We must restore dignity in social care
LIKE local authorities throughout Scotland, the City of Glasgow faces an intractable dilemma of meeting increasing demand with decreasing funding. But there are some ethical and legal considerations surrounding its recent decision to “modernise” its social care support. It wishes to withdraw “sleepover” support to 1,038 vulnerable people, many of whom have both mental and physical impairments, and some who may even be at risk of harm. Instead, they will supply on-call support (or telecare) from “hubs” in the community; hubs which could be several miles from the person’s house.
At the Scottish Parliament Public Audit and Post-legislative Scrutiny Committee meeting last November, David Williams (Chief Officer, Glasgow Health and Social Care Partnership) said that any changes would be done in a co-produced manner, “rather than just putting it in place”. This adds to the injustice of this sudden announcement.
A blanket replacement of all sleepovers with telecare is not necessarily a modernisation of care sector, but a denial of choice. And choice, along with control, constitutes the kernel of the Scottish Government’s policy of self-directed care. Despite assessing each person’s personal response plan, which is proposed, the fact that only one option of support is available to meet such plans take away both choice and control from the service recipient.
It could also be considered a fettering of a local authority’s discretion, which has been proved to be illegal in the courts before now. Yes, telecare might be sufficient for some, but not all, and definitely not the most vulnerable. Yet, for them, there will be no other provision on offer, no matter how valid and essential that might be to the individual.
Even if you are happy with telecare, the logistics of such a depersonalised project makes it impossible to answer calls immediately; to provide people
Telecare might be sufficient for some, but definitely not for the most vulnerable
who are suitable to meet the unique needs of every individual; and for each individual to be comfortable with the help provided.
Dignity and privacy are two of the basic ethical values of social care. They are also rights embedded within the European Human Rights Convention.
The Scottish former ballerina, Elaine Mcdonald, took Kensington and Chelsea to the European Court of Human Rights, because they withdrew her night care, and replaced it with nappies, despite the fact she was not incontinent. She accused them of violating her private life under Article 8 of the European Human Rights Convention. After seven years of legal debate, in 2014 the court finally ruled that, without considering the person’s privacy and dignity, withdrawing care can be seen as a breach of human rights. Nevertheless, the court found in favour of the local authority, because, in a democratic society, its right to pursue the “economic wellbeing of the state” at a time of austerity outweighed the rights of Ms Mcdonald. In practice what this means is that if a local authority is considering cutting social care services it will have to take into account the impact it will have on the dignity and privacy of the individuals who will be affected. One wonders if a personal support plan for a single response, as outlined, would meet the same balance of criteria as that laid down by the European Courts.
The solution to all of this must be to increase social care budgets. But to do that there will probably need to be an increase in taxation, which politicians seem to shy clear of in these times of selfish popular politics; times in which minority interests are often overlooked.
In an epoch of austerity economics, we must now decide where to draw the line below which support arrangements are undignified, to the extent that they are not acceptable in a civilised society.
Agenda is a column for outside contributors.
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