How to fill the huge gaps in social care provision | Letters

Gaby Hinsliff’s piece will have resonated with anyone who has ever provided vulnerable parents with everything that can be labelled ‘care’ (The shrunken state expects families to fill the gaps in health and social care. Wee betide those without children, 9 August). It has always been the case in this country that families, and particularly daughters, bear the brunt of such care. What has changed, as she points out, is the demographic shift towards smaller families and longer life expectancy. On the other hand, however, the state has simultaneously and perversely withdrawn essential support for those families who provide care, such as home help, home-delivered meals and childcare.

This process began under Thatcher, who privatised residential services and, in the name of efficiency, forced councils to outsource community services. Cutbacks led to the concentration of these residual services on the most dependent. This removed the crucial function of social care in preventing the breakdown of family care, and made it an emergency service, only as a last resort.

As Hinsliff says, this system is broken and is failing both older people and their families. As an adviser to Robin Cook when he was Shadow Health Minister, I proposed a Royal Commission into Social Care to build cross-party consensus on this crucial issue. This proposal was in Labour’s 1997 manifesto and the resulting Sutherland Commission did a brilliant job of making the logical and socially just case that social care should be treated in the same way as health care, as a generalised risk.

While the Scottish Government has adopted this principle, successive UK governments have not. The barrier is always cited as cost, but this only reinforces the low priority given to social care compared to health care. The much higher costs of this neglect fall first on older people and their families, and then on the NHS.
Alan Walker
Professor of Social Policy, University of Sheffield

Gaby Hinsliff is right that we need recognition of changing family patterns, as well as a reliable NHS and a national care service. But when so many older people are left to fend for themselves, there is a course of action that has hardly been tried.

The Netherlands offers financial and professional support to over-55s to plan ahead, form and run their own mutually supportive ‘community homes’. These are clusters of households sharing space, offering an alternative to isolation or residential care, and also providing relief for families. Scaled down and age-proofed homes offer additional benefits. This form of community development, with a strong foundation in reciprocity and self-management, has led to what is known in the UK and elsewhere as the cohousing community. However, it is a model that has struggled to gain recognition and support here.

If the state were to invest seriously in community development to help older people stay happy and healthy for longer, the long-term result would be savings in public spending and fewer blocked hospital beds. A proactive government policy, supported by relatively modest grants or loans and professional expertise, could help interested older people create their own ‘mini-neighbourhoods’, combining independent housing with shared space and a sense of community. New Ground, a group of women aged 50 and over in High Barnet, north London, demonstrates the value of this.
Maria Brenton
Co-founder, New Ground

Gaby Hinsliff suggests that there could be another royal commission into long-term care. May I suggest a possible shortcut? Consider the Republic of Ireland’s Fair Deal programme for social care.

The Fair Deal provides an appropriate level of social care support for every Irish person who signs up. It is not a magic money tree. Although it is free for the least well-off, it still requires a financial contribution from those on average incomes and assets.

At the same time, it provides certainty for people in need of care and their families that affordable care will be available. It also creates a good business case for investment. Care homes are opening in small towns and villages across Ireland, providing meaningful jobs for local people and a decent return for investors.
Tim Johnson
London