Care in the Community

I believe that the way forward is not to cling to the ideology of care in the community. That ideology, like the ideologies of eastern Europe, is waning, and we should take a more balanced view. Every ideology, by its nature, imposes a philosophical and intellectual straitjacket on those who practise it, and care in the community has in some ways been as thoughtless as other ideologies. Alan Hurst M.P.)

A really excellent report on the Care Leavers Association Meeting and their professional speakers from the UK.

http://st-ouennais.livejournal.com/18423.html

On one point:

There were some good questions and points raised on the floor. In particular someone from a mental health group asked about the link between abuse and mental health. There is clear evidence of both care leavers and abuse victims/survivors having significantly higher incidence of mental health problems. It is very likely extra resources would have to be found to deal with this locally. So why have we closed the relevant hospital ?

The Jersey authorities, following those in the UK decided more or less on ideological grounds to go for "care in the community", which often meant little care, no community - but it was cheaper than rectifying the problems of institutions for those who needed and still need some kind of 24/7 care because through mental illness or severe mental handicap are never going to be able to take care of themselves.

A similar ideological shift occurred with the "inclusion" lobby against having special needs schools and trying to integrate all children, however severe their mental handicap, in a mainstream school environment. Sometimes it works, sometimes it is impossible, and no amount of ideological fervour will make it anything other than an exercise in futility and demoralisation when it is plainly will not work.

In his study of community care, and its rise as an ideology, Jason L. Powell (http://sincronia.cucsh.udg.mx/nhs.htm) notes the way in which it was promoted both as supposedly empowering people in need of help, and in saving money.

Social services is one of the highest revenue spending departments for most local authorities, and within social service budgets at the time, residential and domiciliary services for older people consumed the largest amount of revenue. Thus, community care for older people in particular presented itself to government, in both financial and policy terms, as an obvious area of provision into which market principles are introduced and implemented

Second, at local levels throughout the 1960's and 1970's, social service departments and health authorities were responsible for joint planning and service development and charged with the need to provide community-based services as alternatives to institutional care (Wistow et al. 1994). In rhetoric, joint planning between health and social services promoted integrated and multidisciplinary community services. In practice, such arrangements failed to realise such services and were criticised as pedestrian and 'patchy' (Working Party on Joint Planning 1985). Community care services were indeterminate, with many users unable to obtain the services they require.

The first is the real reason why St Saviours' Hospital has been steadily closing, while at the same no, no money has been spent on alternative supported accommodation in the community - because the support costs. In the meantime, support is provided by various allowances and access to various outpatient or day services, but that depends upon people being able to take care of themselves, or carers to do it for them (basically on the cheap), and one aspect of the "demographic time bomb" that has not been considered is that there will come a time when substantial numbers of carers will drop from the system, and the authorities will be "fire-fighting" with patchwork remedies, put together at the last minute.