Policy Statement: Health and Social Care

MACC's Manifesto sets out the key principles which shape our approach to health and social care.

Community care must be fully resourced.
MACC supports the principle of care and support provided free of charge to those who need it. Mainstream society takes wellbeing for granted: as individuals it is usually only when our wellbeing is lost that we begin to understand the additional and purely artificial barriers which society places around people with poor health. The UK is the fourth largest economy in the world. To us it is unacceptable to suggest that we cannot afford a properly resourced system which supports the most disadvantaged and vulnerable members of society.

However, our aim is not only to ensure that services of all kinds respond better to the needs of those who have poor health, but that there should be a greater focus on prevention. This is not just about enabling people to maintain the quality of life: taking a more positive, preventative approach ultimately reduces demand for services and so enables services to focus their resources on providing high quality care and support to those who need it: prevention is not only better than cure, it is also cheaper.

Services must be based on a person-centred approach, shaped by informed choice.
The benchmark of this is that “the service” should be defined by the what the person receives, not the activities of the variety of organisations involved. Improvement in the person’s quality of life is a measure of the quality and value of services. This impact should be defined by the person receiving the service. Other measures, such as those which show cost-effectiveness, are important but should not take precedence.

People must not be mere consumers of care services: they must be at the heart of the planning, design and delivery of all the elements of care and support which combine to form “the service”.

People have the right to challenge decisions which affect them.
An important feature of being person centred is the ability to recognise that services get it wrong and need to be rethought. It is also true that a persons needs change constantly, sometimes daily. Yet the current system takes a snapshot and locks people into a routine which can become constrictive rather than supportive.

Often, the only way a person can draw attention to these issues is to make a formal challenge. This is deeply unfair as it places increased strain on the person at the time when they are, by definition, already under substantial pressure.

By ensuring that people have the right to participate at all levels (strategic and personal) in the planning and delivery of services, service providers in all sectors will become better at working in a supportive way with individuals and learning to design services and processes in which flexibility is an essential quality of the approach.

The person centred approach is dependent on a management culture which enables the creation of the service around the person.
Being person-centred is not solely the responsibility of front-line workers. Policies and practice are not planned to be discriminatory but they sometimes have this effect. This leads to neglect, intolerance and, in extreme cases, behaviour which would be regarded as abusive if applied in mainstream society.

For example, an assessment is carried out simply to identify the person’s needs and wishes. Current practice often blurs the assessment process by bringing in other factors such as the capacity of organisations and the person’s ability to contribute to the cost.

The distinction between “health” and “social” care is an arbitrary one which is not about needs but about who pays. By setting artificial boundaries, time and energy are wasted on “bureaucratic and self-serving procedures” (a phrase coined by Lord Laming in his report on the case of Victoria Climbié) which shifts the focus of attention from the needs of the person onto operational issues. The NHS and Community Care Act (1990) was intended to address this by bringing clarity: in practice, it has merely substituted one bureaucracy for another. In this respect, the Act has patently failed to achieve its aim.

The role of carers is undervalued.
Mainstream society is only dimly aware of how heavily it relies on the contribution of informal and unpaid carers. MACC believes that there needs to be increased understanding of the need for carers to be valued and supported and the resources this requires.

No group is “hard to reach” – it is the services which create barriers, not the people in the community.
It needs to be recognised that marginalised groups currently have low expectations and are not always aware that they have the same rights as mainstream society. All forms of discrimination are unacceptable. This is recognised at the delivery level but less so at the planning and strategic level.

Everybody has the right to live and participate in the community.