Care Services for Later Life: Transformations and Critiques

Citation

Glendinning, C. (2001), "Care Services for Later Life: Transformations and Critiques", Journal of Management in Medicine, Vol. 15 No. 5, pp. 405-408. https://doi.org/10.1108/jmm.2001.15.5.405.2

This edited collection of papers draws on contributions to the 1998 Annual Conference of the British Society of Gerontology (BSG). The BSG is distinguished among “learned societies” in the UK by its essentially multi‐disciplinary membership; moreover, this membership includes welfare practitioners and professionals working with older people, as well as researchers and teachers from a wide range of academic disciplines. This multi‐disciplinarity is reflected in the book; its bridging of the divide between research and practice is a major strength, given the contemporary promotion of evidence‐based practice. This major strength also helps to offset some of the inevitable problems of pulling a diverse set of conference papers together into a coherent and integrated publication.

The book includes chapters on a wide range of topics relating to services and the quality of life of older people (income and pension issues are not covered). As well as chapters on medical, social and long‐term care, and the boundaries and interfaces between these sectors, which might normally be anticipated in any such collection, the book also includes contributions on older people, citizenship and collective action; on design and telematics; on care at the end of life; and on older people’s involvement in research and social change. Of particular interest are two chapters exploring the experiences of older Chinese and Bangladeshi people; these particular contributions highlight the major challenges facing the UK as its relatively young ethnic minority communities grow older.

Many of the contributors are deeply critical of the ways in which services in the UK are currently organised and of the professional and structural factors which contribute to insensitive, dehumanising and simply poor quality services. For example, Nolan criticises the professional culture of detachment which dominates much health and social services delivery and discounts the subjective experiences of older users; Longino makes a plea for a holistic and environmental approach to medical care instead of the “western biomedical” model; and, in different ways, Dalley and Twigg challenge the privileging of “health” over “social” needs. Chapters by Davies et al. and by Reed and Stanley lament the lack of choice and involvement of older people and their families in decisions about moving to, and living in, nursing home accommodation. Clarke and Hanson highlight the lack of control which many older people have over the process of their own death. More optimistic are chapters by Barnes and Shaw and by Warren and Maltby, on the successful involvement of older people in dialogues with local services, in research and in development. The contributions by Coleman on the potential for improving everyday design so that it better meets the needs of older people, and by Tetley et al. on how older people and carers can benefit from access to information using telematics, are similarly positive in outlook.

As a reviewer, reading this book was a somewhat frustrating experience. Although all the contributions are of a uniformly high standard, most are relatively short. Moreover, many consist mainly of policy analysis and debate; only about half include original research findings. This cumulative sense of fragmentation is not quite counteracted by the very wide‐ranging introductory and concluding chapters. The book may therefore be best read eclectically, by dipping into individual chapters which are of particular interest to the individual reader, rather than as an integrated whole.

Overall, the book paints a depressing picture of the lack of respect, humanity and compassion which characterises so much service provision for older people in contemporary UK. With the implementation of the NHS Plans for England and Scotland, the National Service Framework for Older People and the rapid development of new intermediate care services, the book provides a timely warning of how professional and managerial concerns can so easily over‐ride the fundamental rights of older people themselves, for services which are delivered with respect, empathy and continuity. It is a powerful indictment of much contemporary professional practice and service organisation and a challenge to do better in the current century than the last.