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HOW DOES THE COMMUNITY CARE? PUBLIC ATTITUDES TO COMMUNITY CARE IN SCOTLAND

CHAPTER THREE: WHO SHOULD CARE?

INTRODUCTION

Whilst a key emphasis of the community care module was on the lives of people with support needs in the community and how these were viewed, the survey also considered perceptions of private and public responsibility in the provision of community care services. A number of issues lay behind these questions.

• What is the perceived balance of responsibility between the state, the individual and the family? (see also the section on the funding of care)
• Does the public really mind who provides care or where it should be accessed, provided appropriate support is available when needed?
• Does the public distinguish between needs for nursing, personal, social and domestic care?

This section therefore is concerned partly with attitudes to the welfare state, as seen through the lens of attitudes to community care services. A secondary focus is the level of awareness amongst the general public of community care provision.

WHO SHOULD PROVIDE CARE?

Further awareness and acceptance of community care was demonstrated by the discernment which respondents showed as to who they thought would be the best person to provide help. For each vignette a particular support need had been identified and the question asked was:

"Say it was possible for any of the people on this card to help … with …who would be the best person to do this?"

The choices offered were:

• someone in the family
• a friend or neighbour
• a nurse
• a home help/carer/care assistant
• someone else.

Volunteer was the most frequently mentioned 'someone else'. It seems likely that in these questions respondents were thinking specifically about the type of support need identified and the findings should not therefore be taken to represent who might be regarded as appropriate to meet other needs in that person.

Over half (55%) of the respondents considered paid workers - a home help or nurse rather than a family member - as the best person to care for a frail older person, although 29% selected a family member. Where a social need was identified -'someone to take them to a club once a week' - respondents chose a family member (31%) or a volunteer (25%). A nurse was identified as the best person to help check medication (for Stuart/Pat who had a mental illness) by 39% of respondents.

Table 3.1 Who should care?

Respondents were clearly distinguishing between different forms of competence/support for different types of need. This distinction may have been encouraged by the question. In retrospect the option 'it doesn't matter who' should perhaps have been offered to test the assumption that people do not really mind who meets the need, provided the need is properly met. It is interesting that taking someone to a club is seen as an unpaid responsibility (family, friend or volunteer). On the one hand greater use of 'natural' supports within the community is a goal of more inclusive services. On the other hand it is possible that this 'social' need is seen either as less of a priority or as not needing formal skills. In fact, building bridges into the community for people who are isolated is one of the most challenging demands for community support services as they shift into providing opportunities for individuals to engage in activities in the community rather than for example, in a day centre.

There were few age variations in preferences as to who should care. However, older people were significantly more likely to choose a nurse as the best person to care for an older person with dementia - 21% of people aged 55 and over compared with 7% of people aged under 35 (Chi-square=40.5, p<0.01).

WHERE WOULD YOU GO TO ARRANGE CARE?

People's knowledge of how to access community care services was explored through a question about who they would first turn to if they needed to arrange care for a person with support needs in their family? Responses to this question showed that people of all ages see health and social services as the gatekeepers and access routes to care. The question asked was:

"Suppose you had a relative like … and had to help him/her find care. Where would you go first, or don't you know?"

Respondents were not prompted with possible options. The replies received were coded into the following categories: GP, social work department, private agency, a charity, hospital or somewhere else. Up to six choices were allowed. Owing to limitations on the length of the interview, this question was omitted for the vignette about the person with dementia.

In this instance there was little variation between vignettes. Social work departments were most often identified as the first port of call, followed by GPs, although many people did not know where they would go. There was little evidence that people thought of going first to voluntary or private agencies of a mixed economy.: only 1% mentioned a charity (most evident for older people) and less than 1% a private agency. Citizens' Advice Bureau was the most frequently mentioned 'other' option. The response of 'Citizen Advice Bureau' was highest (2%) for people with learning disabilities which may reflect awareness of the issues of form-filling in a community setting. Interestingly during the consultation in designing the questionnaire, one person with a learning disability spoke passionately of the need to change the image of people with learning disabilities as benefit claimants and into that of employees and socially useful citizens.

Table 3.2 Who would you first go to?

We therefore found an almost universal perception that community care is a publicly organised service. Social workers and GPs were both seen as the entry routes to care. This contrasts with the wider range of roles identified in the delivery of care.

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