Tag Archives: compassion fatigue

The ‘Big Society’ will not necessarily lead to better elderly care treatment by @dianegalpin

A fantastic blog by our senior Lecturer Di Galpin for LSE Policy and Politics Blog a recommended read!!!

The ‘Big Society’ will not necessarily lead to better elderly care treatment.

Di Galpin looks at the Big Society from a philosophical standpoint and questions whether it can be achieved without encouragement from an active state.

There is a million reasons why ‘big society’ and ‘choice’ are not enough when providing care to older people

Research suggests as many as 500,000 older people are abused each year (Action on Elder Abuse), in the main by those supposed to be providing their care.  Therefore, since the election in May 2010 up to one million older people may have been abused.  

This information is not new, successive governments have been aware of this issue for many years but all have stopped short of introducing a coherent legislative framework to protect those most vulnerable in the care system.  The coalition appear to believe in the power of ‘big society’ and service user and patient ‘choice’ in a market led health and social care system.  My difficulty with this approach is it offers nothing new,  it looks no further than the rhetoric of the ‘free markets’  beloved of every government since Thatcher.  Nobody appears interested in thinking deeper and developing care from a philosophical perspective.  Surely we need to understand what motivates us to care before we can reform the system ?

Historically societal attitudes toward older people have always been poor.  In ancient Greece old age was portrayed as sad with historians arguing the Greeks love of beauty marginalised the old, especially women, sounds familiar!  Cicero’s work De Senecute, written in 44BC, pointed to a variety of individual experiences of ageing, however acknowledging that for those who were poor and without mental capacity ageing is miserable.  Sadly, all of this is still true today with research suggesting those at greatest risk of abuse and mistreatment are elderly women suffering from some level of dementia.  This,  along with the fact that the abuse and mistreatment of older people is a global issue identified by the World Health Organisation over a decade ago, suggests the issue  extends well beyond political systems and party politics in the UK.

I’m with social contract thinkers Hobbes (1588-1679) and Locke (1632-1704) when they suggest as human beings we are inherently selfish and our individual pursuit of pleasure is destructive to society, suggesting the law can be used as an apparatus to modify such human desires.  In my view the  continued economic approach to health and social care has fed such selfishness, to the detriment of certain groups in society, i.e. older people,  and we now require a strong lead from government.

Successive governments since Margaret Thatcher have relied on a consumerist approach to improving the quality of health and social care provision. The question is has turning vulnerable older people into consumers improved their care?  For some yes, but for many of the most vulnerable older people in society, those older old people with dementia and who are frail, I’m not so sure.  However, what it has done is hide the abuse and mistreatment of older people from collective view for the last 30 years, and led society to engage in debate that does not move beyond the financial.  Research suggests this has had a detrimental effect on the moral health of society and academics are now suggesting the use of market mechanisms can change people’s attitudes and values, having a  ‘corrosive effect’.    Michael Sandel makes a pertinent point suggesting

It calls into question the use of market mechanisms and market reasoning in many aspects of social life, ……to motivate performance in education, health care, the work place, voluntary associations, civic life and other settings in which intrinsic motivations or moral commitments matter‘ (What money can’t buy, 2012, p122).

So what can we do? Helen Sullivan suggests ‘a big society needs an active state’.   A useful first step would be for government to accept the Law Commissions recommendations on reforming the law in respect of Safeguarding Adults without delay.  Secondly, abandon the rhetoric of ‘choice’ and ‘free markets’  and develop a meaningful dialogue based on concepts such a honesty, morality and dignity from a philosophical  rather than financial perspective. A new approach might be to have a dialogue that goes beyond party politics (and winning the next election) and begins by asking big society what it wants to afford, rather than politician telling us what we cannot afford.

I am sure many will say we cannot afford to reform the system on philosophical grounds, I would ask those individuals “can we morally afford not too?”

Have we reached the point of ‘compassion fatigue’ when it comes to the abuse of older people?

The BBC will broadcast shocking images of abuse on Panorama whilst the Telegraph suggested last year the treatment of older people in care is now so bad that it meets the legal definition of torture according to the Governments own human rights watchdog (John Bingham, 5th March 2012). How many more news reports do we have to watch and read before society and government decide to react with more than short lived outrage or have we reached the point of ‘compassion fatigue’ when it comes to the abuse of older people?

The BBC’s Panorama (17th June 2013) will make for shocking, and saddening,  viewing on the care of older people in Britain today. Sadly this is not new to many of us who have worked in the care sector. Yet our voices have gone unheard, leading to many, such as myself, leaving the profession.

Unfortunately the abuse of older people is not confined to hospital and residential settings, it is estimated up to 340,000 older people in the UK are abused each year in their own homes. The abuse of older people now parallels that of children with many experiencing emotional, psychological, physical, sexual and financial abuse perpetrated against them by those charged with providing care and support, for example, partners, wider family and professional carers.

This most recent report of abuse appears after many others, highlighting the disgraceful treatment older people experience from those supposed to be proving their care, whether at home, in hospital or residential care. A report by the Health Service Ombudsman on the abuse of older people in hospital settings suggests there is a culture of indifference from both government and staff to the abuse of older people.

The Independent commented:

“For a while we may pause to express outrage. But we then move on to the urgent business of our daily lives. Spot checks and hit squads may arrest the worst practice…..But they will not do much about a society that has hardened its heart against the elderly.”

Doing nothing is not an option. The review of adult social care law undertaken by the Law Commission in 2011 made clear to government the law pertaining to the protection of vulnerable older people requires strengthening as the current framework is clearly not working. However, this alone will not address the issue. The current discourse on the care of older people also needs to change, we have reached the point where ‘cost’ is king, every aspect of care for the elderly is framed in the language of economics. Government and society are so focused on the cost of care they have lost sight of the value of caring to society, from a moral and ethical perspective. Replacing values such as dignity and respect in care with ‘value for money’ has reduced older people to a percentile of spending of tax payers money, rather than being viewed as actual people, people who at some point may require additional help and support, through no fault of their own but as a natural process of ageing. Indeed the focus on cost diverts our attention from the real issue, we as a society are, at best, indifferent to the plight of older people.

Our ability to watch abuse captured on film in care settings and read report after report yet do nothing to change our attitude is disturbing, maybe society is experiencing ‘compassion fatigue’? If this is the case old age is to be more feared than death!

Real change can only occur if built on a foundation of respect for older people. Developing a culture of dignity and respect for older people requires more than codes of practice to guide the carers who look after our older people. We all have to develop a much deeper understanding of what ‘dignity’ and ‘respect’ actually mean and how we demonstrate dignity and respect to one another, starting firstly with ourselves. Arguably if individuals respected themselves they would not allow themselves to act in such a way that is abusive to those they care for. It would also help if we respected carers by paying them a wage that genuinely reflects the complex nature of the work they do.

It is with shame that we should read the treatment of older people in care is now so bad that it meets the legal definition of torture according to the Governments own human rights watchdog. How many more programmes showing carers abusing those most vulnerable must we watch, how many more people have to suffer before society and government decide to react with more than short lived outrage?