Monday, 17 January 2011

The end of day care?

The local rag in my area today carried a story about how the day centres in the district are under threat due to budget cuts. It's made the front page, but to anyone anywhere near the world of social care it's not news at all.

Day care has long been considered to be the weakest gazelle among local authourities portfolio of services. Caught in a pincer movement between cost-conscious authourities who regard day care as an unecessary luxury on one hand and by modernisers who see it as hopelessley out of date the real surprise is how long it's managed to survive.

It could well be that attacking services out in the open is difficult at the best of times as the local rags dedication of their front page testifies, but I distinctly remember talk years ago of a more subtle approach using individual budgets as a way of phasing out day care. The arguement was that people would prefer to buy a football season ticket or do something, anything, other than a jigsaw with missing pieces and a sing-a-long in a church hall. The logic dictated that in the face of greater choice day centres just wouldn't cut it.

Another important argument is that day care is just not inclusive. Social care has a progressive element to it and day care has just got too much of a segregationalist whiff about it. Why should a person not enjoy the kind of leisure activities the rest of us enjoy, football, nights out with friends, watching a gig, just because they have a disability, and hasn't the DDA made all these things more accesable anyway?

There are however, problems with this view. The first being that a lot of people actually like day care. Most centres had a waiting list for spaces and a fair number of people once they had started enjoyed it so much they then asked for a second or third day. This was perfectly understandable as for a lot of people, particularly older people, day centre represented a vital link to the world outside their living rooms. As care managers our day centres also proved invaluable. Their staff could build good relationships with service users meaning they could detect a change in someone which might indicate something was wrong.

Second there is the issue of costs. A football season ticket can cost a lot. Day care on the other hand is cheap. In my area we had a block contract with a voluntary organisation. Most of the premises were also purpose built common rooms at council owned warden assisted accomodation so overheads were low. There may well be better alternatives, but there aren't cheaper ones.

It almost seems like another age, but around four years ago we even offered the service for free and had given days away without any kind of real assessment. Those days are long gone and unlikely to ever return, but I wonder will it be the same for day care?


  1. I completely agree - for what it's worth. We found out one of our day centres is closing on 1st March. I doubt it will be the only one to go.
    I think the problem, as you say, with inclusive day 'care' is that the money isn't there to provide it and to be honest, I've got people going to the day centre just for a chat and a hot meal - it's hard to find services that replicate those simple, small things. Our day centre (yes, the one that's closing) also arranges a weekly shopping trip in the minibus. I know, not very 'progressive' and personalised but for many older adults, it's the only opportunity they get to go to the shops due to difficulties in managing public transport/rising costs of taxicard, lack of availability of dial-a-ride.

    There isn't anything to replace these kinds of services. If there were, it wouldn't sting so much.

  2. Exactly, it's hard to see where replacement services will come from. The 'big society' isn't going to come to the rescue as most of the day centres in the city are run by a nonprofit organisation which uses a lot of volunteers already(in fact in day care volunteers probably figure more than any other area of their operations).

  3. I was hoping if there was a better take up of individual budgets this will have an influence on local services as something needs to happen!

  4. Yes I agree too. Having previously worked in a learning disability day centre ive got to see the good and bad aspects.

    The issue, for me, is that people there is a false dichotomy between the personal and the communal. Yes personalisation is good for those who want to tailor activities but it doesnt mean scrapping day care altogether. I dont think its is an either or; its all about getting a balance. Our day centre - not yet closing - provided mixed centre based and individual support (if the had the funding).

    In my personal life I obviously can choose my own activities, but i also choose communal activities such as sport etc where there is a group atmosphere. I worry that the persoanlisation will isolate people: People in supported living only seeing support workers and others that live in their accommodation. In many cases the people that attend have known each other and socialised together for years. Without the day centre id worry that there wasnt the structure to facilitate this and people would get isolated in the 'independence' of supported living.

    Another point is that it acts as a kind of day respite for parents who are carers and has a S/U living at home. They all have home support help from an agency but for them it is important they have somewhere that their son or daughter feels safe and comfortable in, whilst the have a bit of free time in their own home or at work.
    Leading on from this is the fact that day centres are a hub for expertise and specialist equipment - hoists etc - near the centre of town (its a rural area). This means that its easier for multiple and profound SUs to access town than it would be if they were supported solely from their homes.

    There is much that can be improved in day centres, but that is no reason to close them

  5. Casdok

    I think getting more people onto IBs is probably now the easy part. The 'if they build it they will come' view that if we get enough people on IB's then the voluntary sector and private sector will respond to the stimulus through innovative, client centred services is sure to be tested when voluntary sector organisations face a reduction in funding and when local authourities tighten criteria.


    Thank you so much for sharing your view. Lots of extremely interesting points.

    I beleive it really does come down to an ideological point; a view of individualism, which has a distrust of any kind of communal activity.

    As you point out though, this view isn't necessarily right, it's not simply a binary choice between one or the other, its perfectly possible to accomadate individual choice and a bespoke service within a communal setting.

    Playing advocate for a second I think that the point that will be made by those in favour of closing day centres is that it will be a case of supply and demand. If a day centre is providing a service people want, then people will use their IB's to go there, if it isn't then they'll vote with their feet and it will close down.

    I certainly don't think its as simple as this. As I say, in my area the main day care service is provided by a voluntary organisation. The block contract with the council provides security and enables them to plan for the future, it is also bound to keep the costs down by providing economies of scale.

    Could someone individually, or a small group access a similar service, for a similar cost if the contract was scaled back? I don't think the voluntary sector could do it without the local authourity supporting them and I don't think equivalent services could be purchased in the in the private sector.