Social care still betrays its poor law origins by refusing many older people much more than the bare means of survival. The rhetoric of personalisation may have promoted the ideal of human flourishing, but the inconvenient truth is that councils are cutting spending on social care for older people even while demand is rising fast and unmet need goes through the roof. The system is broken and the Dilnot report is the last chance to mend it.
The political consequences of failure should weigh more heavily with the government than fear of imposing a "death tax". Most local authorities now deny a service to older people whose needs are not "critical" or "substantial", inconsistency is rife so that someone qualifying for help in one area may be turned down in another, and public expectations are such that the baby boom generation will no longer accept sub-standard care as they enter old age.
Dilnot's proposals offer a fair balance between the family and the state.
The poor will be protected and the better off will have their financial contribution to care capped at a reasonable level which it should be possible to insure against. The one in 10 older people who end up with care bills of more than £100,000 won't have to sell all that they have to pay for them.
The Treasury must not shy away from the £2bn extra cost to the state. That's exactly the amount informed estimates show can be saved by integrating health and social care, and by switching more care from hospital to home and community. This alone would improve satisfaction ratings among older people, but social care would begin to look fit for the 21st century if this were coupled with standardised assessment, the right to care and support, and a well stocked preventative armoury that included telecare, home adaptations and help to live independently.
Hospital wards are filled with elderly people who have fallen or had accidents that could easily have been prevented if their homes had been properly adapted. Too many finish up in expensive institutional settings who would have been much happier to look after themselves more cheaply at home, if only they had been given a "reablement" programme of intensive initial support to do so.
Social workers have a vital role in ensuring that older people receive the right support, when and where they want it. It is good, old-fashioned case work, which is what social workers did before the profession was bewitched by "care management" in the 1990s, and many see it as a far better use of their time. So it is important that social work is well rooted in new ways of delivering social care and employers do not replace them with unqualified staff simply because they cost less. End of life care is just one of the areas in which social workers are indispensable.
Success will also depend on how effective the health and social care bill proves to be. If health and well being boards are given teeth – and that is by no means certain to happen – then GP consortiums may yet help to create the kind of social care the Dilnot Commission would like to see.
Mark Ivory is strategic media manager at The College of Social Work.
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