There’s been a lot of welcome publicity
these last few days about the increasing use of zero hour contracts for homecare workers,
and of rushed 15 minute visits for people who need intimate personal care.
Last night on Channel 4 News Rochelle
Monte, a homecare worker, talked of the huge turnover of staff caused by poor
wages and conditions of employment.
This reminded me of a question which the
philosopher, Michael Sandel asked at a Labour Party fringe meeting last year: “Are
there certain moral and civic goods that markets do not honour and money cannot
buy?”
This is a fundamental challenge to many
areas of social and economic policy, such as the re-organisation of the NHS,
but it is particularly a challenge to social care policy.
The nature of our society is increasingly
determined by policies based on the assumption that good choices are made and
good services delivered through self-interest and financial incentives. The 1990 NHS and Community Care Act ushered
in the ‘purchaser/provider split’ in social care services and after more than
20 years of privatisation, it is the market which determines the nature and
quality of care services, rather than moral or political decisions about what
kind of lives we want for ourselves and our communities.
But are there certain things that we value which cannot be delivered by market forces?
Can people who need help to go about their
daily lives - help which involves intimate care, that enables someone to access
the most basic human rights like privacy and communication - rely on the profit
motive to deliver this assistance in a way which protects and promotes their
human rights? Giving and receiving
intimate care is not the same as having your car serviced. To rely on another person in such a way is
inevitably associated with a vulnerability to abuse, unless the person
providing the care holds and promotes values which in many instances are
incompatible with the profit motive.
Maximising profit requires holding down wages, increasing productivity
by reducing the amount of time spent on each task to a minimum, only investing
in training to provide basic competence, and minimising regulation.
This is not to say that services run by
public authorities are necessarily any better at delivering our human rights. The devaluing of the lives of disabled and older people
was manifest in the abuse and poor care standards of the old asylums and
institutions. The mistake was to replace
them with organisations motivated by profit and answerable to their
shareholders. The desire to drive down
costs leaves little room for the development and delivery of services which are
motivated by values relating to the public good and answerable to their users.
The early campaign by disabled people for
direct payments was always clear that giving individuals purchasing power was
only a means to an end, not the end in itself.
Disabled people’s local organisations (Centres for Independent Living) promoted
a value system which would challenge vulnerability to dependency and abuse, and
instead develop empowering ways of delivering assistance. But much of this was lost as organisations
struggled to survive and the more traditional charities and private sector organisations
competed for contracts in a commissioning process which values cost
(‘efficiency’) more than quality.
As Michael Sandel said: “If market
practices sometimes crowd out non-market norms and attitudes worth caring
about, then, in order to decide where markets serve the public good and where
they don't belong, it is not enough to consider standard economic efficiency
considerations alone. It is also necessary to anticipate when values and
attitudes worth caring about may be crowded out by market considerations, and
then to ask how important are those values and attitudes to our society.”
When disabled people campaigned for
independent living in the 1980s and 1990s, we were campaigning for a different
value system to that which had dominated both statutory and charitable support
services. Our tragedy has been that the
progress we made on independent living coincided with the increasing
marketisation of public services. While
private sector organisations may often use the language of empowerment, the
bottom line is whether they can make a profit out of us.
Earlier this year, the Equality and Human Rights
Commission published Guidance on Human Rights for Commissioners of Home Care
These are the values which need to replace
the pursuit of profit and the driving down of wages and working
conditions.
