This is the concise, accessible guide for students and practitioners who want a comprehensive introduction to health and social care.
Engaging practical features, such as user-focused case studies and reflective exercises, promote understanding of theoretical and conceptual knowledge. In turn, clear explanations of social policy theory help frame the policy and practice dilemmas faced by students, front-line workers and policy makers. Chapters cover partnership working and integrated care, independent living, disability and long-term conditions, discrimination, user involvement and support for carers.
This new edition has been updated to cover key developments under the Coalition and beyond, including the 2012 Health Act, the 2014 Care Act, the Francis inquiry, the Winterbourne View abuse scandal, the integrated care agenda and the impact of austerity.
This edited book provides a hard-hitting and deliberately provocative overview of the relationship between evidence, policy and practice, how policy is implemented and how research can and should influence the policy process. It critiques the notion of ‘evidence-based practice’, suggesting instead a more inclusive idea of ‘knowledge-base practice’, based in part on the lived experience of service users. It will be of interest to everyone in health and social care policy, practice and research.
This unique book brings together, for the first time, advocates and critics of the personalisation agenda in English social care services to debate key issues relating to personalisation.
Perspectives from service users, practitioners, academics and policy commentators come together to give an account of the practicalities and controversies associated with the implementation of personalised approaches. The conclusion examines how to make sense of the divergent accounts presented, asking if there is a value-based approach to person-centred care that all sides share.
Written in a lively and accessible way, practitioners, students, policy makers and academics in health and social care, social work, public policy and social policy will appreciate the interplay of rival arguments and the way that ambiguities in the care debate play out as policy ideas take programmatic form.
Drawing on key research, government policies and real-life case studies, the book assists health and social care professionals to work more effectively together in order to improve services for users and carers.
The health and social care divide:
explains why partnerships are important and what helps/hinders partnership working;
reviews the legal and policy framework, providing a chronological overview and placing current initiatives in their historical and social policy context;
summarises existing research findings with regard to key health and social care policy debates;
uses case studies to explore the implications of this research for health and social care practitioners;
provides good practice guidance for both students and front-line practitioners.
The 1996 Community Care (Direct Payments) Act came into force in 1 April 1997, empowering social services departments to make cash payments to some service users in lieu of direct service provision. Social work and direct payments guides readers through the issues at stake in this fundamental area of practice.
The book summarises and builds on current knowledge and research about direct payments in the UK and considers developments in other European countries. It identifies good practice in the area and explores the implications of direct payments, both for service users and for social work staff.
This chapter explores the coalition government’s overall track record on adult social care, focusing on the main policy priorities identified in the coalition agreement of 2010 (namely, the funding of long-term care, the relationship between health and social care, developing a preventative approach and the personalisation agenda). It also examines the impact of massive cuts in the local government budget. There was some apparent continuity between the coalition and New Labour on issues of integrated care, personalisation and prevention, but behind the rhetoric there may be less continuity than at first appears. In particular, the underlying value base and tactics behind such reforms may differ: ‘it ain’t what you do, it’s the way that you do it’.
More than any other area of the welfare state, UK health and social care are big business and are everybody’s business. Each year, they spend billions of pounds of taxpayers’ money, employ millions of staff, and work with millions of patients and service users. While this is true of other services as well, health and social care touch all our lives at so many times and in so many places. Overall, the NHS in England employs 1.4 million people and has an annual budget of some £116 billion. It deals with over one million people every 36 hours, with nearly 10 million operations carried out per year (up 45% in 10 years), nearly 23 million attendances at Accident and Emergency (A&E) (up 22% from a decade ago) and nearly 16 million people admitted to hospital (31% more than a decade ago) (NHS Confederation, 2016a). Adult social care in England has spending of around £19 billion (including £2.5 billion in user contributions), with 1.5 million workers, 5.4 million unpaid informal carers and nine per cent of adults in England limited ‘a lot’ in day-to-day activities by illness, disability or old age (National Audit Office, 2014, p 4). Unlike the NHS, which has often been dominated by public sector provision, social care staff work in a wide range of public, private and voluntary sector organisations, spread across an estimated 17,300 organisations and 39,000 individual establishments. The private sector is by far the largest employer, employing over two thirds of people working in adult social care (Skills for Care, 2015, p 3).
Under the Coalition government (2010-), local authorities have suffered such massive funding cuts that one Council leader has described the situation as ‘the end of local government as we know it.’ While Councils have tried hard to protect their social care spending as best they can, this has inevitably led to significant financial challenges and to social care leaders struggling to make ends meet. All this comes on the back of new responsibilities under the Care Act, changing demographics and policy pressures to develop more personalised services and to integrate care more fully with the NHS. While both personalisation and joint working with partners might be part of a longer-term solution, pursuing both goals at a time of austerity is incredibly difficult – and both agendas are arguably being implemented in less than optimal ways. Taking stock of these developments, this chapter looks at recent changes in adult social care and argues that even more fundamental reform will be necessary in future.
In a new century and with a 24-hour news cycle, it is tempting to see every issue as new and every solution posed as a radical departure from the past. Thus, Labour, the Coalition and the Conservatives have portrayed their reforms as being about modernisation and transformation – and all governments have a tendency to emphasise the distinctive nature of their own policies. The Labour governments of 1997 to 2010 are a good example of this, with the rebadging of the party as New Labour and therefore as being fundamentally different to what went before. In practice, Hegel and George Bernard Shaw are often quoted as concluding that ‘we learn from history that we never learn from history,’ while the Bible is clear that ‘there is nothing new under the sun’ (Ecclesiastes, 1, 9–14). Against this background, this chapter reviews the origins of health and social care services, charting the development of different professions and the way in which this historical legacy continues to influence current provision. While summarising some of the chronology, this discussion does not provide a full overview but instead highlights the key implications of specific aspects of this history (while also signposting to further reading for those who wish to explore these issues further). Essentially, this account does not explain how things have developed over time, but represents a more selective attempt to explore why some things today are the way they are (and perhaps to lay the foundations for readers to reflect on where things might be headed in the future).
By the late 1970s, health and social care in the UK were in difficulty. The NHS had initially been established on the basis that it would improve the health of the general population (and so would cost less in future once health status was generally higher). However, this neglected the fact that many people cured by the NHS (and who presumably might have died in the past) were brought back to full health and discharged from hospital, only to become ill again in the future. By improving the health of the population and by extending life expectancy, the NHS was thus a victim of its own success and its funding requirements far exceeded official assumptions. Following the devastation of the Second World War and with insufficient capital funds, proposed building programmes were limited in scope, and many former workhouses and infirmaries continued to be used in practice. Despite a national system, workforce planning seemed underdeveloped, and many of those areas that had traditionally lacked access to local services still seemed under-served. In spite of repeated attempts to develop more community-based services, the power of the institution continued to dominate and the resources to make a reality of community care never seemed to accompany the policy rhetoric (see Box 3.6 later in this chapter for an example). A series of hospital scandals also brought to light the poor quality of many long-stay services for particular community care user groups.
In social care, the National Assistance Act 1948 initially focused attention on residential forms of care, stating that ‘it shall be the duty of every local authority … to provide residential accommodation for persons who by reason of age, infirmity or any other circumstances are in need of care and attention which is not otherwise available to them.