CHAPTER 5: Elderly Care, the National Health Service 1948 to the Community Care Act 1990
5.3 The role of the family and others – informal care to the elderly
Michael Hill, 440 in his studies has emphasised the importance of the family as
a provider of elderly care.441 In the UK the emergence of smaller families and
greater female participation in the workforce has witnessed the trend from caring within families to one of institutionally based long-term care. Nevertheless any such trends should not disguise the fact that whilst what may usefully be termed “formal care”442 in the non-hospital sense includes home care, respite day care and care
home care usually arranged by the local authority, now depends on institutions for delivery.
The vastness of “informal care”443 consisting of the greater majority of elderly
and other care delivered by an elderly person’s family, friends or neighbours or others providing personal care, practical help and co-ordination of care services, the number of which has grown by 11% in the decade 2001 to 2011, as has the intensity of their caring hours which have risen as has the number of them over 65 years of age. The NAO report estimates that the value of informal care is nearly £100bn per year.444 See diagram below:445
440 Professor Michael Hill, University of Newcastle-upon-Tyne, who uses here OECD developed nations
research and data as well as United Nations data.
441
Michael Hill, Social Policy in the Modern World: A comparative Text (Oxford: Blackwell Publishing, 2006), Chapter 12 – “Ageing Societies.”
442 Described as such together with “informal care” in the Report – Adult social care in England : overview- (11
March 2014) – National Audit Office (NAO) – Report of the Comptroller and Auditor-General to Parliament – Session 2013-2014 – HC 1102.
443 NAO Report (11 March 2014), Ibid. 444
NAO, Adult Social Care in England: Overview HC 1102 (11th March 2014) para. 1.6.
445
Local authority provides important support for this part of care delivery. The Care Act 2014 provides an obligation on local authorities to provide support. This may be in the form of home
Payments for these services may be from the user, the NHS, the voluntary sector and also local authorities. Currently there is a carer’s allowance paid to low paid carers who provide at least 35 hours of
carers receive such support.
5.4 Conclusions
The success of the NHS from the second half of the 20
healthcare provider delivers a variety of medical and related social services to large numbers of the elderly, and helps to prolong their lives. Beveridge’s philosophy of
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Local authority provides important support for this part of care delivery. The Care Act 2014 provides an obligation on local authorities to provide support. This may be in the form of home helps, day care and also nursing care in care homes. Payments for these services may be from the user, the NHS, the voluntary sector and also local authorities. Currently there is a carer’s allowance paid to low paid carers who provide at least 35 hours of care per week. Only minute numbers of carers receive such support.
The success of the NHS from the second half of the 20
healthcare provider delivers a variety of medical and related social services to large and helps to prolong their lives. Beveridge’s philosophy of Local authority provides important support for this part of care delivery. The Care Act 2014 provides an obligation on local authorities to provide support. This helps, day care and also nursing care in care homes. Payments for these services may be from the user, the NHS, the voluntary sector and also local authorities. Currently there is a carer’s allowance paid to low paid minute numbers of
The success of the NHS from the second half of the 20th Century as a
healthcare provider delivers a variety of medical and related social services to large and helps to prolong their lives. Beveridge’s philosophy of
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the elderly being embraced in the concept of universalism remains but restricted to the National Health Service in terms of acute and long term care treatments. In Chapter 7 we see how some sections of this NHS hospital care delivery meet regulatory failure.
Long term residential care is subject to a mixed variety of responses. Private sector interaction in care provision and private sector elderly care delivery growth accelerated from 1997. Indeed it recognised the realities of not redirecting funding into local government care home provision.446
Residential care was often seen as the last resort leaving families to take responsibility. There are also large discrepancies in the delivery of social services and support to the elderly across regions and according to marginal discretion operated by the local authority.
A large proportion of elderly care comes from families and friends that is largely unfunded from the state. The coexistence of public and private health care provision for the elderly continues, but the considerable issue of lack of ‘joined-up’ care persists despite attempts to rectify it.447 Families, who provide much direct care
to the elderly, are often the co-ordinators of the disjointed system as well as GP’s. Families are also frequently at the centre of procuring the maintenance of their elderly in their own homes, much aided these days by modern equipment, skills, and with adaptation of premises more readily achievable than in the past, influencing some of the policy driven fall in care home numbers statistically visible.
446
Which earlier ‘traditional’ Labour governments would have done.
447
The Labour government of 1999 attempted this by removing some legal barriers by Section 31 of the Health Act 1999 (1999, c.56) with important powers for the NHS and social services budgets to be pooled, for local authority agencies to provide some NHS services, and vice versa, and for each to delegate to the other responsibility for commissioning both health and social care services.
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Today the 4% or so of the older population in long term residential care equates roughly with the proportion who were in-house paupers in 1892. An emphasis on community rather than state support, with a major provision of care by the private and charitable sectors is once again to the fore, although in more recent times two thirds of that care may be funded either wholly or in part by the state.
Party political engagement with the elderly has been a mixture of interventions that have varied from the Labour Party Manifesto in 1997 to the Royal Commission Report in 1999, the Royal Commissioners 2003 Statement and the intended effect of the Wanless Review to continue the debate that had been addressed by the Royal Commission in 1999.
It is clear that providing a coherent and over-arching system of elderly care regulation has to take account of the above analysis. Elderly care cuts across many different sectors – private, public, hospitals and care homes. Elderly care delivery and its medical requirements are in fact delivered across a system of hospitals, nursing homes and care homes which between themselves are hard to differentiate. It is in the nature of elderly care that it is multi-disciplinary cutting across a whole range.
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