Jim Elder-Woodward
Rosshead Coach House, Heather Avenue, Alexandria, G83 0TJ
tel.: 01389 756127: email:
Bonded to Poverty
Jim Elder-Woodward
2007 has been the bicentenary of the abolition of the slave trade.
There have been several commemoration events to note the occasion; and many politicians and others up and down the country have been decrying this sinful system and saying how happy they were ‘good’ eventually prevailed over ‘evil’. All this has happened throughout this year, without much reference to the fact that over the many decades of the 18th and 19th century, Britain made much of its fortune from the trade.
However, for many disabled people, using the 21st century social care system, there seems to be many similarities between their experiences, today, and that of those slaves three hundred years ago. But they are now wondering when will people start commemorating the demise of their present day bondage?
This rather radical position may need some explanation. In the 18th century, at the height of the slave trade, the tyranny and oppression of slavery was considered a ‘normal’ part of everyday life. Slave traders and associated others were highly respected, ‘God fearing’ people; and they made a bob or two out of the trade too.
Such practices and customs do seem to have their similarities. In the main, both are seen, as repressive regimes, which create ‘vulnerable’ people, whom they traffic and from whom they profit. However, in the 17th century slave traders were trading with owners for the highest bid; whereas in the competitive tendering world of 21st century, local authorities are now trading with care providers for the lowest bid.
Nevertheless, both regimes keep those they traffic bonded not just to those in power over them, but bonded to poverty itself. As well as this, both deny dignity, individual freedom and opportunity for self-improvement: both unavoidably control lifestyles and personal support systems: and both inevitably create and maintain dependency and disempowerment.
Notwithstanding, any of this, the main difference between the 17th and 21st century, in line with other modern day traffickers who directly charge those they traffic, today local authorities raise money from the system, in the form of ‘community care charges’.
In 1948, when ‘home care’ was first introduced, it was designed mainly to support women after giving birth at home. Disabled people were safely ‘put away’ in institutions, or, like older people, cared for by their nuclear families. So ‘home care’, at that time, could have been seen as an ‘extra’, not a ‘necessity’, and, as such, a contribution may not have been out of the question.
With the advent of modern social policy, though, more and more people are moving from institutional (medical) care to community based (social) care. This means that the ‘extra’ of ‘home care’ has now become the ‘necessity’ of ‘social care’.
This social policy change can be likened to a slow lava flow which relentlessly writhes forward. In its path, abrasions occur as it rubs and burns against the existing, cold, hard rock of ‘institutional’ provision and culture.
Unfortunately, such institutional resistance is proving to be more resilient to the flow of lava than had been anticipated. It is this type of provision, which many disabled ‘activists’ deem to be more akin to the slave trade. For example, according to their perception, ‘users’ of the hard rock mainline social services are seen as being treated as ‘commodities’, bartered between commissioners (the local authorities) and third sector service providers of their social care. The only difference is this time; it is more often than not the lowest bidder who succeeds.
To add salt to injuries, such ‘commodities’, once trafficked, are then required to pay a ‘community care charge’ for the outcome of such transactions. It is this additional malicious practice which really distinguishes the social care trade from the slave trade – the commodity being bought and sold has to contribute a payment to the commissioners for making the sell[1].
Within the lava flow of new social policy developments, local authorities can now, but more often still don’t, give people money to employ their own support, rather than haggling with the lowest bidder to provide a service to them.
These ‘user controlled’, independent living systems of support are proving to be more empowering and better value. They have, nonetheless, created yet another contortion in the lava flow, which further heightens the tensions within today’s social care.
With this money, minus the charge, a disabled person may engage a home care agency, or employ a “Personal Assistant’ (helper), to carry out personal tasks, or social activities, which they could not accomplish by themselves. This direct transaction between the provider and customer means that the duties which are to be performed can be done in a much more flexible and individualised manner.
In this way, the gap between ‘health care’, ‘home care’, ‘personal care’ and ‘social support’ has been narrowed. Even within mainstream institutional provision, where traditionally such care was provided by different professionals, even different agencies, the roles of ‘health care’ and ‘social care’ have become blurred.
Yet ‘health care’ is free at the point of delivery, but ‘social care’ isn’t.
How can this be fair? To begin with, another question must be asked: what is ‘health care’ and what is ‘social care’?
There are many tasks ‘Personal Assistants’, or support workers, and even some home care agency workers, are asked to perform. These include: limb and chest physiotherapy; tube feeding into the stomach; changing urinary drainage systems; stoma care; tracheotomy care: preventing pressure sores; washing; and maintaining basic levels of hygiene. All of these tasks can also be performed by a nurse. Yet, if a nurse does them in a hospital they are free; but if a paid carer does them in the community, they could cost over 75% of a disabled person’s income.
Once again; in hospital, meals and meal preparation, cleaning and some laundry are free. In Scotland, where some personal care is free, to some elderly people, such domestic duties are not. But for disabled adults, neither personal care, nor domestic duties are free, unless they are on very low incomes.
There are further blazing pressures in the lava flow to make social care more accessible to more people by making them free and emancipatory.
As policies and services in health and social care become more and more linked, it has been shown that good, and cheaper, social care reduces the demand for health care. In addition, as the population becomes older, more demand will move political interest away from acute to chronic health and social care.
However, with every yin there must be a yang. The Westminster Government has just introduced its welfare reform proposals. These call for more motivation among those on Incapacity Benefit to get back to work, as a means of reducing poverty. But these proposals do not consider the relationship between social care charging and employment. For many disabled adults, particularly in Scotland, and for pensioners in the rest of the UK, if most of their income goes on social care charges … what’s the point of working?
There is even a question over the effectiveness of community care charging, itself.
On average, 25 – 40% of revenue raised by charging is swallowed up in administrative costs. There is no evidence, either, that charging improves the quality or expansion of services; it is merely a tool to restrict access to service provision.
Research has also shown that there is up to 40% wastage within local social care budgets, through bulk contracts, over bureaucratisation, over assessment and inappropriate residential care. This is real money: money presently inappropriately spent: money, available today, which could go towards offsetting charges.
But why is all this so important to Scotland plc? Not only is it ethically correct to empower disabled people (young or old) to manage their own affairs – including their own support systems – but there is a strong economic argument for developing a social support system, which treats and respects the recipient as a ‘citizen’ of society rather than a ‘commodity’ of care.
By the year 2020, the number of school leavers will only fill a quarter of the job vacancies in the labour market. There will be a drastic need to move people back into the labour market, not just to fill these vacancies, but to reduce the inevitable rise in poverty, including pensioner poverty, and to increase health and wellbeing.
And this does not just concern disabled people, but their family carers as well. There is a crisis in social care today. Public social care throughout Britain relies on 1 million unpaid family carers to support young and older disabled people in the community. The vast majority live in poverty and ill health – many are disabled themselves.
Across Britain, over 100,000 children under 16 years provide more than 50 hrs of care a week[2]. That’s greater than the Working Time Directive stipulates for a paid adult worker. Not only that, but 1,304 five to seven year olds provide 20 or more hours per week of care. That’s not just picking up a book for Granny, but real personal care activities, including help to the toilet.
Most family adult carers could be actively working in the labour market contributing to Britain plc in taxes, skills and talents, if those they cared for could be supported to lead a more independent lifestyle – including being employed themselves
Instead, these informal carers are propping up a mean and oppressive Dickensian social care system, dedicated to giving the least help to the most needy. In so doing, most are condemning themselves, and those they care for, to a life of poverty and confinement.
They may well be making such sacrifices out of love and the kindness of their hearts, or a sense of duty; but a large majority are also doing it out of fear of being saddled with even more bills from the local authority.
Many senior managers and politicians in local government give the plaintive counter argument, “But free care will mean putting up taxes; and people won’t like that!”
However, in a recent Ipsos-MORI poll of the general public for the Disability Rights Commission, the Equal Opportunities Commission and Carers UK:
n 90% wanted support to enable people to stay at home
n 83% wanted support to enable people to visit friends and socialise
n 78% wanted services to enable participation in the community; and
n 66% would be prepared to pay for such services – through taxation; so long as that taxation was ‘hypothecated’ (ring-fenced)
All of this … empowering disabled people to make choices and take control of their own lives; living where they want, with whom they want; and having the support, free at the point of delivery, to participate in the economic and cultural life of the community. All of this is all part of what disabled people have been shouting for, for the past 50 years.
They call it – INDEPENDENT LIVING
When disabled people, old and young, have the right to services, free at the point of delivery, which promote and sustain independent living; when that day comes, let us all hope future generations will not only commemorate the abolition of the trafficking within the social care trade, but celebrate the fact that society finally accepts the responsibility for the full costs of supporting the full needs of all, including those, young or old, who are disabled, because it respects and values the contribution they make as equal citizens to its life.
2,383 words (incl. inserts)
Possible inserts
Community care charging guidance (for non-residential services) is most confusing, sometimes requiring a lawyer to interpret it. Put simply, it says: local authority charges should not reduce a person’s income below the minimum levels of Income Support or Pension Credit, plus a buffer of no less than 16.5% in Scotland, or 25% in England. In England, earned income is also disregarded when calculating charges, but not income from an earned pension. But in Scotland, both earned and pension income is taken into consideration.
There is also a devastating affect on people’s motivation to save. All the different and confusing policies on savings conflict with other Government statements encouraging ‘saving for a rainy day’ and even prevent disabled people saving sufficient sums to meet disability-related expenditure.
But the charging for community care services does not just relate to home care. Means testing means many disabled people have to pay for technical equipment and adaptations within their homes, as well as the maintenance for such equipment and adaptations. It is only those on the very meanest of incomes, who go without any charges at all.
In 2006, Dr Laurence Clark wrote a comparative study between Scotland and England of disabled people’s views on charging. Here are just three of them
“… when people hear about charging, they genuinely think ‘that’s ridiculous’. Even social workers have responded in disbelief when I’ve told them that, out of my wages, I pay more in charges than I get to keep.” (Zoe)“I have no choice but to pay charges. I can’t go without my care package as I don’t have a living relative who could provide support.” (Barbara)
“I think that to pay to have to get out of bed in the morning is iniquitous in this day and age. I think that to be enabled to do the basic things that everyone else can do should be a human right.” (Zoe)
“What you’re buying with your charge is a human right, and I don’t believe that anyone in their society should have to pay for a human right. No-one else pays to go to the toilet or to get out of bed in the morning.” (Sarah-Jane)
The disabled activist Philip Mason has written: