On Wednesday I was delighted to be present when Oliver Letwin rubbished the notion that many users of social care are ‘incapable of making decisions about their own lives’. The Minister of State for Policy was responding to a question from an audience member following his talk on the Open Public Services White Paper. It is ‘desperately patronising and utterly wrong’ to diminish people’s capacities in this way, he said. Not that I have found mention of this among the largely negative reaction to his proposals for reforming public services. Which is a shame because it is rare you hear such an uncompromising and impassioned defence of people’s personal freedoms.
You might not be surprised to hear that I’m sympathetic with what Letwin had to say. I wrote Social Care for Free Citizens for the civil liberties group, the Manifesto Club. I’m also a member of the Personalisation Group to Revolutionise Social Care, a loose collective of social care professionals who think more can be done to really put social care users in control of their own care, and ultimately of their own lives. And the policy makers, to be fair, seem to agree with us. The Department of Health has recently published a Consultation on proposed changes to regulations for Care Quality Commission registration. Included is the proposed removal of the requirement that only CQC-licensed home care may be purchased. The ‘financial costs and the additional bureaucracy’, DH say, ‘outweighs the assurance of safety provided by regulation’. In response, a self-appointed defender of ‘vulnerable’ adults has raised the prospect of ‘perpetrators who will be willing and able to do some caring if it gets them near vulnerable adults or children‘. The vast majority of social care users – mostly older people – have undiminished mental capacity and are more than capable, with a little support, of living independent and fulfilling lives. In a society with an exaggerated sense of the prevalence of abuse, and of the vulnerability of fully grown adults, statements like this can only contribute to a limiting of the choices open to people who use social care.
The spectre of abuse should not be allowed to deny adults their autonomy or to close down debate about improving social care. As the coalition’s Vision for social care says, ‘risk is no longer an excuse to limit people’s freedom’. Which is why I am also nervous about the implications of local authorities issuing smart cards. Instead of personal budgets taking the form of direct payments into people’s bank accounts, these cards restrict what the money can be spent on and allow the council to keep tabs on people’s spending. Unless there are well-founded concerns about a person’s mental capacity, why would anybody choose to diminish the choices they are allowed to make? There are changes that can be made for the better though. A good start would be for those of us in the world of social care not to call people ‘vulnerable’ just because they are receiving a service from us. Letwin was right in his criticism of the paternalistic impulse that deprives so many so-called vulnerable adults of their independence. But we need to go much further than that and look beyond the culture of public service provision. A misplaced tendency to regard people as incredibly vulnerable and lacking the capacity to run their own lives, is fuelled by a wider fearful and risk-averse culture that affects society as a whole. If the transformation of social care is to turn ‘vulnerable’ adults into just adults, then we’ll need to get to grips with this too.