There seems to be a general understanding that the state of social care – particularly in relation to older people – is in crisis. You can look at the headline in the Independent today with their exclusive about a ‘Crisis in the care of elderly as £1 billion cuts bite’ .
I wonder about the use of the word ‘crisis’ though. There is a massive issue in relation to funding but this is not something that has been ‘magicked’ out of the air. Nor is it an issue which has suddenly arrived with this government. We have known about the needs of an ageing population for decades but each government of all parties have continued to try and ignore the fact that there will need to be a higher level of tax receipts or co-payment to meet the needs of people who require support from the state.
If it is a crisis, then it is a crisis created by lack of foresight both politically and economically – it is not a crisis created by the care sector or people who require care.
The Independent article is useful and interesting. It lists a number of cuts in services but also highlights a push into ‘reablement’ services which focus on higher intensity, shorter term care and support ‘packages’ to offset (so the idea goes) longer term care needs in the future. It is, of course, vital to emphasis early interventions and preventative work however as the criteria for access to services initially rises, those who need care are coming to these services generally ‘later’. It’s a useful foil to this Telegraph article a few days ago which talks of the numbers of older people who don’t have access anymore to care provided by adult services locally due to changing eligibility criteria. It’s very important to remember that this system of reducing care to shorter visits by contracted large agencies who deliver poor support by minimum wage workers (some of whom are fantastic but not because the system does anything to actually help them) was created by the push towards contracting out and attempts by local authorities to barter for the cheapest delivery contracts without quality being considered. This is where the NHS will go and it will be the people who are least empowered to complain who will receive the poorest service. This is not an unforeseen crisis. The roots were planted in the 1990s.
Meanwhile, remember Paul Burstow saying about there not being a crisis in care funding. The word is used to create political capital and blame. No more.
I’d argue there isn’t a crisis in care. There is a well foreseen and ignored gap in the funding and provisioning of needs in the sector. This isn’t a surprise to anyone who has an ounce of common sense. It does need action, just as it needed immediate action 5 years ago, 10 years ago and small half-hearted measures were taken without there being a fundamental reorganisation of the adult care sector.
Yes, we have had the move towards personalisation but it should have been accompanied at the time with a move towards changing in the funding systems. Having the ‘postcode lottery’ and care associated with local authority delivery in an era where people are increasingly mobile makes no sense. We are pinning an approach and delivery mechanism from a different era which should have been re-designed from bottom up to account for different needs in relation to geographical mobility and differing family dynamics.
Perhaps that chance has been lost, perhaps there will be some innovation in this field and more than tinkering around the edges and a resolution of ‘who will pay’ which seems to be the fundamental discussion at the moment.
I’d like to move the discussion further not just about how we pay but what we pay for and how these services are delivered. The ethos behind ‘personalisation’ was to transform delivery of services and it has to an extent but we need to really embed this ethos for it to work properly and redesign the methods of assessment that feel like a ‘points for cash’ type system where people have to constantly write and discuss things they can’t do and have money and funds assigned accordingly rather than look at models that can build on strengths and abilities, which don’t discriminate on the basis of age or mental capacity or rely on family without providing safeguards where no family exists.
This isn’t a crisis in care. This is culmination of forecasts which have been long made and which have never been addressed.
Of course this needs to be tackled but lets lay the blame on those who we elect to represent us rather than those who have the needs that are no longer being met.