Hospital discharge and the citizenship rights of older people: will the UK become a test-bed for Europe?

Abstract

The authors are both experienced social workers and teachers in the field of community care. They draw on their UK and European experiences as well as the growing body of research on hospital discharges of older people to illustrate how citizenship rights and social justice cannot be upheld without ethical good practice in this field. Community Care in the UK now contains in-built tensions and potential conflicts between health and social services staff over continuing care. Entitlements and ethical considerations can be obscured by the economic interests of the agencies involved. These developments which are already evident in other European welfare states provide a warning to Eastern Europe about the dangers of importing managerial and market principles into the field of care for older people. Research evidence supported by case studies is used to illustrate how rights to health care and even human rights can be overridden when policies of cost containment combined with efficiency targets begin to shape decisions about care. Further, the recent proposal to fine UK social services departments 100 (140 Euros) per day for delayed discharge will only exacerbate the problem. The authors argue that research can provide guidance on the essential elements for good practice in inter-professional work, especially concepts of well-being that include justice, fairness, participation and autonomy to counteract the jeopardised citizenship of older people.