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Modernisation Muddles What is the Future of Social Care for Older People in England and Wales

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Modernisation Muddles What is the Future of Social Care for Older People ... both celebrates devolution and speaks of and to a sense of newness and modernity. ... – PowerPoint PPT presentation

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Title: Modernisation Muddles What is the Future of Social Care for Older People in England and Wales


1
Modernisation Muddles What is the Future of
Social Care for Older People in England and Wales
  • Professor Robin Means
  • Associate Dean (Research)
  • Faculty of Health Social Care
  • University of the West of England, Bristol

2
THE TALK WITH COVER
  • Reflections on community care/social care.
  • Examples of rapid policy change or what I have
    called modernisation muddles.
  • Exploration of whether this merely reflects a
    continuation of a long standing policy problem,
    namely the artificial divide between what is
    health care? and what is social care?.
  • An argument that social care is merely a
    reflection of more deep seated trends in
    organisational culture which encourages a kind of
    policy attention deficit syndrome?.
  • A discussion with you about whether or not social
    care futures will be different in England and
    Wales.

3
COMMUNITY CARE
  • The Health Service and Community Care Act 1990
    gave the lead agency role in community care to
    social services authorities for all the main
    core groups of service users and required the
    stimulation of a mixed economy of care through
    encouraging independent providers.
  • At a strategic level, this was to be achieved
    through the publication of community care plans
    on the basis of wide consultation with key
    agencies and groups, including service users and
    carers. Care management was to be used at the
    operational level to ensure service users were
    offered flexible packages of care which were to
    draw heavily upon the independent sector.

4
SINCE THEN
  • Establishment of Welsh and Scottish assemblies.
  • Splitting up of social services authorities in
    England with separate arrangements for children
    and adults (Directors of Adult Social Care
    Services).
  • Community care plans have long gone.
  • We no longer talk in terms of lead agency roles.
  • And the replacement of the term community care
    with social care.

5
FROM COMMUNITY CARE TO SOCIAL CARE? WHY?
  • There was no formal announcement but rather
    governments just started to talk about social
    care and not community care.
  • It could simply be because social care is seen as
    a term more easily encompassing Care Homes as
    well as care in the community compared to the
    term community care.
  • Or it could be because no statement have ever
    been made about lead agency roles in social care
    rather than community care and hence it can be
    presented more easily as subservient to health.

6
MODERNISATION MUDDLES IN ENGLAND HEALTH
  • White Paper on the NHS (DH, 1997)
  • NHS Plan (DH, 2000)
  • White Paper on Public Health (DH, 2001)
  • White Paper on Community Services (DH, 2006)

7
KEY CHANGES INCLUDE
  • Primary Care Trusts
  • Foundation Hospitals
  • Market of Independent Health Care Providers
  • Locally Based Commissioning
  • Money following the Patient
  • Endless Reconfigurations of Services, Boundaries,
    Roles and Responsibilities
  • NHS Financial Crisis
  • Endless changes in Workforce Planning

8
MODERNISATION MUDDLES IN ENGLAND SOCIAL CARE
  • Single assessment process
  • Fair access to services
  • Intermediate care services
  • Delayed discharge policy
  • Direct payments
  • Care Trusts (for the few)
  • Reconfigurations of inspection arrangements
  • Changes to the funding of Long Term Care (free
    nursing care)
  • Financial pressures
  • Less organisational disruption

9
WHAT IS HEALTH CARE? WHAT IS SOCIAL CARE?
  • Section 21 of the National Assistance Act 1948
  • it should be the duty of every local
    authorityto provide residential accommodation
    for persons who are by reasons of age, infirmity
    or any other circumstances in need of care and
    attention which is not otherwise available to
    them.
  • The act offered no definition of care and
    attention
  • Over time it has come to include people in
    ever failing
  • health
  • The act is still in operation today

10
WHAT IS HEALTH CARE? WHAT IS SOCIAL CARE?
  • Huws Jones (1952, p. 19) spoke of the emergence
    of a group of older people stranded in no mans
    land between the Regional Hospital Board and the
    local welfare department not ill enough for
    one, not well enough for the other.
  • (see also Lewis, 2001a)

11
WHAT IS HEALTH CARE? WHAT IS SOCIAL CARE?
  • The Ministry of Health clarified the
    responsibilities of local authorities under the
    1948 National Assistance Act as being
  • Care of the otherwise active resident in a
    welfare home.
  • Care of the infirm (including the senile) who
    may need help
  • in dressing, toilet etc, and may need to
    live on the ground
  • floor because they cannot manage stairs and
    may spend
  • part of the day in bed (or longer periods in
    bad weather).
  • Care of those elderly persons in a welfare
    home who have
  • to take to bed and are not expected to live
    more than a
  • few weeks (Ministry of Health, 1957).
  • (Ministry of Health, 1957, Circular 14/57)

12
WHAT IS HEALTH CARE? WHAT IS SOCIAL CARE?
  • Boundaries between health and social care
    continued to shift throughout the period,
    1971-1993. They shifted mainly in one direction.
    Social Services were expected to take on
    responsibilities for older people who would once
    have been deemed to lie well outside any
    definition of in need of care and attention.
    Not only this but they were expected to work ever
    more closely with health over the planning and
    delivery of services, especially at the community
    level. The resultant tensions and arguments
    outlined were inevitable.
  • (Means et al, 2002, p. 95)

13
WHAT IS HEALTH CARE? WHAT IS SOCIAL CARE?
  • If you needed to be conveyed by ambulance you
    went to the hospital. If you could be conveyed
    by a minibus or by care with someone then you
    would go to the day care centre, a staffed day
    care centre. Whereas if you could go by car or
    you were ambulant, you went to the day centre
    that was run by voluntary (organisations).
  • (Means et al, 2002)

14
WHAT IS HEALTH CARE? WHAT IS SOCIAL CARE?
  • The majority Report of Royal Commission on Long
    Term Care (1999) argued for free personal care on
    the grounds that no logical distinction could be
    made either between health care and social care
    or between those services which should be free
    and those that should be means tested.
  • Older person with cancer gets free NHS
    treatment
  • Older person with dementia gets largely means
    tested
  • social care support

15
WHAT IS HEALTH CARE, WHAT IS SOCIAL CARE?
  • Definitions of Personal Care
  • Personal care would cover all direct care related
    to
  • Personal toilet (washing, bathing, skin care,
    personal presentation, dressing and undressing
    and skin care)
  • Eating and drinking (as opposed to obtaining and
    preparing food and drink)
  • Managing urinary and bowel functions (including
    maintaining continence and managing
    incontinence)
  • Managing problems associated with immobility
  • Management of prescribed treatment (e.g.
    administration and monitoring medication)
  • Behaviour management and ensuring personal safety
    (e.g. for those with cognitive impairment
    minimising stress and risk).

16
WHAT IS HEALTH CARE, WHAT IS SOCIAL CARE?
  • Definitions of Personal Care
  • Personal care also includes the associated
    teaching, enabling, psychological support from a
    knowledgeable and skilled professional and
    assistance with cognitive functions (e.g.
    reminding, for those with dementia) that are
    needed either to enable a person to do these
    things for himself/herself or to enable a
    relative to do them for him/her.
  • (Sutherland Report, 1999a, p. 68)

17
WHAT IS HEALTH CARE? WHAT IS SOCIAL CARE?
  • Does the Wanless Review (2006) help to resolve
    the health and social care boundary issue?
  • The review acknowledges the importance of this
    issue but
  • tends to define social care in terms of
    existing LA services,
  • namely residential/nursing care, domiciliary
    care and day
  • care i.e. it takes a pragmatic definition.
  • The review is very knowing about health and
    social care
  • tensions the health and social care
    boundary is far less
  • clear-cut in reality that the funding regime
    impliesit is
  • sometimes very difficult to distinguish
    between the needs
  • of someone receiving free continuing NHS
    care (including free
  • accommodation) and someone with very high
    personal care
  • needs due to, for instance, severe
    dementia. (p. 104)

18
THE CULTURE OF THE NEW CAPITALISM
  • Sennett (2006) in the Culture of the New
    Capitalism profiles how the information
    revolution across the private and public sectors
    has centralised power in the hands of senior
    executives and prompted their belief that they
    know enough to command immediate change from the
    top. Furthermore, he argues that in this MP3
    kind of institution (p. 172), staff become
    overwhelmed by a mixture of information and
    instruction made all the worse by the tendency of
    such technology to disable the craft of
    communication (p. 173). Added to this is the
    speed of innovation and change in the New
    Capitalism with obsolescence and uselessness
    faced by many staff and not just those with the
    least skills and education.

19
THE CULTURE OF THE NEW CAPITALISM
  • Sennett believes New Labour fell into the trap of
    embracing the MP3 culture in its public reform
    agenda without recognising all its limitations in
    terms of maintaining commitment from staff and
    the trust of the public.

20
THE CULTURE OF THE NEW CAPITALISM
  • Interestingly, he is able to show how work
    policies show the same frenetic pattern as those
    for community care
  • The initial policies about work were good job
    training and counselling, industrial safety,
    work-family issues all squarely addressed. Each
    year, however, there were more policies or
    different policies which reformed the previous
    policies which reformed the mess Labour had
    inherited. As the policies kept coming, the
    public trust in them eroded. Within the councils
    of government, the manufacture of ever-new
    policies appeared as an effort to learn from the
    actions previously taken to the public, the
    policy factory seemed to indicate the government
    lacked commitment to any particular course of
    action (p. 174).

21
WELSH POLICY MUDDLES (OR MUCH NEEDED
MODERNISATION?)
  • Welsh Assembly Government (2006) A Strategy for
    Social Services in Wales over the next Decade
  • Welsh Assembly Government (2003) The Strategy for
    Older People in Wales
  • Welsh Assembly Government (2006) National Service
    Framework for Older People in Wales
  • Welsh Assembly Government (2007) Fulfilled Lives,
    Supportive Communities
  • Welsh Assembly Government (2003) Health, Social
    Care and Well-being Strategies
  • National Assembly for Wales (2005) Report of
    Review of the Interface between Health and Social
    Care
  • Welsh Assembly Government (2005) Designed for
    Life Creating World Class Health and Social Care
    for Wales in the 21st Century

22
WELSH POLICY MUDDLES (OR MUCH NEEDED
MODERNISATION?)
  • There is a strong sense that a hegemonic
    discourse of a One Scotland or a One Wales is
    in the making a discourse and ideology centred
    on nationalised and indigenous versions of
    neo-liberalism. Welsh and Scottish social
    policies are tied to particular national
    visions of a better Wales or a new Scotland. But
    these aspirations are also largely New Labour
    UK-wide ambitions a particular language has
    come to dominate in both countries, that both
    celebrates devolution and speaks of and to a
    sense of newness and modernity.
  • (Mooney and Williams, 2006)

23
WELSH POLICY MUDDLES (OR MUCH NEEDED
MODERNISATION?)
  • Devolution may express a sense of national
    difference in Wales and Scotland but the
    existence of the UK state continues to frame much
    of social policy practice even while this is
    being re-badged as Scottish and Welsh. The dual
    national universes of the devolved nations and
    Britain here are reflected in successive attitude
    surveys that show continuing and widespread
    public support for the key institutions of the
    British welfare state (and little in the way of
    support for the modernised version currently
    being constructed by New Labour) across the whole
    of the UK.
  • (Mooney and Williams, 2006)

24
HOW SIMILAR? HOW DIFFERENT?
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