Gaby Hinsliff’s piece will have resonated with anyone who has ever given frail parents everything that is lumped together under the label of “care” (The shrunken state expects families to fill the voids in health and social care. Woe betide those without children, 9 August). It has always been the case in this country that families, and especially daughters, bear the brunt of responsibility for such care. What has changed on the one hand, as she points out, are the demographic shifts to smaller families and extended life expectancy. On the other hand, though, simultaneously and perversely, the state has withdrawn vital support for those families providing care, such as home helps, meals on wheels and daycare.
This process began under Thatcher, who privatised residential services and, in the name of efficiency, forced councils to outsource community services. Spending cuts led to the concentration of those residualised services on the most highly dependent. Thereby the critical function of social care in preventing the breakdown of family care disappeared and it became an emergency, last-resort service only.
As Hinsliff says, this system is broken and fails both older people and their families. As an adviser to Robin Cook when he was shadow health secretary, I proposed a royal commission on social care, to create cross-party consensus on this vital issue. This proposal was in Labour’s 1997 manifesto, and the resulting Sutherland commission did a brilliant job in making the logical and socially just case for social care to be treated the same as healthcare, as a generalised risk.
While the Scottish government adopted this principle, successive UK governments have not. The barrier is always said to be cost, but this only reinforces the low priority given to social care compared with healthcare. 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 have to cope on their own, there is a course of action that has hardly been tried yet.
The Dutch provide financial and professional support for those aged 55-plus to plan ahead, form and run their own mutually supportive “living groups”. These are clusters of households with some shared space, offering an alternative to isolation or residential care, as well as relief to families. Down-sized and age-proofed homes offer added advantages. This form of community development, with a firm base in mutuality and self-management, has produced what is known in the UK and elsewhere as the cohousing community. However, it is a model that struggles for recognition and support here.
If the state were to invest seriously in community development to help older people stay happier and healthier for longer, the result would be long-term savings to public expenditure and fewer blocked beds in hospitals. A proactive government policy, backed by relatively modest grants or loans and professional expertise, could help interested older people create their own “mini-neighbourhoods” combining self-contained homes with shared space and a sense of community. New Ground, a group of women aged 50‑plus in High Barnet, north London, demonstrates the value of this.
Maria Brenton
Co-founder, New Ground
Gaby Hinsliff suggests there could be another royal commission on long-term care. May I suggest a possible short cut? Take a look at the Republic of Ireland’s Fair Deal scheme for social care.
The Fair Deal offers an appropriate level of social care support for any Irish resident who applies. It is not a magic money tree. While free for the least well-off, it still requires a financial contribution from those in the middle range of income and assets.
At the same time it provides certainty, for people needing 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 rate of return for investors.
Tim Johnson
London