community the combination of the crippling means test, and the inability of care providers to reliably meet incredibly basic needs; makes much Local Authority social care a disabling, trauma producing system.
Implementation of an effective social care reform requires primary attention to the solution must reflect the changing demography of England. The needs of older people must dominate the settlement. It would though, be remiss and inequitable to leave working age recipients of social care with a system that fails them as badly as the present one does.
Just social care for working age adults means ensuring that any solutions are able to meet basic life needs of people bringing up families, contributing to society or working. For example, at present it might be difficult to get regular care at a suitable time to allow someone to commute to work, to study, or to take their child to school. That isn’t ethical, or humane. It shouldn’t happen now, and it mustn’t in the future.
There has been tentative proposals that revisions to the social care system be funded by state managed group insurance paid for by a premium: bluntly a tax, paid by all over the age of 40. However it is drawn such a scheme must cover younger adults who need care – perhaps from the day of their birth, or who acquire disability early in life. Such a scheme must be mindful that there are injuries which occur for which no personal injury claim could ever be possibly effective.
Especially in working age adults good integration between health and social care is essential. Integration doesn’t mean one side owning the other though. In fact the NHS taking over social care in another ‘visible from space’ reform that medicalises models of care and strips expertise from Local Authorities is a potential tragedy. Social care has specific connections into the community which aren’t the competence of health care. Broadly Local Authorities are generally incredibly efficient in their delivery of social care through their own staff and contractors. They have to be. The long coming crisis in social care, has forced every efficiency possible to be made. It would be foolishness to hand the complexity of social care – so very different from health delivery to the NHS.