Comparison of Health and Social Care Delivery Systems

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European Perspectives on the Organisation and Delivery of Social Care

ASSIGNMENT TOPIC: What can we learn from other countries about how we fund and deliver adult social care in England?

Introduction

This report will analyse adult social care in England. It will analyse the way it is funded and the delivery of the services provided. Issues/limitations arising from the method of funding and service delivery will be described. This will be compared with how the adult social care service is delivered in other European countries like Finland and France. A comparison of similarities as well as differences in methods adopted by these countries will be discussed critically. Case studies to buttress the stated points will be analysed as well as global standards of service delivery and funding for adult needing care will be talked about. This report will be concluded with a summary of what England can learn from other European countries and the world.  (Checking Charity 2017)

Adult Social care is the care given to adults- adult here refers to older people with physical, mental, learning disabilities. Various care services are provided, which include social or personal. Also, different levels of care are available for the adults this includes assisted living facilities-a housing for people who cannot live independently, nursing home-a residential institution that provides accommodation with health care plan for the older people, hospice care- care for people with lifelong terminal illnesses  or seriously ill, and memory care units- designed specifically for taking care of adults with memory-related problems like dementia and Alzheimer. (Alcock. et. al., 2008) Various elements come together to make what is referred to as adult social care. They include Health services- this includes GP services, mental health, drug and alcohol services, and counselling services. Housing services-this includes social housing, supported living, housing services, and housing-related support. Welfare and benefits services- include employment services, housing benefit, disability benefit, citizen’s advice and professional support. Leisure and wellbeing services- include library services, educational services, sports facilities, transport services and community centres. (Institute for Govt., 2017)

 A lot of adults require social care and support in Britain. About 1.1 million adults receive care at home of which about 80% of them are supported by the state. Approximately 400,000 adults are in residential care amongst which 56% are also supported by the state. (Alcock. et. al., 2008) Local authorities in Britain have stated that adult social care is one of the healthcare areas where they spend the most resource allocation. This is due to the fact that the number of people who require this service keeps increasing at the expense of the budget being allocated to them. The local authorities are struggling to cope with the increase in need; this has led to the need to cut back on the spending on the other services provided. This is to make provision for the increasing need for adult social care. This cut back is approximately 16.1 billion which is a move downwards from about £24.5 billion to £8.4 billion. (Hudson, 2016 )

The Major drivers of Adult social care are

Personalisation – The introduction of personalisation is to ensure better services to each adult as their need requires. Personalisation in clear terms can be referred to as the process whereby an individual in need is responded to and assessed bearing in mind the individuals preference and choices. It is a person-centred approach to adult social care. It empowers older people to be part of the decision-making process that concerns their health and welfare. (Mandelstam, 2011) The core argument for personalisation is responsiveness to individual needs, efficiency, and effectiveness. (Dunning 2008) Adult social care services should be person-centred, safe, effective, caring and responsive. The choice as to how funding is provided is left open for the service user. It could be through direct payment or otherwise. (Gardner, 2011)

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Wellbeing –  This term encompasses various aspects of life like personal dignity, protection from neglect as well as abuse, social, economic, physical, emotional, mental wellbeing, suitability of living accommodation, as well as control the daily life of an individual, all contribute to well-being. All of the listed factors are of equal importance. (Harvey & Taylor, 2013)

Modernisation – Modernisation in social care involves the move towards individualisation of service user budget. The modernisation of adult social care in Britain has improved over the years in terms of effectiveness and efficiency by adopting the person-centred approach to care. The kind of care provided for vulnerable adult gives them the opportunity to make their own choices, promote independence and also access the services provided by the local authority. (Lane & Ersson, 1996)

Social care funding and delivery

England: Adult social care in Britain is funded by the local government from the funds allocated to them by the central government and the service is delivered by the local authorities, in some cases, service users fund their care. Example include People with wealth below £14,250 are funded by the local council, up to £23,250 can be partly funded while above £23,250 will be self-funded. (Checking Charity, 2017) The number of people receiving adult social care in England has dropped drastically due to the lack of funds. The local authorities have had to cut funds in other sectors to fund adult care and also reduce the number of people they are able to support. Adult social care is dependent on both means-testing and assessment. Assessment of needs is performed by a local authority to determine the level of risk an individual has. The most extensive legislation guiding the field within the UK is the Health and Social Care Act 2012. Britain’s current spending on health and social care falls below the European average. Britain spends £57billion a year. (Ebbinghaus, 2012)

France: The adult social care system is handled by the government and funded through the social insurance contributions. It is accessible to all legal residents and all residents are obligated to have a health care provision by Law. (Expatica, 2000-2018) About 9.3% of its GDP is used to cater for the health and social care sector. About 13% of workers wage is paid as income tax and used to pay for their health services, but a lot of workers also have top-up private medical insurance. The public sector expenditure on health is 7.1% of GDP with the private sector adding 2.2%. (Ebbinghaus, 2012)

Finland: The World Health Organisation (WHO) stated that Finland has the best universal health and social care system in the world. The Three tiers of government are responsible for adult social care in Finland. The central government and ministries-They set the legal frames, design, and supervise the social policies. Regional state administrative agencies –they are responsible for supervision. Municipalities organise services but don’t necessarily provide the services. Finland has been able to maintain and sustain its health and social care sector. (Anttonen & Haikio, 2011)

 The adult social care sector of Finland is responsible for the adequate provision of services. This can be in form of Homecare services – this is the service provided in the comfort of the home of the service user, Supportive services – this is the provision of assistance with personal care, cleaning, transportation, and feeding, and  Sheltered housing- this is usually provided in an accommodation with or without 24 hour-assistance. A lot of changes have occurred in the elder care system of Finland these include marketisation, privatisation, increasing costs for individuals, digitalisation, and polarisation. (Anttonen & Haikio, 2011)

Critical Analysis

There are differences and similarities in the adult social care in operation in England and France. The differences include the fact that England’s provision of adult social care is not universal. It operates means-tested government assistance (Adult social care is provided for by the local authority after a need assessment test has been carried out to determine what exactly the person needs.)The central government has empowered the local authority with the power to decide how the allocation is distributed. This simply implies that the service delivery in England is not universal while it is in France. (Checking Charity, 2017) Everybody is entitled to basic adult social care at the stipulated age. Also, the care provision in France has been able to cap health care cost, set standard fees and reimburse majority of costs. Adults in need of social care in France prefer to live in their homes and receive care while in England more live in nursing homes and residential care settings. (Expatica 2000-2018)

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The major similarities between the two countries are the fact that both of them fund their social care through general taxation of the people, they both have adults living longer with multiple conditions, and also an increasing demand for Adult social care. (Polack, 2004)

England can learn from France the universal method of care provision for everyone. All adult should be entitled to social care at a certain age. When this is done the adults will live longer in a good and comfortable environment. Also, the means-tested system needs to be reviewed so that all adult in need of social care can have access to it. (Polack, 2004)  Various factors are preventing England from achieving better social care funding which included but not limited to Underfunding-the government keeps cutting down the amount of money made available for the adult social care sector hereby reducing the financial capacity of the local authorities. A Rigid system-the system is too rigid and not flexible enough to accommodate all the emerging requirements. Neglect and abuse in some residential and care homes-some care home have been found wanting in terms of taking appropriate care of the service users. Retaining and recruiting good quality staff is a major challenge. (Polack, 2004). There are basic solutions to the limitations been experienced in the social care sector, financial transfers from the NHS will go a long way toward making more funds available for the sector. Friends and family members should assist more in taking care of the adults who are in need of social care support. They are the closest to this adult. The system should be made more flexible giving room to the service user to determine what and how they want to be cared for and also improving the working environment as well as the remuneration package for staff. (Polack, 2004 & Institute for Govt., 2017)

Globalisation

Globalisation in social care has provided the privilege for social care workers to learn about how health and social care issues are responded to in other countries. Major areas of concern are child welfare policies, AIDS prevention and management, substance misuse treatment, and health care provisions. (Polack, 2004 & Bochel.et.al., 2005)   

Proper and efficient management of globalisation process can lead to an improved social care system and the healthcare of people generally. It is expected that everybody should have access to social care. The promotion of self-determination, independence, and social inclusion has apparently become associated with worldwide models of privatisation, marketisation, and commodification of social care. (Bochel.et.al., 2005)               

 There are 3 major varieties of globalisation processes namely

Social Globalisation – in the world generally, the average life expectant age is gradually increasing meaning the number of older people in the nations is increasing. An increase in the number of older people simply means an increase in the number of people needing adult social care services. This increase can be partly attributed to the better medical and technological developments in the world. Communication currently is global and instantaneous. The WHO (World Health Organisation) and the UN (United Nation) are some of the organisations responsible for standardising the social care sector and the health sector in general. Individuals, regions, communities, and nations have better links to each other to the extent that the world is referred to as a global village. (Schroth & Khawaja, 2007 and Bochel.et.al., 2005)

Political globalisation – Environmental issues such as pollution and global warming are obviously issues that are no longer in national jurisdictions but international. Restrictions imposed by international economic forces and intergovernmental organisations like the World Bank make globalisation more powerful and effective. (Bochel.et.al., 2005 & Sykes.et.al, 2001)

 Economic Globalisation – Bochel.et.al., 2005 stated that Economic globalisation is the free passage of goods, services, information, and technology between various nations of the world. It helps in improving the connection between national economies by providing cross-border movement. There is the persistent reminder that both individual and government organisations have to survive with the constraint of global economic competition and the problems associated with the interrelations between the different economies of the world. (Bochel.et.al., 2005 &sykes.et.al, 2001)

Key rhetorical terms of policy initiatives

The provision of Services is one of the primary components of the welfare state. The decommodification theory of Esping –Andersen is a welfare state typology that shows a connection between service deliveries with available cash for the provision of social care services. Three major welfare regimes arise during the comparison. (Bambra, 2005)

Decommodification:

It is the rendering of a service as a right. It is the strength of social right and citizens’ extent of immunization from market reliance. In adult social care, decommodification can be related to the right of every adult resident to good quality social care services as at when needed. It makes people and the world at large more human and unique. The level of the resident’s dependence on the state for support is classified into 3 major categories. (Esping-Andersen, 1990)            

The Conservatives want a corporate system that preserves traditional hierarchies. This represents a middle level of decommodification while The Liberals, on the other hand, try to make working population reliant on the labour market so that they are motivated to want to work more so as to earn higher incomes. This is an example of a low level of decommodification. (Esping-Andersen, 1990)

There are three major regime typologies

Liberal/residual – In the liberal regime model, the state is only responsible for providing very marginal welfare, the market is the leading player here. The welfare provided is means-tested and basically for the low-level society. An example is the provision of adult social care through the provision of a personal budget. The other members of the state are protected by other systems like the private insurance. Examples of countries practising this form of government are United States, United Kingdom, and Australia. (&Esping-Andersen, 1990)

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Social democratic/socialist – This is a political ideology committed to reducing inequality and oppression and also objects to private ownership. It sets out to achieve individual independence and employment for everyone. This model exhibits the most redistributive welfare state and a better portion of the national income is channelled into welfare benefits and services. Decommodification is high and social stratification is low in the model. It provides security for universal benefits. Examples of nations practising social democracy include Finland, Netherlands, Norway, and Denmark. (Esping Andersen, 1990, Arts & Gelissen, 2002 & Ebbinghaus, 2012)  

Corporatist/conservative – the basic concept of the conservative ideology is their rooted belief in tradition and authority. Examples are Italy, France, and Germany. It believes in national insurance contribution which leads to citizens enjoying good welfare provisions. (Arts & Gelissen, 2002 & Esping-Andersen, 1990)

Summary of Regime characteristics

Role of Liberal Social Democratic Conservative
Families Marginal Marginal Central
Market central Marginal Marginal
States Marginal Central Subsidiary

Fig 1                                

Social stratification: Social stratification in adult social care is the grouping of individuals based on how much they are entitled to for their care services. Adult in need of social care is assessed based on their wealth in England. In some care homes also people are placed in accommodations based on financial status. Indicators of social stratification include employment status, full-time work, education, occupation etc. Social stratification is basically a 3 tier classification namely Upper class, Middle class, and Lower class. Also, assets are ranked into three types -ownership, organizational, and skill/credential. (Esping-Andersen, 1990)

Conclusion

The increase in the growth in the population of the older people in England cannot be overemphasized and the government’s inability to cope with the increase is an issue. Adult social care needs to be better provided for by establishing a system that works for everyone. (Daly and Lewis, 2000) The British government needs to make sure that the private sector who handles the larger share of adult social care be made accountable for the cost and quality of care provided. They should equally look into standardising the workforce so that qualified personnel are recruited and properly trained too. (Hudson, 2011)

England needs to learn how to make the responsibility of funding adult care that of the welfare state and not individuals. It needs to make adult social care provision universal and equitable. It must be available to all those who need it irrespective of their level of disability, and ethnic origin. This system must be able to promote independence through better coordination of care which will lead to a healthy elderly population. The introduction of The Care Act 2014 is a significant improvement in the care sector but this has been made almost inactive at the local level by the continuous cuts to local government a budget that has, in turn, resulted in the quantity and quality of social care service made available for older people. (Esping-Andersen, 1990) The government needs to improve and put more money into the provision of adult social care. England needs to increase the amount of money being channelled into the National Health Service (NHS). This is to improve the existing care services. England needs to also follow the lead from other countries like France on how to follow up, properly coordinate and check all the service providers regularly and manage both the public and private social care sectors. (Esping-Andersen, 1990)

The government first and foremost needs to design a model that will serve on a long-term basis for the funding of social care. It also needs to urgently look into the ongoing financial crisis in the social care system. The not so supported means-tested policy needs to be reviewed so as to have better quality and quantity of care in the sector. All the older people should have access to social care irrespective of where they are from, what disability they have or where they reside. A simpler and more straightforward policy structure needs to be introduced so as to make it easier to implement at the grass root level. France is obviously doing far better in terms of health and social care hence the WHO (World Health Organisation) rating so it would only make sense if Britain can work towards attaining such height in their health and social care sector too.  (Esping-Andersen, 1990)                    

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Figure

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Culfaz, E. and Serrano, PJG. Parameters of Welfare Regime Typologies (Online) Available at https://www.uhu.es/CIED/pdf/7_11_welfar.pdf [Accessed June 25th 2018]

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