The problems with social care

Social care has been unmanageable for some time, and it’s not simply down to the actions of this government, or the one before it, or the one before that.  The problems run much deeper than any quick fix can address, but many of them can be laid at the door of two very long-standing policies, and I can see no way of resolving issues while those two policies stand.

The first failing policy has been in place for more than fifty years.  Circular 2/62, on Development of Local Authority Health and Welfare Services, declared that “Services for the elderly should be designed to help them remain in their own homes for as long as possible.”   The model sounds plausible, but it is based on the highly questionable gamble that people will never need more intensive support.  This is, quite literally, catastrophic – it generates sudden crises.  It means that we leave people in place until there is a catastrophe, usually a fall or hospital admission.  This leads directly to people being trapped in acute hospitals until they can get an emergency admission into residential care, often settling for a third or fourth choice because that’s all there is.   We need people to be settled in lifetime accommodation long before the crisis happens.

The second failing policy stems from the Griffiths report of 1988, which attempted to provide personalised, individuated social care through the creation of a quasi-market.    Provision based on this model has signally and continually failed to provide people with the level of support they need.    It’s not down, as many supporters of the policy claim, to lack of resources.  Market provision can’t work by providing a flexible response – it implies that support will be fragmented, offered in short bursts of time.   Individuated responses are spectacularly inefficient; they’re also desperately expensive.

The push to personalisation has been based in a futile attempt to implement an impossible dream.  Individuated policies only work for people whose needs are more limited.  The more intensive the support has to be, the more has to be provided in a distinct location.  We spend a great deal of time and money pretending that residential care is really a modified form of domiciliary care, with added accommodation: it isn’t.  A greater commitment to residential care is the only way out of this bind, because residential care brings together trained staff, facilities and resources in the places that allow them to be used for people in need to the greatest effect.

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