community care

Rachel's arguement AGAINST... and a question

2007-11-28T12:49:00.000-08:00

Rachel's arguement AGAINST...

1. Argument against.
‘The government assumes the ultimate responsibility for care.’

Responsibility is NOT shifted to the family - it is the government that is ultimately responsible for care. I would like to give evidence for this by pointing out the governments role in:
- Current core principles of state run care departments
- Legal policies and procedures in place to regulate and improve care facilities

It is the state that is responsible for care. In April of this year, the Care and Counsel stated that the Department of Health is responsible for ‘the effective delivery of health and social care services in England.’ This responsibility is echoed in other government care providers, for instance the NHS core principles include statements such as:
- The NHS will provide a universal service for all based on clinical need, not ability to pay
- The NHS will provide a comprehensive range of services
- The NHS will shape its services around the needs and preferences of individual patients, their families and their carers

These do not sound like the policies of a government trying to shift responsibility away from themselves and onto carers - in fact it seems quite the opposite as Britain seems to remain welfare and needs focused in its delivery of services.

It is the state that produces relevant legislation, policy and procedure as to how care is conducted and managed - guidance which all care providers must abide by. Policies such as Carers and Disabled Children Combined Policy Guidance Act 2000 and Carers (Equal Opportunities) Act 2004 for instance is designed to ensure the rights of carers and the cared for are considered. Such policies are continually under review in an attempt to maintain high standards in care facilities. Such standards are also reflected in the targets for improving and maintaining the physical properties of the NHS. For instance, by 2010 around 40% of the total value of the NHS estate will be less than fifteen years old. State provided care is therefore improving and increasing rather than declining to pass duties on to community care.

It is the state that has established criteria to regulate care facilities to which private facilities and the state themselves are accountable. These national standards ensure that a minimum standard of care is given to service users, and as such the state is the backbone to all aspects of care given.

I would urge you to not to undervalue the benefits and contribution of state care provision and responsibility. Community Care policies do not remove the provision of state services– this option is always available. Instead it simply offers to support an alternative care option for those receiving care.

Question to be read by the FOR side:

I acknowledge that the state provides care services, but how does the government intend to ensure there is a suitable care workforce available to make alternatives to community care a viable option?

Answer to be read by the AGAINST side:

The government has already made plans to ensure that a skilled and highly qualified workforce is in place. In 2000 The NHS Plan Investment and reform for NHS hospitals was produced which displayed the state’s dedication to this.

The document states that plans are being made so that more job vacancies will be created for consultants, G.Ps, nurses and therapists, and that more training places will be made available so that thousands more will have the opportunity to enter into health and care professions.

The Plan also considers a review of the NHS pay system, so that staff are rewarded for what they do, and aims to extend the national recruitment and retention campaign to other staff groups as well as nursing and midwifery. More return to practice courses have been introduced along with effective support and mentoring of newly returned staff.

Overall, an extra £140m was invested in development and training by 2003/04. An additional £8 million to extend occupational health services to GPs and their staff. This is something that the government is taking seriously to ensure that our country can lead the way in public service provision of care.

Laura F's against argument: The meaning of the family within community care

2007-11-25T13:30:00.000-08:00

Recent policies relating to the care of ‘priority groups’ exemplify the importance of the family and uphold the view that ‘family care is best.’ This has two aspects: first that for dependent individuals care is best provided for ‘at home,’ and second, there is an overriding moral duty for them to provide that care. This argument advocating family care is one which has featured strongly in the deinstitutionalisation debate. The revulsion felt towards the grossest examples of dehumanised care is directly linked with the view that the appropriate alternative in all-cases is family based care. The family, in contrast to the impersonal and cold institution, is viewed as a haven, as repository of warm, caring, human relationships based on mutual responsibility and affection and thus a private protection from the cold, hostile, outside world. The impact of removing a person from the comfort and care of their family can be incredibly strong. Institutionalization deprives people of the invaluable opportunities to develop life skills and meaningful relationships within the community. Institutionalization takes away the rights of those who yearn to participate in society and face the challenges and goals in life. Living in the community allows a person control of their own life and circumstances, and that is indispensible to a patient's personal satisfaction and happiness. It might be argued that institutionalization is actually a way of hiding away those away with physical, behavioural or mental challenges away from mainstream society. Those of us who champion the ‘individual rights’ of people afflicted with such difficulties will surely approve the closing down of such institutions in favour of the more personal, individualised and supportive living opportunities found within families in the community. It might, hence, be inferred that the government does not ‘shift’ care to the families. The family, when faced with the alternative of an inhumane institution, often willingly takes on the role of carer. It is reassuring for the family to know that their loved one is being loved, respected and cared for in comfortable surroundings.
It is relevant at this point to consider the meaning of the family. It has been argued that the family is the ‘social structure that links the individuals in all the known human societies.’ It is perhaps helpful to examine other cultures when looking at the notion of ‘family’. In Asian countries, for example, there is a strong tradition of caring for elderly parents. The elderly live in extended, multi-generational households which rely primarily on their children for personal care and financial support.
In Romania families play a large role in caring for elderly relatives. Grandparents often look after grandchildren as it is usual for both parents to work. It is considered shameful to put an elderly relative in a home for the elderly.
In Spain the family is the long-term provider of care for elderly people. Nearly 70% of Spanish dependent elderly people receive exclusive family care, mainly provided by women and children. There is a preference for care within the family, but this does not disqualify formal care intervention.
We can infer from information such as this that basic family values such as love, caring, warmth and support are not confined to one culture, but permeate through every culture to some extent. They are basic and eternal and intrinsic to the very notion of ‘family’.
The government, hence, does not shift responsibility to the family. The family, I argue, often willingly undertakes the caring role as families feel a commitment and responsibility towards one another, and strive to provide loved ones with the most positive and happy future possible. The key to successful community care is being surrounded by basic family values such as listening, friendship, mutual respect. The individualized one-to-one support found at home far surpasses the impersonal institutionalization that preceded community care. I am not denying that community care is demanding, and government financial and personal support is essential to the wellbeing of both the carer and the cared for. But as the future emerges further solutions to quality of living will evolve and more supportive programs will develop to advance community care even more.

Jen's AGAINST argument..

2007-11-25T09:33:00.000-08:00

A tad bit long maybe but we can play around on tuesday...

ARGUMENT 3

Let us consider the real shift in Community Care. It is a shift away from Institutionalised Care..It is a shift towards the rights of Service Users to be treated in their..It is a shift towards Service Users having more choice, more rights and more say!
The 1990 NHS and Community Care Act clearly aims to decrease unnecessary institutionalization, increase the demand for non-statutory community care services, improve collaboration between the private and public service sectors. All of these aims are about the individual having choice.

I would like to take issue with the opposition’s basis for statistics about the population and health changes. I would like to point out that the population is not a static entity in the face of changing health trends. Culture, people and opinion evolve. Furthermore I would like to argue that societal attitudes and demographic changes are well supported by the Community Care Model. For instance, let us take your example of Mental Health. Social Inclusion is now currently high on the government’s agenda, as evidenced by the setting up of the Social Exclusion Unit in 2003. The Social Exclusion Report 2004, highlighted a realistic need for people with enduring mental health conditions to play an active and ‘normal’ part in society. My point, ladies and gentlemen, is that such a fundamental societal expectation and human right as Social Inclusion can not be accommodated through institutionalised care.

Community Care should be celebrated not just for mental health reform but as a way of delivering individualised-tailored care to the masses. In the forward of Caring For People: Community Care in the Next Decade and Beyond 1989 it states the intention of community care clearly as:

Helping people to lead, as far as is possible, full and independent lives is at the heart of the Government’s Approach to Community Care.

People need no longer be ‘patients’ on the ward but can be ‘clients’ in their own home- where people receive professional assessment and care-packages in a collaborative manner (for instance through Care Programme Approach set up in conjunction with the 19900 Care in the Community NHS Act). And subsequence guidance such as ‘working together’ means that professionals are now expected to collaborate in order to provide the best possible care for the client.

We would argue that the model of Community Care does not shift responsibility on to families.

As we have heard, carers are a valuable asset to the concept of community care, not purely from a financial perspective but also from the perspective of person receiving care. In terms of the welfare state, it is only realistic to work within the limits of monetary boundaries and support carers. Even Sweden, famed for its strong welfare state has since the last decade seen the emergence of government policy that supports carers within their system. This was highlighted by the Magnussan and Nolan 2006 paper that explores innovative ways that carers can be supported in Sweden. In the same way I argue that Community Care is a good thing for clients supporting social inclusion and choice. With adequate and innovative support we are not shifting responsibility to carers. Instead we are collectively creating a model of care that empowers individuals- both carers and the cared for alike!

.
Question: What are these innovative ways to support carers?

Answer: you’ll find out on Tuesday!!!

A background statement for each?...

2007-11-25T07:42:00.000-08:00

Found the following 'Newspaper cutting'-quote - a striking one, me thinks. Wondered about it being used as representative (e.g. in the background) by the 'for' team.

If we did collectively like this idea (can discuss on tues) then we'd have to have a striking quote for the opposition too.

[For statement]

'On Monday Morning you will wake up in a new Britain, a state that 'takes over' its citizens six months before they are born, providing care and free services for their birth, for their early years, their schooling, sickness, workless days, widowhood and retirement. All this with free doctoring, dentistry and medicine- free-bath chairs, too, if needed- for 4/11d out of your weekly pay packet. You begin paying next friday.'

Daily Mail, 3 July 1948

Question to 'against' argument

2007-11-24T11:31:00.000-08:00

Q. Many informal carers partially or fully give up paid employment in order to provide the informal care for one or more family members. This often leads to financial strains and issues surrounding their limited pension contributions. Have the Government taken any steps to overcome such problems and financially recognise carers’ contribution?

A. Carers can access financial support. Carer’s Allowance is the main state benefit for carers, which is currently worth £48.65 a week. There are a number of conditions that must be met to qualify for this benefit, however if a person looks after someone for more than 35 hours a week, it may be unlikely that they will earn more than £95 through paid employment. There is a free telephone help-line and many social workers offer advice or referral to benefits teams set up within local authorities. The Carer Premium is an additional payment available up to £27.15 a week. If a carer receives carers allowance and are on Income Support or income-based job seekers allowance, they should receive carers Premium automatically.
Direct payments allow carers to purchase services they are assessed as needing to support them in their caring role and maintain their health and well-being. This may ease financial burdens if carers were previously purchasing services themselves. Just several examples published by the Government include carers purchasing driving lessons or a short holiday with a direct payment.
The Government have taken on board public opinion and largely in response to the Carers UK’s Fair Deal Campaign, introduced in 2002 a £200 million package of increases in carers’ benefits. This almost doubled the Carers Premium paid to the poorest carers.
The Government also increased the earning limits for carers allowance resulting in more carers being able to work part time without it affecting their benefits. The right to request flexible working in employment also made accessing paid employment around caring easier.
With regard to pensions, there has been improvement to pension provision including the introduction of a second state pension for carers. If someone qualifies for Home Responsibilities Protection or to receive Carers Allowance, they can build up their entitlement to the second state pension. So people with caring responsibilities will not be penalised in their pension if they do not earn sufficient National Insurance contributions to build up the earnings related component to their basic pension.
The Government has taken steps and invested spending to overcome financial difficulties faced by carers. So rather than relying on informal care to save public spending on community care, the Government is increasingly recognising carers contribution and financial needs.

Katie's Gender Argument - Against Group

2007-11-22T12:22:00.000-08:00

Gender: Evidence to demonstrate the Government are working towards men and women being supported in their roles as carers/cultural issues and employment law

Parent & Family Support Services

Parent and Family Support Services have been put in place, which are run jointly by the Primary Care Trusts (PCT’s) and Local Authorities, linking with Sure Start Children’s Centres. These services are available during and beyond the school day to accommodate working parents. The multi-agency services that are available are important vehicles for delivering better information and support for parents and carers.

The Every Parent Matters document was published in March 2007, acknowledges the changes in family circumstances since the 1970’s, where some families today will be caring for children and elderly relatives. The health-led parenting projects have started in 10 areas across England, the findings will report on how best to deliver high quality, health-led parenting support. The aim is to get parents involved in their child’s development through a coherent set of services.

It is true that evidence collected so far suggests that father’s involvement has been minimal, which is why opening times have been extended, information is available via the web and over the phone. It is an active process where the needs of different cultures are taken into account, the policies are changing to engage fathers.

The Every Child Matters Agenda aims to provide parents and carers with ‘good quality universal support’, which can be obtained locally, where parents and carers feel comfortable, for example from early years settings, schools, primary health care services, through childcare information services, telephone helplines and the web.

Our Health, Our Care, Our Say

This White Paper sets out the government’s vision to provide people in need of social care and/or NHS services with the care they need in the communities where they live.

The NHS is half way through it’s 10 year plan in becoming more responsive to and more convenient for patients needs, to prevent ill health by promoting healthy lifestyles. Social care services are also changing to give service users more independence, choice and control.

Feedback from the 2005 consultations reported that the public see leading a healthy, active and independent life as a key priority

Advances in primary care aim to ensure they can easily access quality GP Services

People want health and social care services that are convenient and integrated to meet their individual needs.

Money is now available to Regional Trusts to develop more community services.
Commissioning powers for local practices will result in improved services for everyone.

Ensuring integrated practices and quality of information available for patients.

www.dh.gov.uk/en/Policyandguidance/Organisationpolicy/Modernisation/Ourhealthourcareoursay/DH

About Our health, our care, our say
Last modified date:5 March 2007

In 2005 the Department of Health conducted two consultations, Independence, Wellbeing and Choice and a listening exercise, Your health, your care, your say. Independence, Wellbeing and Choice, the adult social care Green Paper, asked for views on how social care services could be improved. The listening exercise, Your health, your care, your say, allowed the public to speak directly to ministers, health professionals, and each other on how improvements could be made to their local services.  

What people wanted
Nearly 143,000 people contributed their views on what they expected from their local social care and NHS services. People wanted their local services to:
* understand how they live and support them to lead healthier lives
* help them to live independently if they have ongoing health or social care needs
* be easy to get to and convenient to use
* be nearer to where they live, or easily available in the areas they work.
The White Paper
In July 2005 Liam Byrne announced these two consultations would form the basis of a single White Paper. The Paper would recognise how NHS and social care services work together and identify how the delivery of these services could adapt to provide individuals with the health and social care services they need closer to their homes.
The proposals in the White Paper, Our health, our care, our say: a new direction for community services, aim to:
* change the way these services are provided in communities and make them as flexible as possible
* provide a more personal service that is tailored to the specific health or social care needs of individuals
* give patients and service users more control over the treatment they receive
* work with health and social care professionals and services to get the most appropriate treatment or care for their needs.
Changing the services
To achieve these aims family doctors, primary care trusts and local authorities who have direct contact with patients and service users will have more say in how best to plan and buy services for local communities. Public, private, voluntary and charitable organisations will need to work in partnership to put the interests of the public first, ensure health and social care staff receive the right training and make good health and social care services an essential part of local communities.

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.'

The 2001 census showed that 21% of population were 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.

There are also more women than men in the older age bracket, therefore the statistics will show more women carers.

Local Authority Circulars are sent out frequently to provide practitioners with clarity on law and policy.

• Families are entitled to a Family Needs Assessment under the Children Act 1989
• Under the Carers (Equal Opportunities) Act 2004, which came into effect in April 2005, carers were entitled to an assessment of their needs, which included consideration for employment, education & leisure activities
• The Carers and Disabled Children Act 2000 supports the carer in their caring role, helping them to maintain their own health and well-being
• Since April 2007 an employee has the right to ask their employer for flexible working hours if they are caring for an adult relative, or someone who lives at their address
• Carers also have the right to take (unpaid) time off work for dependents in cases of emergency.

Question:
Why are services designed mainly for women and delivered by women?

Answer:
The Government have put into place services, which are designed to meet the needs of communities. Statistics show (need some stats here) that women are providing the majority of care in this country, so we have made provisions for those who need it. The Government has recognized the need to extend these services to engage men, which is why services are now open beyond the school day, there are also telephone and internet services available.

It is well documented that employment in the area of caring is traditionally dominated by women, however this is changing as men become more involved in caring for their dependents. Our research acknowledges the need for more men in these roles if engaging male carers is to become a success.

Idea for first section of the argument against

2007-11-22T09:17:00.000-08:00

Under LAC (2002) 13 Fair Access to Care Services, each local authority has the power to determine the eligibility criteria for needs. Most local authorities meet critical and substantial needs. If these needs are recorded in a care plan and met for example through provision of domiciliary services or a direct payment, it may significantly reduce a person’s dependency upon their family. A family may become involved supporting low to moderate needs that cannot be funded by LA, or other forms of support. The duty of care remains with the local authority.

Questions and Answers

2007-11-22T09:12:00.001-08:00

Questions and Answers...

From Tom;

Q: Can you comment on how the shift to the community care model affected services for mental health service users?

A: Yes. Since the early 1950s, psychiatric hospitals in Europe have been running down. It has been estimated that over half a million long-stay patients have been discharged from psychiatric hospitals in the US and UK combined. This massive change in care has been endorsed by successive British governments since 1967, when then health minister Enoch Powell predicted the closure of 75 000 beds in asylums over the next 15 years.

Q: And how successful has the shift to community care in mental health been?

A: Before 1984, problems in mental hospitals dominated the public agenda. Since then, attention and blame have shifted almost completely to community care. Even when incidents occurred in hospitals, care in the community seemed suddenly to play a significant part. This raises several important questions, such as …did hospital care before the 1980s prevent community scandals?... Has mental health care deteriorated since then? … and are people with mental health problems dangerous in the community?

Statistics show worrying results post the shift to the community care model. In 1996, when 1200 000 beds were available for mentally ill people in the UK, compared to 57 000 in 1990, a study in east London followed up people discharged from hospitals. Only 54 per cent of patients with schizophrenia discharged to known addresses could be traced after a year. Only about one third of these lived in satisfactory circumstances and a third neglected themselves. In the early 1990s, several studies give an idea of the state of community services. A survey in west Lambeth followed up 140 patients with schizophrenia after discharge from an acute unit. After a year, only one patient was lost to the services, but four had died, 3 from probable suicide.

Here, we should also highlight what has come to be labelled ‘scare in the community’. Until 1981, inquiries into psychiatric care hade addressed scandals in hospital on behalf of an angry public, almost invariably showing patients as helpless vicvtims and staff as abusers. In 1981, a shocking event had major repercussions for mental health care and public attitudes. Sharon Campbell, a former in patient, killed Isabel Schwarz, her former social worker, at Bexley Hospital. From then on, community care became associated with danger.

Anna's question by against side for for.

It surely wouldn't be practical to shift all those in need of care back into the family home. What about those families who simply don't have room to take on a caring role?

It is true that it wouldn't be practical for community care to simply take place in the family home, but it is important to remember the vast numbers of carers who have dependents in other households. Of these just over a fifth are looking after parents or parents in law, and a fifth are caring for relatives other than parents or children. This may not be in the family homes, but still represents a shift of responsibility to the family.

Argument Against - recognition of carers and support (second section - Naomi)

2007-11-22T09:12:00.000-08:00

In the past, perhaps the contribution of informal carers to community care and the economy was taken for granted. However the commitment of carers and their rights are increasingly recognised and supported, which is reflected in legislation and Government policy and practice guidance. Rather than community care shifting responsibility to the family, the Government could be seen as actively supporting those who choose to take on caring responsibilities.
Under the Carers and Disabled Children Act 2000, carers are entitled to an assessment of their ability to provide and continue to provide care for the person cared for. A carer’s assessment identifies the impact of the caring role, taking into account the other roles and responsibilities a carer has, as well as paid employment, education, training or leisure opportunities that a carer currently undertakes or would like to pursue. Carers’ mental and physical well being are also considered. Following a Carers Assessment a care plan will be drawn up and may incorporate respite, domiciliary services for the cared for person or direct payments, all of which would aim to ease the pressure on carers and help them to establish a better life balance.
Under the Work and Families Act 2006, Carers have the right to request flexible working if they care for someone in the same household or a close relative. This is another measure, which eases pressures felt and gives carers greater ability to balance their chosen commitments.
Introduced initially through the Community Care (Direct Payments) Act 1996 and later amended through the Health and Social Care Act 2001, direct payments are available to users and carers. Direct payments enable a good degree of independence and choice to people assessed as needing services, through enabling them to purchase their own care package. Not everyone does have the ability to manage a direct payment, however they are made widely accessible through direct payment support services funded by local authorities, as well as supported managed accounts and user controlled trusts. A person assessed as requiring care may use a direct payment to pay a wage to one or more carers, formally recognising their efforts and sometimes enabling the carer to leave other paid employment and focus on a caring role. Or those receiving Carers Assessments may choose to receive a direct payment directly to support them in their caring role.
There are support programmes for carers, including those run by carers themselves to share knowledge and experience, which may then be fed through to the Government, for example Carers UK. Organisations commissioned by the Government, for example Rethink provide a forum for education, support and ideas to be shared amongst carers. Dedicated funding has been given to local councils to develop services to support carers. By 2005 this grant was worth £185 million each year.So Government provisions are in place enacted through various pieces of legislation, which provide frameworks to support and empower carers. These actively recognise carers’ valuable contribution to community care and ensure that carers do not take on the responsibility of caring at a cost too great to their own life and well-being.

2007-11-22T08:59:00.000-08:00

The Scottish Office:
Modernising community care: an action plan
"We must make better use of both new and existing resources to provide people with the services they need."

within this action plan it basically implies that responsibility is not being shifted but more money is being put into the community to give care in a way that is preferred by clients, i.e at home.

Below are some of the main points concerning home-based care in the action plan.

A modern, flexible home care service

"Most people want home-based care. We need to shift the balance of current funding and target new resources to increase home-based care."

3.1 One of the central aims of our community care policy is to allow people to be cared for at home, or in homely surroundings. Home-based care, combined with suitable housing, is what most people and those who care for them prefer. Some groups have achieved this aim by resettling users in the community and closing long-stay hospitals.

Shifting resources to home-based care

3.2 However, there has been less progress in helping people, particularly frail older people, to remain in their own homes. Between 1990 and 1996 the volume of services to support these people has increased, but by considerably less than for nursing home care. In some key areas (for example, home help and day care), increases taper off after 1993. Also, in 1996-97, community-based services provided for 84% of people but received less than half of the community care budget. This pattern is not acceptable. We need to increase home-based care by shifting the balance of funding and targeting new resources.

BBC News also had an article looking at the monetary side of community care and the savings that were being made. And that savings could be made as well as pleasing the client.

"A Department of Health spokesman said it was important to remember shifting care was something patients had said they wanted to see happen and was not just motivated by saving money."

"And he added that the study actually showed community care was £100 cheaper on average per patient and provided "an encouraging sign" that money could be saved."

Some points from Chapter 4:
Impact of the NHS and
Community Care Act (1990) on
Informal Carers

Most care for older and disabled people is, and always has been, provided in ‘the community’. Until the 1970s, this was largely taken for granted and rarely excited

policy makers’ attention. Since then, however, there has been increasing emphasis
on the role of the ‘community’, and more specifically family carers, as the main
source of help and support to those who need assistance to live in their own
homes. The reasons for this emphasis are numerous and inter-related and will not
be reviewed in any detail here. The shift was clearly articulated
in the 1982 White Paper Growing Older. The Paper recognised the ‘immense
contribution’ of families, friends and neighbours but underlined a clear message
that the proper role of the state was to enable individuals and families to deliver
community care, not to replace that care: ‘Care in the community must
increasingly mean care by the community’
Policy analysts and researchers in the late 1970s and 1980s questioned the implicit
assumption that women would provide this care, and research began to examine
the costs that reliance on ‘informal care’ (as it had come to be called) imposed.
Despite this growing body of evidence, policy preoccupations from 1985 onwards
were predominantly about the slow transfer of people from long-stay institutional
care, inadequacies of funding or arrangements for the people who were
transferred, and the ‘perverse effect’ of social security funding which had
encouraged the growth of residential and nursing home care for older people
during the 1980s
The Griffiths’ Report (1988), with its brief to review how public funds were used
to support community care and advise on more efficient and effective use of those
funds, is generally seen as Government’s response to the comments of the Audit
Commission about the ‘perverse effect’. The Report again acknowledged the
contribution of informal carers but they were still seen as part of the ‘given’
resources available to support care in the community. Public
services were seen to have a direct role only where informal care had broken down
or could not meet needs.

2007-11-21T05:15:00.000-08:00

Family Support Work in the Community: Parenting

I mainly looked at parenting policy:
DFSE (2006) Parenting Support: Guidance for Local Authorities. Every Child Matters
DFES (2006) The Market for Parent and Family Support Services
Sheffield City Council (????) Parenting Matters: Parenting Support in Sheffield

From this I found…

Evidence FOR responsibility being passed on to the women in the family in particular

Findings show that users of universal services are underrepresented by fathers. This is concluded to be because services don’t engage with fathers, and because most services are within the working day - excluding working parents. (also highlighted in DFES research into the Market for Parent and Family Support Services)

Because parenting services currently seem to only engage with and cater for mothers, there seems to be a definite emphasis of caring responsibility placed on women.

The table below shows their main findings as barriers and enablers regarding fathers accessing parenting and family support services (hope you can read it - it doesn’t look very clear on my computer!):

The research also highlights that one weakness in engaging with fathers is that there are not enough male staff, so even employment in community services seems to focus caring responsibility onto females. (there’s another table with this but its even harder to read that the one above so Ive not included it!)

Evidence gathered from case study authorities suggests that the majority of Children’ Centres are struggling in their early efforts to engage with fathers effectively. “Father’s involvement has been very, very minimal – not even 1%, which is very unfortunate.” Local Sure Start Programme Manager

Evidence AGAINST responsibility being passed on to the women in the family in particular

Suggestions have been made to extend services beyond the school day to accommodate for working parents (though this is still a minority of services)

Some regions have introduced new policies which aim to place a greater emphasis on good parenting amongst both parents (e.g. Manchester Parenting Strategy) (though again no practical examples are given of this in practice)

Research has now been made to try to identify ways of engaging with fathers (see http://www.dfes.gov.uk/research/data/uploadfiles/rw72.pdf) Policy and objectives have been changed to try and incorporate this in the future.

Case studies??

I’ve also been in touch with some people that I used to work with from the NHS, NSPCC, the YMCA and Barnardo’s to see if they can provide any case study info we might be able to use. Im still waiting to hear if this is possible, but when I worked there most parenting work was entirely focused on supporting the mothers, possible because:

For cultural reasons some groups were specifically for women only - meaning that sometimes even if fathers did want to attend they were turned away
Timing of classes was always within working hours, excluding any working parents (usually the fathers). The only fathers who were catered for were teen fathers, who could attend specific day sessions.
There were no male staff in a lot of cases
The majority of referrals from social services were for the mothers rather than the fathers when it came to requesting information about play groups and parenting classes - it wasn’t something that fathers were ‘expected’ to attend. Not sure if that’s the professionals fault or whether its cultural expectations.

2007-11-20T08:47:00.000-08:00

For:

shifting of care was seen done in the best interest of the patient. Need to try and use institutions less. Can a institution ever be good for a person?
women most desirable to do the work because they were considered to already have lots of 'free' time as many were existing housewives.
general feeling- the welfare state is more useful for the women than the man.
community care promotes family care and 'marshals resources.' along with encouraging independence.
When jobs were scarce it made sense that women should work unpaid, as it freed up jobs for men and helped decrease the unemployment rate.
community care promotes self-help and the idea of the wider community helping the elderly etc.
If you have a daughter you are less likely to become institutionalized as women tend to do all the manual handling of looking after a loved one.
need to remember - the initial aim of reducing public services is to save money!

Comparisons with Scandinavia:

Are new policies of community care based on myth???
Myth one - the increasing majority of elderly people today are cared for in an institution?
Fact - Institutionalization rates in both Sweden and Norway have stayed constant between 1970-1982
Myth Two - the situation of the elderly has deteriorated and we are not well informed anymore.
Fact- the general image of pre-industrial Europe as a golden age for the elderly is a myth and should be disregarded. Aging has changed and evolved over time.
Myth Three- The elderly need help because they are struggling withe shock of retiring and worry about their financial situation. Fact - this is secondary to them than them. The elderly in Norway actually appear to be less stressed after finishing work and need less support than previously believed.

Arguments AGAINST..(by Jen)..

2007-11-17T10:15:00.000-08:00

A debate AGAINST…This house believes that Community Care does is not shift responsibility onto the family…

Definition of ‘Shift’:
The act of moving from one place to another

It is incorrect to assume that responsibility of care has been shifted onto Carers.

ARGUMENT 1
The government assumes ultimate responsibility

The Structure of Care Services within Community Care, as stated by the Care and Counsel in April this year, illustrate government responsibililty : The department of Health is responsible for ‘the effective delivery of health and social care services in England.

THE GOVERNMENT IS RESPONSIBLE FOR…Maintaining the overall system
THE GOVERNMENT IS RESPONSIBLE FOR ….Developing policies and guidance and sets out how health and social services are to be delivered.
THE GOVERNMENT IS RESPONSIBLE FOR regulating and inspecting services

Even if health and social care organisations have set up their own systems of care, they must meet the National Standards set out by the government.

[Stategic Health Authorities (SHA) are responsible for managing, monitoring and improving local health services. SHA are responsible for Care Trusts.

Primary Care Trusts (PCTs) are responsible for 80% of the NHS budget, and planning of primary care services for the local population. They arrange the provision of services for the local population. They arrange provision of services like GPs, dentists, pharmacists and opticians. PCTs are also responsible for improving the health of the local population, providing screening services, mental health services and patient transport. They should also make sure that the health and social care systems work well together. More and more PCTs expected to do joint commissioned work with social and health.]

ARGUMENT 2
The Community Care model itself does not shift responsibility on to the carer but rather it empowers the carer by supporting responsibility. There is much government policy and practice guidance that supports this:

National Service Framework:
Sets out standards for carers (e.g. carers needs-assesment)
Provisions for carers (such as respite services)

Organisations commissioned by the government to run carer support programmes: Rethink (then National Schizophrenic Fellowship). Provisions such as support groups

ARGUMENT 3

The argument that Community Care shifts responsibility onto the carer suggests that any direction towards empowering people in their own homes is a bad thing! The Community Care model is a good one by virtue of its ethical standing.

Let us consider the real shift in Community Care. It is a shift away from Institutionalised Care..It is a shift towards the rights of Service Users to be treated in their own homes and to have more tailored local services..It is a shift towards Service Users having more choice, more rights and more say!
[could incorporate some of Tom’s history-stuff to illustrate this point]

If carers are supported well by the government…

ARGUMENT 4

Community Care can be improved by more resources/funding. This means that the more supported carers are in their role, the less validity the argument holds.

[Email received from Zoe Irving]
Dear Jenny,
Thanks for your message. My quick thoughts are this: in Sweden and other social
democratic welfare regimes the underlying principles are 1) the socialisation
of the 'costs' of care both in monetary and (gendered)time terms ie. accepting
that a good society should take collective responsibility for care work that
needs doing and 2) the provision of services which are of a high enough
quality to prevent those who can afford it opting out of state provision and
buying private services (so-called middle-class flight)

Sweden has higher taxation rates than the UK and has moved some way towards more
market oriented systems but nothing like we have here. For the most up to date
information you could have a look at the comparative social policy/social work
journals - you'd be best off doing an article search on the ASSIA database via
the library web pages. You could also use the swedish government site (in
english) http://www.sweden.gov.se/

If you want to come and talk to me my next office hours are: Tuesday 20th
11.30-12.30 and 3-4.

hope this helps.
b/w
Zoe

Material found since email:
‘From institution to Community Care’ (Comparative Mental Health Policy)-
http://books.google.co.uk/books?hl=en&lr=&id=ZPV2n3BcX-AC&oi=fnd&pg=PA6&dq=sweden+%22community+care%22&ots=mo8Pf-EkGx&sig=s6ZRD04B7SsBwz4u6atp8rZ7rCo#PPP1,M1
States: no relationship found between ‘high public expenditure growth’ and a tendency towards de-institution

‘Comparing Health Systems in Four Countries: lessons for the United States’ (get through Scholar)

Tom's addition; history, mental health sector's move to community model

2007-11-17T04:48:00.000-08:00

Arguments confirming the move from hospital care to community care in the mental health sector – and related issues

Potted History related to mental health

• Since the early 1950s, psychiatric hospitals in Europe have been running down. It has been estimated hat over half a million long-stay patients have been discharged from psychiatric hospitals in the US and UK combined. This massive change in care has been endorsed by successive British governments since 19671, when then health minister Enoch Powell predicted the closure of 75 000 beds in asylums over the next 15 years.

Potted history related to general health care

• After 1945, successive governments became increasingly sympathetic towards shifting the balance of personal social services from residential settings to the community. The publication of Care in Action put community care high on the Conservative government’s priorities, 1979-97. The Conservative policy was driven by financial factors linked with cutting back the high cost of publicly funded residential care and by commitment to encouraging enterprise outside the public sector. The Thatcher government was turning away from universal state residential and daycare services and making these services increasingly subject to means testing and private and voluntary provisions.

Problems related to move to community care in mental health:

• Before 1984, problems in hospitals dominated the public agenda. Since then, attention and blame have shifted almost completely to community care. Even when incidents occurred in hospitals, care in the community seemed suddenly to play a significant part. This raises several important questions. Did hospital care before the 1980s prevent community scandals? Has mental health care deteriorated since then? Are people with mental health problems dangerous in the community? In 1996, when 1200 000 beds were available for mentally ill people in the UK, compared to 57 000 in 1990, a study in east London followed up people discharged from hospitals. Only 54 per cent of patients with schizophrenia discharged to known addresses could be traced after a year. Only about one third of these lived in satisfactory circumstances and a third neglected themselves. In the early 1990s, several studies give an idea of the state of community services. A survey in west Lambeth followed up 140 patients with schizophrenia after discharge from an acute unit. After a year, only one patient was lost to the services, but four had died, 3 from probable suicide.

• Frank Dobson’s statement in the House of Commons in 1998 that community care in mental health had failed heralded a series of papers and consultation documents on the revision of the 1983 Mental Health Act.

Public fear in the community

• Until 1981, inquiries into psychiatric care hade addressed scandals in hospital on behalf of an angry public, almost invariably showing patients as helpless vicvtims and staff as abusers. In 1981, when the first green shoots of community care could be seen, one shocking event had major repercussions for mental health care and public attitudes. Sharon Campbell, a former in patient, killed Isabel Schwarz, her former social worker, at Bexley Hospital. From then on, community care became associaterd with danger.

Stuff we didnt use in the speech but may use for questions...

2007-11-17T02:32:00.000-08:00

The peak age for caring was 45-64. One fifth of adults in this age group were providing informal care.

. four out of ten were caring for parents or parents-in-law and two out of ten were looking after a spouse

Of carers with dependants in other households, just over a half were looking after parents or parents-in-law; a fifth were caring for relations other than parents or children and just over a fifth were looking after friends or neighbours.
Shifts responsibility to the family/cultural aspects:

SPEECH FOR

2007-11-17T02:28:00.000-08:00

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.

Katie's

2007-11-16T11:08:00.000-08:00

Arguments for:

Zweiniger-Bargielowska (2001:135) reported
'Caring is of vital importance for the survival of the human race, yet it has never been highly valued in monetary terms. Neither has it been seen as the work of men..'

Women are said to develop strong emotional bonds with those they care for and describe enormous suffering once their services are no longer needed.

Have retirement and nursing homes replaced work houses & hospitals?

The Victorian middle class women's movement into philanthropy came about as they had been excluded from paid work and it was seen as a 'woman's mission' in helping those who were destitute.

***Need to find out when........Women were expected, and sometimes forced, to give up their jobs once they were married. This was true of women working as teachers, within the civil serice and in some factories.

'Family responsibility' was built into the Poor Law, which required families to support their dependants.

Only unmarried women were legally obliged to financially support their parents in their old age.

Daughters were called upon when her ill or disabled parents or elderly relatives were in need.

Because there were more women than men after the wars, working women were blamed for high male unemployment and were expected to step down from their paid positions to make way for the men. Women were seen as truly belonging in the home caring for the family. It is argued that 'Good mothers' and 'dutiful daughters' are expected to work for love not money.

Some daughters were actively discouraged by her parents from getting married so that she would be available to care for them when they became unable to care for themselves. As a direct result of this the state was able to save huge sums of money on providing care for the elderly.

Charles (2002) stated that it is often men who provide financial support and women who provide the 'hands on' care. This is reflected in many cultures across the world. Women tend to provide meals, look after the health of the family members and carry out the day to day tasks.

Archer & Lloyd (2002) acknowledge that proportionally more women than men suffer with mental illness, including depression. Men are reported to thrive on the care they receive once they are married. Women are reported to be healthier living alone (HA LOL!!)

Arguments against:

Brammer (2007) suggests that there are more women than men in the older age bracket.

People feel ill informed about the community care services available to them and how they can influence them. This is particularly true when considering older people within ethnic minorities.

White et al (2007) reports that community care law is extremely complex and is not particularly user friendly. Government circulars (local authority circulars- LAC's) are issued frequently to provide clarity on law and practice. It is the social worker's responsibility to ensure they stay abreast of the new developments.

Community care law is considered in 4 main points
1. Planning for community care operates at 2 levels
i) at community level
ii) at individual level

Also s.46 (1) of the NHSCCA 1990 requires the local authority to
'Prepare and publish a plan for the provision of community care services in their area'. These are often produced annually by social services and the local health commission. There should also be consultation with the local housing authority, voluntary organisations, health authorities and service user representatives. Own thoughts: if there are numerous LAC's issued then these plans will surely be out of date most of the time??

2. The social worker's role is to identify the parts of legislation identifying their duties and powers (duties oblige the local authority to act, powers permit the local authority to act).

3. There are 2 types of duties
General Duties aaplies to those in certain categories eg disabled people; and
Specific Duties (or individual duty) which applies to the individual eg the disabled person

4. Community care practitioners need to be aware of the category/ies the service user falls into so that they can apply the relevant legislation and employ the appropriate duties and powers.

These 4 principles give an indication of the complexities of community care services. The practitioner may be unclear of their legal obligations and as a direct result they won't be able to provide the service user with the appropriate services they are entitled to. Of course, this would be bad practice, however I would suggest that this does happen in some cases.

Other legislation we could consider:
Carers (Recognition and Services) Act 1995
Community Care ( Direct Payments) Act 1996
Caring for Carers DoH (1999)
Independence, Well being and Choice (2005) Green Paper
Carers Strategy (1999)
Carers ( Equal Opps) Act 2004

2007-11-11T15:28:00.000-08:00

· ·One adult in eight (13%) was providing informal care and one in 6 households (17%) contained a carer.
· 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.
· Four per cent of adults in Great Britain (representing about 1.7 million) devoted at least twenty hours per week to caring and
8% (about 3.7 million) carried the main responsibility for looking after someone (that is, they spent more time than anyone else on
the dependant).
· Women were more likely to be carers than men but the difference was not very marked, 14% compared with 11%. However,
since there are more women than men in the total adult population of Great Britain, it is true that the number of women caring is
considerably greater than that of men, 3.3 million compared with 2.4 million.
· The small difference between the proportions of women and men caring was attributable to the higher proportion of women
looking after someone outside the household (10% of women and 7% of men). Women were also more likely to carry the main
responsibility for caring (9% of women and 6% of men).
· Five per cent of adults looked after parents and 3% cared for friends and neighbours.
· The peak age for caring was 45-64. One fifth of adults in this age group were providing informal care.
· Among men of working age, one in six of the economically inactive were carers compared with one in ten of those in work or
unemployed. Among non-married women the proportion caring varied little according to economic status, but among married
women, the economically inactive were the group most likely to be caring followed by those working part time.
ii) 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; four out of ten were caring for parents or parents-in-law and two out of ten were looking after a spouse.
· Where carers were looking after someone in their own household, just over a 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.
· Of carers with dependants in other households, just over a half were looking after parents or parents-in-law; a fifth were caring
for relations other than parents or children and just over a fifth were looking after friends or neighbours.
· 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.

statistics from the General Household Survey 1995

Community care shifts responsibility for care to the family in general and to women in particular.

2007-11-11T13:52:00.000-08:00

Definition of community care

Ø 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 to 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.

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.'

Arguments For...

Gender

Gendered assumptions contribute to the social construction in the process of implementing community care. There is a significant relationship between gender and caring in social work and social care. There is a specific focus on a woman’s capacity to undertake care work. Women are seen as a ‘natural’ carer. This sex-role stereotyping has led to women being confined to the roles which are predominantly unpaid. These roles include looking after the family: children, adult relatives and others within the community. They are more likely to be seen as having ‘typical’ feminine qualities of care Married women (daughters/daughters in law) were the family members who provide care for relatives, including moving the cared for person into their own home. It is suggested that male and female behaviours differ in the way that they cope with emotional issues, this relates to their capacity to nurture. Links to gender identity – women could feel threatened that a man could take over their natural role. However, men within care roles are increasing. It is still females who practice the majority of personal care and men managerial roles. Common male carers are those looking after their wives etc.

Distinguishing informal/formal care

Informal care is mostly unpaid and within private homes – ‘duty care’. The state saves money by transferring the role to family members. There are benefits, direct payments etc…but barriers which prevent this including lengthy forms and the use of jargon. It is also unknown how many informal carers there are and will be more than records show. As for formal paid carers this is reordered. However there is a high percentage of women in informal care in many countries, as studies show:

Percentage of adult population whose daily activities include caring for sick, disabled or frail adults without pay by sex 1996:
France: 27% women, 14% men
Germany: 33% of women, 19% of men
Ireland: 44% of women, 19% of men
Italy: 41% of women, 18% of men
Netherlands 45% of women, 34% of men
UK: 43% Of women, 26% of men

It could be argued that if insufficient resources are put into community care, families often have no choice but to intervene. Dalley (1996, in Ideology of Caring) discusses when professional services are insufficient, extended networks e.g. Neighbours, friends, or more commonly the person/small group closest to the person intervene with additional support to ‘make-up’ this deficit. Twigg and Atkin (1994, in Carers Perceived) also discuss how feelings of responsibility can lead family members to monitor the situation, stepping up their involvement as the need arises and ‘adjusting actions to meet any shortfalls’ (p9).
Twigg and Atkin (1994) discuss the fiscal crises caused in part by the ageing population and GNP being spread more thinly ‘per head’. In light of this, informal care could be viewed as a valuable resource that may save the government a lot of money.

Twigg and Atkin (1994) identify 4 models of carers:
Carers as resources – informal care considered as a free resource. Carers interests not considered, emphasis on meeting dependent person’s needs in most cost efficient way.
Carers as co-workers – focus on the need of depended person. Carers interest/well-being considered, but mainly on instrumental basis
Carers as co-clients – ‘carers are regarded as clients, as people in need of help in their own right’. Services are organised to help relive their situation.
The superseded model - removes the title and even role of carer, family/relatives can become more neutral in role with less obligation and responsibility

The way in which carers are recognised and their needs considered may affect the extent to which the statement is true. Twigg and Atkin suggest that people with social care training tend to engage the co-workers concept where as managers tend to look at a cost-based resource model.

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.
Notion of ‘caring for’ and caring about’ being entwined. ‘Those who care about are always expected to care for and vise versa’ (p17). Dalley argues that it is more acceptable for men to care about but not necessarily for, as long as they take responsibility e.g. provide setting for care, financial support.

Statistics do exist to indicate that men are involved in some aspects of caring roles (office for population censuses and survey data). These are usually lighter and less time consuming responsibilities (Arber and Ginn, 1995).

Maternal Gatekeeping: Mothers’ Beliefs and behaviours that inhibit greater father involvement in family work (from a study carried out by Sarah Allen and Alan Hawkins, Journal of Marriage and the Family 61, Feb 1999):

Ø Maternal gatekeeping is conceptualised within the framework of the social construction of gender and is defined as having three dimensions: mothers’ reluctance to relinquish responsibility over family matters by settings rigid standards, external validations of a mothering identity, and differentiated conceptions of family roles. The study concludes that 21 % of the mothers interviewed were classified as gatekeepers. Gatekeepers did 5 more hours of family work per week and had less equal divisions of labour than women classified as collaborators.

Ø Maternal gatekeeping is a collection of beliefs and behaviours that ultimately inhibit a collaborative effort between men and women in family work by limiting men’s opportunities for learning and growing through caring for home and children. It is clear from its frequent appearance in scholarly research that maternal gatekeeping can be one important source of men’s underinvolvement in domestic labour and may inhibit mutually satisfactory arrangements for sharing family work.

Ø 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.

Ø 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.

Ø If fathers join mothers in this endeavor bur 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

Maternal Gatekeeping: Mothers’ Beliefs and behaviours that inhibit greater father involvement in family work (from a study carried out by Sarah Allen and Alan Hawkins, Journal of Marriage and the Family 61, Feb 1999):

Ø Maternal gatekeeping is conceptualised within the framework of the social construction of gender and is defined as having three dimensions: mothers’ reluctance to relinquish responsibility over family matters by settings rigid standards, external validations of a mothering identity, and differentiated conceptions of family roles. The study concludes that 21 % of the mothers interviewed were classified as gatekeepers. Gatekeepers did 5 more hours of family work per week and had less equal divisions of labour than women classified as collaborators.

Ø Maternal gatekeeping is a collection of beliefs and behaviours that ultimately inhibit a collaborative effort between men and women in family work by limiting men’s opportunities for learning and growing through caring for home and children. It is clear from its frequent appearance in scholarly research that maternal gatekeeping can be one important source of men’s underinvolvement in domestic labour and may inhibit mutually satisfactory arrangements for sharing family work.

Ø 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.

Ø 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.

Ø If fathers join mothers in this endeavor bur 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

Statistics supporting the argument that women do most of the work, from Lena Dominelli (Anti-Oppressive Social Work Theory and Practice, 2002)

Ø Wichterich (2000) has calculated that 70 per cent of the world’s work is performed by women who are not paid for it, a reality that excludes them from wage-based benefits. The United Nations Development Programme has valued their contribution at $US11 billion compared to $US7.3 billion as the total of manufactured goods produced. Yet, 70 per cent of the world’s poor are women, 35 per cent of whom are sole parents.
Ø Despite these well know statistics, the modernising agenda in Britain excludes those who form the working poor or those unable to work and their needs have been ignored by the government (Jordan, 2000).
Ø Dominelli reflects on the familialist ideology constructed around women’s role as a nurturer within the family, seen not as a human being with individual needs but as a carer with responsibilities. Her status is then dependent.

Some Facts and Figures!

I read that informal care saves the government £87 billion a year. In addition to this research by carers UK in 2002 found that carers contribute around 1 billion per year by supporting the community through starting self-help groups, campaigning for carers centres and raising money.
2001 census found that there are 3,400,000 female carers (58%) compared with 2,460,000 male carers (42%)
11.3% of the population are female carers and 8% are male carers.
This pattern, however, is found to be reversed in later life where men are reported to give a greater time commitment to caring. Female carers are well reported, but the importance of men as informal carers in old age is much less commented upon.

Gender and Community Care. Women, Men and Caring

Women seen as innate carers.

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 seen as unnatural if done by men, as it goes against the notion of the ‘rational’ man.
Women are locked into caring. Expectations that they will be available to care. Men who provide care do it for change in familial circumstances,
In the Equal Opportunities Commission, 1981 states that married women and cohabiting women who stayed at home were at one stage not allowed to claim the invalid care allowance available to men and single women performing the same role. Reinforces the economic dependence of women.
Reluctance to accept that men do care. Men ‘fill in’ as carers when unemployed. Women’s overall level of labour market participation does not appear to be affected by caring o the same extent as mens. Women are expected to be at home, and not seeking work.
Class and age differences.
Co-resident care is provided more frequently by working-class men and women than by middle class. Middle aged unmarried women and men 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, young single men and older never-married men are just as likely to involved as their female peers.
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. Challenges the Western notion that men are known to provide care for their partners but very rarely provide care for other relatives or friends.
There may be under-representation of caring by men because the notion of ‘caring’ has feminine connotations. It is seen as ‘woman’s work’ and challenges masculinity.
Early studies show that men are rarely involved in personal care, and feel uncomfortable with certain tasks associated with caring. Men and women, it seems, take on different roles within caring.

Jack, R (1998)
Value of care provided by informal carers estimated in 1988 to be between 15 and 24 billion, but goverment funds for NHS and Community Care Act 1993 came to 539 million.
Community care is increasingly unmasked as care by the family and by women.
National Institute for Social Work 1993 found 3 xs as many carers were women than men.
Feminist writers have advocated residential care as a means by which opression of women in the socially constructed role of natural carer may be alleviated (Dalley 1993)

Arguments Against...

It could be argued that if insufficient resources are put into community care, families often have no choice but to intervene. Dalley (1996, in Ideology of Caring) discusses when professional services are insufficient, extended networks e.g. Neighbours, friends, or more commonly the person/small group closest to the person intervene with additional support to ‘make-up’ this deficit. Twigg and Atkin (1994, in Carers Perceived) also discuss how feelings of responsibility can lead family members to monitor the situation, stepping up their involvement as the need arises and ‘adjusting actions to meet any shortfalls’ (p9).
Twigg and Atkin (1994) discuss the fiscal crises caused in part by the ageing population and GNP being spread more thinly ‘per head’. In light of this, informal care could be viewed as a valuable resource that may save the government a lot of money.

Twigg and Atkin (1994) identify 4 models of carers:
Carers as resources – informal care considered as a free resource. Carers interests not considered, emphasis on meeting dependent person’s needs in most cost efficient way.
Carers as co-workers – focus on the need of depended person. Carers interest/well-being considered, but mainly on instrumental basis
Carers as co-clients – ‘carers are regarded as clients, as people in need of help in their own right’. Services are organised to help relive their situation.
The superseded model - removes the title and even role of carer, family/relatives can become more neutral in role with less obligation and responsibility

The way in which carers are recognised and their needs considered may affect the extent to which the statement is true. Twigg and Atkin suggest that people with social care training tend to engage the co-workers concept where as managers tend to look at a cost-based resource model.

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.
Notion of ‘caring for’ and caring about’ being entwined. ‘Those who care about are always expected to care for and vise versa’ (p17). Dalley argues that it is more acceptable for men to care about but not necessarily for, as long as they take responsibility e.g. provide setting for care, financial support.

Statistics do exist to indicate that men are involved in some aspects of caring roles (office for population censuses and survey data). These are usually lighter and less time consuming responsibilities (Arber and Ginn, 1995).

Maternal Gatekeeping: Mothers’ Beliefs and behaviours that inhibit greater father involvement in family work (from a study carried out by Sarah Allen and Alan Hawkins, Journal of Marriage and the Family 61, Feb 1999):

Ø Maternal gatekeeping is conceptualised within the framework of the social construction of gender and is defined as having three dimensions: mothers’ reluctance to relinquish responsibility over family matters by settings rigid standards, external validations of a mothering identity, and differentiated conceptions of family roles. The study concludes that 21 % of the mothers interviewed were classified as gatekeepers. Gatekeepers did 5 more hours of family work per week and had less equal divisions of labour than women classified as collaborators.

Ø Maternal gatekeeping is a collection of beliefs and behaviours that ultimately inhibit a collaborative effort between men and women in family work by limiting men’s opportunities for learning and growing through caring for home and children. It is clear from its frequent appearance in scholarly research that maternal gatekeeping can be one important source of men’s underinvolvement in domestic labour and may inhibit mutually satisfactory arrangements for sharing family work.

Ø 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.

Ø 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.

Ø If fathers join mothers in this endeavor bur 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

State provision is minimal as it is assumed younger women will provide care.
Women are expected to retire earlier than men but there is no retirement age for women's unpaid labour.

Jack, R (1998)
Townsends' criticisms of residential care were contrasted with his vision of reciprocal family care accross 3 generations but this idealised view is now dated.
The effort of caring for severely handicapped elderly relatives can result in family tensions and breakdown.
Community Care involves housing, leisure, transport, education etc - by no means just family
We are in a time where the institution of the family is least able to provide care
Sally Redfern - there is a need for the provision of good quality nursing 24 hour in both institutional settings and in peoples homes.

Law Lecture Notes
Carers and disabled Childrens Act 2000 - a carer is entitled to an assessment
National Assistance Act 1948 - facilities for rehabilitation, employment and recreation
Health Services and Public Health Act 1968 provides support services for frail older people - domiciliary services lessen the demand on family
Chronically Sick and Disabled Persons Act 1970 provides domiciliary services, home adaptions and assistance for education.
Department of Health def of community care (above) doesnt mention family.
DoH (1990) Community Care in the next decade and beyond: policy guidance says service provision should include support in own home, move to sheltered housing, move to house of relatives or friends, residential care, nursing home care, long stay care in hospital... only one of these mentions family
p3.28 'preferences of carers should be taken into account and their willingness to continue caring should not be assumed'
Housing Grants, Construction and Regeneration Act 1996 - housing authorities have a duty to approve of applicants for disabled facility grants for carrying out home adaptions.
Health and Social Care Act 2001 s57-58 extends direct payments to users and carers which they can spend on services of their choice - increased independence.

And I wasn't sure where to put this...

Formalising community care under a state umbrella disempowers and undermines a community’s natural capacity to take care of itself:

Ø David Brandon, social work lecturer and Zen monk states: ‘Patients and clients are encouraged to depend more on professional who are seen as being experts – as knowing best. Social workers may see themselves as having an investments in their clients’ lives. I recall one young social work students saying that the only serious personal relationships she made in her life were with her clients. We see social work, medicine and nursing at the absolute centre of the social universe whereas, more truly, professional helping is always peripheral to the main caring energy. Worse still, voluntary caring can be seen as inferior or merely supplementary to professional helping. The number of times I have heard a neighbour say of a client ‘I should like to have helped but I’m not qualified’. 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.

· Feminist critique, from Critical Practice in Social Work:

Ø In the liberal tradition, people are seen in the abstract as moral agents and bearers of universal rights. In this view, rights are not affected by one’s specific obligations to the particular, real individuals with whom one happens to have actual, ongoing relationships. Some feminists argue that women think differently, choosing instead to give priority to their real primary relationships over abstract theoretical obligations. They hold that our understanding of moral responsibility has been unbalanced by universalist models of human relationships that are excessively abstract and impersonal, products of male thought.
Ø Feminism puts irrevocably on the welfare agenda that users of formal services are, among other things, individually known persons to whom professionals as well as their own kin are bound by partly subjective ties of partnership in actual human relationships. The relations of welfare, therefore, are not accurately described or properly prescribed by the abstract role obligations favoured in the traditional discourse of the human service professions

Government support for carers
A carers UK study found that only 32% of carers had had a carer’s assessment.
The carer’s allowance, however, is only £48.45 per week, this is for 35 hours of care provision.
Many carers’ sites have been set up which express the hardship of carers in order to push the government into taking action.
1 in 5 carers have to give up work to care, while 1 in 3 are living in poverty and are struggling to pay food and utility bills. Carers are calling for:
A social security payment that reflects their role, improved pensions, necessary benefits, and more flexible employment opportunities.
It seems that informal caring is something that many people want to do, they want to care for loved ones and it is comforting for those receiving the care to be in familiar surroundings with family. Community care, it has been argued, has led to greater patient satisfaction, and also a greater life expectancy.
However, it seems that the vast majority of carers are discontented and unhappy with their situation. If the government are going to ‘shift’ informal care to the family then there needs to be greater support structures in place. Carers save the government £87 billion, yet receive little acknowledgment or support for the sacrifices they have made.
Foster carers, for example, receive between £120 and £205 per week. Foster carers, however, are seen as different because they have chosen to undertake this work, while informal care givers are expected to care for loved ones no matter what, so no financial incentive is offered.

The Gender Divide
Male carers: A study of the inter-relations between caring, male identity and age.

The lack of British phenomelogical studies of male informal carers means that we know relatively little about Male carers’ experiences of caring in this country.
Feminist researchers have begun to look at men as active participants in the informal caring economy. The General Household Survey (1985) showed the 40% of all spousal carers being male. (Evandrou, 1990)
Caring is more of a taboo for male carers.
Recent research shows that men are very good at caring in a practical sense, but not very good on an emotional level.
Women tend to take on caring roles naturally, as if it were an integral aspect of their everyday identity, whilst men it has been argued, will only accept a role if there is no one else who can take on the responsibility or there is a crisis in caring provision.
Exception is men who are married to an ill spouse. In this instance male carers identify their caring responsibilities as a duty that they perform because of marriage vows they made.
‘The Gender Deal’ Pat Carlen (1998) refers to an implicit agreement between men and women based upon gender norms and values. Twin ideals of a wage-earning male, and informal care-giving female.
However the recent destruction of heavy industry, loss of jobs traditionally undertaken by men the increasing employment of women in the economy and better educational opportunities for women, the increasing divorce rate and decreasing marriage rate suggest that the gender deal is less likely to prevail in modern society. Perhaps this might lead to a reassessment of caring as a ‘woman’s’ activity.
For many older male carers, however, the gender deal provides a psychological restriction where caring is concerned.
Male carers see caring as an activity, not as part of their identity. They do not ‘see’ themselves as carers. Identities are formed through paid employment, men see themselves as ‘workers’ first.
If many men do not perceive themselves as carers then it is difficult to calculate the number of male carers in Britain. Many carers may not want to acknowledge themselves as carers, because they see this role as compromising their masculine identity.

21% of population are over 60, there are more older people than children (2001 census). In 1951 there were 0.2 million people over 85, in 2001 there were 1.1 million.
Older men are more likely to recieve and request caring support for basic living needs.
R. Jack (1998)
Community Care can be just as institutionalised as residential. The community consists of a variety of institutions imcluding the family and variety of caring services. There is an independent network of institutions both independent and complimentary.
There is a blind assumption of the existence of a community.

2007-11-07T11:27:00.001-08:00

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