Duty and Obligation - the invisible glue in services and support

The Department of Health’s consultation paper, The case for change, has opened a debate on the long-term future of England’s care and support system. In this Viewpoint, Kalyani Gandhi and Helen Bowers argue that if social care services are to transform people’s lives, they must be based on a deeper understanding of human relationships and the nature of duty and obligation inherent within them

Key points

• Lessons from different generations and cultures about the importance of ‘duty and obligation’ can provide powerful levers for change and strengthen community and family relationships.
• Citizenship and inclusion are key messages in different government policies. We need to increase our understanding about barriers to citizenship and participation in the context of intergenerational and intercultural obligations, including:
  - discriminating attitudes and actions;
  - low levels of awareness and understanding;
  - accessibility issues;
  - poor health;
  - disability;
  - low income; and
  - current and changing expectations.
• We need a refreshed Transformation Agenda, which is global in reach but based on a detailed understanding of what global and specific trends tell us about the contribution of duty and obligation in public service design and delivery.
• Current debates about transforming social care will not generate sustainable solutions if limited to discussions about services and systems – typically adult social care – delivered by local authorities.
• A consideration of wider networks and dynamics involved in providing and receiving support through family, friends and community is needed.
• The Green Paper on the future of social care needs a stronger focus on philosophical underpinnings and a better understanding of ‘what works’ within and across different generations and cultures.
• The current dialogue about demographic change needs shifting from global forecasts about population ageing – and assumptions about what this brings – to a detailed exploration of the ways in which people age, in different circumstances and across the life course. It should include a range of responses to the societal and economic challenges we all face.