Who pays for the obesity crisis …..?

‘The real cost of poor quality food should include the cost to the NHS in diet related illness, but of course the food industry do not pay the true cost for this, this is disproportionately displaced onto the individual consumer via the taxes we pay to fund our health care system….’

As Channel 4 ,  Dispatches , highlights Theresa May’s watering down of governments obesity strategy it is time to reframe the discourse on ‘obesity’.

Regulating the food industry is about more than people being ‘fat’, it is about the role an active state should play in society and the fallacy of ‘choice’ as a panacea .

The current discussion on the food industry must not be overshadowed by the ‘obesity’ debate because there are much bigger issues at stake here, not least the accountability of the food industry and the role government should have, if any,  in regulating the food industry to protect the health of the nation.  By narrowing the focus on obesity we risk  reducing the debate to stigmatizing those who are overweight, and focus too much on individual responsibility.  For once could  the debate also include corporate responsibility.  Whilst Politicians might make noises about supporting free ‘choice’ I would rather see decisive action from government because I trust the food industry about as much as I trust the banking industry, which is zero percent.

Just look at the food labelling debacle, which dragged on for over two decades  The coalition government announced in October 2012 that a consistent system of food  labelling  was set to be launched, however, it was not quite a done deal with food producers still holding back.   Cadbury, amongst others, spurned the ‘traffic light’ system suggesting it focused too much on the negative ingredients in their food, i.e. sugar.….REALLY!

But it is not just about food labelling, more importantly it is also about the food production process. For example research suggests high salt intake is associated with significantly increased risk of stroke and cardiovascular disease, so to reduce risk just reduce salt in take, easy.  However, the same research also suggests high levels of salt intake is related to food production processes, rather than individuals adding salt to their diet, and the biggest barrier to reducing significant salt intake for individuals  is the historical reluctance of the food industry to reduce the levels of salt used in food production.

The seriousness of this issue must not get lost in tabloid headlines about ‘obese’ people.  Any talk of government taking an interventionist approach is met with cries of ‘nanny state’ from the Tory right who use this as a pejorative term to describe excessive state action.  Those who support free markets object to the use of state power in this way perceiving such an approach as restricting individual choice.

Governments approach to this issue is ideological, whilst for some intervention from government represents the worst excesses of the ‘nanny state’, to others it represents an ‘active state’ coordinating an approach to promote public health for its citizens, rather than protecting big industry from taking responsibility for its actions.

A first step might be to regulate the removal of excessive sugar from food production, this would  benefit public health. We need such intervention because we can not trust the food industry, the average consumer can not fight against the unethical and unhealthy practices of large corporations. I feel very strongly the government should undertake a strategy akin to tackling the tobacco industry, because the potential damage to our health from sugar added to our food parallels that of nicotine.

A rise in the cost of food is an interesting argument presented by government and the food industry as an argument against healthier food production. The real cost of poor quality food should include the cost to the NHS in diet related illness, but of course the food industry do not pay the true cost for this, this is disproportionately displaced onto the individual consumer via the taxes we pay to fund our health care system (Do not even get me started on corporate tax evasion).

All most of us want is honesty and transparency, and maybe even an ethical approach in the food industry,  where our health is put before profit, is that too much to ask?

It would seem it is.

‘Old age,more feared than death’…… have we ever cared about older people?

Has there ever been a ‘golden age’ where older people were consistently valued, respected and protected by family and the institutions that make up wider society?

The World Health Organisation suggests the abuse of older people occurs in many parts of the world with little recognition or response. This serious social problem is often downplayed or hidden from the public view, and considered mostly a private matter. Even today, the abuse of older people continues to be a taboo, mostly underestimated and ignored by societies across the world. However, evidence is accumulating to indicate that the abuse of older people in the UK is an important public health and societal problem.

The full extent of abuse is unknown, however, its social and moral significance is obvious. As such, it demands an active response, one which focuses on protecting the rights of older persons, and a change in our perspective on whom, and what, we value in society.

Although representations of old age and societal responses to older people have differed over time it could be argued old age has always been viewed as negative.

In ancient Greece old age was portrayed as sad, with the Greeks love of beauty marginalising the old. Although some commentators suggest the reality was more complex with the portrayal of older people in the classics as ‘both pejorative and complimentary’ (Thane, p.32). For Plato reverence toward old people was a guarantee of social and political stability, whereas Aristotle disagreed with such positive images. Cicero’s work De Senectute, written in 44 BC, points to the variety in individual experiences of ageing, acknowledging that for those who are poor and without mental capacity ageing is miserable, however, suggesting older people need to strive throughout their life to remain intellectually and physically able.

Arguably this belief still underpins social care legislation and policy today in respect of older people.

It has been suggested older people’s status in society is linked to their ability to participate in society from an economic perspective, especially in terms of activity in paid employment. Historically where older people have been unable to participate in paid employment, help and support has been provided through a mixture of family and state support, with an emphasis by government on the former rather than the latter. However, commentators suggest, post industrial revolution, another victim of change were older people. The old did not merely lose power, they also lost respect. The rise of the alms-houses, and institutionalised poor-relief, may indicate their children were increasingly shedding responsibility for their support and transferring it to the community.

Although Thane  argued, this may have been due to families own depths of poverty, rather than lack of care or a shedding of responsibility.

The abuse of older people was not something government identified as a problem throughout this period, although, self-neglect was identified as an issue which government sought to address in the 1948 National Assistance Act.

This is not to say it did not occur, for example, the 1942 Exceptional Needs Enquiry found most older people living with families were there under sufferance. They were often less well off than those who lived with strangers, and lacked essential items of clothing, bedding or household equipment as families used any provision, such as clothing coupons, for personal use. Whether this constituted abuse is not clear as many families who cared for older relatives were often living in poverty themselves and older people often willingly gave their families any support they could, even if this meant going without themselves. Of course, records do not exist to either confirm or deny whether such relationships were abusive or mutually supportive, however, it might suggest in terms of individual worth and personal identity, a cultural norm existed where the welfare of the younger generation was prioritised over that of the old by both young and old.

However, Peter Townsend’s landmark study  of long-stay institutional care for older people in 1950’s Britain, provides a little more insight into the experiences of older people receiving care. One of the interviews he recorded was with a matron of a small private residential home in Greater London, which Townsend suggested was by far the worst home he had visited, was clearly describing abuse, as defined in legislation today.

This suggests the abuse of older people has been going on for a long time. It is increasingly clear the abuse of older people exists, and as a society we cannot ignore it any longer.

CQC, older people & funding cuts:It’s not just about the money….

Di Galpin

As CQC yet again bring to government and wider societies attention the poor levels of care some older people experience, one wonders will we ever get to grips with this issue?

The latest report suggests cuts to social care,  mental health and public health mean “the NHS is being stretched to the limit,” said Stephen Dalton, chief executive of the NHS Confederation, which represents hospitals. “Relying on political rhetoric that promises to protect the NHS but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.”

Arguably, the discussion  needs to go beyond financial issues  to consider the greater deception of successive governments who have consistently ignored their failure to develop an ethically sustainable approach to the care and support of older people.

Let’s be honest, growing old in the UK is not for the faint hearted when we consider…

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CQC, older people & funding cuts:It’s not just about the money….

As CQC yet again bring to government and wider societies attention the poor levels of care some older people experience, one wonders will we ever get to grips with this issue?

The latest report suggests cuts to social care,  mental health and public health mean “the NHS is being stretched to the limit,” said Stephen Dalton, chief executive of the NHS Confederation, which represents hospitals. “Relying on political rhetoric that promises to protect the NHS but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.”

Arguably, the discussion  needs to go beyond financial issues  to consider the greater deception of successive governments who have consistently ignored their failure to develop an ethically sustainable approach to the care and support of older people.

Let’s be honest, growing old in the UK is not for the faint hearted when we consider research and inquiries over the last decade.

In 2007 The Joint Committee on Human Rights suggested older people in hospital and residential care routinely receive inhumane and degrading treatment, whilst an analysis of outcomes for patients commissioned by the Royal Medical Colleges in 2010 concluded inadequate hospital care for older people condemned many to death.  The Health Service Ombudsman review of complaints, in 2011, suggested the National Health Service (NHS) is inflicting pain and suffering on patients, citing examples of older patients leaving hospital with numerous physical injuries, mentally confused, soaked in urine wearing other people’s clothes held together with paper clips.  Sadly the report suggested the individuals discussed are ‘not exceptional or isolated cases’ and clearly indicates the attitude of staff was indifferent to those older people for whom they were supposed to care.    Then in 2012 the Royal College of Surgeons found older people were discriminated against when being assessed for surgical treatment, with decisions being based on chronological age rather than clinical need, whilst Bingham   suggested the treatment of older people in care was so bad that in many cases it met the legal definition of torture. The  scandalous mistreatment of older people in Mid Staffordshire was exposed in the Francis Report in 2013, whilst in 2015 CQC reported on the continuing poor care older people received in care homes …. and so it goes on.

When we move away from  hospital and residential settings things are often not much better with Action on Elder Abuse consistently highlighting the prevalence of abuse older people experience in the community,  leading in 2016 to the publishing of  a ‘dossier of shame’ which outlines how crimes against older people frequently go unpunished.

From a European perspective research findings suggest older people’s experience of ageing in the UK falls behind that of many of its European counterparts, with the UK performing most poorly on indicators such as income, poverty and age discrimination (WRVS,2012).  The report states “the UK faces multiple challenges in providing older people with a positive experience of ageing, scoring poorly (although not always the worst) across every theme of the matrix” (WRVS, 2012, p.8).

This all provides a troubling vision of older people’s experience of ageing in the UK.

Older people’s experience of ageing in the UK can be improved, and it is all of our responsibility to try and achieve this.  However, we first need a coherent strategy to bring about the change desired by many who work with older people.  Government in the UK tend to address issues associated with an ageing population in individual ‘silos’.  Research from Europe suggests those countries taking a joined up approach, where government consider how factors such as income, health, age discrimination and inclusion interact, the more successful policy approaches are likely to be to improve the experience of ageing.

However, any action needs first to take a long term approach and have a strong ethical, rather than financial, foundation founded on a clear understanding of, and agreement to, promote older peoples equality and human rights across the political divide.

‘Dual’ qualified social workers and integration in health and social care project ….. how to get involved!

The social work team at Plymouth University are undertaking a project to support the development of a unique group of workers in health and social care

The social work team, at Plymouth University, are currently being funded by Livewell Southwest, an independent social enterprise and community interest company (CIC) providing integrated health and social care services, to explore the experiences of dual qualified social workers in the work place. We believe the knowledge, skills and experiences of these workers is vital to understanding the support they need to contribute to delivering authentic integrated services.

The integration of health and social care has been a key objective for successive governments in the UK. Whilst some focus on the role of merging of budgets to promote closer integration between the professions, higher education institutions (HEIs) are increasingly turning their attention to the content of courses they provide to individuals who make up the workforce.

A number of HEIs have developed, and deliver, joint integrated degree programmes, which combine both nursing and social work education. These usually focus on learning disability or mental health nursing and social work. The extension of an integrated approach to learning is being developed by the HCPC, who are currently reviewing the standards of education and training (SETs) for health and social care professionals. One area of change being proposed relates to inter-professional education and the Introduction of a requirement in the standards for learners to have the opportunity to learn from, and with, learners and professionals in other relevant professions.

However, whilst new approaches to integrated learning in health and social care has the potential to be a positive step forward, is it really enough to achieve authentic integrated practice on the frontline?

There is some research on those who have undertaken a joint educational pathway, as mentioned above, however, limited research exists on the experiences of ‘dual qualified‘ social workers i.e. those who hold both a social work qualification and an allied professional qualification such as nursing, teaching or counselling for example. Little is known of their influence on promoting an integrated approach to service delivery, at a cultural and strategic level within organisational settings.

We want to hear from dual qualified social workers so that we can take an informed approach to developing an educational approach that both supports their professional development, post qualification, and which also informs employers on how best to maximise their potential to deliver genuine integration in service provision. If you hold both a social work qualification and an allied professional qualification, the team would like to hear from you. There is a short online questionnaire you can complete, which asks about the qualifications you hold, why you changed professions and your experience of being dual qualified in your current role, and what support might enhance your professional development.

If you would like to be involved you can contact Di Galpin and the project team at socialworkresearch@plymouth.ac.uk

 

Why it matters who controls the curriculum in social work education ….

Di Galpin

Change is the life blood of social work. Supporting people to adopt changes which might improve lives is fundamental to social work. Change is also fundamental in government, although , in my experience over the the last 5 years it does not always deliver improvement in a way which is helpful to social work, or those who require services.

Far too often, it feels to me, governments drive for change is ideological and rooted in making changes which ignore issues related to failure in government, especially in respect of their unshakable belief in neo-liberal ideology as the foundation of everything.

As an ideology, neoliberalism perpetuates the belief that the market cannot only solve all problems but also serves as a model for structuring all social relations. It is steeped in the language of self-help and individual responsibility,   purposely ignoring the effects of  inequalities in power, wealth and income and…

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Why it matters who controls the curriculum in social work education ….

Change is the life blood of social work. Supporting people to adopt changes which might improve lives is fundamental to social work. Change is also fundamental in government, although , in my experience over the the last 5 years it does not always deliver improvement in a way which is helpful to social work, or those who require services.

Far too often, it feels to me, governments drive for change is ideological and rooted in making changes which ignore issues related to failure in government, especially in respect of their unshakable belief in neo-liberal ideology as the foundation of everything.

As an ideology, neoliberalism perpetuates the belief that the market cannot only solve all problems but also serves as a model for structuring all social relations. It is steeped in the language of self-help and individual responsibility,   purposely ignoring the effects of  inequalities in power, wealth and income and how these shape individuals and families lives. As such, it supports a society which cruelly ‘others’ those who require support, and is scornful of a critical and politicised social work profession founded on compassion and notions of equality and respect.

It appears to me our current government would prefer potential social workers to be ignorant of the political and structural forces which impact on individuals lives. Back in 2013 Michael Gove, then education secretary, claimed too many social workers had been filled with “idealistic” dogma that viewed people as victims of social injustice. Gove vowed to “strip this sort of thinking out of the profession”.

For example Gove and Co would seemingly prefer the consequences of government policy on those who require social work services in areas such as  housing, benefits sanctions and  zero hours contracts were ignored , ensuring the increasing levels of  poverty and insecurity individuals experience is accompanied by a culture of blame,   leading social workers to deliver individualised solutions to what are structural issues.

The Children and Social Work Bill is the latest ‘change’ causing many in the profession concern. Whilst some, such as Andy Elvin from Frontline, see the Bill as a positive step forward, many others within the profession highlight real issues, yet government appears set on ignoring these  concerns.  As a social work educator I have serious concerns, yes, around the potential privatisation of  children’s services, but also around who will provide social work education and what a future curriculum might look like.

It appears to me Government would like to ‘strip’ ‘idealistic dogma’  out of higher education as well. Instead preferring a depoliticised social work curriculum, a painting by numbers programme of training, rather than an education that prepares potential social workers to support, and challenge, change at an individual and structural level.

I believe a depoliticised education and social work profession, along with an ideologically driven clauses within the Bill would be a disaster for the children it seeks to protect.

A strong social work profession needs an educational system underpinned by critique and analysis, challenge rather than acceptance of the political status quo.  As Henry Giroux eloquently states

“At a time of increased repression, it is all the more crucial for educators to reject the notion that public and higher education are simply sites for training students for the workforce, and that the culture of education is synonymous with the culture of business. At issue here is the need for educators to recognize the power of education in creating the formative cultures necessary to challenge the various threats being mobilized against the ideas of justice and democracy, while also fighting for those public spheres, ideals, values, and policies that offer alternative modes of identity, thinking, social relations, and politics.

Pedagogy is always about power, because it cannot be separated from how subjectivities are formed or desires mobilized, how some experiences are legitimated and others are not, or how some knowledge is considered acceptable while other forms are excluded from the curriculum.”

Will the proposed changes improve life outcomes for children?  No one knows. I just hope the next reading of the Bill on the 18th October  is not reduced to ideological dogma because none of us who  debate the Bill will have to live with the direct consequences of the decisions made, nor any potentially negative consequences that might flow from this Bill if passed in its current form. ….

And these children that you spit on

As they try to change their worlds
Are immune to your consultations
They’re quite aware of what they’re going through

Ch-ch-ch-ch-changes
(Turn and face the strange)
Ch-ch-changes
Don’t tell them to grow up and out of it
Ch-ch-ch-ch-changes
(Turn and face the strange)
Ch-ch-changes
Where’s your shame
You’ve left us up to our necks in it

(Changes, David Bowie)