Care Homes in england failing vulnerable adults…..really……

Care Homes in england failing vulnerable adults?  (BBC News). This is how I, and virtually every practitioner and writer I know on this subject feels when they read this headline  CLICK HERE . Yes, horrified that no matter how often abuse is revealed very little seems to change.

How many more times are we going to have to read yet another report, see another undercover film, how many more vulnerable adults have to suffer before we really try to get to grips with this situation????????????

Sorry, having left practice 7 years ago because of the poor levels of care I witnessed as a social worker and having worked for two years on a doctorate concerned with trying to understand why we abuse and mistreat those most vulnerable in society, I really really find it distressing that we are having the same discussion and have not moved forward to find a resolution more quickly.

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Rowan Williams dismissed the governments version of Big Society as ‘waffle’, suggesting this approach in its current form is nothing more than the state withdrawing its responsibility from supporting those most vulnerable in society, especially older people.  He may have a point.

Ageing in the UK can be a dismal experience for many sadly.  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.  A recent report entitled ‘Ageing Across Europe’ by DEMOS, for the WRVS,  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” ( 2012, p.8).  The media  suggests the treatment of older people in care is now so bad that in many cases it meets the legal definition of torture and secret filming has exposed abuse of the elderly in care home settings.

As a society we know there is a problem and we know things have to change. Debate is developing on how the care of older people should be reformed with much discussion focusing on financial matters.  Government is keen to continue to extend free market mechanisms across the public sector.  This approach appears little different than previous governments, which have arguably contributed to the current situation, so it is unclear to me how this might improve the lives of older people.

The  government is entrenched in a ‘public burden’ theory of welfare.  The Coalition government have sought to return to an economic and political approach that more closely characterise New Right patterns of public protection. Building on Thatchers message of individual freedom, responsibility, free markets,  minimal state intervention and the privatisation of previously publicly delivered services to older people, for example pensions and residential/nursing care, and more recently NHS health care. From this ideological perspective the free market transfers power away from government, previously mandated to ensure universal service provision, toward private capital and consumers whose individual choices drive standards up through increased competition between providers.  Successive government have adhered to this belief for over 30 years, has it worked though?

Whilst such an approach is clearly of benefit to market providers, and the public purse, it is questionable whether it has been of benefit to older people, especially those in receipt of private pensions, healthcare and residential or nursing care. It could be argued the focus is on the displacement of ‘responsibility’ from the state to the individual rather than the transfer of power. The transfer of public provision to under regulated financial markets has not ‘redistributed’ power to all older people. There has been a doubling of the number of private care homes going bankrupt leaving older people without secure housing or care provision, whilst the HSBC bank was fined £10.5m for mis-selling care bonds to older people. The Financial Services Authority (2011) found unsuitable sales had been made to 87% of customers, with the average age of those who purchased bonds being 83 years of age, many of whom having already died before HSBC were exposed. The consequences of free market failure are made clear when considering private pension provision. The Telegraph points to recent findings on the mis-selling of pensions,  however, this is not new, many of those who bought pensions in the 1980/90’s find themselves now without the pensions promised.  Is government outraged?  Apparently not since we are continuing along the same well trodden path.  Of course this suits government because casting older people as consumers means the unaccountable decisions of multinational corporations individualises ageing, in that their living in poverty is seen as the problem of the older person rather than market failure, heaven forbid (as the Prime Minister might say to the Archbishop). From a governmental perspective, market failure is a justifiable risk and the mark of a free society, some pension funds will have made gains others losses, that is the nature of financial markets, there is no point moaning about ‘injustice’ !

In essence as individuals we are engaged in a system  where the emphasis on consumer choice masks the dynamic and unpredictable process by which sudden change (and ultimately disadvantage) may visit upon a citizen at anytime.  A report by the World Health Organisation (2008) makes a pertinent point when it suggests many of the negative experiences of older peoples’ lives are linked to structural determinants, i.e. pensions, poverty, access to free health and social care etc,  suggesting tackling such factors is central to improving the lives of older people in the longer term.

Older people’s experiences 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 so many.  Government in the UK tend to address issues associated with an ageing population ‘within individual silos’ (WRVS,2012,p.103).  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 (WRVS, 2012, p.103).

My views on Big Society  have been stated previously, we must not let Cameron’s idea of  ‘Big Society’  get in the way of looking at our deeper structural problems.  No matter how caring and kind we are to one another we are still at the mercy of the economy and financial systems. For Big Society to be more than ‘waffle’ we need an ‘active state’ (Sullivan, 2012), and maybe more importantly one able to learn from the mistakes of successive governments over the last 30 years, not keep repeating them.

The ‘Big Society’ will not necessarily lead to better elderly care treatment by @dianegalpin

A fantastic blog by our senior Lecturer Di Galpin for LSE Policy and Politics Blog a recommended read!!!

The ‘Big Society’ will not necessarily lead to better elderly care treatment.

Di Galpin looks at the Big Society from a philosophical standpoint and questions whether it can be achieved without encouragement from an active state.

Review of “The Survival Guide for Newly Qualified Social Workers in Adult and Mental Health Services: Hitting the Ground Running”

Formal education has finally ended, you’ve passed your exams and you’re getting started as a newly qualified social worker (NQSW).This handbook guides you through the initial hurdles you may face in this transitional phase, helping you to fully understand your role and how to meet the requirements of NQSW status. Authors: Diane Galpin, Jenny Bigmore, Jo Parker

Review from the British Association of Social Workers (BASW)

THE CLUE is in the title: should social work practice, especially at the outset of a career, be all about “survival”? Well the authors of this helpful book must think so if the title is anything to go by but the book goes beyond this and goes into, in some detail, the transition from student to practitioner.

Having been a social worker who entered the profession in the 1970s, this would have been a very helpful articulation of the process involved in the absence of any easing into practice at that time. But times have changed, thankfully for the better, and we now better understand what fledgling social workers need in order to become functioning professionals.

So does the book do what it sets out to do? Well, yes it does. And credit must go to the authors in attempting to put together a tome which gives both students and supervisors the approaches required to make a successful introduction to becoming a professional social worker in adult and mental health services.

Furthermore, the book takes the aspiring social worker from their early years as being newly qualified to developing a professional identity and then the need for continued professional development. In other words, a fully rounded approach to understanding the role and tasks involved in joining the social work profession.

It is set out in a series of parts: Finding Your Feet, Finding Your Way and Finding The Way Forward. In each part, there are detailed sections which take the reader through the process of development both as an individual and as the organisation responsible for that individual.

The book also stresses that there is an understanding that all newly qualified social workers are entitled to being treated as per the Newly Qualified Social Worker (NQSW) framework.

While this has been developed in each of the nations to support development, it points out that its application may vary from country to country and employer to employer, and it is important that students are pro active in ensuring that they are treated according to this framework.

In other words, take responsibility for your own development! There is also a very useful section on managing stress which recognises the inevitability of having to deal with it and how to develop coping mechanisms and resilience.

The chapters also have a series of exercises which are optional ways to test you against what either you are learning through reading the book or the experience gained in employment.

The sections ‘are readable and relevant and can be dipped into or read from cover to cover. My suspicion is that it is more likely to be dipped into than read. There are good references for further study and a description of the NQSW frameworks across the UK.

One small quibble is that having addressed the UK issue framework-wise, the section on legislation does not mention the specific legislation that exists in Scotland in relation to children, adult protection, incapacity and mental health. All in all, this is an important contribution to the world of newly qualified social work and makes for essential reading. I note that there is a companion guide for those entering the field of children and families. It’s a pity that something similar was not around in the 1970s.

‘Big Society’ and the future of health and social care

David Cameron suggests the Jubilee party was a ‘perfect example of ‘Big Society’.  Whilst it’s okay for a knees up, is it a suitable foundation for improving the quality of care  older people receive in Britain?

Unfortunately, David Cameron’s comments on Big Society do little to help us understand what “it” actually is, and to be honest, I am not even sure he  knows what it is beyond the usual sound bytes of ‘kitchen sink economic theory’*.  However, could the concept of Big Society actually have something to contribute to the debate on the future care of older people?

What is ‘Big Society’?

Big Society has been vilified as a return to the politics of the New Right,  a Trojan horse for smaller government,  and feted as the anatomy of the new politics  on which to establish the legitimate nature, and limits, of the relationship  between the  state and individual in a 21st century system of health and social care.  Phillip Blond is a central figure in the development of the concept of Big Society.  Blond  argues both the political Left and political Right have presided over a collapse of coherent cultural values and a shared commitment to a ‘common good’,  suggesting a redistribution of power from the ‘top’ (state) to the bottom (individual) is required, aligned with a more compassionate form of capitalism, to re-establish the common good.  For the current government this rests on the empowerment of local communities founded on voluntary networks of trust and mutuality.  From this perspective the purpose of Big Society appears to be to extend responsibility for the care of older people to local communities, rather than extending the responsibility of the state.

Policy programmes already implemented by the current government to develop Big Society include the National Citizen Service, which organise voluntary opportunities for young people, and the creation of the Big Society Bank, which will act as a central source of investment income for third sector organisations.  The Localism Bills’ accompanying guidance states ‘Big Society is what happens whenever people work together for the common good.  It is about achieving our collective goals in ways that are more diverse, more local and more personal (HM Government, 2010: p.2).

However, whilst at one level Big Society can be viewed as a mechanism of transferring more responsibility onto individuals, allowing the state to reduce public sector spending (Alcock, 2012) Big Society is also about believing in, and building on, the inherent ‘good’ within humankind.

Jesse Norman suggests Big Society involves moving beyond the ‘two way opposition of state vs. individual’ in the provision of care to ‘the three way relationship of enabling state, active individual and linking institution’ (2010,p.7).  For Norman the former is flawed because it ignores the diversity of human beings and their ability to act morally without interference from the state.  By justifying the legitimacy of the state, it polarises the individual and ignores the positive power and potential of individuals to create and maintain a ‘good society’, which cares for one another for altruistic reasons, rather than because the state legislate that society provide care and support.  Norman suggests state interference is a negative response to care provision, quoting Alex de Tocqueville (1805-1859)

“The more [the state] stands in the place of associations, the more will individuals, losing the notion of combining together, require its assistance.  These are cause and effect that unceasingly create each other.”

The ‘associations’ that mediate between individuals and the state can be conceptualised as operating within civil society.  Civil society is the space of un-coerced human action, the place where people take action as moral beings,  via all organisations and associations above the level of the family and below the level of the state.  The place where your jubilee street party was planned presumably.

Importantly for advocates of Big Society the role of government in this ‘space’ and ‘place’ is minimal.

How does this support the current approach to caring for older people?

From this perspective caring for older people, and ensuring care is dignified, is viewed as something we all agree is a ‘good thing’ and freely engage in, rather than something government should regulate or legislate for.  In this context government relies on ‘phillic’ associations, taken from the Greek ‘philia’, meaning friendship ties, affection or regard that are the essence of the space between individual and state.  Government would rather rely on these to guide human behaviour in the care sector than introducing legislation or regulation.

Hence, the governments  support for the introduction of a voluntary dignity code  (The Telegraph., 2012).

Big Society, freedom and money

However, whilst government may think treating older people with dignity and respect is viewed as a ‘given’, assuming we are all willing to  care for, and protect,  older people,  this is not necessarily true, as evidenced by a number of reports on the poor levels of care provision  older people experience across the care sector.

At the heart of the current debate are two related themes.  Firstly, an attempt to understand how the relationship between the state, private sector and individual should be formulated to fulfil a mutual responsibility in supporting dignified care for older people, and secondly  the affordability of care provision.   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).

It is impossible to ignore the effects of systematic inequalities in liberal societies that effectively exclude, or compromise the rights of a variety of social groups.  Nor can we ignore the corrosive effect successive governments use of a consumerist approach to health and social care might have had on those ‘phillic‘ associations so vital to a ‘Big Society’.   The ‘Osborne Supremacy’  assumes the existence of a single unified ‘big society’ when it actually consists of many ‘societies’ with competing interests where the interests of powerful elites are advanced in the name of defending common interests, whilst the interests of marginalised groups, such as older people,  leave them without support.

Big Society or Big Con?

The answer will depend on your political and ideological viewpoint on the legitimate role, and limits, of the state in the provision of health and social care.  Whilst it is true Big Society clearly already exists, evidenced by the number of people already providing care freely in society, what is in doubt is whether it can be extended any further without an active state (Sullivan, 2012).

* Kitchen sink economic theory -this is a term used in my household to describe David Cameron and George Osbornes approach to the financial crisis.  It refers to a vision I have of a post war couple discussing there finances whilst stood washing up at the kitchen sink.  Gladys turns to husband Frank and says “money is tight Frank, what will we do?”  Frank turns to Gladys and answers “never fear mother, we’ll just have to tighten our belts, don’t worry we’re in this together”.  Of course Frank and Gladys are very naive and do not realise their actions will make no difference because the problem is a global financial crisis and not related to Gladys splashing out on a new apron!

Share your experiences of being a child carer

Zoe is exploring the experience of adults, who as children cared for a parent with mental health problems. Through interviews they can share their journey of growing up with, and older with, a mentally ill parent. Shebelieves that the individuals will all have a unique tale to tell and as such will allow the participants to tell their story in their own way.

If you grew up with a parent who suffered with a mental illness which included symptoms such as hallucinations or delusions, are aged 30 + and would like to take part in Zoe’s research, please contact Zoe Cowie through any of the following:

Address: B412, Bournemouth House, Bournemouth University, 17 Christchurch Rd Bournemouth BH1 3LH 

Tel: 01202 967345

Email: zcowie@bournemouth.ac.uk.

To find out more information go to Zoe’s blog – http://zoecowie.wordpress.com/ 

All communications will be treated in complete confidence and contact will not mean that you are committing to take part at this stage.  You will be sent more information before making any decision and will be able to withdraw from the study at any stage should you wish.