Thursday, 10 May 2012

The social care issue - my initial thoughts

Social care has the potential to become an issue through which society learns a lot about its values, both through reflection on how we currently treat our elderly and vulnerable, and discussion on how we would like it to work.

The perception of social care is clouded by our experiences of how health care is provided - there is something of mission creep in all of this. Our success in effectively creating  a health service that deals with the issues of equity and access of health services effectively creates an expectation that other services will be provided in the same way. Social care suffers by comparison with health care due to its close affiliation, and the fact that distinctions between the two are often blurred.

But the distinction is important - to boil it down, healthcare, particularly in the circumstances I work in, is about how we help others at times of acute and unexpected need (the role of primary care in all of this is an argument for another day), whereas social care centres around the responsibilities of society in the subsistence of others on a daily basis. The transition of patients from the hospital (where they do not have to pay any costs) to social care (where they do) can be stressful and hard to understand.

A sense of entitlement is perhaps justified: the idea that when we are frail or vulnerable, society will ensure that we are looked after is ambition that I share, and one that should not be beyond the wit of modern society to make reality. But what does it mean to be looked after?

Loneliness is a disease of modern society, and one that many of my patients suffer from terribly. Yes, there are repeated problems with the quality of care that the elderly experience both in their own homes and care environments, but perhaps we should take a step back, and instead of echoing the same criticisms of outsourced care, ask ourselves whether the model of social care we use now is the best one available.

Most of the debate about social care that I have heard has focused on the models of funding. This debate needs to happen - the Dilnot report makes it clear that the means-testing model currently used for social care is a very poor model indeed. But there is more to it than that. Perhaps we need to challenge ourselves, and ask whether the kind of care that we provide the frail and vulnerable among us is a function of the priority that we give it.

A great many of our elderly either live in social isolation, or in congregations in care homes, often without any role in wider society. We know that people live healthier and happier lives when they have function and purpose, and yet it is very difficult for a large number of the elderly to continue to maintain important social functions within their communities, living as they do at a distance from their families. And society is complicit in this.

I suspect that financial imperatives will have a greater impact on the choices that we make with social care than anything else: the high cost of social care may well ensure that many families will have to choose to look after their elderly relatives themselves. But an important question that I do not see discussed a great deal, is what we can do as a society to encourage and support families that wish to look after their parents and grandparents at home.

There will always be people who require a level of care that cannot be provided in their own homes, or the homes of their relatives. But perhaps it would make a difference if families were supported in their endeavours to look after their own relatives. There is scope for significant invention here - perhaps through paying for the time that informal carers spend looking after their relatives, or creating communities of carers in different localities. And there is huge scope for programmes to keep the elderly engaged in the wider community, which will also serve to keep them healthier. For example, what would the benefits be if children’s nurseries also doubled up as day centres for the elderly, and vice versa? What if the elderly at day centres ran reading groups for local children, or helped out with after school clubs? Perhaps the little ‘uns could teach their elders a thing or two about using computers, while they were also getting some help with their homework.

Some of this is of course wishful thinking, but perhaps something good can come out of asking the question ‘How should we include our elders in society?’ alongside the question, ‘How can we afford to look after them?’

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