Discuss How Health and Social Care Provision has Changed Over the Last 100 Years.
In this essay the manner and way in which care has been provided to groups of vulnerable individuals will be explored to see how things have developed and changed over the past 100 years. There have been considerable developments in the provision of care, such as the change in approaches from institutional care to more community based, person-centred care. These developments will be a focus in this essay, looking at the effect this has had on both service-users and health care provision.
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Historically, many of the care-provision services that were in place for vulnerable people were in a group, institutional setting. Treating people with mental illness or elderly people in large, purpose-built institutions was deemed to be the most effective and appropriate way as it was cheaper and easier to treat a large group of people in one place than it was to treat smaller groups or 1-to-1 care in lots of different places. Often, these places were built in rural, remote locations, this meant that these care provisions segregated the individuals that used these services from their local communities. Often, these institutions would lock the doors to prevent the service users from being able to leave freely, their freedom and choices were restricted, and they were treated like inmates in a prison. The lack of freedom to leave and the isolated location of the buildings could lead to a sense of dislocation from mainstream society for the service-users. This used to portray a negative, social attitudes towards these vulnerable groups and institutions (Wolfensberger, 1975).
Institutions, such as asylums for those with mental illnesses or group care homes for elderly individuals often ran on strict, daily routines that controlled many aspects of the service user’s life. Things such as mealtimes and what they ate, what they would wear, when they would go to bed, what groups or activities they were to partake in that day were all dictated by the staff. In these historical institutions, there was a clear divide between the staff and the service -users, the staff were at the top of the hierarchy and the service users or patients were very much at the bottom. The daily regime was based on what was best for the entire group of service-users as opposed to what was best for each individual. This rigid routine of uncontrollable events can lead to the service users developing a condition known as “learned helplessness”, after a while service users can become apathetic, withdrawn, and inactive. They don’t seem to take opportunities to regain control over their negative circumstances (Nolen-Hoeksema et al., 2014). This can also be referred to as the service user becoming “institutionalised”. When the service users suffered from being institutionalised, they became heavily dependent on the routines put in place by the staff, they lost their ability to make any decisions for themselves and relied heavily on the perceived sense of safety that these institutions gave them. These effects had varying levels of severity, ranging from the inability to form meaningful relationships to displaying repetitive actions such as rocking back and forth or developing repetitive speech patterns.
The Royal Commission on Mental Illness and Mental Deficiency in 1957 (HMSO 1959) led the way for the move away from large, group based institutional care to community-care. It still recognised that there was a need for smaller, more person-centred group care facilities within the community as an alternative to individual care or care at home as this wasn’t possible for everyone. This move away from institutionalised based care was further supported by the introduction of the Mental Health Act 1959, this gave way to inquiries into the way that some of these institutions were ran and the level of care been provided. These inquisitions showed that there were often service users been abused or badly treated by the people who were employed to care for them. This further cemented the move away from institutionalised care into a more community-based approach. (Hothersall and Bolger, 2010)
With more of a focus on community-based care and moving away from the large institutional settings the 1970’s and 1980’s brought a great development of policies relating to the care of older people and people with mental illnesses. The aim of these policies was to keep these vulnerable groups of peoples out of the institutions and to establish community support as an alternative. These policies look at introducing care at home and provide them with day centres that they could attend. With the reduction in large institutions, came about an increase of residential services, which led to a decline in community services. Due to this, the main source of care and support for these vulnerable groups was of an informal nature, relying heavily on family members and others within the community to volunteer to carry out the required care they needed.
Following this, saw the introduction of The National Health Service (NHS) Act in 1945, the NHS provides the vast majority of healthcare within the UK and was founded upon the below principles:
- “comprehensiveness of the services provided, covering all health needs of the population
- Universality and equity, which means that all members of the UK population have the right to equitable access to the NHS services regardless of money, socio-demographic background and health status
- Free health care at the point of delivery, financed from general taxation”
While the NHS has continued to be the backbone of modern-day health care provision I. the UK, there are some modifications to the above principles. There are now some charges for dental work, opticians work and prescriptions (Hothersall and Bolger, 2010). The Community Care Act 1990 was another act that has contributed greatly to current health care legislation. The 1990 act historically, and at present, remains a benchmark on which all current health and community care and practices are based (Powell, 2001).
The 1990 act offered direction to alter the care that was been given:
- “move from institutional care to community-based care (which in this sense does not mean residential care in the community but care within peoples own homes.)
- Move from a supply-led, provider dominated system to a needs-led, purchaser dominated system.
- Move from public sector (state) provision to independent / voluntary / provate sector provision.
- Move from NHS to local authority responsibility for funding” (hothersall and bolger)
By following these principles, this would provide the individuals with more of a focus on ensuring that services would become needs led as opposed to resources led. However, this has been argued that this is only providing the individuals who use the services with options as opposed to choices. (Myers and MacDonald, 1996)
Since the introduction of the improved health care standards in the wake of the NHS and 1990 act, there has been a significant improvement to the services on offer for people with mental illnesses or older people. These services have moved away from the large institutions and now both focus on more of a person-centred, needs led approach. This carters to the individuals need’s as opposed to the needs of a group. This health care approach means that care and services been provided are tailored to the individual service-user and allows for the best care to be given.
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With regards to mental illness, historically it has often been portrayed negatively, with a lot of fear and stigma attached. The services provided to them were often secluded and in large asylums or ‘madhouses’. Mentally ill individuals were often subjected to cruel and inhumane techniques of ‘care’ in order to try and ‘cure’ them. The NHS and the 1990 act provided the legal basis that allowed the closure of institutions such as the asylums and paved the way for the move over to community-based care (Hothersall and Bolger, 2010). The Mental Health (Care and Treatment) (Scotland) Act 2003 then allowed the issues surrounding mental illness and the continued support of the service-users to be given the spotlight and gave more of a priority status to the further development of these services. (Hothersall, Maas-Lowit and Golightley 2008). A higher focus on mental health has led the way for further developments like recovery-focussed services which focusses on the service-users ‘recovery’, this is “understood as when the symptoms of mental illness have been clinically treated and this intervention is judged to have been successful by the professionals, not by the person” (Slade, 2009). When working with people with mental illnesses it is important to be familiar with the individual care plans, with the improvements to the services on offer to people with mental illness, there has been much more of a focus on individual needs and the best treatment for the service-user. Rather than putting individuals with mental illnesses in to large, group institutions, there has been a focus on different types of recovery, such as the recovery-focussed method mentioned above, or personal recovery. Personal recovery can be described as seeing recovery as a longer process, like a journey, and that each individuals journey is unique depending on their needs. This recovery is not seen as a cure but more of an idea of moving from a state of illness to a state of wellness. Recovery is about the individual with mental illness taking back control over their own life and choices (www.scottishrecovery.net).
Similarly, with mental illnesses, older people were often put into large group homes as it was easier and cheaper to care from them all in one place rather than provide them with individual or small group care. Older people experienced a lot of mistreatment and historically were seen as a nuisance with nothing to contribute to society. The introduction of the NHS and the Community Care Act 1990 provided older people with much more rights such as an improved focus on community-based support, and an increase in state pension. The Community Care and Health (Scotland) Act 2002, had proposed that all individuals over the age of 65 should be entitled to free personal care. This has allowed a lot more health care providers to offer care at home services (Hothersall and Bolger, 2010). When working with older people within health and social care settings it is very important to ensure the service-users do not experience any form of ageism. Ageism is a form of discrimination that can be at a cultural, structural and personal level in accordance with the role in which older people have within society. Each of these levels can be explored in more detail: at a cultural level, older people may be seen as more of a burden on society. Older people will be generalised as a group of vulnerable people who may hinder the community as opposed to what they are able to contribute. At a structural level, it is common for older people to have an overwhelming lack of basic support services and they often live in poverty. Older people are much more likely to live in poverty and be poor than the general population. Many of the needs of older people, regardless of age or range of abilities, lacks the correct awareness. The personal level of ageism is the way in which older people are viewed by other individuals, there is a lack of awareness to the individuals and personal needs of older people. (Thompson, 2005).
The improvements in the health provisions for both older people and people with mental illnesses has been significant. It has gone from historically, the service-users of both of these services been mistreated and having their needs neglected. They were put in secluded, rural areas which were completely segregated from mainstream communities as there was a lot of stigma attached to the conditions. Nowadays, there are far more person-centred approaches been taken to provide each individual with personalised, high-level care. This allows them to feel respected and that they have a say in their own care as opposed to having to do what was set out for them by staff and having the risk of becoming institutionalised. There is a far greater emphasis on listening to the individual and further developing the healthcare that can be provided.
- Alcock, P., Haux, T., May, M., and Wright,S. (2016) The Student’s Companion to Social Policy West Sussex: Wiley Blackwell
- Hothersall, S. and Bolger, J. (2010) Social Policy for Social Work, Social Care and the Caring Professions Scottish Perspectives. Surrey: Ashgate
- Hothersall, S. Maas-Lowit, M. and Golightley, M. (2008) Social Work and Mental Health in Scotland. Exeter: Learning Matters
- Myers, F., and MacDonald, C. (1996) I Was Given Options not Choices; Involving Older Users and Carers in Assessment and Care Planning. London: Jessica Kingsley
- Nolen-Hoeksema, S., Fredrickson, B., Loftus, G. and Lutz, C. (2014). Atkinson & Hilgard's Introduction to Psychology. 16th edition. China: Cengage Learning EMEA.
- Powell, J. (2001) The NHS and Community Care Act (1990): A Critical Review. [online] Available at: http://sincronia.cucsh.udg.mx/nhs.htm (Accessed on 6th December 2019)
- Scottish Recovery Network (2010), What is Recovery [online] Avaliable at: https://www.scottishrecovery.net/what-is-recovery/ (Accessed on 6th December 2019)
- Slade, M. (2009) Personal Recovery and Mental Illness. Cambridge: Cambridge University Press
- Thompson, N. (2005) Anti-Discriminatory Practice. 4th edition. Bassingstoke: Palgrave
- Wolfensberger, W. (1975) The Origin and Nature of our Institutional Models. New York: Human Policy Press
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