Volume 7 Number 2 Biology and Society June 1990 The Journal of the Galton Institute

CARING FOR PEOPLE The Government White Paper "Caring for People: Community Care in the Next Decade and Beyond" which was published last year is a blue-print for far-reaching changes, both for those in need of care and for those who provide it. The Social Services Departments of County Councils the "service providers" are at present involved in a major exercise of planning and putting into effect the necessary administrative structure in conjunction with the Health Authorities in their areas, since the care of those not able to look after themselves is in essence a joint responsibility of these two services. The impetus for the proposals stems mainly from a change in the overall philosophy concerning the management and delivery of care services for those affected by problems of ageing, handicap or disability. Importantly, a move away from institutionalised care for the handicapped and the elderly is considered desirable wherever possible. The heavy hand of bureaucratic control is seen as inimical to full personal development or of individual choice and preference. In future, each person in need of services is to be regarded purely as an individual, not as a case type to be fitted in to an existing pattern of available resources. The key objectives detailed in the White Paper may be outlined as follows:- to promote the development of improved domiciliary help of various kinds in a person’s own home and, if necessary, ‘day care’ in special centres. Importantly, respite-for-carers services, including regular or occasional admission to nursing homes, will be made increasingly available. This is to enable people to live at home wherever feasible and sensible, which is what most of them strongly desire. Existing funding structures have worked against the development of such services. In future, the Government will encourage the directing of comprehensive home-based services to those people whose need for them is greatest. They will be made available to mentally and/or physically handicapped children as well as adults of all ages. to ensure that service providers, i.e. all social workers, make practical support for carers a high priority: the needs of the caring family, friends and neighbours should always be taken into account good case management is a cornerstone of high quality care. Following assessment, "packages of care" are to be designed in line with individual needs and preferences. to clarify the responsibilities of the various service-providing agencies, so as to make it easier to hold them to account for their performance. This is an area which has not been sufficiently strictly monitored in the past, frequently leading to confusion and poor overall performance. to secure better value for taxpayers’ money with the introduction of a new funding structure for social care from April 1991. This will be the responsibility of the Local Authority in collaboration with medical, nursing and other professions. The Government will take powers to make sure that plans are open to inspection and to call for reports on care provisions for individuals. The Government also expects maximal use to be made of the independent sector, both private and voluntary, again with powers of inspection ‘at arm’s length’ by a special appointed unit there will be new specific grants for the social care of the seriously mentally ill. The local authority will be responsible for financial support of people in private and voluntary homes, over and above any general social security entitlement. There is no suggestion in the White Paper that Care in the Community ought to be or will be cheaper. Indeed, catering as far as possible for individual preferences and needs, as well as ensuring that the carers are cared for, too, is bound to make additional calls on the taxpayer. The steep increase in the over-85 age group, as well as the survival of a rapidly growing number of often severely handicapped children and adults because of medical innovations, pose an enormous problem for the social services. It seems that Social Service Departments were reluctant at first to accept the underlying philosophy of the proposed changes, fearing that ‘privatisation’ was the Government’s real objective. But most Local Authorities are aware that the personal initiative and responsibility of each social worker will be challenged and enhanced by new attitudes and practices, something which most of them welcome.