Monthly Archives: May 2012

There is a million reasons why ‘big society’ and ‘choice’ are not enough when providing care to older people

Research suggests as many as 500,000 older people are abused each year (Action on Elder Abuse), in the main by those supposed to be providing their care.  Therefore, since the election in May 2010 up to one million older people may have been abused.  

This information is not new, successive governments have been aware of this issue for many years but all have stopped short of introducing a coherent legislative framework to protect those most vulnerable in the care system.  The coalition appear to believe in the power of ‘big society’ and service user and patient ‘choice’ in a market led health and social care system.  My difficulty with this approach is it offers nothing new,  it looks no further than the rhetoric of the ‘free markets’  beloved of every government since Thatcher.  Nobody appears interested in thinking deeper and developing care from a philosophical perspective.  Surely we need to understand what motivates us to care before we can reform the system ?

Historically societal attitudes toward older people have always been poor.  In ancient Greece old age was portrayed as sad with historians arguing the Greeks love of beauty marginalised the old, especially women, sounds familiar!  Cicero’s work De Senecute, written in 44BC, pointed to a variety of individual experiences of ageing, however acknowledging that for those who were poor and without mental capacity ageing is miserable.  Sadly, all of this is still true today with research suggesting those at greatest risk of abuse and mistreatment are elderly women suffering from some level of dementia.  This,  along with the fact that the abuse and mistreatment of older people is a global issue identified by the World Health Organisation over a decade ago, suggests the issue  extends well beyond political systems and party politics in the UK.

I’m with social contract thinkers Hobbes (1588-1679) and Locke (1632-1704) when they suggest as human beings we are inherently selfish and our individual pursuit of pleasure is destructive to society, suggesting the law can be used as an apparatus to modify such human desires.  In my view the  continued economic approach to health and social care has fed such selfishness, to the detriment of certain groups in society, i.e. older people,  and we now require a strong lead from government.

Successive governments since Margaret Thatcher have relied on a consumerist approach to improving the quality of health and social care provision. The question is has turning vulnerable older people into consumers improved their care?  For some yes, but for many of the most vulnerable older people in society, those older old people with dementia and who are frail, I’m not so sure.  However, what it has done is hide the abuse and mistreatment of older people from collective view for the last 30 years, and led society to engage in debate that does not move beyond the financial.  Research suggests this has had a detrimental effect on the moral health of society and academics are now suggesting the use of market mechanisms can change people’s attitudes and values, having a  ‘corrosive effect’.    Michael Sandel makes a pertinent point suggesting

It calls into question the use of market mechanisms and market reasoning in many aspects of social life, ……to motivate performance in education, health care, the work place, voluntary associations, civic life and other settings in which intrinsic motivations or moral commitments matter‘ (What money can’t buy, 2012, p122).

So what can we do? Helen Sullivan suggests ‘a big society needs an active state’.   A useful first step would be for government to accept the Law Commissions recommendations on reforming the law in respect of Safeguarding Adults without delay.  Secondly, abandon the rhetoric of ‘choice’ and ‘free markets’  and develop a meaningful dialogue based on concepts such a honesty, morality and dignity from a philosophical  rather than financial perspective. A new approach might be to have a dialogue that goes beyond party politics (and winning the next election) and begins by asking big society what it wants to afford, rather than politician telling us what we cannot afford.

I am sure many will say we cannot afford to reform the system on philosophical grounds, I would ask those individuals “can we morally afford not too?”

Lost families: “I can’t take one more step toward you because all that’s waiting is regret….” (Christina Perri)

This is the 2nd of three blogs on my adoption, to read part one please go to https://digalpin.wordpress.com/2012/03/08/adult-adoptees-and-identity/ and part 3 here

As my adoption file arrives I cancel my appointment, after 8 months you would think I’d prepared myself but apparently not!  My emotions get the better of me and I re-arrange the meeting.  In preparation I go over the bits of my adoption journey  that are known to me, those key moments, the most important being the first time I ever saw my natural mother in a photo.  

There are 3 photos, her with a small child (not me), one of her with a handsome man and a photo that looks like a passport photo of an attractive dark eyed woman, of about 30 years  of age, looking directly into camera, hair smart, her skin looks dark, or is that because it’s a black and white photo? (I find out later she is Anglo Indian).  I stare at the photos looking for similarities, are those my eyes, her chin, how tall is she, how thin is she, is that my nose?

It’s like ‘wah hey I look like someone’ , this is the first time I have ever had a resemblance to anyone.  This is very important to me because I share no physical features with my adoptive family and have always felt like a ‘cuckoo in the nest’.

After getting over the initial excitement deeper thoughts emerge, more  unknowns to be known, questions I would desperately like to ask her.

Turning the passport photo over there is a small faded date stamp “Jan 1960”, what does this tell me?   Repeating the date in my mind, “Jan 1960, Jan 1960”  the penny drops, of course this is the year of my birth.  More significantly its January, she is already pregnant with me, not more than a few days/weeks though, does she know?   The eyes look sad, did they before I knew the date on the back of the photo or am I seeing something that is not there?    We are in a peculiar position at this moment she and I.   The dark eyes that look back at me hold her secret, yet the eyes that look at her, mine, know her secret and  what is going to happen within a few months of this photo being taken.  I am looking at  a woman whose life is out of control as all that she loves, and might have loved, will soon to be lost to her forever but she does not know this yet.

The small child turns out to be my half sibling and the man her husband, but not my father. Within a few months of these photos being taken my half siblings life would be turned upside down as my (our!) mother loses a hard fought custody battle.  For her husband his beautiful wife, the mother of his first born, will soon break his heart as she tells him she is pregnant with another mans child. The unborn child within her, me, will spend just a few days with her in a hostel for unmarried mothers, the only time we have met.

Fifty years after the taking of these photos I learn the fate of my half sibling as we are happily reunited via an incredible stroke of luck, when in a moment of boredom I surf the internet and come across a website called ‘Tombs in Ooty’ (I know!),  this site leads to us finding one other,  but of the central figure, the one who has been totally absent in my life, and the one who has had the biggest impact, well …………..

When I reflect on the reasons for my adoption, basically because my mother was ‘unfaithful’ and pregnant by another man,  she probably had very few options as a minority ethnic woman in 1960.  It makes me realise how far society has advanced, and how proud I am of those advances, although others may not see it in the same way as me!

I know reading the file will not make up for these lost years or bring to life someone who only exists in my mind and in 3 little photos, I know all thats waiting is regret, but still the desire to make some kind of sense is strong, and so with some trepidation the file will be read, but just not now.

(The full story, and outcomeof my sear, can be read here <a href="here“>)