The following blog is based on a talk given on Monday 15th August at the inaugural meeting of the GCVS Health and Social Care Network. SeeNetworks – Glasgow Council for the Voluntary Sector (gcvs.org.uk)
I am absolutely delighted and honoured to have been asked to speak at this the launch and opening event of the Glasgow Voluntary Sector Health and Social Care Network. As has been advertised I want to speak about why I think social care is so fundamentally important to both individual citizenship and wider society in Scotland; how the essence of the Feeley Report needs to be upheld and implemented; how a human rights and inclusion perspective needs to be at the heart of social care delivery, and lastly why social care needs to be seen as distinctive from, different to but yet intrinsically complementary to a robust health and wellbeing system.
I suspect that there will be little I say today which will come as novel or new because GCVS and other civil rights infused disability organisations have been stating much the same, championing and campaigning for what I am talking about for decades and decades.
In starting our conversation where better to start than me explaining the title of this talk. ‘Always the Bridesmaid and never the bride.’. First of all, I have to thank Lynn Williams who used the remark in a conversation we were having about the way in which social care seemed to be being ignored and sidelined in so many of the meetings and discussions she and I sometimes share. It felt then and still do now that the title was apt – but then I explored where the phrase came from.
The phrase first originated in a music tune, but it came to huge prominence when the mouthwash brand Listerine in 1924 launched a series of advertisements with the slogan “Often a bridesmaid, never a bride”. These ads portrayed a forlorn woman by the name ‘Edna’ or ‘Eleanor,’ who was unlucky in love and for reasons unknown to herself and was never being able to find love and settle down. The manufacturers marketed the mouthwash by insinuating that everyone around her, even her friends knew the real reason for her lack of success- Halitosis (bad breath). But since it’s an embarrassing subject to bring up, they wouldn’t tell her. This line of advertising sold millions of bottles of mouthwash increasing the company’s sales from $100,000 in 1921 to over $4,000,000 in 1927.
It just goes to show how a phrase can have such a power to convey a message – and whilst the way we use it today is significantly divorced from taking fun out of someone – it has a sense of never being the centre, the focus, special and valued – always playing runner up or the forgotten one. Never getting the main focus and prize. So is that really the case for social care in Scotland in 2022 – you bet it is!
But what is it I am meaning when I talk about social care. After all definitions are important and I am so often in meetings and at events – not least with those who comment about the sector but do not work in it or use its services and support – when they think they know what they are talking about but evidentially it soon becomes clear they do not – and yes that especially includes our politicians and media.
The common misunderstanding is that social care is a series of services which are done to and for a person. It is the tasks and functions that help someone or support them. In fact, in a lot of the recent debate – not least on the National Care Service – the word social has dropped out completely – we are to have Care Boards – but I want to argue that care is not the same as social care and social care is more than simply care (especially if that care is narrowly understood and defined)
I am quite sure if we did a straw poll of what social care was for most of this audience it would not primarily be about services, and tasks and functions – but would be much broader.
For me social care is about connection and relationship, about belonging and being, independence and community. It is for me something which is profoundly about enabling people to be and become fully human to realise their potential and to flourish until the last gasps of living and loving.
There are loads of definitions of social care – the one I often use is this one – it has a forward dynamic – it is not about doing to or for – but enabling, empowering, – it is not about bringing order into the messiness of living but allowing that life to mess up the order and bring creativity, vibrancy, energy, and vitality to life.
‘The enabling of those who require support or care to achieve their full citizenship as independent and autonomous individuals. It involves the fostering of contribution, the achievement of potential, the nurturing of belonging to enable the individual person to flourish.’
That is why social care is so important – it is social – it is connectedness, citizenship, discovering abilities and celebrating diversity. We need to re-discover the social in social care – and tell policy makers and politicians to take their hands off something which will long outlive them and of which they know not.
Social care is therefore for me a human rights issue and a human right in itself.
More of that in a minute – but one of the problems in the ‘Always a bridesmaid’ scenario is that people – even those who should – simply do not recognise and value the massive role and contribution which social care is making every day to our society.
The work of many not least the SSSC has highlighted the economic benefit of social care to the Scottish economy – but that is often lost – even our latest national plan for economy and business Does NOT mention social care -a shocking dereliction of ability and priority and an even greater marginalising of the value of the sector.
Even just last year another report – this time commissioned by Enable showed that far from being a burden on public finances, the sector contributes more than £5.1 billion Gross Value Added (GVA) to the country’s economy and supports some 300,000 jobs.
That report demonstrated that social care’s direct economic impact is more than £3.3bn GVA and its indirect economic impact, through supply chains and supporting industries, contributes £800 million. The impact of the sector from employees spending their wages generates £1.1bn.
So, given all this – and the shocking failure of our economic leaders to recognise social care and its prospect as an economic driver and contributor – much more than many other valued sectors – what is going on here you might well ask? … you could ask a lot about why it is that social care is marginalised – always the bridesmaid and never the bride –
… but I hardly need to articulate the reasons to this audience – is it not the same reasons which in ancient times saw the ban on anything other than perfection in Greco-Roman sculpture and art? Is it not the same attitudes and reasons which saw throughout history the diminishing of those who were different because of disability, mental health challenges or health needs – a diminishment which still goes on to this very day? Is it not the age-old desire to have disability – out of sight and out of mind – shut off from the mainstream, prioritised as other? Is it not the same source of behaviour which has created a cult of youth and beauty and which even today dismisses older age as having had its day, finished its contribution, not worthy of voice or listening to? Is it not the same attitudes which have never treated dementia as a disease of equal health impact such as cancer or diabetes because primarily it impacts upon the lives of women and of those who are old.
The answer is of course discrimination and inequality, the othering of those who we can label, the dismissing of value and voice, of contribution and importance. It is as old as the heavens and as perverse as it has always been.
That is why we who use, access, work in and are involved in social care supports have to find a voice to challenge the status quo – to say enough is enough – we will not be marginalised or silenced – this is our lives and livelihoods – if we change and do things better, seek to be better, to reshape and reform then we can do so much better; we can then celebrate social care as an essential component to civic life and Scotland.
Now both those elements – a broad inclusive definition of social care and a sense that social care had the potential to be an economic driver and contributor to the whole economy can be found richly running through the Feeley Report
I have to confess to something of a Damascus Road conversion to the work of the IRASC – I was a cautious critic at the start because I thought that the task Derek and others were set was impossible to achieve within the time frame given and that they would not fully and properly engage and consult and involve in anything other than a tokenistic manner. It is to the immense credit of Derek Feeley and the whole tram that what resulted was such a dramatically positive and at times visionary report. It was a report set at a particular time, but which managed to capture the spirit of the hour, to offer pragmatic solution and to describe reality warts and all.
The problem is that today or at least for me the Feeley report feels like a dream slowly disappearing into the distance, having been touched by the cold abnorming of political reality and opportunistic pragmatism.
Feeley rightly emphasised the contributive economic and societal nature of a social care system which worked well and enabled the flourishing of all within community. He rightly addressed the implementation gap – or for me the chasm between aspiration and the legislative potential of things such as Self-directed Support which could and should and can still be transformative and revolutionary – he described in words of your making and shaping the practice reality for people who receive care support. Why is it that everything feels like a battle and grind to achieve what should be the right of those who are supported?
This is not the place to go into detail on the NCS – but oh I groan at the gap between vision and reality, between energy of Feeley and the lethargic texts and framing we are now presented with. There is such a slew of despond when by a thousand deaths of bureaucratic implementation, the whisper of originality and the spark of excitement is silenced and snuffed out.
There is still time to shape and influence to try to keep the jewel at the heart and not just create a mini-NHS with the failings its parents are unwilling or unable to recognize such is the adoration of the original.
But you see I am more and more convinced that social care is too important to be left to the politicians and professional policy makers. Indeed, social care is more than the National Care Service – it is more than a service or system, a model or framework – it is about lives and people, about dreams and relationships, about freeing the person to become and the community to flourish – the NCS may enable that, but social care is much much more …
Social care cannot be left to be the plaything of politician and commentator, the disinterested only thinking about a vote or a story, or a sale or a system- It is ours – those who use and have used, those who are family and informal carers, the frontline workforce in projects and care home, homecare and addiction services, mental health recovery and day services – and so many other places where the SOCIAL matters and takes place and shape.
It is not time to be silent during consultation; it is time to press upon our elected representatives that they cannot get away with half-baked, half costed and half resourced plans and ideas – this is our life, and it will shape our future community – we cannot get it wrong.
The title of this talk is ‘Always the bridesmaid never the bride’ – it is time for social care to take centerstage – not as the bridesmaid to the NHS bride, not as the handmaiden, the Cinderella, the forgotten one, the one who gets the crumbs from the NHS table. We must call out the lazy political speak and mantra which sees the world through NHS eyes, which perceives the need of social care by its impact on the NHS – such as classically the debate about delayed discharge. Such myopic obsession with the NHS is damaging, dangerous and obscenely short-sighted.
Living well in community, independent and with a life that is flourishing is just as important and worthy of resource, political attention, and popular valuing, as the emergency and acute and dramatic success of hospital, GP, nurse, and clinical professional. They are symbiotic partners of a whole fount of wellbeing.
It is the people on this call and beyond who have the power to advance, to rescue and to advocate for social care support. It is time to make the system human rather than transactional. We cannot continue to have a system which is built around the cult of maintenance – keep people as they are, where they are, who they are – that is the complete opposite of social care which is about enabling the person to change and grow, to flourish and renew, to adventure and discover. Independence is too important for it to become a matter of constitutional debate – independence is first and foremost, most, and best – the enabling of a person to be who they are and to grow to their full potential often in relationship to others.
For me we have a very real potential to rescue the human at the heart of social care – to nourish the social within services and to discover the breadth and depth of a mature modern social care world. That potential is rooted in recognising that social care is, as I stated above, a profound human rights issue.
I have written – at some length – about why I think we need to seize the opportunity of Scotland creating a Human Rights Act – and to become the first nation to explicitly describe what the rights are engaged when we seek to incorporate the International Covenant on Economic involved in the Economic, Social and Cultural Rights into Scottish law – now I know the right to health is critical within that. But I want us to go further and to make explicit – even with the likelihood of progressive realisation – the human right to palliative care, the human right to bereavement support and explicitly and most fundamentally the human right to social care.
The right to health has been interpreted more than just the right to physical and physiological health – in case law it has included emotional and psychological health, but I really hope we can go broader than a loose definition of wellbeing to say that social care – regardless of age – is distinctive, it enables the fulness of life and the achievement of other fundamental human rights and without it being protected as a distinct right then others are diminished. Social care is a human right – it is my right to flourish and thrive, to be independent, to have voice – this is not about attending to my health needs but meeting my social care needs. And in that sense social care can only be judged as a human right realised through the United Nations human right test principles of availability, accessibility, acceptability, quality, participation, and accountability
It is not enough to have a new National Social Care Service, or another set of legal obligations, you become the bride when you are treated as valued and wanted, centre-stage in economic and societal priority, considered as worthy of focus and attention, adequately resourced and prioritised, and for me social care to be human has to be seen as a human right with all the protection that affords, not just a bridesmaid to the NHS bride.
