During times of austerity and funding pressures on commissioners and providers of services, can person-centred care be maintained?
A number of agencies and care experts in Scotland have protested recent policies and decisions by some care funding Councils. They give examples where people have been, or may be moved to care homes when the cost of maintaining these people in the community increases above a certain limit. The Centre for Welfare Reform, Age Scotland and In Control have spoken out about this
The issue has been described in the Herald newspaper; some of the examples are very concerning.
Backward Steps?
The paper gives examples of an elderly disabled person being moved into a care home, despite having lived with family support for 20 years.
One Council has written to people with a warning on costs of support. They have stated that if the cost of support in the community rises above 10% the cost of being in the care home, then the Council will offer them a place in a care home. After some feedback, the Council reportedly backed down..
These ways of responding to funding difficulties are ironic. Apart for the tragic consequences for those who feel forced to move. In Scotland, we are engaged in a drive for improvement of support services. The aim is to make them more preventive, innovative and outcome-based. Yet these responses by some funders are fitting people into affordable services. This is precisely the opposite of the objective the sector as a whole is following. We need affordable services to be constructed around people’s needs. Clearly positive and better solutions are needed.
Advocacy
Experts have pointed out that not only is this a possible breach of people’s rights, but in some cases it could be a threat to people’s lives. It is well recognised that changes in people’s living habits as they get older can affect their health and well-being. Some care home closures have resulted in life expectancy being shortened after a change of care setting.
The experts have also pointed out that not every vulnerable person has got representation advocacy or even someone to speak out for them. Dr Duffy of the Centre for Welfare Reform is himself acting as an advocate for a person with severe physical disability, facing the difficulty of being moved from a community setting to a care home.
People’s Rights
At present Scotland is also moving towards a more rights based set of standards by which all care services must operate and by which they will be regulated. It is very easy to see how some of these new standards will be automatically unmet by the very agencies who are commissioning these services.
The new standards have been devised after extensive consultation with local authorities, care providers and individual people receiving care. They imply that the people have a right not to have such draconian moves imposed upon them. One would imagine that funding or more person focused services must be made available to support these rights. Otherwise the people receiving care are having their rights guaranteed on one hand, but taken away with the other.
The Future
The regulators, funders, and Government itself must take steps to preserve and enhance the rights of people receiving care. People, and not money, should be the driver for future improvement work.
In 2011, the Christie Commission, investigating the need to improve care services in Scotland, stated that one of the ‘key objectives of a reform programme must be to ensure that public services are built around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience’. It looks like we have some difficult challenges to overcome to fully realise that goal.
