There is a clear divergence emerging between each region in the UK in terms of the nature and pace of implementing a policy framework that supports older service users and promotes a person-centred framework.
Following devolution, Scotland and Wales have developed adult social care strategies underpinned by person-centred principles through divergent policies and provision from each other and England. Meanwhile, in Northern Ireland, policy developments have not progressed at the same pace as the rest of the UK and there has been emphasis on a person-centred policy for adult social care users. The acknowledged shift in dependency ratios and increasing social care projects have emphasised a sense of urgency to reform adult social care policy in Northern Ireland.
Despite considerable reference to ‘personalisation’ in an independent review of health and social care services (Transforming Your Care), no specific proposals have outlined how this could be applied in statute in Northern Ireland for older users. There have been no new proposals to introduce new legislation akin to that proposed in other jurisdictions in the UK to put social care entitlements in a new statutory framework.
The lack of pace with regard to social policy making is very apparent in social care. Community care legislation in Northern Ireland still operates under People First: Community Care (1990) framework. This was designed for an entirely different set of needs and is no longer compatible with the current government’s drive towards transferring responsibility from the state to individuals. Recent work from The Commissioner for Older People in Northern Ireland recognised that the effect of an outdated legislation has the potential to disadvantage older people in both the understanding of social care services that are available to them and in terms of how to access these services.
The ageing population is on our collective minds, more than ever before. The fluctuation of demographics and longer life expectancy have fuelled a political movement to look after our ‘oldest old’ to provide good quality care for social care users. Yet, those who aren’t in receipt of social care but could potentially be in the future have been widely neglected in the social care debate, particularly in Northern Ireland. There is growing recognition that future social care users should have greater opportunity to plan their future care. It is believed that knowing preferences for types of future care may be useful for those receiving care and for their care providers. Advance social care planning and preparation for the eventuality of needing some form of care provision may enable older people to cope more effectively with increasing frailty. This was one of the challenges that I stumbled across in my own fieldwork.
It was clear that participants had given little thought to the different options and types of care provision they would like, if they were to need care in the future. None of the participants had existing plans, nor had they discussed this with others. What stood out the most when discussing different preferences was that participants had thought more about the care services they would not like to receive, rather than the care they would like to receive. Having choice and control over the services that are available to them was also important to ensure that care is person-centred and tailored to individual need.
It was ironic, given the current policy drive, that the majority of participants were confused by what ‘community care’ meant and were unable to define what a person-centred approach could look like for them as they were reluctant to think that far ahead. Participants assumed that they would only begin to think about care options once they needed care. This finding corroborates several other research studies that assert that older people only think about social care when they are at crisis point. This was not a subject that participants enjoyed discussing as many associated receiving social care with end of life care. Some participants preferred not to dwell on possible future health problems or care needs and had actively avoided care planning altogether.
It is difficult to examine how this could be applied in Northern Ireland for older users when participants were reluctant to outline what they envisaged or would prefer if they were to need future care, thus creating potential difficulties for policy-makers. Debates in personalisation have criticised the implementation of the policy with several academics arguing it was introduced without ‘user-led’ participation as a cost-saving mechanism. In contrast, Scotland and Wales both relied heavily on service user involvement when introducing recent adult social care policies for older users. Arguably social care policy has been neglected in Northern Ireland, however, there is some indication that this is now changing. Northern Ireland has the opportunity to learn from each jurisdiction to ensure that implementation can be fit for purpose in an era of shifting responsibilities to the community beyond the current narrow focus on social care cut backs and economic efficiency.
Alexandra Chapman is a PhD candidate at Ulster University (School of Criminology, Politics and Social Policy)
If you enjoyed this blog post, you may also be interested to read Personalisation, ambiguity and conflict: Matland’s model of policy implementation and the ‘transformation’ of adult social care in England by Kathryn Ellis