One of the joys of reaching a certain age is that when you look back over a decade or two you can see that despite the many frustrations and false dawns, there have been radical steps forward in social and health care policy.
On my personal list would be the closure of long-term institutions for people with mental health problems and/or learning disability, the introduction of personal user-held budgets, and the recognition that abuse of vulnerable people is a crime.
Of course none of these issues have been addressed fully or policy aims implemented perfectly, and we have a long way to go before the standard of care and quality of life that we aspire to available to everyone is achieved.
Support for people from Black, Asian and Minority Ethnic (BAME) communities is one that would have been on my short list ten years ago. This is not on the basis that adequate culturally appropriate services were sufficiently available but there was a growing acceptance in policy and practice that people had a right for their heritage, language and religion to be positively considered and responded to.
This article by Valerie Lipman provides a timely review of the current state of play regarding support for older people from BAME communities.
It focuses in particular on the experience of BAME voluntary organisations, which were seen in the 1980s and 1990s as essential contributors to a culturally diverse patchwork of social care provision. Through national and local grants they were encouraged and financially supported to provide direct services and support including interpretation, translation, research or representation.
Reflecting the general spread of voluntary organisations these ranged from small groups run on a shoe string up to larger entities involved in a range of activities in different regions. Some communities and user groups within these were undoubtedly better served than others, and there was often a lag between a community emerging in a locality and the local authority accepting that tailored services had to be provided.
However, the general direction of policy and provision was positive even if it often lacked sufficient momentum and consistency.
This was a mixed methods study. Data for the article was gathered from a variety of sources, including research, websites and interviews with stakeholders from BAME voluntary organisations, academics, and commentators.
A review of the policy and research literature and then 12 semi-structured interviews were undertaken. Most interview participants came from BAME policy and service provider organisations and organisations focusing on older people.
The author has gathered sufficient insights (including from her own practice) to provide a meaningful commentary on what has been happening to the provision of support to BAME older people in recent years. And it’s not good.
Withdrawal or reduction in grant funding is leading to closure or restrictions in services and smaller organisations finding it hard to compete in tendering processes.
Local authorities seem confused about how to interpret the national government steer for ‘cohesion rather than multi-culturalism’, and assessment processes are described as inadequate due to cultural unfamiliarity.
Choice, one of the key expected drivers of the current system, is often limited or denied due to older people from BAME communities not having access to information or budgets, and opportunities for collective representation also seemed to be few and far between.
It appears then, that the patchwork of services that was steadily being developed is starting to look threadbare.
In terms of solutions, the article recommends improved data gathering and analysis of uptake and outcomes for these communities with corresponding actions being taken, and improved funding for voluntary groups which can support those communities who are most in need.
The title ‘contracts and commissioning’ also suggests that these are the core of the malaise in local authority response. I would not agree with this per se – if local authorities have the capacity and commitment to implement the whole commissioning cycle then this should engage community voices in the scoping of need and in the mapping of local resources.
Tendering can then act as an opportunity for voluntary groups with new approaches to win funding, and if (and only if) specifications sufficiently reflect the need for cultural diversity then these organisations will have an edge over others which are less culturally relevant.
The trend to consortium based contracts could also be enabler, with lead providers looking for partners with the required cultural knowledge and skill sets.
Training for current and future care managers would also seem essential, and as we move into more integrated arrangements this will also need to include health professionals.
The author concludes that
Practitioners should contribute to data collection about protected characteristics, such as race/ethnicity to establish if BAME older people’s needs are being assessed equitably, whether access to care and support is easy; and how market-shaping at local levels can ensure a range of providers.
Strengths and limitations
Methodologically it would be possible to suggest potential limitations as this is a complex and enormous topic, and there is some lack of clarity in the data gathering and analysis process (for example how were websites selected and search terms for evidence review).
In summary, this article provides an important commentary on the provision of culturally diverse adult social care services.
It highlights that previous improvements have been lost and that without renewed vision, focus and momentum there is a grave danger that the inequalities faced by many such communities will grow rather than diminish.
It is to be hoped that before too long we will once again see adult social care taking a lead in enabling such communities to be heard. This includes not only local authorities with their purchasing power and strategic influence, but also larger voluntary organisations which can connect the experience of dispersed communities.
The patchwork will never be complete, as communities mature and new ones develop, but with collective action we can prevent further holes emerging and build a legacy to be proud of.
Lipman, V. (2015) Contracts and commissioning: what’s happening to social care services for black and minority ethnic older people? Working with Older People 19 (2) pp.85-93. [Abstract]