SPEECH FOR

This is our speech for. It lasts 9.5 minutes. Afraid we'd written it before katie had added her stuff but I reckon we can write questions that use the info that she's added - we'll need to be able to bring some new stuff in at that point anyway.



Community care is a broad almost indefinable concept and much has been written about the contentious nature of both ‘community’ and ‘care’. The disability movement criticise the concept of ‘care’ as it implies passive recipients and powerful providers. Put together, ‘Community Care’ has been used to describe the development of domestic-scale residential establishments as opposed to huge campus institutions; the development of domiciliary care delivered to people’s own homes, and informal care provided by spouses, other family members, friends and neighbours. It can be both informal and professional. Services-users may be children, adults or older people; they may have a physical or mental illness or be managing a physical or mental disability or problems with addiction. Service-users will be performing a variety of roles as parents, partners, students, employees or carers for others with an illness or disability.

Department of Health 'Caring for People' 1989 'provision of services which people who are affected by problems of ageing, mental illness, mental handicap or physical or sensory disability need to be able to live as independent a life as possible in their own homes or in homely settings in the community.'

In order to argue that there has been a shift towards community care in the family it is important to recognise how things have changed in this century. The 2001 census showed that 21% of population are over 60, so there are more older people than children. In 1951 there were 0.2 million people over 85, but by 2001 there were 1.1 million. This would suggest a dramatic growth in the need for care provision for the elderly, which has not been matched in the growth of statutory provision. In the 1950s the main inheritance of the NHS was a system of over 100 asylums or mental hospitals with an average population of over 1000 patients in each. 1976 saw a peak in mental hospital admissions, which has since fallen. The 1979 Parkinson report strongly endorsed community care and called for a determined programme of hospital closures, linked to a statutory duty and financial incentives for councils to make community provision.

Statistics:

We now turn to examine statistics highlighting the extent to which family and informal care have grown. According to statistics from the General Household Survey, as, recently as 1995, one adult in eight was providing informal care and one in 6 households contained a carer, whilst four per cent of adults cared for someone living with them and 8% looked after people living elsewhere. The survey findings
indicate that there are about 5.7 million carers overall in Great Britain with about 1.9 million caring for someone in the same household. About 1.7 million adults devoted at least twenty hours per week to caring and around 3.7 million carried the main responsibility for looking after someone, which means they spent more time than anyone else on the dependant.
We will now progress to the fundamental question of who is caring for whom?
In total, 18% of carers were looking after more than one dependant. Nine out of ten carers were looking after someone who was related to them. Where carers were looking after someone in their own household, just over half were caring for a spouse; just over a fifth were caring for parents or parents-in-law and a similar proportion were caring for children. Sixty per cent of carers had dependants with physical disabilities only; a further 15% had dependants with mental and physical
disabilities and seven per cent had dependants with mental disabilities only. Almost all remaining carers said that their dependant's disability was the result of ageing.

There are different types of care, which are broadly distinguished as informal or formal care. Informal care is mostly unpaid and within private homes, also known as ‘duty care’. This allows the state to save money by transferring the role to family members. There are benefits to the family, such as direct payments, however these can be hard to access due to lengthy forms and the use of jargon. It is unknown how many informal carers there are as unlike within formal paid care the record will fall short of the real number. Twigg and Atkin (1994) identify 4 models of carers, two of which are Carers as resource and Carers as co-workers.The notion of carers as resource shows how informal care is considered a free resource. Carer’s interests are not considered and there is an emphasis on meeting the dependent person’s needs in the most cost efficient way. The model of carers as co-workers also highlights the need of depended person. Carers` interests and well-being are considered, but mainly on instrumental basis.

There is a strong economic basis for the argument that a large proportion of community care falls in the hands of the family. The value of care provided by informal carers in 1988 was estimated to be between 15 and 24 billion, but government funds for NHS and Community Care Act 1993 came to 539 million. We would suggest that much of this shortfall is met by family provision.

The law too can be seen to support our argument. The Carers and Disabled Children Act 2000 covers support services for carers aged 16 years or over and parents of disabled children, including Domiciliary and respite services and benefits such as Direct Payments and vouchers. Although the state is providing assistance this would suggest that care lies primarily within the family/

We will now go on to consider the question of how community care in the family means that care becomes the responsibility of women in particular. In the 19th century ideological construct of the doctrine of separate gender spheres, the ideas of women as nurturers of home, and children and men as breadwinners came to represent an ideal in which women, by being central to the home and family, were given the opportunity to wield some domestic power and privilege over men. Thus, a wall was built around a maternal garden of home and family, complete with a latched gate to ensure the specialisation of gender. In the 1940s/50s direct care work was held in low regard and therefore thought suitable for women, predominantly working class and Black and ethnic minority women. Care work is particularly suited to women because it is consistent with their traditional roles in the home. Caring was seen as unnatural if done by men, as it goes against the notion of the ‘rational’ man. All this laid the foundation for a situation in which community care could be pushed upon women in our contemporary society. Women are expected to be at home, and not seeking work.

Dalley (1996) discusses the expectation for women to care for dependent family members, following from the common pattern around childcare. The role of the mother may be extended in relation to other relationships and contexts. Women are more likely to carry the main responsibility for caring. Although among non-married women the proportion of caring varied little according to economic status, with married women, the economically inactive were the group most likely to be caring followed by those working part time. The high percentage of women in informal care in many countries, is reflected across Europe. In the UK 43% of women’s daily activities included caring for sick, disabled or frail adults without pay in 1996 but this was the case for only 26% of men. Ireland is comparable with 44% of women, 19% of men caring daily, whilst in Italy the statistics show 41% of women and 18% of men. These statistics don’t just apply to Europe, but to global situation. Wichterich (2000) has calculated that 70 per cent of the world’s work is performed by women who are not paid for it.

Dominelli reflects on the familialist ideology constructed around women’s role as natural nurturer within the family, seen not as a human being with individual needs but as a carer with responsibilities. Women in a patriarchal society are socialised into taking on these stereotypical caring roles. Mothers may feel that they need to manage or oversee their husbands’ participation in housework and child care because fathers can’t do it ‘right’ without supervision from someone more competent. If fathers join mothers in this endeavor by becoming collaborative partners in housework and child care, some mothers may fear loss of self-respect or self-identity as a woman, perhaps because doing family work is a way to validate a mothering identity externally and is a source of self-esteem and satisfaction

Community care is provision in the family is also influenced by cultural factors such as class.Co-resident care is provided more frequently by the working-class than by the middle class. Those who are middle aged and unmarried have a much higher chance of becoming carers than any other group. Men as a group are much less likely to be expected to provide informal care. Different housing patterns, age structures and cultural traditions all influence statistics. Sons in Asia, for example, take a lead role in caring for their mothers. This challenges the Western notion that men are known to provide care for their partners but very rarely provide care for other relatives or friends, but community care in Britain is an ethnocentric construction.

In discussing how community care shifts responsibility to the family we risk the assumption that this is a bad thing, but there are also arguments to state that the shift is a positive one.
David Brandon, social work lecturer and Zen monk states that voluntary caring can be seen as inferior or merely supplementary to professional helping.. When you measure the gigantic forces of caring for one another existing within the community, professionalised helping emerges as a grain of sand on a large beach. Social work in particular has failed to see the vital role of friends, relatives and neighbours. Helping should place more general stress on assisting the community. This would suggest that instead of worrying about the trend towards care in the family it should be encouraged by social work practitioners. Carers save the government £87 billion a year, yet receive little acknowledgment or support for the sacrifices they have made. Maybe it is time to acknowledge the level of care being carried out in the family, so we can begin to give this sector the support it deserves.