Monthly Archives: December 2012

An MP, A Suicide Note and a Commons Challenge – watch how #Cameron responds. #disability #wca #ukmh

Have the Tories really changed since Thatcher…….watch this and make your own mind up An MP, A Suicide Note and a Commons Challenge – watch how #Cameron responds. #disability #wca #ukmh. p.s look at IDS face!

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Is more private provision in health and social care the only way to improve care?….

Di Galpin

What has HSBC to do with the NHS?  Quite a lot in my mind.  

My biggest worry is we will not learn any lessons from the financial meltdown of the past 3 years as government persists in its drive to privatise the public sector.  As the ‘Peter Principle’ reminds us……why does history keep repeating itself?   Because nobody ever listens.

With commentators suggesting barely 10% of total care home provision remains in state hands confidence in the ability of the free market and financial sector to provide quality care is important. However, for me it boils down to trust and respect, and the simple truth is I do not trust the private sector to deliver, and I do not believe the private sector respects me enough to ensure it will prioritise meeting my care needs, rather than making as large a profit as possible.

The recent review of care at Winterbourne…

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HSBC shows the way of a privatised NHS…..ignore at our, and our childrens’, peril if we want a fair system of care in the future

What has HSBC to do with the NHS?  Quite a lot in my mind.  

My biggest worry is we will not learn any lessons from the financial meltdown of the past 3 years as government persists in its drive to privatise the public sector.  As the ‘Peter Principle’ reminds us……why does history keep repeating itself?   Because nobody ever listens.

With commentators suggesting barely 10% of total care home provision remains in state hands confidence in the ability of the free market and financial sector to provide quality care is important. However, for me it boils down to trust and respect, and the simple truth is I do not trust the private sector to deliver, and I do not believe the private sector respects me enough to ensure it will prioritise meeting my care needs, rather than making as large a profit as possible.

The recent review of care at Winterbourne View Hospital demonstrates this clearly when it suggests lack of funding was not an issue, Castlebeck Ltd had clearly put profit before care. Indeed the very foundations of Winterbourne View Hospital lay in its ability to make money for investors.

However, successive governments continue to believe free markets are able to respond to individual need more quickly and flexibly than over bureaucratic state funded systems, leading to better quality care as providers compete to attract consumers.

Faith in the free market is unshakeable in government, and in many areas of life it has proved of benefit, however, the re-branding of care as a commodity over the last 30 years has all but ignored some simple truths pointed out by the economist Adam Smith several hundred years ago;  the purpose of the free market is to generate wealth for those who own the means of production, or the ‘masters of mankind’ as Smith christened them, it is not a charitable endeavour but a single minded system driven by cash not compassion, who Smith suggested had a ‘vile maxim‘  of  “all for ourselves”.  The ‘masters of mankind’  in Smiths time were the merchants and manufacturers who supported policy that enabled them to make more profit, they were not concerned with how such policy and their actions might impact on others.  Today the ‘masters of mankind’ appear to be financial institutions; banks, insurance companies, private healthcare providers and  international management consultants, such as  McKinsey and Company who wrote many of the proposals contained within the Heath and Social Care Act , and stand to makes several millions from there implementation.

At a macro level those private institutions who have already taken over some areas of  care provision have been found lacking, which does not bode well for extending this strategy.  Take, for example, HSBC who were fined £10.5 million last year for mis-selling care bonds to older people.  The Financial Services Authority 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 the scandal came to light.  Whilst £10.5 million might sound a lot its not for a company who was recently exposed as allowing the laundering of at least 7 billion dollars of drugs money through its bank and who set aside 700 million dollars to cover fines, although it was eventually fined £1.2 billion (not too harsh for the share holders as the company made approximately £12 billion in profits last year).

The selling of care related products by the private sector can leave individuals vulnerable in a variety of ways, look at the treatment of vulnerable adults in Winterbourne View and the recent review, owned by a Swiss private equity company, has the company been penalised in any meaningful way? Or look at the doubling of the number of private care homes going bankrupt leaving older people without secure housing or care provision.

Successive governments are keen to point to the failure of ‘state’ provision as an argument for the introduction of more private sector provision. True there are problems, however, rather than addressing these issues government seeks to displace them into the private sector, an under regulated private sector, where problems can conveniently disappear from view and politicians spout an empty rhetoric of disgust when an issue is exposed. For example failure within the NHS in Cornwall and Sutton and Merton in learning disability services led to private providers, such as Castlebeck Ltd, replacing NHS provision. However, issues highlighted in the subsequent inquiries in Cornwall and Sutton and Merton, around the training of staff, shift patterns,  management systems and a general culture of indifference toward those who are vulnerable, were not addressed in any lasting or meaningful manner, so poor levels of care have continued, just in a different (private) setting.

It would appear when abuse occurs because of  failure of ‘free market’ providers, government believes the private sector is  not only to big to fail, but more worryingly, to big to jail.  In essence some major private providers, whether of financial care products or personal care, seem to operate with impunity to wrong doing.  If they are not held accountable and government is not held accountable, who is?  Oh of course, the ‘care consumer’ who bought the product will have to take responsibility, after all it was their ‘choice’.

The truth is the ‘free market’ is anything but ‘free’.  A favourite of Mrs Thatcher, economist Friedrich Hayek compared the free market to a ‘game’ where there are winners and losers suggesting trying to regulate the market in the name of social justice was a waste of time, there are winners and losers and it is not governments place to even the odds because we are all free to make choices, and should live with the consequences of those choices and not try to displace them onto others, such as government or other taxpayers.  Which in many ways I support, however, the market is not free and is comparable to a casino where the ‘house’ always wins.

Lets reflect on the global economic crisis brought about by the current ‘masters of mankind’ and the displacement of said crisis  on the public sector, and consequently those who use the public sector, to see how a system premised on  the free market is neither free nor fair, and the biggest losers are those most vulnerable.

The current government appear to believe there is only one game in town when it comes to the future of our health and social care sector, in fact the whole of the public sector,they are wrong.  Call me old fashioned but for me an active State should be about taking a lead, collective action and solidarity, setting a high bench mark for all in society, not running away and hiding behind the financial sector and an outdated ideological mantra of ‘private sector good, public sector bad’ where ‘money is the anthem of success’ like some National Anthem (Lana Del Rey).

 

Di Galpin

For some patient groups replacing values such as dignity and respect with ‘value for money’ has reduced patients, in particular older people, to a percentile of spending of tax payers money, rather than being viewed as actual people, people who at some point may require care, help and support

The BBC expose poor patient care on Panorama, whilst earlier this year The Telegraph suggests the treatment of older people in care is now so bad that it meets the legal definition of torture according to the Governments own human rights watchdog. How many more news reports do we have to watch and read before society and government decide to react positively and engage in change, or have we reached the point of ‘compassion fatigue’?

Sadly this is not new to many of us who have worked in the care sector. Yet our voices have gone unheard, leading to many…

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We have to respect each other if we want a compassionate culture in patient care ……..

For some patient groups replacing values such as dignity and respect with ‘value for money’ has reduced patients, in particular older people, to a percentile of spending of tax payers money, rather than being viewed as actual people, people who at some point may require care, help and support

The BBC expose poor patient care on Panorama, whilst earlier this year The Telegraph suggests the treatment of older people in care is now so bad that it meets the legal definition of torture according to the Governments own human rights watchdog. How many more news reports do we have to watch and read before society and government decide to react positively and engage in change, or have we reached the point of ‘compassion fatigue’?

Sadly this is not new to many of us who have worked in the care sector. Yet our voices have gone unheard, leading to many, such as myself, leaving the profession. Last year a report by the Health Service Ombudsman on care in hospital settings suggest there is a culture of indifference from both government and staff to some patients.

Doing nothing is not an option.  The current discussions on the care of patients needs to change, we have reached the point where ‘cost’ is king, every aspect of care system is framed in the language of economics. Government and society are so focused on the cost of care they have lost sight of the value of caring to society, from a moral and ethical perspective. For some patient groups replacing values such as dignity and respect with ‘value for money’ has reduced some patients, in particular older people, to a percentile of spending of tax payers money, rather than being viewed as actual people, people who at some point may require additional help and support, through no fault of their own but as a natural process of ageing. Indeed the focus on cost diverts our attention from the real issue, we as a society are, at best, indifferent to many vulnerable groups, especially the plight of older people.

Our ability to be aware of these issues, to watch programmes and read report after report yet do nothing to change our attitude is disturbing, maybe society is experiencing ‘compassion fatigue’?

Real change can only occur if built on a foundation of respect for people. Developing a culture of dignity and respect for others requires more than codes of practice to guide the carers who look after patients. We all have to develop a much deeper understanding of what ‘dignity’ and ‘respect’ actually mean and how we demonstrate dignity and respect to one another, starting firstly with ourselves. Arguably if individuals respected themselves they would not allow themselves to act in such a way that is uncaring toward those they care for.

It is with shame that we should read the treatment of older people in care is now so bad that it meets the legal definition of torture. Let us hope the response to these recent revelations are resourced adequately and really embedded across the health and social care system, but we as a society also have a role to play, we need to learn to treat one another with dignity and respect on a daily basis, wherever we are and in whatever we do, whether as a carer, nurse, social worker or patient. That would change things a lot quicker than policies and endless new initiatives.