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Modernizing social care services for older people can face significant challenges at the provider and institutional levels

Jacobs S, ChengQiu X, Reilly S, et al.  Modernising social care services for older people: Scoping the United Kingdom evidence base  Ageing & Society. 2009; 29(4): 497-538.

Review question

What was the state of social care for older people in the United Kingdom (U.K.) prior to the Labour party administrations modernization reforms?

Background

In the 1980s and 1990s, the public sector in the U.K. adopted management theories from the private sector to address concerns regarding the quality and financing of centrally-provided health and social services. However, these approaches were ill-fitted for the complexity of public services. By 1997, the incoming Labour administration committed to modernizing health and social care by transforming the system into one driven by partnerships, pragmatism and direct accountability, with a particular emphasis on evidence-based policymaking. This review assesses the state of social care for older people prior to the Labour reforms through three modernization themes: integrating health and social services, promoting the independence of older people, and meeting individuals’ needs.

How the review was done

A detailed search of a number of electronic databases for studies with data collected from 1990 to 2001 was conducted. Empirical studies that described the state of community-based social care or social services for older people at the turn of the 21^st century in the U.K. were included in the review.

Over 7,000 studies were identified in the searches, and 234 were included in the review after assessments for eligibility.

This review was funded by the U.K. Department of Health Policy Research Programme.

What the researchers found

The review found that barriers to the integration of health and social care included professional mistrust, problems with information sharing, and threats to professional identities. General practitioners dominated the decision-making, while social services representatives were marginalized.

Evidence strongly suggests that organizational issues, including many involving coordination with social services, were the main cause of delayed hospital discharges of older people.

The review also found that with the tightening budget, assessment of seniors was more resource-led than needs-led, resulting in increasing restrictions on user-choice and inappropriate placements in care homes.

Overall, the review emphasized a need for higher-quality studies exploring social care for older people. The review also found many instances in which policies and practices were instituted despite little supporting evidence.

Conclusion

This review found that prior to the Labour administration reforms, there were substantial areas in need of improvement with respect to integrating health and social care, increasing the independence of older people, and making sure that services fit individuals’ needs. Additionally, more high-quality evidence is needed to provide a holistic assessment of the state of social care and to support evidence-based policy-making.