Personal social service has a long history however; it has gradually developed in different forms and approaches for example, the Monasteries, the Friendly Societies, the Poor Law and the National Assistance Act (1947), who provided safety net for universal standard of care. Despite the legislative frameworks for care standards, family care system has been unique and the longest approach known to human race to support the disabled and sick people in society. Thus, the legislation in 1947 only unified, strengthened and shifted emphasis towards the state’s interventions through health and social services. However, the sectors have witnessed a number of changes and developments though; the focus has been to support older people, people with learning or physical disabilities, those with mental health problems and recently those with HIV/Aids. In hindsight, the advent of “care management process (DH 1990), personalisation of services (DH 2005) and recently the Eligibility Criteria Matrix (DH 2010)” has revealed the declining of universal standards for care. Yet, the proponents of the “Care Quality Commission” may argue that the commission is in a position to address the issues relating to poor quality of care and Safe Guarding of Vulnerable Adult but; practice observations have shown otherwise.
In this age of civilisation, quality of care is paramount in the lives of the vulnerable in society. We have to admit that some of the concepts or service frameworks such as care management approach have contributed to falling standards of care. This is because social workers are no long able to practice social work but gate keepers for budgets. They barely apply their knowledge-based practice, experience and professionalisms to monitor services delivery. On reflection, the system faces increasing pressures from people living longer and some have more complex needs as they approach the end of life. Given the current economic climate within health and social care the government needs setting out the support and services that service users, patients, carers and families can expect to receive from the establishments. Equally, there should be a declaration from the government to rein-fence social care budgets now and the future as this would help to uphold standards of care. The redesigned services and budgets would enhance the safety-net of the vulnerable in society. This would indicate new systems of support to achieve high-quality care. In addition, families’ involvements and supports would promote lasting support services for the growing vulnerable users in our society.
We must not lose sight that development in medical sciences and bio-technological advancements mean that people are living longer even with disabilities and chronic conditions. These reflect the complexity of service users’ and patients' needs and the type of care required. However, enhanced community care with adequate budgetary commitments would allow social workers and allied professionals (community nurses, occupational therapists and physiotherapists) to practice their profession. This would tentatively modernise community-based services whilst enabling more people to remain in their own home for as long as possible. Experience has shown that collaboration between health professionals and social workers have the propensity to deliver quality care standards within best value principles. By contrast, collaborations have been slowed down because of both internal and external factors such as, organisational cultures and traditions, politics, power and technical know how while budget constraints have been put at the forefront. To avoid these mishaps, there should be a change in the system to allow merger of the two agencies and this would enable them work together towards a common goal.
Operationally, service users get better clinical or personal social services and economic outcomes when they receive services in their own home. This means social workers should be given the freedom to practice social work as directed by their professional ethical standards. Lack of this opportunity meant there is no adequate tariff to monitor quality in the community and is not surprising that good outcomes are not achieved. The tariff would cover all patients' or service users’ clinically assessed needs, regardless of setting, age and disabilities. Each patient or service users would have an appointed health/social care worker to help guide them through the different services. They would also have their social care needs covered at the end of life. However, the modernisation agenda/personalisation of services such as “Cash for Care, Direct Payments or Individual Budgets” have not made significant contributions to improve quality standards hence there is little interventions by social care workers in the community.
On the other hand, family units are declining yet, in most cases families are the first point of call for service users before they could approach the state for support. To facilitate universal standards of care, families have to be involved working in parallel with either personalisation or care management service frameworks. However, it could be argued that quality is in the eyes of the beholder but practice evidence has demonstrated that families have the abilities to provide psychosocial wellbeing than strangers and that enhances quality and standards of care. Family care giving is linked with cultures and traditions as well as sharing past and present family history between generations. Interactions of any kind provide learning opportunities for the younger members of the family who disseminate such practices, experiences and knowledge to their own offspring. Families’ involvements are not a question of parochial views but significant observations because they know the standards their relatives are used to as a result they would endeavour to maintain that better than strangers. Nonetheless, to achieve universal care standards it requires political will that is unconditional, this is directed to promote family values and norms while social workers are encouraged to practice social work to later.
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