This undertaking centres on the response from a group of service users who have been diagnosed with dementedness and go to a twenty-four hours attention service in the Perth and Kinross country to a audience sing the future bringing of attention for older people in Scotland. Clearly, the Scots authorities has stated that with the population of people aged 65 and over in Scotland expected to increase by up to 21 per cent by 2016 and 62 per cent bigger by 2031, every bit good as the increasing cost of funding wellness and societal attention – infirmary and attention places peculiarly, there is an pressing demand to make things otherwise in order to be able to go on to supply sustainable and low-cost and high quality attention for older people in Scotland ( Scottish Executive 2010 ) . With the jutting growing in the figure of older people expected to make extra important demand on attention and support services ; the inquiry therefore arise ; what is to be done to reshape the bringing of attention services in the hereafter given these projections? The audience exercising focused on two chief countries ; duty for paying for the personal attention of older people and the type of attention that service users prefer.
Free personal attention for older people ( aged 65 and supra ) was introduced in Scotland in 2002 after the Community Care and Health ( Scotland ) Act 2002 ( afterlife referred to as CCHSA 2002 ) received royal acquiescence. The background for the debut of the policy is in the recommendation of the Royal Commission on Long Term Care ( 1999 ) which states that personal attention should be available after appraisal, harmonizing to demand and paid for from general revenue enhancement. Scotland entirely as Bowes and Bell ( 2007 ) noted, of the legal powers of the United Kingdom implemented the recommendation of the Royal Commission on Long Term Care ( as above ) . In regard of the CCHSA 2002 which is the statute law that implements the policy of free personal attention, personal attention is defined under the Regulation of Care ( Scotland ) Act 2001 as including aid with continency direction, personal hygiene, mobility, aid with feeding, support and guidance services, personal aid such as aid acquiring up and out of bed, every bit good as aid with medicine.
Many societal policy observers and research workers every bit good as assorted stakeholders have described Scotland ‘s free personal attention policy in assorted ways. Blair ( 2002 ) for case positions the free personal attention policy as stand foring the really least that could be offered to older people with digesting ill-health, while Age Concern Scotland ( 2009 ) described the policy as successful in assisting older people remain populating independently in their ain place alternatively of traveling into residential attention. While Dickenson et Al. ( 2007 ) viewed the coming of the policy as a ‘defining minute ‘ in the development of political degeneration in the United Kingdom, Bowes and Bell ( 2007 ) described it as a ‘flagship policy ‘ of the Scottish Parliament and stand foring a ‘considerable investing ‘ by the disposal. In a much less enthusiastic tone nevertheless, Ferguson ( 2005 ) noted that the recommendation made by the Royal Commission on Long Term Care ( stated before ) was ab initio rejected by the Scots Executive as being excessively dearly-won and that it was subsequently accepted by the Scots Executive in order to avoid parliamentary licking.
However, despite the success of the policy therefore far and its political impact as briefly highlighted above, there is a turning concern in relation to its long term sustainability particularly with the jutting growing in the population of older people in Scotland ( mentioned before ) and the attendant force per unit area on the public bag. For illustration Sutherland ( 2008 ) and Bowes and Bell ( 2007 ) both highlight the unequal consideration of the cost of the policy, every bit good as the study of the Scottish Parliament Audit Committee ( 2005 ) which was really critical of the Scottish Executive ‘s failure to to the full understand the cost of the policy.
Bell et Al. ( 2006 ) noted that there had been an evident displacement in the balance of attention towards increased proviso of attention at place in Scotland before the debut of the policy of free personal attention and has remained the instance since the policy was introduced, and remains one of the strongest points in relation to the purposes of the policy. Bell et Al ( 2006 ) further postulate that the free personal attention policy may hold served as a logical solution to what the Royal Commission on Long Term Care ( 1999 ) termed the ‘particularly debatable boundaries between wellness and societal attention ‘ in relation to people with chronic conditions such as dementedness whose societal and personal attention needs consequence from a medical status. If we agree with Bell et Al here, we can see deductions of the policy of free personal attention within the incorporate services and procedures such as individual shared appraisals – designed to promote and back up flexibleness in services therefore supplying better pick for service users, while besides advancing equity through standardization ( Alaszewski et al 2004 ) .
The chief purposes of the policy of free personal attention harmonizing to Scottish Executive ( 2005 ) include ; promote and assist older people to stay and remain in their ain places for every bit long as is feasibly possible and sensible to make so, every bit good as provide personal attention services on an just footing based on an appraisal of people ‘s demands. Merely one of the service users ( out of a group of 12 ) who participated in the focal point group audience for this undertaking said she would prefer to travel into residential attention instead than to have attention at place. This farther highlights the already good documented penchant of older service users for attention in their ain place instead than travel into residential attention – a major purpose of the policy.
Why the Policy is of import: The policy of free personal attention has been shaped by, and since its origin has shaped other policies in a figure of ways – both expected and un-anticipated. This interaction with other policies has been chiefly in community attention and spans societal attention and wellness, pensions and benefits, lodging, rights and citizenship scenes. One of the policy aims pursued by authorities in the United Kingdom has been the de-institutionalisation of societal attention ; whereby societal attention is moved off from institutional scenes to the community which harmonizing to Godfrey et Al. ( 2004 ) reflects the general penchant of older people to have attention at place and within their ain communities ( besides expressed by the focal point group participants for this undertaking ) . The free personal attention policy can be seen as a really of import policy hence as it supports attention at place ( a position shared by the focal point group participants for this undertaking ) by supplying older people with a batch more pick ; for illustration, they can take when and if they will travel from place attention into residential attention.
Harmonizing to the John Rowntree foundation ( 2006 ) the policy of free personal attention for older people in Scotland has created a fairer system of attention every bit good every bit good as reduced means-testing and money concerns for those households with modest or limited agencies. This is besides one of the of import issues raised by some of the service users who participated in the focal point group I facilitated for this undertaking. Some of the participants revealed that things would decidedly hold been really hard for them if they did non acquire aid with personal attention. To farther buttress the above point, some of the service users who participated in the focal point group were non in support of the authorities being responsible for the proviso of personal attention but did nevertheless back up the proviso of free personal attention for those with limited agencies or who do non hold a household to back up them. One of the points besides highlighted by service users during audience was that the free personal attention policy has helped their carers ( informal carers ) every bit good because it allowed them more clip to transport out other less hands-on support and undertakings such as societal excursions.
Some of the issues the policy aims to turn to include ; a greater apprehension of the function of the household, the proviso of informal attention and the mechanisms which can be farther developed to supply support for the proviso and acknowledgment of the of import part s of informal attention. The overall design of the hereafter societal attention makes looking at the policy of free personal attention really of import because of its direct and indirect interaction with other policies and countries of societal attention huffy wellness, every bit good as lodging, benefits and pensions, citizenship and rights. Some of the interactions of the policy with the wider aim of switching the balance of attention off from institutional scenes towards attention at place have already been mentioned. The policy of free personal attention has deductions for lodging, for case if more and more people are traveling to be having attention at place, to be able to populate independently with support therefore, possibly a good figure of houses would necessitate versions particularly for those service users with mobility jobs whose ain houses may non hold been built to barrier free criterions. If besides look at pension credits, for illustration, harmonizing to the Help the Aged ( 2005 ) one deduction of the debut of the policy of free personal attention is that local governments have directed increased attempts towards service user ‘s income maximization – significance local governments will desire to do certain service users claim pension recognition if they are eligible for it because it will local governments will be paying less in fees and therefore salvaging money.
Erskine ( 1998 ) argues that the point of going for believing about societal policy includes the consideration of societal issues ( for illustration, the altering demographic construction of society ) and the experience of societal groups ( for illustration older people ) and therefore leads to ‘social action ‘ ( Alcock 2008 ) aimed at turn toing the issues identified.
One of the grounds I selected the free personal attention policy for my undertaking – apart from the fact that it straight affects the service user group with whom I worked during my pattern larning period, there is a wealth of grounds from research which suggests that the current system of grownup societal attention is non sustainable in the longer term particularly with the jutting growing in the figure of older people who will be necessitating attention every bit good as the terrible squeezing on public disbursement. Clearly, an addition in length of service would be regarded as a mark of success in the betterment of health care it besides presents a immense challenge. Consequently, the proviso of high quality attention services and support for older people, given the demographic alterations and decreased public fundss is regarded as one of the three biggest challenges confronting Scotland – aboard economic recovery and clime alteration ( Scots Executive 2010 ) .
The policy of free personal attention is portion of the overall vision of the Scots authorities to modernize grownup attention services, make it suit for intent, a systems that gives pick and control to service users, is antiphonal to the demands of a twenty-first century Scotland and switch the focal point off from ‘crisis response ‘ towards a more preventive attack ( Scots Executive ( 2010 ) . The proviso of high quality attention and support for older people is a cardinal rule of societal justness and is an of import trademark of a society that is both compassionate and lovingness, Scots Executive ( 2010 ) . This is one of the very grounds why the policy was selected for this undertaking ; to garner grounds from service users in relation to their positions and sentiments on the hereafter of attention services and support for older people in Scotland. The value of user engagement and engagement in the planning and development of the services they receive can non be over-emphasised as will be discussed in the following subdivision of this paper.
This undertaking focuses on service users who have been diagnosed with dementedness or a cognitive damage and go to a twenty-four hours centre service in Perth.
Part Two: Brooding History
Service users ‘ choice and engagement: One of the grounds I facilitated a response from the service users in my arrangement bureau for the audience and policy used in this undertaking was because the service users themselves are of import stakeholders and are at the having terminal of execution – they experience it on a day-to-day footing. Service users can be viewed as experts by experience and as such their positions and sentiments are priceless assets in the planning and bringing of grownup societal attention services.
All the service users who participated in the audience live in their ain places and are in reception of free personal attention and therefore hold firsthand experience of the impact of the policy and are besides in a good place as ( service users ) to portion their positions on how big attention and support services can be farther developed to run into future demands. After initial meetings with my Link Worker and the other members of staff during which the intent of the audience was discussed and ethical issues looked at, I spoke with service users separately ( with the aid of three members of staff ) in the twenty-four hours Centre. I discussed the intent of the audience, took the names of those who indicated their willingness to take part, and informed them about the consent signifier to be made available before the focal point group, every bit good as negotiated a suited clip and day of the month. My arrangement bureau being a twenty-four hours attention Centre which the service users attend on a day-to-day footing, what I did was to set up information about the clip, purposes and day of the month of the audience on the notice board in the dining room every bit good as the 1 in the activity room from about two hebdomads before the day of the month of the focal point group. One of the grounds I did this was so that service users are invariably reminded of the day of the month and inside informations of the audience.
In relation to user engagement, as Ross et Al. ( 2005 ) points out, there is no individual blue print for user engagement as it calls for working with a diverseness of positions. Importantly, as an emerging societal worker who firmly believes in the rules of anti-oppressive pattern or what Thompson and Thompson ( 2001 ) termed ’empowering pattern ‘ I wanted an attack that would further service user engagement, and back up their battle every bit much as possible in the audience. I decided to utilize Beresford ‘s ( 2002 ) democratic theoretical account of user engagement as against the consumerist theoretical account because it is much more in line with the intent of the audience itself – conveying about alteration through corporate action every bit good as to give service users more say and control in determinations that affect their lives. In using the democratic theoretical account of user engagement for case, I encouraged unfastened engagement in the focal point group. I did non choose a peculiar service user to take part in the focal point group treatment, instead what I did was to promote everyone to take part and the response was really positive as 12 out of 13 service users participated in the focal point group treatment. Two of the participants in the focal point group had particular demands – visual and hearing damage severally. I arranged with one of the three members of staff who co-facilitated the focal point group to work the two service users utilizing single work sheets to enter their positions and sentiments. I provided each participant with a transcript of the purposes of the audience, every bit good as a transcript of the docket for the focal point group treatment. I besides used one of the pre-focus group meetings that I had with the service users to promote their engagement ; for case one of the service users asked me if I would wish them to state me merely what I wanted to hear during the focal point group treatment and I told the service user that I was non looking for them to state me merely what I would wish to hear, instead they should show their sentiments and positions on the issues we were traveling to discourse. I believe such an attack to user engagement is of import for increasing the assurance of participants in the focal point group.
Data aggregation: I used a qualitative instead than a quantitative method of informations aggregation for the undertaking and this was chiefly informed by a consideration of what Becker and Bryman ( 2004 ) termed the chief concerns and preoccupations of the qualitative method – histrions ( for illustration service users ) , significances and descriptions, every bit good as an accent on flexibleness, procedure and context. The chief qualitative method I used was the facilitation of a focal point group with the service users in my arrangement bureau as participants. I used a focal point group attack to garner informations from the service users because it generates informations in a narrative instead numerical signifier. It was besides really of import for the informations aggregation method to be flexible and take history of the fortunes of the information topics – in this instance the service users are aged people with dementedness or a cognitive damage and it was really of import to set this into consideration. The focal point group attack was the most suited method because it provided a forum within which the service users could discourse of import facets of a policy which straight affects them, and their positions on the hereafter of grownup societal attention services is really utile because they are of import stakeholders. If we besides look at it from the point of position of service user authorization and anti-oppressive pattern, the focal point group attack besides gives the service users control as they are able to portion and discourse their experiences and the interaction amongst the different participants would bring forth a batch of informations every bit good as being utile and gratifying. Other beginnings of informations used in the undertaking include ; authorities policy and legislative paperss, literature reappraisal, every bit good as publications/evidence reappraisals from voluntary groups/organisations such as Age Concern Scotland and the John Rowntree Foundation.
Ethical and effectual pattern: As portion of the consideration of the ethical facets of my work with the service users who participated in the focal point group which I facilitated in the class of transporting out this undertaking, some of the things I did include ; promoting engagement was voluntary and that consent was obtained from all the service users who agreed to take part in the focal point group. I provided each service user with a consent signifier which they signed as grounds that they consented voluntarily and that they had the right to retreat their engagement at anytime. I besides made certain none of the service users was deliberately or indirectly excluded from take parting in the focal point group ( as mentioned earlier ) , or disadvantaged.
As mentioned earlier, I two of the participants in the focal point group had particular demands – 1 was visually impaired but non blind while the other was hearing impaired and used hearing AIDSs. Some of the things I did to enable their engagement in the focal point group for case includes ; supplying written information in big print format every bit good as doing agreements for one of the co-facilitators to work with them. I besides ensured that they were able to take portion in the treatment ; for illustration, inquiring them courteously for their sentiments while besides doing certain ( given group kineticss ) that the treatment was non being dominated by merely those who could actively discourse.
Part Three: Measuring the Impact on Users and other Key Stakeholders
Several participants in the focal point group revealed that the free personal attention policy has been of aid to them and has enabled them to stay at place instead than traveling into residential attention. About all the participants agreed that personal attention should stay free. However, there were strong responses from some of the participants in relation to duty for paying for personal attention ; one participant was really strong on his place that the household should be responsible for paying for personal attention, another argued that while he was non against the thought of the household taking duty for paying for personal attention, he was being considerate of those who did non hold a household or who merely could non afford it because they had really limited or no agencies at all. The participant with the latter statement suggested that older people should be agencies tested for the reception of free personal attention. Another participant besides argued that older people should go on to have free personal attention because they had spent their on the job old ages paying revenue enhancements and national insurance and should hence be taken attention of by the province. All participants in the focal point group emphasized the of import function of informal attention and the support they receive from their household members, merely one of the participants revealed that she would prefer to travel into residential attention – her ground being that she lives entirely in her place and would experience safer in residential attention. Several participants said they would prefer to stay in their ain places for every bit long as possible and free personal attention has been conducive to doing this possible.
There is a strong suggestion from the authorities paperss consulted for this undertaking and publications from cardinal administrations such as the John Rowntree Foundation, that the free personal attention policy has been really successful as confirmed besides by the participants in the focal point group for this undertaking. However, there is besides a strong tone of concern ( in most of the authorities publications and grounds reappraisals ) vis-a-vis the fiscal deductions of the policy given the jutting growing in the figure of older people by the twelvemonth 2032. For illustration, if we look at lodging, a greater proportion of older people having attention at place would possibly increase the demand for lodging and lodging related services ( Scots Executive 2010 ) . Age Concern Scotland ( 2009 ) noted with concern that much of Scotland ‘s lodging stock is non easy adapted for person with mobility jobs, and with the balance of attention progressively switching towards attention at place ( with free personal attention and personalisation as powerful drivers ) there are deductions for local services and the design of communities in the hereafter.
Most of the participants in the focal point group were diagnosed with an early oncoming of dementedness – intending their dementedness has non reached an advanced phase and so make non miss capacity. One impact of free personal attention for this group of service users is that it has given them pick ; they can take to have attention at place or take up residential attention. About all the participants expressed penchant for attention at place, increased support, pick and flexibleness for their household and informal carers, every bit good as support to maintain them ( individual with dementedness ) in their ain place for every bit long as possible – even during advanced phases of dementedness. Participants besides said they would wish to see more pick and control ; some of the participants expressed letdown in the fact that while they are frequently consulted with about their sentiments, some of the of import things they need are non provided. The service users would wish to be more involved in determination devising as one of the participants in the focal point group said ; ‘I can state you a job that is fussing me and near to my bosom and you can travel off and assure to make something about it without making it. ‘ By and large, the participants in the focal point group appeared to be more concerned about the quality of the services they receive than the cost or who pays for it. The participants all said they wanted services that are dependable every bit good as responsive to their single and altering demands.
Two of the participants with other disablements – ocular and hearing damage severally, besides agreed that while the free personal attention policy has added to the fiscal resources at their disposal, they still feel they have a figure of unmet demands. For illustration, they mentioned transit and being able to travel on societal excursions, cleaning their places every bit good as taking attention of their garden as some of their demands which remain unmet. They besides appear to hold a holistic position of what free personal attention entails ; they believe it covers all facets of attention for older people. These two participants besides noted that while the free personal attention policy has enabled them to have attention at place, it is likely that as their conditions deteriorate they may still hold to travel into residential attention and this may possibly be the instance for the larger proportion of older people with disablements.
In footings of the wider deductions of the free personal attention policy, one of chief aims of the reshaping attention programme ( Scots Executive 2010 ) for which this undertaking is based overall, as I mentioned earlier is a displacement in focal point from crisis response to preventive attacks, Scots Executive ( 2010 ) . This renewed accent on preventive and early intercession attacks by the Scots authorities Dickinson et Al. ( 2007 ) believe would be helped as free personal attention may do older people more willing to reach their several local governments and therefore supply some range for early intercession and preventive work.
As we can deduce from the findings and grounds from research presented in this study therefore far, the proviso of free personal attention is merely one facet of the overall image of services and support for older people in Scotland. There are ( as discussed earlier ) important deductions for other cardinal countries of public policy including lodging, conveyance, pensions every bit good as employment.
Partially Four: Critical Analysis
The debut of the policy of free personal attention in Scotland as Ferguson ( 2005 ) puts it, marks the beginning of policy divergency between Scotland and the remainder of the United Kingdom. Ferguson ‘s averment besides echoes Mooney and Wright ‘s ( 2009 ) history of the difference in the manner the four states which constitute the United Kingdom position, experience and organise policy responses to their societal jobs. The policy has been mostly welcomed and viewed by assorted stakeholders as portion of a Scots solution to Scottish jobs. Drake ‘s ( 2001 ) averment that societal policies are non created in a vacuity but are guided by values, rules and aims is possibly utile here when we look at the overarching rules and values which underlie the policy of free personal attention. For illustration, Scoot and Mooney ( 2009 ) postulate that the publicity of shared citizenship and societal justness, every bit good as the relief of the effects of economic inequality are some of the indispensable rules of the policy. While these rules and values were ne’er rather in uncertainty in relation to what the policy stands for, one of the points raised during audience ( in the focal point group with participants from my arrangement bureau ) and as stated by the Care Development Group ( 2001 ) is the issue of equity of entree for different user groups – in this instance for illustration, service users with dementedness. Harmonizing to the Care Development Group, free personal attention is right in rule because it removes the favoritism antecedently encountered by older people with chronic or degenerative conditions such as dementedness who require personal attention.
The findings in this undertaking are critically analysed ( in this subdivision of the paper ) in relation to the specific subjects covered in the focal point group. The three subjects are ; duty for paying for attention, the preferable type of attention, and be aftering for the hereafter.
Duty for paying for attention: As I mentioned in old subdivisions of this paper, participants in the focal point group expressed assorted positions refering duty for paying for personal attention. Although most participants agreed that personal attention should be provided for older people and paid for by the authorities, there were some participants who held really strong opposing positions and argued that the household should either pay for personal attention or at least do some fiscal part ( co-payment ) towards it. Another participant besides suggested the debut of means-testing to the policy so that lone older people with limited agencies receive free personal attention. Overall, participants in the focal point group treatment did non look to be excessively concerned about the cost or who pays for personal attention. The participants revealed that they were more concerned about the quality of the services they receive, guaranting that such services meet their single demands and are able to stay in their ain places for every bit long as possible and spend clip with their households. Sutherland ( 2008 ) reminds us that while free personal attention is presently available to older people at the point of bringing, person still had to pay for it – soon the taxpayer.
On the inquiry of who should be responsible for paying for personal attention, findings from the focal point group autumn under two wide classs ; selective entree and cosmopolitan proviso. Both classs possibly raise a figure of interconnected issues including ; rights, citizenship, pick, authorization, every bit good as the redistribution of public assistance resources which harmonizing to Hills ( 2008 ) is cardinal to the assessment of societal policy. If we apply Drake ‘s ( 2001 ) construct of the map of rights to the above findings from the focal point group, most participants view free personal attention as something they have a right to ( as older Scots who had spent their working lives functioning the state in different ways ) receive and it confers certain benefits on them ; pick and empowerment peculiarly as they can now take whether to have attention at place or travel into residential attention as one participant even revealed ‘at least I will non hold to sell my house to pay for my personal attention. ‘ While it was apparent from the focal point group as I mentioned earlier, that service users had a holistic position of what free personal attention entails, some of them were besides non cognizant of or possibly considered the wider deductions of the cost of the policy – for illustration the deductions for lodging as I besides discussed earlier. The cost of the policy in the longer term has been highlighted in worrying footings by many authors and observers on societal policy, every bit good as the by Scots authorities. Considered against the background of Scotland ‘s altering demographics, grounds from the literature consulted for this undertaking suggests that the policy may non be sustainable in the long term. For illustration, in an independent study on the free personal attention policy by Lord Sutherland ( 2008 ) it was argues that a more holistic position of public support agreement would be required because the policy is merely sustainable ( under the current agreement ) over the following five old ages after which the impact of a rapid addition in the figure of older people and demographic alteration will get down to put in. The inquiry so arises ; why was the fiscal deduction of the policy non strongly considered before the machinery of execution was set in gesture? There are a figure of statements emanating from several of the literature consulted for this undertaking in relation to the fiscal cost of the policy and there are suggestions as I highlighted earlier, that bing the policy has been unequal and that the policy had more of a political purpose ( Sutherland 2001 ; Eccles 2001 ) .
Blair ( 2002 ) posits that societal policy plays a polar function in the building of ulterior life itself. Blair ‘s statement that older people are frequently discussed and defined in studies through the psychological distance of human ecology, shortage and economic sciences ( Blair 2002 ) is apparent in most of the studies and grounds reappraisals consulted for this undertaking therefore obscuring the world that many older people are already making good for themselves without or with really small province support as one of the participants in the focal point group treatment said ‘we are already making adequate to take attention of ourselves but what is incorrect with having free personal attention, have we non worked for it ‘ ?
The preferable type of attention: As I reported in old subdivisions of this paper, merely one of the participants in the focal point group said she would prefer to travel into a residential place. She cited fright and insecurity when her wellness deteriorates as the chief ground for her pick of residential attention. As is already good documented in research ( Dickinson et al. 2007 ) older service users would prefer to remain out of the formal system of attention for every bit long as possible given the pick. Although participants in the focal point group were clearly cognizant that the demand to travel into institutional attention may originate when their wellness status deteriorates, they will really much prefer to remain off from residential attention for every bit long as they can perchance can, some of the participants even said that every bit long as members of their household are willing and able to back up them residential attention would ne’er be an option.