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The Leveson Centre for the study of Ageing, Spirituality and Social Policy

This year's big idea?

Les Bright, an independent consultant and Professional Adviser to the Relatives and Residents Association suggests that a 'New Vision' may be welcome.

The Green Paper, Independence, Well-being and Choice: our vision for the future social care of adults in England (HMSO, 2005) was published at the end of March, alongside the government's strategy on ageing. That the two were put together and launched by the Prime Minister is a reminder - if it were needed - that we have just had a general election.

During that election adult social care really only emerged as a footnote to attacks on the Liberal Democrat plans to introduce free personal care for older people. It is suggested in many quarters that we can neither afford to fund people's personal care needs, nor is it desirable to spend public money on people who have more than £20,000 (the present limit to which one's personal assets have to fall to attract financial support to meet the cost of residential care). I don't want to explore those issues here - but suffice to say that as a parent I was not asked to demonstrate my financial position before the state used taxpayers' money to meet the cost of my children's education (well, not until university anyway!), and I can't remember the last time a librarian or adult educator asked for a sight of my bank book before deciding how much to charge me for their services. But I digress!

Social care seems to occupy a niche that keeps it out of sight for much of the time - unless and until there is a tragedy such as the death of someone whose body lies undiscovered for many months. Then the calls for reform of systems, or for individuals to lose their jobs begin and new interest is shown. So a Green Paper (leading to a White Paper, and then an Act?) which is not precipitated by death, misfortune or some lesser shambles must receive a warm welcome from all those organisations and individuals who want to engage in a debate about the things that sustain people's independence, enhance their well-being and offer them wider choices.

My concern is that a politician's 'big idea' emerged ahead of the thinking to support it, and that what we may have in some parts of the paper are a series of views that could be described as prejudice wrapped up in rhetoric. Here are two examples to support my view:

  • The document introduces the idea of a 'right to request' not to live in a residential care or nursing home.

  • There is a proposal to improve assessment and give greater control to service users by creating new roles or posts.

The former minister for community care, who conceived this baby, is especially well known for his antipathy towards care homes (I may be unfair - it may have been towards care home owners whom he had previously described as 'Tories'). He has been highly critical of the kind of lifestyle that people might have as a result of living in a care home, and had been championing the idea of extra care housing - 'sheltered housing with knobs on' as a sceptic once called it!

In offering people the chance to request not to go into a home the paper parts company with reality in that it is well known that in many parts of the country people are serving time on waiting lists (despite the High Court having declared them illegal some years back). For these people - assessed as needing care - waiting in line for a vacancy, resulting from the death of a publicly funded resident, moving into a care home can't come soon enough. Older people have been resisting giving up their homes - and I don't just mean those who own their homes and are wanting to protect their children's inheritance - for as long as there have been homes established to look after people who can no longer care for themselves. And, social workers have often done their level best to arrange a variety of services to support them at home. So let's have no more of this suggestion that people are being pressurised into going into care when in many parts of the country demand far outstrips supply as a result of the homes closures that have been occurring for the past half dozen years.

Living independently for as long as possible is undoubtedly a laudable goal for public policy. But the reality for some of the more frail older people remaining in their own homes is that their quality of life may be poor with an ever-changing succession of people coming into their home to get them in and out of bed, on and off the toilet, dressed and fed. Sometimes returning to bed without seeing another caller who isn't wearing - literally or metaphorically - the uniform of a care organisation. 'House arrest' as a consultant geriatrician once described it to me.

Are the days of social workers numbered? Certainly some commentators have begun pointing towards the end of the road for social services departments since this publication emerged. The document describes a series of roles (or posts?) which it thinks necessary to enable people to have greater choice and control: a person-centred facilitator, a care manager, a care navigator, and a care broker. Maybe 'Back to the future' should become the new slogan, rather than 'Forward not back' as we were told during the election?

If the community care reforms that were introduced in 1993, as a result of the NHS and Community Care Act 1990, aimed at developing services in response to people's needs, rather than requiring them to fit into the existing provision have failed, we should not identify social workers as the culprits. Good practice needed to be backed up by the cash to enable change to occur, but an early victim of councils' financial difficulties was the collection of data on unmet need - vital to inform the planning of new services. And while the NHS has enjoyed unprecedented and very welcome increases in spending this has not been matched in social care budgets.

I welcome the idea of someone to assist people in 'navigating' through the jargon, uncovering information to assist in making informed choices. I'm even more excited by the idea of a broker who won't just negotiate funding and organise services, but will stick around to monitor the quality of services provided to vulnerable people. Many older people struggle to collect all the information they need - but that's only half the problem: making sense of it is even more challenging; and then having the support to dispute charges for work not done, or to complain about the way the job has been done will make a big difference.

I am worried about the mismatch between so much of the jargon and the realities of so many people's lives. Older people whom I have been speaking to in the course of collecting their views as part of a review of health and care services have overwhelmingly commented on the availability of information, and the importance of transport - whether they live in urban or rural areas. And many talk of the need for help with shopping, and other routine household tasks that make such a difference to their ability to carry on living independently. What's in it for them?

Les Bright

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