Introduction

In this debate piece (written by UK and Australian academics), we discuss the utility of the term ‘social care’. This term has been used in the UK for more than 20 years. While not as widely used in Australia, it is understood in both countries to describe the provision of social work, personal care, protection or social support services across the lifespan for those with needs arising from illness, disability, old age and/or poverty. The overall aim of this article is to debate whether ‘social care’ is the right term to support people and governments to create inclusive, equitable and fair societies. We focus on three issues: first, the historical adoption of the term ‘social care’ across both countries, that is, the why and the what; second, in what ways social care is ‘social’; and, third, whether the term ‘social care’ can be deployed more effectively to support positive change.

The use of the term ‘social care’

In the UK, the term ‘social care’ emerged in the early part of the 21st century as an alternative to ‘social services’. In the post-Second World War period, ‘social services’ had been used to capture the range of supports offered to people who were in need of assistance due to disability or frailty in old age. A more comprehensive set of supports, provided by local government, replaced the existing patchwork of charitable supports and ‘workhouse’ provision. These were separate from social security, that is, the cash benefits paid to people in poverty. Social services included the provision of residential care and, increasingly over time, support in people’s homes. Much of this support was focused on the so-called ‘activities of daily living’ (washing, dressing, preparing and eating food), but with some assistance for accessing community activities.

Similarly, in Australia, the philanthropic roots of social welfare were gradually replaced by state provision after the Second World War. The period from 1970 to 1990 was the community services era, championed by a Labor government that, among an array of policy and programme initiatives, created universal health insurance, community health services and dental health programmes, and abolished fees for tertiary education. In the early 1970s, the term ‘community welfare’ was adopted to further signal a change from the charity model to a social justice model. Later in this period, the term ‘community services’ replaced ‘community welfare’ in an attempt to move away from the stigmatising and discriminatory connotations of ‘welfare’ (Ayton et al, 2012).

Both countries sought to put a boundary between healthcare – where scalpels and pharmaceuticals could wield effective treatments and cures – and long-term social services for the frail, disabled and people with mental health conditions. As healthcare became increasingly high-tech with protected funding and professionalised staff, social services remained underfunded and politically marginal.

Both countries started to see growing momentum for deinstitutionalisation and a shift to more community-based support from the 1990s. Some of this ‘community’ support came from the private sector, with an increase in the outsourcing of state services. At the same time, there was growing recognition of disability rights and more inclusive approaches to supporting people with learning disabilities. Demographic trends indicating the rising numbers of older people raised the profile of policy debates on the adequacy of the post-war model.

The term ‘social care’ in the UK seems to have emerged in the late 1990s as a conflation of ‘social services’ and ‘community care’, both commonly used in the 1980s and 1990s. While those alternative terms continued to be used within policy papers, in 2000, the first government consultation paper appeared with ‘social care’ in its title, and the term has now eclipsed those alternatives in government statements and wider policy debates.

In Australia, the term ‘social care’ is still only one of several terms used, though it is gathering momentum. The early 2000s saw Australian state governments, community service organisations and tertiary healthcare begin to reference ‘social care’ in their policies, reports and strategic plans. In particular, social care models from the UK were being integrated as new and novel ideas that could guide the restructuring of systems, funding models, models of care and job roles, for example, the use of Daly and Lewis’s (2000) social care model in the fundamental understanding of young carers in Australia (Cass et al, 2009). As the term ‘social care’ was a direct reference from UK documents, reports and white papers, the term had the same meaning. However, over the following decade, ‘social care’ lost its identity as a term used in isolation from ‘health’ or ‘healthcare’, and by 2015, ‘health and social care’ was much more commonly referenced. This phenomenon continues to this day.

How is social care ‘social’?

The term ‘social services’, and now ‘social care’, is embedded in the UK’s welfare state model. Its use in Australia (as well as in Canada and Ireland [Lalor and Share, 2009; Moscovitch and Thomas, 2018]) reflects colonial history and the resultant shared administrative heritage. It is less well known outside these countries, and the norm in comparative research is to use the term ‘long-term care’ (Comas-Herrera, nd). This begs the question of whether we ought to give up on the language of social care and call it ‘long-term care’, or at least be clear on what work ‘social’ is doing here. Why call it ‘social’ care at all?

One interpretation is that the language of ‘social’ reflects the responsibility of the state towards people who require assistance; therefore, ‘social’ here means ‘public’, as distinct from the private care given in families. However, increasingly, the unpaid care provided by families and communities does fall within the social care remit (for example, the carers’ rights bestowed by England’s Care Act 2014), so this boundary no longer fits the case. It could mean social as in ‘publicly funded’, as much social care is, but this again neglects the large proportion of people who self-fund their care as private payers, who have come under the scope of recent legislation (for example, the Health and Care Act 2022 in England). It could mean social as in ‘congregate’ services, that is, group homes and residential care; however, again, this is now an outdated meaning given that the majority of social care provision is in people’s homes.

Certainly, in neither country does the term ‘social care’ indicate a willingness among policymakers to engage with what it might mean to live a good life in communion with others. There have been efforts by campaigners in both countries to shift attention away from social care as functional services for marginalised groups. In the UK, disabled people have campaigned under the slogan ‘A life not a service’ to highlight that care needs to be more than the narrow functional tasks of personal care. In Australia, the ‘Every Australian Counts’ campaign that preceded the creation of the National Disability Insurance Scheme (NDIS) drew attention to an inclusive approach to disability. However, high levels of unmet need and loneliness in both countries highlight how far away we are from developing social care that makes people count.

Nor does the term ‘social care’ indicate a willingness to address the social determinants that shape people’s life chances and to rethink the welfare state more broadly. This is the possibility of social care set out by Daly and Lewis (2000) in one of the first academic articles to use the term. In ‘The concept of social care and the analysis of contemporary welfare states’, they identify care as sitting at the intersection of state, family and market in a way that is highly gendered but that could be an organising principle across different forms of exclusion. However, we know that governments continue to ignore the inequalities that play a major role in people’s health, well-being and life chances. Poverty continues to disproportionately affect disabled people, and the marginalisation and neglect of disabled people were starkly revealed in the COVID-19 pandemic. For those experiencing marginalisation from disability along with other forms of exclusion related to, for example, gender, ethnicity and sexuality, these issues are even more intense.

If we conclude that the term ‘social care’ is a historic hangover from the social services that emerged out of the Second World War, then we need to recognise the inadequacy of the term. When used to justify institutionalisation – not only historically but also ongoing for some groups – the term ‘social’ takes on an Orwellian aspect of denoting the opposite of living a meaningful life within a community. Even for many people living at home, the experience of poverty and exclusion takes away the ‘social’ from social care.

Shall we give up the term ‘social care’?

In moving forward, should we encourage policymakers to retire the term ‘social care’, or should we look for ways to make it more meaningful? As we seek to address the parlous state of support for older and disabled people in the UK and Australia, we can look at the extent to which social care is a mobilising force for change. In the UK, it appears to have very little traction. People do not understand what the term means, and while politicians claim that it is a priority, we repeatedly see delays and abandonment of key legislative commitments (for example, the inadequate implementation of the Care Act 2014 [Burn et al, 2023]). The term ‘social care’ is increasingly coupled with ‘crisis’ in media headlines about delayed discharge from hospitals, underpaid staff and bankrupt governments. It has been suggested that we give up the term ‘social care’ and start taking about ‘disabled people’ and ‘older people’ instead, so that the general public know what we mean.

Australia offers an interesting counterpoint here, in that the separation of disability services from eldercare does mean that these are presented separately. To some extent, this has been an advantage, for example, in the way that the campaign slogan ‘Every Australian Counts’ was used to build public support for the disability reforms that became the NDIS. However, services for older people in Australia remain in dire need of investment – as highlighted in the 2021 report from the Royal Commission into Aged Care Quality and Safety – and the NDIS itself is struggling to make the difference that was hoped (Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, 2023).

Rather than moving away from the term ‘social care’, an alternative is to lean into the ‘social’ and make ‘social care’ more social. To embrace the social is to recognise that care and well-being are relational and locate us within communities. Shifting away from individual blame and focusing on the context of people’s lives can be the basis for providing holistic, wrap-around support that is tailored to the needs of people and their communities. This requires the breaking down of silos and providing unified and purposeful care that is driven by the voice of individuals and communities. This social action of working ‘with’ the people can enable a better and deeper understanding of the needs of communities and populations. Crucially, this needs to be done with people who have lived experience of care and support, encouraging peer support and rights-based approaches rather than top-down solutions.

The Australian federal government has released a ‘Measuring What Matters Framework’ focused on understanding the well-being of Australians, which is grounded in overarching principles of inclusion, fairness and equity. The framework is designed to explore individual and collective well-being across all phases of life, taking a holistic perspective. The evidence gathered across this framework may provide an opportunity for governments, politicians and public service providers to plan for current and future care provision. Additionally, we need to encourage our social care organisations to share their learning from practice about what is working, what is not and how best to support people in a way that acknowledges people’s strengths and assets rather than focusing on people’s deficits.

In the UK, the principle of well-being has been embedded in legislation in England and Wales. Indeed, Wales has passed the Well-being of Future Generations Act 2015 to highlight the need to consider well-being across a much longer time frame, recognising the challenges that long-term threats like climate change pose to us all. In Australia, the Measuring What Matters Framework is a helpful step in the same direction. However, these overarching commitments to well-being need to be translated into change on the ground for disabled people, older people and people with mental health conditions.

There is space for the ‘social’ in social care if it is framed in relation to the shared human need for care and support. As Tronto’s (2013) work on ‘caring democracies’ reminds us, this is a political question about how we make caring more just in societies that remain dominated by market logics. Rather than shifting to the descriptively simple term ‘long-term care’, let us continue to work to make social care more meaningfully social.

Funding

RM’s contribution was funded by the National Institute for Health and Care research (NIHR) Applied Research Collaborations (ARC) West Midland. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The other authors received no financial support for the research, authorship and/or publication of this article.

Conflict of interest

The authors declare that there is no conflict of interest.