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Social Care Crisis & COVID-19

The Coronavirus pandemic in the UK looks like putting off all bets on the future of social care. If we could have almost taken it for granted that the Johnson government would do little or nothing to challenge the long term crisis in English social care, its confused and confusing response to the outbreak now means few predictions are safe for social care’s post-pandemic future. It might be even more precarious - or there may be an opportunity for positive change. 

While countries like South Korea has approached the virus and public health with a good sense born of preparation, good organization and infrastructure and a sense of public and social responsibility, here it’s been the opposite story. A tradition of politicizing everything, small state thinking and damaged infrastructure, means government response has oscillated between meaningless mantras like ‘herd immunity’ to arbitrary lock-downs that mean unsupported older people are threatened with being isolated for four months, while Amazon etc go on delivering non-essentials.

Meanwhile calls for myriad ‘volunteers’ without serious thought of their use or the consequences, and photo opportunities of happy clapping for the NHS and the letting off of fireworks (purchased where?) are reminiscent of the mindless enthusiasm that greeted the outbreak of the First World War in 1914. This was the war you may remember described by the poet Siegfried Sassoon as ‘beginning with the ringing of bells and ending with wringing of hands’. We have to hope the present policy won’t be a tragi-comic rerun.

So let’s remind ourselves of some of the known realities. This is a pandemic which affects different groups very differently. For those not in the medical front line or without compromised health/immunity, it seems to be a relatively minor issue. We know that it can kill those whose health is compromised and this particularly relates to older and disabled people and people with some long term conditions – yes the client group for social care. Thus from the start, it was the latter who should have been given particular priority attention and support in the pandemic. The opposite has happened. 

Generalised policies have been adopted and little specific attention has been paid to vulnerable groups except where they are already in health or institutional settings. No policy was in place for rapid large scale testing, provision of effective face masks or ventilators. So we start with a confused and negative response to the groups most at risk. Nothing was done either in the spring budget to strengthen social care. Amazingly the emergency pandemic legislation introduced further restricts access to social care, the rights of mental health service users and disabled children to education. In a widely-praised speech, Baroness [Tanni] Grey-Thompson told fellow peers during the bill’s second reading in the Lords on Tuesday that the measures outlined were ‘draconian’ and ‘life-changing for disabled people.

We don’t know what other restrictions are now being imposed on people seen as having ‘non-urgent’ long term conditions as the emphasis is placed instead on Covid-19. Certainly, we are hearing about delayed operations and halted chemotherapy sessions which can only be damaging for particularly at-risk groups. There has so far been a complete failure to consult with or additionally resource the disabled people’s and user-led organisations (DPULOs) which could and should play a key role in these difficult and disturbing times.

Currently, the headlines are about further extending the current lockdown and emergency measures – both in severity and length of time. This is the same press that set off the panic buying only quelled by the responsible behaviour of supermarket chains. 

All this is raising enormous questions far bigger than the impact on social care however important that is. How long will the present draconian measures be seen as politically viable? They aren’t economically viable. Is there some hidden political agenda at work unrelated to safeguarding our health? 

So at present, the future looks frightening for social care, older and disabled people. But Johnson’s throwing all the balls into the air with his inconsistent and arbitrary response to the Covid-19 crisis may also be the spark that sets of a serious political rethink of social care in England, something none of the three major political parties has so far attempted – including Corbyn’s Labour at the last general election. And it is this hope for long term change we must all put our shoulders behind. 

We already have the blueprint for such change and how to achieve it. This is provided by the Care Act, now abrogated by the government, The United Nations Convention on the Rights of People with Disabilities (UNCRPD) and the pioneering thinking of the disabled people’s movement. These move us from the present broken model of social care based on poor law principles of impoverishment and a residual service to the NHS’s founding principles of a universal service free at the point of delivery paid through a progressive system of taxation. 

The Care Act is based on a positive concept of ‘wellbeing’. The UNCRPD on the notion of ‘independent living’ developed by disabled people; that is ensuring them the support to live their lives on as equal terms as possible with non-disabled people. And finally, the UNCRPD acknowledging political and economic realities recognizes that such reform will need to be introduced gradually. This can be done on a rolling programme basis, gaining an accurate idea of the cost of recording unmet need for the first time, in order to get a realistic idea of the funding gap. Adopting such a vision and strategy could be the silver lining of the current Covid-19 health and policy tragedy.