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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.

Grenfell Tower represents the culmination of Thatcher and all who follow in her neoliberal footsteps ….. Time for change

Commentator, after commentator have made political links to the manmade tragedy that befell the innocent residents of Grenfell Tower. Within such commentaries the authors refer to the ideology of ‘neoliberalism’, which whilst well known to economists, politicians, Guardian readers and academics (like me!) is rarely thought about in wider society. Yet its impact on society over the last 40 years is immense, and for me Grenfell Tower represents all that is wrong with this insidious ideology that does more harm than good.

But, what it is?

Firstly, I think it is important to be aware of the power of  ideology, and neoliberalism, because it provides government with  a  framework which shapes its ideas, ideals, values and beliefs about the world, what motivates individuals, and provides a guide on how life should be lived, how society should be structured and our role in society.

In short it determines the nature and limits of that state, what matters and whom.

An example of the power of ideology can be seen in religion. Religious values and beliefs  shapes its organisation and provides motivation for the actions of its leaders and believers. As we know all to well religious ideology can lead to intolerable acts of violence, whether it be the Christianity of the  Klu Klux Klan or the Islam of ISIS.

Just as religious ideology can be a strong motivator in shaping thoughts and actions, so to is the  political ideology of neoliberalism.

There are a number of strands to neoliberalism which are, arguably, as relevant as the cladding on Grenfell Tower in understanding why so many lives have been destroyed. In political terms neoliberalism depends on, firstly, stigmatising those who require support and then disinvesting in the public services that provide their support to promote open unregulated markets and the transfer public services into the free market.

This has resulted not only in the deregulation and privatisation of publicly owned assets, such as housing, but also the transfer of responsibility for those requiring public services away from government, so that when, as in this case, there is a failure in the system,  holding someone to account is almost impossible due to a diffused chain of responsibility government has put between it, and the individual,  by creating a host of intermediary layers of officials and organisations , such as management companies, contractors and sub-contractors.

A key tenet of neoliberalism is the role of free market in delivering everything from baked beans to iPhone to cancer care. The free market is highly valued by neoliberals because it is viewed as a more efficient system in providing goods and services and promotes individual liberty by empowering society through consumer choice.

In the case of Grenfell Tower, the extremes and limitations of these beliefs are starkly revealed. Not least in Brandon Lewis’s comments regarding regulation to enforce the installation of sprinkler systems in tower blocks.

Mr Lewis, recently promoted to immigration minister by Theresa May, had declined in 2014 to force building developers to fit sprinklers. The coroner’s report into the 6 deaths after a fire in a block of flats at Lakanal House had recommended regulations be updated, and called for developers refurbishing high-rise blocks to be encouraged to install sprinkler systems. But five years later, Mr Lewis told MPs:

“We believe that it is the responsibility of the fire industry, rather than the Government, to market fire sprinkler systems effectively and to encourage their wider installation.”

He said the Tory government had committed to being the first to reduce regulations nationwide, pledging a one-in-two-out rule. He added:

“The cost of fitting a fire sprinkler system may affect house building – something we want to encourage – so we must wait to see what impact that regulation has.”

Even after the controversy when these comments were publicised  Micheal Gove’  still held to the neoliberal ideological line when interviewed in respect of Grenfell Tower, suggesting that it is a matter for “debate” that government should regulate so that people could have safe housing conditions.

Whilst some might find such comments incredulous, these responses are wholly consistent with neoliberal ideology, which promotes the commodification of everything from  housing to education to health, to social care and more worryingly clearly includes ‘risk’.      This combined with limited regulation of the free market and an unshakable belief that all consumers can exercise free choice  to control, or eliminate,  risk is concerning.

Those in power do not seem able, or willing, to recognise there are  flaws within the neoliberal  ideology they so zealously adhere to, that authentic consumer choice is often a facade in important areas of life, such as housing and health and social care, that individuals cannot always eliminate risk because of the governments hand in creating structural inequality, which restricts the individual autonomy and consumer choice they purport to support, unless, of course you are very wealthy.

The powerlessness of the residents of Grenfell Tower to exercise autonomy and choice is seen in their inability to challenge decisions around whether a sprinkler system should have been installed and this exposes the interplay  between the structural and personal realms of life. Peter Weatherby QC is one of Britains top lawyers, and he suggests a key action of government had been overlooked in this tragedy, the swinging cuts to legal aid. Residents of Grenfell Tower had sought to challenge  decisions being made, and residents did try to get a lawyer, however,  they could not get a lawyer because of cuts to legal aid, according to campaigner Pilgrim Tucker, speaking on BBC Newsnight

“These are poor residents – or they’re ordinary residents. They’re not 
the wealthy. They’re not the Camerons. They can’t afford private 
schools, they can’t afford lawyers. They tried to get lawyers but,
because of the legal aid cuts, they couldn’t get lawyers. ”

Other lawyers have also pointed out the role of legal aid cuts in this tragedy.

However, again, this is consistent with neoliberal ideology, why should the state fund legal aid?

This is actually structural abuse, which is defined as ‘the process by which an individual is dealt with unfairly by a system of harm in ways that the person cannot protect themselves against, cannot deal with, cannot break out of, cannot mobilise against, cannot seek justice for, cannot redress, cannot avoid, cannot reverse and cannot change’

I think this sums up the plight of the residents of Grenfell Tower pre and post fire!

Albert Camus wrote “We must mend what has been torn apart, make justice imaginable again in a world so obviously unjust….. ”, going onto suggest mending a broken world is ‘steadfast, often unglamorous work – it is the work of choosing kindness over fear, again and again…’

To mend the broken in this society,  those marginalised through poverty and  homelessness, or through age and fragility, to ensure we never subject anyone to the horrors of those lives ruined in Grenfell Tower we all need to be more aware of the ideology that underpins our current system of government and decide if it is fit for purpose, and where we find it lacking, find new ways of governing.

Replacing Theresa May with Boris Johnson or Micheal Gove or A.N . Other will not mend our broken society because politicians all seem to adhere to the same ideology – neoliberalism.  Nothing will change until this insidious ideology is revealed and challenged by us the people, and we hold our politicians to account for their actions.

Let the fate of the individuals of Grenfell Tower be a lesson to us all, and lets ensure their tragedy is never forgotten. We need real change for all our futures.

Tories brand millennials as ‘hard left’ – good! It’s time for real change ….

A recent headline in the Daily Telegraph suggests something needs to be done to save young voters from the ‘hard left’ ….

The article in The Daily Telegraph suggests the young  need reminding of the benefits of a Neo-libeal economic system. Stating ‘millennials’ need to be reminded that the free market has filled their world with iPhones, Just Eat deliveries and  internet dating, and they should be thankful!

The benefits of the free market and a neoliberal economic system are further extolled by the author suggesting  free markets create the wealth to pay for the welfare state.  Not wholly the case, I thought the disproportionate tax low earners pay, compared to the rich, also funded our public services?  The free market also provides full employment, the author suggests, although it does not mention the multitude of jobs with no future or meaning the young languish in, zero hours contracts, low wages and ongoing insecurity which prevents millennials seeing a future, let along planning a future.

Ways of wooing millennials away from the ‘hard left’ are explored, firstly by tackling extortionate student loan interest rates, increased this year to 6.1%.  Ummmm, hasn’t neoliberal ideology,  making education a commodity to be bought and sold like baked beans,  created the student loan process in the first,  and given providers free reign to set interest rates? Tackling rising housing costs is identified as another area to focus on to woo millennials away from the ‘hard left’.  Ummmm, aren’t rising housing costs due to the free market and Neo-liberal ideology also?

These minor points aside….., there are further  suggestions, such as  millennials should be given shares for nothing, and government should deposit £10,000 in an Isa for 18-30 yr olds.  Not sure how this would be funded, but possibly from  the much maligned ‘magic money tree’ ….. which should’nt be a problem as our hard up government managed to magic up £130 million for a snap election we did not need!

Another fab suggestion is that millennials should be given a copy of Hayek to inform them of the positives of  neoliberalism and the free market.  The same system that has led to nearly 10 years of austerity, tuition fees, unaffordable housing, increased use of food banks, zero hour contracts  etc etc ….???

I wonder if hard left millennials might like to read something that offers an alternative perspective, albeit from those pesky lefty Nordics.   The United Nations World Happiness Report 2013 shows that the happiest nations are concentrated in Northern Europe. The Nordics are ranked highest on the metrics of real GDP per capita, healthy life expectancy, having someone to count on, perceived freedom to make life choices, generosity and freedom from corruption. Imagine freedom from corruption…ooh arrgggh

Neo-liberalism is all pervasive, it is like the air that we breathe, invisible and ever present, but, increasingly only life enhancing for the rich elite. As George Monbiot suggests

We internalise and reproduce its creeds. The rich persuade themselves that they acquired their wealth through merit, ignoring the advantages – such as education, inheritance and class – that may have helped to secure it. The poor begin to blame themselves for their failures, even when they can do little to change their circumstances.

Never mind structural unemployment: if you don’t have a job it’s because you are unenterprising. Never mind the impossible costs of housing: if your credit card is maxed out, you’re feckless and improvident. Never mind that your children no longer have a school playing field: if they get fat, it’s your fault. In a world governed by competition, those who fall behind become defined and self-defined as losers.

All I know is I am thankful for the voice, and votes, of our millennials, because you are giving me hope for the future …. Thank you.

 

 

 

 

 

Who pays for the obesity crisis …..?

‘The real cost of poor quality food should include the cost to the NHS in diet related illness, but of course the food industry do not pay the true cost for this, this is disproportionately displaced onto the individual consumer via the taxes we pay to fund our health care system….’

As Channel 4 ,  Dispatches , highlights Theresa May’s watering down of governments obesity strategy it is time to reframe the discourse on ‘obesity’.

Regulating the food industry is about more than people being ‘fat’, it is about the role an active state should play in society and the fallacy of ‘choice’ as a panacea .

The current discussion on the food industry must not be overshadowed by the ‘obesity’ debate because there are much bigger issues at stake here, not least the accountability of the food industry and the role government should have, if any,  in regulating the food industry to protect the health of the nation.  By narrowing the focus on obesity we risk  reducing the debate to stigmatizing those who are overweight, and focus too much on individual responsibility.  For once could  the debate also include corporate responsibility.  Whilst Politicians might make noises about supporting free ‘choice’ I would rather see decisive action from government because I trust the food industry about as much as I trust the banking industry, which is zero percent.

Just look at the food labelling debacle, which dragged on for over two decades  The coalition government announced in October 2012 that a consistent system of food  labelling  was set to be launched, however, it was not quite a done deal with food producers still holding back.   Cadbury, amongst others, spurned the ‘traffic light’ system suggesting it focused too much on the negative ingredients in their food, i.e. sugar.….REALLY!

But it is not just about food labelling, more importantly it is also about the food production process. For example research suggests high salt intake is associated with significantly increased risk of stroke and cardiovascular disease, so to reduce risk just reduce salt in take, easy.  However, the same research also suggests high levels of salt intake is related to food production processes, rather than individuals adding salt to their diet, and the biggest barrier to reducing significant salt intake for individuals  is the historical reluctance of the food industry to reduce the levels of salt used in food production.

The seriousness of this issue must not get lost in tabloid headlines about ‘obese’ people.  Any talk of government taking an interventionist approach is met with cries of ‘nanny state’ from the Tory right who use this as a pejorative term to describe excessive state action.  Those who support free markets object to the use of state power in this way perceiving such an approach as restricting individual choice.

Governments approach to this issue is ideological, whilst for some intervention from government represents the worst excesses of the ‘nanny state’, to others it represents an ‘active state’ coordinating an approach to promote public health for its citizens, rather than protecting big industry from taking responsibility for its actions.

A first step might be to regulate the removal of excessive sugar from food production, this would  benefit public health. We need such intervention because we can not trust the food industry, the average consumer can not fight against the unethical and unhealthy practices of large corporations. I feel very strongly the government should undertake a strategy akin to tackling the tobacco industry, because the potential damage to our health from sugar added to our food parallels that of nicotine.

A rise in the cost of food is an interesting argument presented by government and the food industry as an argument against healthier food production. The real cost of poor quality food should include the cost to the NHS in diet related illness, but of course the food industry do not pay the true cost for this, this is disproportionately displaced onto the individual consumer via the taxes we pay to fund our health care system (Do not even get me started on corporate tax evasion).

All most of us want is honesty and transparency, and maybe even an ethical approach in the food industry,  where our health is put before profit, is that too much to ask?

It would seem it is.

‘Old age,more feared than death’…… have we ever cared about older people?

Has there ever been a ‘golden age’ where older people were consistently valued, respected and protected by family and the institutions that make up wider society?

The World Health Organisation suggests the abuse of older people occurs in many parts of the world with little recognition or response. This serious social problem is often downplayed or hidden from the public view, and considered mostly a private matter. Even today, the abuse of older people continues to be a taboo, mostly underestimated and ignored by societies across the world. However, evidence is accumulating to indicate that the abuse of older people in the UK is an important public health and societal problem.

The full extent of abuse is unknown, however, its social and moral significance is obvious. As such, it demands an active response, one which focuses on protecting the rights of older persons, and a change in our perspective on whom, and what, we value in society.

Although representations of old age and societal responses to older people have differed over time it could be argued old age has always been viewed as negative.

In ancient Greece old age was portrayed as sad, with the Greeks love of beauty marginalising the old. Although some commentators suggest the reality was more complex with the portrayal of older people in the classics as ‘both pejorative and complimentary’ (Thane, p.32). For Plato reverence toward old people was a guarantee of social and political stability, whereas Aristotle disagreed with such positive images. Cicero’s work De Senectute, written in 44 BC, points to the variety in individual experiences of ageing, acknowledging that for those who are poor and without mental capacity ageing is miserable, however, suggesting older people need to strive throughout their life to remain intellectually and physically able.

Arguably this belief still underpins social care legislation and policy today in respect of older people.

It has been suggested older people’s status in society is linked to their ability to participate in society from an economic perspective, especially in terms of activity in paid employment. Historically where older people have been unable to participate in paid employment, help and support has been provided through a mixture of family and state support, with an emphasis by government on the former rather than the latter. However, commentators suggest, post industrial revolution, another victim of change were older people. The old did not merely lose power, they also lost respect. The rise of the alms-houses, and institutionalised poor-relief, may indicate their children were increasingly shedding responsibility for their support and transferring it to the community.

Although Thane  argued, this may have been due to families own depths of poverty, rather than lack of care or a shedding of responsibility.

The abuse of older people was not something government identified as a problem throughout this period, although, self-neglect was identified as an issue which government sought to address in the 1948 National Assistance Act.

This is not to say it did not occur, for example, the 1942 Exceptional Needs Enquiry found most older people living with families were there under sufferance. They were often less well off than those who lived with strangers, and lacked essential items of clothing, bedding or household equipment as families used any provision, such as clothing coupons, for personal use. Whether this constituted abuse is not clear as many families who cared for older relatives were often living in poverty themselves and older people often willingly gave their families any support they could, even if this meant going without themselves. Of course, records do not exist to either confirm or deny whether such relationships were abusive or mutually supportive, however, it might suggest in terms of individual worth and personal identity, a cultural norm existed where the welfare of the younger generation was prioritised over that of the old by both young and old.

However, Peter Townsend’s landmark study  of long-stay institutional care for older people in 1950’s Britain, provides a little more insight into the experiences of older people receiving care. One of the interviews he recorded was with a matron of a small private residential home in Greater London, which Townsend suggested was by far the worst home he had visited, was clearly describing abuse, as defined in legislation today.

This suggests the abuse of older people has been going on for a long time. It is increasingly clear the abuse of older people exists, and as a society we cannot ignore it any longer.

CQC, older people & funding cuts:It’s not just about the money….

Di Galpin

As CQC yet again bring to government and wider societies attention the poor levels of care some older people experience, one wonders will we ever get to grips with this issue?

The latest report suggests cuts to social care,  mental health and public health mean “the NHS is being stretched to the limit,” said Stephen Dalton, chief executive of the NHS Confederation, which represents hospitals. “Relying on political rhetoric that promises to protect the NHS but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.”

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 older people.

Let’s be honest, growing old in the UK is not for the faint hearted when we consider…

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