It’s time to stop meeting needs and start focusing on developing a ‘good life’ for those who use health and social care services…..

The funding of the health and social care system is currently at the forefront of policy and is overshadowing any understanding of the values and ethics that should underpin care provision, to the extent a consumerist based system is viewed as superior simply because patients and service users become purchasers. However, evidence would seem to suggest this is not always the case. This raises the question for me is it possible to build a system of health and social care provision that is both affordable and based on values such as dignity and respect?

Developing a sustainable care system

Drawing on the ecology movement sustainable development is defined as “development that meets the needs of current generations without compromising the ability of future generations to meet their needs”. This captures two important elements, the need to support those currently requiring care without compromising the future of the care system which is able to accommodate a growing number of users within budget constraints.

Need, capabilities and the ‘good life’

A first step might be to reframe our understanding of ‘need’. The concept of human need is a relatively new one, and is used in different ways. Need in a health and social care context is often used to refer to a function to be fulfilled, i.e. nutrition, physical care. Such needs might be viewed as a necessary condition for survival. However, we can also view need in terms of security, respect, love and justice.

The failure to expand our understanding of need has arguably led to limiting our vision of human needs, and subsequently influenced how service provision has developed across a number of patient/service user groups i.e. older people, learning disability. A more useful way of thinking about need, from a values perspective, is provided by Amartya Sen with his concept of ‘capabilities’. Sen is concerned with identifying what individuals require to flourish and live a ‘good life’. For Sen whilst some capabilities depend on the fundamental provision of the basic elements of life i.e. nutrition, warmth and shelter, others require particular kinds of freedoms and social relationships. In this model it is recognised different people require different capabilities to flourish, depending on their personal circumstances and the community they live in, whether that community is within an in-patient/residential setting or lived in the wider community.

While the ‘good life’ is to some extent subjective it is also socially defined. In modern western societies it is largely defined in material terms as our ability to be consumers. A consumer culture within health and social care provision appears to be the route to a ‘good life’ as it enables individuals to increase choice and control by becoming consumers of care, rather than receivers of care. In this context care is viewed as a commodity, to be bought and sold. Thus enabling the individual to pursue their own version of the ‘good life’. Yet many people who use health and social care services are unable to flourish in a culture that defines the good life in terms of their ability to engage in a consumerist model of care.

A more useful way of thinking about this from an ethical perspective links Sen’s idea of capabilities back to Aristotle’s idea of the ‘good life’, where the good life was a life of happiness based on the exercise of rational capacity and moral virtue, but also requiring material means and relationships with family and friends. These were the essentials of a good life. Martha Nussbaum has expanded the specific capabilities drawing attention to the need for individuals to be free from state interference and free to form meaningful relationships with others to flourish. Nussbaum locates a capabilities approach around an individuals quality of life suggesting ‘it holds that the key question to ask is “what is each person able to do and to be?”. In other words it is not just about achieving an ‘average’ notion of well-being but about the opportunities available to the individual which will enable them develop their full potential, whatever that might mean for that individual.

This involves going beyond ensuring people have the ability to flourish to ensuring they are actually flourishing. This is pertinent to all service provision whether within the community or in-patient/residential setting.

Five areas important to flourishing and living a good life, regardless of the society/community you live in are: belonging to a family; belonging to a community; having access to material goods for sustenance, adornment and play; living in a healthy environment; and having a spiritual dimension to life. Arguably commissioning and delivery of service provision based on supporting the development of these five areas might enable individuals in receipt of health and social care services to flourish and have if not a good life, a better life.

A way forward

Conceptions of what constitutes a good life are varied, however, within health and social care provision it is prudent to assume a good life involves at a minimum care provision that is not abusive of those who are vulnerable. A first step might be to be more explicit in embedding the principles of capabilities and the good life to provide a solid foundation on which to build for the future.

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About digalpin

I gained my social work qualification from the University of Southampton and worked for 14 years in mental health, disability and older people services. I am currently a senior lecturer in post-qualifying social work at Bournemouth University and am conducting research on government and societal attitudes and responses to the mistreatment of older people in health and social care provision for my doctorate. My views are my own.

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