Do we have a responsibility for using public services we are entitled to?
I was prompted to ask this question after hearing countless of stories of families caring for their loved ones around the clock, 24 hours a day, 7 days per week, 52 weeks per year. Too often family including several generations of relatives juggling full-time jobs and child care responsibilities whilst providing personal assistance with daily living activities to a elderly relative with both physical and mental health needs are becoming the norm.
The level of care is not simply checking loved ones are okay within their own homes. Care can often be of an extended nature covering substantial personal tasks such as hoisting and moving the disabled person safety from bedroom to bathroom, dressing whilst maintaining the person’s wellbeing. It’s clear from the outset there is a lot of pride with not simply ensuring the relative is up and dressed and fed, but their environment is well maintained and attention to detail is a must that includes maintaining upkeep of the garden and alike.
Why aren’t families (as its usually them) are not asking for any assistance from either the local authority or NHS despite the heavy caring responsibilities for their loved ones. The latter if the loved one meets the assessed criteria for NHS continuing care then they would receive care free at the point of need, no financial assessment is needed.
If as a nation fewer and fewer people engage in the system, then is there a danger of the services becoming more marginalised and stigmatised, only used by those unable to cope or unable to source and fund their own care. Research has shown that universal services that have a general buy-in from the population are services that are more likely to be well-maintained, resourced and highly regarded.The NHS is a good example, the resourcing and continuation of the services (whilst far from perfect) is because people from different social classes and backgrounds are being treated and care for. However, when the welfare system only provides financial-means tested services, then by nature the services are only being made available for the poor, who are generally experiencing social disadvantage.Increasingly, social care services are being expected to do more and more for less and less funding, resulting in downward pressure on quality and price. This in turn makes requesting for social care services more unlikely, especially if the care provided is likely to be of a poor quality or are failed to be provided in a consistent manner by reliable and known care workers. It therefore becomes a vicious circle, where less investment is made in social care services as a result of fewer family members wanting to use the services – to the point where one day, they may be gone for ever.
But there is one way of getting around the issue of poor quality care that is to request a direct payment which can be used to employ social care workers of one’s choosing. However, direct payments regulations are based on public policy, where there’s no need to pay relatives for that which they would willingly do for free, out of ordinary love and affection. Hence, social care provision is based on the assumption that family providing care is really expected to get on with it, with little interference from the state. And families should only look to the state if they are desperate and unable to provide the care for their loved ones.
If the market cannot provide community care services that accommodate families requirements then surely it becomes a market failure. In such failings is it our duty as citizens to engage in services to stimulate and create a market that will deliver what families require to provide familiar and on-going support for their loved ones. On one hand, it could be argued that there is no duty for any of us to engage in any public services. However, through none or disengagement in public services, is there a risk of fellow citizens with fewer resources than ourselves losing out of receiving social care support because they will no longer be there.
If we do not use the services, we are in danger of not only losing them for ourselves but for future generations who may not be able to provide the level and quality of care for our loved ones. And therefore the question is, do we owe a responsibility for using social care services in the interests of others who may need to rely upon the more than we do.
Secondary, our lack of responsibility for using and shaping the social care provision is what is causing the quality of provision?