Suchergebnisse

Two years after the government consulted on the next steps for a Carers Strategy, the Department of Health and Social Care has published its 'Carers Action Plan'. Melanie Henwood explains that, although this provides some assurance to carers that they are on the government's agenda, the action plan must be followed through with demonstrable objectives in the forthcoming green paper.

The NHS and social care systems are turning 70, and for almost as long as they have existed, there have been attempts to join up the services and improve coordination. Despite multiple reorganisations, however, efforts have had limited success. Melanie Henwood explains what the conclusions and recommendations of new analysis by the Care Quality Commission tell us about operating these parallel but separate organisations.

The challenges posed by an ageing population are major preoccupations of governments throughout the developed world. There are many dimensions to such challenges, and this paper focuses on issues relating to long-term care in old age. The debate around such matters has been similar in the UK and in Australia. In both countries, a history of incrementalism and poorly presented policy reform has contributed to widespread public mistrust, and a sense of injustice at the extension of means-testing or user pays principles. This paper examines the analysis and conclusions of a Royal Commission in the UK, set up to explore options for the finance and structure of long-term care. A fundamental principle advanced by the Commission is that the risk of needing long-term care should be shared by all citizens, rather than borne by those who have the misfortune to need such care. A separation of the personal care costs of long-term care from the living and housing costs components has been proposed as the most equitable way of sharing costs between individuals and the state.

English
The boundary between health and social care in England has been problematic throughout the postwar period. The 1997 Labour government put a specific emphasis on partnership working across these two policy areas and developed a coherent strategy for promoting the collaboration agenda. However, it has almost simultaneously turned against partnership working and in favour of restructuring as a way of securing integrated care. This has caused confusion and resentment in the field and is argued to be inconsistent with the complex requirements of governance and the management of 'wicked issues'.

The policy drive to support carers is a longstanding national and international priority. Research about the design and delivery of support for carers is critical to the underpinning evidence base. Through a timely exploration of a third sector perspective, the UK-based study discussed in this article provides insights into approaches to, and the commissioning of, support for older carers and carers of people with dementia. The study highlights the importance of: embedding carers' perspectives in service developments; the provision of both generic and targeted support which adopts a nuanced and tailored approach; titrating the delivery of information and advice at a pace to match carers' needs; capturing quantitative and qualitative dimensions in service evaluation; and increased quantity and longevity of funding. Such insights not only complement existing research but are also generalisable to other countries at a similar stage in the development of carer support.

The community care reforms which followed the 1989 White Paper "Caring for People"were apparently focused on addressing the needs of people requiring long‐term care, and on achieving improved outcomes and better quality of life.The agenda set out by the White Paper was for community care in the next decade and beyond. Half way through this decade, we question the extent to which the objectives of promoting choice and independence for users and carers have been achieved. The paper draws particularly on a programme of monitoring conducted jointly by the Nuffield Institute for Health and the King's Fund, based on national and local focus groups meeting over a two‐year period. It proposes a framework for evaluation which consists of four components: the definition of desired outcomes; specification of service systems necessary to deliver such outcomes; promotion of access to services; and the development of supporting operational policies and resource allocation mechanisms.This framework offers a substantial step beyond much of the monitoring of the community care reforms which has taken place to date. This has assessed progress largely in terms of the establishment of new systems and processes. We conclude that such changes were essential building blocks for delivering better‐quality community care services, and in the short term it may have been legitimate to view their establishment as proxies for progress towards delivering user‐centred services. However, monitoring and evaluation should now be increasingly oriented towards ensuring that these changes are in fact producing the desired service outputs and urn outcomes. We propose that our framework offers one such way forward.