Monthly Archives: October 2017

Government claims “families are too selfish to care for their ‘elderly’ parents”… Really?

Government minster, Phillip Lee, suggests families in Britain  are too selfish to care for their ‘elderly’ relatives.

Whilst there are ‘selfish’ people in society from my experience of coming into contact with primarily women trying to care for older relatives, successive governments policies and economic strategies has done little to support them in this task.

The Carers Trust provides some insight into the demographics of care in the UK. Their figures suggest

  • 58% of women are carers
  • 1 in 5 people aged 50-64 yrs of age is a carer in the UK
  • 60% of carers have used all their saving to cover the cost of care
  • 61% of carers have to borrow money to make ends meet

From my professional, and personal experience, I have found caring for older parents tends to fall upon women between the ages of 55 and 65 years of age. These women are also carers of their grandchildren, because their children cannot afford the high cost of childcare and/or afford to pay high rents due to unaffordable housing, or to afford a large mortgage due to inflated housing costs linked to government policies.  Reports suggest many families would have to give up work if grandparents did not help out with childcare. Also we need to keep in mind many of these woman are also trying to support themselves, because they now have to continue to work until they are 67 yrs of age before they can get a pension.

So, Mr Lee, we have many  women in the UK today who still work to support themselves, they support their children, their grandchildren and their ‘elderly’ parents. They are not rich women, they often work in low paid jobs, physical jobs, with no professional pension to fall back on.

Indeed in my view these women are heroes, and on top of that they contribute to the estimated £132 billion unpaid carers save the tax payer every year.

So I think it would be nice if these heroic women were recognised and thanked by the Minister.

 

 

 

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To deliver good, safe, sustainable care, leaders need to think beyond traditional boundaries ……

Our care system is at breaking point. People are struggling to find a good care home when they desperately need it. With demand for beds set to rise, the time for action is now. Help us convince the regulator to confront the care crisis before it’s too late.’ (Which?)

CQC have confirmed in their State of Social Care report the problems many requiring social care already know, the system needs reform.

As Which?  and CQC yet again bring to government and wider societies attention to the problems and poor levels of care some older people experience, one wonders will we ever get to grips with this issue? The transformation of ‘care’ into a commodity that can be bought by families and those who use services, like any other product, dominates current health and social care reform, however, discussion on what ethical principles underpin the delivery of such care has not emerged. This raises the question for me, is it wise to continue to build a system of care provision with no clear ethical foundation outside of that of the free market? Arguably, we need greater ambition in developing great care for older people and a more strategic approach to make real improvements. But how?

Developing ethically sustainable care for older people

Drawing on the ecology movement sustainable development is defined as “development that meets the needs of current generations without compromising the ability of future generations to meet their needs”. This captures two relevant issues; the need to support those older people currently requiring care, without compromising the future of the care system.

Need, capabilities and the ‘good life’

A first step in developing ethically sustainable care involves reframing our understanding of ‘need’. Need in a health and social care context is often used to refer to a function to be fulfilled, i.e. nutrition, physical care. Such needs are viewed as a necessary condition for survival. However, we should also view older peoples’ needs in terms of security, respect, love and justice.

The failure to distinguish between different types of need has led to limiting our understanding of how to care for older people, and has subsequently influenced how service provision has developed. Amartya Sens’ concept of ‘capabilities’ provides an alternative approach Sen is concerned in this model with identifying what individuals require to flourish and live a ‘good life’. In this model it is recognised older people require different capabilities to flourish, depending on their personal circumstances and the community they live in, whether that community is within an in-patient/residential setting or in the wider community. Successive governments’ appear to believe an expansion in a consumer culture within health and social care provision is the only route to a ‘good life’ for older people, as it enables individuals to increase choice and control by becoming consumers of care, rather than receivers of care.

Yet many older people are clearly not flourishing in a culture that defines the good life in terms of their ability to engage as a ‘customer of care’. A more useful way of thinking about this, from an ethical perspective, links Sen’s idea of capabilities and Aristotle’s vision of the ‘good life’. From this perspective achieving quality of life is central, rather than just meeting physical needs. In other words it is not just about achieving an ‘average’ notion of well-being but about the opportunities available to the individual which will enable them to develop their full potential, whatever that might mean for that individual.

This approach moves beyond ensuring older people have the ability to flourish to consider whether they are actually flourishing. Commentators suggest there are five areas in which older people need to flourish to live a good life, regardless of where they live. These are: belonging to a family; belonging to a community; having access to material goods for sustenance, adornment and play; living in a healthy environment; and having a spiritual dimension to life. Arguably the commissioning and delivery of service provision based on achieving these five areas might enable older people to receive care that is both compassionate and dignified.

The way forward

Conceptions of what constitutes a good life are varied, however, within health and social care provision it is prudent to assume a good life involves at a minimum care provision that is not abusive to older people.

Within the public sector the organisation and delivery of care is structured to focus on the meeting of targets rather than enabling an individual to flourish. The health and social care sector is arguably over managed and under led. In the private sector it could be argued a free market economy contains structural incentives for business to pursue a notion of the good life that supports the sale of a narrow range of care ‘products’, whilst there are not mechanisms in place to ensure the market operates within a clear ethical framework outside of the profit ethos.

By not actively endorsing care provision from an ethical stand point the government and regulatory bodies may actually be unwittingly aiding the abuse of the most vulnerable within the care system. A shift in focus from human need to human flourishing has already begun with the development of the personalisation agenda and emphasis on voice, choice and control however, this agenda has been overshadowed by a managerial approach to consumerism and consumption in a low paid, low status care system and this is undermining the ability of the care system to develop ethically.

Markets versus Values

Michael Sandel argues markets are not a mere mechanism designed to deliver goods, they also embody certain values, and the problem is these values ‘crowd’ out non market values like compassion and dignified care. Where values and ethics are weak we need a strong and active state to intervene, where both are weak those most vulnerable in society will continue to be exploited and abused. This begs the question can we afford not to have an ethical care system?

 

Social Work education; is there a future under neoliberalism?

As an ideology, neoliberalism perpetuates the belief that the market cannot only solve all problems but also serves as a model for structuring all social relations. It is steeped in the language of self-help, choice and individual responsibility,   purposely ignoring the effects of  inequalities in power, wealth and income and how these shape individuals and families lives. As such, it supports a society which cruelly others those who require support, and is scornful of a critical and politicised social work profession founded on compassion and notions of social justice, equality and respect.

Back in 2013 Michael Gove, then education secretary, claimed too many social workers had been filled with idealistic dogma and theories of society that viewed people as victims of social injustice. Gove vowed to “strip this sort of thinking out of the profession”.

More recently Ray Jones argues politicians are stealthily trying to take control of social work, possibly because social workers expose the failings of their ideologically driven policies?

Maybe this is why Government would like to diminish the role of Universities in social work education, to depoliticise the profession and create a beige curriculum.  A painting by numbers programme of training, rather than a vibrant colourful education that prepares social workers to support, and challenge those in power. The extension of neoliberal ideology and discourse into higher education already provides a framework to socialise academia into working in a manner akin to managerialism i.e targets/NSS, where knowledge is viewed as a commodity for customers (students) to purchase and consume.  Packaged as one dimensional capabilities rather than multifaceted knowledge and skills .

(see Grant and Radcliffe, 2015, whose paper on higher education in mental health nursing has many synergies with social work).

Arguably an effective social work profession is a political profession as well, able to critique and analyse, to challenge, rather than accept the status quo.  As Henry Giroux eloquently states

“At a time of increased repression, it is all the more crucial for educators to reject the notion that public and higher education are simply sites for training students for the workforce, and that the culture of education is synonymous with the culture of business. At issue here is the need for educators to recognize the power of education in creating the formative cultures necessary to challenge the various threats being mobilized against the ideas of justice and democracy, while also fighting for those public spheres, ideals, values, and policies that offer alternative modes of identity, thinking, social relations, and politics.

Pedagogy is always about power, because it cannot be separated from how subjectivities are formed or desires mobilized, how some experiences are legitimated and others are not, or how some knowledge is considered acceptable while other forms are excluded from the curriculum.”

Whilst we have a plethora of educational routes into social work, Frontline;Think Ahead;Step-up;Apprencticeships and HEI’s no one appears to be asking any political leader of any persuasion one very important question as far as I can see.

Given our politicians feel their governments policies and leadership over the last 3 decades has led to continuous improvements, why is society in such need for ever increasing numbers of social workers?

If we can move beyond the divisive  narratives of  ‘broken families’, ‘recruitment and retention’, ‘the demographic time bomb’, ‘austerity’ and ‘we can’t afford X’,  and consider addressing the structural issues that impact on individuals lives, such as housing, benefit reforms, energy prices, the environment, job insecurity, food insecurity, low wages, affordable higher education etc, we might then be able to formulate a different ideology, a different discourse, one that unites us for the good of all.