Framed in the philosophy of independent living and human rights, this book provides a profound and timely critical analysis of adult social care in the UK, compellingly calling for its renewal. A paradigm shift is increasingly justified, given major demographic change exerting pressure on social care systems, and activism demanding rights-based social change and sustainability. ‘Times for public policy, including social care, are changing’ (p. 159), the authors argue; thus, politicians and policymakers need to catch up with these realities. Underlining the role of social care as a critically important policy for human beings, the book also highlights its untapped potential as an economic wealth generator, including job creation in care and support under a green economy strategy.
The authors draw on their extensive personal and professional involvement in the field, Peter Beresford as a service user, activist and educator and Colin Slasberg as a social worker in strategic planning, operational management and practitioner roles. Using examples from the UK, primarily England, the book exposes institutional, financial and operational inadequacies in social care, illustrating how the crisis-ridden system denies many older and disabled people their dignity, control and choice, and became ‘a death trap’ (p. 13) during the Covid-19 pandemic.
Twelve interwoven chapters in three parts present the dysfunctional UK care system, whilst envisioning a pathway forward. Part I ‘Social care in the UK: how it works and how it got here’ (Chapters 1–6) provides a historical account of the charity-based social care model prevailing over the past seven decades and successive strategies falling short at tackling its shortcomings. A key flawis traced to the onset of the Welfare State in 1948, when the National Health Service (NHS) was established as a universal system, with progressive principles grounded in rights, and needs prioritised over resources, whereas social care was conceived as a residual, non-universal and local policy, restricted to allocated resources.
Failing to develop a system on par with the NHS has maintained social care in the UK as a ‘Cinderella service in the shadow of health care’ (p. 22). In stark contrast with the vision of ‘social justice and citizenship’ proclaimed by Prime Minister Clement Attlee, under whose mandate welfare emerged, social care remains an ‘appallingly neglected and devalued sector’ (p. 102), where ‘fewer people needing support are actually able to access it’; ‘quality of support is worsening’ (p. 100); and there is ‘preoccupation with funding constraints over rights’, ‘marginalisation in its workforce’ (p. 22), and ‘deep dissatisfaction amongst all interests’ (p. 8).
Part II ‘An agenda for social care change’ (Chapters 7–10) proposes the adoption of a rights-based paradigm for social care, drawing from the widely ratified United Nations Convention on the Rights of Persons with Disabilities (CRPD). In particular, emphasis is given to the progressive realisation of its Article 19, related to equal rights of persons requiring care and support to have choice and access to a range of in-home, residential and other community services that enable independent living and inclusion in their communities. A key step in this direction would be fulfilling England’s 2014 Care Act’s original ambitions. These include a reform in need identification and resource allocation processes, integrating person-centred practice and abolishing standardised eligibility policies that restrict needs to fit available resources. This new paradigm would rely on more authentic partnerships, co-production, lived experiences and balanced power dynamics between service users and the political, judicial and professional systems operating social care.
Part III ‘A changing world driving change in social care’ (Chapters 11–12) examines the global issues likely to drive political impetus for a shift towards a rights-based approach in social care. The authors ultimately situate this shift as a political challenge, reflecting on the broader cultural and systemic context. Change will face tough resistance, given a persisting charity-welfare model under both left and right politics and neo-liberal governmentality resulting in an ‘exclusionary, prejudiced and unsupportive world’ (p. 97). Notwithstanding these challenges, the book argues that social care is expected to gain increasing appeal, as pressures accumulate from a growing population requiring assistance worldwide and strengthening its political force. Change could also be driven by intensifying activism demanding social justice, and the urgent need to transform economic systems threatening the planet.
As a person with disabilities who has worked on care policies internationally, I found this book thought-provoking, insightful and inspiring. It delivers a thorough analysis, gradually peeling through the complex layers of UK social care and powerfully raising awareness about its critical pitfalls and the related political economy. The commitment to elevating service users’ voices and giving visibility to their perspectives is commendable. The book is UK-based, but it has international resonance, given common challenges facing care systems worldwide. Lessons from the UK experience and the rights-based paradigm shift proposed offer a policy foundation for other contexts and enrich ongoing discussions about care systems reform globally.
Despite the book being an engaging read, there remain a few criticisms. The dialogue between feminist ethics of care and the disability movement’s philosophy of independent living could have been more cohesive throughout the book. The volume could have also benefited from exploring specific international examples of care policies developed from a rights perspective. Additionally, referring to older and disabled people as if it was a homogenous category of persons requiring care and support overlooks that fact that most people in old age and persons with disabilities do not depend on assistance for daily living. Lastly, although I understand that identity-first language (‘disabled people’) is favoured in the UK, I prefer person-first language (‘persons with disabilities’), in line with the UN Convention.
With non-technical language and available in open access, this book should reach a wide readership from academia, policy, advocacy, service users and their families. A word of caution to eager readers: Given its level of detail, the book is best enjoyed if digested in small portions, allowing for thoughtful reflection.
I highly recommend this book as essential reading for anyone interested in a meaningful, rights-based transformation of care systems, reaffirming care’s central role for sustaining life, humanity in all diversity, societies and economies worldwide.
