DEBATE: He who pays the piper calls the tune?

Copyright: Brad Calkins | Dreamstime.com Ideas about the policy for health and care services are shaped by lots of political and social forces. The agenda for personalisation and the allocation of budgets was lobbied for by activists and was in tune with theoretical ideas such as the social model of disability. But this wouldn’t be successful if the policy did not also make sense to the ideological convictions of the politicians running the country. Ideology is about the way someone thinks is the best way to run things. The two extremes are a collectivist ideology that says that we should all (through the state) provide what is needed and that we take a shared responsibility for looking after each other (like the state education or NHS in the UK). At the other extreme is the view that the individual knows best and that it is best that they manage and take responsibility for their own choices and destiny by being able to shop around in a market of providers (like the health system in the USA). This doesn’t mean there isn’t a safety net or bottom line for people who can’t or don’t provide for themselves. But this does mean that the safety net has to be pretty basic and not something you would choose unless you were desperate.  The ideological convictions of all governments in the UK have been somewhere in the middle, but the suggestion is that we are moving more towards a system that promotes the individual deciding and taking responsibility for their own health and care rather than us thinking the “welfare” state should provide when you need help. So for example, as a first step, disabled and older people are often expected to pay themselves for help they need and use any resources and savings they have. Only when these are below a certain level, state support is provided. This ideological move is based on the principle that being the “customer” or “purchaser” you can ensure better quality and control of exactly what you by shopping around in a market of provider services or available PA’s.

There are different views on how far these principles work for social care, but it does raise some points to think about;

• Can you think of health or social care in the same way as commodities such as tins of beans or washing up liquid?
• Does being a customer give you control of what you want or does the market decide your choices?
• If there is only one provider i.e. “state welfare” don't you just have to put up with what you are given?
• Why should we all pay collectively through our taxes for a service that we don’t need or use e.g. people without children contribute to the state education of all children?
• However some things are better organised collectively and reflect the sort of society we all appreciate e.g. the police and fire service, collecting rubbish from our streets.

What are your thoughts on this? Have your say in the comments section below. 

This debate is part of a collection produced to accompany the OU/BBC co-production Wanted: A Very Personal Assistant