Changing care

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.