Dignity and aspirations denied: unmet health and social care needs in an inner-city area

United Kingdom Government guidance emphasizes the importance of service users' choice, dignity and realization of their personal aspirations as essential values underpinning the implementation of its community care policies, including services for people living at home. In response to concerns expressed by senior officers in health and social services, a qualitative study was undertaken to identify gaps and overlaps in domiciliary health and social care services in an impoverished inner-city area. Thirty-seven people aged between 52 and 90 years, and identified as in need of domiciliary health or social care services, participated in in-depth interviews that sought to identify their health and social care needs, and how they wished them to be met. The 37 participants' accounts identified significant gaps within and between the domiciliary services provided, and little evidence of any overlaps. The principal concerns were loneliness and isolation, including bereavement, bathing and personal hygiene, and the scarcity of domiciliary services where only basic physical needs are met. Participants' accounts indicated that their contact with services was often limited so that little more was possible than bare physical maintenance, rather than empowering and supportive social care. The findings suggest that the 1993 community care reforms have had little impact on the daily lives of these frail and disabled people. Unless there are significant changes in resources for domiciliary services and in the way in which services are conceived and delivered, people dependent solely on state services will, as they have for many years, continue to be denied the choice, dignity and aspirations that official policy claims as its aims.