Do the Media Really Care So Little about the Vulnerable in Society?

Last week (12^th Sept) the Health & Social Care Information Centre published their provisional report on the Abuse of Vulnerable Adults in England 2012/2013. (https://catalogue.ic.nhs.uk/publications/social-care/vulnerable-adults/abus-vunr-adul-eng-12-13-prov/abus-vuln-adul-eng-12-13-prov-rep.pdf)

The report reveals that of the 86,000 completed referrals to social services 43% were substantiated or partially substantiated.

That means around 37,000 cases of adult abuse occurred.

Yet the news reporting on this staggering statistic has been woefully small, there has been no obvious political indignation that such a large number of vulnerable people have suffered abuse and there has been no official comment from Westminster on the matter.

The statistics are similar to the previous year but that should not mean a lack of interest in protecting those who are vulnerable in society nor should it mean that the abuse of so many should become less news worthy. In fact there should be a national outcry that nothing has been done to reduce the number over the last year.

Another aspect of the released figures should also be raising eyebrows. Of the 86,000 completed referrals more than a quarter (27%) were inconclusive – neither substantiated nor unsubstantiated after investigation. And, while adult protection issues can be notoriously complex, this seems a high number yet there has been no call for an explanation of why this may be the case and what action is taken to protect those who may be at risk following an inconclusive investigation.

Do we really care so little about the plight of the most vulnerable in our society?

Obviously the Health & Social Care Information Centre can only publish the official statistics and given the high amount of abuse in them there must also be concern about the level of unreported abuse of vulnerable people. If there is so little news and Government interest in the numbers of those we know have been abused what is the likelihood of action being taken to help those who are vulnerable and abused yet unknown to the system.

There has always been a lack of interest in social care by the mainstream media and, for that matter, by central Government, yet it is people at their most vulnerable who are suffering from various levels of abuse who are left unprotected by Government and, importantly, by social pressure through the media.

This has to change.

How can we call ourselves a society when we ignore the needs of those who need our help the most and by allowing these levels of abuse to continue? How can the public know of the staggering numbers of people being abused if the media is not interested in them?

We need change but that change can only come if there is enough social pressure on politicians and that can only come from the media.

Do the media really care so little about the plight of the most vulnerable in our society?

Dear Jeremy Hunt, Focus on People with Dementia not just the Cost

Today the Government announced a G8 Summit on Dementia.

https://www.gov.uk/government/news/uk-to-host-g8-dementia-summit

While every effort to raise awareness of dementia has to be welcome, the tone of the press release announcing the event shows that the Government is more interested in cutting the cost of dementia rather than helping those who suffer from the condition.

The press release quotes Health Secretary Jeremy Hunt saying,

“Dementia requires long-term health and social care support that can be hugely expensive. Currently 70 per cent of the global cost is incurred in medically advanced nations like Western Europe and North America. But nearly 60 per cent of people with the condition live in developing countries. As their populations grow and age, the pressure on their services and budgets will inevitably increase.” &

“The G8 today have a unique chance to come together to help people manage dementia better, lead healthier lives and deliver real improvements in care and substantial economic savings.”

Yes the increase of the numbers of people with dementia will put pressure on budgets but, surely, the primary focus has to be how to give people with the condition the best possible quality of life as the disease takes hold.

Yes we need to find ways to eradicate dementia but we also need to help people NOW rather than solely focus on cures that could be many decades down the line.

Yes there are still economic troubles yet to focus on the cost of dementia rather than improving care and support for those who need it now is a shameful way for a Government to act. Social care funding has decreased year on year for at least the last five years and the costs of providing social care have spiked – food and energy inflation have a huge impact on care provision – and the Government has done little to redress this issue.

The press release today effectively labels those with dementia as a cost burden to the State and I hope action will be taken immediately to apologise and redress this.

Social Care - It's Not Rocket Science

How long has the debate around integrated care been going on? It’s a constant theme running through the social care debate yet one that remains fully unresolved and one that seems difficult to achieve but why?

It’s not rocket science!

Take, for example, the space shuttle. That feat of engineering consisted of 2.5 million component parts, including more than 200 miles of wiring! Thousands of scientists, designers, engineers and manufacturers managed to come together to create a single machine that enabled regular space travel. Even so that would not have happened without the thousands of others who also played a role. The astronauts who flew the shuttle were also products of a system that selected, trained and developed them to ensure they were capable of operating such a complex machine. Then there were those on the ground who made sure the launch and landing were successfully achieved.

Yet we struggle to give individuals the integrated care and support they need!

The component parts of providing integrated care are considerably less than those needed for space travel and the cost considerably less!

Yet bringing together social care, health, housing, benefits and employment for the benefit of an individual seem to be an impossible task for the bureaucracy of the U.K.

Obviously because social care is so low on the bureaucratic pecking order it means that the other elements needed for integrated care tend to take precedent. Social care is a small part of the Department of Health and Housing and Benefits sit within in two other Whitehall departments. At the level of the Whitehall bureaucracy focus is on departmental achievement and policy formation with little or no consideration to the individual yet by changing focus to achieving integrated care for the individual departmental achievement and policy formation could actually improve.

With the space shuttle, the goal was achieving manned space travel that could benefit the space programme by being reusable. All those thousands of people involved in the project came together to achieve that goal, integrating their role into that single achievement. Obviously there were disasters yet overall that particular programme was a success.

Those in Government should learn that if the goal of social care is the life of the individual we can begin to make social care the Primary service under which all other elements needed to provide effective integration are mustered and directed by social care services.

Completely effective social care means having a fully integrated service whose goal is the needs of the individual, why is it so hard after all it’s not rocket science.

Take Care Before Wielding the Knife

An interesting piece of news from the National Skills Academy for Social Care (https://www.nsasocialcare.co.uk/news/whitehall-to-consider-protecting-social-care?utm_source=twitterfeed&utm_medium=twitter) which suggests that the treasury are looking at further ways of cutting the social care budget, including curbing care provider fees.

Now the reality is that care providers have, in general, had lower than inflation increases in fees since at least 2008, well before the current financial crisis really kicked and, the bottom line is, the constant reduction in real terms of care fees impacts on the quality of care that providers can deliver.

Costs have spiralled, even if social care workers pay has be held back the costs of heating premises etc has risen sharply as have food prices and other costs.

While we have to accept the implementation of austerity measures handed to us the fact is further cutting back on care provider costs affects the lives of those who need care services.

While providers focus on meeting increasing costs and maintaining the level of care they provide there are inevitably areas that have to be cut back, invariably training of staff is one of those areas and because of this it means less well trained staff are providing direct care services and because they are less well trained it means the level of service will drop.

This is, of course, exacerbated by the fact that much of the funding for care training has almost completely disappeared. Where once NVQs for workers of all ages were funded, now only under 24s generally get free training yet many of those coming into care are older, usually returning to work rather than as a first job, which means the £1000 plus cost of a formal qualification is beyond the realms of realistic costs for many and, unfortunately, because it is no longer a requirement under the current standards it means many employers will not see the point of spending that amount out.

The real issue that needs to be tackled right now is not how we can save money but how we can ensure the safety and dignity of those who need social care services, yes we need to ensure people can stay in their own home as long as possible but this should not solely be based on saving money. Those who provide care in a person’s home still need to be adequately trained and given time to sufficiently care for the individuals rather than be forced into excruciatingly tight time slots which do little for helping the individual.

There are, undoubtedly, savings that can be made yet the Government must proceed with caution to ensure the well-being of those who need care services. Cutting care provider fees could drive some providers out of business, if that happens then the Government will find themselves actually increasing social care costs as they will have to fill the gap. The reason most care is provided by private companies is because it was felt this was a cheaper option than local authority provided care by driving providers out of the market it is probable that local authority provision will have to increase.

Social care in the U.K. is increasingly complicated, with control from Whitehall being disseminated through local authorities while actual provision is delivered by private companies who receive payment for services through many different channels, i.e. local authorities, the NHS, private funding or a combination of those.

If we want to save money let’s start by reducing some of this bureaucracy rather than targeting those who provide front line care in order to minimise the impact of cuts on those who actually need care services.

Let’s be totally, brutally honest, Governments don’t want to tackle social care.

Let’s be totally, brutally honest, Governments don’t want to tackle social care.

They may want to be seen as dealing with social care but the reality is to tackle it properly will cost money and Ministers would rather spend that money on things that get them re-elected than on an area which, frankly, does little to ignite the public imagination.

There are, of course, many individual MPs who are intensely passionate about social care as the recent debate on dementia showed, many have personal experiences of dementia, ageing and social care and they bring at least some balance to the lack of real debate on tackling largely unanswered questions on the future of social care.

While social care may fail to ignite public imagination it does, frequently spark public indignation. Widely publicised cases of abuse or of people having to sell homes to pay for social care  lead the social care debate and, while the majority of those who receive social care services are satisfied with their care, it is the negatives that drive Government reaction to social care and influence policy making decisions.

This, unfortunately and detrimentally to social care, means that the reality of today’s society is ignored completely in favour of short term reaction.

The reality is people are living longer and because of that there are an increasing number of people who need or will need social care services as the get older. Ageing increases to probability of age related conditions in turn increasing the need for people needing support in their everyday lives. Whilst, rightly, people are encouraged and supported to remain at home as they age there also has to be a recognition this will not always be possible nor will it always be in the best interest of the person. So we also need to recognise and acknowledge the place of care homes in the social care system.

The perception of care homes is, perhaps, outdated. The image of a home for retired genteel folk is outdated and the reality is that those who do go into residential or nursing care do so at a much later age and those care providers are having to become increasingly specialised in dealing with age related conditions, such as dementia, incontinence and osteoporosis. Yet the need for such specialism, and the cost of it, goes largely unrecognised in Government policy.

Naturally not all care providers are perfect and there are certainly those who do not provide the necessary training in the specialisms required and those whose sole aim is profitability rather than care provision yet they can only exist in a culture that doesn’t focus on the reality of social care and policy that fails to meet this reality.

The ageing society also provides other challenges to social policy that Governments have failed to tackle. People with disabilities are also living longer and need services to meet the challenges of ageing. Many people with learning disabilities are unknown to social services and support during their life by their parents, but as they age, and their parents age or pass away, they are increasingly in need of social care services yet social policy has yet to recognise this demographic and appropriate services are in woefully short supply.

Not everyone who needs social care services is over the age of 65 and that needs to be equally recognised. For these individuals the issue of who pays for social care is unimportant and many of the health related ideas of integration are minimal compared with the need for integrated services in housing and employment.

If society is to provide the best possible social care to those who need it we need to recognise the changes to society and the increasing importance of social care to our society. We need to change how we think about social care and recognise that ageing comes to all of us and our own future is equally tied into social care policy as that of those who need social care services now.

Government, of whatever colour, must lead the change in thinking about social care, it must raise the debate for all who need social care services, no matter what age and it must find the money to meet the demands of social care now.

Front Line Social Care Health & Well-Being

Ergonomics, occupational health, employee well-being. Probably familiar phrases if you are employed in a large organisation, in fact those larger organisations will usually have people employed specifically for occupational health to ensure the well-being of their employees. This is often supplemented, particularly in public sector organisations, by union representatives with specific roles in promoting workplace well-being.

Smaller organisations, generally, do not have any of this and 80% of social care is provided by smaller organisations.

Naturally the principle focus of social care is on those who use services yet in order to deliver those services we have to rely on front line workers and, unfortunately, little attention is paid to ensuring their health and well-being in performing such a vitally important role.

We need a wider focus on those who actually provide care in order to improve the quality of care as well as the quality of life for the workers the nation depends on.

For example, much is made of the 15 minute visit rightly maligned by many as inadequate for those who need care and support services. Yet how often is the effect it has on care workers? Simply imagine the stress of having to complete a visit in such a limited time, or, maybe, think about the pressure of travelling between visits. I am sure everyone has been in a situation where traffic delays get us frustrated as we try to get to an appointment, what impact would that frustration have to a person who then has to rush through a 15 minute visit before heading out onto the road again to get to the next?

What is the impact on the health and well-being on those who daily support those who have challenging behaviours?  What is the impact on the health and well-being on those who daily support those at the end of their lives? What is the impact on the health and well-being of those who daily support those need intense physical support? And, importantly, how does this affect the quality of care delivery?

It is not rocket science to know that how we feel, both physically and mentally, impacts on the way we work, no matter what our job is yet for front line social care it will also impact on those who receive care services.

It is not unusual to hear about the work-place stress on social workers who are becoming increasingly over-loaded in their work. We hear about it because the majority of social workers work for public sector organisations where such things are monitored both by the organisation and unions. What hear little about is the workload and stress of front line care workers because most are employed by small employers with little union representation across the sector.

Whenever those who set policy for social care, national Government or Local Authority, speak there always seems to be an assumption that social care is a public sector service and that it operates in the same way as public sector bodies and that those who work in social care are the same as any other public sector workers. The truth is that the vast majority of social care workers are employed by small, private sector companies who do not have the same ability as larger companies to employ people to manage occupational health.

If we are to ensure the health and well-being of those who need social care services then we have to also ensure the health and well-being of those who deliver those care services. To do so we need Government to recognise that the thousands of small companies that provide care services need support to be able to do this.

Dilnot or Not Dilnot - The think tank question

At the start of the month there was a call from the think tank, Centre Forum, for Winter Fuel payments to be concentrated on those who receive pension credits in order to fund the reforms proposed by the Dilnot Commission, particularly those focused on capping the cost of care for individuals who have to contribute to their care costs.

This week another think tank, the Centre for Social Justice, have called for the Dilnot Commission proposals to be ignored stating, “Whilst the CSJ is not against the Dilnot proposals in principle, it insists this measure must come further down the Government’s priority list. Any new funding, says the CSJ, should be targeted at the poorest people in the current means tested system who have few or no assets. It adds that the Dilnot plans are the wrong priority at the wrong time.”

Naturally the question many will ask is who is right yet, perhaps, it would pay to look a little deeper.

Both think tanks describe themselves as independent organisations. The Centre Forum describes itself as liberal and there can be no doubt of its Lib Dem leanings, just a quick glimpse at its advisory board will tell you that. The Centre for Social Justice has a distinctly Conservative flavour, founded by Iain Duncan Smith and currently chaired by Mark Florman, a former senior deputy treasurer of the Conservative Party.

Obviously it could be entirely coincidental that the Centre for Social Justice raise the issue of the Dilnot proposals in the same month as Centre Forum, in which case we are faced with the equally daunting case of bewilderingly mixed messages being sent out by organisations with very close links to senior coalition Ministers.

So is Dilnot the solution for social care or not?

Perhaps surprisingly of the two messages it is the Centre for Social Justice who stress the current care crisis calling it a broken system stating “People delivering care services can think of much better ways to spend the £3.5billion that is about to be invested in the Dilnot proposals.” The CSJ focus on the elements of the care crisis that will not be settled with the capping of care cost, such as 15 minute home care visits and “Tackling the destructive underpayment from Councils to care homes which forces many providers to cut corners”.

Centre Forum on the other hand focused on paying for the Dilnot proposals and the particularly controversial idea of withdrawing the Winter Fuel Allowance as a universal benefit and calling for “ the "appropriate legislative levers" to be inserted into the draft care and support bill so that the Dilnot Commission's proposals on care financing can be delivered in full by the end of this parliament.”

Certainly, as I have argued before, the Dilnot Commission was limited in its scope, focusing almost entirely on who pays for care and bypassing the crucial question of how much does quality care actually cost. It also has some short comings in terms of the reality of imposing a cap (see The Social Care Capping Debate MUST be Wider) and is unclear on how some of the proposals will impact on younger adults who need care and support services (Isolated and Underfunded). Yet it remains an important part of the debate.

 

The danger is that with two think tanks with close connections to the coalition partners calling for different approaches to social care that the debate with Government will become protracted to the extent we see nothing happening in this Parliament and social care left in the wilderness for another few years until the next Government either acts or, as previous Governments have done, prevaricates over social care to the detriment of the millions who need or provide care services.

The Centre Forum Report 

The Centre for Social Justice Press Release

Isolated and Under Funded

How would you feel if you were unable to wash, dress and feed yourself without support yet that support was denied to you, you would be outraged, wouldn’t you, and certainly agree there was a crisis in the care system.

Talk of a crisis in care often evokes imagery of older people who need care and support as they age, of coping with life as the rigours of life take their toll on the body and mind. Yet new research, published today by five major charities, shows the crisis in care is much wider and that the needs of younger, disabled people are not being met.

The report, ‘The Other Care Crisis’ highlights the fact that nearly 40% of disabled people do not get sufficient support in their daily lives with such things as washing, dressing and eating. Also highlighted is the £1.2 million funding gap in social care support for the disabled under the age of 64 with services being withdrawn because of a lack of funding and the criteria for being entitled for support becoming ever tighter.

It does not stop there, the report estimates that more than 100,000 people will be affected by proposed Government reforms.

It is not just about the clinical financial practicalities of providing care and support, it is about individuals. Being unable to wash without support is bad enough yet the impact on self-esteem is immeasurable, ask yourself now, how do you feel when you are dirty? Being unable to feed yourself without support has much greater impact on health and well-being and while Ministers talk of ‘prevention’ to reduce hospital admissions etc it seems, from this report, that the rhetoric remains more important the any real action.

The most shocking revelation in the report was nearly half of those who were interviewed in the study said the lack of support they receive meant they were unable to take part in community life in a way they wanted to. Once again imagine yourself in that situation, how would it feel to be socially isolated and unable to take part in the activities you enjoyed, the opportunities to talk and engage with friends. Picture the impact such social isolation would have on your mental well-being and the general frustration with life that would start to eat away at you.

In fact just over half of those interviewed for the report stated they felt anxious, isolated or experienced declining mental health as a result of services being cut.

It is time Government, and the wider discourse of social care, changed. When there is talk of integrated services it often basically means integration between health and social care yet the needs of younger disabled peoples goes far beyond that. There needs to be integration with housing services, integration with employment services and integration with benefit services. The debate on social care must encompass all those who need help and support, including those under the age of 64.

There are many great schemes that have been developed over recent years, such as direct payments, but these depend on individuals actually meeting eligibility criteria and as this becomes tighter less and less people will actually be entitled (although Governments will claim success as the percentages will be higher because less people are entitled!).

Today’s report has to be commended for highlighting the care crisis does not just apply to older people nor does its solution solely rest on whether or not property needs to be sold to pay for care. For those under the age of 64 who have life-long conditions the current system is failing many of them.

Yes we live in austere times and economic sacrifices have to be made but that does not mean we should penalise those in society who need societies support to live their lives in a way most of us take for granted.

The report “The Other Care Crisis” has been produced by Scope, Mencap, National Autistic Society, Sense & Leonard Cheshire Disability and is available at

http://www.scope.org.uk/sites/default/files/The_Other_Care_Crisis.pdf 

Social Care: A Culture of Unimportance

The Government’s Winterbourne View final report talks of a ‘culture of abuse’ being allowed to flourish within the establishment. This is nothing new there have been plenty of cases where this has happened and many commentators have mentioned this, we have periodic exposes of abusive culture within social care settings followed by a brief blustering of politicians yet these things keep happening.

The real issue that needs to be addressed in adult social care is the culture of unimportance that pervades society when it comes to the needs of the elderly and disabled in the country.

                                          

The Winterbourne report highlights this culture of unimportance. There is no Prime Ministerial forward promising whole Government action, there is not even a signature from the Cabinet Minister for Health. This should not distract from many of the good proposals in the report yet it, in terms of promoting social care as a national important area of policy it fails.

This is, obviously, only the latest in the line of things were the Government continues to cultivate the culture of unimportance around adult social care. The Dilnot Commission , set up as part of the coalition agreement,  submitted its final report in July 2011 and, since then, has largely been scrupulously avoided aside from the odd burst of political gusto when it seemed convenient. In the meantime the reality for many older people remains the same, sell your house to pay for your care.

Naturally Dilnot is itself a product of the culture of unimportance. The Commission was set up to tackle only how care is paid for, what has not been tackled is the ever tightening eligibility criteria for state support with care nor has the needs of other vulnerable adults, such as those with learning disabilities, had any consideration.

The social care culture of unimportance cannot just be ascribed to this Government, the previous Labour Government prevaricated and delayed taking action on social care producing a White Paper on 30 March 2010 just weeks before an inevitable General Election, and even then their ideas where merely a tinkering of what already existed rather than wholesale reform.  

The culture of unimportance that is allowed to flourish at Westminster inevitably and naturally trickles down to the rest of society. Undoubtedly if many average people in the street were to be asked what has been the most important issue discussed at Westminster this week the answer, inevitably, will be that of same sex marriage. While that is important in its own right surely the needs of the most vulnerable in society should take precedence and, although I don’t know the exact numbers, I suspect that the issue of same sex marriage will have a direct impact on far fewer members of the population than social care reform would.

The culture of unimportance MUST end and social care must take its rightful place alongside the other major areas of social policy. As society continues to age the implications for social care are significant, more and more people will need social care services and it is societies duty to ensure those needs are met.

Personally I feel it is obviously right that social care should have its own Cabinet Minister and Department for Social Care and have started a e-petition to this effect (click here to sign) as I believe that this will be a start to raising the importance of social care nationally. Yet beyond this we do need those in charge now to stop treating social care as a side issue to other areas of social policy and start treating social care with the importance it needs in order to ensure the well-being of the millions who need social care services.

Compassionate Government - Bah Humbug

This week’s Autumn Statement from the Chancellor seems to finally put paid to any pretence of ‘compassionate conservatism’ as, subtly he put social care under increasing economic pressure and impacted on the lives of the millions who need social care services to help them in their everyday lives.

There were multiple blows to social care, none of which actually identified it but the implications are there and the vulnerable in society will suffer from the impact.

Firstly there was central Government spending. George Osborne announced that all Westminster departments will need to cut spending further. There were only a few exceptions, his own department HMRC, education and the NHS. There is an important distinction here, as the NHS is not the whole of the Department of Health and the social care side of the DH looks like it will have to reduce spending in line with the cuts made across other departments meaning less money to essential front line services.

On top of this local authority spending will have to be cut further. Back in October the President of the Association of Directors of Adult Services warned the care services were on the edge (see here) and the prospect of extra cuts can only mean those vital services may tip over the edge as less and less people either fall out of eligibility criteria or services become so time orientated that any form of personalised care goes out the window.

Yet the cuts to local authority spending will have a secondary impact. Under the health reforms the responsibility for public health functions was transferred to local authorities including things such as health protection, public health initiatives to tackle social inclusion, initiatives to reduce seasonal mortality rates, public mental health services and many more which have a direct impact on the lives of those who need social care services.

The real irony is that investment in social care and public health could actually be more beneficial to the NHS budget than simply ring-fencing that alone. It is well documented that prevention services mean less need for hospital admissions etc, people prefer to remain at home during illness and home care with preventative public health services can increase the likelihood of that.

So the Autumn Statement proposals are not just punitive punishment on those who need social care services but they are also false economics.

The other aspect of social care overlooked by the Government is the fact that not all people who need social care services are over the age of 65. Many people with learning disabilities receive ordinary benefits which have now been capped meaning an increasing number will fall further into poverty. The Foundation for People with Learning Disabilities stated that only 7% of people with learning disabilities are in employment yet 65% want a job. It is unfair to label these people as shirkers when it is the Government’s failure to create an economic climate that creates full-time jobs.

In addition to all of this we have the lack of action on social care funding in general, it has been nearly 18 months since the Dilnot Commission submitted its final report yet still nothing has happened, the urgency with which the Government launched the commission has totally and utterly turned into a lethargy of inaction.

There are millions of people with social care striving to make life as bearable as possible yet the shirkers in Westminster seem to determined to make that as hard as possible.

The World is Changing, Let's Prepare for the Future

Not strictly a social care blog I will admit, but social care is intrinsically linked hence the reason for putting it here.

The world is changing and, unfortunately, the politicians are failing to acknowledge and address the change that has a huge impact on all levels of society.

We are living longer.

As a result there is a change in the dynamics of society which are only partially addressed by Westminster and, as a result, preparation for the future is woefully short.

Take, for instance, working and the State pension. The age at which the pension can be claimed has risen and will continue to rise over the coming years to mitigate the ever increasing state pension bill. But what notice has been taken of the implications of this? Much is made of the current economic climate, unemployment figures especially among younger people. What we do not here about is the effect of people working longer on the unemployment figures.

It does not take an economist to work out that if people are working longer there are going to be less entry positions available to younger people and where people are working longer the size of the available workforce grows, meaning there is also a need to ensure growth in the number of jobs available otherwise the employment benefit bill will continue to rise.

Ironically, given the current Government approach, one of the areas of employment growth will be needed is in the public sector. As the population ages so will the age related conditions that need to be dealt with by the NHS and its staff, the number of those with dementia will increase dramatically as will other conditions that effect people as they grow older. As the population of the country continues to grow, because of ageing, other public services will need to meet the increasing demand.  It is all very well cutting services to reduce the deficit today but where will that leave us tomorrow?

It is not just politicians that need to adjust to the change in social dynamics. Businesses to need to be aware their customer base is getting older and adjust accordingly. As we age our needs change and it is folly to simply appeal to the younger market (personal bug bear – I do not want skinny jeans but why is it only them available in most shops!), with the high rate of youth unemployment and the fact that people are working longer in life businesses have to consider where the disposable income is!

Institutional ageism has to be halted, older people are now the majority rather than a minority to be sat in the corner and ignored. Some organisations (such as the BBC) have often been accused of ageism (especially with female employees) yet, increasingly their audience have become older people who deserve to be represented.

We are living in an ageing world and as the life expectancy rate continues to grow society will change. Those in charge of policy etc in the country, and, indeed, around the world, need to start changing too, in order to meet the challenges this changing society will bring.

The world is changing, let’s prepare for the future.

You Do Not Get Excellence On The Cheap

At a recent press conference Lord Coe said, "You can never spend too much on elite sport. It will always be the greatest driver of sporting participation and we should be unashamed about that.” He went on to say “Of course, you have to have the right structures in place to deal with that demand. Be under no illusion, you do not get excellence on the cheap”

While we are still in the grip of celebrating sporting achievement those words of Lord Coe could resonate throughout any aspect of society not just sport and particularly in social care.

Excellence is always a driver for success, the concept of being a role model is hardly a new one and while the concept may have become something of cliché it remains a fact that we will always try to emulate our heroes or businesses will endeavour to emulate the success of rivals. Unfortunately, in social care, we do not see the success achieved in supporting people to live active and fruitful lives with the support of family or care workers, we do not outwardly demonstrate the excellence of so many care workers dedicated to enhancing the lives of those who can no longer fully participate in society on their own.

Obviously within the sector we do celebrate excellence, primarily through various awards schemes such as the Skills for Care Accolades, yet those celebrations do not extend outwards to the general population and the only view of social care that achieves mainstream coverage is when things go wrong such as the Winterbourne View case. Yet it is only through showing excellence on a wider scale that we can improve recruitment and retention in the sector and inspire people to work in social care.

The Daily Mirror has stated they have found 61,309 jobs in social care (Care for a Change) and, in the current economic climate it seems incredible that so many jobs are available and, let’s be honest, if that many vacancies exist there are some companies struggling to provide a full level of care and support.

To provide the best possible care services we need the best possible care workers and entice the best we need to demonstrate to the wider public the excellence that already exists to inspire people to see social care as a vocation that is rewarding and intensely satisfying. To achieve that we need investment in the social care workforce, we need to move it from the perception of an underpaid, poorly regulated job to a career that promises recognition and gives a sense of pride in working in a sector that is recognised for its contribution to society and the lives of individuals.

The fragmented nature of social care means that the only way this can be achieved on a national level is by the Government coordinating efforts across all of the Local Authorities and the myriad of care providers. The Government needs to invest in social care to ensure a high level of excellence in care provision that will inspire the public and restore faith in the social care system.

Naturally not everything can always be perfect and rogue careers will always enter the system (not unlike drugs cheats who enter sport) but we need to ensure that excellence is highlighted above all else. To achieve this the Government needs to invest in social care – you do not get excellence on the cheap.

Ministers Need to be Aware of Learning Disability Services

It is Learning Disability week and a great opportunity to raise awareness of the needs of those who have learning disabilities especially as we await the forthcoming White Paper and draft social care bill.

Given the wider debate on social care, particularly around who pays for care it is easy to forget that social care does not solely focus on the elderly and that people with learning disabilities use and need social care services. These services are not exclusively care home services but a wide range of services that have a different focus from elderly care and are vital in helping people live as independently as possible.

The exact number of people with learning disabilities in the UK is not known but what is known is that the numbers of people accessing those services is increasing.

Over the last few years there has been a very small drop in the overall numbers of people accessing council funded services but in those with learning disabilities the number has increased, and quite dramatically with an increase of around 10%. At whilst, relatively speaking, those with learning disabilities are a small percentage of the number of overall numbers of people receiving care services, those services are required over many more years and have an impact on social care provision and funding. Research suggests that about 16% of the total social care budget goes toward learning disability services.

In addition people with learning disabilities are living longer and the rate of longevity is rising faster than that of the general population. Between 2005 and 2010 the numbers of people with learning disabilities over that age of 65 increased by just under 20%. With ageing comes increased need for social care and health services that have to be acknowledged by those on high.

There is, quite rightly, a high focus on dementia and the needs of the elderly but there also needs to be a recognition that learning disability services are different, requiring a care workforce with a different set of skills, knowledge and training that focuses on the different challenges faced by those with learning disabilities.

There needs to be a recognition that ‘Learning Disability’ is a wide ranging catch-all term that encompasses a number of different conditions (and a number of undiagnosed ones) and therefore the number of services needed to meet the needs of the individuals has to be greater than any other aspect of social care.

With the focus on funding elderly care there is a danger that the needs of those with learning disabilities will be passed over by the Government yet the needs of people with learning disabilities are as important as any other group requiring social care services.

Ministers need to be aware of the issues facing learning disability services and ensure that the White Paper and draft Bill reflect those needs.

Care, Communities and Questions

I read a quote from Care Minister Paul Burstow yesterday saying “We need to reconnect care homes with their communities” and it is evident he said broadly the same thing today (Thurs) at Community Care Live.

But what does that mean?

I know I will stand accused of being a ‘naysayer’ but have care homes ever been connected to their communities?

For starters a care home should be just that, a home. One that looks after those who are no longer able to look after themselves independently and those who are living there should be treated with the same dignity, respect and privacy that everyone should expect from their own home.

So a question, how connected with the community is your home?

Chances are not at all, it is probably the place where you retreat from the community, the place where you can drop the ‘outside world’ persona we all employ and indulge yourself in your own private pleasures, where you can shut out the pressures of modern society and allow you mind to mentally recharge before stepping back through the front door into the hurly-burly of the world. Obviously not every home is a happy home and, sometimes, what happens behind closed doors is truly horrendous but in most instances the home is the place of privacy and the expression of your personal identity, the only invasion from the community is of your choosing and then probably limited to friends and families.

Then of course we come to the other question – what is a community? The definition is simply ‘a group of people living together in one place’ there is no connotation of that group being connected in any other way. How connected are you to those who live in the same street? The answer will largely depend on where you live, smaller villages tend to have greater connection than large cities but, in general, in even if you know everyone quite well it is unlikely that the community will be the focal point of your life.

Additionally the location of the care home will not necessarily reflect the community of those who live in the home but perhaps the greatest connection with the community already exists as the people working in the home are, more often than not, drawn from the immediate area.

Given all of this it seems something of a something of a meaningless platitude to call for “care homes to reconnect with their communities”

If, however, Mr Burstow means we need to reconnect those who live in the care home with their communities that is a different matter. My last blog focused on the human need for connection (Craving Connection, Fulfilling Personalisation) and, yes there does need to be greater effort made in helping people maintain the social contacts they had before moving into the care home. Our friends our an important part of how we define who we are (and of course who we are not) and by maintaining those social contacts it allows a person to ‘keep hold’ of that identity even when they are in a setting where those around them are there due to circumstance rather than choice. It is equally important that care homes develop a sense of community within the home by finding common ideas and themes that all (or at least the majority) of residents can be involved in.

However, I suspect, and I am happy to be proved wrong, what the Minister actually means is that we need to get communities involved in care homes, particularly the voluntary community who can provide services for the care home and relieve the financial burdens on the state in delivering care services.

There is certainly a case for encouraging volunteers to come into the home especially in the development of community activities within the home but they should certainly not be used as a means of financial avoidance by the state.

It has been stated recently that the ‘Big Society’ appears to be a means of Government misdirection and encouraging ‘communities’ to take over where the Government knife has wielded huge cuts but care of the most vulnerable in society should not be one of those areas and Government MUST TAKE RESPONSIBILITY for those who need care services.

Skills, Social Care & Society

Very soon the whole social care consultation merry-go-round will start once again with the emergence of the White Paper. When the Government  publish this  undoubtedly the focus, once more, will be on who pays for care services and how they do so, leaving out HOW MUCH such services really cost.

Part of the debate on social care is about providing quality services but there is little discussion how this is achieved and how the front line care workforce is trained to deliver that quality and why training is so important to achieving the best possible outcomes for those who rely on care services.

Everyone sitting in an office right now knows about Health & Safety at Work, to most it is something that is fairly abstract but rigorously enforced by the ‘Health & Safety Police’ in a manner that appears somewhat obsessive. Yet in social care health and safety is a lot more immediate and is not only about the workers but also about the people they support and care for. Slips, trips and falls, for example, become a much greater hazard for those who are frail and have problems with mobility, it is not just a case of worrying where computer terminal wires trail but all small lumps and bumps in the flooring become potentially hazardous.

Care workers, therefore, have to have a  greater awareness  of health and safety than the average worker and, of course that level of training costs.

One of the favourite things in social care is to compare the workforce (in terms of pay conditions etc) with the retail sector. I have often questioned this comparison but the issue of training helps illustrate why the comparison is a false one, particularly moving and handling. Obviously both jobs involve manual handling, lifting etc but in a supermarket the only handling involves inanimate objects. How much more complex the need to be able to handle people, to help them in and out of bed or the bath, how to use the more complex equipment, such as hoists, which need to be tailored to the individual.

Care workers, therefore, have to have a  greater awareness  of moving and handling than the average worker and, of course that level of training costs.

The same applies to many of the basic training elements in many workplaces where care workers have the additional element of having to take into account how that knowledge applies to those they work with.

Beyond that the care workforce is expected to have additional knowledge that is, generally, only otherwise found in the health sector. This includes infection control and ensuring that the risk of infection is minimised, they need to understand the concepts of cross contamination, the hazards of handling bodily waste and how to deal with contamination if it occurs. Care workers need awareness of medication, how to store it, deliver it and record its use and care workers need to understand the signs and symptoms of adult abuse and what to do if they suspect abuse has taken place.

Society also expects care workers to deliver dignity and respect to those they provide services for. While the words dignity and respect are often bandied about very little is said about what this involves and the principle skill is communication and care workers need to be trained in the complexities of communication in order to listen to and understand the needs of the individual to deliver the best possible service.

Social care is often portrayed as a generic service where care workers are transferable. But, in fact, care services are far from generic, older peoples services are vastly different from learning disability services or mental health service or physical disability services and aside from the general skills listed above there are also specialist skills needed by the care worker dependent on the service they are working in. Knowledge of dementia is an essential skill for working with older people but not in many other services, (although in learning disability services dementia is an issue that is probably needs more consideration as the population ages), knowledge of autism and epilepsy is needed in learning disability services where these conditions are prevalent and, of course, knowledge about specific learning disabilities need to be known in order to provide the best possible service.

Overall then the care workforce  needs  extensive skills and knowledge to deliver the best quality care. This sometimes fails, as demonstrated by Winterbourne View and Ash Court but this cannot be surprising in a society that undervalues care workers and fails to see the importance in ensuring care services are funded sufficiently to allow the full spectrum of  specialist  training to match the  specialist  service that care workers are expected to deliver.

When the White Paper is  published  and the consultation process around the proposed draft social care bill starts they needs to be a greater examination of what we expect the social care workforce to deliver, the skills and knowledge that are needed to deliver quality care and how much investment is needed to ensure these skills are in place.

Lest We Forget

            Many elderly people who use care services are, generally, over the age of 80 and they have lived through a great deal in life.

            My Nan, for example, turned 90 this year. She not only lived through the Second World War, she gave birth to my father in 1943 in Bermondsey, London.

Can anyone, nowadays, imagine what it would be like to bring up an infant under what was, effectively, the German Bomber flight path to the Capital?

My Nan now has advanced Parkinson’s disease and relies on carers coming to her Warden-Assisted home to get her up and put her to bed. She can do very little in between times.

            My Nan is, of course, not alone there are millions of elderly people relying on carers, either paid or unpaid, to help them live their daily lives and to them it must seem nonsense when we talk of austerity. Austerity is, surely, living through rationing and experiencing such delights as powdered egg (I’ll be honest and say the thought of it makes me cringe). Austerity is living part of your daily life in bomb shelters in the fear of losing your home or your life.

            The same generation has lived through economic good and bad times since then, from ‘never having it so good’ in the 60’s through the three day week and electricity blackouts of the 70’s and all else up till now. Surely having been through all of that they should be able to enjoy economic stability at the end of their lives and know that their care provision is not impacted by the banking/government created recession that we are in today.

            Why should those who have been through and seen so much bear the brunt of failed policies and economic mismanagement?

            Social Care is an important part of our society yet it seems those in Westminster fail to see the impact it has on those who need social care services, their families and those who provide care services. Social Care is about peoples’ lives not about political expediency, social care should be about providing the best possible services not just those that are financially viable.

            When David Cameron stood outside Downing Street as he took office he said. “I want to make sure that my Government always looks after the elderly, the frail, the poorest in our country”. Two years on and they are still waiting

            Every year politicians stand at the Cenotaph and, quite rightly, honour those who have fallen in conflict yet they also need to honour those who survived and provide the best possible support and care services, let’s not impose under-funded services on those who deserve better.

Shiny New House on Rotting Foundations

If someone spent time and money putting up a shiny new conservatory at the expense of sorting out the subsidence and rotting foundations in their house, what would you think of them?

If a business tried to launch a shiny new product with expensive advertising and a fancy, high profile launch at the expense of repairing the decrepit machinery in their crumbling factory that limits their ability to make the product, what would you think of them?

In both cases you would think they are fools.

So why should we think any less of the Government today.

Electoral reform and democratising the House of Lords will be the shiny product launch today, the new conservatory under in which the coalition can bask while ignoring the crumbling social care system which is subsiding fast under the Governments lack of action on supporting the most vulnerable in society.

The plight of millions is being ignored, the millions of unpaid carers who look after the millions of individuals who need care, the millions who receive funded services or who have to pay for those services themselves and the million or so low paid workers who are expected to deliver high quality care yet are in danger of being in a poverty trap themselves.

And while the coalition basks in the vain glory of their shiny House of Lords they forget another important point. Those millions affected by social care are also voters and why should those ignored by the coalition, left sinking in the financial quagmire of social care, even consider voting for the two parties that have flagrantly displayed contempt for the most vulnerable in pursing political expediency over the more pressing needs?

Of course the previous Government was no better but now at least the Labour leopard has the chance to change its spots and pursue the goal of achieving the best possible outcome for those who need and deliver care services.

The Government have exposed themselves as fools by, yet again, prevaricating over social care. Social justice is what underpins modern democracy and the shiny new house will be sitting on the rotting foundations of social justice presided over by the current Government

Social Care MUST be a Part of the Budget Debate

If past years are any guide the political agenda for the next week and a bit will focus on the Budget. There will be, and has already been, calls for changes at either end of the tax spectrum, we will see senior politicians  offer ‘expert’ insight  into what the Government should be doing (probably having already been briefed in what they are actually doing!) but, undoubtedly, the thing least likely to be on the agenda is social care.

Obviously the lives of the most vulnerable in society should be at the top of the agenda when it comes to talking about the nations finances and how we use the national income to provide for them first.

Yet most  politicians are too wrapped up in party ideologies   to focus on the real issue facing the country – an increasing elderly demographic that will require more social care services in the future.

Take, for example, last weekend’s LibDem spring conference where the call has been for lower tax for those on lower incomes and higher tax for the wealthy. Whilst lower tax would certainly benefit the large number of low paid social care workers taxation is an issue that does not immediately impact on the lives of social care users.

Many vulnerable adults do not pay tax, employment amongst those with learning disabilities, for instance, is incredibly low, and they are dependent on the State to be able to live day to day. Many of those who live in care settings only retain a personal expenses allowance of £22.60 (increasing to £23.25 in April) and many of those receiving social care services at home only have their pension or benefit payment to live on.

Many of us have benefitted from the historically low interest rates, which has allowed some of the increasing rate of inflation to be balanced out but, again, many of the most vulnerable in society are not home owners or have already paid the mortgage on their home or, indeed, had to sell it for care services.

Therefore, it  is important  that the Budget reflect the increasing pressure on the low incomes of the most vulnerable.

The actions of the Chancellor can impact on the costs faced by the population, where this may be offset by raising the income tax threshold the vulnerable, who pay no tax, are more vulnerable to increasing prices caused by the Governments actions.

Over recent years the services available for the vulnerable have been reduced or costs increased, the rising fuel costs have pushed up food prices and made the cost of care in the home more expensive, VAT has risen as has the general cost of living.

Social Care needs to be at the top of the agenda and this includes being at the top of the Chancellors agenda when delivering the budget.

The first aim of a civilised society should be to care for the most needy in that society and George Osborne should  take the responsibility  for ensuring that the most vulnerable are not disadvantaged by next weeks budget.