Does anyone care about fairness in adult social care?

Justin Keen
25th Sep 2008

How can we develop practical policies that ensure fair funding for adult social care?

This Viewpoint by Justin Keen, Professor of Health Politics at the Leeds Institute of Health Sciences, University of Leeds, analyses key adult social care proposals from the last ten years.

He argues that we can develop practical policies, informed by clearly stated equity principles, so that the most disadvantaged people are treated more fairly. He proposes:

  • we need a framework that will allow us to judge the merits of different proposals, and translate equity principles into policies that work on the ground;
  • we also need a framework for practical reasons: Funding is shared between the state and individuals, and individuals need to know what the state is willing to provide so that they can make their own financial plans;
  • consequences for key groups should be discussed in more detail: the lowest paid care staff, the poorest older people who need care, and the poorest carers.
Summary

Summary

This Viewpoint reviews some of the key proposals in adult social care of the last ten years from an equity perspective. It uses the analysis to argue that we can develop practical policies that are informed by clearly stated equity principles which serve to ensure that the most disadvantaged groups of people are treated more fairly.

Key points

  • All parties with a stake in adult social care, including the main political parties, say that they are in favour of fair funding arrangements. The problem is that everybody has been saying this for many years, and we are still stuck with a system that everyone agrees is unfair.
  • Looking forward, any new system will need to be equitable, and seen to be equitable.
  • The task of identifying the most equitable funding system is not straightforward. Equity can be defined in different ways, and there are genuine differences in beliefs about the fairness of any given reform proposal.
  • These difficulties cannot be used as an excuse for inaction. A difficult task is not an impossible one. We need a framework that will allow us to judge the merits of different proposals, and translate equity principles into policies that work on the ground.
  • We also need a framework for practical reasons. Funding is shared between the state and individuals, and individuals need to know what the state is willing to provide so that they can make their own financial plans. The state’s policies need to be seen to be equitable, otherwise they will not survive and we will quickly return to the current unacceptable situation.
  • More detailed discussions should take explicit account of the consequences for key groups of people, notably the lowest-paid care staff, the poorest older people who need care, and the poorest carers.
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