I have had the honour over a couple of days to be attending and speaking at the European Ageing Conference and during that time to further my own knowledge about and awareness of the delivery of care and support to older people right across Europe I have been talking to lots of practitioners from many countries.
Inevitably such conversations lead you to share and talk about what is happening in your own country. These reflections have also come about at a time when I have been considering what it is was or maybe should be distinctive about the way social care is delivered in Scotland, not least because a few have challenged me as to whether our claims to be ‘different’ in Scotland stand up to any serious scrutiny!
My starting contention is that both in policy articulation, legislative underpinning and in practical application that our approach in Scotland is distinctive, and not just within the United Kingdom but across Europe.
There are for me four main strands which come into play here, firstly policy grounded in a commitment to human rights, a legislative focus upon person-centred or person-led care and support, a particular emphasis upon the nature of community and what is meant by the ‘social’ in social care’, and lastly the belief that social care should be a fundamental right accessible to all who need it, what might be termed a universalist position. These are all somewhat interrelated.
It might be helpful to start with what I would suggest is the foundation of social care universalism.
At the heart of Scotland’s social care philosophy is the principle of ‘universalism.’ We see this particularly relevant within the foundational Social Work Scotland Act of 1968. Scotland has chosen to take a path where social care and support is seen as a public good – a service that should be available to everyone, based on need and not on the ability to pay. This approach contrasts sharply with many parts of the UK and Europe, where social care can often be a postcode lottery, heavily means-tested, and dependent on local funding and resources.
For instance, Scotland’s decision to provide ‘free personal care for those over the age of 65’, regardless of their income or savings, is a testament to this universalist ethos. This policy, in place since 2002, and extended to people under 65 in 2019, has ensured that older people in Scotland receive essential support, from help with bathing and dressing to preparing meals, without the fear of unaffordable costs.
I would be the first to accept that such a universalist policy does not come without consequence not least in terms of sucking up limited resource at the expense of preventative and more upstream interventions. Universalist approaches cost resource and cannot be achieved on the cheap and without fiscal prioritisation.
Nevertheless, as has been seen in the reaction to the UK Labour Government’s recent decision to end the universal principles behind the Winter Fuel Payment, the defence of universalism as a mechanism for social care and advancing wellbeing and addressing health inequalities is robust in Scotland, whether that be prescriptions, bus travel or carers allowance and child support like the Baby Box.
Universalism is a distinctive approach to social care provision not at the moment commonly seen to the same extent elsewhere in Europe. Indeed, many in Scotland would like to see its extension not least to reduce the inequality of treatment and care response to conditions such as dementia.
The universalist approach is not accidental, but I would suggest rooted in a particular emphasis upon the ‘social’ – of which more later. But for now, it is worth stating that the idea of the social relates to broader questions of ‘justice and equality.’ Social care, when viewed through a social lens, is about ensuring that all individuals, regardless of their personal or economic circumstances, have the opportunity to live with dignity. Philosophers like John Rawls emphasise that societies must ensure a fair distribution of resources, including care, so that individuals are not disadvantaged by circumstances beyond their control. The social component of social care thus implies that care is a ‘public good’ and a ‘collective responsibility,’ that there has to be a ‘universalist’ emphasis, that it is not just a private or familial duty as was often the case in earlier care and support in Scotland as elsewhere.
The second dominant strand I’ve mentioned that is distinctive though not perhaps so unique in Scotland is a commitment to human rights and person-centred or person-led care and support.
At least in legislation and policy if not sadly fully in implementation Scotland has embraced a model where care and support is not simply about managing needs or balancing budgets but about recognising and valuing the inherent dignity and worth of every individual.
The Social Care (Self-directed Support) (Scotland) Act 2013 embodies this philosophy at its best. It gives individuals greater choice and control over their care, enabling them to decide how their support is provided, whether through direct payments, direct public sector care services, or those purchased from independent providers or a mix of all. This is about putting the person at the heart of their own care journey, empowering them to shape the support they receive around their own needs, aspirations, and preferences. It should not be about maintenance but about enabling a person to thrive and flourish.
It strikes me in some of the conversations I have held that elsewhere in Europe, social care can still be overly bureaucratic, prescriptive, and service-led, Scotland has taken steps to ensure that individuals are not passive recipients of care but active participants in their own lives. This is a fundamental shift, from a paternalistic model of care to one where the rights, choices, and voices of those who use care and support services are prioritised above all else.
This is a journey, and we have a considerable distance to go to its full realisation in Scotland and for me I believe that this has to be grounded by embedding the human right to social care as part and parcel of the development of wider human rights legal protections. Added to this is the urgent requirement to develop mechanisms to ensure adequate redress where bodies and persons are found not to have acted in a manner which upholds the human right to social care.
A third and further strand which I think is distinctive is an emphasis on the ‘social’ and the communitarian and a resultant focus in policy if not sufficiently in practice upon prevention, early intervention, and community-based care and support. There is an accepted understanding that the best way to support individuals is to prevent the need for more intensive care in the first place. This means investing in community services, promoting health and well-being, and supporting people to live independently for as long as possible.
This, for me at least, stems from a dominant philosophical and policy thread in Scotland which emphasises the ‘social’ in ‘social care’ and indeed ‘social work’ – it’s one of the reasons why the increasing use of the phrase ‘health and care’ rather than ‘health and social care’ is for me more than just a linguistic irritation.
The concept of the ‘social’ in social care carries significant philosophical and policy implications. It reflects both an ethical understanding of human relationships and obligations and shapes the ways in which care is structured and provided within societies.
Philosophically, the concept of the ‘social’ emphasises the ‘interconnectedness of individuals within a society.’ It moves beyond a purely individualistic view of human needs to recognise that care, well-being, and health are deeply rooted in social relationships and structures. It reflects ideas in ‘communitarianism’, which argues that individuals are embedded in a network of social relationships and that their well-being depends on their connections to the community. It also challenges the more atomistic views of human beings that are often emphasised in liberal or market-driven frameworks, which tend to see individuals as self-sufficient.
Such a social and communitarian understanding is, I would contend, rooted in the pages of the 1968 Social Work Scotland Act – services are there not to be an end in themselves but to enable people to be as independent as possible. The 1968 Act is foundational in that it established local authorities’ responsibilities for providing social work and social care services in Scotland. It outlines the duties of local authorities to assess needs and provide appropriate social care services. The Act remains a cornerstone of social care legislation in Scotland, forming the basis for subsequent reforms and additions.
Its emphasis upon independent living was strikingly different from what had come before with a stress upon institutional care and support. But independent living was not about living alone, separate or detached from others. Social care is deeply communitarian in that it was and is about enabling people to be part of their communities and to actively – should they desire – be able to exercise the full citizenship of belonging to the local community. This is about an approach to care and support where the resourcing and developing of community supports and connections is as profound a dimension of social care as the delivery of direct services.
This approach also represented a more holistic understanding of social care, seeing it not just as financial support but as comprehensive care that also included social and emotional support within the community context.
Critically and perhaps something that in straitened financial times is forgotten was that in the 1968 Act local authorities were also empowered to intervene and offer social services aimed at ‘promoting well-being’ and addressing a wide range of social issues, including poverty, family problems, and issues faced by children and the elderly.
Therefore to sum up – a critical aspect of the distinctiveness on social care in Scotland is the emphasis in policy and philosophy upon the ‘social’ within social care. Its importance is because philosophically it highlights the relational, collective, and ethical dimensions of care, positioning it as a core aspect of human interdependence and moral responsibility. In policy terms, it shifts care from being a private, individual matter to one of public responsibility, leading to state involvement, universal access, and the integration of care within broader welfare systems.
In conclusion, I think there are reasons to be proud of and celebrate Scotland’s distinctive approach to social care, but at the same time we know there is still much more to be done. The proposed National Care Service (NCS) represents a historic opportunity to take forward the values of universalism, human rights, and person-led ‘social’ care and support on a national scale. But it is also a moment that calls for courage, vision, and a steadfast commitment to the principles that have made our approach to social care unique. I will leave for another time a reflection as to whether or not the current NCS proposals achieve that protection and further realise the vision.
In Scotland, we are on a journey — one that embraces a distinctive path marked by fairness, equality, and the belief that everyone has the right to live a full, independent life. There are obvious risks to a universalist approach that emphasises the social within care and support and that embeds dignity and human rights. Ignoring them with naive dreaming will not protect what has been developed over the years.
Social care in Scotland should not be seen as just a service or model – it is a testament to the kind of society we are and the kind we aspire to be, and that’s a social one!
Donald Macaskill
Photo by Shane Rounce on Unsplash
Last Updated on 28th September 2024 by donald.macaskill
