Some questions for the construction of a care policy

With the permission of our good friend Fernando Fantova, today we bring you a text originally published on his blog, in which he poses some questions that should be asked when designing a care policy.

1. What care? We need a very operational definition. Assuming that people need the care we are referring to here because there are activities of daily living that they cannot do for themselves: What activities are we talking about? In what circumstances? At what ages? Typically, care policies (or parts of them) distinguish between activities (e.g. basic or instrumental), circumstances (e.g. disability due to an accident at work) or age (e.g. early childhood or over 65).

2. What consideration is given to primary care? Everyone understands that it is preferable for part of the day-to-day care to take place within primary relationships (family or similar). To what extent and in which cases would we still consider primary care to be preferable? In what terms should we regulate the family care obligation? Do we encourage community care? How?

3. What is the policy response to the need for care that is envisaged and preferred? Care as such (professional, it is understood)? Facilities and support for caregivers? Money for those who need care? Care-facilitating infrastructures? Social awareness of the value of care? Labour regulation, qualification and professionalisation of professional care? Reorganisation and redistribution of care? Other?

4. What general perspectives, approaches or orientations will be applied? For example: rights-based approach, friendliness, gender perspective, independent living model, community approach, intersectionality, decolonial perspective, person-centred care, preventive orientation, deinstitutionalisation?

5. Is care policy more cross-cutting or more sectoral? A sectoral care policy is one that is based solely or mainly on one branch or area of productive activity (e.g., social services). A transversal care policy interacts with a variety of sectoral policies (such as health, social services, housing, employment, income security, urban planning, taxation and more). How are vertical and horizontal integration in care policy approached and resolved?

6. A public system? The question is whether public institutions, in addition to regulating, planning, promoting, inspecting or guaranteeing, should be responsible for the production or provision of care. Public capacity to provide a good is often essential (along with legal and judicial guarantees) if public authorities are to guarantee it as a right.

7. Create a new system or use an existing one? In the event that a more sectoral policy and a public system are chosen, the next question is whether a "care system" is to be created or whether existing public systems (such as public social services systems, for example) are understood to be responsible for the care to which the policy refers. For example, Law 39/2006 on autonomy and dependency foresees "the integration of the benefits established in this Law in the social services networks of the Autonomous Communities".

8. Universality? A public system of services is considered more universal to the extent that more and more people take it as their (first or preferable) option to respond to the corresponding needs, to the detriment of other providers. It is usually associated with a greater number of services being free of charge and with a strategically designed model of incorporation (collaboration, contracting, concertation or other) of solidarity organisations or commercial companies in one or other links of the value chain.

9. Role of technological innovation: To what extent and in what sense does the policy address technological innovation in or for care? What technologies? For what tasks, activities, functions or processes? How is the knowledge ecosystem articulated? What role does the public sector play in the system of science, technology and innovation for care?

10. Transformation and transition strategies (and financing) How will we move from the current situation to the desired situation? What theory of change will be adopted? What will be the drivers of change? How much will it cost? Who will pay? Remembering that care is at the heart of the social contract (with its gender, generational, patrimonial or positional dimensions in the productive system).