Within the UK there is a growing social care funding gap with the number of adults in receipt of this care progressively falling, in spite of trends towards an ageing population.
Since the Care Act was launched in 2014, I have been employed as a researcher and front-line worker in the social care sector as well as being an unpaid carer for my mother. All of these roles have given me an insight into the Act’s effectiveness in achieving its aims to improve the lives of those in need of social care services and the creation of a more equitable system for all.
In spite of these commendable aims, my experiences suggest that they have not been met with social care services remaining patchy, under resourced and difficult to access with ongoing staff shortages and cuts to services being a particular issue.
Thus, within the UK there is a growing social care funding gap with the number of adults in receipt of this care progressively falling, in spite of trends towards an ageing population. While the fragmentation of the social care system as a result of neo-liberal trends in welfare pluralism can see many people ‘falling through the gaps’ due to poorly integrated services that can be difficult and confusing to access.
Access is further restricted by the consumerisation of these services and the increased use of means testing and charging with some potential service users being unable or unwilling to pay for such services. These barriers to access arising from under resourcing, fragmentation and consumerisation can run counter to the principles of personalisation, choice and control which the Care Act has aimed to promote. For not only do they limit choice but they also encourage a reliance on relevant professionals for guidance in accessing social care support.
Although these barriers to access and the general under resourcing of social care provision have been apparent throughout the UK, in spite of the aims of the Care Act to promote a more equitable system, certain groups have been disproportionately affected by these developments. Thus, it is poorer communities that have felt their impact most keenly with lower socio-economic groups being much less likely to be receiving the social care support they need than better off counterparts.
This unequal impact may be attributable to the higher levels of support need experienced by the less well-off due to their greater likelihood of experiencing ill health and disability. It could also be due to their reduced access to the material and cultural resources which are increasingly required to access the consumerised welfare market. However, the personalisation agenda and its focus on individual need has tended to obscure these systematic differences in access to social care support. Also obscured by this approach is the common need shared by care givers and receivers for adequate and affordable help. For although the Care Act aims to provide parity of esteem for unpaid carers and their needs, the inadequacy of social care provision potentially exacerbates the demands placed upon them. While individualised assessments can falsely construct two potentially conflicting subjects within caring relationships, overlooking the way in which needs may coincide within these relationships.
Older people are also disadvantaged within the current system. For the focus on user led involvement and the promotion of choice within the welfare market can be incompatible with their particular needs and aspirations. This can be due to the often sudden onset of infirmity in older age as well as the innate stoicism found to be common amongst older age groups, rendering them unable or unwilling to proactively pursue this support.
Consequently, access to it is commonly initiated by welfare professionals after a crisis situation has been reached.
This is upheld by my experiences as an unpaid carer for my mother who, although having dementia, always wanted to remain independent and refused to accept the need for help from anyone apart from me. However, matters were taken out of her hands when on the eve of the first lockdown in 2020 she fell and broke her hip after which she was admitted to hospital and then to a care home where she rapidly deteriorated and died a few months later. While I did my best as her carer, I can’t help but think that her quality of life would have been improved if she had accessed outside support sooner. It would also have taken some of the pressure off me.
The tendency for older people to resist accessing formal support and the common need for persuasion and prompting from others in initiating this access suggests the need for preventative and proactive approaches to its introduction. While the barriers to access currently experienced by those of all ages suggests the adoption of universal, integrated and ‘low level’ services such as home care which can be gradually built upon as the recipients needs change. In accordance with this UNISON advocate the need for a National Care Service. This would involve the development of interconnected support services and would aim to reverse the privatisation and fragmentation that characterises the current social care system.
Shared care initiatives which involve the merging of formal and informal sources of support are also gaining increasing popularity as a means of increasing the capacity of care provision within the context of resource constraint. While in order to challenge this resource constraint and its negative impact on the social care sector, the adoption of collectivised and campaigning approaches would also be appropriate. Although such developments may seem ambitious, they do not have to involve ‘reinventing the wheel’ as examples of relevant and innovative approaches are already apparent around the world.
References:
Cooper, B. and Harrop, A. (2023) Support Guaranteed: the roadmap to a National Care Service, London, Fabian Society
Lloyd, L., Calnan, M., Cameron, A., Seymour, J. and Smith, R. (2014) Identity in the fourth age: perseverance, adaptation and maintaining dignity, Ageing and Society, 34(1), 1-19
Office for National Statistics (2022) Census 2021 Statistics, First results from 2021 in England and Wales, published 28 June 2022
