John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit, King’s College London. (455 words)
On Friday 14 September I met with a small international delegation of Occupational Therapists who work in two hospitals in Hong Kong: Pamela Youde Nethersole Eastern Hospital, an Acute District General Hospital, and Kowloon Hospital, a slightly smaller institution which offers general care to people who have chronic health conditions. They were accompanied by Denise Forte, who works as a senior lecturer in gerontology at Kingston University and who had organised the itinerary of the group. I had been invited to talk to them about two topics about which they were keen to know more: personalisation for older people in England, and the role of social workers and social services in supporting older people. Though the group was small, which enabled the seminar to be very informal, I did prepare some slides which I used where necessary.
There was some ground to make up because health and care provision in Hong Kong works very differently to the UK, and the group were here to find out how personalisation was achieved. It was necessary to explain about the emergence of personalisation from the earlier concept of person-centred care: arguments set out in a paper I published in 2015. I also explained the importance of self-directed care and personal budgets, particularly Direct Payments. I then described some of the research that has been done to assess the impact of this approach to service delivery on older people, including my own work, and concluded that, a decade after the mainstreaming of Direct Payments and personal budgets, there is not really any credible evidence to suggest they deliver better outcomes for older people (unlike younger adults) and that a different model of provision might be more effective. The second part of the seminar was focused on social work with older people in England.
The discussion and questions that followed were interesting. What I had said had, unsurprisingly, challenged a great deal of what they had previously heard from those they had met in the previous week, so I hope it may have provided food for thought. I argued not for a return to earlier forms of service provision but for a recognition of the importance and value of care—in everyone’s life—and how the ability to give and receive care was a natural part of human relationships. I also argued that the commodification of care created conditions in which people came to be seen as consumers, rather than citizens, and that this eroded and undermined true citizenship. My own thinking these days is towards the value of ‘relationship-based’ care for older people, perhaps through the direct or quasi-direct employment of Personal Assistants by older people, with sufficient support and advice on hand for both employer and employee.
John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit, King’s College London.