Frances NeilsonThis weekend, the Citizens’ Assembly for Northern Ireland will meet for the second time to discuss social care for older people. Frances Neilson explains why this issue is the first to be deliberated by this new democratic innovation. You can follow the activity of the Citizens’ Assembly on Twitter @CA4NI.
Every year, Northern Ireland’s Health and Social Care (HSC) Trusts spend over £900 million on adult social care. But what exactly is adult social care? The key aims of this brand of care are to help individuals remain as independent as possible; retain their dignity; and achieve a better quality of life. These aims are achieved through the provision of care in residential homes, nursing homes, and individuals’ own homes. The delivery of adult social care can prevent admissions to hospital, as well as shorten the length of time individuals spend in hospital – thus reducing demands for hospital beds.
These principles of adult social care are solid, but the legislation underpinning community care provision in Northern Ireland is almost thirty years old. The demographics of Northern Ireland have drastically changed; the population of older people is significantly larger than it was three decades ago and currently one third of those who receive adult social care in Northern Ireland are older people. More people are requiring social care, but the number of care workers is failing to keep up.
Care workers receive amongst the lowest wages in the labour market, and it is a workforce defined by low pay and high rates of turnover. In Northern Ireland, the shortage of qualified nurses and care workers is noticeable with the closure of care homes as a result – Drumclay Care Home in Enniskillen is the latest to announce its likely closure. This shortage of care workers means much of the care older people receive is carried out by unpaid carers – usually members of their family. The social care system aims to support these carers, but the 2011 census identified over 11,300 older carers (those over the age of 75) in Northern Ireland – a far greater number than anticipated by the outdated legislation.
All regions of the UK have recognised the need to reform adult social care provision and bring the legislation up to date with the requirements of the 21stcentury. Prior to the collapse of the Executive at Stormont, Northern Ireland’s policy makers and service providers had agreed that the system of adult social care was in need of reform. However, unlike in Great Britain where local councils have responsibility for the provision of social care, in Northern Ireland the responsibility falls to the Department of Health. This is just one example of many policy reforms that has been delayed due to the breakdown in power-sharing at Stormont.
The Citizens’ Assembly for Northern Ireland first met over a weekend in October (Photo credit: Involve)
The purpose of the Citizens’ Assembly for Northern Ireland is to identify the values and principles that should underpin a reformed system of social care for older people, as well as make informed recommendations for the future of the system. This is not the first citizens’ assembly to be held on adult social care: in June, a citizens’ assembly of 47 individuals from across England met to deliberate how to fund the system in the long term.
The funding and provision of social care is an issue that will affect all of us during our lifetime, and the Head of Policy at AgeNI has described social care as the “most challenging” issue in Northern Ireland. The topic also presents the perfect first issue to be put to a citizens’ assembly in Northern Ireland: it is an area of policy that is suffering because of the deadlock at Stormont, but it is not the cause of the deadlock. The provision of social care transcends issues of national identity.
When the Citizens’ Assembly met previously in October, the participants heard from a range of experts, including academics, directors from the Department of Health, spokespersons from advocacy groups such as AgeNI and Carers NI, service provider bodies, and recipients of adult social care. Having learned about the current challenges facing social care for older people in Northern Ireland, the participants of the Citizens’ Assembly will spend this weekend deliberating possible changes that can be made to the existing legislation, before developing recommendations for new social care policy for older people. These citizen-led recommendations will be presented to the Department of Health in a report compiled by Involve.
Whatever recommendations the Citizens’ Assembly proposes will need to take in account the obstacles current legislation faces; changing demographics and funding pressures have created an outdated model for social care provision that receives very little public attention. The Citizens’ Assembly presents a unique opportunity for individual, community, and public expectations of social care to be voiced and taken under consideration for a new model of provision.
The recommendations of the Citizens’ Assembly have no statutory powers, and it could be months before power-sharing at Stormont is re-established and able to take into consideration the recommendations. However, the Department of Health has already begun work to transform its approach to adult social care provision. The recommendations from the Citizens’ Assembly will help inform the Department’s policy currently under development. With the proposals from the Citizens’ Assembly, Northern Ireland will be one step closer to an effective, forward-looking social care system that reflects the priorities of its citizens. I, for one, cannot wait to see what the participants come up with this weekend.
