Age UK Bristol/Brunel Care Research Forum The Ethics of Social Care and the Personalisation Agenda Liz Lloyd School for Policy Studies

Political visions ‘The overall vision is that the state should empower citizens to shape their own lives and the services they receive’ Dept of Health Green Paper on Social Care: ‘Shaping the Future of Care Together’

Vision for Social Care: Capable communities and active citizens ‘Individuals not institutions take control of their care. Personal budgets, preferably as direct payments, are provided to all eligible people. Information about care and support is available for all local people, regardless of whether or not they fund their own care’. DH November 2010

Personalisation could mean ‘co- production’ More customer-friendly services Giving service users more say in navigating services Giving service users more say over how money is spent Service users not just consumers but co- designers and co-producers of services Self-organisation. People designing own solutions. (Leadbetter 2004)

What is driving the personalisation agenda? Demographic trends: Projected increases in demand for health and social care Political aim to further reduce state involvement in care provision and promote the market Political aim to discourage welfare dependency Continued demands of service user groups for less standardised forms of care Dissatisfaction with current system. Postcode lotteries, unfairness in funding (Dilnot Report 2011)

Ethics: moral values in practice. Principles of organising human activities. Might be codified (professional codes of conduct) Inseparable from questions of rights and justice

Ethic of care: key principles 1.It is our relationships with others that makes us what we are as individuals 2.Our dependency on others is life-long, with varying degrees of dependency at different times (eg infancy, end of life) 3.Our dependency on others runs counter to cultural ideals of independence. Care has been kept out of the public eye 4.An ethic of care necessitates attention to the needs of care providers and receivers

An ethic of care model Attentiveness - caring about identified need Responsibility -ensuring need is taken care of Competence - being able to give care Responsiveness - being able to receive care All these elements need to be integrated

Ageing and the need for care Help is often sought at a time of crisis, when rational plans and decisions are hard to make The changing nature of older people’s health and wellbeing is not adequately recognised Older people are already disadvantaged in the care system with lower per capita spending than other groups What is the impact of public concerns about the cost of an ageing population on older people?

Audit Commission (2010) Under Pressure: tackling the financial challenges for councils of an ageing population. 10

Personalisation as a strategy to reduce the cost of welfare is unacceptable Complex and changing needs necessitate expertise and competence in helpers. Poorly funded personalisation means worse terms and conditions for care workers – increased mechanisation of work Potential for exacerbating loneliness and isolation (eg closure of day centres/reduced range of activities. Restriction of choice follows inadequate funding

Does personalisation meet the ethic of care test ? Personalisation as an orientation towards understanding individuals’ specific circumstances is a good aim Personalisation as giving people the money to organise their own care might be conducive to an ethic of care in the right circumstances

Final thoughts…. Our connections to others and our dependency on others are highly visible at the end of life. Our declining health and increasing frailty as we age highlight our need to be cared about and cared for An ethic of care should underpin all policy developments in social care for older people, including personalisation.