Monthly Archives: April 2013

Morals & Markets:Welcome to Health and Social Care Plc,we are here to care for you, how would you like to pay?…..

Evil drug companies, bailiffs in care homes and profit before people, welcome to the brave new world of Health and Social Care Plc.

As we wonder why compassion in care is so difficult to maintain…..

The Independent reports an influential group of cancer experts warn high prices charged by pharmaceutical companies for cancer drugs are effectively condemning patients to death, claiming drug companies are “profiteering” using unethical methods.

Government reform will mean multi-million pound opportunities for pharmaceutical companies in the provision of goods and services to the NHS in the UK.   Is this advisable when we consider previous reports from The Independent who highlighted the criminal wrong doing of drug companies along with The Guardian  who reported on GlaxoSmithKlines fine of $3 billion dollars, for admitting to bribing doctors to encourage the prescription of unsuitable antidepressants to children, and then reports that GSK  concealed data about the damaging side effects of the drug Avandia.

However, ‘big pharmas’ reach extends well beyond the suppression of drug trial data, drug production and distribution. A central tenet of the health care reforms is the introduction of ‘any qualified providers’, which will now force CCGs to put provision out to tender to private firms to provide NHS services.  This means the Department of Health will take the most potentially lucrative, standardised, high volume and low risk treatments provided by the NHS and offer these up to private companies, the Americans charmingly refer to private providers who deliver such treatment as ‘focused factories’.  These healthcare companies will already have had some influence on deciding which treatment will be handed over to the private sector, for example companies like 2020Health  who have links to the two big pharmaceutical companies Pfizer (fined over 2 billion dollars since 2009 for criminal wrongdoing) and Lilly.   There is evidence to suggest pharmaceutical companies explicitly determine which health care problems are publicised and researched to maximise their profits.

Such unethical practice is linked to profit.  Pharmaceutical companies appear driven by a different set of moral and ethical standards than most professionals working in the health service.  The government is effectively asking advice from a woefully under regulated market on creating a market for its products, which may actually damage patients health.

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 it’s 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 has set aside 700 million dollars to cover fines.

The selling of care related products by the private sector can leave individuals vulnerable in a variety of ways, look at the doubling of the number of private care homes going bankrupt leaving older people without secure housing or care provision. Latest reports in The Independent suggests nothing had changed as the bailiffs are set to move in on some care home providers.

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 can relieve themselves of any responsibility. When ‘responsibility’ is lost all we are left with is accountability, and as privatisation extends deeper and deeper into the psyche of our health and social care system that too will be lost, leaving individual ‘consumers’ of health and social care at the mercy of the markets, and look where that has led us!

And we wonder why compassion in care seems to have been lost, surely for compassion to be integral to care it needs to be present at every level? The language of the free markets, individuality, austerity, profit and value for money is so ingrained in the fabric of our lives that I wonder if our capacity to care is now so corrupted compassion in care is beyond us? All I want is compassion, honesty and integrity in a free market approach to our care system, but that seems increasingly unlikely to me.

Is the review of social work education a genuine attempt to improve service provision for those most vulnerable in society?

What one ‘academic’ really thinks about the proposed review……

Government has announced a review of social work education to be under taken by Professor David Croisdale-Appleby (OBE). I do believe we need to see change in the system, however, am I convinced this is a genuine attempt by government to improve social work education and the quality of practice?

My instinct tells me there is no need for a costly review because the decision has already been made, we have ‘Frontline’ and ‘Step Up’ already, no matter that we do not really know whether they work or not that is not the purpose of this exercise. The purpose of this exercise is to reduce cost and divert attention from the real issues. Regardless of where you train or your academic ability unless change occurs in the organisational and managerial culture of health and social care, and additional resources are provided, those high flyers government are seeking to attract to the profession will soon succumb to the harsh realities of life as a professional in social work. My fear is social workers will be less prepared as local authorities ‘educate’ workers who can follow policy and procedures, rather than practitioners who challenge.

Some suggest students are not prepared for practice on their courses, is this the case? Could it be students are prepared for social work but the problem is many local authorities do not want professionals trained to work with people, they want workers trained to work with the system?

I do not disagree that some provision of undergraduate social work education is not of an appropriate standard, and some of those on courses are not suited to the role, but maybe that’s a consequence of the continued demeaning of the profession by politicians and the media and the process of funding in higher education. These are all part of the equation which needs to be looked at. However, will a perceived shift of emphasis to local authorities address the apparent failure of higher education? In some cases yes and some no, because some will be good programmes and some will be not so good, some local authorities will be up to the challenge, others not. Is the proposed ‘new’ system not so dissimilar from the system which pre-dates the current DipSW and degree? Where local authorities trained their own social workers, and will it not be reviewed in a few years because it is perceived to have failed by what ever incumbent government wants to divert attention away from addressing the real issues that face social work?

I appear to have completed the loop de loop of life, where I am now experiencing a reappearance of the system I took part in replacing many years ago!

Maybe I am missing the point. Frontline has some big academics advising, however, the emphasis for providing training and education appears to be on local authorities because the whole of higher education is failing. It feels like there has been a campaign against university social work education departments in the last two years based on the failure of the few. We saw it with the removal of PQSW, which I would argue has had a positive effect on practice in many areas, however, the focus when reviewed was on where it did not work, thus leading to the system being replaced. It saddens me that it appears those who teach in universities are perceived as some doddery relic from the past with limited knowledge of social work today, or even worse they live in an ivory tower totally out of touch with reality (just for clarity I actually live in a bungalow) and clearly have nothing to offer in terms of education for social work. I see it on social media sites where ‘academics’ views and opinions are rubbished because they are not front line practitioners, where the label of ‘expert’ is attached to them by others and then disparaged. When in reality not many would call themselves an expert, and firmly believe academics and practitioners are not in competition with one another, but complement one another. This is the approach I use when working with qualified practitioners and it appears to work very well.

Still, it’s a good old tactic divide and rule, let’s all blame each other rather than look to those with power and the ideology underpinning so many of the divisive policies handed down by this government.

Still the one good thing to come out of ‘Frontline’ is that it has reminded me I need to stop off at Pampured Pets on the way home! (Barney, 18 years old, tabby, dodgy eye, one replaced hip, one pinned hip, a small hole in his ear and a massive hole in my bank account)

Why we have to turn our backs on Margaret Thatcher’s ideology, not her funeral….

The mixed response to Margaret Thatcher’s death is to be expected. For those of us who saw our home towns and cities decimated by the mantra of ‘free markets’ and ‘privatization’ good and public sector bad, the reality of her ideological stance is personal. However, even if you were not members of those communities who saw lives, and futures, destroyed by ‘that’ woman, we are all still living with the consequences of an approach that is no longer fit for purpose.

We must not under estimate the power of this ideology. In effect the same ideology that under pinned Thatcher has provided successive governments’ with a blueprint of how society should be structured. Ideology determines what, and whom, counts in a society, differentiating between the deserving and underserving, along with structuring the role the state, free markets, families and individuals should play in meeting need in society. This drives government policy and tells society who will receive what, its cost, who will pay for it and how it will be provided. A particularly disturbing aspect of the current crisis is the displacement of responsibility for ‘austerity’ onto seemingly everyone, except those who caused it; an under regulated financial sector, because this would contradict the efficacy of a neo-liberal approach.

However, the exercise of Thatcherite ideology is not just about political power and the domination and oppression of those most marginalized in society. It also requires the consent and compliance of wider society to operate without challenge. For real change to occur society needs to withdraw its consent and compliance if we want to see a shift away from the current approach which appears to underpin all the political parties ideas for our future.

We need to be able to imagine a world not driven by neo-liberalism, free markets and the profit motive. Arguably our biggest problem is the lack of vision our politicians seem to have. Regardless of political persuasion nobody seems able to conceive of an approach not centred on neo-liberalism and a free market. How about basing our futures on compassion as a foundation for action and a belief in one another instead of stigmatising those who require support?

Rejecting such ideology at the ballot box will do more long term good than gesturing for a few minutes at her funeral.

Free adoption story ibook: finding my family

An afternoon read….

Di Galpin

About a year ago I started the search for my biological mother and shared my experience in a blog entitled ‘The Adoption Files’. However, writing ‘The Adoption File’ became as much about understanding the effects of childhood on individuals as finding my natural family. Whilst my story is related to my adoption much of what I discovered about the effects of childhood and family is the same for anyone, whether adopted or not. The truth is family is central to many of our life experiences and sometimes those are good and sometimes not so good. When childhood has not been so good it can overshadow the rest of our lives, however, it does not have to, we can turn those negatives around to achieve positive outcomes.

Many people spend their lives trying to be the person their family want them to be rather than just being themselves. This often stems…

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Free Adoption ibook: the journey to finding a birth mother…………..

About a year ago I started the search for my biological mother and shared my experience in a blog entitled ‘The Adoption Files’. However, writing ‘The Adoption File’ became as much about understanding the effects of childhood on individuals as finding my natural family. Whilst my story is related to my adoption much of what I discovered about the effects of childhood and family is the same for anyone, whether adopted or not. The truth is family is central to many of our life experiences and sometimes those are good and sometimes not so good. When childhood has not been so good it can overshadow the rest of our lives, however, it does not have to, we can turn those negatives around to achieve positive outcomes.

Many people spend their lives trying to be the person their family want them to be rather than just being themselves. This often stems from negative experiences in childhood that shape relationships within families. That childhood and family shape our lives is not exactly a startling revelation, however, this much I know, they do not have to define who we are and who we become. As George Eliot suggests “It is never too late to be who you might have been”. We are not bound by our childhoods, forever imprisoned in a world defined for us by others. Throughout life we meet individuals who are equally as important in shaping who we are and what we might become, and of course we also have our own will, intellect, humour to carry us forward into life to become the people we want to be.

The central message from my adoption story can be summed up in the words of Steve Jobs, who, like I was also adopted, and they apply to anyone who might have had a difficult childhood or who is still affected by negative family relationships

Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary”.

The ‘Adoption file’ is a free short ibook and provides a snapshot of my journey to finding my natural family, and my reflections on famly and relationships. It is a story of life and hope.

The Adoption File by Diane Galpin
The Adoption File by Diane Galpin
from the introduction

‘Ayaan Hirsi Ali begins her book “Infidel my life” describing a scene with her grandmother when as a five year old she was able to name her family ancestry back three hundred years. In Somali culture lineage is central to belonging, this was something Ayaan had drummed into her as a child. Knowing our cultural heritage, our ethnic roots and family history is important to understanding who we are, they provide reference points from which we can develop an understanding of the factors that have helped shape who we are today. It is easy to over emphasise the importance of these when you do not know them, or under value their importance when you do. However, equally important is the way we are brought up and our relationships within the family. Whether who we are is predetermined by some invisible invention of science called genetics or the highly visible ‘*uck ups’ (as the poet Philip Larkin would suggest) made by our parents is commonly known as the ‘nature vs nurture’ debate and has been the subject of much discussion for decades. The truth is we are probably shaped by a bit of both[…]’

The book can be downloaded here

(You will need an iPad to read it)

Why is being in receipt of benefits so stigmatizing? Surely it’s a good thing for the whole of society…..

Since when did being in receipt of a welfare benefit become such a crime against humanity in the UK?

I feel like I have been transported somehow back to the 1980’s with all the nastiness of Thatcher and Co. Most of the time these days I am either ranting at the radio/TV/Twitter/Blog because of the governments distortion of the facts or holding my head in my hands as I read the Daily Mails latest inflammatory headline. My blood pressure must be sky rocketing!

Why does this get to me so? Well I really believe in the ‘welfare state’, probably due to personal experience. My Dad was a dock yardie in Plymouth working on the lagging side, which meant lagging pipes on ships with asbestos. He was very hard working, did overtime and was getting on well but then he was involved in an accident in the dockyard and he damaged his spine and was disabled. This must have been a blow to my family as my Dad was only in his late thirties and he had a wife and three young children to support. Fortunately the welfare state was there for us, he never worked again. Later he developed Asbestosis and died when he was 59 years old. Presumably my Dad would have been assessed by ATOS today and found fit for work!

Did growing up in a house hold where my parents did not work affect me? Yes it did, however, it did not turn me into a ‘skiver’ and I have never claimed a welfare benefit (that’s not to say I have not benefited from living in a society committed to collective provision of a publicly funded ‘welfare’ state i.e. education,health care, social care etc). What it did do was enable me to understand that at any point in any of our lives our circumstances can change in the proverbial blink of an eye, and when that happens you need long term support to get back on your feet, and infact sometimes people can never get back to where they were. You do not need stigmatising or shaming, you do not need to be marginalised by the rest of society because you are down on your luck, you do not need to be made to feel you are worthless and committing a crime against humanity for claiming benefits. What you do need is support and a future, you need hope to be able to see a way out of the situation, a way forward. The constant negative stream of abuse from this government toward those who use the welfare state is creating a society that is so divided feelings of hopelessness and helplessness are turning into resentment. This does not bode well for the future, building anything on just the negatives will not serve us as a nation well.

We see the consequences of such an approach already in the way the government is using ‘austerity’ in a cynical manner to ensure we turn on one another in the blame game, diverting attention from the real issues – under regulation of the financial sector, free market failure, profits put before people, low living wages, lack of housing etc etc.

The real victim of austerity is our compassion toward one another. I wonder what sort of person I would be if such compassion had not been shown to my family all those years ago?

What would the UK be like without a collective system of ‘welfare’? Is this how we want future generations to live?

Free on-line reflective guide for professionals Safeguarding Adults

Protecting those most vulnerable from abuse and mistreatment in health and social care is central to professional practice

The World Health Organisation suggest for many staying out of harms’ way is a matter of locking doors and windows and avoiding dangerous places, people and situations; however for many individuals requiring care it is not quite so easy. The threat of abuse is often behind those closed doors, hidden from public view and for those living in the midst of adult abuse fear permeates many aspects of their lives. We just have to think of mid Staffs and Winterbourne View Hospital to realise the consequences for patients when staff get things wrong. The role of professionals in Safeguarding Adults at risk of harm from those providing care is an increasingly important, and complex, area of practice requiring a good level of skill and ability. Whilst the media rightly focuses on the failings of the system it is important for us to also celebrate the little successes achieved on a daily basis but never seen by the media or wider society, but which make such a difference to those professionals work with. Its right not to be complacent, but, it is also right to be confident, confident that those caring for the most vulnerable do make a difference.

However, caring is not like any other job, it is not something you can do on automatic pilot. Caring requires staff to continually update their skills and knowledge, and maybe more importantly, to stop and think about what they are doing, to reflect on their daily practice so that practice does not become routine. Otherwise carers can develop ‘bad’ habits and take shortcuts that put meeting the requirements of the system before the care of the patient.

Coming into contact with nurses and social workers on a daily basis I know the majority want to do the best they can. Therefore to assist those who work with the most vulnerable we have developed a free on-line tool for practitioners (SAFE tool) to support their professional development in protecting patients at risk of harm. It takes about 5 minutes to complete and provides those who complete it with the resources to stop and think about their practice, to recognise the good and reflect on areas that might require improvement.

The Safeguarding Adults Framework Evaluation tool (SAFE tool) provides practitioners with an easy to use resource, which they can use to both evaluate and develop their practice.

The development of this tool follows work begun in 2010 when Learn to Care commissioned us at the National Centre for Post Qualifying Social Work to develop a framework to quality assure practice in Safeguarding Adults at risk of harm when in hospital or in need of social care to try an ensure consistent practice across England and Wales. Lucy Morrison (Research Assistant) and I undertook research to identify the key areas of practice which were failing those most vulnerable. Findings from CQC inspection reports, serious case reviews, a review of academic research, focus groups and interviews with professionals and managers who deliver services, along with feedback from service users and carers, was collated to discover areas of practice that required improvement. Drawing on work already undertaken by East Sussex County Council, Brighton and Hove City Council and Lambeth Safeguarding Adults Partnership the National Capabilities Framework for Safeguarding Adults was born. Since its development over 12,000 copies have been distributed across health and social care departments throughout England and Wales.

The resources above are part of our ongoing commitment to supporting practitioners, and the organisations they work in, to continue improving the lives of those in need of care and support from health and social care services.

We must never forget at the centre of health and social care is an individual who is trusting professionals to care for them, and to step in if they see others mistreating them. Doing nothing is never an option, but doing something requires courage and confidence. We hope these resources will help develop these.