Monthly Archives: December 2013

Rochdale, the mantra of ‘choice’ and a culture of blame that shames us all………..

The Guardian reports on the catalogue of failure across 17 agencies that allowed the unthinkable to occur in Rochdale. The fact that so many agencies failed suggests this is not just about individuals, it’s also about systems and something much bigger….us, society today and what we value.

Coming from a social work background I’m not surprised at the failure of multiple agencies to work together effectively to safeguard vulnerable children. A colleague and I wrote a paper a couple of years ago around decision-making in a multi-agency context, this paper came about because of our despair at how agencies failed to work together to safeguard those most vulnerable in society. Whilst one might assume multi-agency decision-making is safer this is not always the case. Professionals have to be aware of the dynamics of group decision-making.

Mullins (2007) found that instead of groups taking fewer risks by making ‘‘safer’’ decisions the opposite is often the case. Studies suggest that group members, often under pressure to conform, will take higher risks than they would take individually. It is suggested individuals do not feel the same sense of responsibility for decisions made when in groups. This is sometimes evident when a multi-agency meeting advocate ‘‘doing nothing’’; this type of behaviour in decision-making is referred to as the ‘risky shift’.

However, beyond the policies and procedures that should guide good practice there is a far more important element which is often underestimated, that of ‘culture’. By this I mean the organisational culture that seems to disempower intelligent and caring professionals from doing what would clearly be the right thing to do. For example at some stage within many of the organisations involved in this case ‘child prostitution’ and ‘choice’ were conjoined to provide some kind of rationale for not acting. It is hard for me to imagine how the words ‘child’, ‘prostitution’ and ‘choice’ can exist together without individuals feeling shocked, but that did happen and we have to ask how did we get to this point?

Of course there is much more to this than mentioned above, if my opinion were sought I’d suggest re-visiting Eileen Munros recommendations, embed them in practice, then evaluate them to move forward again…but then what do I know!

I hope professionals reading the report will be shocked, horrified, angered-anything that elicits an emotional reaction, so that blaming the victims never happens again.

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How to develop a whole systems approach to Dementia care…

Richard Ashcroft makes some pertinent comments following the G8 dementia summit last week when David Cameron and Jeremy Hunt’s use of language took a ‘President Bush’ turn. We are now going to win the war on dementia by “fighting back” to combat the dementia “explosion” and subsequent dementia “time bomb” awaiting us. All well and good, however, talk of improving dementia services by politicians is a lot cheaper than bringing about real change, real change requires investment and a comprehensive strategy.

Some commentators are looking to France for inspiration. The French launched their dementia strategy in 2008 and are already beginning to reap rewards. One reason for this is a commitment to fund research, 200 million euros worth. Compare this to the UK, £26.6 million in 2010 (one eighth of that spent on cancer) and we can see we have a lot of catching up to do. However, it’s not that the UK is not spending on dementia. Estimates suggest dementia costs the UK £23 billion per year. Possibly the problem lies in how we spend the money. If we cast our eyes toward another European counterpart, the Netherlands, we can see how re-structuring care provision differently can work. ‘Complete Care’ provides a model we might like to consider, where district nurses work in teams in specific localities in providing care. There is no such thing as a 15 minute ‘task centred’ visit, instead carers can spend up to 2 hours on a visit, beginning with making a cup of tea and a having chat. This model has been highly successful in delivering person centred dementia care in the community which is high on quality yet costs less than our current approach.

However, it’s not just about health and social care services. Wider society also has a role to play,
and it is to be welcomed that big business, such as Lloyds’ Bank, is making a commitment to develop ‘a frontline force’ educated to recognise the effects of dementia. The Telegraph reports bank staff are to “look for dementia”, with Sir Win Bischoff suggesting he wants the bank to become “a dementia friendly bank”.

Great, but it is still not enough, we need ‘dementia friendly banking’. The abolition of cheques, closure of local branches, centralised call centres all over the world and the ever increasing need to remember a plethora of pin numbers and passwords is the antithesis to “dementia friendly banking”.

Arguably, the governments’ dementia strategy would also benefit from taking a much broader view on how to improve the lives of those affected by dementia. For example our biggest assets are the networks of support around us. These help reduce social isolation, and subsequently reduce the high levels of depression which often co-exist with a diagnosis of dementia. Family friendly work policies, such as affordable child care, flexible working and a decent wage would do much to support the inter-generational family approach to dementia care that many families are currently struggling to maintain. A dementia friendly housing strategy could make a significant difference, firstly in terms of provision for those with a diagnosis of dementia, and secondly, by enabling families to buy affordable homes in areas where they already have family networks. Instead of having to move away from older relatives, due to lack of job prospects and unaffordable housing costs. Both of these might then allow resources to be directed to those without networks of support. Arguably to “combat” the negative effects of dementia we need to take a whole systems approach.

Government and communities working together is vital to the future of all those touched by dementia. “Fighting” talk is all well and good but will amount to nought without a comprehensive strategy and adequate resources to support it’s delivery.

Improving care for older people is about building a relationship based system of care…..

More headlines confirm what we must all know by now, surely. The care for some older people in the UK today leaves much to be desired.

Old age must now be more feared than death!

Ultimately good care is about the relationship between the carer and cared for, and that involves the development of an emotional attachment that goes beyond our current ‘task’ focused system. Relationships are, in my opinion, the missing link in delivering compassionate care.

Traditionally successive governments have tried to ‘codify’ practice to make it ‘professional’ and ‘commoditized’ care to make it a deliverable ‘product’. Putting such frameworks around practise makes problems in the care system easier to talk about and resolve, i.e we need more training for carers, more training for leaders and managers, different providers, a mixed economy of care etc. However, what we are not talking about is relationship based care focused on supporting the emotional aspects of care provision.

There is no doubt in my mind caring for older people can be difficult,I’ve written before on ‘social defences‘ used in professional practice to help carers protect themselves from the emotional and psychological stress they can experience when caring for vulnerable people. Our organisation and delivery of care services facilitates the maintenance of such social defences by reducing care into individualised elements where a succession of carers carry out particular tasks, and so we lose sight of the person. However, by developing a system designed to keep relationships ‘professional’ we have lost the key ingredient to delivering compassionate care. For those on the front line this must lead to very limited levels of job satisfaction and feeling one has made a difference to someone’s life, which is often the primary reason individuals choose to enter the caring profession.

In the Netherlands they use a model called ‘complete care‘ in the care of older people. This involves developing relationships with people, not carrying out care tasks on a patient.

Such an approach can cost more, in the short-term, but in the longer term the potential of fewer hospital admissions, reduced levels of depression and isolation of older people, along with lower levels of stress and burn out of carers, resulting in sick leave and expensive locum/bank nurse cover, must work out far more cost efficient (but more importantly ethical).

To achieve relationship based care will require a reorganisation of systems and structures currently in place, for example work rotas’, shift patterns etc. The cost of such a reorganisation could be off set by the impending spending by the NHS on privatisation and on commissioning costly training programmes. Yes training is always required but please focus on key people and problems. (The NHS sadly takes the ‘hospital gown’ approach to training – designed for everyone and fits no one!)

If we really want compassionate care we need to focus on building a system built on developing healthy relationships, not targets and tasks.

It is time to give professional carers the support to do the job they thought they were training for.

Will welfare reform result in a ‘two nation’ society?

Di Galpin

As David Cameron makes a U-turn on cigarette packaging and George Osborne finally understands government does sometimes need to intervene in the free market will others follow?

Our ability as an individual to stand against the power of big business is limited to say the least, however, some on the Tory right still expect individuals to form a ‘government of self’ and develop individualised systems of social protection (via ‘big society’). Such personal independence is beyond the reach of many.

However, David Cameron and George Osborne appear to have finally grasped that for ‘big society’ to truly thrive an active state is a necessity.

Commentators are suggesting Osborne is playing social democratic catch up on pay-day loans as the Conservatives have realised Ed Miliband has struck a chord with voters by focusing on the way markets are rigged against consumers.

Yet the prevailing ideology of the right is so strong…

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