A report about the key concepts about care underpinning the policy proposals presented in the Coalition Government’s Department of Health Consultation Document A Vision for Adult Social Care: Capable Communities and Active Citizens, (2010) Department of Health website, http://dh.gov.uk/publications

Dawn E. Paton

Table of Contents Page

1 Introduction 3

1.1 Aims and objectives 3

1.2 Report structure 3

2 Dept of Health paper: A Vision for Adult Social Care 3

2.1 Background 3

3 Consultation document proposals 3

3.1 Table of proposals 4

3.2 Evidence to support the proposals 5

4 Constructions and locations of care 6

4.1 Table of the constitution and the concepts of care 6

4.2 Some key concepts to illustrate the mutual constitution of personal lives and 7 social policy

5 Theoretical perspectives and normative assumptions, and the Beveridge Report 8

6 Conclusion 9

7 References 10

1. Introduction

This report has been written to inform an independent policy organization - a think tank - of the main concepts about personal lives and adult social care, which are found in the present Coalition Government’s consultation document.

1.1 Aims and objectives The aims and objectives are to: * To demonstrate the main ideas, arguments, concepts and theoretical perspectives regarding the way the personal, the care system and social policy are constituted in and underpinning the consultation document extract proposals. * Explore the implications of the proposals in the consultation document as an illustration of the mutual constitution of personal lives and social policy, and theoretical perspectives.

1.2 The report structure
Initially the background to the consultation document will be considered. The proposals and evidence will be identified and analyzed, followed by the constructions and locations of care at personal, individual, local, national and societal levels, key concepts, and the mutual constitution of personal lives and social policy. Furthermore normative assumptions and theoretical perspectives will be considered, followed by a final conclusion.

2. Department of Health Paper

2.1 Background

The Coalition Government wants to devolve power to individuals giving and receiving adult social care, breaking down divisions between health and social care, giving greater choice of services. The Government also believe service providers and users desires are changing, and do not want to trade independence for dependence, and so propose a ‘Big Society’ approach (DOH, 2010:para 3.3).

3. Consultation document proposals
The consultation document contains several major overarching proposals which are outlined in the table below, stating Government reasons, strengths and weaknesses.
3.1 Table of proposals
|Proposals |Reasons |Prospective Strengths |Prospective Weaknesses |
|Personalisation: | | | |
| | | | |
|The Government intend to devolve |To maintain dignity, freedom, and|The feminist notion of an ethic |There is a possibility that |
|power to individuals, giving them|quality of life. |of care (Williams cited in Fink |choice will bring an element of |
|choice and control regarding | |2004: p.37) promotes the view of |risk (Kestenbaum cited in Fink, |
|care. | |choice as a positive proposal. |2004: p.14). |
|(DOH 2010:para 1) | | | |
| | | | |
| | | |The Government is negating its |
| | | |duty of care to citizens (DOH |
| | | |2010:para 5.1), reducing welfare |
| | | |state provision, and replacing it|
| | | |with other normative structures, |
| | | |which may have a negative impact |
| | | |on care. |
| | | | |
|Personal budgets will be given to|They give people control of their|Greater choice of service |Personal budgets will not suit |
|individuals considered eligible. |care. |provision, which is not limited |everyone due to increased |
|(DOH 2010:para4.1). | |to the social care sector. |personal responsibility and |
| | | |therefore should not be a |
| | | |statutory requirement. |
| | | | |
| | | |Those considered undeserving may |
| | | |be unfairly excluded from social |
| | | |care without adequate statutory |
| | | |guidance and monitoring, as the |
| | | |moral boundary is subject to |
| | | |change (Fink, 2004, p.30). |

|Prevention requires: | | | |
| | | | |
|Communities to meet their own |To delay dependency, promote | |Not all individuals will want to |
|care needs. |independence, and make | |comply, and additionally |
|(DOH 2010:para3.5) |communities stronger. | |feminists believe this type of |
| | | |provision will fall on women |
| | | |(Fink, 2004: p.30) |
| | | | |
| | | | |
| | | | |
| |To restore independence through | |Expectations put on informal |
| |early community intervention. | |carers could lead to neglect. |
| | | |A lack of accountability |
|Not looking to the state for | | |(DOH 2010:foreward ). |
|answers. (DOH 2010:para 5.1) |“Prevention depends on promoting | | |
| |health and well being at a grass | |It will be a managerialist |
| |roots level”. (Fink, 2004: p.5) | |discourse, which raises questions|
| | |Local authorities will be more |of efficiency of service in |
|Local Authorities are to decide | |in touch with the community than|people’s homes (Clarke & |
|on the changes to be made in | |the Government. |Newman;Newman cited in Fink, |
|adult social care (DOH | | |2004: p.31). |
|2010:3.15). | | | |
| | | | |
| |To limit welfare service input. | |The focus on the carer in the |
| | | |consultation document could cause|
| | | |the cared for to become of less |
| | | |value (Harris, 2002, cited in |
| | |Unpaid work will be |Fink, 2004, p.13). |
|Personal support to be given to | |acknowledged, and services will | |
|carers (DOH 2010:para 3.10). | |be available to unpaid carers | |
| | |similarly to those mentioned by | |
| | |Barnes (cited in Fink, 2004: pp.| |
| | |12,13). | |

|Plurality and partnership, which | | | |
|involves: | | | |
| | | | |
|Embracing different services from| | | |
|a variety of sectors who will |A wider choice of services. |It will create greater personal |Varied markets include voluntary |
|work together (DOH 2010:para | |choice of care provision from the|organizations (DOH 2010:para |
|5.1). |Better provision. |proposed varied markets. |5.1), which rely on Government |
| | | |funding as they are not usually |
| |It supports the vision of a ‘Big | |free (Fink, 2004:p.33), and which|
| |Society’. | |may take funding needed for |
| | | |service users. |
| | | | |
| | | | |

3.2 Evidence to support the proposals:

• The office of fair trading is said to have found people prefer to purchase services with a personal budget, but it is not clear what these services are, and therefore it is unreliable evidence. • Seebohm 1968 (cited in DOH 2010: foreward) suggests social care needs to motivate people to care for each other, but without supporting evidence. Furthermore Seebohm only addresses reciprocal care, similarly to the examples given of successful care schemes. This is a weak foundation to base the adult social care proposals on, apparently ignoring the complexity the issues surrounding care (Fink, 2004, p.15).

To give an overview of the proposals, the table below (4.1), shows how care is constituted, the concepts of care, and the mutual constitution of personal lives and social policy.

4. Constructions and locations of care

4.1 Table

Levels: Personal (P), Individual (I), Local (L), National (N), and Societal (S)
|How care is constituted in the DOH 2010 |P |I |L |N |S |Concepts |
|document. | | | | | |of care (Fink, 2004). |
| | | | | | | |
|A choice (4.1) |x |x | | | |Choice and risk (p.15) |
| | | | | | | |
|Earned if eligible (4) |x | | | | |Deserving/ |
| | | | | | |Undeserving (p.30) |
| | | | | | | |
|Mutual and reciprocal (3.3) |x |x |x | | |Cared for/carer (p.28) |
| | | | | | | |
| | | | | | |Work/home (p.36) |
| | | | | | | |
|Giving independence/preventing dependence, | | | | | | |
|so people can live in their own homes (3.5)|x | |x | | |Care and control (p.85) |
| | | | | | | |
| | | | | | | |
| | | | | | | |
|A devolved power given to carers (1.2 ) | | | | | | |
| | | | | | | |
|A shared responsibility with the state (3) | | | | | | |
| | |x | | | |Power (36) |
| | | | | | |Identity (p.32) |
|Voluntary ( 3.3) | | | | | | |
| | | | |x | |Formal/informal (p.34) |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | |x | | | |Paid/unpaid (p.33) |
| | | | | | |Natural/normal (p.34) |
| | | | | | |Being caring/doing caring (p.31) |
|Communities’ and societal responsibility | | | | | |Formal/informal (p.34) |
|(Active citizens)( 3.5) | | | | | | |
| | | | | | | |
| | | | | | | |
|A community and statutory service | | | | | | |
|partnership ( 3.3) | | |x |x |x |Adult worker model (p.24) |
| | | | | | |Identity |
| | | | | | | |
|An individual responsibility | | | | | | |
|(4) | | | | | | |
| | | |x | | |Adult worker model (p.24) |
|A product of local support networks | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | |x | |Identity(p.32) |
| | | | | | | |
| | | | | | | |
| | | | |x |x |Adult worker model (p.24) |
| | | | | | | |
| | | | | | | |

4.2 Some key concepts illustrating the mutual constitution of personal lives and social policy * Choice was introduced with the 1990 Community Care Act, (Open University, 2009, Community Care), which is now being extended. Jane Campbell suggests choice gives greater autonomy (Jane Campbell., in Open University, 2009), positively influencing the ‘personal’, demonstrating mutual constitution of the ‘personal’ and social policy at both state, and service provider level. Kestenbaum (cited in Fink, 2004: p.14) suggests that choice may present risk.

* The concept of unpaid, informal care is being shifted by the Government to a duty for active citizens (Harris; Lewis; cited in Fink, 2004, p.3), and is moving away from the discourse of the expectation of women as carers (Fink, 2004, p.35). However, the subject position of active citizen may be rejected, demonstrating excess (Lewis & Fink, 2009: pp. 22-23), and also demonstrating the mutual constitution between the ‘personal’ and social policy at state level (Lewis & Fink, 2009, p.7).

* There is a failure to address the complex nature of care and the different boundaries, when relating to cared for /carer (Fink, 2004, p.15), with each shaped by the other, and informed regarding their sense of self, and identity as carer and cared for (Fink, 2004, p. 150). This is at a service/user level, with the potential of having to negotiate diversity. Choice of carer could minimize the diversity, as in the case of Campbell (Jane Campbell., in Open University, 2009).

* Considering the concept of work and home, boundaries can be unclear and could unsettle an individuals ‘personal’, because of the uncertainty of where the boundaries lie, and therefore will require much consideration regarding the dignity and autonomy of the one being cared for in their own home according to Fink ( 2004, p.32). Here you can see how social policy affects individuals at a service provider level, being life changing.

5 Theoretical perspectives and normative assumptions and the Beveridge Report, 1942

* Feminists would argue that as the UK is moving towards the ‘adult-worker model’, with the Government devolving power to individuals and communities, it is not accounting for the expectation that women will still be identified as carers (Lewis cited in Fink, 2004, p.24), as this is the normative assumption with women stereotyped as ‘natural’ carers (Carabine cited in Fink, 2004: p.11), and which could essentially undermine the Government reform.

* Post structuralism concerning the adult worker model, would look at the way women are not specifically mentioned, with this absence intimating them to be active citizens, a current discourse presented as a ’truth’ regarding building stronger communities (DOH 2010:para 3.5), and with the normative assumption becoming that it is a citizenship obligation (Harris; Lewis; cited in Fink, 2004, p.3), and with the normative assumptions predominantly drawn from the Beveridge Report 1942 (Fink, 2004:p.30).

* The concept of cared for/ carer through the eyes of the feminist notion of an ‘ethic of care’, no longer sees care as an issue that remains in families, but that it should bring people together in communities and in society, recognizing reciprocal care, although the concern would be that it wouldn’t happen (Fink, 2004, p.27) . This influence can be seen in the consultation document, and with it will bring the same concern.

* Post structuralism would consider the concept of deserving/undeserving, although considered some what ambiguous when related to the Beveridge report, 1942 (Fink, 2004, p.30), to exist because of hierarchical oppositions, becoming strong societal discourses. In the consultation document the criteria will be based on need, and perhaps financial status. Even though there is no stability in these oppositions (Lewis et al, 2009, p.67), they are used as measures, as they have self perpetuated and become embedded in society. Ultimateley, ‘Welfare subjects negotiate and resist such discourses and become active agents in the constitution of their own discourses’, according to Lewis et al., (2009.p.68).

Conclusion
Choice can both be beneficial and present risks, with the risk of returning to a pre welfare state possibly outweighing the luxury of excessive choice. There are also no strong assurances of success with such a high dependency on the voluntary sector, unpaid and informal carers, who may not be able to meet the expectations placed on them. This failure could result in a deficient quality of care, negatively impacting the personal of all of those being cared for, regardless of personal budgets. This is exacerbated by the fact that the Government is negating its duty of care, taking away any accountability.
It also should not be assumed that communities want to be active citizens in terms of care, as they may not, but may do so reluctantly under pressure, and therefore potentially putting people at risk due to their lack of commitment.
Personal budgets have the potential to put people under pressure, and should therefore be a choice and not an obligation, and it should be everyone’s right to choose.
There also needs to be consistency in criteria in different councils, particularly regarding the criteria for eligibility, making it a fair system, with the addition of the promotion of the equal value of both the carer and the cared for.
Word count 1928

Reference List

Department of Health (2010) A Vision for Adult Social Care: Capable Communities and Active Citizens, Department of Health website, http://dh.gov.uk/publications

Fink, J., (2004) Questions of Care, in J. Fink, Care: Personal lives and social policy, Milton Keynes: The Open University

Fink, J., (2004) Care: Meanings, Identities and Morality, in J. Fink, Care: Personal lives and social policy, Milton Keynes: The Open University

Fink, J., Lewis, G. (2009) Themes, Terms and Concepts, in J. Fink, G. Lewis, J. Carabine, J. Newman and B. Korner (2nd Ed) Course Companion: Personal Lives and social policy, Milton Keynes: The Open University

Goldson, B., (2004) Victims or Threats:children, Care and control, in J. Fink, Care: Personal lives and social policy, Milton Keynes: The Open University

Lewis, G., Newman. J., Carabine. J., Fink. J., Korner., B. (2009) Theoretical Perspectives, in J. Fink, G. Lewis, J. Carabine, J. Newman and B. Korner (2nd Ed) Course Companion: Personal Lives and social policy, Milton Keynes: The Open University

The Open University (2009) Personal Narratives and Resources [CD-ROM], Milton Keynes, The Open University.