Category Archives: Social Care

What is the point of choice in care, if your choice is between an inadequate care provider or one requiring improvement?

As CQC finds 32% of facilities in England inadequate or in need of improvement and says social care in ‘precarious’ state one wonders will we ever get to grips with this issue?

This latest report suggests

social care is in a “precarious” state – and according to Age UK the results leave elderly people and their families “playing Russian roulette” when they choose a nursing home or other care service. Inspectors making unannounced visits to care homes found medicines being administered unsafely, alarm calls going unanswered and residents not getting help to eat or use the toilet. Some residents were found to have been woken up by night-shift care workers, washed and then put back to bed, apparently to make life easier for staff

This is not just poor care but adult abuse.

Governments response is to promise more money for social care, however, I feel we would be foolish to rely on the same old political rhetoric. This amounts to no more than economic deception as successive governments continue to adhere to the neoliberal principles of the quality and responsiveness of free market provision and consumer choice. The current approach is failing to deliver either of these fundamental neoliberal principles as the care ‘market’ flounders.  According to research, carried out for BBC Panorama by Opus Restructuring and Company Watch, the care ‘industry is in crisis with 69 home care companies having closed in the last six months and one in four of the UK’s 2,500 home care companies is at risk of insolvency.

Anyone reading this who has sought to purchase care for their relatives can attest to the lack of ‘choice’ the current system provides. Indeed most would forfeit ‘choice’  to just have one provider who we can trust to provide decent care for our loved one’s.

What is the point of choice if your choice is between an inadequate care provider or one requiring improvement?

The primary issue, for me, is that care should never be treated as an ‘industry’ because the conflation of care and profit should never ever have occurred because marker values have altered our understanding of the value of humanity in care. Arguably, the discussion needs to go beyond financial issues to consider the greater deception of successive governments who have consistently ignored their failure to develop an ethically sustainable approach to the care and support of those requiring care, especially older people.

Let’s be honest, growing old in the UK is not for the faint hearted when we consider research and inquiries over the last decade. Action on Elder Abuse have consistently highlighted the prevalence of abuse older people experience in the community, leading in 2016 to the publishing of a ‘dosier of shame’ which outlined how the abuse of older people frequently go unpunished.

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 (WRVS,210). The report 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 (WRVS, 2012, p.8).

This all provides a troubling vision of older people’s experience of ageing in the UK.

Successive Governments in the UK tend to address issues associated with care and an ageing population in individual ‘silos’.  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 develop more successful policy approaches, which improve our care provision and the experience of ageing.

However, any action needs first to move away from the dogma of neoliberalism and take a long term approach with a strong ethical, rather than financial, foundation.  This needs to be founded on a commitment to promoting care as a humane act rather than promoting the care of those most vulnerable as a  product to be bought, sold and profited from.


A Trade in People: the ‘free market’ is failing us all …..

Arguably, the ‘free market’ is anything but ‘free’ with  the cost to many in society excessive in terms of compassion and inequality.

A report published by Lancaster University  entitled ‘A Trade in People’ expresses the failure of the free market in providing services to those most vulnerable in society when it writes

‘it is clear to us that the way in which the healthcare economy has been encouraged to develop by recent governments turns people into commodities and liabilities. For local authorities and CCGs they are liabilities that they have often sought to export to other areas and for independent hospitals they are a commodity and source of millions of pounds of income and profit.’

Whilst an economic and political system premised on the commodification of people and neoliberal theory maybe a reliable form of wealth generation for some, it is also associated with little compassion for those who require support, as well structural inequality and poverty for many.

Nobel prize winning economist Joseph Stiglitz is clear, we are now engaged in a battle which is ideological, describing free market neo-liberalism as  a stifling economic ideology which has run it course.

Neoliberalism has an insidious presence in our lives, much like the air that we breathe, everywhere, yet unseen. George Monbiot  provides a compelling argument against this ideology, which values the free market as the place in which citizens can exercise their democratic choices through consumer choice and the private provision of goods and services.    Supporters of neoliberalism maintain  “the market” delivers benefits that could never be achieved by government, and that the more unregulated the market, the better the efficiency. Within this framework everything we do, and every person is a potential commodity that can bought, sold and traded for profit.

However, for me,  the free market  is associated with a loss of compassion, dignity and respect for one another as an inactive state projects structural failure onto the individual, along with an outdated mantra of ‘private sector good, public sector bad’.

One need not dig too deep to see the flaws within the current system. The research by Lancaster University adds to a plethora of  reports, all stating the same thing. This system is broken!

Just consider  housing and the care of older people to establish the limits of the free market.

Shelter’s report on the barriers low-income households face in private renting exposes the private housing  market’s limitations,  clearly arguing significant government intervention is needed if it is to play an expanded role in preventing homelessness and housing people on low incomes.

The same issues arises in the care of older people, where significant market failure is a continuing problem.

Over two years ago the King’s Fund  highlighted what many in the sector already know, the free market is failing stating

‘Social Care is now a complex and sprawling sector – more than 12,000 independent organisations, ranging from big corporate chains to small family-run businesses, charities and social enterprises, which makes the NHS provider landscape look like a sea of organisational tranquillity. Less than 10 per cent of social care is actually provided by councils or the NHS – their retreat from long term care provision is virtually complete. But unlike the NHS, when a social care provider hits the financial rocks, bankruptcy not bail-out is the more likely scenario.  But a deeper problem is the failure to think through the consequences of shifting the bulk of our care provision to a private business model’.

This is supported by  Andrew Dilnot , former drector of the Institute of Fiscal Studies, who suggests social care is is a classic example of a market failure where the private sector cannot do what’s needed.

However, the effect of the failure of the free market and neoliberal ideology extends beyond money,   the real effect of failing markets rests upon the poorest and most marginalised in society, like the  residents of Grenfell Tower and those with social care needs in private institutions, the frail and vulnerable who require support.

The problem in government today is that many of those who govern this country are woefully out of touch and too quick to blame individuals for their descent into a commodified system of care, rather than look at their own role in the rising tide of compassionless care which threatens us all.

Michael Sandel argues the free market is not just a mere mechanism designed to deliver goods, it also embodies certain values, and the problem is these values ‘crowd’ out non market values which are really worth caring about and preserving, such as compassion’.

Where values and ethics are weak in any system which seeks to support those in need, we need a strong and active state to intervene, where both are weak those most vulnerable in society will continue to be denigrated and exploited.