Social Work and Older People Essay
Going with the assumption that an older person is one whose age is 65 or over – the one distinguishing feature that they possess is that they appear not to work for a living. Older people have always been a major focus for social policy and because the UK is an ageing society, their importance to the subject is increasing further. Life expectancy has been growing steadily for over half a century and the UK has now reached a point where there are more people over State Pension age than children.
In 1950, a man aged 65 could expect on average to live to the age of 76. Today, he can expect to live to 87, and by 2050 to 91. Today there are 10,000 people aged 100 or over. By 2050 there will be 275,000. By 2030, people over 50 will comprise almost a third of the workforce and almost half the adult population. An ageing society is no longer on the horizon; it is here with us today.
Before the introduction of public pensions, workers relied on the good will of their employers to provide occupational pensions and in the late 19th century, it was common for people to work until they were too ill to continue rather than a fixed age.
The first state pension was introduced in the Edwardian period under the “Old Age Pensions Act 1908” with a state pension age of 70 which was reduced to 65 in 1925, then in 1940 women’s pension age was reduced to 60.
The introduction of the welfare state mainly for older people can be traced back to the Beveridge report of 1942 which identified the “five giants” illness, ignorance, disease, squalor and want – this in turn led to the National Health Service act 1946, Education Act 1944, National Insurance Act 1946, National Assistance Act 1948, family allowances and unemployment benefit which all contributed to the abolishment of the Poor Law System.
Fast forward to the 1980s, ageing issues were now taking centre stage on the political agenda and in policy and practice debates. The restructuring of the welfare in the Wake of the Conservative election victory in 1979 was driven by the new right. Privatisation, competition and the development of what Le Grand (1990) called the quasi-market, anti-state and decentralisation of services were the order of the day. The state was left to regulate, finance and co-ordinate care for older people and other vulnerable groups.
Whilst there is still debate as to whether the changes in the supplementary benefit rules was a means-tested benefit in the United Kingdom, paid to people on low incomes, whether or not they were classed as unemployed such as pensioners, the sick and single-parents. Introduced in November 1966, it replaced the earlier system of discretionary National Assistance payments and was intended to ‘top-up’ other benefits, hence its name. ) were a convenient mistake or a planned policy of welfare privatisation, the resultant massive growth in private residential care is a legacy that is still being dealt with up to today.
The changes introduced by the Thatcher administration revolutionised the fundamental principles which had underpinned policy since the 1940s and began to challenge the key relationship between the state and older people. For instance, a key reform was introduced at the end of Mrs Thatcher’s period in office – the NHS and Community Care Act 1990. .Sir Roy Grif?ths – an independent adviser to the government and chief executive of Sainsbury’s supermarkets wrote the report which led to act being implemented.
Sir Roy’s 1983 “AGENDA FOR ACTION” report and the subsequent White Paper, “CARING FOR PEOPLE” (DoH 1989) were the key piece of social policy legislation affecting the lives of older people and the context within which these services are provided. The Act was based mainly on three things of ‘autonomy’, ‘empowerment’ and ‘choice’ and was endorsed by many commentators as the political and philosophical universal remedy for alleviating the deep and destructive problems confronting the community care system in the UK (Levick 1992).
Three key objectives of Community Care policy: The overriding objective was to cap public expenditure on independent sector residential and nursing home care. This was achieved in that local authorities became responsible for operating a needs-based yet cash-limited system. There was a clear agenda about developing a mixed economy of care, i. e. a variety of providers. The mixed economy provision in residential and nursing home care has been maintained despite the social security budget being capped.
And there are now many independent organisations providing domiciliary care services. To redefine the boundaries between health and social care. Much of the continuing care of elderly and disabled people was provided by the NHS. Now much of that has been re-defined as social care and is the responsibility of local authorities. An important point to note though is: that NHS services are free, whereas social services have to be paid for. So how the care you require is defined, that is health or social care, determines whether or not it will be free.
The main aim of community care policy has always been to maintain individuals in their own homes wherever possible, rather than provide care in a long -stay institution or residential establishment. It was almost taken for granted that this policy was the best option from a humanitarian and moral perspective. It was also thought to be cheaper. A close and cogent examination of the emergence of the NHS and Community Care Act raised serious questions about its main purpose e. g. he older people were secondary in most discussions leading up to its implementation in 1993 and policy makers relied heavily on several reposts e. g. (Griffiths Report 1988 which was influenced by the ideology of managerialism – that problems could be solved by ‘management’. Griffiths firmly believed that many of the problems facing the Welfare State were caused by the lack of strong effective leadership and management. Because of this previous work, which was greatly admired by the Prime Minister, Griffiths was asked to examine the whole system of community care.
In 1988 he produced a report or a Green Paper called ‘Community Care: Agenda for Action’, also known as The Griffiths Report. Griffiths intended this plan to sort out the mess in ‘no-man’s land’ which was the grey area between health and social services. This area included the long term or continuing care of dependent groups such as older people, and in 1988 Griffiths said of community care that it was everybody’s distant cousin but nobody’s baby.
Basically he was saying that community care was not working because no one wanted to accept the responsibility for community care. There was a lot of talk of terms such as, empowerment, advocacy, user involvement and participation, care management, purchasers and providers, enablers and facilitators, internal markets and packages of care but it took a while for most of these terms to actually be implemented and it still promoted less involvement of the state in the care of older people.
Alan Walker (1993) amongst others argued that the new act was imposed from the top and was mainly concerned with cost containment and management issues. Higgs (1995) talked about how rights disappeared as services were withdrawn and older people without financial or personal resources had little say or choice over their lives. The problems of the health and social care divide, which had been present for more than the past 50 years, had not gone away but had manifested especially in the wake of the NHS & Community Care Act 1990.
It was more evident in the NHS as they tried to shed any involvement in the social care of older people – the decline in numbers of long stay bed were now being well-documented with older people being left largely reliant on private and means-tested provisions. E. g. within whose remit should responsibility for respite care fall? If it is seen as relief of cares, some argue that it is therefore a social provision; if it is about rehabilitation of the older person then it can be seen as a health provision.
Other criticism of the act were that the diversion of finances from the social security budget to the local authorities was not to be ringfenced (financially separated) for community care in the long term as Griffiths had hoped. A specific grant was to be diverted to local authorities in order to implement the outcomes of individual assessment and encourage the genesis of services in the private and voluntary sectors. Interestingly, receipt of the grant was contingent upon the publication of community care plans and would be ringfenced only in the short term.
Some of the things that could be seen as a positive were that community care was to be used as a vehicle for the marketisation of the public sector. Thus, a ‘contract culture’ was to be applied to the provision of personal social services and social services departments would need to develop processes to specify, commission and monitor services delivered by other agencies. The organisation of service delivery was to be instigated through assessment and care management including devolved budgets and decentralisation.
There are a number of problems in evaluating the success of community care post-1990 and they include the lack of information before the reforms, the lack of national standards and structural changes in health and local government which have had an effect on it The immensity of the task facing social service departments was made clear in the Audit Commission’s report The Community Revolution: Personal Social Services and Community Care (Audit Commission 1992).
This report exhorted social service departments to gain the commitment of its professionals, develop systems to support strategic and operational aspects of implementation. In the 1993 Audit Commission’s report Taking Care: Progress with Care in the Community, ‘cautious but steady progress’ was reported (Audit Commission 1993: 1) but some authorities were ‘rather slower than others, and a few are in danger of lagging well behind’ (Audit Commission 1993: 14).
In 1996, the Audit Commission in Balancing the Care Equation: Progress with Community Care claimed that financial resources dominated any change in the delivery of good practice and service delivery. conclusion On 1 May 1997, Britain elected a new Labour government following 18 years of Conservative rule; the election of New Labour seemed to offer an alternative way forward for community care.
Under the mantra of „third way politics, the incoming government stressed the need to move beyond what they portrayed as polarised ideological approaches to the respective benefits of the state and of the market, arguing that „what matters is what works. Under New Labour, policy with regard to health and social care for disabled and older adults was described initially in terms of „modernisation, with more recent policy emphasising the importance of „personalisation”.
In May 2010 the Tory & Lib Dem coalition government came into power and some of the big issues that the Government had sought to tackle in its first year against a backdrop of economic austerity were Reform of the NHS, pension’s reform, and fuel poverty. Overall the Coalition has taken some positive and welcome steps towards creating a better later life for older people – under the pension system one of the first moves of the Coalition Government was to introduce the ‘triple guarantee’ promise to uprate the state pension in line with earnings, inflation or 2. %, whichever is higher.
One the other hand, The Coalition agreement promised that it would not raise the State Pension Age for women before 2020 – a promise that was broken less than 6 months later in the Comprehensive Spending Review, when both the equalisation of State Pension Age for men and women and the rise to 66 were brought forward to 2018. In George Osborne’s Autumn State 2012, he promised that pensions will rise in line with either wages, inflation or 2. 5 per cent – whichever is highest – in a flagship promise. As both wage rises and inflation rates are ow, George Osborne said the basic state pension would increase by 2. 5 per cent from next April. The “triple lock” restored the link between pensions and earnings and Mr Osborne confirmed that the full Basic State Pension would rise to ?110. 15 a week from April. However, pensioners’ groups said the increase was only worth an extra ?1. 60 a week for elderly women who do not receive a full pension. And the Chancellor was unable to give any further details about how the proposed new ?140 a week single tier state pension would work. Though progress has been made so far, much more can still be done to improve the lives of older people.
Bone, M. (1995). Trends in Dependency among Older People in England. London: OPCS. Department of Health. (1989). Caring for People: Community Care in the Next Decade and Beyond, London: HMSO. Department of Health (1998). Modernising Social Services. Promoting Independence, Improving Protection, Raising Standards (Cm 4169). London: Stationery Office.