Abstract
Prioritisation concerns choosing something before something else, and in a welfare state context, this is about decisions on distribution, redistribution and rationing. This article investigates consequences of prioritisation within long-term care in Denmark, England and Norway. Analysing interviews with policy actors and policy documents, we find that prioritising home care, combined with increasing targeting of help and restricting institutionalised care towards those with the most severe needs, may reduce both service quality and equality for those not being prioritised. Moreover, monitoring and central control of service provision restrict individual discretion of care workers, with implications for service quality.
Highlights
Issues of prioritisation range from the assessment of needs at the individual level to the overall allocation of resources to the long-term care (LTC) sector, compared to other societal sectors.At the intermediate level, prioritisation in the Norwegian case concerns how municipalities and local councils must balance budget limits, tensions resulting from the needs of different user groups, and basic welfare state values such as universalism, equality and justice
Population ageing challenges the sustainability of developed welfare states (Österle and Rothgang, 2010).With population ageing comes an increase in needs, while municipal resources remain limited yet subject to political choices, making prioritisation crucial for policymakers, as well as for welfare state research
An overall prioritising dilemma is how comprehensive public responsibility should be within LTC.This topic is important in all three countries, with funding of social care especially important in England.When we asked interviewees to consider the main challenges within LTC services for older people, there was relative agreement on these
Summary
We rely on the Organisation for Economic Co-operation and Development’s (OECD, 2017a) understanding of LTC:‘As people get older, it becomes more likely that they will need day-to-day help with activities such as washing and dressing or help with household activities such as cleaning and cooking.This type of support (along with some types of medical care) is what is called long-term care.’ We depart from the care regime literature by emphasising how responsibility for care has shifted historically and developed into distinct types of care provision (Timonen, 2005; Österle and Rothgang, 2010). The public effort as regards LTC is highest in the two Scandinavian countries.We see that coverage is higher in Denmark and Norway than in England. Given the labourintensive character of LTC services, employment in health and social work as a share of total employment provides a rough indicator of their quality. This reveals distinct differences between Norway at one end and the UK at the other. The indicator on development in coverage between residential care and home care shows that coverage is decreasing in all three countries.Table 1 provides some indicators for public provision but not total effort within LTC. We focus on what these actors identify as the most important trends and prioritising dilemmas with implications for inequality and quality of care
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