Is there really ‘Crisis’ in Care?

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.

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Care Lobby 2012

Londra - The House of Parliament e il Big Ben
Today there will be a lobby and representation made to Parliament by the Care and Support Alliance – which is an umbrella organisation of a number of charities and representative groups for people with disabilities, illnesses and their carers.

The Care and Support Alliance is campaigning to change the current system of care which exists, claiming there is a ‘care crisis’ which needs fixing and is pushing the government to act on Dilnot’s proposals to change the system of funding for social care.

There is much that needs to be changed – not least the funding of care which at the moment is very dependent on location. It is a postcode lottery of funding in every sense of the word with different local authorities having very different systems which creates a very extrinsic ‘unfairness’.

But there is  more that needs to be changed than just creating a more equitable national system of payments for care. There is much about the way care is delivered, commissioned and organised that needs changing too.

There needs to be an improvement not just of the quality of care that is delivered but the quality of support that is offered to families of people who have care needs. While the government can have as many meetings about improving dignity in care as they like, these reports will all sound the same unless they do more to change the fundamental way that services are financed and delivered. Currently pushing costs between health and social care is detrimental to those who need support from both and until there is both better integration of budgets and greater attention to the fundamental needs of

I am very much in support of the Lobby today. For those who are not able to take part in person (like me, as I’ll be at work), there are ways to take part and show support online both on Facebook and Twitter.

Everyone needs to push on this point. We have to actively engage with the government to show them how much this matters and how much it matters that social care is important as a political issue. Health and Social Care are intrinsically connected and money pushed between one and the other without proper systems will cost more to both but not much in money, in quality and length of life, in stress and distress to those who need care and those who provide it.

The government has to act. Please join the Lobby or the #Twobby to make our voices heard together.

photo: Gengish/Flickr

Burstow’s Bluster

I, like many others in the sector, no doubt, were perplexed by the headline as I read it yesterday on the Guardian website that Paul Burstow, the Minister of State for Care Services, claimed there was ‘no funding crisis in social care’.

Although I follow Burstow fairly regularly and have a good idea of his rhetoric, I thought it was worth checking to see if a quotation or ‘soundbite’ had been taken out of context.

Indeed, he concedes that there needs to be a push of money from the private sector into the care sector – I’m not sure how exactly he intends for this to happen because unlike in the health sector, there’s not much left to privatise in adult social care.
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