Disappointing vision of social care in government’s midterm review

The coalition’s review lacks information on social care funding and ministers fail to grasp the important role of communities

A plan to cap individual liability for social care costs was widely trailed as a central theme of the coalition’s midterm policy review and care minister Norman Lamb indicated last week that a government decision was imminent.

But in reality the review has been disappointing and does little more than indicate that further announcements on funding long-term care will be made “in due course”.

The ending of the protracted delay in responding to the Dilnot Commission would be welcome, but Lamb also used negative, and potentially divisive, language when he said that everyone has a part to play in supporting an ageing population to “reduce the burden on the state”.

Lamb suggested that we expect the state to do everything, and we must all do more to support older people to live independently. Such generalisations appear both ill-informed and naive.

The minister also claimed that Britain has become a “neglectful society” where elderly people are driven into residential care because they lack the support of their families and communities. This is over-simplistic and will not be recognised by the millions of people who support friends and relatives every day.

It is dangerous to slip into easy nostalgia for a past golden age when everyone cared for each other and neighbours looked out for one another. The truth is rather different.

Never before have there been so many people potentially needing care and support, and families are providing more care than ever. The 2011 census revealed an increase over the last decade in the number of carers in England and Wales from 5.2 to 5.8 million, with 2.1 million providing more than 20 hours care a week.

The idea that “we have lost the extended family” does not fit with the facts. Certainly, families may not always live around the corner from each other, but people still manage to support each other, even at a distance.

It is probably also a mistake to assume – as Lamb appears to – that neighbourliness can simply substitute for formal care, and that rebuilding “neighbourly resilience” will stop people going into care unnecessarily.

The difference between coping at home and needing permanent residential care is unlikely to be the presence of a neighbour popping in and providing a bit of companionship.

The issue is much more about managing personal care – the day-to-day reality of being able to use the toilet and shower, to dress and handle laundry, and to organise shopping, cooking, and cleaning.

Furthermore, it is not clear what the role of central or local government should be in this territory.

The fate of David Cameron’s “big society” should give pause for thought; the idea failed to ignite largely because its architects appeared not to understand the motivations of people getting involved in their community, or the fact that such networks develop organically.

There is a wealth of social capital in communities, and much of it is small scale and unrecognised.

The richness of local community development and social capital creation could be jeopardised by crude attempts to formalise or direct it.

The government’s vision for care and support was set out in a white paper last summer, and sees as integral “the development of initiatives that help people share their time, talents and skills with others in the community”.

Supporting the development of reciprocal networks and helping “build relations and connections between people in local communities” feels very different as an approach from one that starts from the premise that people are passive, expect the state to do it all, and ignore the needs of their families and wider communities.