Archive for the 'Social Care' Category

It’s not just about the money: 5 dilemmas underpinning health and social care reform

Following on from the publication of the third edition of Understanding health and social care, Jon Glasby looks at what’s needed for long-term, successful health and social care reform.


Jon Glasby

Open any national newspaper or turn on the news and (Trump and Brexit aside) there is likely to be coverage of the intense pressures facing the NHS.

Throughout the winter, there have been stories of hospitals at breaking point, an ambulance service struggling to cope, major problems in general practice and significant financial challenges.

For many commentators, this is one of the significant crises the NHS has faced for many years, and quite possibly the longest period of sustained disinvestment in its history.

“Draconian funding cuts have decimated services at the very time that need is increasing.”

In adult social care, the situation is even worse. Draconian funding cuts have decimated services at the very time that need is increasing with an ageing population, a rise in the number of people with multiple long-term conditions and growing numbers of young people surviving into adulthood with complex needs.

Increasingly, NHS leaders have argued that if any extra money is to be found, it should go to adult social care – otherwise the system as a whole could simply clog 1280px-nhs_nnuh_entranceup, fall over and fail.

However, we can’t keep doing more of the same. Health and social care provision must align with how we live other aspects of our lives in the 21st century.

While we need a funding settlement which gives some certainty for the future, we also need to address the underlying tensions that continue to dominate many of our services.

As explained in the new edition of Understanding health and social care, five key dilemmas are:

1. How best to promote more joined-up responses to need in a system that continues to assume that it is possible to distinguish between people who are ‘sick’ and those who are ‘frail and disabled’.

2. Whether to support people with long-term conditions because they are citizens with a right to independent living, or simply as a means of reducing reliance on expensive hospital services.

3. Whether to focus on challenging discrimination in health and social care or in wider society, and whether to do so via specialist initiatives or via general approaches.

4. Whether to involve people with experience of using services because they are ‘customers’ who can help improve the ‘product’ or because they are citizens with a right to greater choice and control.

5. Whether to support carers because they run the risk of being exploited by formal services and deserve the same access to a meaningful and stimulating life as everyone else, or because this is a cheap way of helping the ‘service user’ and reducing demands on formal services.

In the short term, it is probably possible to do a little of each of these ‘either-ors’ – to promote partnership in a system that is deeply divided; to tackle discrimination in formal services and in wider society; and to support people with long-term conditions, involve service users and support carers for a mixture of (not necessarily compatible) motives.

In the long run, however, the jury must remain out on the extent to which the current system can continue to contain these contradictions and tensions.

The second edition of Understanding health and social care appeared part-way through the Coalition government of 2010-15, asking whether massive public spending cuts and an uncertain economic outlook would lead to radical new ways of working in health and social care.

“Evidence of genuine and long-lasting reform still seems lacking.”

The third edition now appears under a Conservative government, when the full force of these cuts is being felt, and when austerity is feeling to many like a long-term state of affairs.

east_midlands_ambulance_service_nhs_trustEvidence of genuine and long-lasting reform still seems lacking.

Government remains committed in principle to further joint working between health and social care, but not to removing the underlying distinction between free health care and means-tested social care altogether.

There is talk of greater choice and control, but a very real risk of simply co-opting this language and creating little more than ‘zombie personalisation’ (a phrase coined by leading personalisation expert, Simon Duffy).

Discrimination remains widespread, the focus is often on ‘user involvement’ rather than on human rights, and support for carers continues to evolve but with longstanding and significant barriers remaining.

“Every problem can also be an opportunity.”

Choices still need to be made, but, in the meantime, every problem can also be an opportunity.

For example, the current policy rhetoric around ‘integrated care’ is a helpful hook for local partners keen to promote more effective joint working, while the personalisation agenda could still be transformative if we could implement it in a way that is true to its original values and ideals.

The Equality Act gives significant scope to take positive action to promote equality (not just avoid discrimination), while the importance of user involvement and the need to support carers are now so widely recognised that the genie feels well and truly out of the bottle.

Understanding Health and Social Care helps to explain these opportunities and tensions, thus supporting students and practitioners to change future practice and attitudes for the better, whatever the choices made by those at the helm.

Jon Glasby
School of Social Policy
University of Birmingham
February 2017


understanding-health-and-social-care-3rd-fcUnderstanding health and social care by Jon Glasby can be ordered here for £17.59.

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The views and opinions expressed on this blog site are solely those of the original blogpost authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

Get social care right and the NHS will benefit

How can we improve access to and quality of social care? Catherine Needham, co-author of Micro-enterprise and personalisation, discusses how micro-enterprises and micro providers could improve care services. 


Catherine Needham

At a time when the Red Cross is warning of a ‘Humanitarian Crisis’ in the NHS, there is a growing recognition that pressure on NHS services will not be alleviated unless we get social care right.

Social care services support frail older people and people with disabilities. They are run by local government and have borne the brunt of the local authority cuts in recent years, with around 26 per cent fewer people now getting help than did in the past.

Many care providers have gone bust due to downward pressures on fees and in many parts of the country it is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.

“It is very hard to recruit trained staff to work in care when the pay rates are higher at the local supermarket.”

Together these pressures contribute to older people being stuck in hospitals, unable to be discharged into the community because the support is not available to them.

Fixing social care

Getting social care right is not a quick fix. Access to good quality, affordable care for people with disabilities and older people is a challenging issue.

Continue reading ‘Get social care right and the NHS will benefit’

10 things you should know about foodbanks

hunger-pains-fc-4webThink you know about foodbanks and the people who use them? Think again.

Kayleigh Garthwaite’s book , Hunger Pains, challenges some of the biggest foodbank myths.

Here are the top 10…

1. Anyone can turn up and get a food parcel

You need a red voucher to get food, given to you by a frontline care professional who has identified you as being in need. It is likely that many people in food poverty who are outside of the ‘system’ aren’t getting help.

If somebody does come in and say “Can I have some food?” you can say “Have you got a voucher?” as that’s the rules.” Foodbank volunteer

Continue reading ’10 things you should know about foodbanks’

Manufactured Excellence Everywhere: but what about the human cost?

Educational excellence has been in the news a lot of late – from the row over seven year old testing through to the latest government U-turn on school academisation. In today’s guest blog, author of recently published Pushed to the edge: Inclusion and behaviour support in schools, Val Gillies provides her insights into a system that falls far short of providing quality education to a large number of children in its care…

Val Gillies (2)Recent developments at the Department for Education have managed to out-parody even the sharpest of political satires. Attempts to subject primary age children to more demanding standards have descended into confusion and controversy, with experts highlighting the ambiguities and misleading nature of the questions.

The perversely difficult spelling, grammar and punctuation tests stumped even the Schools Minister himself and have sparked mass protests from teachers, parents and kids. Then in the midst of the furore it was discovered some of the tests had previously been published online, not just once but twice. Meanwhile screeching U turns have had to be made on the issues of baseline testing for reception children and the forced academisation.


The recently published Government white paper ‘Educational Excellence Everywhere’ has acquired a comic irony in the context of this omnishambles. Continue reading ‘Manufactured Excellence Everywhere: but what about the human cost?’

Policy Press Impact: MPs and peers hear why morality must be included in public policy

One of the founding principles of Policy Press is about publishing books that make a difference and have impact on our wider society, so we were delighted to discover that author Clem Henricson recently visited the House of Lords to present the findings of her latest book Morality and public policy.

A plea for morality to be put into public policy was made by Clem Henricson when she presented her book, Morality and public policy, to the Intergenerational Fairness Forum of peers and M.P.s on Wednesday 9th March.

Evidence was being examined with a view to reducing current unfairness between the generations. Henricson discussed the book’s findings concerning moral divides which she contends are not adequately or fairly dealt with by government.

Changes in attitudes

Making the case for a higher profile for morality to address changes in attitudes between the generations in a more timely and conciliatory manner, Henricson stressed that it should not take so long for legislation to keep up with shifts in approaches to matters such as abortion, homosexuality, cohabitation and assisted dying. Continue reading ‘Policy Press Impact: MPs and peers hear why morality must be included in public policy’

Does child protection need a rethink?

David N Jones and Maggie Blyth are Independent chairs of Local Safeguarding Children Boards (LSCBs) and David Jones is also chair of the Association of Independent LSCB Chairs. In today’s post they explain why the review of local safeguarding children boards is an opportunity to improve accountability of schools, health and social care and police.

This was originally posted on the Guardian site Wednesday 13th January. To see the original post click here.

Maggie Blyth

Maggie Blyth

David Jones

David Jones

Buried in the prime minister’s December announcement about improving children’s services was a review of Local Safeguarding Children Boards (LSCBs), which coordinate child protection in England.

This is the first stocktake of these arrangements since the battered baby syndrome guidance was first issued in 1970. This review, undertaken by former director of children’s services, Alan Wood is hugely significant, with enormous implications for the protection of children. Continue reading ‘Does child protection need a rethink?’

Women and alcohol: Why ‘no shame no blame’ is essential to recovery

Today sees the launch of the Women’s Independent Alcohol Support helpline which author of Women and alcohol: Social perspectives Patsy Staddon has been instrumental in setting up. In today’s guest post Staddon shares insights from both her research and experience on the complexities of  alcoholism and why it needs to be better understood as a social issue, not a personal failure.

Patsy’s book, Women and alcohol: Social perspectives is on offer until the end of January for just £9.99  (RRP £24.99).

Patsy blogI have never been an ivory tower academic—I gained my doctorate in 2009 at the age of 65 so it’s not surprising that most of my life, whether in the period it was governed by alcohol (from the mid-‘seventies to November 1988) or while I have been researching and practising alternative approaches for women with alcohol issues, has centred on what could be called fieldwork.

As soon as Women and alcohol: social perspectives had been completed I was back out in Bristol, as chair and co-ordinator for Women’s Independent Alcohol Support (WIAS), advertising and running alternative groups for women with alcohol issues and (as of January 20th 2016) a weekly helpline—0117-9428077.

Helpline launch

This January seems to be a particularly apt time to launch such a helpline: not only are many people attempting (and perhaps failing?) to keep to a ‘dry January’, but the government chose this month to launch new guidelines, recommending that both women and men should limit their alcohol use to 14 units a week, and stating in addition that there was NO completely ‘safe’ level of alcohol use, as only a small amount increased the risk of cancer and other health conditions.

This increased risk (for moderate alcohol use) does, however, appear to be very small.

“…‘alcoholism’ is a social issue, rather than a personal failure…”

One of the things we hope to do is to counter some of the more hysterical media reports. The WIAS ‘telephone team’ possesses experience and professional expertise in the areas of alcohol recovery itself, mental health, domestic abuse and physical abuse, and has also received training from SISH (Self-Injury Self-Help), a national organisation based in Bristol.

We are taking forward in practice the ideals embedded in the book: ‘alcoholism’ is a social issue, rather than a personal failure. It is a consequence of social disasters at least as much as a cause of them. It is certainly not inevitably permanent, but can be managed and ultimately overcome.
Continue reading ‘Women and alcohol: Why ‘no shame no blame’ is essential to recovery’

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