Deconstructing the social care ‘meal’

Between 2010 and 2014 there was a 63 per cent fall in the number of people receiving ‘meals on wheels’ in England[1] and between 2011 and 2015 the number of hospital beds taken up by people with malnutrition rose by 61 per cent.[2]

It would be wonderful if someone wanted to do a PhD (full or part-time – maybe even with us at Leeds?) on social care meals (a bit like Julia Twigg’s seminal paper Deconstructing the ‘social bath’[3])

The origins of meals services (like home help services) owe much to the conditions created by the Second World War and the mass discharge of frail and ill older people from hospital that resulted in (among other things) the Women’s Royal Voluntary Service emerging as the dominant player.

Meals were specifically mentioned in National Assistance Act 1948 and the Chronically Sick and Disabled Persons Act 1970 and now in the Care and Support (Eligibility Criteria) Regulations 2015 regulation 2 ‘Managing and maintaining nutrition’.

Meals are not simply about ‘managing and maintaining nutrition’ – they are (or should be) social activities – and if there is any doubt about this, read Bourdieu.[4]

There is a material difference between the provision of assistance to help an individual prepare a meal, and the provision of the meal itself. The manner in which the need is addressed should depend upon the assessed need, rather than (for example) the financial implications for the authority.[5] Supporting individuals in the preparation of their own meals (shopping, preparing and cooking) will be a service that is more likely to promote their ability to live independently and challenge loneliness than the mere provision of a cooked meal, and it may also address user choice.

A 2016 ombudsman complaint[6] found it to be maladministration for a council to fail to recognise that ‘fresh food is essential to meet nutritional needs’ and that ‘consumption of fresh food once it has started to perish carries a significant health risk’ (a complaint concerning a visually impaired adult who needed help to check the contents of her fridge, read cooking instructions and on occasions to be escorted to a local shopping centre.

[1] Rowena Mason, ‘Meals on wheels for elderly in 63% decline under coalition’, Guardian, 3 January 2015, concerning a freedom of information requests submitted by the then shadow care minister Liz Kendall: the figures being 296,000 in 2009/10 and 109,000 in 2014/15.
[2] Parliamentary Written Question ‘Malnutrition 53159’ Jonathan Ashworth (15 November 2016) Answer, Department of Health Nicola Blackwood (18 November 2016) the figures being 128,361 in 2010/11 and 184,528 2015/16.
[3] Julia Twigg, Deconstructing the ‘social bath’ Julia (1997)Journal of Social Policy, 26 . pp. 211-232 (doi:https://doi.org/10.1017/S0047279497004960)
[4] Pierre Bourdieu ‘Distinction’ (Routledge Classic 1984)
[5] Many councils impose a flat rate charge for meals (see para 8.324 below): a person on a low income may therefore be exempt from charging ‘home help’ but required to pay a not insignificant sum for their ‘meals on wheels service’.
[6] Complaint no. 15 011 661 against London Borough of Hammersmith & Fulham 21 July 2016 para 24.

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