This issue has articles from Canada, the UK and Sweden and properly reflects our international aspirations. It also covers public health, informal carers and eligibility for social care.
This editorial also enables me to acknowledge the work of the peer reviewers who read and comment constructively on articles submitted for publication. This is a kind and voluntary effort that gives the journal the credibility it has to the care sector. There are too many reviewers to acknowledge all by name in this editorial, but the efforts of individuals such as Professor Tracey McDonald of the Australian Catholic University and Ms. Anne Gill formerly of the University of Greenwich are greatly appreciated and demonstrate a support of the journal and the work that is published therein. Readers who might wish to join the task and review others’ work would be most welcome to make contact.
In this issue
In the UK, Public Health has recently re-joined the portfolio of local government, having transferred back from the Department of Health and the NHS. The reason for the decision to do this is not apparent but it had been located there from the outset of the welfare state until 1970. It certainly can be argued that the preventative Public Health role belongs here as the general health of the population can often be influenced more effectively in the community's intervention than in the hospital or clinical environment. It remains the case that the biggest positive health impact in the UK over the last couple of centuries was because of clean water and sewerage management.
Di Matteo's article deals with the financial sustainability of the public health system in Canada. The graph showing per capita public health spending in a range of counties highlights the wide range of levels of investment. Its wrestling with the semantics of sustainability will be familiar almost everywhere but is especially interesting from Canada who avoided the worst of the financial crisis by prudent strategic financial management in the mortgage market.
In the Nordic and Baltic States, it is common to see high personal taxation met by high levels of public service. Many other countries’ populations would like the latter but not at the price of the former!
The review of the impact of mandatory requirements on behalf of informal carers in Sweden, though a relatively small sample confirms the experience in many places. People who are providing support to someone else, most often a family member, are difficult to assist or decline opportunities for support. My own experience when enquiring why carers did not engage with presented offers of help was that they were too busy caring. It may also be true that they are relatively passive as a group and therefore undemanding of professionals who should be helping but have many more overtly demanding tasks and people pressing them for attention. Jegermalm's article on Swedish Carers presents this quandary very effectively.
Pressured finances continue to be a feature with Slasberg's propositional article on an eligibility system that will cope in these parlous times. The UK is at the late stages of enacting a Care Bill that regulates the financial contribution people make for care more fairly. This Care Bill will give an up-to-date description of the role of safeguarding adults and minimising abuse but will also formalise a commitment to a person-centred model of individualised budget packages and Direct Payments to most people needing public support to maintain their independence.
For some time, the innovative discussion that offers to empower the individual at a promised price that is less than the amount being spent has been met by concern within local authorities. This concern is that, with rising populations of older people in need in particular, despite any efficiency, resources will be overtaken by demand very quickly.
The question is whether to take a principled stand and bear the cost consequences, which (according to Slasberg) could be beneficial, or to count the beans and see what is affordable before setting out and model the innovation on that.
I am not sure if it is a common experience elsewhere but in the UK, officials of ‘spending’ departments like Health will often baulk at a plan on the grounds that they cannot get it past the Treasury. If this is true, then the bean-counters probably rule. Although it is not all bad. At a conference a few years ago, a colleague working for a national think tank said that only three things caused politicians to go with change: if it threatened them, if it made them more popular or if it saved them money, and that more than one strengthened your case still further! A simple but quite useful rule of thumb, I have thought since.
A wider perspective
Being an international journal with a specialist focus, it is occasionally useful to lift our head from our particular interest and take a view of the wider world and the impact of things beyond the boundaries of care management. I do not suggest for a minute that our readership do not do that routinely. Those I know in the sector often have wide and varied interests with a steady concern for humanity in all settings.
When events like Typhoon Haiyan or the recent massive Australian bushfires occur, it is interesting to contemplate what happens to those who were in need before the event. Certainly in the Philippines, the populations of the affected areas of the country were turned into people in grave need overnight.
There are always stories of those who saved someone; a child, a parent or disabled friend, occasionally at the expense of their own life. But generally speaking, what happens when the able can salvage food from broken shops and warehouses? Is our inclination a Darwinian one where the fittest will survive or are we inclined to get a slice of the action on which to build our entrepreneurial future, acquiring goods to sell on to those who can pay or otherwise barter with us? In the care sector, we place our hope in the heroic story in which any action is taken to improve the lot of a group depending on us.
It is also interesting to contemplate what skills become important in these circumstances and who succumbs first when they happen. I worked in Papua New Guinea in the 1970s/80s and village elders were valued for their memory of communal history. The resilience and resourcefulness of the community depended on their knowledge and they were in the forefront of the planning in response to any crisis because they might remember what they did last time. There may be studies in this area of ‘extreme social care’ and no doubt someone will tell me but as we experience the effects of this typhoon, it might be good to capture data on how we dealt with it as people, especially if we don't want to depend on the memories of grandparents!
I hope you enjoy the issue.