Long-Term Care: Matching Resources and Needs

David Challis

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138621671
• eBook ISBN: 9781351153546
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Improving equity and efficiency in the long-term care of older people is an international concern, with governments attempting to ensure that policies and practice develop so that resources are used to best effect. This requires good quality evidence founded on sound theory. This volume honours the outstanding contribution of Bleddyn Davies to this field, bringing together perspectives of scholars and practitioners from many countries including the UK, Australia, Hong Kong, Japan, Sweden and the USA. Contemporary policy dilemmas are considered, leavened by professional anecdote. A chapter from Davies himself, reflecting on the origins of the PSSRU (Personal Social Services Research Unit), concludes the volume that also features a full listing of his books and monographs, which will prove invaluable to those seeking to engage with his contribution to the field. This volume will greatly interest academics in social policy, social work, gerontology and social care as well as professionals in the field.

1 Introduction: Bleddyn Davies

Martin Knapp, José-Luis Fernández, David Challis and Ann Netten

The world comprises two groups of people: those who have never met Bleddyn Davies; and those who have never forgotten him. Many people in the latter category also have a fond anecdote or two about Bleddyn that they are delighted to share with others.

What is it that makes you remember your encounters with Bleddyn so vividly? His intellectual acuity? His encyclopaedic knowledge? His ability to engage you in meaningful, indeed usually stimulating, discussion no matter what your own area of expertise? Those excellent pieces of advice that improve your conceptual argument or empirical exploration? That slightly mischievous twinkle as he shares his latest insight? That long, heavily sub-claused question at the end of one of your presentations that, once it has ended, leaves you struggling to remember how it began? Those sotto voce, almost conspiratorial, utterances that bring you ever closer to the edge of your chair as you strain to understand what is invariably well worth hearing?

For many of the people who attended a Festschrift for Bleddyn at the London School of Economics in September 2002 it was doubtless many of these things. About three hundred people gathered to celebrate Bleddyn's achievements. The day was structured around a series of presented papers, followed by a wine reception, but was perhaps dominated by reminiscences, sharing of experiences with long-unseen colleagues and friends, and of course shared anecdotes about Bleddyn. The event was organised by the Personal Social Services Research Unit (PSSRU).

Bleddyn retired from full-time employment in 2002, but continues to work actively both at the University of Kent and at LSE (where a branch of the Unit was opened in 1996) and to be associated with the Unit's other branch at the University of Manchester (also established in 1996). Bleddyn holds emeritus chairs at Kent and LSE, and an honorary chair at Manchester. Never one to contemplate a simple life, Bleddyn has now moved his family home to Oxford, where he regularly attends university seminars. He also maintains his hectic international schedule.

A long career

Bleddyn gained a scholarship to the University of Cambridge from his Welsh grammar school, graduating in economics in 1959. He then moved to the University of Oxford to complete his doctorate. His thesis led directly to the first of many books, the widely acclaimed Social Needs and Resources in Local Services. (A list of Bleddyn's books and monographs is an appendix to this volume.) The incisiveness of his mind and his attention to technical sophistication were already very evident, as Robert Leaper's recollections in box 1.1 describe.

Box 1.1

Bleddyn Davies — a personal tribute

Others will provide commentaries and illustrations of the themes of Bleddyn Davies' major contributions to social policy research. May I offer brief anecdotal evidence, garnered from forty years of personal acquaintance, in support of the tribute now rightly paid to him.

In 1960 Bleddyn and I were postgraduate students at Barnett House, Oxford. Under the somewhat remote general guidance of Leonard Barnes, we were tutored by Peter Collison, Henri Tajfel and Dorothy Jackson, among others. We were part of a good company from diverse academic backgrounds and varied personal experience and employment. In our year we shared the Barnett House experience with Juliet Cheetham, David Haxby, Pat Macmanus and Sylvia Clerk, to name but a few.

We were all slightly in awe of Bleddyn. He was good company in common room and hostelry but his mastery of social economics and his apparent enjoyment of statistics (not a favourite dish on the Barnett House menu) reproached us with our own inadequacy. Worse still, he marshalled his arguments and presented them with a self-effacing smile and the occasional Welsh witticisms. We didn't always understand all he said, but we recognised that he was leading us through complexity to irrefutable conclusions. Whatever happened to the rest of us, we concluded that Bleddyn would make his mark in social policy with distinction.

So over the 1970s and 1980s we eagerly followed his thorough and prolific published research on the personal social services. Those of us in academic teaching used his work as highly valued reference texts. Those of us in social service provision measured our progress by reference to his yardsticks, and some of us collaborated with him and his growing company of research colleagues at Kent. We recognised in the Griffiths community care documents the hand of Davies — and we learnt to measure critically the real application of community care, our minds sharpened by the Kent PSSRU studies. We admired his skill in deservedly attracting large government and other research funding and in painstakingly negotiating academic networks. We also kept up with his family life, and had evidence of it in seeing Grandpa pushing his grandchild's pram around Oxford.

In two other contexts Bleddyn's combination of scholarship and good personal relations has to my knowledge come even clearer. His publication record is second to none and his involvement with journals in our field is varied and interesting. Some years ago we tried to negotiate a deal between the Blackwell journal Social Policy and Administration and another journal for which Bleddyn was responsible. The deal did not come off but it left no legacy of resentment on either side. Some years later, on my retirement from the board of Social Policy and Administration, Bleddyn was persuaded to join and later succeeded me as chairman. His vigilance for high standards has continued but he also published a very generous tribute to his predecessor, showing his typical readiness to give credit to his colleagues and collaborators.

The second context is the European one. Among the best of the PSSRU studies in my judgement is Community Care in England and France. Like the British studies, it is thoroughly documented and a good example of collaborative research, both with British colleagues and with those responsible for local services. Those of us involved in comparative local studies and in staff and student exchanges have found it invaluable as a reference text, and the work also refers to help from colleagues in the Ecole Nationale de la Santé Publique at Rennes. Drawing on both those experiences it is no surprise that the Director of the Ecole has for years been represented on the board of the journal, now edited by Catherine Jones and John Baldock. To anyone involved in the round of European conferences on social policy and later life (for example, through the Grenoble Institute) it has been a rewarding experience to share the presentation of academic papers and practical experience with Bleddyn and European colleagues. It also validates the prediction of Bleddyn Davies' future which we made at Barnett House 40 years ago.

Robert Leaper
Emeritus Professor, University of Exeter

Bleddyn moved from Oxford to an assistant lectureship in economics and statistics in the University of Wales and subsequently to Richard Titmuss' Department of Social Administration at the LSE in 1963. Those LSE years — for two of which he was seconded to the Higher Education Research Unit —provided a springboard for many of Bleddyn's later studies in the field of long-term care.

In 1974 he founded the PSSRU at the (then) University of Kent at Canterbury with funding from the (then) Department of Health and Social Security. He was elected Professor of Social Policy in 1978. Bleddyn's early approach was to combine his territorial justice arguments with insights from the 'production of welfare' framework — developed in those early PSSRU days — in the analysis of equity and efficiency in social care. The 'social production of welfare' approach, focused on household care processes, followed shortly afterwards. (Chapters 13 and 14 discuss some of the developments and challenges in these fields.) The approaches developed in the early years of PSSRU continue to provide many of the core questions to be addressed when discussing, planning and evaluating systems of long-term care. Bleddyn's own chapter in this volume (chapter 19) offers a fascinating historical, indeed aetiological, and personal account of PSSRU and Bleddyn's roles in it.

Bleddyn was appointed OBE in 2001 for services to social science and social policy. He is an Academician of the Academy of Learned Societies in the Social Sciences. In 1993 he was elected a Fellow of the Gerontological Society of America, one of only a handful of Europeans to be honoured in this way. At the 5th International Care Management Conference of the American Society on Aging in Vancouver in 2001, a number of distinguished contributors from the US, Hong Kong and Australia paid tribute to the impact of his work. Other tributes have followed since Bleddyn's retirement.

Pervasive themes

From his early work as a PhD student in Oxford, examining responses to differences in need across localities, to his work on care management and his examination of the genesis and consequences of community care reforms, Bleddyn has made fundamental, indeed unique, contributions to policy development and its practice consequences in the UK and elsewhere.

A recurrent theme in his work has been the desire to move towards optimisation in the complex relationships between resources, needs and outcomes. This is evident in his early work on territorial justice, which influenced central government policy making in the late 1960s and early 1970s. It is later reflected in his research on school meals at the LSE, work that was included in an appendix to the Plowden Report. His ideas on territorial justice later influenced the planning of a needs-based allocation of NHS resources with the establishment of the Resource Allocation Working Party. The territorial justice theme and Bleddyn's approach to it continue to enthuse and influence others (see box 1.2).

Box 1.2

My first memory of Bleddyn was at a Social Policy and Administration conference about 15 years ago. I was presenting a first paper at this conference (with George Boyne, now Professor of Public Sector Management, Cardiff University) on the topic of territorial justice. A small number of people were in the session, and most seemed not particularly interested apart from this older gentleman at the back. In the questions at the end, a rich Welsh accent suggested that the questioner was Bleddyn. Our first feeling was of concern that the man who had written the seminal text of the topic was going to ask a professorial 'put-down' question. However, it was clear very quickly that his intention was not to show how clever he was, but due to genuine interest and to help us. A few minutes later, at the end of the session, he had covered the board in diagrams. This sums up Bleddyn as one of those rare leaders in the discipline who is always interested and prepared to give his time and immense knowledge to younger academics.

Martin Powell
University of Bath

Although the overarching analytical framework for much of PSSRU's work, the production of welfare, was first articulated in the early PSSRU years, its roots lie partly in Bleddyn's earlier work on university costs and outputs. Its deceptively simple approach has certainly been influential (see box 1.3). The framework asks the core questions: who gets what, with what outcomes and at what cost? Bleddyn applied unrelenting rigour of analysis and a constant search for the most illuminating analytical techniques in order to answer these questions and so help care systems move towards greater equity and efficiency.

Box 1.3

Old People's Homes and the Production of Welfare — this has always been one of my bibles on long-term care for older people: a true reference for research for which thanks to Bleddyn and Martin. The work of PSSRU is a credit to you Bleddyn and a treasure trove for those of us who communicate the findings in teaching. Here's to your own active ageing!

Sheila Peace
The Open University

With the Kent Community Care Project (KCCP) came the development of an approach which built explicitly on the ways that incentives could shape practice. This led to improvements in the quality of care at a level where the relative costs and benefits of alternative provision were best seen. The devolution of budgets to frontline staff within a coherent framework for care delivery led to improvements for older people and their carers and simultaneously offered policy-makers a coherent and logical mechanism for achieving their policy aims. Sir Roy Griffiths recognised the strength of the KCCP framework when setting out his recommendations for reforming community care in England and Wales in the early 1990s. In this way the project, with its subsequent replications and developments, achieved an influence far outweighing its original impact as a field experiment in the home care of older people in East Kent (see boxes 4,5 and 6; and chapters 8 and 17).

In this and his subsequent work — particularly within the Domiciliary Care Project (DCP) and its sequel, Evaluating Community Care for Elderly People

Box 1.4

Neither long-term care and care management nor were familiar terms in Hong Kong in the early 1990s. Long-term care services at that time were fragmented and most people thought that care management was not necessary, as services provided for older people are viewed as simple and less complicated, and negative images of managed care preoccupied most policy-makers and some geriatric consultants. What could be done to help Hong Kong professionals and policy-makers recognise the complexity of long-term care and the benefits of adopting care management to improve long-term care? Bleddyn and his associates' work at PSSRU on care management in long-term care helped raise important policy and practice issues which confront all ageing societies. With the support of the UK-HK Research Grant, I went to Kent for my first meeting with Bleddyn, David Challis and their research team in 1994. After this meeting, Bleddyn and I were both astonished by the similarity of the problems we were facing in long-term care for frail elderly people. The same grant brought Bleddyn and David to Hong Kong the next year and their lectures were very well-received. Ever since, Bleddyn and his associates' work have had an important influence on the local understanding of long-term care issues and the development of care management practices in long-term care.

Iris Chi
Hong Kong

Box 1.5

I would like to send my best regards to Bleddyn Davies, to thank him for his cooperation, effectiveness, sense of humour and his openness to colleagues. In addition I would like to express my great appreciation for his work and congratulate him for his career. Best wishes for the future.

Kees Knipscheer
Vrije Universiteit, Amsterdam

Box 1.6

Some odd antipodean thoughts on Bleddyn's contribution

Bleddyn always seems to have been aware of the need to continually rethink and redesign social programmes in relation to shifting demographics, changing social contingencies and economic circumstances.

He was one of the earliest researchers to bring together social and economic reasoning at system and service delivery level. He combined a focus on equity, with one on efficiency/effectiveness and insisted on the economic being combined with the social.

Bleddyn was a pioneer in rethinking the welfare state in the light of the new social and economic realities. He was also a pioneer in terms of his empirical, comparative and interdisciplinary orientation to his subject matter and his ability to consider both micro and macro issues — unusual in an...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of Boxes, Figures and Tables
• Contributors
• 1 Introduction: Bleddyn Davies Martin Knapp, José-Luis Fernández, David Challis and Ann Netten
• Long-term care in the United Kingdom
• International perspectives
• Conceptual frameworks and care developments
• Appendix: books and monographs by Bleddyn Davies
• Index of Citations
• Subject Index