Health and Social Care Policy

Cultural Challenges within Multi-Disciplinary Team Approach for Hospital Discharges: A Perspective for Collaborative Health and Social care Management

2013-02-09T06:37:00.001-08:00

A successful collaborative team would include all health and social care specialists (Doctors, Social Workers, Nurses, Occupational Therapists, and Physiotherapists etc.) to gather on an equal level, to come up with a strategic hospital discharge plan to enable continuing care in the community. It is hoped, the meeting would decrease revolving hospital admissions; mainly by older people. Although, the questions are: Dose the means justify the end?

In theory, the perspective is endeavoured to reduce acute hospital bed blocking by older people. The answer would be to offer care to the aged in their own homes and in the community they are used to for as long as possible. In practice, however, some of the specialists are meddling with politics and show of professional know-how. The doctors for example, tend to over shadow the meeting and dominate decision making whilst lowering other professionals to just audience and spectators, which collapses the collaboration.

Even so, social services suffer due to its inability to negotiate effectively on equal-terms with doctors, because of a “power of professionalism, politics, wide-ranging knowledge and influence”. The differences between professional and political power versus doctors are very wide, which gives them a competitive advantage to make unilateral decisions. In this perspective, most professionals do not have the expertise to debate or argue on equal footings, failing to represent or advocate for service users, families and the wider organisations.

Unfortunately, political interference within the team and the wider health and social care institutions has renewed the gap between the two inter-related sectors. In light of this, it is now a common experience to see erratic hospital discharges of older people into community without adequate care to support them with their holistic needs. This is seen as the perils of social services that have a duty to assess and provide care within a critical and substantial matrix. Though, the eligibility criteria for care in the community is complex and not many service users would qualify and may not have enough money to buy private care and, or family members to assist them with their care needs. Equally, community nursing are rationed; they have long waiting lists, which are triggered by poor hospital discharge planning, that is in practice created by the doctors and hospital management.

A Multi–Disciplinary Team Approach is now the buzz word in practice, which is supported by both health/social care executives, and it is aimed to accelerate hospital discharges. Based on this assertion, the objectives in practice should be to piece together an integrated care management approach; something that is appropriate to simplify care provision in the community. The framework should take a holistic approach, which includes: mobility in and around the house/community, housing issues, benefits, family support systems, community nursing and care; rather than curative and biological pathways which has a narrow vision. The system must be free from politics and professional bigotry but, it needs to focus on the wellbeing of the service users, consumers, patients, clients and their families. Community care is not only to be used to rehabilitate patients/clients or consumers in their own house, it is also to improve their psychosocial wellbeing and recovery as they are in the community of their relatives whom they know well. Whole systems policy and practice reduces wastage and readmission costs to the wider organisations of health and social care on the long-run.

It is imperative to understand we live in an ageing society, this due to advancement in biotechnological systems and medical sciences as well as strategic investment in human resources, pharmacology and healthcare infrastructures. These have undoubtedly enhanced longevity of older people and those with chronic diseases, helping them; to live and immerse themselves with their wider community of relatives, friend and carers. However, there has been an increase in demand for care by significant number service users, which requires 24 hours care; ensuring their safety. In addition, the number of formal and informal caregivers is plummeting, this is presenting itself as a major challenge especially to the authorities, to provide and meet the care needs of the ever growing elderly population. This indicates the beginning of a potential crisis, which would someday engulf the society in future only if both national and local governments, including health and social care authorities do not come up with strategic vision on how to tackle future care for the aged.

Society today has seen a multiplicity of developments, including the economic down turn, demographic change, politics and a declining family unit, as such; these are some of the pathways going against the increasing older people population to needed. Indeed, an integrated health and social care that has pooled budget might be the solution. This has the propensity to remove departmental financial interests, politics and cultural administrative dissimilarities. If we saw a merger of health and social care training policies, this would provide the staff with a wide range of knowledge-based experiences to address older people’ needs. Additionally, joint training has the opportunity to address professional, knowledge-based experiences and bigotry which is evident in practice. Family support systems, training and engagement should be a priority as some older people would prefer their own relatives to support them in times of need and poor health. In most cases, their family know their needs and the standards they are used to, allowing care professionals to provide peripheral care support services.

Yet, the biggest treats are demographic change, cultural and administrative politics, which would continue to present tough problems for the authorities because longevity of older people and their demand for care. However, this could be minimised if the government would relax some of the legislation and current policies on immigration, health and social care funding mechanism and behaviours.

Misrepresentation of Sociology: A Perspective on the Aged and Health/Social Care.

2013-01-11T06:52:00.003-08:00

Health and social care is anchored on the philosophy of sociology, which is about inclusiveness, social cohesion, social administration and wealth distribution to all citizens of the state as appropriate. And since the inception of universal services, sociology has even broadened its scope and definition, which has surpassed the widely held empirical and academic theories of the subject. In the light of that, the contemporary understanding of the theme is now comprising different cultures, traditions and learning from around the world to promote social diversity. This opportunity is endeavoured to advance health and social lives of the wider community, assimilation and co-habitation in society of all populations.

However, recent government policies have deflected some of the fabrics and meaning of applied sociology and what it stands for in a wider context of health and community wellbeing, in particular the needs for the aged people in society. It could be argued that recent micro and macroeconomic down-turns have brought about new interpretations of the conceptual framework as one of the measures to manage the nation’s debt (the big society agenda). Nevertheless, this perspective is not new, society already exists and functions in different cardinal points such as individualism, capitalism, consumerism and voluntarism in order to produce and deliver social goods. From every count, this philosophical discourse has resonated the conflict between current interpretation of sociology and universal services; in particular the perception held about older people in society.

The present day health and social care philosophies for older people is now at the centre of political treatise hence the aged are the highest consumers of the welfare services. In view of these assertions; long-term policies on capacity and resource planning for the elderly people have been erratic and short lived. This however, tantamount to tunnel vision, which could be a problem for the wider society in future if longstanding strategies are not developed. We live in an ageing society where a significant majority would need health and, or social care yet; the support systems in place is drastically declining because of changing behaviours, values and societal norms of smaller family units. In contrast, universal services originated from “sociology”, as this epitomises the birth of social administration. Nonetheless, the question is; “what is the inter-relationship between; sociology, welfare state and the “Big Society” agenda?”

Historically, “sociology” is about the understanding of social lives and behaviours, especially in relation to social systems, how they work, how they change, the consequences that society produces and their complex relationships to peoples’ lives and how they inter-relate. For example, different parts of society submerge to a completely different setting and fused themselves to deliver welfare services to older people and other vulnerable people in the community. Practice observations indicate that sociology and welfare systems are intertwined as the main focus is to integrate norms and values to facilitate community and psychosocial wellbeing of those in society, who rely on others for their functional activities of daily living. Universal service must be seen in context of a whole systems approach, how that impacted on other sub-systems therefore, any derailment within the system collapses the entire cell. Thus, sociology examines the epistemological and ontological issues affecting all parts of the system, such as the welfare services and its contribution to the maintenance of health and social care; in particular the aged.

We should be mindful, though broader interpretations of the subject divulge that individual situation or problems within the wider community could become a public issue. But, when that is inter-related with another pattern it could produce pressure groups, which might destabilise the set values and foundations of the system if not handled properly. Therefore, the growth of older people and political interference in health/social care could endanger the outlook for strategic planning and continuing care management. On reflection, low morals within the care profession and the wider health care sectors could disenfranchise the entire welfare services. Based on the contemporary structural adjustments in the organisations and community services providers, it would be assumed that sociology and its wider remits have taken a different turn to embrace neo-political indulgences.

New geo-political dispensations meant that the current sociological concepts engaged dual frameworks; legislation (Laws) and policies (individualism) as social norms (the “Big Society”) and some of the principles clash with sociological understanding. This dictates a range of different values existing in society and has to be tolerated because; people have different types of rights from one another. It is undisputable that individuals are unique and hold different views, values and practice. However, current government approaches show discernment against older people within the wider society. Their services are in contrast with other service users’ groups whilst funding for services cannot be compared. Realistically, this is what I call “positive discrimination against the aged” and unfortunately, there is no apex of the wider society that is able to challenge or speak against the plight of this client group.

Sociology promotes life changes and an equal society, where people and services integrate to acquire new knowledge and develop an acceptable behaviour in the environment around them. The quintessence of the welfare service was to cater for the frail older people and other vulnerable people in society. In contrast, the post-modern interpretation of the system has discarded the link between sociology and social administration. Sociology forms the pillars universal welfare systems, which originally focused on the fours giant killers in society “idealness, diseases, squalor and want”. However, the current challenges facing health and social care sectors are; the growth of older people and their increasing demand for care, which the coalition government of the day is struggling to cope with

Homogeneity of Care: Recognising Individuality of Older Person’ Care Needs – Policy and Practice

2012-11-14T09:26:00.002-08:00

I applied mine heart to know, and to search, and to seek out wisdom, and the reason of things, and to know the wickedness of folly, even of foolishness and madness Ecclesiastes (7:25 KJV). In my studies and career, I have continuously searching to uncover ontological issues why older people are not been perceived as individuals with distinctive needs but to no avail. The perceptions of the national and local governments as well as the wider health and social care organisations have revealed the folly of the widely held societal belief systems against older people. They should be recognised and their contributions acknowledged for laying the foundations and structures of the universal welfare systems in the UK.

In the welfare discourse, older people are seen as one entity rather than individuals who have different care needs. Naturally, humans are individuals with special characteristics and genetic makeups, which is unique to identify their needs from others. However, health/social care institutions and professionals tend to see older people’s care as homogenous thus, devising policies and practices that justifies the implementations. Practice observations have revealed that such policy/service frameworks can sometimes encourage discrimination and abuses of older people mostly, those who are unable or have no family members to advocate for them. These act of inequality, negligence as well as poor services delivery for older people; who are in care triggered the development and implementation in the UK; the “National Service Framework for Older People” and “Personalisation of Services”. The aims and objectives of these polices were to eradicate discrimination, so that older people could be seen as persons with individual needs.

In contrast, cuts in services and restructure of human resource in the sector indicated that older people’s service have been perceived as a weak sub-system, which could be targeted for savings. The reforms have ignited the debate whether the above policies are political rhetoric or manipulation of ideology. With older people’ population expected to increase substantially in the next two decades, politician, physicians, health/social care professionals and managers need to be prepared for overwhelming challenges they will face looking after this user group. In practice, health and social work teams are swept over with referrals from this group, their families and other professionals. Casework are growing daily at alarming rate and that is an indication of what lies ahead. In most developed societies, nearly one in five will be 65 or older by 2030 (according to the UK census (2011). People in this age group constitute the majority of referrals to health and community welling organisations in the UK when compared with the rest of the population.

Consequently, the austerity measures have affected all parts of the welfare systems but, services for older people have been severely embattled and that has led to care support structures been rationed under the umbrella of the “Eligibility Criteria Matrix”. This is despite personalisation of services (“Cash for Care, Personal Budget”). Unfortunately, this has become the fate of some older people who are in receipt of care hence care giving and packages of support plan systems are undistinguishable. Most social service departments up and down the country in the UK only assist those with “critical” needs; whilst a significant minority of others provide assistance to those needing “critical and, or substantial” care and those requiring medium and low needs have to fend for themselves. However, the danger is; this policy might be contributing to users’ health deteriorating conditions and would cost more money in the long term to care for them. This is a common experience of those users who are unable to buy care privately and, or may not have family members around that are willing to support them. Current policy frameworks are not supporting preventative strategies, which could reduce future costs and admission into hospitals; rather the focus is to make substantial savings in line with the coalition government’s ideologies such debt reduction and promotion of “the Big Society” agenda.

However, the consequences of quick fix solution and reactive measures would be to the peril of older people, their family and the wider health and social care organisations in the long run. On reflection, a significant majority of older people who are in receipt of care tend to be frail and or, disabled and suffer from hearing deficit or dementia. Based on this understanding, homogeneous or residential care setting appears to be cost effective for the authorities. The setting offers more environmental friendly services as well as providing safety net for users and their families because most of their needs could not be met in the community. Most users’ needs are complex, unpredictable, and intense; associated with challenging behaviours. These meant that individual programme plans may be over exaggeration for this age group as care giving is offered according to presented condition at the point in time.

In hindsight, offering standardised care without due consideration for individuality meant that a considerable number of older people would suffer and their care needs and health condition worsens. Practice observation discloses that hospital readmissions are higher amongst those service users whose needs are not adequately met. Addressing these issues requires a complete change of attitude and perceptions held by the government, professionals and service managers. Older people should be seen and not heard; whilst a whole systems approach should foster individual programme approach to later. This has the potential to accommodate older people and their holistic needs within systems approach, which would promote psychosocial wellbeing and assurance that their needs could be met in their own house/community for as long as possible.

Conversely, recent census in the UK as well as the USA and other developed countries illuminated decline of younger people whilst the population of older people is growing at arithmetic progression and a significant majority may need care in that circumstance. The question is how could the increasing needs of older people be handled individually? Apparent a higher proportion of younger people does not like to seek employment or trained to offer care of any sort to older people due to the nature of tasks involved such as intimate personal care and domestic chores. These observations justify change of government policies and legislation such as the “Immigration and education”. Relaxing these have the tendency to promote migration of people from developing nations and it is hoped, this would boost labour force in care industries in the UK and other developed societies. The caregivers would act as surrogate employees in the host nations particularly in the wider welfare services. The anticipated outcome is that immigrant workers would cover the vacuums in the care sectors, which was created by the declining younger people’s population in the counties in question.

Rejuvenating Core Skills and Knowledge: Personalisation of Care for the Aged and Demented

2012-10-23T09:14:00.003-07:00

Ageing and disabilities tends to incapacitate humans’ abilities to undertake and fulfil functional activities of daily living. Majority would lose a significant amount of skills and knowledge to attend their care needs. However, personalisation of services has inevitably reactivated some user’s skills and knowledge as they are to some extent able to join in their care. This is a new model, which provides the opportunity for some users to exercise choice and control with regard to their holistic care needs. This permits them to make informed decisions and choices to recruit their own personal assistants who they believed would assist them meet their needs. This preposition contrasted with the ethos of “direct provision” – a formal assessments and care delivery by local social services departments.

The new model is empowering some users to be proactive to participate in their own care on a daily basis and within their capabilities. The framework is classified into different forms and characteristics, which encompasses: “Personal budget; Cash for Care and, or Direct Payments”. These care pathways have provided an avenue to revitalise care reminiscence for many older people and those suffering dementing ill-health. One of the core properties of the model is to redesign service frameworks; from “direct care provision” to self-fulfilling service. This facilitates social re-engineering and enablement so that the aged and disabled people could be fully involved in their own care for as long as possible. This would also stimulate social skills’ re-acquisition and ability to regain some lost skills and experiences whilst learning new skills. This ensures that dementia suffers and the aged could contribute immensely towards achieving their wide ranging needs. Equally, the care pathways have the prospect for reducing dependency culture amongst many service users.

Reflecting on the advantages of the model, psychosocial wellbeing and emotional attainments for most clients groups have become prominent. It provided the opportunity to re-orientate some users with times, people and environment. This increases the propensity for some to be involved in their own care for as long as possible. Thus, they would not totally lose the ability to maintain a whole person approach and the abilities to uphold quality and standards they are used to. In the current health and social care reforms, personalisation of services though may have different cardinal points such costs savings and social re-engineering however, it is also capable to re-establish some social chores that has been lost.

The model has illuminated the desire for most people to care for themselves. This aspiration is never blunted but the ability to do so have been robbed from them due to past welfare policies such as “direct provision”. This might have left them very frustrated and hopeless to attend their holistic care. However, the contemporary service frameworks such as “personal budget and cash for care” have invigorated some users’ skills and capabilities to join in their functional activities of daily living. The care pathways are helping some service users to reconnect with old skills and experiences from their past. It is also opening up new approaches in their mind and within their environment. For some, having their own personal assistants have helped them identify areas of concerned; where they have lost expertise and their personal assistants could gradually help them to reinvent their skills and knowledge.

Although, some older people with dementia have benefitted from having either personal budget or direct payments to revive their skills yet, a high proportion of service users have not been enthusiastic. Dementia and longevity of older people are to some extent inter-connected as a result majority of older people are physically disabled and frail to partake in their care needs. Therefore, the current service frameworks are not appropriate to facilitate home support services for a significant number of the aged and disabled. Practice based-observations have identified that predominant number of the aged and disabled still prefer “direct provision” as this care approach helps them reduce anxiety and stress of managing their own care and dealing with complexities around employment laws, finance and taxation.

Practice based-knowledge has shown that a high percentage of older people who are in receipt of health and social care in the community are diagnosed with dementia / Alzheimer. Apparently, displaying dementia symptoms can be extremely confusing, often belligerent and their ability to learn, reconnect with the past or understand complex/routine tasks have become difficult for most. Nonetheless, as personalisation of services is being universally introduced across social care sector, this would undoubtedly revolutionise a new perspective and probably attract many users or potential users and their families.

This approach would chimes with aspects of the government's recent health and social care white paper as well as the “Big Society” agenda and consumerism focus. In as much as these service frameworks may be appealing to some yet, a substantial number of older people would be unable to facilitate and participate in their own care. Equally, family units are getting smaller and many are migrating to other part of the globe for economic reasons thus, would not be available to support older relatives manage their care support plans. These care models may be suitable for younger older people or non-severely disabled people who have families around to support them as appropriate.

Retrospectively, the focus for “Direct Payments” was that majority of service users would flood the gates of local authority’s social services department and possibly take up the care model in place of direct provision. Experience has shown that direct payments did not attract many users therefore; the new approaches may not be exceptional. “Direct Provision” from social services may still be the right option for a large number of service users as they would rely on social/healthcare workers to organise their care and manage the risks associated with it. However, some of these risks could be managed by trustee yet; practice observations indicate that a high proportion of older people or disabled elders would reasonably ask for “Direct Provision” of care.

Managing the Storm: The Real World of Growing Older and Long-Term Care In The Future.

2012-10-22T09:40:00.000-07:00

"Rejoice, O young man, in thy youth; and let your heart cheer thee in the days of thy youth, and walk in the ways of thine heart, and in the sight of thine eyes: but know thou, that for all these things judgement awaits you (Ecclesiastes 11:9 KJV)" Growing old is what most humans do not envisage when they are young and in youthful/adult ages. Besides, ageing and retirement is inevitable for a significant majority of the population in society. This trajectory is encapsulated with a number of factors such as chronic medical conditions, physical disabilities, mental health and poverty. These manifestations could incapacitate peoples’ ability to sustain their living standards and functional activities of daily living. In addition, these situations have some inherent characteristics for example, stigma, loneliness, exclusion, low income, rejection and isolation. During this period of bewilderment and life alone with little or no support systems could be unbearable and devastating for many and might lead to a number of catastrophes in their lives.

Long are the days when traditional norms, values and support for care giving to older relatives were obvious and this promoted family cohesion and societal belief systems. In contrast, declining birth rate, smaller family members and, or composite/reconstituted family units have changed cultures and traditions that was widely held as natural family orientation. In addition, global migration of younger family members; perpetuated by economic prosperity has created devastating effects for older long-term care for older people in society today. Older people in most societies are left in the mercifully hands of local authorities' social services departments for their holistic care needs. However, this is common to the western world whilst in other parts of the glob for example, the African and Asian continents; family support systems are still firm and flourishing. Nonetheless, the growing older people’ population, the recent census (2011) in the UK indicated a huge decline in younger people. Practically; demographic change in the West is presenting challenges to the authorities. The questions are what would be the consequences to those older people, which have little or no resources to carter for their older age? Would local authorities and national governments be able to manage the increasing demand for care by this age group?

The financial gap between this group and the rest of society cannot be bridged hence the mainstream service users are on state benefits and a significant percentage do not have employment pensions especially the women. This undoubtedly has affected their standards of living and ability to privately fund their needs like the affluent in the wider population. It could be arguable that poverty within this group is endemic and most would not be able to purchase the necessary goods and services to sustain their psychosocial wellbeing and physical properties appropriate for activities of daily living. In the current economic situation and changing demography, an older person needs substantial savings in order to have the opportunity to safeguard their future. Unfortunately, the benefit systems in the Western world do not encourage endowment for the future. In hindsight, the current economic downturn would be a lesion for the youth and adult within working ages.

The austerity and financial turmoil affected many counties such as the USA and the West European countries more than the less privileged and undeveloped nations who are used to hardship for GDP per head. The recession from 2007 to the present time (2012) has exposed the vulnerabilities of those older people who have not thought about getting older and difficulties associated with ageing process. Historically, the youth and grown up adults have been reluctant and oblivious of saving and planning for the raining days; but have squandered their earning on lifestyles. Degenerating economic and financial circumstances and standard of living in the Western countries have uncovered the ingenuity and problems lying ahead regarding long-term care and other purposeful activities of daily living for the aged, which is inescapable for most humans.

However, it is a natural phenomenon to anticipate that as people gets older; the propensity is that most would not be able to attend their comprehensive activities of daily living such preparing meals or undertaking personal hygiene. It is then inevitable to assume that some would need assistance to manage their affairs and, or domestic chores. Dowelling on these, the government in the UK has introduced eligibility criteria matrix, which is banded at four different (critical, substantial, medium, low) levels. These are measures to identify those individuals that could be supported by the local government’ social services Departments with their needs. In practice, support is given to those that meet critical or substantial needs after thorough and due process of assessment of needs. Nonetheless, a significant majority suffer as they do not fall within criteria or substantial matrix and had no savings or asset/investment to rely on to maintain their wellbeing.

The growth of older people has intensified demand for social care and community wellbeing. This means those that have savings or assets are in a better position to buy their own care privately without relying on the state. In contrast, those without savings or investment but needs long-term care are added on to the waiting list and their conditions could deteriorate further whilst waiting. This development challenges the youth’s and adult’s behaviours/attitudes relating to savings for their future wellbeing in terms of; longevity and long-term care. On reflection; it is normal that most humans would grow older but, what is likely to be the outcome in relation to; physical and psychological welfare towards the end of life? The long-term liberal views of wealth redistribution and universalism are no longer pertinent in this contemporary era of calamitous economic position. Rather this has resonates the argument for and against “family care systems, individualism and capitalistic” conceptual frameworks as the national resources are scarcely available and only the very vulnerable could be supported.

Ageing and Disability: The Ramifications of Longevity of the Disabled Elders.

2012-09-02T08:51:00.000-07:00

Ageing and disabilities are inter-related and that constitutes human's genetics and pathological properties. Thus, being elderly is a process and expected but, being disabled is an addendum to these holistic trajectories of chromosomal makeup of mammals for which humans are one of them. These metamorphosis characteristics are inevitable though fluctuates and, or depends on once "moral luck". In our human experiences, it could be overwhelming to be elderly but, to be disabled is even more devastating. Thus, living with these distinctive features could pose some difficulties to undertake activities of daily living. The compound effect sometimes might be unhelpful and demoralising to most service users as they are living longer and incapable of attending their needs.

For some, undertaking holistic functional activities of daily living could be prodigious. This is particularly apparent with those people that have severe pathological and physical defects or challenging behaviours. As disabled people are living longer, their needs are becoming critical or substantial and that could be presenting difficulties in terms of physical and financial to both the informal and formal caregivers. It is now been observed in practice that “Pathological Demand Avoidance Syndrome” client group (PDA) is at increase and are living longer than other disabled people. This ailment is part of autistic spectrum and their care needs are complex and requires specialist input at all-time due to unpredictable nature of their condition.

This condition is a lifelong disability that affects boys and girls in society. People with PDA need different amounts of support depending on how their condition affects them. The main difficulty for people with PDA is their avoidance of the everyday demands made by other people, due to their high anxiety levels when they feel that they are not in control. However, because they tend to have much better social communication and interaction skills than other people on the spectrum, they can use those skills to disguise their resistance through common avoidance behaviour.

People with Pathological Demands Avoidance illnesses usually experience increased difficulties throughout their lives. They often imitate inappropriate exhibitions within a setting and may cause chaotic and distressing home life situations. This is the reason why they should have high input of support systems at all times. Autism is an overwhelmingly male diagnosis – it has even been described as the "extreme male brain". The question is why do women only make up one in four of those diagnosed with autism? Are women really less likely to have autism or are they just slipping through the net? Could it be that they are just better than their male counterparts at adapting to social situations or are simply more skilled at pretending not to have autism?

However, disabilities in general is inter-twined to sensory processing which describes our ability to take in information through our senses, organise and interpret that information, and make a meaningful response. For most people, sensory integration develops in the course of ordinary childhood activities, but for some people with disabilities despite the classifications (autism, learning difficulties, learning disabilities, cerebella palsy et al) sensory fraternization does not develop as efficiently as it should. Nevertheless, longevity amongst disabled people is on the increase and costing health and social services as well as the informal society a lot of money.

In the recent economic meltdown, questions are being asked whether the national health and social care would be able to continue to absorb increasing costs to maintain the statuesque. Does this mean that public opinion is shifting against normalisation of disabled people and their support systems? On the other hand, demographic change is presenting some difficulties to both the informal society and the wider welfare organisations that could support the aged and disabled. The latest census in the UK (2011) showed there are older people than the younger adults and this an issue of concern, which needs to be thought through, while adequate economic and structural adjustments are made to sustain holistic care needs of disabled people and the aged.

Therefore, planning for continuing care for the aged and disabled people is now paramount important hence this is likely to affect every citizen of the state in their lifetime. This challenge calls for political alliance hence non one political persuasion or organisation has the qualifications to deal with increasing disabled and older peoples’ health and social care needs. Care needs are not limited to a certain group of people, it rather poignant to all and sundry thus; collaboration between local and national governments as well as merger between health and social care would be appropriate and welcomed

Celebrating the National Health Service: Longevity of Disabled People.

2012-08-14T12:47:00.003-07:00

Historically the National Health Service is the crown jewellery of the welfare state in the UK. Its successes have become the envy of the world since its inception in 1948. The institution has improved and maintained the lives and health of the nation and its citizens. This is irrespective of sex, gender, ethnicity, age and disabilities. Health care has been free at the point of delivered. Yet, the service is paid for with National Insurance Contributions by the working population in the UK.

Despite its achievements and accomplishments, disabled people (learning and physical disabilities) were not seen as people with equal rights compared to non-disabled people. They were stigmatised and called different names such as the “mongos, cripples, loonies and handicapped”. Besides their castrations, they were locked up in “long stay hospitals” and had very little access to the community. Their life-expectancy was short, in many instances this determined by medical practitioners in the hospitals/homes who pegged it at 40-years-old, while many did not even have the privilege to live up to that age. Their needs were poorly managed and they had no choice of the services/care other than accepting what was available. Most were ill-treated and their outcry rose the issues of “Moral Integrity, Human Rights and Equal Opportunities” for all.

The plights of disabled people touched the hearts and minds of some members of the parliament and clergymen/women in the UK. The proponents for change exploited this opportunity and called for the abolition of the policies and legislation that supported segregation. This was widely supported by many pressure groups who lobbied their constituency members of parliament in the House of Commons. The protagonists sought for change and reforms of the National Health Service and the wider welfare services. This received “A Royal” shield and the birth of the “NHS and Community Care Act (1990). Since then reforms have not stopped but has gained momentum.

Thus, 1990 would be remembered by many people as a year of liberation for disabled people. It also marked the beginning of a road map for reforms in the wider welfare systems and normalisation of disabled people in the wider community. Normalising the lives of disabled people and their assimilation in the community has revived the general public’s attitudes and behaviours towards disabled people of different classifications. The reforms have made significant changes and improvements in the lives of this client groups as widely observed in practice and in the communities they live.

Reflecting on the attainments and realisations of the reforms, many disabled people now lives over 65-years-old and relatively in good health. Credits are due to the multitude of support systems such as advances in medical sciences, assistive technology, personalisation of services (Direct Payments, Cash for Care) and independent living. These have provided immerse opportunities and lifestyle for the client groups and their caregivers. For example, they are now able to access the community with their personal assistants and socialise with non-disabled people.

Similarly, health and social care professionals are now well educated in practice to understand and respond to challenging behaviours in children and adults with multiple pathology of disability. Every day, we see people with disabilities such as autism and attention deficit and they are expected to cope with their functional activities of daily living in a world, which can often seem bewildering and irrational. Most of the client groups (mild or severe disabilities) may need one form of support or the other therefore, it is imperative that their support systems are not interrupted in order not to confuse their retinue.

This can cause high levels of anxiety and stress, resulting in behaviours that can be difficult for other people to deal with. This could also offer significant trials to professionals who are involved in the provision of education, health and welfare services. Examining the unique tasks facing children and adults with disabilities, their conditions may exacerbate as they are ageing. This would tentatively present some dilemmas to professionals who are supporting them to attend their holistic needs. Thus, support plan or individual programme plans (IPP) for disabled people require continuous monitoring and appraisal of their needs as well as adequate financial and human resources.

The current reforms within health and social care sectors are threaten some of the achievements already made to safeguard the wellbeing of many service users. The danger is that as people with learning disabilities for instance are getting older, they may face the same physical and mental problems of all ageing people. Most would need increasing support to ensure they grow old in a society where their safety and dignity could be maintained. On the other hand, parents who are the main caregivers for their children with learning disabilities or those with physical infirmities may find it more difficult to cope as they get older. More than often, siblings and other relatives who take on this role struggle to find information they need because they have not been part of care giving.

Consequently, older persons with disabilities who do not have relatives risk a future of increasing isolation hence social work has changed to care management approach. They have little opportunities to rapport with service users as it used to be in the past. They are now responsible for care commission while service users have to source and appoint their own personal assistants and this could be a difficulty for many. Thus, the unanswered questions within the current welfare systems are who will protect the interests of the vulnerable if their parents are no longer able to? Would the local authorities’ social services departments perform dual roles of commissioning and care delivery therefore, what’s going to be the legal and financial implications for authorities?

In anticipation, adults with profound, moderate or severe behaviours who are living independently with their personal assistants may find it difficult in the long-run when they are aged. There are still many potential issues around; choice and control, managing their personal budgets and finances as well as maintaining health and safety around them. It is been observed in practice that supported or assisted housing is not always appropriate for older adults with disabilities, who might need assistance with physical activities for example, mounting stairs or getting in/out of the bath as well as preparing meals and other domestic chores. Conversely, generic homes for the elderly may not have resources or be suitable for the specific needs of people with challenging behaviours. Longevity of disabled people needs to be celebrated owing to the NHS and community care reforms and continuous re-organisations of the industry.

2012-07-20T09:55:00.000-07:00

The Ailing Welfare Service: Reforms of Health and Social Care Needs Proper Scrutiny.

Change is part of a humans’ existence therefore, it is unavoidable and timeless. This concept is interrelated and insensitive to current occurrences within the wider welfare institutions in the UK’s health and social care sectors in particular. At present, health and social services are yet again undergoing a painstaking restructuring that is creating psychological and physical stresses to the entire workforce and consumers. This trajectory is building uncertain future due to continuous re-organizations, change of emphasis and redirections of care delivery to the general public. Ironically, people are not sure where their future and loyalty lies as changes in the system is triggering great worries to all concerned.

On reflection, health and social services went through a huge conscientious change in 1990s (The NHS and Community Care Act), that reconfigured the welfare systems to what many practitioners and managers thought would be a modern establishment. However, the New Labour government in 1997 to 2010 changed the prospect and redesigned it to new approaches such as personalization of services (Direct payments, Cash for Care and Personal Budgets) that transformed services delivery within the sectors. Change can make or break staff commitment, maximization of services, profitability or industrial disputes between the management and employees, this owing to mishaps within industrial relations’ policies and protocols.

Changing organizational cultures as well as philosophy and employee’s terms of reference requires effective governance and scrutiny in order to ensure health and social care reforms work for the benefits of all. The key to making the reforms work as planned would be to safeguard effective analysis of all new policy directives and structures. It is now questionable whether the “New Ways of Working” is capable of changing the fabrics and structures of the welfare services in the UK. The main themes of the overhauls are to reduce costs/budgets, staffing and improving quality and standards of services.

Decision making in some departments or services are proving to be irrational because costs are escalating, standards declining and waiting lists for assessment increasing across many social services departments. Most quality newspapers affirm that the coalition may have done everything they could to start implementing health and social care modifications before being properly examined. But, without careful considerations and good governance the plans would be an unmitigated disaster. That notwithstanding, the speed of restructuring and reallocation of services have produced an unsettling atmosphere for most health/social care workers and managers. The government’ itinerary to continue with reforms and their failure to allow time for study or to win the professional's backing for these radical plans have been challenging to the wider community of experts and the public at large.

Considering the clamor amongst practitioners and clinicians, the question is, would the governments’ defiant be regarded as democratic or dictetorism? In contrast, it is believed that democracy means “government for the people and by the people”. If that is the case, the coalition would have itself to be blamed for any criticisms regarding their actions. The dismantling of the (PCT) Primary Care Trusts throughout the country in the next two or three years could be termed as political vandalism of tax payer’s money and good governance.

Similarly, most strategic health and local government authorities have expressed concerns regarding cutbacks on their budget, which could have huge ramifications to services for older people and other vulnerable groups such as people with disabilities and mental health. This has also been widely highlighted by a large proportion of the professional bodies such as the Nursing and Midwifery Council, British Medical Association and BBC 2 News Night in particular. The criticisms of the government is now without seasoning because health and social care organizations needs to double their expected cuts in order to remain afloat.

The growth of older people and their increasing demand for care is now unprecedented and becoming a threat to the welfare service and public services. This is despite extraordinary support from informal caregivers who are believed to have saved the government over eleven (£11bn) billion pounds a year. That notwithstanding, change is needed to reduce duplications within the system therefore, what is desirable now is a long term strategic alliance between all stakeholders (the national and local governments, health and social care and family members etc.). This would guarantee and strengthen collaborative services and minimization of costs and wastage within the sectors involved. Yet, judging from the current state of the economy both the macro and micro variable, it is certain that change is foreseeable in order to meet the challenges presented by the turmoil in the financial market and escalation of cost to maintain health and social care.

However, the difficulty in planning, management and administration of the ageing universal service in the UK has been made a lot harder as a result of disproportionately deep cuts to local authorities. The Big Society agenda indicated that the government should devolve responsibilities to the community, individuals, families and the third sector. By all assumptions, this would ensure that service users’ care would continue while restructuring is in progress. In hindsight, the key to making the reforms work would be to safeguard effective control and scrutiny of all the workflow patterns and services delivery. Practically, this has proved overwhelming for the organizations and management as details of the shake-up is superficial in terms of economics and socio-politics in line with social policy in the UK.

Presently, the government seems unconcerned and flustered regarding the “House of Common’s” health select committee's proposal that councillors should be appointed to have seats on the boards of GPs consortia. On reflection, the quality and capacity of the representatives of some voluntary bodies such as: patients/service user’s liaison body and the local involvement network agencies could be inconsistent and lacking because of clinical and financial expertise. Thus, as a scrutiny committee, it would in practice be problematic to work closely with Health Watch, as well as with the health and wellbeing boards.

For further reading connect to my blog: http://changinglifeparadigm.blogspot.com

Living with Disability: The Marginalised Society.

2012-07-04T09:15:00.000-07:00

Disability is a condition which has no barriers despite ones’ position and heights of achievements in society. This could occur as a result of certain conditions such as genetics, accident, degeneration of physiology and anatomy of human structures and organs. Disabled people are humans and they deserve fair access, treatment and respect in the community they belong to.

Disability is defined as the inability to attend ones holistic functional activities of daily living hence the person relies on others to meet this end. This condition could be grouped under the following pathological properties: physical or sensory disabilities; learning disabilities and or, difficulties; dementia and mental health problems. I tend to extend this definition to cover; the aged who are physically frail and bed ridden and all their care needs are provided by multidisciplinary teams (nurses, carers and social workers) either in their own home or in institutional settings.

Disabling conditions could be minimised, prolonged or complicated, this owing to improvements or poor public services as well as the complex universal welfare services or more of the sort in some countries. On the other hand, advances in techno-medical sciences have lead to longevity of disabled people and this was unthinkable in the last century when diagnosis and prognosis of disability were very poor. Meanwhile, some disabled people appear to enjoy the privileges and standards of living that were available only to the able bodied persons which, have been engineered through progressive political emancipation to recognise the existence of people with infirmities in society. Also, the pressure groups as well as the Disability Alliance in the UK have intensified lobbing to all political parties seeking equal rights for disabled people.

However, if the support systems are working well to support disabled people irrespective of their age, creed and gender, the question remains does non- disabled people understand what it is to be disabled? A number of legislation and policies such as the National Assistance Act (1948 s29), Chronically Sick and Disabled Persons Act (1970 s 1), the NHS and Community Act (1990) and Department of Health (2008) have been enacted to support disabled people. Should we assume that this justify “Moral Integrity” to the dilemmas of disabled people, as a means to an ends?

Morals as well as ethics in this concept can be complex, as it could possibly be argued either from the “conformist or non-conformist” ideological perspectives. The conformists would argue that supporting disabled people is a duty which the public in general should embark upon given that a significant majority of disabled people need all the help they can muster as a means to an end. Conversely, the non-conformists would argue, expressing their views from a different standpoint, illuminating the fact that moral justification to support disabled people should be an individual acuity and cannot be imposed on others. In this frame of mind and ideological conviction, individuals cannot take over governmental duties and responsibilities in expectation that they are carrying out civic duties.

The argument highlights the personal aspect of ethics within the wider society. In hindsight we all have a personal sense of duty, of what is right for them to do and so choose to waive their right to exceptions such as moral conscience that most people use to excuse for not performing such duties. Most forms of utilitarianism are rigidly impersonal, treating every life as of the same value in moral assessments, and tend to underestimate the importance of personal aims and commitments. These are often overridden when the utilitarianism standard is used in reaching moral decision, and to this extent utilitarianism is seen by some as giving a less than adequate account of peoples' own priorities and sense of their own moral integrity.

In what ever cardinal point the argument may be directed, it should be noted that disabling conditions can be debilitating and can also increase the vulnerability of disabled persons. Some times disabled persons may look like scroungers relying on others or the welfare systems to achieving their holistic needs. Yet, how does the disabled person feel about his/her condition and equally, what are the wider societal views? Whatever the reason might be, the perceptions of the wider community may vary and the question is does their views supports the “Golden Rule” philosophy; which implies - “Do to others what you expect to receive from them.” Would these conceptual frameworks be conciliation for disabled people that the public understands their plight therefore, they are accepted as equal in the community at large?

Moral opinions have some relevance to most scriptures and religions of the world but, the question is, are these universally tolerable to all? Answers to these may have subjective and inter-subjective properties hence people would not be compelled to abide by a defined moral obligations. However, the “Golden Rules” have set the yardstick for moral discourse to support the needy and treat all evenly and be mindful of discriminating against those who are less privileged. Living with disability has profound consequences for the lives of disabled people to fit in with peer groups, sometimes within the family, friends and the wider society. Prejudice at this level has some pathological, psychological and psychosocial implications in the person’s life. This may some time lead to psychotic episodes as well as an undignified life style and uncertain future to succeed as a good citizen of the state.

Reflecting on the current economic meltdown, everything seems to be against disabled people as they have little opportunity to pursue a career of their choice because of societal bigotry and non-forbearance of social justice and diversity. Based on these beliefs, one would assume that the Equality Act and other related legislation are “White Elephant”? For example, the "Golden Rules, Bill of Rights and Humans Rights" lay down conventions and policies recognising the rights and existence of every one irrespective of their ability and effrontery to abhor discrimination and uphold common values, norms, co-habitation and equality of opportunities to all in a fair and equal society and the world at large.

For further reading, go to my Blog: http://changinglifeparadigm.blogspot.com

Discrimination against the Elderly; Facing the Reality Life

2012-06-06T03:53:00.001-07:00

In today’s world the aged are seen as a burden on the working population and the universal services framework. By coincidence, the support structures that formed the central plank of the welfare service that is meant to sustain the vulnerable in society appears inadequate, despite the current and past legislation to address stereotypical about them. In accordance with the NHS and Community Care Act (1990), long stays in hospitals were disestablished in order to accommodate older people in the community; so they could excise their rights in line with any other citizen of the state. In the main, the terms “Normalization and Social Valorization” were invented and mobilized to eradicate discrimination against the aged and the services they receive in their own home in the community or institutional settings. Despite that, the Equality Act (2010) was enacted and implemented to supersede all previous legislation, policies and frameworks that were already in place. The overall aims is to strengthen services for older people however, the widely held perceptions about them have not changed in practice.
The elderly are still more at risk than before when compared with other vulnerable groups such as those suffering from mental health problems, learning disabilities and physical impairments that rely on public services to survive. In some local authorities, the cost of maintaining an older person in his/her own home is benchmarked at four hundred pounds (£400.00) per week; whilst a person with learning disabilities can receive up to one thousand pounds (£1,000.00) per week and a person with physical impairment can receive up to seven hundred and eighty pounds (£780.00) per week. Based on these observations, one would conclude that discrimination against the aged population is endemic in all spheres of the welfare systems.
The question is would the “New Ways of Working” such as personalization of services (Individual budgets, Cash for Care) be different from the previous practices of direct provision, care management approach and generic social work? These service frameworks were embedded in the system to engage with and integrate fully with the service user(s) and their informal carers/families, in anticipation to help them turn their lives around and manage their needs. Actually, social work is about lives changing and that is characterized by nurturing social inclusion, education, advocacy, advice and providing enhanced opportunities to reduce social malice, squalor and deprivations in the wider society. However, these conceptual frameworks on the other hand, encouraged dependency culture that is in some cases proliferate generational cycle of benefits seeking, laziness and unproductiveness in society at large.
The approach may have good intentions to revolutionize health/community wellbeing and organizational structures but, the model is adopted to curtail spending on staffing and services for which the aged and other vulnerable groups depend upon. Most users have seen their care packages reduced and are now unable to cope with their increasing needs. The framework is about changing social services for the aged; from welfare rights to care systems, which I call “Manipulative Power of Delegated Authority”. Unfortunately, a high proportion of the aged service users would not fare well in this socio-political and economic model of the welfare service and would continue to suffer as a result.
Judging from history, politicians of all political persuasions have always seen the aged population as the “Weaker Partner in the Welfare Discourse”. This indicates that any downwards trend in the economy, cuts would commence from that spectrum of the welfare service. The current economic decline and austerity measures have proven the case. These viewpoints tend to drive a high percentage of older people into unbearable economic difficulties, poverty and isolation, which could on the long-run lead to poor health; if services are not provided.
On reflection, government policies have always been geared towards improving the older people services in line with other clients group. Yet, that seems not to the case hence policies are overwhelmed by emergency cost implications due to care breakdowns thus, services are rationed within budgets. This has necessitated reactive management arrangement which only promotes ad-hoc services that has a limited range of support systems articulated to addressing long-term issues concerning the growing older people’s population. The present macro and micro economic situations around the globe has worsened the fragile recognition and respect accorded to the aged and their wellbeing.
The New Ways of Working has in away collaborated by ignoring their plights therefore, compelling a significant majority to take full control of their holistic functional activities of daily living. This is in contrast with their abilities to undertake personalization of services where they can make choices to control to and employ their own assistants. In most cases, the majority of the aged are frail, disabled or may have dementing illnesses that could inhibit their abilities to make decisions concerning their social care needs. However, it is imperative that change must form part of social reengineering in an effort to cater for the growing older people’s population and their increasing social care with limited resources.
Both the contemporary and previous practices have tried to ignore the fact that older people are the architect of the socio-economic wellbeing and occupy centre ground in society where we all thrive. In this reverence, we should be mindful that older people are what I call a "Fragile Economy of Mankind", nature cannot be ignored, and ageing is a process thus, it is imperative to acknowledge that the aged needs continuing care. The growth of the aged population demands a joint effort from all stakeholders such as the local and national governments as well as the family members who supposedly would be at their beck and call to maintain life.
Sadly, family units at this contemporary age are shrinking; the aged cannot willfully rely on their immediate family as a source of help to meet their functional activities of daily living. Inevitably, the aged are at all times more vulnerable than the rest of the population and the question is why this should be the case though ageing is a journey that awaits all; if you have the privilege.

Growing Old in the 21st Century: Inclusion through Policy and Practice

2011-08-18T05:51:00.000-07:00

Dementia is one of the signs of the ageing process and a significant number of people; irrespective of their colour and gender would go through this journey in their life time. The disease carries a “stigma” which can be demeaning to suffers and their family members who assist them with their functional activities of daily living. The ill-health may present a momentous threat to the wider welfare service in the 21st Century and beyond if strategic investment in human resources are not made. This is due to increasing chronic medical conditions; longevity; the growing older peoples’ population; globalisation; migration and liner family units. However, the current social policy on immigration and universal benefits have influenced the opportunities for influx of migrants who could potentially be employed in the care sector to assist older people with their holistic care needs.

It is quite obvious there are gaps in how services are provided within the wider older people service, which leads to a large number of re-admissions and delayed discharges as services are not joined up (DoH 2003, 2005). Good practice suggest; in older people's “mental health” services, the need for a holistic assessment of the person's physical and mental health needs are key to maintaining and supporting the person and their informal caregivers to remain in their own homes for as long as possible. This requires a commitment from all services to work together to achieve this. In practice, this is not always easy due to conflicting priorities and financial restraints both in the acute hospitals and local authority budgets. What would really help is a joint commissioning strategy across all agencies and even pool budgets.

Reflecting on dementia service, practice observations have highlighted gaps in meeting holistic needs of the service users; this is due to disparities within the health and social care sectors. Conflicting policy decisions and different organisational cultures have created some difficulties for older people and their families to access services and support systems available to them. They have to go through different health and social care services to be able to gain access while repeating themselves as they go through the process, seeing different people/specialist and formal caregivers. Nonetheless, this is despite the present and previous government’s endeavours to develop strategies to address the gaps, which ensures joint strategies between health and social care.

Joint working initiatives are intended to oversee a design models for services in place that underpinned whole systems approach in the sectors. This model is crucial to facilitate a modernised health and social care that is capable enough to address the growing older people’s care needs now and in the future. By all means, this is critical in this period of financial challenges that agencies work together to ensure the best outcome for vulnerable older people. Thus, collectively the organisations can achieve best value by looking at services from the perspective of whole systems while giving priorities to the following measures:

Risk minimisation

The current eligibility criteria (DoH 2010) has provided a new assessment matrix that underpinned assessment models however, most health and social care authorities have focused on “Critical and Substantial” needs while moderate and low needs are ignored. This policy decisions are in contrast with long term measures to reducing future critical and substantial needs that are likely to cost a lot of money in the future. Preventative services have the potential to curtail spending both in the short and long-term processes. It would help to stabilise and co-ordinate community service, give the professionals the opportunity to plan and execute procedures that are designed to minimise risks and speed up responses by health and social care teams. The key critical success factors are to provide people with the tools to make decisions about what keeps them well, maintains their quality of life, empowering them to be responsible and active in their own community, reducing the dependence on health and social care.

Choices and control

Personalisation of services have provided an avenue to uphold choice and control while seeking access to services and this is a critical ingredient for supporting older people to live independently in the community for as long as they wish to do so. Equally, housing and assisted living equipment such as “Telecare systems”, individual budgets or direct payments are important ways of ensuring independence whilst maintaining safety environment and support. This provided service users with the opportunity to choose their own personal assistants to support them with their functional activities of daily living. It has also intensified flexibility in the social care market, providing a range of choices and interactions between service users and providers of services. The model has the propensity to remove barriers, which hinders equity and quality of care giving; while older people and other vulnerable users are able to challenge discrimination in the service. Personalisation, linked with “Telecare” and assisted living tools surpasses the benefits of managed/direct provision, whilst service users are able to exercise their human rights. Nonetheless, it is expected that for some people living at home alone perhaps can increase the danger of vulnerability but it is important that we do what we can to understand and minimise this with regular support and monitoring.

Monitoring of services

An essential component in services delivery is the ability to stabilise checks and balances while achieving best value and quality of care. By contrast, practice observations have revealed that consistent services review is lacking and a high proportion of care packages have not been reviewed for a number of years and this has contributed to poor budgetary control. Therefore, continuous reviews and monitoring of services have the potential to reduce dependency culture, duplication of services and maximisation of resources, giving the growing older people population; liner family units and demographic change. Interestingly, personalisation of services is one of the ways to remedy some of the mishaps within the service as the service users are able to demonstrate the ability to choose their own personal assistants and manage their budgets. Monitoring is core to effective services delivery, quality, equality and equity as having a trained worker which respects individual dignity, choice and promotes empowerment is both satisfying to the professionals delivering a service and for the person receiving this good quality service. However, the quality of any service depends on the people who deliver it. Quality of service is the most important aspect of our service delivery model.

To sum up, we all have to remind ourselves that these are not just services for "older people". These are services we will all be using at some point in our life time therefore, it is important that we ask ourselves, “What type of services would we desire for when we need it…”? Our futures are all at stake. An ad-hoc financial management is not the answer for our future existence, effective and constructive planning is imperative to safeguard older people services now and in the future.

Vision for Community Health and Social Care: A Perspective for Collaboration between Agencies

2011-08-04T06:47:00.000-07:00

Restructuring of health and social care is forcing many services to close or become streamlined and managers have had to find new ways to ensure they get financial support to continue services’ delivery. In the current climate of rationing services, preventative care should be re-in fenced to minimise accidents and service users’ health deterioration at home. The measure is intended to save health and social care money in the long run. By contrast, due to drastic cuts across the public sector organisations, unfortunately preventative services are often the first to be axed. This actually tantamount to negligence at core, which later challenges the existence of our prime services – to manage complex situations such as the critical and substantial care needs. Therefore, what is the rationale behind this policy decisions?

Nonetheless, it could be argued that such decisions are accredited to the tunnel vision of some senior managers. In hindsight, some of them can only see within the parameters of their corporate responsibilities that is “to save money”. In reality, it is only the older people and the other vulnerable groups in society that would suffer the consequences of such irrational decision-making. Thus, the aims of this article is to illuminate how the managers could make the case for continuing care delivery in a changing economic environment in relation to; demographic change and linear family units in the 21st Century and beyond.

On reflection, best practice would suggest that in a time of economic and budgetary constraints, collaboration with the local primary care trusts, community organisations and the third sector institutions would prevail. This would ensure that the vulnerable service users will be supported adequately to become more independent in their homes. Partnership working between agencies has the propensity for sharing resources such as, staff, information technology, offices, intelligence etc. If we are to emulate the private sector, mutualisation would help in reducing unmet needs and service breakdowns in the community. Sharing responsibilities would also promote health and psychosocial well-being among service users as well as reducing the need for admissions into nursing homes or hospital admissions.

Managing community services require organisational cultures and political change, which would give rise to the sharing of intelligence between the collaborated organisations who are working for the benefits of service users (older people, learning disabilities or mental health). This approach is intended to provide opportunities in reducing services’ duplications, costs and antagonistic relationships between agencies. Whilst capitalising on intelligence sharing, a lot of soft evidences could turn to hard evidences, this coming directly from community health practitioners such as community nurses and social workers. This data would show for example, figures on how many older people or the other vulnerable groups that were admitted to hospital after a fall or care breakdowns and what these cost the NHS and social services in after-care.

Looking at the frequency of falls and care breakdowns among the service users in a given period, the estimated figure would provide a relative forecast for the number of incidents that could lead to hospital admissions in future, costs to local primary trust and cost of care packages to social services. These results would be instrumental to future planning for community base services and implementation of strategies appropriate in reducing falls or care breakdowns at home. The projected cost savings could be reinvested to preventative services in line with continuing safe environments, where older people and other service users could be rehabilitated to minimise falls.

In practice, good risk assessments provide the opportunity for service users to be assisted in a safe environments, this could be in their own home or in a residential setting. These should be incorporated into day-to-day operations and will often run alongside equality monitoring of services. This is about getting the balance right between planning, delivery of services and managing information. This approach should be robust and prudent as to ensure cost recovery and quality care management for service users and their informal caregivers. Information gathering and monitoring of services would intensify support for community services while users are able to make choices and control of their support networks.

Another important source of evidence is feedback and “quotes from service users”. This adds to the richness of evidence. Hence, the service users know what they want and the standards they are used to, rather than the professionals prescribing for them. This signals the process for change and how services could be delivered in future. The service users and their families should be part of the new thinking in a modernising health and social care sectors and they have rights like any other citizen of the state to make informed decisions and choices.

For health and social services to remain in the premier league of services delivery within the wider welfare and universal service frameworks, it is imperative that investment in research and development is forthcoming. This provides an apparatus for good evidence based practice, where data could be shared, analysed and put to action as a mechanism in maintaining safety net. In the light of this, there is every indication that unless mutualisation is considered each of the organisations would not be able to meet the increasing needs of the growing service users now and in the future.

Inevitably, advancement in technology is changing our world and the methods of working. Thus, capturing quality practice based evidence from service users and their families could be made simple by developing and implementing scorecard systems so that individuals who come to the service can tell us things. This could be on a scale of one to five for example, telling us how depressed they feel about their care; how they feel about their health; how many falls they had in the last one month and how to improve services further. These questions or survey could be repeated every three to six months in order to compare and contrast findings. The information gathered would help determine investment in human resources and hospital avoidance strategies necessary to support older people and the other vulnerable groups to be cared for in the community for as long as possible.

All things being equal, Data Protection Act (1998) and Freedom of Information Act (2005) could constrain sharing and flow of information between agencies and this would influence services delivery in the community. If that is the case, duplication of services would continue to be present coupled with poor information sharing between agencies. In practice, duplication of services and assessment works against the best interest of the service users, hence this can create anxiety, repetition of information and exacerbation of stress amongst the users. Equally, duplication of services could lead to costs escalations between agencies and these defies the objects for cost effectiveness and strategies for recovery and business turnaround (Ugwumadu 2011).

Privacy and Dignity: The Quest for Quality Care Delivery.

2011-07-19T06:59:00.000-07:00

The basic principle of human right is the ability to safeguard dignity at all times. However, in some cases, longevity of care linked with poor health and disabilities mean older people as well as other vulnerable groups’ have had their dignity compromised to some extent during care giving. This is because some of these groups are unable to maintain their dignity and rely on others such as informal or formal carers to assist them. This situation is likely to become a challenge or degrading to some people in future as the population is becoming older with complex needs as well as increasing demand for care in their own homes or in an institutional care homes. In reality, this would mean that in some instances their dignity and basic human rights might be overlooked.

In this endeavour, maintaining human dignity is a basic principle. As a result one should have the values to cherish and respect people irrespective of gender, colour, age and disabilities. These principles and values are enshrined in both the Humans Right Act (1998) and Equality Act (2010) yet; politicians of different persuasions have shielded away positive actions to address the issues regarding: poor quality of care; demographic change, the growth of older people and their increasing demand for care and significant support for carers. Most times, when you read headlines and comments by leading politicians (law makers, executives etc) you will find that they suggest ways of helping older people as well as other vulnerable groups and their families to come to terms with their current needs.

Nonetheless, changes within health and social care have created a market where demand has superseded supply. This has affected the supply of quality workers who probably have the right skills and experiences to assist older people to observe their dignity. Practice observations have uncovered worrying cases of neglects, abuse, deprivations and institutional abuse of different kinds. This typifies examples of lacking respect for older people's privacy and dignity. Social worker’s caseload on “Safeguarding of Vulnerable Adults” is on the increase as they are trying to address issues emanating from poor quality and lack of experience to deliver care. Neglecting service user’s dignity is a disturbing experience that has to be tackled but can only be achieved through comprehensive funding supported by all political parties. Otherwise there is uncertain future facing mostly the poorer in society who cannot afford private carers to support them at the greatest time of need in their lives.

Promoting dignity and privacy of older people and other vulnerable groups during care giving is paramount. But as evidence has shown there has been a shortage of both formal and informal carers as well as the lack of experience by a high proportion of carers are major problems in the home care system. Some of the complaints from both families and users of service are for example, people being left in filthy nightwear and bedding after a home care visit or without a wash or hair wash for several weeks. Home care visits are sometimes so brief (fifteen minutes) and people have to choose between having a cooked meal or a wash. The short visits also mean that carers have to rush tasks like washing and dressing, which frustrates the users of health and social care and care staff as well as family members.

Apparently, high staff turnover both in home care and residential care settings have a profound impact on the cared for persons and to some extent their relatives. Both the cared for persons and their relatives have described the emotional impact of being washed and dressed by a large number of different people, and having to repeatedly disclose personal information every time a new care worker comes around to assist them with personal care. In addition, some older people find it difficult in engaging with younger carers who have no experience of care giving. Some feel that their privacy and dignity are not respected when they are undressed by some care workers in front of family members or in front of their bungalow window.

The problems or the difficulties come from two dimensions - when organisations lose sight of the person they are caring for and it becomes about a task, and – How do we get older people (in particular) to be well-informed as powerful consumers? They are very passive about complaining. Hence social services’ budgets are under a lot of pressure because of: the growing older people population and their increasing demand for care; the comprehensive spending review and the government policy on spending. Nonetheless, service users need to be more assertive in getting the right care they need, at the time they need it.

Despite government commitments made by both the previous and current government, basic rights to dignity, respect and autonomy are still being breached. The biggest threat to the human rights of older people as well as other vulnerable groups who are receiving care at home is from cuts to adult social care budgets, and it is very unclear whether tightening eligibility criteria to care will allow local authorities to continue to meet their human rights obligations. It should be recognised that there is no place for poor quality care in care services, either in the home care system or in residential homes (Ugwumadu 2011).

Unsettling Future: The Implications of Personalisation of Services for the Ageing Population

2011-07-11T08:29:00.000-07:00

Personal social service has a long history however; it has gradually developed in different forms and approaches for example, the Monasteries, the Friendly Societies, the Poor Law and the National Assistance Act (1947), who provided safety net for universal standard of care. Despite the legislative frameworks for care standards, family care system has been unique and the longest approach known to human race to support the disabled and sick people in society. Thus, the legislation in 1947 only unified, strengthened and shifted emphasis towards the state’s interventions through health and social services. However, the sectors have witnessed a number of changes and developments though; the focus has been to support older people, people with learning or physical disabilities, those with mental health problems and recently those with HIV/Aids. In hindsight, the advent of “care management process (DH 1990), personalisation of services (DH 2005) and recently the Eligibility Criteria Matrix (DH 2010)” has revealed the declining of universal standards for care. Yet, the proponents of the “Care Quality Commission” may argue that the commission is in a position to address the issues relating to poor quality of care and Safe Guarding of Vulnerable Adult but; practice observations have shown otherwise.

In this age of civilisation, quality of care is paramount in the lives of the vulnerable in society. We have to admit that some of the concepts or service frameworks such as care management approach have contributed to falling standards of care. This is because social workers are no long able to practice social work but gate keepers for budgets. They barely apply their knowledge-based practice, experience and professionalisms to monitor services delivery. On reflection, the system faces increasing pressures from people living longer and some have more complex needs as they approach the end of life. Given the current economic climate within health and social care the government needs setting out the support and services that service users, patients, carers and families can expect to receive from the establishments. Equally, there should be a declaration from the government to rein-fence social care budgets now and the future as this would help to uphold standards of care. The redesigned services and budgets would enhance the safety-net of the vulnerable in society. This would indicate new systems of support to achieve high-quality care. In addition, families’ involvements and supports would promote lasting support services for the growing vulnerable users in our society.

We must not lose sight that development in medical sciences and bio-technological advancements mean that people are living longer even with disabilities and chronic conditions. These reflect the complexity of service users’ and patients' needs and the type of care required. However, enhanced community care with adequate budgetary commitments would allow social workers and allied professionals (community nurses, occupational therapists and physiotherapists) to practice their profession. This would tentatively modernise community-based services whilst enabling more people to remain in their own home for as long as possible. Experience has shown that collaboration between health professionals and social workers have the propensity to deliver quality care standards within best value principles. By contrast, collaborations have been slowed down because of both internal and external factors such as, organisational cultures and traditions, politics, power and technical know how while budget constraints have been put at the forefront. To avoid these mishaps, there should be a change in the system to allow merger of the two agencies and this would enable them work together towards a common goal.

Operationally, service users get better clinical or personal social services and economic outcomes when they receive services in their own home. This means social workers should be given the freedom to practice social work as directed by their professional ethical standards. Lack of this opportunity meant there is no adequate tariff to monitor quality in the community and is not surprising that good outcomes are not achieved. The tariff would cover all patients' or service users’ clinically assessed needs, regardless of setting, age and disabilities. Each patient or service users would have an appointed health/social care worker to help guide them through the different services. They would also have their social care needs covered at the end of life. However, the modernisation agenda/personalisation of services such as “Cash for Care, Direct Payments or Individual Budgets” have not made significant contributions to improve quality standards hence there is little interventions by social care workers in the community.

On the other hand, family units are declining yet, in most cases families are the first point of call for service users before they could approach the state for support. To facilitate universal standards of care, families have to be involved working in parallel with either personalisation or care management service frameworks. However, it could be argued that quality is in the eyes of the beholder but practice evidence has demonstrated that families have the abilities to provide psychosocial wellbeing than strangers and that enhances quality and standards of care. Family care giving is linked with cultures and traditions as well as sharing past and present family history between generations. Interactions of any kind provide learning opportunities for the younger members of the family who disseminate such practices, experiences and knowledge to their own offspring. Families’ involvements are not a question of parochial views but significant observations because they know the standards their relatives are used to as a result they would endeavour to maintain that better than strangers. Nonetheless, to achieve universal care standards it requires political will that is unconditional, this is directed to promote family values and norms while social workers are encouraged to practice social work to later.

New Ways of Working in Health and Social Care: New Management Challenges

2011-06-28T03:00:00.000-07:00

Changing work plan and culture in health and social care means organisations having to do things differently This is obvious in every day practice for example, professionals such as social workers, nurses, doctors and physiotherapists, may have been well trained but not necessarily on how to manage resources at large. In practice, management of resources deserves a special skill and knowledge necessary for anyone wanting to lead a changing organisation. The enthusiasm for health and social care to move into employee-led mutual will create new issues for managers, who have been promoted to a higher levels and those left behind, not least in dealing with each other.

Decentralisation and delegation of authorities would create new management challenges. Managers of employee-led mutual must be comfortable with making money from practice and taking risks for their business to survive and thrive. Invariably, health and social care managers needs to be innovative and entrepreneurial within their particular specialism however, that's quite different from their career and their professionalism could be on the line if that does not work out well The difficulty is health and social care sectors are militated against by its many layers of bureaucracy and management, while guaranteed work flow and pension’s provision, which is fast disappearing and make any change a scary prospect for managers.

To facilitate the move towards employee’s led mutual, decentralisation or innovation within the sectors for example, bottom up management approach has to be explored, though these have been overlooked for a long-time in public sector organisations such as social service. Professionally, employee’s led mutual could be an answer to vocational calls from service users for better services delivery. This would allow leaders to dismantle some of the bureaucracy, frustrations and risk-aversion within sectors. Operationally, employees’ led mutual is a great way of doing things, because you make people fully responsible for what they do. Involving them in the decision-making process means staff does not get to disassociate themselves from the consequence of their actions. The focus now is one of collaboration and empowerment, rather than the hierarchical, command-and-control structure of the organisations.

New ways of working could have some ramifications in practice for example, a recent social enterprise coalition poll of 2,000 people showed that 43% of respondendants would entrust public services to social enterprises that reinvest profits, 36% would prefer the government/local authorities or public sector and 4% want the private sector to run health and social services of the future. This survey clearly rejected private enterprises to run the welfare services. The popular opinion indicated that social enterprise could provide adequate and enviable services to users however, does the sector have the skills, knowledge and experiences that the managers of public sector organisations have. The emerging cultures and work plan approaches are yet to be tested to meet the increasing and complex needs of the patients/service users and their families.
On reflection, health and social care sectors could learn much from private sector models of innovation, and the skills and capabilities of private sector managers must be adopted by those heading the changing organisations. In practice, professionals generally do not particularly have strong skills to manage complex issues within the organisation. People have been recruited on their specialism for example, being the best surgeon does not make you the best chief executive director of service delivery. In local government, there is certainly a propensity to administer rather than manage.

Typically, you will have professionals who have been well trained, but not necessarily to manage for example, social workers or nurses will know how to carry out needs assessment and provide care within resources available to them. However, they may not have the skills and knowledge to manage budgets, capacity and aggregate planning or being diplomatic while managing the services they deliver. Working in a mutual organisation requires a different mindset and requires managers to perform differently outside the protected environment of the welfare service (specialism).
It is no longer sufficient just to do a good job; managers must be able to sell, develop and deliver, knowing that the market will always be on the lookout for a better option. This removes the safety net, meaning they must be less risk-averse, more dynamic and certainly more efficient, effective and economical in order to maximise resources and budgets. In the current climate of new ways of working, managers and leaders will need to adopt many new skills and competencies required to demonstrate their abilities to defend their positions.

In hindsight, health and social care sectors could lose its brightest and best people to employee-led mutual hence they are able to engage user’s participation, more innovative, blending policies into practice and meeting service user’s aspirations. This would embrace new ways of doing things and this would enhance resource management and commissioning of services within best values principles. This would also means getting smarter to work with third sector organisations, though the welfare organisations in particular has not got its head around professionalising in this way.

Compliance and Risk Management: Embracing Change in a Modernising Welfare Service

2011-06-14T07:21:00.000-07:00

Compliance and risk-management in social services is not a tick-box procedure however, it is the bottom line in service users care. The social service staff has as much responsibility as the organisation to maintain standards within budgets.

It is been well noted that social services is facing unprecedented change, focusing on four structures which are: planned; unplanned; safeguarding and procurements. This is certainly the case with the “Birmingham County Council” (May 2011) who was summon to the Court to determine the eligibility criteria matrix (DH 2002) for care needs assessment (within critical level of needs) and it lost the case on technicalities. The decision of the court was that Birmingham County Council did not consult its intentions widely to all the stakeholders.

The Court’s decision has halted drastic changes that most social services would have wished to pursue in recent times. However, the intended changes may have resulted in many challenges but, also opportunities for efficiency. One critical task is to standardise compliance to governance and risk-management requirements across the new structures and streamline the organisation’s activities. In health and social care, compliance is not just a process of ticking the right boxes and this is the difference between services to people who can make contibutions towards their well being and tragedy. Care giving has to be tailored to individual needs irrespective where the service is delivered (in the primary or secondary sector) while compliance is imperative.

Monitoring services has taken on even greater resonance with the “Care Quality Commission's” new authority to sanction and even close down services if concerns of significant risk to service users are identified. The Commission can and does turn up unannounced at any service within an NHS trust or a care home and question staff, patients and service users about key areas within the standards of quality and safety, as set out by the legislation (DH 2000, 2005). The task of ensuring our enlarged workforce and all the services provided within the NHS and social service organisations should complie with the standards. In the present time, the standards are further complicated by the reorganisations and restructuring around the departments while bridging operational and culture differences between services.

Nonetheless, developments in technology has enhanced as well as embedded a sophisticated but easy-to-use real-time quality monitoring tools; from allocation of cases, to self-assessments, inputting relevant activities in the system, and ensuring correct processes. Through the dashboard technology, managers have instant access to up-to-date information or are able to extract information and give advice to all concerned at any giving time about what assurance is available to them, gaps in services or budget constraints that exist, and what is being done about issues in question.

This level of visibility is an absolute prerequisite to running health and social care at this point of demographic change and budgetary control. Yet, it is not uncommon to work in an organisation such as social services that still relies on multiple spreadsheets with outdated information and a poor grasp of what their problem areas are. Not only are these organisations ill-equipped to cope with the changing demography, policies, budgets as well as staffing issues, transformation and redesigning of the systems, they are also impeded by an intellectual deficit to embrace business culture within the organisations. In reality, the health care and social care sectors should welcome the extra stringency being exercised by the “Care Quality Commission”. It is now empowered to help drive quality performance and safeguarding of service users care, a goal we should all strive to achieve. Equally, as long as good governance is implicit in everything we do, we need not fear its new powers.

For a long time, the NHS and social service organisations have exhausted their resources and attention by seeking to back up everything they do with documentary evidence of good practise rather than focusing on practicing budgetary management on a day-to-day basis, in the field, where it matters. To date only a few management teams have placed adequate emphasis on taking a bottom-up approach to service developments and delivery. Time has come to shift the emphasis from creating paper trails and searching for proof of protocol, to each member of staff taking personal responsibility for their actions. This approach requires a level of education for all front line staff, which will involve keeping standards in the front of their minds in everything they do.

Compliance in budgetary rules, quality assessment and care as well as risk management is paramount for the NHS and social care to survive in the current macro and micro financial challenges and increasing demand for care. Front line staff needs to be reminded that compliance is not about form filling or chasing evidence for abstract standards, it is in fact about practicing the basic standards of care every day.

Empowerment in the New Era: A Perspective for Building Bridges in Care Systems

2011-05-21T03:04:00.000-07:00

The Pillars for preserving personal health and social care in society are underpinned by involving family members during critical and substantial care needs of older people. Practice experience has uncovered that a large number of family caregivers are caring for their older relatives, offering them practical and psychological support. Some considers it to be their duty and responsibility thus, feeling guilty for not participating in the care of their older relatives. Most family members see the family care system as a link that connects the old and the young, as well as family history, which points them to the future. On reflection, family care giving includes personal care, nursing care to an extent, assistance with medication/drugs administration, housekeeping, transportation, meals preparation and assistance to feed.

The framework is drawn from several social psychological theories such as: Reactance Theory; Equity Theory and the Threat to Self-Esteem model, which identifies the psychological and environmental processes involved when people consider giving or seeking care assistance to older relatives. However, from a broader perspective there are a variety of factors which could influence the family care system or reciprocal family care for example, ageing and poor health of some family caregivers, financial wellbeing, and social needs, accessibility and environmental factors such as housing, transport, and cultural antagonism. Yet, the delivery of services; health and social care in particular are intertwined with education, knowledge and awareness of holistic assessment and care management.

In practice, older people appreciate value for money. This has been supported by both practice observations and research findings, which reveals that interdependence between family members in their own home would enhance the existence of care giving. Thus, better understanding is required regarding the impact of prolonged and complex care giving by strangers. In view of that, older people see respect and dignity as issues of great concern when it comes to receiving personal care from caregivers. Practically, older people do not feel comfortable with strangers assisting them with personal care but would accommodate their own family members as they understand their wishes and standard of care they are used to. This view draws reference from "Modernisation of Social Care" which demands proactive action to achieve better governance that is more responsive to the plight of older people. This means raising all services for older people to the standards of the best and recharging social services with fresh vigor, incentives and new ideas.

Older people deserve this right like any other citizen of the state and should receive quality care in their own home without prejudice (irrespective of gender colour of the skin and disabilities). However, in practice there have been wide variations in quality and in some areas ineffective and waste of resources. Thus, family involvements in care needs assessment and care would help to develop a consistent care approach that is based on family values, norms and principles, which could be cascaded from one generation to another. Thus, it is hoped, this practice would potentially ease the shortage of formal caregivers; reduce wastes and duplications in the social market. The family will be the champion of the care systems and support for older relatives. This care model would support personal social services in the wider welfare systems, promoting whole systems frameworks. Involving family members would re-invigorate care in the wider community as well as family networking which is geared toward supporting older relatives. The service framework would offer the opportunity to develop innovative and integrate services that provides greater choice and control of services for the growing older people population.

Involving family members during long-term care would promote users empowerment, which allows them to participate in their own care. Reflecting on practice experience, the presence of family members in care giving is more important to older people that enable them to regain health and confidence as opposed to when in receipt of professional help. The availability of family support is found to be an important factor in determining whether a service user can be discharged home from hospital, rather than entering institutional care. I believe that family support places a high value on kinship, kindness, caring attitude, reliability, un-hurried care, consistency and continuity of care. This model of care advocates a joint ownership of care management between the family and the service users who supposedly being the overall controller of their care. In most cases, ageing and cognitive impairment have limited the ability of many service users to understand and manage their care packages, without working alongside their families.

By contrast, family care systems could propagate some form of abusive situations during care giving. However, the principles of care needs assessment and care management dictates that the presence of an advocate would deter any act of gross abuse such as: financial; physical; sexual; emotional and neglect to the frail vulnerable older people and this collaborate with the “Department of Health (2000) (No Secret)”. To reduce this incidence, it would be reasonable to have a family caregiver and not necessarily a qualified social worker, someone actually being involved, who also has basic understanding and knowledge of the needs of their older relatives. Families play a crucial role in the lives of older relatives; family involvement is most often interpreted as an indicator of social support rather than an influence on decision-making and protection of the vulnerable older person.

In retrospective the dominant sociological view, for a number of years has been that; older people turn first to their families for help, then to neighbours and finally to the state, because they expect their families to help in case of need. In some cultures, not only does most care come from the family but that most people think that this is where the responsibility should lie. This view is central to the philosophy of community care and more prominently end of life care services for older people in the wider society. In hindsight, there is a need to reinvent family care giving as the norm to enhance older people's welfare and psychosocial wellbeing during longevity of care in the community.

For further reading refer to http:// tinyurl.com/e.marketing01

Preserving Health and Social Care through Collaboration of Services

2011-05-21T02:05:00.000-07:00

This is very much in the spirit of creating sustainable organisations, recognising that preaching to stakeholders is no longer the answer and that the 21st century is very much about engagement with them. At the heart of any health and social care organisation there must be a dialogue with its service users, as well as creating strong connections with other stakeholders such as suppliers, care provider agencies and limiting impacts on the environment through responsible health and social care practices. With subjects such as end of life care, longevity of care, technically complex and wide-ranging as endangered species, demographic change and increasing dementia amongst older people, collaborating with experts and our community is essential.

Mutualisation of strategic care provider agencies is aimed to liberating health and social care institutions from budgetary constraints, declining frontline care providers and increasing demand for high standards of health and social care. A new collaborative approach to health and social care that incorporates social inclusion is changing the way we work – for the better – giving service users/patients the opportunity for choice and control, health and education policy. Mutualised health and social care: it may sound a bit faddy and contrived, but it's possibly the most profound – and in many ways liberating – development in power shift to individuals, communities and service users.

Health and social care has always been to some extent a partnership between the professionals. They have always had some forms of joint working approaches both official and unofficial. However, the modernisation of services and interactive digital technology such as Telecare systems has massively expanded that pool of resources by enabling the authentic, unmediated voices of social workers, doctors, nurses, therapists – as well as students, patients and other users of health services – to emerge. Medical technology has changed the face of community support services and how care is delivered in modern times. Medical technology such as hydro-dialysis has enabled more users to remain and receive home care in their own home. It has also helped to capture more referrals and assessment of care needs as experienced by and effectively reported on by some of the professionals and families.

Read more: http://www.articlesbase.com/health-articles/preserving-health-and-social-care-through-collaboration-of-services-4060436.html#ixzz1MyY0vlQN
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Reshaping the Power and Care Balance for the Elderly Care Systems

2011-05-10T03:39:00.000-07:00

The ideological position of this thesis is located within the traditional family care model, where the family members are able to uphold their values and belief systems and capable to exercise choice and control over their functional activities of daily living. In this context, family refers to both blood relatives and to non-related significant family friends or neighbours. Even without this extended definition, the term family contains a bewildering diversity of the meaning. These relatives may have no common purpose or views in relation to the older relative’s best interest, yet they try to come together in times of family difficulties to support one another in order to avert family breakdown (Ugwumadu 2011). Nevertheless, the experience and views of some family members are often not sought for and therefore unknown or they are ignored by the professionals or decision makers. This behaviourial attitude or professional limitations tend to deprive some family members the opportunity to partake in decision making about their older relative’s long-term care needs and their wider family.

This article thus, aims to advance on the limitations and gaps on political ideologies, and current legislation such as the NHS and Community Care Act (1990) and Carers and Disabled Children Act (2000). Upholding family norms would have a deliberate strategy to preserve core family values; tradition, culture and purpose, at the same time stimulate, encourage progress, and change within the wider welfare service. The family is a social structure; their values apparently provide a compact incentive to respect the co-operative strength of culturally accepted decision-making process. Yet, inconsistent political ideologies and limitations within legislation and policies, has contributed to dependency culture amongst the users of public services. Family values and norms are unique and transferable between cultural settings and it could be argued that there is no similar motivational coherence in the complex of cultures and disparate family structures, which must be served by the state.

The characteristics of the family directed support care systems include: early intervention; targeted support where families understand the aims of services to enhance wellbeing; support which uses and builds on strengths which tackles the main problems and vulnerabilities; and a whole family approach, which considers how services and plans should fit together rather than considering problems in isolation. Family care system could usefully be engaged to the early consideration of care and applied to strategic recovering plans, which emerge from the family interactions and shared initiatives. The care model would assist in the reconnection and reconstruction of care needs assessment and safety parameters with support plans, in which the family members can understand, and produce by themselves. They would when appropriate source external help to bridge gaps within the family care systems and to support them in their caring role.

The ideology is to promote active partnership – a three dimensional approach – the family, the older relative and the state. Partnership in this context implies a measure of quality and agreed decision sharing between the stakeholders on how best to plan and manages the growing older people’s population and their care needs. However, in practice, in almost all the adult social care services for example, older people service – assessment and care planning which sometimes involve professionals, family members and service users, there are usually both stark and subtle differences in authority, responsibility and influence between them. Thus, difference of opinion could lead to waiting list for assessment and care, complaints against social services and poor quality of care that, if not resolved might lead to abusive situation in the long-run (Ugwumadu 2011).

In policy term, working in partnership with the families is an aspiration to share knowledge, responsibilities and to maximise resources for the benefit of all stakeholders. The concept of partnership with and within families is conditional, layered and would sometimes be completely elusive. However, reinvention of family reciprocity and partnership with the state could be a means of progressing beyond professional dominated care system and practical engagement. Family members tend to respond to situations that they have been involved with, listened to and their views respected. In common with long-term care planning for older relatives, family participants would respond constructively if they are being asked what they would recommend, and what plans and services they believe would benefit their older relatives.

The care model is aimed to be a care pathway and a robust set of idea that is continually challenged and refined as we move forward with preparedness to changing policies, procedures and structures in the wider welfare systems. It is systematic approach to reinvent traditional family care systems and the opportunities inherited within that system, so that key support and interfaces are maintained. The ideology would remain relevant and responsive to the growing population and care needs of older people. The key emphasis of this study is on restructure and reconstruction of personal social services for older people and the systematic approach is to maintain a high level of quality and human capacity consistent to meet the increasing older relative’s aspirations (Ugwumadu 2011).

The focal point on traditional family care systems would reassert for example, two things: Firstly, family is socially moralist than strangers as some would see family care giving as a duty to reciprocate. Secondly, family is seen as the basis for stability and strong moral foundations in society, albeit alongside a recognition that the family is changing (reconstituted and composite family). In ideal world, a traditional family oriented care system could offer stability and security in a fast moving world of globalisation, migration, demographic change and smaller family units. My view is that the family should be seen as part of that world, expressing flexibility and inclusive to form a long lasting contemporary welfare systems.

The decline in traditional family care systems has contributed to a greater welfare dependency, especially among older people who tends to rely on the state for their functional activities of daily living. The reassertion of strong collective values in the community requires the family. The family has a lot to offer particularly that associated with personal social services for older relatives and the growing welfare dependency. In policy terms, the care model is articulated as a reaction to the failure of both political ideology and legislation to shift the power balance to the traditional care model with adequate support system to enhance their socio-economic needs to continue in their caring role (Ugwumadu 2011). In practice as well as in policy terms, there has been an unhealthy polarisation between liberals who affirm individualism, and tend to take a relativistic view of family values and structures, and conservatives who talk a lot about values but neglect household economies. Yet we have been presented with a false choice. Problems being experienced by families today are rooted both in economic stress and in family disintegration. Any progressive family policy must address both these issues or it will fail.

Family directed support care systems would contribute to the reconstruction of politics, which prioritises responsibilities and obligations that individual/family members owe in the community. On reflection, this thesis has argued for family members to undertake holistic care needs assessment of their older relatives and provides care, it is hoped, and this would help to reduce pressure on social workers. The commentary also illuminates the plight of the family caregiver’s socio-economic needs, which has been a concern for some family caregivers to continuing care for older relatives. Given the changing economic situations in society and carers’ financial needs, this article indicated the need for family assessor/caregiver to be paid for the services they render to older relatives.

I demonstrate that family forms matters because they both requires and underpins individual responsibilities in promoting family holistic wellbeing for example, continuing care for older relatives and children. The arguement is that the state alone would not be able to meet the increasing needs of older people in the future, unless families are involved in reshaping the power balance.

New Face of Home Care: The Telecare Systems

2011-05-04T09:52:00.000-07:00

Successful home care and assisted living for older people is depended upon on a holistic assessment framework carried out by assessors who are able to identify risks and draw up strategic risk management plans to overcome the risks within the environment. The Social Work Task Force Board identified among other things: the need for more emphasis on risk assessment frameworks; risk analysis and joint working with other professionals such as the occupational therapists. On refection, Telecare systems are changing the face of home care for older people within the wider welfare services. Telecare by definition is electronic tools (sensor mat, medication alert system, task alert reminder) designed and capable to assisted living in the community. These devices are now helping many older people to achieve their aspirations to be cared for in their own home. Most local authorities prefer to maintain, as many older people as possible in the community rather than in residential care, settings and telecare have been instrumental to achieve this policy framework. Telecare also provide assurance to some family members that their older relatives are safe in their own home and potential risks are reduced. Thus, to greater extent, telecare has enhanced home life environment, older people are no longer compelled to move into residential setting because of risks within their environment.

Institutional care is an environment where, despite good intentions, there is a great imbalance of power between the residents and those providing care or support them. This power imbalance can also arise when older people receive a lot of support at home. From practice based observation, the author argued that low self-esteem amongst older people living in different kinds of supported accommodation (residential care home' sheltered accommodation) is a huge and multifaceted issue. Low expectations of a fulfilling life are issues of concern and as a result older people prefer to remain and receive care in their own home for as long as possible.

According to Raynes et al (2001, 2005), older people rejected institutional care in favour of home care because there is a clear lack of strong and unifying vision of good life for older people with high support needs. Increasing choice for older people and their carers/families has been one of the cornerstones of government policy, both Conservative and New Labour. The NHS and Community Care Act (DoH 1990), and more recently the Royal Commission on Long-Term Care for Older People (1999), aimed to ensure that older people have increased opportunities to stay at home rather than enter residential care. Jospeh Rowntree (2009) noted that this was the choice of older people and their carers/families, and that more resources should be put into enabling them to satisfy that choice.

The author emphasise the need for telecare systems to form a significant part of home care package for older people.Telecare is a wake up call for social workers to advocate for their clients psychosocial wellbeing and their safe environment. For detail reading, refer to "http://www.articlesbase.com/authors/dr-felix-ugwumadu/550700

Sustainability of Balanced Diet by Aged Relative during Later Life Care Through Family Participation

2011-05-03T14:42:00.000-07:00

The majority of the stakeholders believed that the model would help reduce waiting times for assessment and care, hospital bed blocking and antagonistic relationships between social workers and family members. It could equally reduce re-imbursement fees (DH 2003) and enable social workers to concentrate on core and complex case management. The model could generate some savings to the county council in the long run. The family caregivers would be involved from the onset, planning and providing care for their older relatives as soon as possible. Such an early intervention would reduce stress, anxiety, and frustration and would promote psychosocial wellbeing amongst the users and their family members.

Intimate Knowledge of the Person Providing Care

Most stakeholder groups, particularly the family caregivers, service users, one of the two councillors, five of the seven practitioners and three of the four managers acknowledged that knowing the caregiver very well could potentially reduce the tendency of care breakdown. The older relatives would be assured that they would not be seeing different faces visiting them to offer care, consequently they would not be repeating themselves all the time to explain their care plan to strangers. This opportunity would enhance family relationships, as they would be in a better position to share their family norms and values, history and culture. Almost all the practitioners and mangers claimed that knowing the caregiver would reduce any complaints arising because of missed visits, lateness or poor quality of care giving.

Shared Care Packages

Almost three quarters of the stakeholder representative’s thought that the model would promote shared responsibilities. Most thought that shared care packages would reduce reliance on the state and delegate responsibility to the family. The families would play a crucial role in the system by assuming responsibilities and being accountable for their part in the process. Most managers, family care givers, service users and one councillor thought that the model would promote partnership and collaboration between the state and the family; as a result, blame culture would be reduced. Some of the managers, and one of the two councillors in particular thought that the model would enhance capacity within the welfare system as well as the distribution of scarce resources to all users.

Cost Benefits/Savings

The study indicated that the proposed model could save the County Council some money in comparison with the existing service frameworks. This view was shared by three quarters of the managers, and the two councillors despite differences in their political opinion, and a large number of the practitioners. The managers, the councillors’ thought that the difference in unit cost would be significant, and any savings could be reinvested into the system to support more service users. The councillors and managers as well as some practitioners highlighted some of the attractions of the model as including no overheads and variable costs because the £8.00 per unit cost would be a fixed cost for the financial year. Since the unit cost would be above the national minimum wage, this could attract more family members into the social care market and give the council a competitive advantage over other potential employers.

Individualised Care

A large number of the stakeholders thought that the care model would facilitate individualised care. This would enable the older relatives to see themselves as individuals who have rights, choices and opportunities to achieve their aspirations in life. Most service users and family caregivers acknowledged that because strangers have limited time available they are unable to offer quality care to service users, and this could be depressing and frustrating. Family caregivers know the standards of care their older relatives are used to and would endeavour to facilitate that. This means that family care giving would promote person centred care, giving the users the opportunity to enjoy their holistic functional activities of daily living, like any other person (Equal Opportunity Act 2006).

Respect and Dignity

Respect and dignity were seen as essential components of care giving by most stakeholders. The majority of the family caregivers and one of the two councillors thought that family caregivers are better positioned to accommodate and respect their older relatives, irrespective of their character or behaviour than strangers. Most acknowledged that some families have a particular lifestyle which may not be tolerated by strangers but which their family members were used to and have tolerated throughout their lives. Family care giving in this respect would help to reduce care breakdown, complaints, stress and breaking relationships between the cared for person, family members and social workers. Payment to the family caregivers was seen as a justifiable incentive for them to undertake assessment of care needs, planning and providing care for their older relatives.

Maintaining Quality of Care

The study uncovered some differences of opinion between the groups regarding standards, and the quality of care giving to the service users. Most practitioners, managers, and one of the councillors pointed out that social care workers carried out their role within professional guidelines. Almost one half of the practitioners argued that the Commission for Social Care Inspectorate and In-house Quality and Development Section of the County Council monitored the services they provided for older people. As a result, the professionals are in a better position to maintain quality standards than the family caregivers. However, most family caregivers and service users argued that family caregivers knew their relatives better than they knew social care workers. Most felt that their in-depth knowledge of their older relatives had given them the advantage to maintain quality care standards over and above that provided by strangers

Sensitive Nature of Care Giving

Eleven of the fifteen service users thought that care giving (e.g. personal care) can be sensitive and they would prefer their family members, mainly their spouse, daughters or daughters-In-law to assist them rather than strangers. Some felt that it would be embarrassing for strangers to assist them, as they have no bond with them, whereas their spouses, daughters/daughters In-law are part of their family with whom they have some form of relationship and that would be more accommodating. In contrast, four out of the fifteen service users, one third of the practitioners, two of four managers, one of the two councillors, and a few family caregivers, argued against family caregivers assisting their older relatives with personal care. This on the ground that offering intimate personal care to some one very close is sensitive and could influence their relationship.

End of Life Care by Proxy: Empirical Research Findings – The Need for and Potential of Family Care Systems

2011-04-29T09:59:00.000-07:00

This publication reflects the findings of a fieldwork carried out in Essex, which looked at the views of older people service users, their caregivers and the County Council representatives. Besides, practice observations has also revealed that a large number of the stakeholders (service users, family caregivers and staff and councillors) are of the view that family caregivers have the potential to offer more emotional and practical care for their older relatives, rather than strangers. They cited a number of reasons (fear of strangers, knowing the person providing care, sharing family norms and values as well as fulfilling duties and responsibilities) as to why the family care system would be more appropriate than direct provision or direct payments (Ugwumadu 2011).

A high proportion of the stakeholders claimed that enabling support systems (aids and equipment, respite and day care, shared care packages) would encourage family caregivers to continue care giving to their older relatives. They thought that aids and equipment would reduce dependency levels, accidents, falls and potential deterioration in health amongst the family caregivers. Day and respite care would enable carers to have breaks from care and increase their commitment to continuing care for their older relatives. Offering carers respite care would bring about shared responsibilities between the social service and the family, enabling the State to concentrate on the commissioning of other services, while the family take a lead responsibility to offer care for their older relatives.

Reflecting on assessment of needs, the study revealed contrasting views amongst the three groups. A high proportion of the service users and the family caregivers felt that families are best placed to carry out needs assessment rather than social workers. They said that they know the service user and their needs better, and would be able to draw up a flexible care plan that would accommodate a holistic need for their older relatives. Some argued that social workers do not have enough time to spend with the cared for person to obtain the in-depth information necessary to prepare a wide ranging care package. In contrast the majority of staff and councillors thought that social workers are professionally trained and have wide ranging practice based knowledge, skills and experiences to meet older people needs, in line with legislation and availability of resources. Some stated that family members lack basic knowledge and skill and their involvement might encourage potential abuse and poor quality of care for older people.

In terms of a payment to family care assessors and caregivers, the study found contrasting views amongst the stakeholders. A large number of the service users and family caregivers felt that family care assessors and caregivers should be paid. For them a payment would help them maintain their lifestyle and at the same time assist their older relatives with their care. A payment on the other hand would otherwise act as an incentive and that could attract families who would not have thought about offering care to their older relatives. For some of them the payment that they receive would be used to buy extra care to support themselves in their caring role, as well as giving them the time to undertake other activities in order to support their nuclear or reconstituted families. Yet a high proportion of the staff and councillors thought that a payment to family care assessors/caregivers is not the best preposition with which to redesign the welfare system, in line with the 21st century community care for older people. What is needed is joint investment between the welfare institutions (e.g. health, housing, Works and Pensions) to tackle the new demand for care from older people.

The study found that a large number of the three stakeholder groups expressed some ambivalence over family care giving. Most of them stated that care giving would impose a lot of difficulties on some of the family caregivers and their nuclear or reconstituted families. This is a decision most of them would not take in haste. They cited a number of reasons (employment, ageing and poor health, distance, potential abuse) why they need to take time to think it over before embarking on it. On the one hand some of the staff and councillors raised the issue of compliance to legislation, policies and procedure and lack of knowledge by some of the family caregivers to undertake assessment and care. A large number of the family caregivers said that despite the difficulties they are committed to care giving to their older relatives.

Consistent with the conceptual dimensions, the majority of staff and councillors expressed concerns over family care giving; this was in contrast with both the service users and family caregiver’s views. For them family care giving would mean abdication of duty and responsibilities by social services. Some felt that social service should continue to meet the obligations, bestowed to it by Parliament and that social workers are best placed to deliver those services to older people and their families. These views were supported by a fewer number of the service users who claimed that family care giving means interfering with their family and their livelihood. They prefer to seek support from social services, friends and neighbours; their family would be the last resort, when other opportunities have failed.

Those stakeholders (users, family caregivers, staff, managers and councillors) who do not think that family caregivers should be the sole assessors also think that family members are unlikely to provide quality care during care giving. Some family caregivers lack knowledge and skills to undertake assessment and might be unable to maintain standards of care. The framework might encourage abuse (financial, physical, deprivation, exploitation) during care giving.

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Rethinking Community Care in the 21st Century: The Perspective for Marketisation of Social Care

2011-04-27T07:10:00.000-07:00

The agenda for marketisation of social care revisited familiar themes around the enhanced involvement of users in service delivery, upholding choice and control, increasing accountability and developing these by integrating a role for self-organisation and independent living within services. The modernisation of the social care market, drawing on the principle of provider/purchaser split (NHS and Community care Act (DoH 1990), managerialism in welfare services and best value cost effectiveness, provided a focus for delivering social care. Both the Conservative/Liberal Democrats government and New Labour administrations have pursued these ideologies. It also has included the privatisation of care for older people, raising the issue whether the for-profit sector in indeed likely to be the best option for good quality care, especially for frail older people.

A key feature of marketisation policy is about breaking down large-scale organisations providing social care and using competition to enable exit or choice by service users. The ideological position is to increase flexibility in the social care market as this would bring about equilibrium of demand and supply in the market. Individuals and groups at different positions on the political spectrum have promoted the idea of users’ rights to exercise choice in their use of public services. Progressive self-help movements have argued for choice as a means of promoting market-based solutions and curbing the power of the state (Clarke et al 2000; Leadbeater 2004; Cameron 2010; Ugwumadu 2011).

Marketisation significantly centred on issues of cost efficiency, consumerism, and responsibilities and cost savings, whereby the allocation of cash for care rather than services raised concerns as to the accountability of government monies. Marketisation policy clearly presents significant opportunity for delivering personalisation of services through direct payments and individual budgets model and related support structure in the future social care market (Leadbeater 2004; Hasler 2006). According to Zarb and Nadash (1994) and Hasler (2000, 2006), they argued that direct payments is around 40% cheaper than direct provision. New Labour government assured in its positioning of direct payments and individual budgets as part of a wider marketisation of social care, established initially through the 1990 Community Care Act. This framed the market as an instrument for accessing choice and diversity in social care provision through the development of local care markets (Hasler 2006; DoH 2008).

The central doctrines for the Conservatives/Liberal Democrats government and New Labour government’ agenda are: a focus on managerialism not policy and on performance appraisal and efficiency; the disaggregating of public bureaucracies into agencies which deal with each other on a user-pay basis; the use of quasi-markets and contracting out to foster competition; cost-cutting; and a style of management which emphasises, amongst other things, out-put targets, limited-term contract, monetary incentives and freedom to manage (Hood 1991; Osborne and Gaebler 1992; Leadbeater 2004; Cameron 2010). These ideological policy frameworks are fundamental principles behind the Big Society’s agenda to enhance the welfare systems. The Big Society project is claimed to offer the opportunity to deliver the personalisation agenda and to maintain cost effective social care.

However, many people would disagree with this position on the grounds illuminated below. For example, changes in delivering personal social services are accompanied by an increasing tendency to define home care intervention in terms of narrow tasks. This has resulted in complaints of unmet needs and lack of opportunities for more generalised social interaction between carers and service users (Sale and Leason 2004; Ugwumadu 2011). The continuous changes within social services’ policy and practice have influenced social work practice and social care delivery. According to Morris (1993a) and Glendinning et al (2002, 2009), changes in policy meant that social workers were no longer in a position to uphold social work ethical practice, but had to participate in a policy that deprived users of their rights and choices, as outlined in the National Health Services and Community Care Act (DoH 1990).

It is also possible to see the Community Care (Direct Payments) Act (DoH 1996 a & b), and the Carers and Disabled Children Act (DoH 20001 b) as an attempt by government to promote a distorted and flawed notion of empowerment by exit, shifting responsibilities to users. The aim was to control and reduce an escalation of public expenditure. In such a service, Leece (2000) claimed that it would be left to local authority social services departments to balance the books and reconcile the very real demand for direct payments with already stringent budget constraints. Pearson (2004a, b and 2006) noted the contradiction and tension between the legislation and practice.

The Conservatives/Liberal Democrats government has largely intensified the marketisation approach as the basis of their broader modernisation programme in social care with its increasing focus on personalisation services. The Big Society project and Personalisation of services are very potent but, highly contested and ambiguous idea that could be as influential as a privatisation was in the 1980s and 1990s in reshaping public provision.

For related article/promotion see:

http://tinyurl.com/E-Marketing01

Health and Social Care Policy: Reconstruction of Social Work Through Personalisation

2011-04-26T08:22:00.000-07:00

Health and Social Care Policy: Reconstruction of Social Work Through Personalisation

Reconstruction of Social Work Through Personalisation

2011-04-26T06:23:00.000-07:00

This book is aimed at bridging the gap in the existing literature in the field of social policy for older people; personalisation of services, family reciprocity and education regarding contemporary social care and the social care market in the UK. While there are publications in social inclusion and personalisation, yet, they do not look at the inter-relationships between personalisation of services for older people, family reciprocity and payment to informal family caregivers. In essence, life long learning by service users and their informal carers are lacking and as a result they are not conversant with developments within the system, therefore do not know how to access services within the wider welfare systems. Publications on longevity of care giving to older people, care needs assessment and demographic change also do not focus on life long learning. Thus, this book aims to break new ground by linking these important issues. However, it might be unusual within older people service and long-term care literature to have a focus on the learning needs of a particular population for example; those with long term health and social care problems.

This book has revealed the views of the key stakeholders (service users, family caregivers, social workers, social work managers and councillors) about the potential of family care giving. The majority profess the need for a changed social work practice in order to offer personalisation of services to the growing older people population. In as much as transformation and personalisation are the “buzz words” in social services, yet, many older people would prefer their family members to help them with their social care needs. This view is supported by both practice experiences and empirical research carried out in Essex County Council area of the United Kingdom (Ugwumadu 2010). Thus, the aim of this book is to modernise social work practice in line with the aspirations of the baby boomers that are now entering the social care market. This would provide the opportunity for power balance from the professionals “do it all” to the family members who would carry out assessment of care needs and provide care for older relatives for payment if they wish to.

This book has also highlighted the interrelationships between health and social care for which longevity of care is now prevalence in our society. Presently social policy for older people, in particular the NHS continuing healthcare for older people, is undergoing a considerable paradigm shift in terms of re-thinking core services that have been taken for granted such as collective welfare systems, ability for social inclusion, informal care, education, training, empowerment, and the meaning of recovery from physical disabilities. The re-thinking is accompanied by a slower pace of changes in social care and clinical practices, albeit no less significant, and at times with projects reflecting a leap into the new world of personalisation services.

The book can be bought from major bookstores and Amazon: (www. Amazon.com)