The government published its welfare reform public consultation; they’re calling it a green paper as well, presumably that means the same thing. It is called: No one written off: reforming welfare to reward responsibility. This follows the government approach to welfare, which is increasingly communitarian, that is, rights go with responsibility; you don’t get anything unless you give something. In this case, you don’t get pensions or social security unless you work for them. This is hitched up to a quotation from Beveridge, the man who wrote the original green paper during the war (except that they called it a report then) on the welfare state. He said government and the individual should share responsibility for social security. While this is true, we have always understood this to mean that the government would be there to fall back on if you landed in difficulty. Both medical and social ethics say you should be entitled to the means of life because you’re a human being, we’re all human beings and we’re all in this world together.

Why is this important for palliative care? Social workers know that feeling secure in your home and a reasonable income, no matter what disaster may befall is an important part of being able to struggle on against adversity. The signs for the health service are there. The government wants to sweep up government funding streams together, so that for disabled people social care, housing support, employment support, equipment and adaptations to your house are all connected to one another. This sounds very sensible and joined up, until you wonder what happens if, say, the employment support people cannot make their objective of getting you into work because you are feeling insecure about your health and the social care provided to your sick wife. I just wonder whether failure to keep employed is going to lead to all your help being insecure, and what this will mean to families trying to struggle on with multiple problems, including a sick or dying family member. I can just imagine some private sector employment ‘adviser’ with a target backed up with financial penalties for non achievement, saying: ‘So your wife is dying: what’s that to do with you getting back to work?’

As it is, the idea to make all funding streams connect up is fine: but what if the people managing the funding streams don’t agree with each other? And it is said that they are going to experiment with NHS funding streams to connect with that. So perhaps in future, your wife will not get her continuing care support to go home, if it means you are going to stay off work to help her. At the very least, I would want to hear about some very firm legislation about people’s rights not being affected by how their families behave. And I’d want to see how much consultation is going to be needed between these different funding streams before they are all coordinated. Otherwise, we’ll get massive six-monthly meetings taking a year to make decisions, or ‘we’re not going to help you because they’ve decided they’re not going to give you the benefit they manage,’ Don’t tell me it can’t happen, my daily penance is continuing care.

Department of Work and Pensions (2008) No one written off: reforming welfare to reward responsibility: Public Consultation. (Cm 7363) London: TSO http://www.dwp.gov.uk/welfarereform/noonewrittenoff/noonewrittenoff-complete.pdf