The inequity of social care

I’ve spent a lot of my professional life working in areas to challenge and address inequity and inequality. Indeed since I took over the role of CEO of Scottish Care a great deal of my focus has been on highlighting the challenges of unequal treatment in older people’s care and support. That has included the very real funding imbalance which has over time seen less and less proportionately allocated to resource older people care whether in the community or in care homes.

But increasingly I believe that there is an overarching inequity at the heart of our health and social care policy and practice. At its centre is a critical question.

Put simply what defines a support or service as social care and therefore currently chargeable and what defines a condition or illness as a health condition whose treatment and support is free at the point of delivery?

I was reminded of this when I listened this week to a presentation from Alzheimer Scotland on their Fair Dementia Care campaign

Alzheimer Scotland has recently published a report from the Fair Dementia Care Commission chaired by former First Minister Henry McLeish.

At the heart of the report is a description of the life experience of thousands of our fellow Scots who live with or support someone living with advanced dementia. A number which is due to grow significantly in the coming years.

As well as offering a definition of what is meant by advanced dementia the report highlights the confusing and complex maze of charging policies for social care services across Scotland’s local authorities which end up meaning that people with advanced dementia pay a staggering £50.9 million in care costs every year.

The report does not call for the end of charging per se but for greater transparency, consistency and understanding. But I think one of its greatest services has been to shine a light on the inequity of social care and health in Scotland today.

In the dictionary inequity is defined as ‘a lack of fairness or justice.’

Whilst the report from Alzheimer Scotland rightly highlights the inequity faced by people living with dementia I believe the inequity or lack of fairness goes even further.

At root is it fair that if in life you are struck down with a life limiting cancer that you will receive your care and support free of charge but if you are someone living with dementia you will face charges for social care which might include disposing of your home and assets in order to pay for care home fees?

Is it fair and right that many people living with neurological conditions are treated as having social care needs and not primarily health and clinical needs? I think not. We have too many individuals living with conditions such as Parkinson’s, Huntington’s, Multiple Sclerosis and so on who are paying for the essential support that enables them to continue to live and contribute as citizens in our communities.

Is it fair that a person who suffers the ill health that arises from frailty and age and requires appropriate support for that should have to pay over and above their lifetime contributions to taxation for that care including nursing care?

Just as Scotland is seeking to create a rights-based social security system I am convinced that we need to seriously start a debate about the inequity, the lack of fairness and justice that lies at the heart of social care charging for specific conditions such as advanced dementia.

But I am equally convinced that we need to go much further and start the conversation to move us to enshrining the human right to social care, to have your care and support provided equitably regardless of the condition or illness or disease, regardless of the realities of age or decline, that life deals you.

In the words of Bill Gates:

“Humanity’s greatest advances are not in its discoveries but in how those discoveries are applied to reduce inequity.”

Dr Donald Macaskill
@DrDMacaskill