What Price Care?


Today the Institute for Public Policy Research publishes a study about adult social care on the cusp of the publication of a new Green Paper next month.

As they claim, the study

seeks to generate public debate about the future of social care; and consider how the social contract between the state, organisations, communities, families and individuals may need to fundamentally change to ensure that the future of social care is based on principles of fairness and sustainability.

Quite a substantial task!

It does make interesting reading though – especially as the gap between expectations which have possibly been raised to unrealistic heights by a free health care system and realities which are that the costs of social care in a society which is ageing can only increase – possibly exponentially.

What is clear is that no-one wants to pay for services. No-one wants to have to sell a property in order to fund care services. No-one wants family members to be obliged to pay for care services. No-one wants higher taxation levels to pay for care services. But everyone wants high quality care services that are not means-tested and are, like health care, free at the point of delivery.

So looking back to the study, the main points raised were that

  1. Low awareness and uncertainty: confusion about the nature of social care services

There was shown to be confusion on where the barrier is drawn between health care and social care. One only has to see the balance that is drawn by continuing care funding to see how difficult it is to judge at times. It is also something that is rarely going to be seen to be  equitable.

There was a general wide understanding of the most obvious social care provisions like directly provided home care, residential care and day care but this tapers off when provisions like support for those who are homeless or support for substance misuse services or even direct payments for carers are considered.

– Misconceptions about social care funding

    When it came to asking about how social care is currently funded there was a large proportion of people who just didn’t know that the services were means-tested. Unsurprisingly, the younger the age of the respondent, the less likely they were to know about how funding was implemented!

    Which leads to the third ‘heading’

    – Lack of preparation and planning for care needs

      The vast majority of people have made no plans to fund future care needs and unsurprisingly, the younger the respondent, the less likely they were to have made plans – or as in the older age groups – feel that they wouldn’t be able to make plans in any case.

      – Reluctance towards greater family responsibility for funding and providing care

        This heading is an interesting one and one that is a model in other countries but here in the UK, there is seemingly strong resistance to any kind of obligation to fund older family member’s care with only 4% of respondents feeling that there should be an obligation on children to pay for their parents care. 14% would support a system based on means-testing to fund parents’ care however 52% believe that is fundamentally wrong to make any expectations of children to pay for their parents’ care.

        Interestingly this resistance to pay increases with age. Perhaps because of closer experiences with the caring role and the need for social care provision.

        Also, there was a preferred role for professional ‘paid’ carers providing social care as opposed to family or friends, either voluntarily or in a paid capacity, providing that support.

        Although these figures are significantly varied when related to Minority Ethnic families where there is a higher willingness to take up the costs of care for older relatives and a greater desire for that care to be provided by family members.

        – Views on the principles for future care and support for a more collective, universal system

          When asked about possible models, by far the most popular seems to be a free, universal system of care available to all and funded through taxation on a strictly need basis. I have to say I’m not surprised by this although I wonder if it would change if a proposed level of taxation had been mooted.

          – Space for change: a strong desire for more information and debate on the future of social care

            With information comes understanding and only 7% of respondents claimed to feel well-informed about the current ways and means that social care is funded, against 69% who feel they are uninformed and 11% who are somewhat informed but would like to know more.

            image mickeymox at Flickr

            In all I think it’s a study that possibly can link in to the Green Paper proposals – not because there is anything particularly new but because it reiterates the point that there is vast confusion about the current system and will continue to be into the future. People don’t like to think about getting old or needed care until these issues are sometimes quite literally, staring them in the face.

            Personally, I can only see some kind of mixed pattern of care with some kind of means testing and some kind of base free entitlement for the most critical needs, possibly with the additional of a type of insurance. The free universal pattern would be wonderful  but is not economically viable.

            It will be interesting to see what the Green Paper comes up with.

            4 thoughts on “What Price Care?

            1. The ‘cost of care’ is only an issue because profit is at the centre of planning, development and running of care. If non profit social services were brought into the general discussion and evolution of services, we’d have an opportunity to have a less divided and aggressive society.

              The Institute for Public Policy Research is peripheral to the market that’s really taking the mickey out of democracy and the future quality of life expectation of everyone in the UK. For example:

              Adjusted profit before taxation of Care UK rose to £12.3m for the six months ended 31 March 2009 from £8.7m the same time a year before. Revenue rose 16% to £194.2m.

              Care UK said its healthcare business traded ahead of expectations, with a 42% rise in revenue and a 59% rise in adjusted operating profit. Growth was helped by the fact that Care UK now fully owns the former 50% owned independent sector treatment centre (ISTC) joint venture, PHG.

              Do you think that legislation to make all care services not for profit, charities, or social enterprises is the real structural underpinning that should support the so called (but,as everyone knows, not real, research and debate?)

            2. When I say ‘not real’ research and debate, I mean that not for profit should be attached to future development. Otherwise people who care little for the people they ‘provide for’ just use the research as marketing for totally unaccountable behaviour.

              This is why people mistrust and sometimes disrespect social services and Inspectorates, it’s really because they feel their own ‘cowardly powerlessness’ reflected in the actions of people they see as really making no difference or, at worst, even compounding the humiliation and exclusion of vulnerable people.

            3. I think one of the reasons people don’t make provision for their future care needs is that they have enough problems paying for their current needs . It is only human nature to worry about the wolf at the door rather than the one round the corner.

            4. Soapsoane – Thanks for that. I would love care services to be not for profit but I expect some of my thoughts edge around an ideal.
              And I think you are exactly right about the lack of respect. I feel a lot of anger sometimes from people who feel very guilty.

              WL – It is exactly that, and the wish to push the future to the back of our minds (I’m exactly the same!).

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