A gap exists between the expectation of older service users and the provision that they actually get.
This is the finding of a study published today in the Journal of the Royal Society of Medicine.
The participants in the study, who were diagnosed with lung cancer, heart failure or stroke and judged by health professionals to be in the last year of life, displayed a strong sense of entitlement to services that were tax funded, after working lifetimes contributing to the state. Alongside this, a sense of social responsibility emerged in views that people should contribute to the costs of their social care if they were able. However, this did not extend to selling assets or using savings to pay for residential care, which was viewed as unjust.
Dr Barbara Hanratty, a senior lecturer at the Hull York Medical School and the University of York’s Department of Health Sciences, who led the research team, said: “People who are old, unwell and from disadvantaged areas are least likely to be heard in the debate on welfare funding. Indeed, the voices of older people with high support needs on what they would want and value in their social care have been described as ‘so quiet as to be practically silent’.
“The views expressed by participants in our study suggest that some of the silent voices may be dissenting, and out of line with current government thinking.”
Among the study group there was a perception that entitlement to services had been earned, not only through a lifetime of working and paying taxes, but also through a far broader sense of being a good citizen; working hard, staying in employment and minimising earlier demands on the welfare state.
Those that had been in low-income occupations were most keen to emphasise their contribution to society through work and taxes.
“These older people felt that a lifetime of tax contributions should represent an obligation fulfilled”, commented Hanratty. “It is clear that any changes to existing systems will be unpopular with a cohort who have paid taxes and have an expectation of comprehensive services.”
The Government gave a cautious response to the 2011 Commission on Funding of Care and Support, which recommended a cap on lifetime contributions to social care, raising the means tested threshold above which people are liable for full costs of care, national eligibility criteria and portable assessments. The White Paper anticipated later this year is not expected to accept all the Commission’s recommendations.
“The views of our participants are at odds with the direction of welfare reform in many European countries, where the balance continues to shift from public to private provision”, said Hanratty.
“At a time when financial stringencies may prompt interest in safety-net welfare provision, our participants affirmed support for the principle of institutional welfare, provided on a universal basis. Such strong support for tax payer-funded social care grounded in values of mutuality and earned entitlement through long working lives is striking.”
The researchers conclude that policymakers should listen to the views of older people and consider the widest range of options, not ruling out those anticipated to be unpopular with the wider electorate.