While the challenges of developing sustainable social care for
the future are undoubtedly real, the experiences of other countries
indicate that they are far from insurmountable.
Of course many countries, such as the new eastern European and Baltic members
of the EU, are struggling to develop even a basic network of non-institutional social
care services, particularly in rural areas. But in western European, Scandinavian and
other developed welfare states, social care provision appears surprisingly resilient
in the face of the twin pressures of fiscal constraint and population ageing. From this
brief survey of current international trends and reforms, three broad themes can be
identified. First, there appears to be a widespread commitment to developing and/or
maintaining universal access to social care. Previous fragmented, uncoordinated and
locally variable arrangements are being replaced with national schemes in which
conditions of eligibility for social care are the same across the country; sometimes
these conditions are formalised as clear entitlements. The commitment to universality
also covers younger as well as older disabled people – it is rare for reform measures
to focus solely on older people. Major questions therefore arise about the equity of
the English Green Paper’s proposals to establish different arrangements for older
and younger disabled people. Moreover, no reforms to universal schemes in other
countries in response to financial or demand pressures involve excluding the well-off
or targeting social care services only on the poorest. Rather, it is more likely for
certain types of help, particularly hotel costs in institutional settings and domestic
home help services, to be excluded from publicly-funded social care.
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