As a final year Law student undertaking research for a dissertation on how ethics might affect the law surrounding the adult social care system, I have become aware of the marginalisation of those within the system. While studying for another module I was shocked to read that the authors considered that Dr Harold Shipman had managed to kill over 200 of his older patients without suspicion being raised simply because they belonged to a group considered ‘low value’ by society.
Uncomfortable though this suggestion is, there may well be significant truth in it. Utilitarian policies, directing resources to the majority without evaluating the needs of individuals, attach labels to groups which enable local authorities to deliver a blanket, one size fits all service. It does not take a huge amount of research to realise that the growing older population, who are benefiting from free health care and scientific progress on one hand, are being failed on the other because their need for good, basic care is not being addressed adequately.
Liberal policies which place focus on autonomy, such as individual budgets  have increasingly pushed service users into becoming employers and accessing the services they need for themselves. While this might seem attractive in theory, it can be difficult in practice. As Ann Marie Mol  discusses, having more choice does not always lead to better health care and care is best when it works collaboratively and in recognition of the complexities of individual lives. Unfortunately, in the realm of adult social care, this emphasis on choice has led to government being able to look away from those who need support.
As Luke Clements  argues, there are questions whether personal budgets actually address the needs of many older people in practice. This is further compromised by the fact that they do not have any choice in whether they really want to have this level of responsibility in the first place. It is not necessarily easy or practical to have to arrange personal care and this is further affected by fluctuations in charges depending on where a person lives.
Lucy Series and Luke Clements  argue that resource allocation systems lack transparency in some areas with regard to what criteria are used to ascertain needs. The law centres on personal assessments which can generate budgets which are not sufficient to meet the requirements of service users. This is further affected in cases where some level of care is provided by family or friends. These informal carers are also not recompensed adequately (if at all) by government for what they do, nor are their broader needs and commitments, perhaps work or family life, addressed properly. This presumption that care should take place within the private spheres of home and the family again allows those in power to look away.
Care needs to be positioned centrally within both politics and society in order that carers are valued appropriately and they receive the support they deserve. When this happens we can begin to build upon it and progress to delivering excellent care for everyone, using resources and time to their fullest potential.
Laura Wares is a Mature final year Law student at the University of Kent, currently researching for a dissertation around the subject of the ethics of Adult Social Care. She can be contacted via:
Kent Law School
University of Kent
 Ann Stewart, ‘Choosing care – dilemmas of a social market’, 2005.
 ‘The logic of care: health and the problem of patient choice’, 2008.
 ‘Social Care Law Development: A Sideways Look at Personalisation and Tightening Eligibilty Criteria’, 2011.
 ‘Putting the cart before the horse: resource allocation systems and community care’, 2013.