Tuesday, 19 July 2011

Health care, social care - do we care?

I spend a lot of time thinking about the care of the elderly; in a way I get paid to. But often my thinking is determined by what is possible, in the context of the services available to my patients, and the input of the family and friends involved. It can often become frustrating having to shoe-horn what you would  like to do, into what you are in reality able to do.

In deciding how to look after patients safely after discharge from hospital, there needs to be considerable overlap between geriatric care and social care. The National Service Framework for elderly care was published the year I graduated, 2003, and observed that many elderly patients ended up in hospital for want of community based services to meet their needs. In the last 9 years, I’m not sure that much has changed: it is still routine to admit patients to hospital when their support networks at home break down, and it is still common for patients to remain in hospital when they are fit for discharge because of delays arranging suitable social care.

Social care is getting people quite exercised at the moment - The Dilnot Report has just outlined how future contributions to social care could work in the future capping social care contributions between £25k-£50k, and only kicking in when people have savings above an agreed level.

What continues to confuse me when talking about social care, is how people seem to class social care and health care under the same banner. What are the responsibilities of the individual to provide for their own old age, and at what level should the state intervene? The whole issue of social care is a massed tangle, so let us try to tease out what the most important questions are:
  1. What is the current role of the elderly in society, and does this need to change?
  2. Is the practice of looking after our elderly in care homes sustainable?
  3. Has our perception of how health care is provided in the UK skewed our views on how social care should be provided?


My answers to these questions remain incomplete, but their nature reveals where I am heading: I think that we make too little use of our elderly, both as sources of experiences and wisdom, and as people who would like the opportunity to continue to contribute to society. I think that the practice of putting our elderly in care homes will end as a result of financial imperatives, and it is as a result of the economical bottom line that we will ask ourselves whether it is the right choice for people we love. I also think that the success of the health service may have contributed to a sense of entitlement in old age. We will probably have to issue ourselves with some challenges on this issue, and we will have to ask each other what the role of the state really is in the situation of social care. More on this over the coming weeks.

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