26 April 2012
Views of old, unwell and disadvantaged people ignored in debate on welfare funding
A gap exists between the health and social care system that older adults expect and what may be provided by a reformed welfare state. Researchers writing in the Journal of the Royal Society of Medicine say that the values underpinned by the views expressed by a group of older adults receiving health and social care for life-limiting illnesses are an important contribution to the debate on welfare funding. The research was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) programme.
The participants in the study, who were diagnosed with lung cancer, heart failure or stroke and judged by health professionals to be in the last year of life, displayed a strong sense of entitlement to services that were tax funded, after working lifetimes contributing to the state. Alongside this, a sense of social responsibility emerged in views that people should contribute to the costs of their social care if they were able. However, this did not extend to selling assets or using savings to pay for residential care, which was viewed as unjust.
Dr Barbara Hanratty, a senior lecturer at the Hull York Medical School and the University of York's Department of Health Sciences, who led the research team, said: "People who are old, unwell and from disadvantaged areas are least likely to be heard in the debate on welfare funding. Indeed, the voices of older people with high support needs on what they would want and value in their social care have been described as 'so quiet as to be practically silent'. The views expressed by participants in our study suggest that some of the silent voices may be dissenting, and out of line with current government thinking."
Among the study group there was a perception that entitlement to services had been earned, not only through a lifetime of working and paying taxes, but also through a far broader sense of being a good citizen; working hard, staying in employment and minimising earlier demands on the welfare state. Those that had been in low-income occupations were most keen to emphasise their contribution to society through work and taxes.
"These older people felt that a lifetime of tax contributions should represent an obligation fulfilled", commented Hanratty. "It is clear that any changes to existing systems will be unpopular with a cohort who have paid taxes and have an expectation of comprehensive services."
The Government gave a cautious response to the 2011 Commission on Funding of Care and Support, which recommended a cap on lifetime contributions to social care, raising the means tested threshold above which people are liable for full costs of care, national eligibility criteria and portable assessments. The White Paper anticipated later this year is not expected to accept all the Commission's recommendations.
"The views of our participants are at odds with the direction of welfare reform in many European countries, where the balance continues to shift from public to private provision", said Hanratty. "At a time when financial stringencies may prompt interest in safety-net welfare provision, our participants affirmed support for the principle of institutional welfare, provided on a universal basis. Such strong support for tax payer-funded social care grounded in values of mutuality and earned entitlement through long working lives is striking."
The researchers conclude that policymakers should listen to the views of older people and consider the widest range of options, not ruling out those anticipated to be unpopular with the wider electorate.
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Notes for editors
Funding health and social services for older people – a qualitative study of care recipients in the last year of life Barbara Hanratty, Elizabeth Lowson, Louise Holmes, Gunn Grande, Julia Addington-Hall, Sheila Payne and Jane Seymour, will be published online at 00.01 hrs Thursday 26 April 2012 by the Journal of the Royal Society of Medicine (JRSM). Please make sure you mention or link to the journal in your piece. Many thanks.
The JRSM is the flagship journal of the Royal Society of Medicine. It has full editorial independence of the RSM. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.
The National Institute of Health Research Health Services and Delivery Research (NIHR HS&DR) programme was established to fund a broad range of research. It builds on the strengths and contributions of two NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which merged in January 2012. The programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS. The HS&DR programme is funded by the NIHR, with specific contributions from the Chief Scientist Office (CSO) in Scotland and the National Institute for Social Care and Health Research (NISCHR) in Wales.
The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk
The Department of Health Sciences at the University of York is a multidisciplinary department with over 250 staff and 600 students. The Department was rated equal first for Health Services Research in the UK (RAE 2008) and voted Top Department in the UK for Nursing in The Times Good University Guide 2011.The Department's mission is to improve health and healthcare through high-quality research and education and their application to policy and practice. A wide range of flexible education programmes is offered, including undergraduate and postgraduate courses in Nursing, Midwifery, Public Health, Health Sciences and Health Services Research.
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