First published 1998 by Ashgate Publishing
Reissued 2018 by Routledge
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Typeset by Jane Dennett at the PSSRU, University of Kent at Canterbury
ISBN 13: 978-1-138-62449-8 (hbk)
ISBN 13: 978-0-429-46076-0 (ebk)
by Marie-Jo Guisset
The idea of a comparative overview of the French and English systems of domiciliary care for elderly people had its roots in the visits to Kent by French gerontological teams. It finally saw the light of day in 1992.
La Fondation de France had several reasons for financing this study in Athis Mons, La Manche and St Omer. At one level, it reflected the increasing awareness in France of care management and a desire to learn more, following its widespread introduction in England and Wales after April 1993 as a result of the National Health Service and Community Care Act 1990. At another level, it contributed to the intense and long-lasting debate over nearly ten years, over the allowance for dependent elderly people, which has just been formalised in the PSD (prestation spcifique dpendance).
It seemed worthwhile, therefore, to compare how the systems worked in Great Britain and in France in terms of: those systems which allocate resources for the care at home of dependent elderly people; their effects on the demand for entry into residential care; and the role of the informal sector in the provision of care for the elderly. These represent a whole range of highly topical questions for each of our two countries.
Despite the adversity of our legislation and the complexity of the financing system in France, the research team from the PSSRU has managed to produce an extremely interesting comparative analysis. It illuminates the choices faced by the funding agencies and the work of those at local level, so that the new view of ageing which la Fondation de France is seeking to develop will come to be reflected in the intentions of legislators and everyday reality.
Mme Marie-Jo Guisset
Responsable des Actions Personnes Ages
Fondation de France
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Study visits organised by INRAC Grand Age (Institut national pour la retraite active, Paris) in conjunction with PSSRU, University of Kent.
Foci and research questions. This book is about equity and efficiency in England and France. After giving an account of institutions and of the history of development and reform in the two countries, it summarises the results of a comparative empirical study of aspects of equity in care consumption and efficiency in care production. Another book, produced with a grant from the British Council, will contain a more detailed description of English and French policy and institutions and an analysis of the literatures about equity and efficiency.
The equity and efficiency concerns determined the research question: who obtains how much help with the activities of daily living from what source, at what costs of public funds, and with what effects?
By who, we mean what persons with what need-related characteristics. By how much, we mean the number of hours of assistance. By the activities of daily living, we mean tasks of everyday life such as personal care and supervision (e.g. washing, grooming, feeding), and household care (e.g. the procurement of adequately attractive and nutritrious meals, transfer to and from bed, keeping the home warm and tidy, shopping), and related tasks like help with administrative activities. By source, we mean persons from the family and other parts of the entourage who are not paid a sum of money for the tasks on the basis of a formal contract, or various organisations for whom a major goal is the provision of services in response to difficulties with precisely such tasks. By costs to public funds, we mean financing from a collective source financed by compulsory contributions, including taxation.
The two countries have complex policy aims. However, both have adopted what the OECD has claimed to be the highest common factor of reform goals among all the countries investing in reform: to provide choice to a higher proportion of persons at high risk of unwanted entry to institutions for long-term care (OECD, 1994). That is the main effect measured in this study.
We undertook these Anglo-French comparisons for two reasons. First, France and England.) Both acknowledge a public responsibility for minimum care provisions and standards. In both societies, individuals value their autonomy and privacy more greatly than in China, for instance (Olson, 1993). Without these similarities, the contrasts would stretch our imaginations much less productively. In their different ways, both France and Great Britain are currently engaged in the reform of community and long-term care. It is therefore natural for both to look to the outside world, both to compare the equity and efficiency of their policy efforts and also, by explaining differences, to gain insights into how to make their own systems better.
But their interdependence makes their analysis still more interesting. At the time of writing, the European Union seems to be the Millennium Dome of international alliances: a structure of great political symbolism under which there will surely be important activity of as yet an unpredictable kind. In no century of this millennium have England and France failed to have powerful impacts on one another. Arguably, they are one of a group of nations which have almost established their sense of identity by their contrasts. But the signs are that their interdependence will be still greater in the next millennium. The degree of competition between producers from economies within the frontiers of the Union will surely increase. In many of the sectors which will make the running, the important players in the new economies will not be truly national at all. It is a clich of our times that once economies are opened, the capacity of the governments of nation states to dominate becomes progressively less. The pressures of the Europe-wide economic competition will increasingly shape all policy. And it is difficult to see how the European economy can insulate itself from an increasingly competitive world economy and so drive towards improved efficiency. That will put new constraints on social policy. Indeed, it will create what Richard Titmuss feared: a social policy whose values themselves more closely reflect
