Saturday, 30 January 2010


We all love the NHS. So much so that when it was slurred in the context of an American political debate thousands of people inventively hollered their support from cyberspaces newest technological rooftop.

We love the NHS for one simple reason. It is universal - Simply put it means the same to all of us; healthcare when we need it without regard to our material or social position. The NHS is the most true monument to the thinking which underpinned the development of the welfare state; All citizens, not just those who succeed via the free market, possessing rights; rights to education, rights to health, rights to live a fulfilled life.

Well, there are two reasons we love the NHS. The second is that despite Thatchers attempts at destabilisation in the late 1980s it delivers a high standard of care. Though to be fair to myself this is linked much more closely with universalism than is first thought. Universal services tend to be of higher quality and like the NHS are far more resilient to Politicians cutting funding. Cut Jobseekers allowance - the unemployed suffer. Cut a local hospitals budget we all suffer.

So what are we to make of the Government's suggestion for a "National Care Service". The name choice seems like a supermarket own-brand cola brands attempt at aping coca-colas distinctive packaging - in effect branding piggybacking; in this case suggestive of the national standard and universal entitlements of our beloved NHS. But will we be getting the real thing or a cup of water with a spoonful of sugar and a drop of food dye?

Social Care on the other hand combines universalism with it's opposite number selectivism. We are all entitled to an assessment and to services but when it comes to funding services this is by way of means-testing which varies across local authorities and can be in some cases quite punitive, by the Government's own admission penalising those on middle-incomes or with savings. The Government's plans keep this structure in place for the vast majority of service users but add an outhouse of universalism for the much lower number of people with the highest level of need. Local authorities will also still be in charge of delivering services which will mean that National standards will be logistically hard to implement and postcode lottery most likely to be the result.

As this article points out the National Care Service idea seems to have materialised from nowhere. There was certainly no talk of it when I was still in an authourity at the tail end of last year. Which all begs the question... just what is going on?

I beleive there is a divorce taking place between care management and social work. If the kind of initiatives I have seen piloted in the last couple of years such as individual budgets, self-assessment and care management being carried out by voluntary sector 'Brokers' works out as planned then Government can scale back their involvement in this area, concentrating instead on service users with high-level and complex cases which are primarily the realm of qualified social workers. A National Care Service encompasing only this latter area and which overlaps with the NHS and its universal ethos would certainly be a way of creating a framework in which this could be achieved.

This would be entirely consistent with what has been happening at a local level. Since the 1980s local authourities have increasingly outsourced. Beginning with workers in peripheral activities and/or at the bottom of local government pay scales, cleaners, cooks, carers, the tide has been rising higher up the pay grades, council tax officers, finance officers, IT technicians, HR, payroll are now likely to be found with ID badges bearing the tell-tell words of privitisation: 'working with.' The future is I beleive one where authourities will consist of a rump of qualified professionals involved in complex cases or enforcement functions; town planners, highway engineers, and social workers who will direct and supervise work carried out by outsourced non-qualified staff.

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