Estimating demand pressures arising from need for social services for older people

The twelve years preceding the introduction of the community care reforms in 1993/4 saw an increased demand for health and social services generated by the increase in numbers of older people (particularly the over 85s) and reflected in the rapid growth of residential and nursing home places over a twelve year period (from 224,000 in 1983 to 427,000 in 1994). While the move into the residential and nursing home sector was partly driven by the perverse incentives offered by social security in the early 1980s, it may also have reflected a real increase in the levels of dependency experienced by older people coming into contact with the services during the period. This has fuelled concern about rising costs. However, there are competing forecasts of how big a burden the costs of care will be. One of the difficulties is in determining how far the burden will fall on statutory services or formal services (provided by either the statutory or independent sectors) and how far the pool of informal carers will be large enough to maintain the level of care which it provides currently. The Institute of Actuaries published an influential paper in 1993 (Nuttall et al, 1993) suggesting that the current cost of informal caring based on a rate of £7 per hour could be estimated at £33.9 billion. The House of Commons Health Committee (1996) took evidence during 1995 and 1996 and concluded that the gloomiest forecasts were unfounded and that radical action was not needed in the immediate future. Nevertheless, whatever the predictions for the medium and long term, concerns have been raised with regard to current capacities to meet demand. The community care changes resulting from the Act were funded by a transfer, Special Transitional Grant (STG), to the local authorities with which to meet their new responsibilities. There has been a continuing debate as to whether the STG and the SSA allocations have been sufficient to enable them to do this. The Association of Directors of Social Services and the Association of Metropolitan Authorities (now subsumed into the Association of Local Government) have repeatedly called for a review of the current funding of community care saying they are unable to meet the full needs of dependent people (Community Care, 1996, 1997a).elderly, social services

Exploring financial abuse as a feature of family life: an analysis of Court of Protection cases

Presents an analysis of Court of Protection cases dealing largely with applications to revoke lasting powers of attorney (LPA) often where financial misbehaviour is implicated. In particular it focuses on the role of intra-family dynamics showing how family disputation can play a significant part in relation to the financial abuse that takes place. While financial abuse is frequently committed by strangers, in certain circumstances the perpetrators may be members of an older person’s own family. The research described here was part of a wider project exploring the financial abuse of adults of all ages who lack capacity, examining the role of various agencies in preventing or dealing with it. It used a mix of methods including the analysis of national and local statistics, interviews with professional experts in the law, banking and health and social work, together with a local area case study

Beliefs, culture and circumstance : a critical examination of the concept of professional ideology in relation to the health and social services

The research described in this thesis is concerned with examining the views of a range of health and social service professionals towards policies devised by central government in the mid-1970s, relating to the care of particular patient or client groups, namely, elderly, mentally ill. and mentally and physically handicapped people. The policies called for priority in resource allocation to be given to these groups - although this was likely to involve withdrawing resources away from other groups (notably from the acute sector within the health service); they alsocalled for a move away from institutional care towards community care. By the beginning of the 1980s. little progress in achieving such a shift had been made. and recent reports in the late 1980s suggest that subsequent progress has also been slow.Analysts have given various reasons for this failure, but this study is founded on the proposition that professionals in the organisations responsible for the delivery of care to the 'priority' or 'dependency' groups are likely to have played a significant role in the only partial implementation of the policies. It reviews literature on theories of social policy development. organisational behaviour and the role and significance of professionals in organisations, arguing that the beliefs and attitudes of professionals may amount to what can be called ideologies which condition and mould behaviour.The study is based on extended, semi-structured interviews with 236 respondents in three Scottish locations. It finds that distinctive patternings of attitudes emerge according to professional affiliation; other factors, however, also exert a conditioning effect - such as organisational position, agency membership and the practitioner/manager distinction. Attitudes directly relating to the policies themselves are moulded by the significance which the issues hold for the respondents concerned - thus a dichotomy between the abstract and the concrete emerges. Although support for the policies in principle is usually forthcoming, it tends to be couched in equivocal terms. The study concludes that such ambivalent attitudes are likely to play a major part in shaping the outcomes of the policy process