Steve Fouch

Social Care Crisis: time for a modern ‘reformation of manners’

Steve Fouch is CMF Head of Communications. He has worked in community nursing, HIV & AIDS and palliative care. He serves on the International Board of Nurses Christian Fellowship International.
The views expressed do not necessarily reflect those of CMF.

oldage3It seems that the world has made some broad progress on health in the last fifteen years, according to a new index that The Lancet has published.  This SDG Heath Index promises to increase the level of detail and consistency in how data is collected from different nations so that real comparisons in development can be made.

Interestingly this index suggests that both the US and Russia have fallen well behind with progress on health development compared to countries like Uruguay and Morocco. This in itself will make this new metric interesting to follow, as it will be looking at health and development in every nation, not just the developing world.  We are moving from an ‘us and them’ approach, to recognising that the rich nations are as much under scrutiny about how they are caring for their poor and sick as are the developing nations.

It is against this background that the Care Quality Commission has released figures suggesting that the whole care sector in the UK is on the verge of collapse.  We have reported before about the growing strains on the National Health Service, but the challenges faced by the care sector are, if anything, much worse.

In the last year alone, the number of care homes for the elderly in England has fallen by 1,500 or 8%.  This is on top of an ongoing series of alarms raised across the social and political spectrum that funding and staffing of domiciliary care is declining as demand is increasing.  Hospitals and GP services are bearing the strain of this, as elderly people who could have lived in their own homes or care homes with support are now being admitted for preventable reasons, and cannot quickly be discharged because there is no intermediate care available and limited or no domiciliary care for them when they get home.  The elderly are more prone to infection and other health problems the longer they stay in hospital, compounding the problem.

It seems ironic (if that is not too weak a word!) that at the very moment we are urging the developing world to care for the vulnerable in their societies more effectively, we are failing to do the same in one of the richest countries on the planet.  The Sustainable Development Goals (SDGs) apply to us as much as they do to the developing world, and we need to hold our government accountable.

However, government alone cannot provide the answer to this unmet need. I remember sitting in a medical anthropology seminar many years ago, discussing the UK’s domiciliary care system and how funding followed ‘clients’, allowing the elderly or disabled person or those granted power of attorney for them, to make decisions about the type of care they received.  Several Africans and Asians in the seminar looked aghast. Where were their families, they asked? Why were their children, siblings or spouses not providing this care? Surely that was a better solution than the state pouring money out for strangers (however skilled or kindly) to provide the support that families should?

It remains a good question, and one with which policy makers are beginning to engage. For, despite lots of time and effort, the long promised, cross party consensus on the future of care in the UK has not emerged. The State is proving singularly incapable of providing the scope, quality and duration of care needed.  The future, it would seem, is that families will have to gather around much more than in the last thirty or forty years.  The State will only be able to support a limited number who have no prospect of family support.  The vast majority of us, as we grow older and more frail or contend with long-term disabilities, will find that the only source of support will be family. However, with families in a weakened and fractured state, one wonders if that is a realistic alternative as well?

If we want to see a strong health service, we need a strong framework of social care in the community. If we want to see a strong framework of social care in the community, we need stronger families and stronger informal social support networks.  I do not see any government of any hue being able to deliver stronger families or a strong local civil society (much as I value the perspectives of so called ’Red Tories’ and ‘Blue Labour’ thinkers).  This is where the church has a role – from marriage and parenting courses, to running day centres and social clubs, to parent and toddler groups and pre-schools, to debt counselling services. The church is already engaged in building the civil society networks to support those in need.

But these are only a fragment of what we can and should be doing – because, at its heart, the only real hope for changing society so that it cares for the most vulnerable is a spiritual transformation found in the gospel of Jesus Christ.

William Wilberforce understood this need for political, social and spiritual activism. As he campaigned on so many social issues of his day in Parliament, influencing governments and political parties and cross party movements, he also worked on societies and associations that promoted transformation of ‘public manners’, built up families, translated and distributed Bibles and proclaimed the gospel of Jesus Christ. It was his work (inspired in turn by the Wesleyan revival of the previous generation) that envisioned the work of the Victorian social reformers, from Fry to Barnardo, who laid the foundations for the welfare state that we see struggling today.

What we are in need of is another generation of Wilberforces, Wesleys, Frys and Barnardos to transform our society from the bottom up.



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