Cultural Challenges within Multi-Disciplinary Team Approach for Hospital Discharges: A Perspective for Collaborative Health and Social care Management

A successful collaborative team would include all health and social care specialists (Doctors, Social Workers, Nurses, Occupational Therapists, and Physiotherapists etc.) to gather on an equal level, to come up with a strategic hospital discharge plan to enable continuing care in the community. It is hoped, the meeting would decrease revolving hospital admissions; mainly by older people. Although, the questions are: Dose the means justify the end?

In theory, the perspective is endeavoured to reduce acute hospital bed blocking by older people. The answer would be to offer care to the aged in their own homes and in the community they are used to for as long as possible. In practice, however, some of the specialists are meddling with politics and show of professional know-how. The doctors for example, tend to over shadow the meeting and dominate decision making whilst lowering other professionals to just audience and spectators, which collapses the collaboration.

Even so, social services suffer due to its inability to negotiate effectively on equal-terms with doctors, because of a “power of professionalism, politics, wide-ranging knowledge and influence”. The differences between professional and political power versus doctors are very wide, which gives them a competitive advantage to make unilateral decisions. In this perspective, most professionals do not have the expertise to debate or argue on equal footings, failing to represent or advocate for service users, families and the wider organisations.

Unfortunately, political interference within the team and the wider health and social care institutions has renewed the gap between the two inter-related sectors. In light of this, it is now a common experience to see erratic hospital discharges of older people into community without adequate care to support them with their holistic needs. This is seen as the perils of social services that have a duty to assess and provide care within a critical and substantial matrix. Though, the eligibility criteria for care in the community is complex and not many service users would qualify and may not have enough money to buy private care and, or family members to assist them with their care needs. Equally, community nursing are rationed; they have long waiting lists, which are triggered by poor hospital discharge planning, that is in practice created by the doctors and hospital management.

A Multi–Disciplinary Team Approach is now the buzz word in practice, which is supported by both health/social care executives, and it is aimed to accelerate hospital discharges. Based on this assertion, the objectives in practice should be to piece together an integrated care management approach; something that is appropriate to simplify care provision in the community.  The framework should take a holistic approach, which includes: mobility in and around the house/community, housing issues, benefits, family support systems, community nursing and care; rather than curative and biological pathways which has a narrow vision. The system must be free from politics and professional bigotry but, it needs to focus on the wellbeing of the service users, consumers, patients, clients and their families. Community care is not only to be used to rehabilitate patients/clients or consumers in their own house, it is also to improve their psychosocial wellbeing and recovery as they are in the community of their relatives whom they know well. Whole systems policy and practice reduces wastage and readmission costs to the wider organisations of health and social care on the long-run.

It is imperative to understand we live in an ageing society, this due to advancement in biotechnological systems and medical sciences as well as strategic investment in human resources, pharmacology and healthcare infrastructures. These have undoubtedly enhanced longevity of older people and those with chronic diseases, helping them; to live and immerse themselves with their wider community of relatives, friend and carers. However, there has been an increase in demand for care by significant number service users, which requires 24 hours care; ensuring their safety. In addition, the number of formal and informal caregivers is plummeting, this is presenting itself as a major challenge especially to the authorities, to provide and meet the care needs of the ever growing elderly population. This indicates the beginning of a potential crisis, which would someday engulf the society in future only if both national and local governments, including health and social care authorities do not come up with strategic vision on how to tackle future care for the aged.  

Society today has seen a multiplicity of developments, including the economic down turn, demographic change, politics and a declining family unit, as such; these are some of the pathways going against the increasing older people population to needed. Indeed, an integrated health and social care that has pooled budget might be the solution. This has the propensity to remove departmental financial interests, politics and cultural administrative dissimilarities.  If we saw a merger of health and social care training policies, this would provide the staff with a wide range of knowledge-based experiences to address older people’ needs. Additionally, joint training has the opportunity to address professional, knowledge-based experiences and bigotry which is evident in practice. Family support systems, training and engagement should be a priority as some older people would prefer their own relatives to support them in times of need and poor health. In most cases, their family know their needs and the standards they are used to, allowing care professionals to provide peripheral care support services.

Yet, the biggest treats are demographic change, cultural and administrative politics, which would continue to present tough problems for the authorities because longevity of older people and their demand for care. However, this could be minimised if the government would relax some of the legislation and current policies on immigration, health and social care funding mechanism and behaviours.

Misrepresentation of Sociology: A Perspective on the Aged and Health/Social Care.

Health and social care is anchored on the philosophy of sociology, which is about inclusiveness, social cohesion, social administration and wealth distribution to all citizens of the state as appropriate. And since the inception of universal services, sociology has even broadened its scope and definition, which has surpassed the widely held empirical and academic theories of the subject. In the light of that, the contemporary understanding of the theme is now comprising different cultures, traditions and learning from around the world to promote social diversity. This opportunity is endeavoured to advance health and social lives of the wider community, assimilation and co-habitation in society of all populations.

However, recent government policies have deflected some of the fabrics and meaning of applied sociology and what it stands for in a wider context of health and community wellbeing, in particular the needs for the aged people in society. It could be argued that recent micro and macroeconomic down-turns have brought about new interpretations of the conceptual framework as one of the measures to manage the nation’s debt (the big society agenda). Nevertheless, this perspective is not new, society already exists and functions in different cardinal points such as individualism, capitalism,   consumerism and voluntarism in order to produce and deliver social goods.  From every count, this philosophical discourse has resonated the conflict between current interpretation of sociology and universal services; in particular the perception held about older people in society.

The present day health and social care philosophies for older people is now at the centre of political treatise hence the aged are the highest consumers of the welfare services. In view of these assertions; long-term policies on capacity and resource planning for the elderly people have been erratic and short lived. This however, tantamount to tunnel vision, which could be a problem for the wider society in future if longstanding strategies are not developed.  We live in an ageing society where a significant majority would need health and, or social care yet; the support systems in place is drastically declining because of changing behaviours, values and societal norms of smaller family units. In contrast, universal services originated from “sociology”, as this epitomises the birth of social administration. Nonetheless, the question is; “what is the inter-relationship between; sociology, welfare state and the “Big Society” agenda?”

Historically, “sociology” is about the understanding of social lives and behaviours, especially in relation to social systems, how they work, how they change, the consequences that society produces and their complex relationships to peoples’ lives and how they inter-relate. For example, different parts of society submerge to a completely different setting and fused themselves to deliver welfare services to older people and other vulnerable people in the community. Practice observations indicate that sociology and welfare systems are intertwined as the main focus is to integrate norms and values  to facilitate community and psychosocial wellbeing of those in society, who rely  on others for their functional activities of daily living. Universal service must be seen in context of a whole systems approach, how that impacted on other sub-systems therefore, any derailment within the system collapses the entire cell. Thus, sociology examines the epistemological and ontological issues affecting all parts of the system, such as the welfare services and its contribution to the maintenance of health and social care; in particular the aged.

We should be mindful, though broader interpretations of the subject divulge that individual situation or problems within the wider community could become a public issue. But, when that is inter-related with another pattern it could produce pressure groups, which might destabilise the set values and foundations of the system if not handled properly. Therefore, the growth of older people and political interference in health/social care could endanger the outlook for strategic planning and continuing care management. On reflection, low morals within the care profession and the wider health care sectors could disenfranchise the entire welfare services. Based on the contemporary structural adjustments in the organisations and community services providers, it would be assumed that sociology and its wider remits have taken a different turn to embrace neo-political indulgences.

New geo-political dispensations meant that the current sociological concepts engaged dual frameworks; legislation (Laws) and policies (individualism) as social norms (the “Big Society”) and some of the principles clash with sociological understanding. This dictates a range of different values existing in society and has to be tolerated because; people have different types of rights from one another. It is undisputable that individuals are unique and hold different views, values and practice. However, current government approaches show discernment against older people within the wider society. Their services are in contrast with other service users’ groups whilst funding for services cannot be compared. Realistically, this is what I call “positive discrimination against the aged” and unfortunately, there is no apex of the wider society that is able to challenge or speak against the plight of this client group.

Sociology promotes life changes and an equal society, where people and services integrate to acquire new knowledge and develop an acceptable behaviour in the environment around them. The quintessence of the welfare service was to cater  for the frail older people and other vulnerable people in society. In contrast, the post-modern interpretation of the system has discarded the link between sociology and social administration. Sociology forms the pillars universal welfare systems, which originally focused on the fours giant killers in society “idealness, diseases, squalor and want”. However, the current challenges facing health and social care sectors are; the growth of older people and their increasing demand for care, which the coalition government of the day is struggling to cope with

Homogeneity of Care: Recognising Individuality of Older Person’ Care Needs – Policy and Practice

I applied mine heart to know, and to search, and to seek out wisdom, and the reason of things, and to know the wickedness of folly, even of foolishness and madness Ecclesiastes (7:25 KJV). In my studies and career, I have continuously searching to uncover ontological issues why older people are not been perceived as individuals with distinctive needs but to no avail. The perceptions of the national and local governments as well as the wider health and social care organisations have revealed the folly of the widely held societal belief systems against older people. They should be recognised and their contributions acknowledged for laying the foundations and structures of the universal welfare systems in the UK.

In the welfare discourse, older people are seen as one entity rather than individuals who have different care needs. Naturally, humans are individuals with special characteristics and genetic makeups, which is unique to identify their needs from others. However, health/social care institutions and professionals tend to see older people’s care as homogenous thus, devising policies and practices that justifies the implementations. Practice observations have revealed that such policy/service frameworks can sometimes encourage discrimination and abuses of older people mostly, those who are unable or have no family members to advocate for them. These act of inequality, negligence as well as poor services delivery for older people; who are in care triggered the development and implementation in the UK; the “National Service Framework for Older People” and “Personalisation of Services”. The aims and objectives of these polices were to eradicate discrimination, so that older people could be seen as persons with individual needs.

In contrast, cuts in services and restructure of human resource in the sector indicated that older people’s service have been perceived as a weak sub-system, which could be targeted for savings. The reforms have ignited the debate whether the above policies are political rhetoric or manipulation of ideology. With older people’ population expected to increase substantially in the next two decades, politician, physicians, health/social care professionals and managers need to be prepared for overwhelming challenges they will face looking after this user group. In practice, health and social work teams are swept over with referrals from this group, their families and other professionals. Casework are growing daily at alarming rate and that is an indication of what lies ahead. In most developed societies, nearly one in five will be 65 or older by 2030 (according to the UK census (2011). People in this age group constitute the majority of referrals to health and community welling organisations in the UK when compared with the rest of the population.

Consequently, the austerity measures have affected all parts of the welfare systems but, services for older people have been severely embattled and that has led to care support structures been rationed under the umbrella of the “Eligibility Criteria Matrix”. This is despite personalisation of services (“Cash for Care, Personal Budget”). Unfortunately, this has become the fate of some older people who are in receipt of care hence care giving and packages of support plan systems are undistinguishable. Most social service departments up and down the country in the UK only assist those with “critical” needs; whilst a significant minority of others provide assistance to those needing “critical and, or substantial” care and those requiring medium and low needs have to fend for themselves. However, the danger is; this policy might be contributing to users’ health deteriorating conditions and would cost more money in the long term to care for them. This is a common experience of those users who are unable to buy care privately and, or may not have family members around that are willing to support them. Current policy frameworks are not supporting preventative strategies, which could reduce future costs and admission into hospitals; rather the focus is to make substantial savings in line with the coalition government’s ideologies such debt reduction and promotion of “the Big Society” agenda.

However, the consequences of quick fix solution and reactive measures would be to the peril of older people, their family and the wider health and social care organisations in the long run. On reflection, a significant majority of older people who are in receipt of care tend to be frail and or, disabled and suffer from hearing deficit or dementia. Based on this understanding, homogeneous or residential care setting appears to be cost effective for the authorities. The setting offers more environmental friendly services as well as providing safety net for users and their families because most of their needs could not be met in the community. Most users’ needs are complex, unpredictable, and intense; associated with challenging behaviours. These meant that individual programme plans may be over exaggeration for this age group as care giving is offered according to presented condition at the point in time.

In hindsight, offering standardised care without due consideration for individuality meant that a considerable number of older people would suffer and their care needs and health condition worsens.  Practice observation discloses that hospital readmissions are higher amongst those service users whose needs are not adequately met. Addressing these issues requires a complete change of attitude and perceptions held by the government, professionals and service managers. Older people should be seen and not heard; whilst a whole systems approach should foster individual programme approach to later. This has the potential to accommodate older people and their holistic needs within systems approach, which would promote psychosocial wellbeing and assurance that their needs could be met in their own house/community for as long as possible.

Conversely, recent census in the UK as well as the USA and other developed countries illuminated decline of younger people whilst the population of older people is growing at arithmetic progression and a significant majority may need care in that circumstance. The question is how could the increasing needs of older people be handled individually? Apparent a higher proportion of younger people does not like to seek employment or trained to offer care of any sort to older people due to the nature of tasks involved such as intimate personal care and domestic chores. These observations justify change of government policies and legislation such as the “Immigration and education”. Relaxing these have the tendency to promote migration of people from developing nations and it is hoped, this would boost labour force in care industries in the UK and other developed societies. The caregivers would act as surrogate employees in the host nations particularly in the wider welfare services. The anticipated outcome is that immigrant workers would cover the vacuums in the care sectors, which was created by the declining younger people’s population in the counties in question.

Rejuvenating Core Skills and Knowledge: Personalisation of Care for the Aged and Demented

Ageing and disabilities tends to incapacitate humans’ abilities to undertake and fulfil functional activities of daily living. Majority would lose a significant amount of skills and knowledge to attend their care needs. However, personalisation of services has inevitably reactivated some user’s skills and knowledge as they are to some extent able to join in their care. This is a new model, which provides the opportunity for some users to exercise choice and control with regard to their holistic care needs. This permits them to make informed decisions and choices to recruit their own personal assistants who they believed would assist them meet their needs. This preposition contrasted with the ethos of “direct provision” – a formal assessments and care delivery by local social services departments.

The new model is empowering some users to be proactive to participate in their own care on a daily basis and within their capabilities. The framework is classified into different forms and characteristics, which encompasses: “Personal budget; Cash for Care and, or Direct Payments”. These care pathways have provided an avenue to revitalise care reminiscence for many older people and those suffering dementing ill-health. One of the core properties of the model is to redesign service frameworks; from “direct care provision” to self-fulfilling service. This facilitates social re-engineering and enablement so that the aged and disabled people could be fully involved in their own care for as long as possible. This would also stimulate social skills’ re-acquisition and ability to regain some lost skills and experiences whilst learning new skills.  This ensures that dementia suffers and the aged could contribute immensely towards achieving their wide ranging needs. Equally, the care pathways have the prospect for reducing dependency culture amongst many service users.

Reflecting on the advantages of the model, psychosocial wellbeing and emotional attainments for most clients groups have become prominent. It provided the opportunity to re-orientate some users with times, people and environment. This increases the propensity for some to be involved in their own care for as long as possible. Thus, they would not totally lose the ability to maintain a whole person approach and the abilities to uphold quality and standards they are used to. In the current health and social care reforms, personalisation of services though may have different cardinal points such costs savings and social re-engineering however, it is also capable to re-establish some social chores that has been lost.

The model has illuminated the desire for most people to care for themselves. This aspiration is never blunted but the ability to do so have been robbed from them due to past welfare policies such as “direct provision”. This might have left them very frustrated and hopeless to attend their holistic care. However, the contemporary service frameworks such as “personal budget and cash for care” have invigorated some users’ skills and capabilities to join in their functional activities of daily living. The care pathways are helping some service users to reconnect with old skills and experiences from their past. It is also opening up new approaches in their mind and within their environment. For some, having their own personal assistants have helped them identify areas of concerned; where they have lost expertise and their personal assistants could gradually help them to reinvent their skills and knowledge.

Although, some older people with dementia have benefitted from having either personal budget or direct payments to revive their skills yet, a high proportion of service users have not been enthusiastic. Dementia and longevity of older people are to some extent inter-connected as a result majority of older people are physically disabled and frail to partake in their care needs. Therefore, the current service frameworks are not appropriate to facilitate home support services for a significant number of the aged and disabled. Practice based-observations have identified that predominant number of the aged and disabled still prefer “direct provision” as this care approach helps them reduce anxiety and stress of managing their own care and dealing with complexities around employment laws, finance and taxation.

Practice based-knowledge has shown that a high percentage of older people who are in receipt of health and social care in the community are diagnosed with dementia / Alzheimer. Apparently, displaying dementia symptoms can be extremely confusing, often belligerent and their ability to learn, reconnect with the past or understand complex/routine tasks have become difficult for most. Nonetheless, as personalisation of services is being universally introduced across social care sector, this would undoubtedly revolutionise a new perspective and probably attract many users or potential users and their families.

This approach would chimes with aspects of the government's recent health and social care white paper as well as the “Big Society” agenda and consumerism focus. In as much as these service frameworks may be appealing to some yet, a substantial number of older people would be unable to facilitate and participate in their own care. Equally, family units are getting smaller and many are migrating to other part of the globe for economic reasons thus, would not be available to support older relatives manage their care support plans. These care models may be suitable for younger older people or non-severely disabled people who have families around to support them as appropriate.

Retrospectively, the focus for “Direct Payments” was that majority of service users would flood the gates of local authority’s social services department and possibly take up the care model in place of direct provision. Experience has shown that direct payments did not attract many users therefore; the new approaches may not be exceptional. “Direct Provision” from social services may still be the right option for a large number of service users as they would rely on social/healthcare workers to organise their care and manage the risks associated with it. However, some of these risks could be managed by trustee yet; practice observations indicate that a high proportion of older people or disabled elders would reasonably ask for “Direct Provision” of care.

Managing the Storm: The Real World of Growing Older and Long-Term Care In The Future.

"Rejoice, O young man, in thy youth; and let your heart cheer thee in the days of thy youth, and walk in the ways of thine heart, and in the sight of thine eyes: but know thou, that for all these things judgement awaits you (Ecclesiastes 11:9 KJV)" Growing old is what most humans do not envisage when they are young and in youthful/adult ages. Besides, ageing and retirement is inevitable for a significant majority of the population in society. This trajectory is encapsulated with a number of factors such as chronic medical conditions, physical disabilities, mental health and poverty. These manifestations could incapacitate peoples’ ability to sustain their living standards and functional activities of daily living. In addition, these situations have some inherent characteristics for example, stigma, loneliness, exclusion, low income, rejection and isolation. During this period of bewilderment and life alone with little or no support systems could be unbearable and devastating for many and might lead to a number of catastrophes in their lives.

Long are the days when traditional norms, values and support for care giving to older relatives were obvious and this promoted family cohesion and societal belief systems. In contrast, declining birth rate, smaller family members and, or composite/reconstituted family units have changed cultures and traditions that was widely held as natural family orientation. In addition, global migration of younger family members; perpetuated by economic prosperity has created devastating effects for older long-term care for older people in society today. Older people in most societies are left in the mercifully hands of local authorities' social services departments for their holistic care needs. However, this is common to the western world whilst in other parts of the glob for example, the African and Asian continents; family support systems are still firm and flourishing. Nonetheless, the growing older people’ population, the recent census (2011) in the UK indicated a huge decline in younger people. Practically; demographic change in the West is presenting challenges to the authorities. The questions are what would be the consequences to those older people, which have little or no resources to carter for their older age? Would local authorities and national governments be able to manage the increasing demand for care by this age group?

The financial gap between this group and the rest of society cannot be bridged hence the mainstream service users are on state benefits and a significant percentage do not have employment pensions especially the women. This undoubtedly has affected their standards of living and ability to privately fund their needs like the affluent in the wider population. It could be arguable that poverty within this group is endemic and most would not be able to purchase the necessary goods and services to sustain their psychosocial wellbeing and physical properties appropriate for activities of daily living. In the current economic situation and changing demography, an older person needs substantial savings in order to have the opportunity to safeguard their future. Unfortunately, the benefit systems in the Western world do not encourage endowment for the future. In hindsight, the current economic downturn would be a lesion for the youth and adult within working ages.

The austerity and financial turmoil affected many counties such as the USA and the West European countries more than the less privileged and undeveloped nations who are used to hardship for GDP per head. The recession from 2007 to the present time (2012) has exposed the vulnerabilities of those older people who have not thought about getting older and difficulties associated with ageing process. Historically, the youth and grown up adults have been reluctant and oblivious of saving and planning for the raining days; but have squandered their earning on lifestyles. Degenerating economic and financial circumstances and standard of living in the Western countries have uncovered the ingenuity and problems lying ahead regarding long-term care and other purposeful activities of daily living for the aged, which is inescapable for most humans. 

However, it is a natural phenomenon to anticipate that as people gets older; the propensity is that most would not be able to attend their comprehensive activities of daily living such preparing meals or undertaking personal hygiene. It is then inevitable to assume that some would need assistance to manage their affairs and, or domestic chores. Dowelling on these, the government in the UK has introduced eligibility criteria matrix, which is banded at four different (critical, substantial, medium, low) levels. These are measures to identify those individuals that could be supported by the local government’ social services Departments with their needs. In practice, support is given to those that meet critical or substantial needs after thorough and due process of assessment of needs. Nonetheless, a significant majority suffer as they do not fall within criteria or substantial matrix and had no savings or asset/investment to rely on to maintain their wellbeing.

The growth of older people has intensified demand for social care and community wellbeing. This means those that have savings or assets are in a better position to buy their own care privately without relying on the state. In contrast, those without savings or investment but needs long-term care are added on to the waiting list and their conditions could deteriorate further whilst waiting. This development challenges the youth’s and adult’s behaviours/attitudes relating to savings for their future wellbeing in terms of; longevity and long-term care. On reflection; it is normal that most humans would grow older but, what is likely to be the outcome in relation to; physical and psychological welfare towards the end of life? The long-term liberal views of wealth redistribution and universalism are no longer pertinent in this contemporary era of calamitous economic position. Rather this has resonates the argument for and against “family care systems, individualism and capitalistic” conceptual frameworks as the national resources are scarcely available and only the very vulnerable could be supported.

Ageing and Disability: The Ramifications of Longevity of the Disabled Elders.

Ageing and disabilities are inter-related and that constitutes human's genetics and pathological properties. Thus, being elderly is a process and expected but, being disabled is an addendum to these holistic trajectories of chromosomal makeup of mammals for which humans are one of them. These metamorphosis characteristics are inevitable though fluctuates and, or depends on once "moral luck". In our human experiences, it could be overwhelming to be elderly but, to be disabled is even more devastating. Thus, living with these distinctive features could pose some difficulties to undertake activities of daily living. The compound effect sometimes might be unhelpful and demoralising to most service users as they are living longer and incapable of attending their needs.

For some, undertaking holistic functional activities of daily living could be prodigious. This is particularly apparent with those people that have severe pathological and physical defects or challenging behaviours. As disabled people are living longer, their needs are becoming critical or substantial and that could be presenting difficulties in terms of physical and financial to both the informal and formal caregivers. It is now been observed in practice that “Pathological Demand Avoidance Syndrome” client group (PDA) is at increase and are living longer than other disabled people. This ailment is part of autistic spectrum and their care needs are complex and requires specialist input at all-time due to unpredictable nature of their condition.

This condition is a lifelong disability that affects boys and girls in society. People with PDA need different amounts of support depending on how their condition affects them. The main difficulty for people with PDA is their avoidance of the everyday demands made by other people, due to their high anxiety levels when they feel that they are not in control. However, because they tend to have much better social communication and interaction skills than other people on the spectrum, they can use those skills to disguise their resistance through common avoidance behaviour.

People with Pathological Demands Avoidance illnesses usually experience increased difficulties throughout their lives. They often imitate inappropriate exhibitions within a setting and may cause chaotic and distressing home life situations. This is the reason why they should have high input of support systems at all times. Autism is an overwhelmingly male diagnosis – it has even been described as the "extreme male brain". The question is why do women only make up one in four of those diagnosed with autism? Are women really less likely to have autism or are they just slipping through the net? Could it be that they are just better than their male counterparts at adapting to social situations or are simply more skilled at pretending not to have autism?

However, disabilities in general is inter-twined to sensory processing which describes our ability to take in information through our senses, organise and interpret that information, and make a meaningful response. For most people, sensory integration develops in the course of ordinary childhood activities, but for some people with disabilities despite the classifications (autism, learning difficulties, learning disabilities, cerebella palsy et al) sensory fraternization does not develop as efficiently as it should. Nevertheless, longevity amongst disabled people is on the increase and costing health and social services as well as the informal society a lot of money.

In the recent economic meltdown, questions are being asked whether the national health and social care would be able to continue to absorb increasing costs to maintain the statuesque. Does this mean that public opinion is shifting against normalisation of disabled people and their support systems? On the other hand, demographic change is presenting some difficulties to both the informal society and the wider welfare organisations that could support the aged and disabled. The latest census in the UK (2011) showed there are older people than the younger adults and this an issue of concern, which needs to be thought through, while adequate economic and structural adjustments are made to sustain holistic care needs of disabled people and the aged.

Therefore, planning for continuing care for the aged and disabled people is now paramount important hence this is likely to affect every citizen of the state in their lifetime. This challenge calls for political alliance hence non one political persuasion or organisation has the qualifications to deal with increasing disabled and older peoples’ health and social care needs.  Care needs are not limited to a certain group of people, it rather poignant to all and sundry thus; collaboration between local and national governments as well as merger between health and social care would be appropriate and welcomed

Celebrating the National Health Service: Longevity of Disabled People.

Historically the National Health Service is the crown jewellery of the welfare state in the UK. Its successes have become the envy of the world since its inception in 1948. The institution has improved and maintained the lives and health of the nation and its citizens. This is irrespective of sex, gender, ethnicity, age and disabilities. Health care has been free at the point of delivered. Yet, the service is paid for with National Insurance Contributions by the working population in the UK.

Despite its achievements and accomplishments, disabled people (learning and physical disabilities) were not seen as people with equal rights compared to non-disabled people. They were stigmatised and called different names such as the “mongos, cripples, loonies and handicapped”. Besides their castrations, they were locked up in “long stay hospitals” and had very little access to the community. Their life-expectancy was short, in many instances this determined by medical practitioners in the hospitals/homes who pegged it at 40-years-old, while many did not even have the privilege to live up to that age. Their needs were poorly managed and they had no choice of the services/care other than accepting what was available. Most were ill-treated and their outcry rose the issues of “Moral Integrity, Human Rights and Equal Opportunities” for all.

The plights of disabled people touched the hearts and minds of some members of the parliament and clergymen/women in the UK. The proponents for change exploited this opportunity and called for the abolition of the policies and legislation that supported segregation. This was widely supported by many pressure groups who lobbied their constituency members of parliament in the House of Commons. The protagonists sought for change and reforms of the National Health Service and the wider welfare services. This received “A Royal” shield and the birth of the “NHS and Community Care Act (1990). Since then reforms have not stopped but has gained momentum.

Thus, 1990 would be remembered by many people as a year of liberation for disabled people. It also marked the beginning of a road map for reforms in the wider welfare systems and normalisation of disabled people in the wider community. Normalising the lives of disabled people and their assimilation in the community has revived the general public’s attitudes and behaviours towards disabled people of different classifications.  The reforms have made significant changes and improvements in the lives of this client groups as widely observed in practice and in the communities they live.

Reflecting on the attainments and realisations of the reforms, many disabled people now lives over 65-years-old and relatively in good health. Credits are due to the multitude of support systems such as advances in medical sciences, assistive technology, personalisation of services (Direct Payments, Cash for Care) and independent living. These have provided immerse opportunities and lifestyle for the client groups and their caregivers. For example, they are now able to access the community with their personal assistants and socialise with non-disabled people.

Similarly, health and social care professionals are now well educated in practice to understand and respond to challenging behaviours in children and adults with multiple pathology of disability. Every day, we see people with disabilities such as autism and attention deficit and they are expected to cope with their functional activities of daily living in a world, which can often seem bewildering and irrational. Most of the client groups (mild or severe disabilities) may need one form of support or the other therefore, it is imperative that their support systems are not interrupted in order not to confuse their retinue.

This can cause high levels of anxiety and stress, resulting in behaviours that can be difficult for other people to deal with. This could also offer significant trials to professionals who are involved in the provision of education, health and welfare services. Examining the unique tasks facing children and adults with disabilities, their conditions may exacerbate as they are ageing. This would tentatively present some dilemmas to professionals who are supporting them to attend their holistic needs. Thus, support plan or individual programme plans (IPP) for disabled people require continuous monitoring and appraisal of their needs as well as adequate financial and human resources.

The current reforms within health and social care sectors are threaten some of the achievements already made to safeguard the wellbeing of many service users. The danger is that as people with learning disabilities for instance are getting older, they may face the same physical and mental problems of all ageing people. Most would need increasing support to ensure they grow old in a society where their safety and dignity could be maintained.  On the other hand, parents who are the main caregivers for their children with learning disabilities or those with physical infirmities may find it more difficult to cope as they get older. More than often, siblings and other relatives who take on this role struggle to find information they need because they have not been part of care giving.

Consequently, older persons with disabilities who do not have relatives risk a future of increasing isolation hence social work has changed to care management approach. They have little opportunities to rapport with service users as it used to be in the past. They are now responsible for care commission while service users have to source and appoint their own personal assistants and this could be a difficulty for many.  Thus, the unanswered questions within the current welfare systems are who will protect the interests of the vulnerable if their parents are no longer able to? Would the local authorities’ social services departments perform dual roles of commissioning and care delivery therefore, what’s going to be the legal and financial implications for authorities?

In anticipation, adults with profound, moderate or severe behaviours who are living independently with their personal assistants may find it difficult in the long-run when they are aged. There are still many potential issues around; choice and control, managing their personal budgets and finances as well as maintaining health and safety around them. It is been observed in practice that supported or assisted housing is not always appropriate for older adults with disabilities, who might need assistance with physical activities for example, mounting stairs or getting in/out of the bath as well as preparing meals and other domestic chores. Conversely, generic homes for the elderly may not have resources or be suitable for the specific needs of people with challenging behaviours. Longevity of disabled people needs to be celebrated owing to the NHS and community care reforms and continuous re-organisations of the industry.