Introduction
During my time as Chair of the British Council of Disabled People (BCODP), the National Centre of Independent Living broke ranks and joined up with the newly formed Disability Rights United Kingdom (DRUK). I opposed this move as I believed in would be harmful not only for the Disabled People’s Movement, but also for the emancipation struggle of Disabled people as a whole. Nothing has altered my opinion on this. At the time I was of the view that there were Disabled people better placed than I was to develop Independent Living however as the years have progressed, I have come to realise this was a mistaken position to hold.
It is true that I was not directly involved because I did not require personal support and I shared the narrow view that this was the core element of Independent Living, however, my own political development has led to a reappraisal of what should be understood by this term. Like many concepts associated with disability politics, Independent Living is open to interpretation and it is also a fact that it is not always possible to characterise these interpretations from left-right or reformist-revolutionary perspectives. This said, I believe that within the mainstream political arena, Independent Living was being held hostage by perspectives which were open to accommodation by the British State via existing social policy and this situation has helped de-politicalise the concept.
In 2015, I published an article called, ‘Personalisation and self-determination: the same difference’, which considered the central ideas that informed disability politics within the United Kingdom over the last thirty years to see to what extent they had informed the personalisation agenda. (1) I put forward the view that the tensions between dominant ideologies and practices associated with disability and the alternative social oppression approach had not been resolved, but hidden by the process of transforming radical ideas into ones that can be absorbed into the status quo. I still maintain the opinion that the chameleon characteristics of the personalisation agenda have allowed it to appear attractive to the more accommodating sections of the disabled community. Six years on, I believe this willingness to compromise has now spread into the activist agendas because things have become so desperate.
In the first part of this blog I want to ground the debate around the ‘crisis within Social Care’ (sic) as a contribution to a discussion on the question of reform or transform the system of support that older and Disabled people require. The distinction I am making here between ‘reform’ and ‘transform’ is that the former is about changing, but also maintaining, what exists, whereas the latter recognises the need for a complete system change. The second part I will primarily drill down into emerging positions that raise massive issues for Disabled people and their organisations. A key issue for me is the shift right in the thinking around how to address the position of older and Disabled people in society. It is my opinion that the question of Independent Living has fallen off the agenda; not only because aspects of it were replaced by the Neoliberal concept ‘Personalisation, but also because the public narrative on Social Care is solely about ‘looking after the elderly’ (sic). The way Social Care is perceived currently ignores other service users and is a disabling barrier to furthering the struggle for an inclusive society.
Whilst I acknowledge there are issues with speaking of ‘service users’, I have elected to do so here in order to distinguish between people who are currently within the existing system and groups of people who require social support for independent living.
Addressing the ‘Crisis within Social Care’ from a Human Rights perspective
There is broad agreement that there is a crisis within the system called Social Care however there are vast differences of opinion in terms of its causes and what is required to develop strategies to bring the crisis to an end. During the Age of Austerity we have seen massive cuts to Local Authorities’ budgets, the undermining of the NHS and, for example, the dismantling of both children and mental health services. All of these have contributed to the crisis, but this is not the full picture.
There is still a stereotyped perception that ‘Social Care’ is simply about ‘looking after the older people’ which means other groups of people in need of social support are either ignored or subjected to inappropriate services. Another major problem is that there is much confusion and disagreement over what is understood by ‘Social Care’ and as a result, differing interests are being played off against each other. ALL the major political parties have misrepresented the crisis within so-called ‘Social Care’ due to the stereotyping of people in need of support via a crude collapsing together of health and social issues, hiding the impact of the implementation of cuts e.g. focusing on ‘risk management’ within criteria and undermining advocacy and independent living. People seeking services are finding their support needs are no longer considered to be significant enough to merit support or that the services they need no longer exist.
Disabled people, for example, argue Adult Social Care and Independent Living needs to be addressed other than through an outdated ‘one size fits all’ approach that has been adopted by both the National Health Service and local authorities over the last forty years. I want to employ a series of quotations from Ken Davis to connect the past with the present. (2)
“In Britain, the controllers of disability policy, building on the work of generations of their ablebodied predecessors, have defined disability in terms of the ‘medical model’. Such definitions locate the cause of the problems we face in us and our individual impairments. For as long as these people are able to maintain the idea that it is our bodies that are at fault, the social structure they have created can be protected. By the simple device of focussing on our bodies, these definitions draw attention away from their discriminatory society. Such definitions underpin the dominant hegemony of ideas these people have constructed to support their vested interests.”
Ken follows this up by saying:
“It was to some extent the notion of ‘independent living’ that provided the stimulus for thinking about DCIL’s eventual services in a rational rather than a reactive or ad hoc way. Independent living has been described as being about the process of improving the quality of life, by having access to the help necessary for disabled people to identify and pursue their own life choices. The process of comparing local experiences of de-institutionalisation with the independent living philosophy forced a careful analysis of the elements involved.”
This is what I refer to as disability praxis – theory, reflection, action, and reflection around addressing encountered social restriction. Ken put it this way:
“It was out of this kind of analysis that the step-by-step schema, later to be dubbed the ‘seven needs’, emerged. From the point of view of disabled people who were setting out to achieve full social integration from the extremity of social deprivation in segregated residential institutions, these seven elements were encountered in the following logical order:
� information
� counselling
� housing
� technical aids
� personal assistance
� transport
� access
The identification of these areas for practical action at once underpinned the operational framework for DCIL and put flesh on the social model of disability.” (3)
This final sentence, I would argue is crucial for understanding the relationships that exist between the social model of disability, independent living philosophy, our emancipation struggle, and the direction of travel needed to develop a transformative system. Our starting point has to be that those who require social support come from a range of service users with differing support needs – not everyone needs ‘health care’ or even ‘health and social care’ – to conflate them can lead to inappropriate assessment processes and service delivery; denial of any support whatsoever and this can have oppressive consequences. All people require ‘health care’ at different points in their lives and chronic illness or impairment reality may increase the need for health interventions. A considerable number of people within and outside the current system have significant personal support needs which ought to interact with their wider social support requirement. How these three types of interventions interact depends upon individual lifestyles and practices within Health and Social Care regimes. This is called ‘Personalisation’ however it is anything but because ‘the focus on the individual’ is mediated through assessment of ‘needs’ as defined by ‘well-being’ appraisals as set out in the Care Act 2014. Thus:
The duty to carry out a needs assessment applies regardless of the authority’s view of—
(a) the level of the adult’s needs for care and support, or
(b) the level of the adult’s financial resources.
(4)A needs assessment must include an assessment of—
(a) the impact of the adult’s needs for care and support on the matters specified in section 1(2),
(b) the outcomes that the adult wishes to achieve in day-to-day life, and
(c) whether, and if so to what extent, the provision of care and support could contribute to the achievement of those outcomes.
(5) A local authority, in carrying out a needs assessment, must involve—
(a) the adult,
(b) any carer that the adult has, and
(c) any person whom the adult asks the authority to involve or, where the adult lacks capacity to ask the authority to do that, any person who appears to the authority to be interested in the adult’s welfare.
(6) When carrying out a needs assessment, a local authority must also consider—
(a) whether, and if so to what extent, matters other than the provision of care and support could contribute to the achievement of the outcomes that the adult wishes to achieve in day-to-day life, and
(b) whether the adult would benefit from the provision of anything under section 2 or 4 or of anything which might be available in the community.
What exactly are the matters specified in section 1(2)? The Act states:
The general duty of a local authority, in exercising a function under this Part in the case of an individual, is to promote that individual’s well-being.
(2) “Well-being”, in relation to an individual, means that individual’s well-being so far as relating to any of the following—
(a) personal dignity (including treatment of the individual with respect);
(b) physical and mental health and emotional well-being;
(c) protection from abuse and neglect;
(d) control by the individual over day-to-day life (including over care and support, or support, provided to the individual and the way in which it is provided);
(e) participation in work, education, training or recreation;
(f) social and economic well-being;
(g) domestic, family and personal relationships;
(h) suitability of living accommodation;
(i) the individual’s contribution to society.
(3) In exercising a function under this Part in the case of an individual, a local authority must have regard to the following matters in particular—
(a) the importance of beginning with the assumption that the individual is best-placed to judge the individual’s well-being;
(b) the individual’s views, wishes, feelings and beliefs;
(c) the importance of preventing or delaying the development of needs for care and support or needs for support and the importance of reducing needs of either kind that already exist;
(d) the need to ensure that decisions about the individual are made having regard to all the individual’s circumstances (and are not based only on the individual’s age or appearance or any condition of the individual’s or aspect of the individual’s behaviour which might lead others to make unjustified assumptions about the individual’s well-being);
(e) the importance of the individual participating as fully as possible in decisions relating to the exercise of the function concerned and being provided with the information and support necessary to enable the individual to participate;
(f) the importance of achieving a balance between the individual’s well-being and that of any friends or relatives who are involved in caring for the individual;
(g) the need to protect people from abuse and neglect;
(h) the need to ensure that any restriction on the individual’s rights or freedom of action that is involved in the exercise of the function is kept to the minimum necessary for achieving the purpose for which the function is being exercised. (4)
Reading through this, one could not be blamed for thinking that the approach outlined here couched in terms of ‘well-being’ corresponds with the philosophy of Independent Living and Article Nineteen of the United Nation Convention on the Rights of Disabled People, but the manner in which these assessments are conducted fail to respect people’s opinions or lifestyles too many times as we see being argued later. Disabled people reject the view that ‘protecting an individual’s well-being’ is identical to ensuring their human and civil rights.
It is why I believe community based social support through independent living, should replace the old fashioned ‘social care’ model in order to change the relations between health, local authorities, other professionals, service users and communities. I recommend reading Ken’s paper in full.
It is vital, of course, to acknowledge different perspectives among service users; hence: “…the words ‘care’ and ‘carer’ are regarded by the disabled people’s movement as paternalistic and dependency creating when used with reference to disabled people. Social ‘support’ is currently considered the more appropriate phrase for disability related services. Adult disabled people require …. ‘support workers’ or ‘personal assistants’”
Teppo Kroger writes:
Due to their aversion to care, disability scholars have developed alternative concepts. Tom Shakespeare (2000) talks about help, referring primarily to reciprocal relationships among peer groups where help is provided on a mutual basis. Vic Finkelstein (1998) and several other disability activists use the term support when speaking about the needs of disabled people. Assistance is another concept, used widely in current disability studies, particularly in connection to the work of personal assistants. Nick Watson et al. (2004: 336–7) have commented that these alternative conceptualisations aim to transform care, based on an unequal relationship and including an emotional dimension, into a less personal, contractual relationship. From the employer position relative to a personal assistant, the disabled person is said to acquire power over her/his own life and become ‘protected from the pejorative, symbolic and practical elements of caring relationships. (5)
Promoting a Human Rights perspective
Sandra Daniels and I have been putting forward the ideas found within the Reclaiming Our Futures Alliance’s position paper on “Independent Lives for the Future” in many of the forums we operate within however it should be noted that some of the proposals within the paper are at odds with the views held by others within the campaigns and various political tendencies within wider society. (6) Our own political activism has led us to question how grounded Reclaiming Our Futures Alliance’s position paper is in the final analysis. I will return to this question in my second blog.
We fully stand by the view that there is an urgent need to promote a Human Rights perspective on Independent Living to both disabled and non-disabled people but this is becoming more complex each day. Among the things that complicates the issue is that there is not only the historical relations between how governments, NHS and local authorities on “Social Care” and their inadequate understanding of disabled people’s perspective on Independent Living, but also the fact that many of our allies or potential allies are equally spellbound by the way social support has hitherto been planned and delivered. Reclaiming Our Futures Alliance’s critique of the failings of existing services and the overall framework developed, especially since the 1990s and Community Care is understood by many Disabled activists, but it the wider audiences are still not onboard with it. Like so many other things Community Care began as a radical approach, but soon it became a victim of Neoliberal social policies. While there is such confusion and ignorance around Social Care and Independent Living it is hard to see how the Reclaiming Our Futures Alliance’s critique and proposals for the future will get a fair hearing and my fear is that this will result in them seeking ‘compromises’ in an attempt to get a foot in the door.
What are we up against?
I believe the push for a Human Rights perspective is undermined both by the policies and positions being promoted by various agencies and the lack of awareness among our allies or potential allies. It is clear that people are still confused as to why Disabled activists are distrusting of local authorities and NHS. It is not that we do not take health or what should be covered by “social care” seriously; nor do we claim to have all the answers within the social approaches we promote. What we do understand is the oppressive ideologies and practices that currently exist and are in the pipe-line.
Many disabled activists view the Local Government Association and the Social Care Institute Excellence, along with Think Local Act Personal, as very much part of the problem and anything other than part of the solution at this moment in time. Further, it needs to be recognised that there are both individuals and some organisations who believe it is possible to have their feet in both camps – work with the existing structures and policies while claiming to support radical alternatives. This position creates distrust and it does demand greater transparency from those involved. The Labour Party is a prime example of this, but they are not alone. Many decent people remain confused as to why the agenda of integration of NHS and Social Care structures is so dangerous and oppressive.
The only way to address the ‘Crisis within Social Care’ and promote Independent Living from a Human Rights perspective is to plea for people not to buy into the fake hard sell that emerging. Disabled people and their organisations have a wealth of material, knowledge and experience that can be drawn upon to develop democratic structures, policies and practice which is capable of delivering good quality services to all communities. We are all for ’shifting the centre of gravity’ by placing people at the centre of decision making with the capacity of agenda setting. This is why we favour new national and local structures that would change how the NHS, local authorities, voluntary and service user groups worked together but this cannot be a piecemeal approach. What is required is a transformative system change alongside new national and local structures.
Everything I have written to date attempts to focus upon seeking a way out of the current crisis within Social Care, but this crisis cannot be addressed in isolation; it needs to be understood from within the context of the social oppression of Disabled people. Disabled people’s social oppression revolves around our relations with the rest of society. In simple terms Disabled people want to be included in structures, systems, and practice which are managed by powers that have no desire whatsoever, unless pushed, to accommodate us as this would threaten the status quo. The Disabled People’s Movement has always been confronted by a huge contradiction: we want to end our oppression by entering a society created in ways that reject us at every turn. Historically, two approaches have been used to address this contradiction: seek improvements within the system versus seeking to transform the system into a new one.
In 2001 Vic Finkelstein argued Civil Rights were about individuals or groups of people – it was a legalistic approach. In the ‘rights’ approach, he said, parliament grants legal rights to those it defines as ‘disabled’. The focus is on identifying characteristics of the individual, rather than the nature of society, and then making selected ‘concessions’ to those so defined. (7)
How do we make sense of the fact there are people who believe the DDA was a victory for disabled people? This goes against all the evidence that exists. In my opinion the DDA was a political defeat because it would not or could not deliver on our demands. The mid 90s saw the first indication of a fundamental split within our Movement with a tendency emerging focused on accommodating to the service sector and solely engaged with protecting disabled people from ‘discrimination’ and/or making life better. This was at the time when Neoliberalism was about to roll back the progress our Movement had made and disabled people’s organisation were in decline. (8) Again, I believe Finkelstein hit the nail on the head when he said:
The ideological problem facing the ….movement….from the 1990s onwards was whether the social model ….was still relevant in guiding our struggle or whether social changes had advanced so far that the original model no longer reflected the social context in which it had been created? Is the ‘rights’, or ‘potpourri’, model of disability now more in tune with the market economy expanding into the health and social services sector of society? Was the social model….really understood? These are a sobering set of questions which are still relevant today, twenty years on. I have my own take on them however, I am raising them here because I believe they also force us to consider not only Disabled people’s social oppression in terms of Disabled people’s relations with society, but the relations they have with the Capitalist state. In both situations, unequal and differential treatment has historically been employed to create and maintain Disabled people’s exclusion from and marginalisation within mainstream society and the system of Social Care lies at the very heart of this. Given this, how do Disabled people respond? Are they engaged in an emancipation struggle or do they simply want choice and control over the redecoration of their prison cells? (9)
From where I sit currently, most of the ‘solutions’ to the crisis in Social Care fit into various reformist agendas, hardly any are really transformative and that includes those coming from Disabled people’s organisations. In the second part of this discussion, I wish to critique various positions and statements that have emerged over the last few years and months.
Part Two
A critique of current positions on resolving the Crisis within Social Care
In this section I want to highlight issues that exist in key position papers. I have only selected those which pose questions for Disabled people and their organisations. Policy papers written on this subject by the Labour Party and trade union Unison are ignored here because both fail to engage with our issues and their content are in my opinion, ageist and disablist. (10) My intention is to employ quotations from position papers and comment on them. The quotations are used to raise issues that I believe merit discussion and resolution, but also to challenge some of the opinions being expressed.
Reclaiming Our Futures Alliance – Independent Living for the Future
‘The language of independent living has been appropriated by Government and public bodies to justify the cuts they are making. Policy documents at national, regional and local government levels repeatedly refer to “helping people to stay independent for as long as possible”, often while simultaneously claiming to be in accordance with Article 19 and yet demonstrating a clear failure to comprehend a concept of independent living based on Disabled people’s right to exercise choice and control over our everyday lives and to access the same chances in life as non-Disabled people on an equal footing. It is common practice for essential support to be removed from Disabled people through social care assessments under the justification of “helping” them to “improve their independence”. Article 19 rights have thus been co-opted and subverted in order to facilitate the retrogression of Disabled people’s rights.’ (11)
There has been recent debate about whether it is useful to still use the language of independent living. We would argue that it is. With certain audiences we are seeking to influence it may be expedient to tailor language in order to be better understood and to convey our messages more effectively, for example referring to cuts to “social care” rather than “independent living support services”.’
There are issues with this in my opinion as it sends out mixed messages and risks undermining the arguments for independent living. Personally, I am weary of speaking in terms of ‘…. to access the same chances in life as non-Disabled people on an equal footing’ as in my opinion it can present an unhelpful idealistic picture of what is being championed – it is dangerous to imply “equality” means “sameness” – Disabled people want to participate in mainstream social activities however that means their lifestyles, incorporating their needs and interests, have to be respected and addressed. The Union for Physically Impairment Against Segregation’s social interpretation of disability is clear on this point. (12)
I also believe there is a problem with the proposal that with ‘certain audiences we are seeking to influence it may be expedient to tailor language in order to be better understood and to convey our messages more effectively’. Again, whilst grasping the logic behind this pragmatic thinking, it has some serious risk factors. Disabled people must be careful not to underestimate the power in the language that maintains and protects the status quo. As I will argue later, if we compromise on presenting our argument in appropriate terms, the outcome could be disastrous. I do not feel comfortable with the notion of being “expedient” because I have passed experience within the Disabled People’s Movement of people being expedient and as a result allowed New Labour to shaft us.
‘Disabled people have long called for the radical overhaul of both the social care and mental health systems in order to better fit a human rights approach to disability.’
Again, I am troubled by the language being employed here; am I being too pedantic when I question what is meant by ‘a radical overhaul’? In my opinion, we ought to be seeking new systems altogether. Social care in particular needs to be replaced not simply “overhauled”.
‘By building on what was most successful about the Independent Living Fund which had considerably lower overheads than local authority administered support, it could also be more cost effective and achieve much better outcomes than the current system.’
What does this actually mean? I am not against incorporating what was ‘most successful about the Independent Living Fund’ into any new service or system, but the Fund was limited in its function and who it supported. I totally dislike the financial ‘justification’ ROFA present here – not only could it be regarded as misleading, but it also has the same whiff as Neoliberal policies connected with Personalisation. (13) I worry about some of the articulations around ‘direct payments’ because they DO accommodate Neoliberal values and this is politically dangerous because some of the arguments around ‘direct payments’ I have heard do risk setting up the vision for Independent Living up to fail. Vic Finkelstein was extremely critical of this area of debate and in many arenas this debate has ALREADY been used against us. (14)
‘The social care element of Disabled people’s right to independent living will be administered through a new national independent living service managed by central government, but delivered locally in co-production with Disabled people.
It will be provided on the basis of need, not profit, and will not be means tested. It will be independent of, but sit alongside, the NHS and will be funded from direct taxation.’
I dislike this formulation utterly: ‘ a social care element’. Not only is it confusing, I believe it once again undermines the fact Independent Living is a holistic approach. As I said previously, personal support tends to be viewed as toileting, washing, dressing, and feeding, but I believe it would be a grave error to articulate this as being the ‘social care element …. administered through a new national independent living service’. Personal support would be integral to what the new service provided, but it surely must be expected to do more than this? I agree with the view that the new service would, ‘be administered through a new national independent living service managed by central government, but delivered locally in co-production with Disabled people’, however, the next quotation I use paints this slightly differently and in doing so, causes concern for me.
‘It will build on and learn from the success of the Independent Living Fund, closed by the coalition government in 2015, and the failures of the local authority care and support system. It will also learn from the experiences of user-led Disabled people’s organisations (DPOs), including those run by people experiencing intersectional discrimination and disadvantages, user-led social enterprises and co-ops which have innovated and developed exciting models of self-organised and self-directed care through personal budgets and peer support. It will work with non-Disabled allies who share the critique of the existing system and who work to the social models of disability and distress.’
This paragraph is too abstract and clumsy; it will need mapping out. My experience suggests there is a high level of ignorance or misunderstanding about the concept “intersectionality”. Not only is there a lack of understanding in terms of its meaning; there is also a need for it to be understood as a methodological tool as well – how to address diversity of experience among disabled people and how differing oppressive ideologies and practices intersect.
The following two quotations are problematic in my opinion. They are messy, both ‘idealist’ and prescriptive in places. What I need to ask after reading this section of ROFA’s vision for the future is: what exact is the nature of this new National Independent Living Support Service? From my perspective and I believe many other Disabled people and our allies, NILSS has to be far more than a ILF mark II.
The vision paper states that at the national level:
‘The national independent living service will be responsible for supporting disabled people through the self-assessment/assessment process, reviews and administering payments to individual Disabled people. Individuals will not be obliged to manage their support payments themselves if they choose not to.’
Then at a local level:
‘Alongside establishment of the national independent living service will be investment in local service provision so that within each area Disabled people will be able to choose from a range of peer support options delivered by user-led Disabled people’s organisations and co-operatives wherever they live. These services will support them to exercise choice and control over the support they receive and to manage their financial, administrative and employment responsibilities including legal duties as employers. Local Disabled people will be meaningfully involved in investment and commissioning decisions, as well as in researching and monitoring how well provision is meeting need. Disabled people who are involved in these processes will also be demographically representative.’
I am fully supportive of having NILSS, but I have real concerns about this proscriptive vision. Just how realistic and desirable is this picture the above quotation paints? Let me be clear: I am not querying the functions that will need undertaking or the need for direct involvement of Disabled people in all areas of planning, development, implementation, and management; what I am questioning the bold claim that: ‘within each area Disabled people will be able to choose from a range of peer support options delivered by user-led Disabled people’s organisations and co-operatives wherever they live’. As a longstanding Disabled activist, I believe this picture is fraught with problems and requires sober discussions among those who are supportive of the overall vision.
There are many other issues in the position paper that need unpacking and exploring; I will refrain from outlining my take here. A major barrier I do see, and have already indicated, is how does ROFA and other like-minded forces such as Act 4 Inclusion mediate between “the orthodox language of our welfare system” and the language and concepts associated with our Movements? I am specifically thinking about concepts such as needs, assessments, etc. as I see this issue as being problematic. This issue will come into sharp focus when we consider the language employed in the Disability Rights UK’s statement.
ACT 4 INCLUSION
A small number of people organised a very successful national Health Campaigns Together Conference in Birmingham in November 2018, which was called Reclaim Social Care and later this was adopted as the name of the organisation. The uniqueness of the group was that it involved activists and campaigners, professionals, academics, trade unionists, and most importantly disabled people. Lively debates both at meetings and by email exchange eventually led to agreement on a set of objectives which are incorporated into the constitution in the summer of 2019. Reclaim Social Care saw itself as a non-party political, coalition of individuals and organisations campaigning for all social support, independent living and care services to be:
- Free at the point of use
- Fully funded through progressive taxation
- Subject to national standards based on article 19 of the United Nations Convention on the Rights of Disabled People, addressing people’s aspirations and choices and with robust safeguarding procedures.
- Publicly and democratically run, designed and delivered locally and co-productively involving Local Authorities, the NHS and service users, disabled people and carers
- Underpinned by a workforce who have appropriate training, qualifications, career structure, pay and conditions.
- Committed to giving informal carers the rights and support they need. (15)
On the 22nd of May 2021, Reclaim Social Care held an AGM at which it adopted a new name and strapline: Act 4 Inclusion – choice, control and independence. At the same the campaigning organisation agreed a vision and strategy for the future. What lay behind the idea of a new vision? Their new vision emerged from discussion, research, changing circumstances, development, lived experience, and the recognition of the need to go beyond reclaiming, fixing or integrating the failing current system of Adult Social Care.
The launch of a campaign for a National Care, Support and Independent Living Service (NaCSILS) and their involvement in helping to shape and develop that campaign required them to reassess the role of Reclaim Social Care so the two bodies could sit alongside and complement each other.
They recognised the need to resolve increasing dissatisfaction with their name which many people believe suggests that they wanted to return to some ‘good old days’ that never existed and it was their hope that by clarifying their vision, having a framework for action, and coming up with a new name would better reflects our mission. The organisation had held a series of discussions that had resulted in the recognition that the crisis within Social Care was beyond fixing and therefore what was urgently needed was the development of not only a new national service but a completely new system altogether.
Act 4 Inclusion want to see the development of a new national service framed by a community based eco–social system which needs to work for all disabled people, of all ages, with all types of impairment, and for everyone in society. A community based eco–social system would take an intersectional approach towards policy making, considering the differential impact of universal and targeted policies across the diversity of disabled people (e.g. people with different types of impairment, older people and younger disabled people, disabled women and from other oppressed groups.)
Developing an eco–social system would involve making physical environments, housing, transport, information technologies, etc. more accessible to disabled people whilst at the same time benefiting families, communities, and society as a whole.
Act 4 Inclusion believe Independent Living can be developed through a community based eco–social system ensuring civil and human rights. What do they mean by an eco–social system? Let us consider how these two things are defined. Ecological means: of or relating to the environments of living things or to the relationships between living things and their environments. It can include the need for sustainability. Social, on the other hand, means relating to society or its organisation.
An eco–social system would involve consideration of how people interact with their immediate and distant constructed and natural environments. A community based eco–social system of delivering services would therefore take a holistic approach using coproduction to put individuals and groups at the centre of identifying and addressing barriers to independent living. Act 4 Inclusion seeks to argue that Independent Living is possible through addressing a combination of various environmental and individual factors thus allowing disabled people to have greater control over their own lives. This includes the opportunity to make real choices and decisions regarding where to live, with whom to live and how to live.
What do Act 4 Inclusion see as needing to be done to further their vision?
They want to see a strengthening the resistance to cuts and that all resistance struggles should be based on coproduction with the users of the service under attack at the fore, along with families, friends, front line workers and local communities.
The Covid-19 pandemic has also brought to the fore the need for safeguarding and deinstitutionalisation. Act 4 Inclusion support the relatives and friends campaigning not just for visiting rights to their loved ones in residential care but also to be regarded as valuable partners for care workers. They want the transform the entire sector from market based to community based. Crucial for Act 4 Inclusion is the need to initiate a dialogue on deinstitutionalisation.
Developing the future strategy involves challenging all moves to “integrate” Health and Social Care, campaign against Social Care Charges and promoting what is a radical vision – to build inclusive communities and services through genuine coproduction.
Using a community based eco-social approach for understanding the basic relationships between service users and their environments moves away from traditional need-led assessment procedures towards addressing how to create inclusive participation in both local communities and wider society. Having support to make decisions, exercising choice and control are all aspects of inclusive participation. Effective inclusive participation enables individuals and communities to work together to build capacity in shaping and engaging in decision-making processes through coproduction and the development of confidence, skills, knowledge, and experience.
Act 4 Inclusion asks the bold question: Why would striving towards a community based eco-social system be transformative? They draw their inspiration from the words of Maria Barile, disability activist, feminist, researcher, visionary:
“We cannot achieve social change by using the same structures that exclude people. Rather, it can be achieved by replacing these, with more egalitarian structures.” (16)
I am biased because I have played a major role in shaping Act 4 Inclusion’s new vision. In comparison with other positions being put forward it is without doubt the most radical and ambitious. Promoting community based eco–social system of delivering services is unlike anything being proposed and it is not without risks. Firstly, it may be too advanced given the current socio-political climate, but it is necessary to pursue it because the crisis within the present system is not the only one that impacts upon Disabled people’s lives. The growing ecological disaster has to be factored in as well. Secondly, advocating an eco–social system is also fraught with problems because there are already models which operate within an eco–social approach towards disability but these employ a bio-psycho-social understanding of disability. Act 4 Inclusion acknowledges that these existing models could be adapted, but they want to avoid being connected to the bio-psycho-social understanding of disability. Act 4 Inclusion is an extremely small organisation, so its success or failure will be measured by its ability to draw others such as ROFA and NaCSILS towards them.
National Care. Support, Independent Living Service
The original ‘project’ initiated by a number of Keep Our NHS Public (KNOP) and the Socialist Health Association (SHA) members who wanted a knee-jerk reaction to the terrible events that were unfolding during the early stages of the Covid-19 pandemic. It was thought that existing campaigns were acting too slow. They sought to set up a loose network to campaign for demands which simply mirrored many of those formed by Reclaim Social Care, but also followed the Labour Party’s ‘solution’ to the crisis within Social Care by calling for a National Care Service. There was no reference to Independent Living nor any intention to engage with Disabled people’s organisations.
Angered by this move that had the support of KONP and SHA, Disabled activists in RSC and ROFA challenged the ‘project’ and demanded negotiations. The result was the adoption of a new set of demands:
- National Care Support and Independent Living Service (NaCSILS)
The Government shall have responsibility for and duty to provide a National Care and Supported Living Service to provide care, independent and supported living, adopting into English Law Articles from the UN Convention on rights of disabled people that establish choice and control, dignity and respect, at the heart of person-centred planning.
- Fully funded through government investment and progressive taxation, free at the point of need and fully available to everyone living in this country.
- Publicly provided and publicly accountable:
The NaCSILS will have overall responsibility for publicly provided residential homes and service providers and, where appropriate, for the supervision of not-for-profit organisations and user-led cooperatives funded through grants allocated by the NaCSILS. A long-term strategy would place an emphasis on de-institutionalisation and community-based independent and supported living. All provision will deliver to NaCSILS national standards. There will be no place for profiteering and the market in social care will be brought to an end.
- Mandated nationally, locally delivered:
The Government will be responsible for developing within the principles of co-production, a nationally mandated set of services that will be democratically run, designed, and delivered locally. Local partnerships would be led by stakeholders who are delivering, monitoring, referring to or receiving supported services or budgets, e.g. organisations representing disabled people (DPOs), older people, and people who use mental health and other services, in partnership with local authorities and the NHS.
- Identify and address needs of informal carers, family and friends providing personal support:
The NaCSILS will ensure a comprehensive level of support freeing up family members from personal and/or social support tasks so that the needs of those offering informal support, e.g. family and friends, are acknowledged in ways which value each person’s lifestyles, interests, and contributions.
- National NaCSILS employee strategy fit for purpose:
The NaCSILS standards for independent and supported living will be underpinned by care and support staff or personal assistants who have appropriate training, qualifications, career structure, pay and conditions to reflect the skills required to provide support services worthy of a decent society.
- Support the formation of a taskforce on independent and supported living with a meaningful influence, led by those who require independent living support, from all demographic backgrounds and regions. This would also make recommendations to address wider changes in public policy.
Whilst this was a welcomed step forward, Disabled activists involved from RSC and ROFA remained cautious because many of the bodies and individuals associated with NaCSILS had or have positions on finding solutions to the crisis within Social Care which focus on “care services” and KONP/SHA were insistent that “care” was included in the service title. Reclaiming Our Futures Alliance and Reclaim Social Care compromised on this point, but it remains an elephant in the room.
It is questionable whether or not the supporters of NaCSILS understand the deep rooted feelings “care” triggers. This has ramifications in terms of trust on two levels: firstly, the vast majority of the solutions to the crisis within Social Care involving calls for a National Care Service only refer to older people and then only as passive receivers of “care”! All too often those on the receiving end of Social Care are totally absent from the narratives – as things stand, people say they support the seven demands, but flatly refuse to discuss the ‘differences’ that may exist. Secondly, if there are fifty seven interpretations of what a National Care and Supported Living Service might be, where does the power lie in this situation? The Disabled People’s Movement historically has numerous scars from being screwed over by the charities and do-gooding people.
The refusal to discuss how the demands are understood by participants also has implications for the manner in which NaCSILS campaigns. Apart from stating what the seven demands are, what more can be said? In a steering group meeting they could not even agree a stance over the integration of health and social care. Do those associated with NaCSILS even know what the UN Convention on the Rights of Disabled People says or are even bothered? There are also different positions on the fourth demand with some appearing to advocate a return to Community Care delivered by local authorities.
So when NaCSILS is asked, what makes care, support, and IL different from each other or are they one and the same; what will the answer be? When NaCSILS is asked about independent living, inclusivity, coproduction, the relationships between the seven demands; again, what will the answers be? A consistent theme within this blog has been the need to address how “Nothing About Us, Without Us” acts as a principled position within campaigning around the seven demands or working alongside other campaigns? Do we ignore the stereotyping or absence of service users voices in order to achieve ‘unity of purpose’? Does NaCSILS have a set of agreed principles or just a lumpy carpet where difficult issues are swept under? Recently a dialogue was opened up inside NaCSILS in order to address these questions.
SOCIAL CARE FUTURE
I want to turn my attention to a letter sent by those who claim to be ‘leaders of organisations that represent adult social care nationally’. This body is known as Social Care Future. (17) As with the ROFA’s position paper, I will limit my comments to selected paragraphs of the letter.
Unlike Act 4 Inclusion, Social Care Future does not find the notion of ‘Social Care’ problematic and they are willing to speak about ‘providing care to the most vulnerable within society’ (sic). I acknowledge from the beginning that there are sentences that could sit comfortably within other position papers, but elsewhere what is stated makes it clear that we are far from being on the same page.
SOCIAL CARE REFORM
‘We are writing as leaders of organisations that represent adult social care nationally to urge the Government to act now on reform of England’s social care system and publish its proposals before the Summer Recess. In common with all people who draw on care and support, and colleagues working across social care, we are clear that the time to deliver reform is now. Reform must be underpinned by a positive vision: “We all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us”, as Social Care Future put it.’
Firstly, there is always a debate to be had about what the nature of ‘reform’ looks like. Usually it is mainly concerned with changing things within the existing system. In my opinion, the government has already indicated its direction of travel with the publishing of the Health White Paper which talks about the Integrated Care Services. Social Care Future, again unlike Act 4 Inclusion and NaCSILS, seem to support an integrated system which calls into question to next two paragraphs of their letter.
‘Transforming social care so that it is sustainable and helps enable people with care and support needs to be fully included in their communities matters in its own right. More broadly, as we look to recover from the pandemic, we need to see social care as a key part of the solution and a key part of our infrastructure.
The vision we share cannot be achieved by social care or even wider public services alone. Public resources need to be targeted to support and supplement the efforts and activities of citizens, community groups, voluntary organisations and local businesses, building on the best of what we’ve seen in our local communities over the last fifteen months. The social care sector, working alongside other council services and the NHS, can shift its practices to enable a much-increased level of preventative activity, freeing up resources for personalised support to local people requiring long term care.’
Their vision doesn’t break with the idea of a mixed market facing approach towards services. It is important to note exactly where their focus of attention lies – ‘to enable a much-increased level of preventative activity, freeing up resources for personalised support to local people requiring long term care’. This is such narrow a focus.
‘Policy on social care, including funding reform, should be guided by and tested against this vision – with a single shared ambition across health and social care which puts people’s expectations for their lives at the centre. This can be measured using TLAP’s Making It Real framework. (18)
This is not the time or place for me to discuss Think Local Act Personal and their Making It Real Framework. It is a discussion that needs to be had because it does have implications for how we understand and address what ‘choice and control’ means, the perceived relationship between personalisation and independent living, and coproduction. I personally find the methodology of TLAP contradictory and not an adequate basis to shape policy or practice on, however, neither am I willing to throw the baby out with the bathwater – expectations I believe need to be placed in context.
‘Addressing longer term funding and co-producing a ten-year plan for social care will help enable successful implementation of the forthcoming Health and Social Care Bill and the revision of the Mental Health Act. We recognise that helping people to avoid catastrophic care costs and selling their home to pay for care are important dimensions of the reform debate. But action on these issues alone will not suffice.’
I find the above paragraph extremely disturbing for many reasons. It isn’t just weak, there’s a whiff of accommodation and it reminds me of the Disability Big Six Charities who offered to jump into bed with the Tories around the Disability Discrimination Bill. The real crunch however lies with their three priority areas for action – everyone, I would contend, feathers their own nest.
‘We have collectively agreed that the priority areas for action are therefore as follows:
- Funding for short-term stabilisation
As a first step, the government must urgently address short-term funding challenges, which have been worsened by Covid, to prevent further deterioration in the access to and quality of care. An immediate injection of funding is needed to enable short term stability and avoid serious risks to support during the next phase of the pandemic and beyond. Work by our organisations and others has identified the most serious challenges to support which will require funding.
“This may look reasonable, but it doesn’t really square with the realities that have deteriorated at a faster rate due to Covid and government policies. The injection of funding, I would argue, would in no way create short term stability – the patient is critical.”
- Urgently bringing forward investment and reform proposals needed to ensure the sustainable long-term future of social care
The government should bring forward proposals for longer-term investment and reform as an immediate priority to create a simpler, fairer system. However, any additional funding that is made available to social care, should not simply be used for ‘more of the same’ and the pre-COVID-19 status quo. It should be targeted on action to shift towards the above vision, such as more home, housing and community focused, asset-based, inclusive and preventative models of care.
“When they speak of funding being ‘targeted on action to shift towards the above vision, such as more home, housing and community focused, asset-based, inclusive and preventative models of care’, we should be demanding to know exactly what this means in relation to the government’s pending proposals. As a statement, Act 4 Inclusion, wouldn’t disagree but of course the devil is in the detail.”
- Investment in the short term to speed the shift towards a system of social care that is both sustainable and fit for the modern age.
This includes:
A targeted fund enabling councils and their partners to make a rapid shift towards prevention.
A new deal for the care workforce, including personal assistants and other non-traditional workforce roles.
Funding support for action on inequalities and levelling up.
An innovation fund to enable local authorities to harness the true potential of technology.
Transformation and improvement support to councils and providers and to ensure a new funded transformation and improvement framework for adult social care.
Each of these actions is essential for creating the conditions in which social care can be a full and equal partner with the NHS and enable more people to remain independent, living in their own home or in their community.’
This third priority area really lays bare the nature of the growing consensus that’s emerging – they can employ the word ‘transformation’ as many times as they like, but any close scrutiny of these priorities will show that this is not an actual transformative agenda but a re-run of ground covered during the mid-1990s when New Labour set out its stall for Adult Social Care – Personalisation: the great Con.
‘We would welcome the opportunity to discuss our concerns with you and stand ready to work with the Government to ensure that our future social care system is best able to support people to live their best lives.’
Sorry, but I do not trust Social Care Future to further the long-term interests of Disabled People because I believe just like the Disability Charities, they would stab us both front and back.
DISABILITY RIGHTS UNITED KINGDOM (DRUK)
The statement issued by Disability Rights United Kingdom on the 21st of June 2021 is probably the most disturbing of the positions and statements I have so far referred to from a disability politics perspective. (19) The reason I say this is because within the statement there are views and sentiments expressed that I fully endorse, but it is also true to say that there are also views and sentiments expressed within it I have serious issues with. To make matters worse, the statement is signed by organisations I am a member of or have worked for; I understand why this statement has been written and signed, but I believe it is a strategic mistake.
Disabled people’s organisations have not a great track record when it comes to acting in a strategic manner. This was an issue just post the passing of the DDA and setting up the Task Force by New Labour. I felt DPAC often lacked a strategic plan and had an over reliance on spontaneity.
I am growing deeply troubled by a number of political blocs that are being formed around demands or pleas to the government around ”social care” reforms (sic). Many of the statements that are appearing are ’compromised’ positions using language from both Disabled people’s organisations and mainstream social policies. Some of the signatures are from forces who are not in support of the various views held by Disabled people and, in my opinion, this should raise alarm bells as we have been here before.
The United Kingdom Disability Right’s statement refers to Social Care reform and I fully acknowledge that this is the mainstream agenda, but as Disabled people we need to be open about what we want, not trying to sneak it in under the carpet. UKDR’s statement makes no mention of Independent Living and it glosses over how Personalisation has distorted key concepts from our Movements.
Why were only certain Disabled people and organisations made aware of this statement and others kept in the dark prior it becoming a done deal? (20)
I do not want Disabled people to be ignored or excluded from developing a way forward obviously, but our power of influence is limited and needs to be used both wisely and strategically. Getting a seat at the table is one thing, sitting at the table in a straight-jacket and being compromised by stronger voices is another. If one lies down with dirty dogs then picking up fleas is a real possibility.
As previously, I will break the statement down into quotations, then offer a critique of the content and where appropriate, context.
DISABILITY RIGHTS UNITED KINGDOM – Social Care Reform; improving Disabled people’s lives
‘The biggest goal of any social care reform should be to improve the lives of people who draw on it. We are a coalition of organisations led by Disabled people and supported by allies. We are the direct voices of Disabled people who draw on social care support to lead our lives. We want Disabled people to be central to shaping Government reforms to social care.’
Call me cynical, but why would the Government at this eleventh hour suddenly change its approach? The relationship between governments and Disabled people’s organisations has radically changed since the 1990s and since New Labour’s engineering of the unprincipled ‘Disability Movement’ – an unholy alliance of disability charities and neoliberal market facing Disabled people’s organisations – which assist in the marginalisation and exclusion of voices from the Disabled People’s Movement, especially those on the Left. It is worth noting that in the last few weeks DRUK has broken its historical links with the ‘Disability Movement’ and I am wondering if I am reading too much into this, however, I could see this statement as acting as a form of rehabilitation and forgiveness for past sins. (21)
Two issues stand out regarding wanting ‘Disabled people to be central to shaping Government reforms to social care’ – firstly, do Disabled people want to give credibility to the idea that it is both possible and desirable to reform social care? Secondly, what are the risks involved in asking for a seat at the table?
The following quotation relate to the issues I have raised.
‘These are the basic rights we want the Government to adhere to in the reform of social care:
Disabled people should have the right to thrive, not just survive.
The role of care and support in today’s society must be to provide care, support and connections that enable people to live the life we choose within their community.
Social care must provide support to people to live, learn, work, participate and connect, on an equal basis with others.
Reform must be fully informed by the experiences, expectations and aspirations of Disabled People who draw on it.’
Who could disagree with these so called ‘basic rights’ (sic); is that not an issue in and of itself? But more fundamentally, are these four ‘desires’ as I would define them, really basic rights if they are so open to vastly different interpretations? Exactly what does ‘fully informed by the experiences, expectations and aspirations of Disabled People who draw on it’ mean in material and practical terms? I am asking about this in relation to legislation and policy development, not simply in terms of service delivery. I am in no way dismissing the experiences, expectations, and aspirations of Disabled People, but I am questioning how these would be collectively articulated. This concern I have links directly with the methodology Mike Oliver saw applying to the Social Model of Disability. He wrote:
‘Using the generic term [Disabled people] does not mean that I do not recognise differences in experience within the group but that in exploring this we should start from the ways oppression differentially impacts on different groups of people rather than with differences in experience among individuals with different impairments.’ (22)
Do the authors and supporters of DRUK’s statement really understand this vital political issue?
Moving on, the statement speaks about principles for reform. I will target my comments around specific issues.
‘1. Any reform should implement the UK’s obligations under the UN Convention on the Rights of Persons with Disabilities to ensure Disabled people’s right to live independently and be included in the community. This means people should have a real choice of where and with whom to live, and have all the necessary support provided to live in the community.
- Social care must support the choice, control and inclusion of the people who draw on it. Processes must allow the voice of Disabled People to be heard and their choices respected. It must enable people to achieve their potential and have equal life chances to others.’
In the United Kingdom the Disabled People’s Movement’s disability politics are grounded by the social interpretation of disability which established the political identity, Disabled People. This is a crucial aspect of our politics; even the United Nations acknowledged from the outset our right to speak of the UN Convention on the Rights of Disabled People, so why these organisations undermining the framework of British disability politics? I do not regard this to be a small pedantic point; the social interpretation of disability is being undermined at every turn currently and it is vital that British disability politics challenges disablism which is rooted in all government policies. This relates directly to these so called, principles for reform. The UK signed up to the UKCRDP, but what is needed is not the implementation of “the UK’s obligations” which the government has already claimed it is doing, but the development of new legislation which grounds Disabled people’s human and civil rights within all future policy development. The basis of this new legislation has to be Independent Living. (23)
‘3. Social care support should enable people to live an ordinary life. High quality personal care is essential as well as support to get out and about, build connections with others and enjoy open spaces.
- People should receive and experience social care support based on their needs not on geography, impairment, age, race, ethnicity, gender or income.
- Relying on social care support must not put people at risk of increased poverty.
- People, especially those with complex support needs, should have access to good quality support in the community. Reform must accelerate the deinstitutionalisation of care and support provision towards more responsive, flexible, varied and self-directed support within the community.’
I believe “the third principle” is supposed to reflect the UNCRDP and to a degree ROFA’s position but it is extremely poorly articulated and therefore dangerous. Some of the language is highly questionable and panders to dominant thinking. There are sentences here that simply left me bewildered, such as ‘Social care support should enable people to live an ordinary life.’ Is this saying that Disabled people should have the appropriate support to be able them to develop good quality lifestyles? What is an ‘ordinary life’ and for whom?
There are real problems with how “the fourth principle” is articulated. How is the concept of ‘their needs’ being understood here? If the authors are opposing the postcode lottery of provision, the medicalisation with the assessment processes, the employment of assumptions around impairment, age, race, ethnicity, gender or financial ability; then they ought to have been more upfront.
I am also critical of “the fifth principle” as it lacks real context, ‘Relying on social care support must not put people at risk of increased poverty. It is unhelpful for two reasons: firstly, the language panders to the ‘dependency’ narrative found within Finkelstein’s ‘Administrative model of disability’; and secondly, it does not openly oppose existing mean testing and charging policies. (24) It is weak and risks being divisive. Personally, as a long standing disabled political activist, I find this whole approach embarrassing and detrimental to our struggle.
The statement then goes through a catalogue of things which the authors of the statement see as ‘progressing the reform agenda’. I would take issue with its approach towards “Nothing about us without us” because I believe it distorts Disabled people’s encountered experiences over the last thirty years. The statement says:
‘Making change happen
To make change happen there must be:
Nothing about us without us
Changes that led to radical improvements for those who use social care, such as person-centred planning, personal budgets and direct payments were developed by Disabled people ourselves. The viability of any reform proposals and their likely success should be judged by those of us who draw on social care. Disabled People’s Organisations have already developed solutions which should be considered. (22) This is why we urge the government to engage directly with people who use social care and organisations that are led by Disabled people.’
Exactly how radical has ‘person-centred planning, personal budgets and direct payments’ been? Is it not the case, as Jenny Morris and others including myself have argued, these concepts have been transformed to comply with status quo ideas and methodologies since the late 1990s for example via Personalisation? (23)
‘Long term funding
People should receive the care and support we need to lead full lives. Social care must be put on the same footing as the NHS, free at the point of use and funded through general taxation. There must be a long term plan for social care, as there is for the NHS. Funding must be based on robust evidence of current and future needs and provide a sustainable solution.
Funding reform must ensure that the experience of people who draw on social care continues to improve. In line with expectations laid out by the UNCRPD the Government should take concrete and targeted action to ensure year on year improvements in the achievement of independent living.
Developing good social care infrastructure is an investment, not only in the potential and future of people who need the support, but in good, green jobs and wider economic prosperity. A vibrant, diverse and innovative social care sector could play a vital role in our economic recovery after the Covid-19 pandemic.’
Apart from the first two sentences in this quotation above which I fully agree with, I have considerable reservations about the line of travel that is advocated. As stated, I want a new system altogether and social care as currently constituted, brought to an end. The third paragraph in particular is written in language I am really uncomfortable with as I am totally in favour of removing the market-place. (24)
‘Reform of the law to give more power to Disabled people and support inclusion
The Care Act has failed Disabled people. It has not prevented severe cuts to support, or the imposition of needless red-tape on those using direct payments. People are denied the power to make decisions about their own needs, support and wellbeing, with councils often making life-changing decisions with very little accountability and with few opportunities for decisions to be challenged. The law must be strengthened, in line with UNCRPD
- to guarantee Disabled people the right to choose where we live and who we can live with
- to get the care and support we need to lead full lives
- to be supported to live in the community
- to access community activities like everybody else.’ (25)
This is one aspect of the statement where I totally agree with the sentiments expressed. Nonetheless, as with ROFA’s position paper, I believe there is a need to discuss the role of direct payments because the landscape has changed since they were first spoken about. (26)
‘Funding to meet needs and reduce waste
It is critically important to ensure that money is spent on services that Disabled people of all ages want and need – services that move the UK forward towards standards set out in the UNCRPD. Currently, money is often wasted on services that do not support choice, control and inclusion. (27) This must stop. The reform must put maximum available resources into direct support, allowing people to control their support and have real choice and power. There should be reductions in money spent on administration, decision-making and rationing processes.
Understanding current and future needs
When the NHS does not have enough resources to meet the needs it encounters we are able to see this through the existence of waiting lists and then policymakers can respond accordingly. There is no similar measure of shortages in social care. Local authorities should record the needs that they are currently unable to meet to provide similar information. This will make it possible for the Government to work towards filling the gap.’
The framework and resources allocated to Social Care are not fit-for-purpose which is why a complete system change. Talking about measuring the ‘shortages in social care’, and ‘Local authorities should record the needs that they are currently unable to meet’ without placing them in the context of ageist and disablist assessment processes and delivery mechanisms is dishonest and not in the best interests of Disabled people.
‘Abolish charges for social care
Social care should be free at the point of use. It is completely unacceptable that people on means-tested benefits have to pay a significant proportion of their already small income for social care support. The system is particularly unfair towards young Disabled People with high support needs. Reforms must address this problem and stop pushing people into poverty. Charging for social care should end.’ (28)
The system is oppressive and unjust FULL STOP.
‘Enabling Disabled people to innovative
Disabled people often feel as if care is done to us and decisions are made for us. Professionals do not always view themselves as enablers and often regard providing care and support as the end goal. This can lead to high levels of bureaucracy, lack of trust of Disabled people to make ‘good’ decisions, and rigid frameworks with limited options and over the top monitoring systems.
The experience of people who use direct payments is a particularly troubling example of this. Over the past few years, the bureaucratic burden and increasingly rigid requirements imposed by local authorities have left people with additional responsibilities. At the same time, these have removed the freedom and control associated with direct payments. Innovation is not possible without choice and control and therefore reform must promote a radical change in the approach, ensuring that restrictions are removed so that people are truly able to self-direct their support.’
The first part of my blog touches on many of the points found in this quotation, however, I dislike the presentation of the issues here. I believe it has been written in a style designed to side-step the political and ideological realities, thus ‘blaming’ professionals and local authorities rather than the nature of the system itself and its relations with disablement. Promoting self-determination is something I have done for forty years however I always argued that ‘choice and control’ is dependent on existing power relations – we live in an oppressive society that socially restricts us.
Those Disabled people who are reformist in their politics have replaced the struggle for emancipation with the demand for accommodation. They hide their reformist agenda behind the call for “Rights” and pleas for ‘choice and control’ so they can fit in alongside their nondisabled peers. Independent Living as a philosophy and practice can adopt one of two routes. It can be reformist and seek accommodation into the status quo or it can become a platform for transformative social change. Talking about ‘innovation’ cuts on ice with me.
Conclusion
In this piece I have tried to outline the difficult twists and turns that are unfolding and link them back to the roots of disability politics. It is obvious that the situation is dire and there is no unified movement of Disabled people. I am an old school Disabled activist and I believe the current agendas being cobbled together will once again end up betraying our people. Figures show that this is no small beer we are talking about. (29) Much of the nondisabled Left are ignorant of the core issues and the Disabled Left are extremely marginalised. If the Conservative government does put forward a reform strategy for Social Care, I believe my picture shows a very sorry state of affairs. Only by raising the radical vision for social change will any resistance or transition be even remotely possible.
Notes
(1) Williams-Findlay, B. (2015) Personalisation and self-determination: the same difference? Critical and Radical Social Work, Policy Press
(2) Davis, K. A SOCIAL BARRIERS MODEL OF DISABILITY: THEORY INTO PRACTICE The Emergence of the “Seven Needs”
Paper prepared for the Derbyshire Coalition of Disabled People: February, 1990
(3) The seven demands have been expanded into twelve or even fifteen however the framework offered by DCIL in my view has been altered and what are now seen as the ’twelve pillars of Independent Living’ have been watered down. This is material for a separate blog.
(4) The Care Act 2014
https://www.legislation.gov.uk/ukpga/2014/23/contents/enacted
(5) Kröger, T. (2009). Care research and disability studies: Nothing in common? Critical Social Policy – CRIT SOC POLICY. 29. 398-420. 10.1177/0261018309105177.
Kröger’s references
Shakespeare, T. (2000) Help. Venture Press: Birmingham
Finkelstein, V. (1998) ‘Re-thinking Care in a Society Providing Equal Opportunities for All’, Discussion Paper prepared for the World Health Organisation. Milton Keynes: Open University.
Watson, N., McKie, L., Hughes, B., Hopkins, D. and Gregory, S. (2004) ‘(Inter)dependence, Needs and Care: The Potential for Disability and Feminist Theorists to Develop an Emancipatory Model’, Sociology 38(2): 331–50
(6) See footnote 22 and later my critique of ROFA’s position paper.
(7) Finkelstein, V. (2007) The ‘Social Model of Disability’ and the Disability Movement – here Vic is talking about what I call the Disabled People’s Movement
Click to access finkelstein-The-Social-Model-of-Disability-and-the-Disability-Movement.pdf
(8) Resist the Punitive State – Grassroots Struggles Across Welfare, Housing, Education and Prisons, Edited by Emily Luise Hart, Joe Greener, Rich Moth – The Disabled People’s Movement in the Age of Austerity: Rights, Resistance and Reclamation – Bob Williams-Findlay (British Council of Disabled People, UK)
(9) Finkelstein, V. (2007)
(10) People must come before profit in reformed social care system: Social care provision must mirror the structure and ethos of the NHS
https://www.unison.org.uk/news/2021/03/people-must-come-profit-reformed-social-care-system/
(11) Independent Living for the Future – Reclaiming Our Futures Alliance
(12) In Fundamental Principles of Disability (1975) and UPIAS wrote: Thus the Union’s approach to disability …. leads the way to a truly integrative struggle to bring physically impaired people into line with the general, social situation and away from ‘special’ struggles, etc. Whereas the traditional segregationist approach, which treats our problems as a ‘special’ case, has always left us isolated and weak, the struggle for full integration will develop our strengths and bring us into contact with many groups who also have an interest in influencing social change. This is the realistic alternative which the Union proposes to the incomes scheme of the Alliance’s “experts” which still seeks to tie down physically impaired people with tape measures and inflict on us the probing, prying, interfering, dominating control that we have all experienced and struggled against.
(13) Kendall, S. Cameron A. (2013) Personalisation of adult social care: self-directed support and the choice and control agenda – British Journal of Learning Disabilities, Volume 42, Issue 4, Pages: 251-336, December 2014
(14) Finkelstein, V. (2007)
(15) Reclaim Social Care
https://e-voice.org.uk/reclaimsocialcare/
(16) Maria was ahead of her time in her vision of disability rights activism. “We cannot achieve social change by using the same structures that exclude people. Rather, it can be achieved by replacing these, with more egalitarian structures” she said at Action des femmes handicapées Montréal (AFHM)’s 25th anniversary conference in 2011.
(17) ‘#socialcarefuture is a growing movement of people with a shared commitment to bring about major positive change in what is currently called “social care.” It’s for those who want to take part in imagining, communicating and creating together a future where what we currently call social care makes a major contribution to everyone’s wellbeing and which, as a result, will enjoy high levels of public – and hence political – support.’
https://socialcarefuture.blog/
(18) See:
https://www.thinklocalactpersonal.org.uk/_assets/MakingItReal/TLAP-Making-it-Real-report.pdf
(19) See: https://www.disabilityrightsuk.org/about-us and
https://www.disabilityrightsuk.org/news/2021/june/social-care-reform-improving-disabled-people%E2%80%99s-lives?fbclid=IwAR3pJ6sH5MBOgFHRT1NUtP7I1YmDwkFiCHK-N7d3-46JWMmpzRbLy4Z-0Us
(20) I was alerted to the statement via ROFA’s Newsletter. The reason I am annoyed is that I am one of ROFA’s representatives on NaCSILS and in my opinion it was disrespectful not to provide me with prior knowledge about this. Other central activists were caught unaware of this as well.
(21) See: https://dpac.uk.net/2012/12/a-question-of-intent/
(22) Oliver, M. (1994) Capitalism and ideology: A materialist critique of the Normalization principle
(23) See for example Independent Living for the Future – a proposal developed by Reclaiming Our Futures Alliance – https://www.inclusionlondon.org.uk/wp-content/uploads/2019/06/NILSS_final.pdf
(24) Morris, J. (2011) Rethinking disability policy
https://www.jrf.org.uk/report/rethinking-disability-policy
Also see:
https://jennymorrisnet.blogspot.com/2016/03/self-determination-and-citizenship-out.html
(25) Effectively this means incorporating article 19 of the UNCRPD into UK law. The Equality and Human Rights Commission has developed a legal model which we believe should be implemented as part of the reform. https://www.equalityhumanrights.com/en/publication-download/strengthening-right-independent-living
( 26) Priestley, M. and Jolly, D. (2005) A Postcode Lottery? Explaining the uneven implementation of direct payments in the UK Centre for Disability Studies
(27) For example evidence of how people with learning disabilities and autism are treated in ATUs: Joint Committee on Human Rights (2019), The detention of children and young people with learning disabilities and/or autism (DRUK)
(28) The picture of how much individuals are asked to pay for their care is different in the UK nations, for example, personal care is free in Scotland. Local authority charging policies also vary a lot, which leads to a post-code lottery. For example, Hammersmith and Fulham Council in London does not charge for homecare at all.
(29) Keep Our NHS Public inform us that: Local authority social care services involve a vast remit and £billions of annual funding with more spent on people aged 18-64 than on people over 65. A Health Foundation summary of local authority-funded social care services illustrates this:
In 2018/19 some 842,000 people were receiving long term social care support from their local authority. 548,000, (65%) of these are older adults. 293,000 (35%) are aged 18-64. Of those aged 18-64: 134,000 (46%) have learning disabilities as their primary disability; 94,000 (33%) have physical or sensory impairments; 59,000 (20%) have mental health needs, and 7,000 (2%) have other social support needs.
Only 10% of those with physical or sensory impairments, 18% of those with mental health issues and 19% of those with learning disabilities are supported in nursing or residential care homes, the rest receive their local authority support in the community. In contrast, 61% of older people who are funded by local authorities live in residential or nursing homes. https://www.health.org.uk/sites/default/files/upload/publications/2020/Social%20care%20for%20adults%20aged%2018-64_Analysis.pdf5