Fifty years ago care for older people, for those with mental
health issues and those with significant physical disabilities was centred in
institutions. Regimented care, delivered efficiently but without much reference
to individuality, was the norm. Societal change and a greater understanding of
individual rights led to the introduction of “community care”, the idea that
long term care should as closely as possible reflect the de-institutionalised
nature of society in general. Smaller facilities within local communities with
higher levels of personal privacy and an improved quality of life. Such changes
coincided with another change, this time in economics the idea that given the
right circumstances the market could meet every need. This neo-liberal ideology
found favour with global leaders, Reagan and Thatcher led the way and societal
change became wrapped in an economic strait jacket. Out-sourcing became the key
objective of service delivery, if you can put a value on something it can be
traded. Due to Northern Ireland’s political and security issues we lagged behind,
our councils delivered less services to be privatised and central government
never had the clear understanding of the neo-liberal mantra driving change elsewhere, quite apart
from the lack of confidence in anyone investing in NI. But that has changed
over the past 20 years and more and more the drive to change service delivery
from the public sector to the private sector has driven the change in what
services look like. There will have to be significant changes in how we care
for all those in society who need additional support at different times in
their lives, this must be led by a desire to improve the quality of life of the
individual, the desire to make a profit can never be the primary factor because that
profit comes at the expense of the individual. We monetised our most vulnerable
and transformed them from people into assets to be traded. When such a system
fails to protect the weakest in society it is defined as market failure. Care
must change, from the very basic level of designing facilities which allow for
communal living yet capable of transforming into socially isolated havens, to
stabilising the workforce by improving training and terms and conditions.
Society must change, if we are to deliver more of what people need then we must
have less of what we want. There are bigger challenges ahead, we can overcome
them with a common purpose, or we will succumb to them due to the selfish profit making agenda of the few.
