The health and social care divide , livre ebook
177
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English
Ebooks
2004
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177
pages
English
Ebooks
2004
Obtenez un accès à la bibliothèque pour le consulter en ligne En savoir plus
Publié par
Date de parution
12 mai 2004
Nombre de lectures
1
EAN13
9781447342250
Langue
English
Poids de l'ouvrage
1 Mo
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.
Voir
Publié par
Date de parution
12 mai 2004
EAN13
9781447342250
Langue
English
Poids de l'ouvrage
1 Mo
REVISED SECOND EDITION
THE HEALTH AND SOCIAL CARE DIVIDE The experiences of older people
Jon Glasby and Rosemary Littlechild
REVISEDSECONDEDITION
THE HEALTH AND SOCIAL CARE DIVIDE The experiences of older people
Jon Glasby and Rosemary Littlechild
Consultant Editor: Jo Campling
In memory of Marjorie Fielding (19161996) and for Les and Gladys.
First published in Great Britain in May 2004 by The Policy Press University of Bristol FirstFloor 1-9OldParkHill Bristol BS28BB UK
Tel +44 (0)1179545940 email tppinfo@bristol.ac.uk www.policypress.co.uk
North Amerîcan oice: Polîcy Press c/o The Unîversîty of Chîcago Press 1427 East 60th Street Chîcago, IL 60637, USA t: +1 773 702 7700 f: +1 773-702-9756 e:sales@press.uchîcago.edu www.press.uchîcago.edu
© Jon Glasby and Rosemary Littlechild 2004 Index © Caroline Wilding 2004 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress CataloginginPublication Data A catalog record for this book has been requested. 9781447342250EPDF
Jon Glasbyis a qualified social worker and Senior Lecturer in the Health Services Management Centre, andRosemary Littlechildis a Lecturer in Social Work in the Institute of Applied Social Studies, both at the University of Birmingham.
The right ofJon GlasbyandRosemary Littlechildto be identified as authors of this work has been asserted by them in accordance with the 1988 Copyright, Designs and Patents Act.
All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of PolicyPress.
The statements and opinions contained within this publication are solely those ofthe authors and not of The University of Bristol or Policy Press. The Universityof Bristol and Policy Press disclaim responsibility for any injury to persons orproperty resulting from any material published in this publication. Policy Press works to counter discrimination on grounds of gender, race,disability, age and sexuality. Cover design by Qube Design Associates, Bristol. Front cover:photograph supplied by kind permission of www.JohnBirdsall.co.uk.
five
Ben’s story: continuing care
165
Marjorie’s story: older people with mental health problems
eight
115
Ivy’s story: domiciliary care in the community
Contents
List of tables, figures and boxes Preface Acknowledgements
iv v vi
5
1
Partnership working in health and social care
two
Bert and Babu’s story: rehabilitation and intermediate care
Bibliography and relevant websites
Index
19
75
153
129
147
seven
six
three
four
Andrew’s story: hospital discharge
Health and social care: the legal and policy context
Introduction
61
105
one
iii
nine
93
ten
Postscript:Sid and May’s story
Mary and Dennis’ story: primary care
Boxes
3.4 3.5 4.1 5.1 5.2 7.1 7.2 8.1 9.1 9.2 9.3 9.4
5.1
Different levels of partnership working
The health and social care divide
iv
Tables
Predicted and actual destinations
Defining partnerships The rationale for partnership working Partnership working: what helps and what hinders? The Partnership Readiness Framework Key themes of HC(89)5 The eight key tasks for local authorities Services to be arranged and funded by health authorities and GP fundholders TheNational service framework for older people Reimbursement ‘Bed blocking’ Intermediate care: short and longterm issues Practical difficulties in establishing intermediate care: a case study Domiciliary care and older people’s priorities Domiciliary care and older people’s priorities Forget me not GPattached social work Lessons from successful partnerships Partnership working in primary care Partnership working and the National Tracker Survey
54 57 63 81 83 107 108 120 131 135 138 140
76
15
List of tables, figures and boxes
2.1 2.2 2.3 2.4 3.1 3.2 3.3
6 10 13 13 29 33 36
Figures
2.1
Preface
This book is intended to provide a human face to some of the many research findings that point towards the problematic nature of the health and social care divide. The case studies included here are composites compiled from the experiences of people whose lives have been severely affected, often for the worse, by the issues discussed. This book is testimony to their suffering, courage and endurance.
v
The health and social care divide
Acknowledgements
Thanks to our colleagues at the University of Birmingham for their comments and suggestions, and to practitioners in a range of health and social care settings for their input, advice and experience. We are particularly grateful to The Policy Press for all their help and support and to PEPAR Publications (the publishers of the first edition of this book). We are also grateful to Professor Caroline Glendinning and Professor Jill Manthorpe for their comments and support with early proposals and drafts.
vi
Introduction
ONE
Introduction
Since coming to power in May 1997, the New Labour government has pledged its commitment to bringing down ‘the Berlin Wall’ that has developed between health and social services (DoH, 1998a). This may seem like dramatic language, but the problematic nature of the division between these two public agencies has been one of the most controversial and enduring issues of modern British social policy. For frontline workers, the need to overcome a tangle of legal, administrative and organisational obstacles in order to work effectively across service boundaries with colleagues from other professions and backgrounds is an almost daily struggle. Be it hospital discharge, continuing care, domiciliary care or rehabilitation, the boundaries between these services are an almost constant source of difficulty, debate and consternation. For individual service users who find themselves trapped between these two large and powerful agencies, the experience is frequently one of frustration, disillusionment and despair. In extreme cases, it is not unknown for a patient to fail to meet the criteria for either health or social care, falling between the boundaries of existing service provision and being passed backwards and forwards until a major crisis occurs. The dangers of this have recently been recognised by the government, which has pledged its commitment to supporting more effective joint working between health and social services. As part of this process, a wide range of new policy initiatives has been introduced, many of which will significantly affect the work of frontline practitioners, but have not yet become widely known at ground level. Against this background, this book seeks to provide an easily comprehensible introduction to policy and practice at the interface between health and social care. Chapter Two begins with an introduction to partnership working between health and social services, exploring the rationale for working together and some of the factors that help and hinder. Next, Chapter Three explores the legal and policy context, providing a chronological overview of developments in the field of health and social care provision since the Second World War. Chapters Four to Nine examine key issues from practice, combining a review of the existing research with detailed case studies compiled from a number of examples from practice. These case studies are designed to provide a human face to the various administrative and professional difficulties that are often involved in multidisciplinary working. Although the health and social care divide is a difficult issue for the workers involved, they should never lose sight of the human suffering that can be caused by the failure of service providers to collaborate effectively. Aimed at students, frontline workers and firstline managers, each chapter concludes with good practice guidelines and guidance on further reading for
1
The health and social care divide
those interested in following up particular issues in more detail. Throughout, the book contains a number of reflective exercises so that readers can take time out from the text and consider how the issues raised can be translated and applied to their own situations and work places. Finally, the book concludes by summarising key implications for policy and practice and provides details of how to access relevant websites. Although many of the issues highlighted here are applicable to a range of community care user groups, analysis focuses specifically on the experiences of older people. This is the result of six main factors:
• Older people are major consumers of health and social services, with estimates of the amount of money spent on community care services for this user group ranging from 4782% of total public expenditure on health and social services (Victor, 1997, pp 912). • Older people often have multiple and complex health needs, straddling the boundaries of traditional service provision (Sidell, 1995). • Demographic changes mean that the number of older people has increased dramatically and is set to carry on rising. Since the turn of the 20th century, the number of older people has risen by 400% and is forecast to continue to grow until at least 2030. By far the most significant increase will be in the number of people aged 85+, who will be three times more numerous in 2050 than in the 1990s (Royal Commission on Long Term Care, 1999). These changes will clearly impact upon health and social services, placing greater strain on the current system and forcing practitioners to consider new ways of working. • Older people have been slower than other client groups to form a user group or movement to represent their interests. Attempts to involve older people in service planning or delivery have also been few and far between (Barnes, 1998). • Some older people are particularly prone to poverty and poor housing (Tinker, 1997), and lack the resources to aid recovery from illness or to make alternative provision for their needs. • Work with older people has traditionally been seen as a low priority (Bowl, 1986; Marshall, 1990; Means and Smith, 1998a), attracting fewer recruits and being perceived as ‘unglamorous’ work suitable only for less qualified workers.
For all these reasons, older service users are particularly vulnerable when divisions emerge between health and social service providers. Despite this, many of the issues discussed and the policy initiatives reviewed will also be of relevance to other user groups. Thus, while partnership working initiatives often focus on older people, we know that people with mental health problems (Hancock et al, 1997; Glasby et al, 2003), people with learning difficulties (DoH, 2002a;Towell, 2002), people with physical impairments (Glasby and Littlechild, 2002; RADAR, 2003) and children and young people (Watson et al, 2002; DfES/DoH, 2003; HM Treasury, 2003; Laming, 2003) all have needs which require a multiagency
2
Introduction
response. Similarly, the partnership working themes and issues explored later in Chapter Two within the context of health and social care may also be applicable to other areas of social policy such as housing, regeneration, public health, crime and disorder, substance misuse and promoting social inclusion (see, for example, Balloch and Taylor, 2001; Glendinning et al, 2002a). Throughout this book, we focus on partnership working or interagency collaboration between health and social care as a means to an end (that is, as a means to better services, experiences and outcomes for service users and carers). In the current policy context, we feel that there is a danger that partnerships are seen as an automatic policy response to all kinds of issues and problems – almost to the extent that they become an end in themselves. While we welcome the current emphasis on services working more effectively together, we feel that partnerships should be the means by which we improve things for individual service users like the ones whose cases are cited in Chapters Four to Nine of this book – if partnerships do not lead to improvements for users and carers, then they are part of the problem rather than part of the solution. Although we acknowledge that frontline health and social care agencies are often doing their best to work together in difficult circumstances, we support a summary of the current situation provided by a Department of Health discussion document, Partnership in action(DoH, 1998a, p 3):
All too often when people have complex needs spanning both health and social care good quality services are sacrificed for sterile arguments about boundaries. When this happens people, often the most vulnerable in our society … and those who care for them find themselves in the no man’s land between health and social services. This is not what people want or need. It places the needs of the organisation above the needs of the people they are there to serve. It is poor organisation, poor practice, poor use of taxpayers’ money – it is unacceptable.
It is what this poor practice means for service users and their carers and what workers can do to improve the situation that is the focus of the remainder of this book.
3
