The Transforming Care conference brings together researchers and practitioners across the globe to explore how changes in adult and children’s social care affect policy and practice.
Together with Anette Fagertun from Western Norway University of Applied Sciences, we facilitated a session titled ‘Routes out of the care crisis: exploring care system innovations in comparative perspective’.
Many countries are facing similar challenges within their social care system such as the increasing demand for services and workforce shortages. These challenges are similar despite different welfare histories and care regimes – for example in Nordic countries (Hansen et al., 2021) and in the UK (Needham and Hall, 2023).
Drawing on international examples, we considered the different approaches countries have taken to strengthen their care systems. This commentary outlines the discussions and draws out some key themes. By doing this, we start to identify what factors can influence attempts to improve care systems.
The first two presenters used policy analysis to reflect on how the challenges facing long-term care systems have been interpreted and how these frames inform governments’ attempts to improve care. In their presentation, Hanne Marlene Dahl and Minna Zechner drew comparisons between how Denmark and Finland have framed the problems that are affecting their long-term care systems.
In Finland, these difficulties were attributed to workforce shortages. International recruitment was viewed as a route to bolster the numbers of available care workers to meet growing demand. Denmark also recognised the difficulties of recruiting and retaining the care workforce but using technology was positioned as a way to increase the independence of people drawing on care, reducing demand.
Frode Jacobsen presented on innovation in Norway and how this concept of innovation is deployed as a potential solution to address challenges in the long-term care system. The presentation outlined the implications of associating innovation with technology and the limited attention paid to technology’s potential downsides.
The last two presentations took a slightly different approach, exploring how routes out of the care crisis have been implemented. Ingrid Jerve Ramsøy’s presentation explored innovation within Norway’s home care services. Substantial changes to home care were planned but were limited by funding constraints. Innovation was positioned as a cost-saving exercise.
Our presentation
We also presented during this session, complementing the focus on Nordic countries by outlining how Scotland has positioned integrating health and care services as a way out of the care crisis. Our presentation considered how integration has been playing out in practice, noting that change has been gradual and not as transformative as hoped. We also discussed the planned, and subsequently dropped, intention to introduce a National Care Service in Scotland. We called on theories around institutional layering to highlight the problems created when reforms are incoherently layered on top of each other.
Drawing these international examples together, we can identify some areas of commonality. Across all presentations, there was an emphasis on top-down approaches to address the challenges in long-term care systems. Attempts to introduce structural reorganisation were not supported by the work needed to bring about cultural change. These reforms did not have the strong foundation needed for changes to be sustained and could be left by the wayside. Frequently, innovation was linked to the introduction of technology. Thinking about the wider effects and how technology may influence how care is organised and experienced by people drawing on services was limited.
Plotting a route out of the care crisis needs to be understood as a series of reforms, rather than isolated changes. Our session at the Transforming Care conference highlighted that we need to think about how these reforms affect and influence the way other changes can be implemented and their eventual success. Part of this is also thinking about the timing of these changes and being aware of the wider effects of reforms.
Developing solutions to the care crisis means being clear about what the problems are that the reforms try to address. Our session has shown that we need to be aware of how we frame these challenges and the silences that our interpretations can perpetuate. In doing so, we can be better informed about the likely success of any changes to ultimately improve services for people drawing on care.
References
Hansen, L.L., Dahl, H.M. and Horn, L. (eds.) (2021) A Care Crisis in the Nordic Welfare States?: Care Work, Gender Equality and Welfare State Sustainability. Bristol University Press.
Needham, C. and Hall, P. (2023) Social care in the UK’s four nations: Between two paradigms. Bristol: Policy Press.
About the Author
Emily is based at the University of Birmingham where she is focusing on exploring the application of systems thinking to the analysis of social care. Prior to this role, Emily was part of a National Institute for Health Research (NIHR) funded project at the University of Birmingham exploring local authority market-shaping activities in social care and how these facilitate the development and access of personalised care and support.
