Re-thinking older care

The recent reforms to social care in England should pose serious questions closer to home. Changes and reforms to health and social care all too often get hung up on bricks and mortar at the expense of focussing on the quality of care.

In particular, the dominant perception of care services for older people has become synonymous with institutional care provided by private companies.

That raises a number of fundamental questions, not least of which is whether institutional care is the best option for the care of a growing elderly population

Clearly it is not. If all we can offer an ageing population is to put them in a home then we need to re-evaluate our approach.

Given the opportunity, the majority of people would prefer to be supported in their own home, if that is possible. Once we accept that principle, we need to ensure that not only is that service provided but that it is provided to the highest possible standard in the most innovative, flexible and inclusive manner possible.

To achieve that, NHS staff should do what they do best – provide care. While the fundamental responsibility for resourcing and providing social care rests with the state, there are many additional aspects to supporting people to live in their own homes and communities than can and should be provided by a combination of voluntary and community groups, social enterprises and families.

Issues of social isolation, mobility, access, contact, involvement and the pursuit of interests are all part of the care requirement and need to be planned, structured, funded and delivered as an integral part of the care of older people at home and in the community.

Communities, and all that they comprise, have a social responsibility to older people. A number of European and north American cities have developed Older Aware environments in which entire communities – social, cultural, educational and recreational organisations, voluntary, community and religious groups, businesses and statutory bodies undergo training and awareness and work together to help provide a community which understands, empathises and actively supports older people as active and involved citizens.

Supporting older people to live in their own homes and communities should be a social care priority. It must be resourced and supported with research and best practice and is provided by a workforce which is trained, well-paid, has a clear career path and is encouraged to excel.

Older care in the community must never become a cliché or a soft option. It is neither. Trusts and trust staff must seek to provide not just good care but the best care. We can and should become an exemplar for the design, and delivery of the care of older people – primarily in their own home for as long as that is possible.

Hospitals and the medical model still dominate our health and social care thinking. That cycle, and the vested interests which it serves, needs to be broken.

A wide range of factors impact upon dependency levels as people grow older. Housing, employment, education, lifestyle and diet throughout our lifetime will all have an impact on our level of dependency as we grow older. Investment in our environment, our opportunities and in our awareness and understanding of health and well-being can have a massive impact on the type of older people we will become and the level of dependency we display. Health prevention resources and culture are still not in sync with that reality.

We are still too happy to wait until people become ill and then seek to cure them. Similarly we wait until people become old and dependent before we start to address and plan for their care. We need to rethink almost everything we know about care for older people.

We need to challenge our own assumptions and contest those of health and social care planners and policy makers. We need to recognise and support the fact that people want to remain as long as possible in their own home and their own community.

We must design and deliver services best placed to achieve that. We need to align all the resources of our society and channel them to that end. That approach is not only desirable – it is achievable.

Time to talk seriously about Health

Hospital waiting lists and the future of health and social care services here have been one of the most covered news topics in recent weeks.

Unfortunately, many of the discussions, the radio phone-in shows, the newspaper columnists, the letters to the editor and the contributions in the Assembly have generated more heat than light.

We are probably less informed now than we were at the start.

Founding principles

However, several things are clear. There needs to be an informed public discussion about the future of our health and social care services, there needs to be a re-affirmation of the founding principles of the NHS – that it is a public service, publicly funded and free at the point of delivery, and there needs to be a clear and unambiguous declaration that health and care are human rights not opportunities for profit and financial gain.

Any discussion of the future of services might start by asking “are we running a Health service or a ’Sick’ service”? Currently nearly all our efforts are directed to treating people when the become ill, not on trying to ensure that more people stay healthier for longer.

When we talk about the health of the population, we can’t restrict that to a debate about hospitals, nurses and doctors.  If we are to help prevent more people becoming ill in the first place then we need to be talking about redirecting resources and looking at the impact of a poor environments, housing conditions, job opportunities and working conditions, improved educational attainment, information on diet, opportunities to exercise and avoiding and relieving stress.

How much would a four-day working week contribute to a healthier and less stressed population?  The causes of ill-health, not just the cures, need to be up front and centre in any and all discussions.

Traditionally we have thought, and been encouraged to think, that health was exclusively about hospitals. Much more care and treatment in the community and in people’s own homes is now possible and preferable thanks to new working practices, more developed skills and modern technologies. Developing that must be on the agenda, as must the source of any opposition to its extension. 

Some other issues are blindingly obvious. If dozens of hospital wards and hundreds of beds are closed down if the number of nurses in training is cut dramatically and funding is consistently cut, then there are going to be problems and there are going to be longer waiting lists.

We currently spend less per head of population on health services than France, Germany, Belgium, Denmark, Norway, Finland, Austria, and of course Cuba.

Shaping the narrative

In the past twenty years there have been at least four major reports proposing various levels of change to local health and social care services. 

The most important one has yet to be written. That one will recognise the social function provided by a public health and social care system, it will acknowledge the political agenda which, since the foundation of the NHS in 1948, has sought to undermine it, privatise it and profit from it.

It will concede the role that capitalist working practices and over production have on our environment and our health. Socialists, trade unionists, progressive thinkers and all those committed to a better and radically different future, need to start shaping that narrative now.