Welfare & Subsidiarity
October Tue 02, 2012
All the articles in Welfare & Subsidiarity
There’s no doubt that we can’t afford social care as we know it. We can’t afford to provide care to the people, who receive it now, nor to the people who need it, but are judged not ‘vulnerable’ enough to be eligible, let alone to the growing numbers of older people who will need care in future.So it is not surprising that the debate about social care often focuses on how to cut costs, increase efficiencies and scale up effective interventions. But social care, even less than health care, refuses to conform to the economics of mass production.UK health policy makers are learning from ‘the Henry Ford of heart surgery’, Dr Devi Shetty, whose 1,000-bed hospital in Bangalor last year carried out 6,000 operations. Performing surgery at high volumes has not only driven down the price of an operation to as low as $1,500 (through making constant use of expensive equipment, for instance), but has driven up quality: doctors performing many more surgeries a week can become more practiced.Scaling up makes sense for surgery, but can be disastrous in social care. Southern Cross provided residential care to around 30,000 older people, with a half-billion turnover, before collapsing last year. Successive reports into home care have found large providers being commissioned for 15 minute slots and in one case a woman recorded 106 different care workers sent to support her husband with dementia, who needed consistency above all.Whilst advances in mobility equipment, telecare and online technology can help streamline some areas of social care, social care’s key interactions - one person assisting, listening to or talking with another person - resist automation and standardisation. The ‘personalisation’ of social care reflects this, embedding facilitated choice-making and individual tailoring of services. Service users are increasingly recognised as experts in their own lives.In the development of choice and control within social care, the desire to improve ‘customer’ relations and experience reflect the private sector’s recognition that, whilst a large offshore call centre may have a cheaper unit cost, customers are more likely to be loyal to a company which offers personal customer relations and personalised services.
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