Redesigning Health and Social Care

Today there is speculation that the government’s guidance on salt intake has been set too high. Last week there was confusing informaton on calorie intake. The week before that there was the fall out amongst the government’s advisors on the danger of various legal and illegal substances.

Bearing this in mind, can anyone be held responsible for an ‘unhealthy’ lifestyle when there is a myriad of such confusing advice and guidance? And how can resources be allocated to support those who develop conditions as a result of misleading guidance (if indeed, it is misleading)? When will come the day when someone is refused some kind of treatment and argues that they have only been living within all these varying guidelines? Will all this quantification of what constitutes a ‘good’ lifestyle and what falls outside of that create a two tier system of access to support? Should we scrap all this lifestyle guidance altogether or will it help to stave off problems in the future?

Today we have learned that the government plans to introduce a Bill that will ensure free personal care at home for a number of older people and disabled adults. Crucially, this will not be means-tested, but instead offers the prospect of care based solely on an individual’s assessed needs, regardless of income. It is undoubtedly good news for those people who want to access care services at home. It is likely to reduce the numbers who feel pressurised into residential care and subsequently lose their savings – and often their homes – as a result. For years the sector has campaigned to get social care higher up the political agenda. And here we are, with personal care tipped as Gordon Brown’s flagship domestic policy for 2010. Not only that, he must view social care as a potential vote winner, with a general election just round the corner.

But I’m confused. The government has only just finished consulting on its Green Paper on the future of adult social care, which sets out a plan of action far more complex than what is presented in the Queen’s Speech. Andy Burnham, Health Secretary, has commented that the new bill would be an ‘interim measure’ – something to help people out whilst the final decisions are taken on the ‘National Care Service’ of the future.  But in a system that already baffles most who come into contact with it, does the government’s decision not just add another layer of complexity that will ultimately make it all the more difficult to initiate full-scale reform? It could be enough to make some of us a little cynical about the whole consultation process surrounding the Green Paper. Political expediency over the sector’s views? Now there’s a thought!

I also wonder what this bill says about the nature of residential care. Current policy discourse tends to promote the idea of ‘independent living’ as meaning staying in your own home. This is what is ‘normal’; this is apparently what we all want for ourselves. But for some, staying at home can become a lonely existence in older age. So whilst acknowledging what is good about this bill, let’s not forget that we should also be striving to ensure that people receive quality care in residential and nursing homes too.  And this must also be central to debates about adult social care funding.