Wednesday, October 29, 2014

Social Care

There will be nothing new in this Blog but the message is one of the most important for planners in this country - and possibly elsewhere.  The costs of social care is probably the only common life risks where the costs are not pooled and paid for by the state like the NHS for health treatment and care or insurable like our cars and property.  Sir Andrew Dilnot recommended state support would be beneficial and could be politically attractive if capped so that there would be sharing of the expense. his proposal was a cap to the individual of between 25k and 50k with the state picking up the extra. He believes that the cap might be nearer 60k for those who have it (there would be a means test). Higher figures have been suggested but the means test would afford some protection to those of modest means.

My layman's eye view of this (supported by any number of reports on the costs (eg from IPPR, the Kings Fund and Age UK) is that we are in denial about the affordability and desirability of the current system, by which I mean the caring burden carried by families and institutions.  I can't see that families will be able to cope with the extraordinary increase in older people including an increasing number of frail elderly with multiple conditions.  And I can't see that the state can pick up the cost of what families cannot do, as the tax payers of the future will have many other financial commitments (including student fees, mortgages, pensions - theirs and those of the retired) but having more precarious employment.  The Chancellor has already experienced a low tax take despite high levels of employment.

But my point is that the financial cost of social care is not the point.  It is the need to reduce the need for care by the state (and sometimes by families) by building caring environments.  We should not be building one more private house that is not designed to relate closely to the public realm and to a space where people can stand and sit and be noticed in all weathers.  Just by designing spaces where falls are less likely to happen will have a substantial bearing on the costs to the NHS.  If falls do not occur or are less serious, older people will continue to venture out and the need for care in the home will be reduced.  If a neighbourhood builds levels of familiarity and companionship then people will feel more comfortable about providing companionship and elements of care in the home.

This should not need saying and of course there are places where these traditions are alive and well, and in Leeds and Cornwall systems are being introduced to nurture this informal care.  However, planners, architects and urban designers are still pandering to privacy and making it sufficiently difficult for incidental caring to flourish at the scale that will be necessary when (and not if) existing social care systems crash.  So the point that needs repeating is that the growth of informal and mutual caring should be a massive benefit arising from the failure to maintain the institutionalised methods. And I can't end without saying that co-housing models would do all these things, whether designed from scratch or as a plan to adapt existing urban areas.

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