Dear G8 Summit on Dementia

Please, please remember to focus on the people who suffer from dementia as well as the diseases themselves.

It will be very easy for those at the summit on dementia to fall into a medical model discussion on dementia, the medical research on cures and ways to alleviate the symptoms of dementia but it is equally important that there is a focus on how we support and care for those who have dementia now when there is no known cure available and we focus on supporting those families who care for people with dementia, whose levels of stress may increase causing them to suffer from illness as well.

Medical advances have meant wonders for many diseases, many who suffer from cancer for example can live in hope, especially if the disease is caught early, of a cure or remission, for those beyond that hope there is the comfort of pain relief and, hopefully, effective palliative care. This does not in any way ease the distress but it does, to some extent, provide clarity on the future and provides the help of the health system.

With dementia however, there is no clarity nor is there effective medical assistance. Those who have dementia are dealt with by a social care system that is fragmented, under-funded and, unfortunately, largely ignored by social policy.

Whilst there will be a great many politicians, bureaucrats and medical experts at the summit on Dementia the reality that the actual care is delivered by families or low-paid care workers and if we want to address the care and support of people who have dementia now then it is those people the summit needs to find ways to support in order that they in turn are better able to support those with dementia right now.

Medical cures and research success take time, time that many of those with dementia right now will never see come to fruition, in addition to the medical research there MUST be social research looking at what is effective in supporting those with dementia in the absence of medical help. There must be a concerted effort to ensure that best practice in dementia care is applied across the board, there needs to be a policy of high quality standards for care services rather than one of ‘essential’ standards and there needs to be a recognition that social care services provide and equally important role in supporting those with dementia and that dementia services should be funded in the same way as any other long term medical condition.

The G8 summit on dementia is important in raising awareness of the issues but let us hope that the issues go beyond medical science and include the aspects of providing social care support to those who suffer from dementia right now.

Social Care Culture Wars

One of the changes promised by the Care Quality Commission in their “Fresh Start” document published yesterday (http://www.cqc.org.uk/public/news/new-approach-inspecting-social-care-services) was that they will be “checking providers who apply to be registered have the right values and motives, as well as ability and experience.”

This could be challenging!

Whether we like it or not the bulk of social care provision, at present, is delivered by companies, large and small (and every size in between!) who are out to make a profit, because without profitability the business will fail. Therefore private company that applies to register a care service has, naturally, to have the right business values and motives to be profitable in order to be able to deliver the care service.

This fact highlights one of the issues with social care in England and why integration seems such a difficult thing to achieve.

The word ‘silos’ is often used to describe the way in which different parts of the care system are isolated but, in reality, we should see them as different cultures and, as often happens with cultures, the existence of that particular culture is built on difference rather than commonality and those within a culture will defend the values and motives that underpin that culture.

So at the front line of social care provision we have providers who have to make money, even charities and not for profit companies have to ensure their income in order to carry on their business, so they have to exist in a ‘market’ culture where income must exceed (or at least match) expenditure, their actual provision of care is limited by the monies they receive, however good their values and motives are in terms of wanting to care they are constrained by economics. There are over 12,000 registered care providers and each one will have a different organisational culture based on the values and motives of the company owners.

Another culture within the system are the Local Authorities, 152 with social services responsibilities. Each on will have their own ‘corporate’ identity, influenced by working practices, senior leadership and, importantly, politics. All local authorities are over seen by elected councillors and this, obviously, impacts on the organisational culture. Somewhat like the EU, the heads of social services departments gather together to discuss overarching policy but, again like the EU, these can be implemented slightly differently in each council because of the values and motives of those who lead the council.

Within the local authority system are other elements that those who need care services also need to access, e.g. housing. In many areas these are located within a different authority than the one responsible for social care which, again, has its own particular organisational culture.

Then there is the NHS, another completely different organisational culture, founded on a basis totally different from care providers and local authorities. Health services (either NHS or private) have grown from medical science with a fairly rigid hierarchy of who is allowed to do what and developed a clinical culture that is different from other fields of work. The NHS itself is more fragmented now, which is why individual hospitals or trusts have failed because of inadequate leadership, but the overall structure is the same. In this realm we have the Royal Colleges which underpin the professional expertise of those who work in health, and which elevate the roles they undertake, all of this creates the values and motives of the NHS and other health services.

The problem for those who need care services is that all of these different cultures have different languages and practices, all have different values and motives that underpin their roles.

Because different cultures defend their identity through maintaining difference with other cultures, the integration needed by those who need care services is hampered and will continuously be so unless we develop a culture which recognises that the individual is more important than any of the organisational cultures involved.

To achieve connected services for people who need care services all involved need to recognise the commonalities in their services and who they benefit the individual.

Before care providers can be judged on their values and motives we need to establish what those values and motives are and how they benefit the individual rather than imposing values and motives that cannot be achieved at the ‘market’ end of the system and which, ultimately, impact negatively on the care service provided.

Issues in Integration

Twelve weeks ago I went over on my ankle, it hurt. The swelling and bruising was pretty nasty but I just put it down to a twisted ankle that would clear itself up. Unfortunately, after a couple of weeks it was still intensely painful so I went to the nearest A & E where they x-rayed it and told me I had a fracture, they gave me a pair of crutches (no other treatment) and told me they would get me an emergency fracture clinic appointment and I could expect a call on the next working day.

Two days later I finally got through to the clinic who mentioned they had seen something with my name on and could I come in later in the week.

At the fracture clinic I was told I didn’t have a fracture (they used the same x-rays) and it was severe wear and tear, even though I protested that my ankle was fine before going over on it, I was summarily dismissed with a piece of paper to give to my G.P. to arrange for physiotherapy.

When I got to the G.P. I was asked what the piece of paper was because hospitals do not normal send that bit of paper to G.P.s! However I had a telephone consultation arranged and was referred to the Physiotherapy Dept.  I then had to visit the G.P. because the pain was still intense and I was simply given a co-codamol prescription, again with little other advice.

It then took six weeks to get a physiotherapy appointment. While, of all the different elements of the NHS involved, the physiotherapy team have, undoubtedly, been the most helpful, once at my first appointment I had to relay all the details of my injury as they had no notes on my fracture clinic appointment or the history so far.

Because of the time lapse between referral and getting a physiotherapy appointment I had a follow up fracture clinic appointment after my second physio session. Again this was another frustrating experience, quick chat with consultant who I told I was still in pain, hour wait for x-ray, then back to consultant who told me there was definitely no fracture just evidence of an old injury. What old injury, I exclaimed, only to be dismissively told, “oh it might have been something minor” and then told to come back in six weeks.

Following week back to physiotherapy, who had no knowledge of fracture clinic appointment and I had to explain what had happened there.

That was last week and I still have bursts of intense pain

The point of this story? We have this long running debate on integration between health and social care yet it is evident within the health service alone there is no real integration and, while mine is a relatively minor injury, I have no doubt people with much more serious conditions suffer from the same frustrations of the lack of ‘joined-up’ care in the NHS.

Social care itself is not a ‘whole’; it is a combination of public sector and private sector services that because of those different sectors cannot fully be bought together efficiently. The bottom line is most of the private sector works for profit and the public sector works toward bureaucratic efficiency.

Integration: The act of combining parts to form a whole.

When we talk about integrated services for health and social care is this what we mean? For those who use services yes it is. Anyone who needs services wants an holistic approach, seamlessly receiving care and support from all aspects of the ‘system’, support with health, social care, housing etc. is, idealistically, delivered in a joined-up way that involves everyone responsible for delivering the services knowing exactly what everyone else is doing and working together toward a single purpose.

From a public sector point of view the issue is different. Technically speaking, integration would mean combining all the parts of the system into one and that is not likely to happen, so the key word here is collaboration rather than integration and this is where the difficulty often arises. Who is responsible for this collaboration, who takes the lead to ensure the individual needing services gets a seamless service?

Naturally people are territorial about their domains, and certainly ‘professionals’ can often give the impression of others not really knowing enough to give a valid opinion, so there is inevitably some tension between ‘professionals’ of different sectors. Yet this approach does not benefit the individuals who need the services which is why there must be clear, defined leadership.

Before there can be talk of, and delivery of, integrated services for those who need them there must be a clear demonstration that those services are themselves integrated as until that happens it means they will be unable to deliver on that which is truly desired.

The Confusion of Westminster

Last week we had an announcement that £3.8 billion will be given to social care yet official sources cloud this. For example the Department for Communities and Local Government describe it as;

“£3.8 billion, including £2 billion of new NHS investment, to improve adult social care and join up with health services. This will help older and vulnerable people to stay healthy and remain at home thereby avoiding unnecessary hospital admissions or emergency visits to A&E. To stimulate real change, £1 billion of this funding will be paid when local results are achieved.”  (https://www.gov.uk/government/news/eric-pickles-hails-council-tax-5-year-freeze-and-38-billion-for-social-care)

In other words the money is for preventative health support to reduce the need for admissions in hospital.

Obviously this has to be welcomed by preventing a health issue becoming a health crisis the pressure on Accident & Emergency departments can be eased a little and, more importantly, being healthier should lead to a better quality of life for those who need social care services.

But what it does reveal is the ignorance of those in Westminster about what social care is.

Eric Pickles demonstrated this with his quote on the DCLG website saying;

“For the last 30 years all too often the care home, social services, and the local GP haven’t been working together to prevent unplanned hospitalisation of elderly or vulnerable people.”

The last set of statistics from the Health & Social Care Information Care show that care home residents only account for 14.6% of council funded care recipients. How, one wonders, does Mr Pickles think the new investment will help the 85.4% of social care users who are not in care home?

If the role of preventative health is to be transferred to social care then considerably more money will need to be ploughed into the sector. Social workers and social care workers are not health professionals and if it is to be their role to work with the health of an individual then they will need significant training in order to do so effectively. If however the onus is on health professionals then the money is not for social care it is simply transferring health funding!

Following on from the spending announcement we have learnt that the Care Bill will set the ‘substantial’ criteria as the benchmark for individuals to access care funding from the state.

The current ‘substantial’ criteria mentions health briefly, the majority focuses on personal dignity, daily living and family and community life and when the Care Bill final goes through there will be a significant increase in funded care users as many councils are currently only funding those with ‘critical’ needs. Therefore councils will need a staffing infrastructure to cope with this increase if current social workers are not to be totally overloaded with paperwork, especially if they also have to assess health needs!

Westminster seems to be clueless about social care and solutions to support people to live life in the way they want to is lacking as Ministers continue to confuse social care and health.

Social care should be about supporting people and bringing together the services they need. Health is just one of those services. A person’s health needs will vary over time and, where social care support is involved, it is social care’s responsibility to ensure the individual is able to access those health services, but social care also has a responsibility to ensure the individual is supported in every aspect of their life, from adaptations in housing to maintaining community links.

Social care is ever more important in society and demand for social care services will grow as the population ages. We need a social care service that is fit for now and the future and that cannot happen until those in Westminster recognise that they need to recognise the true importance of social care.

Let's Have CONNECTED UNDERSTANDING

We often hear the terms, integration, connected thinking, joined- up thinking etc. when talking about providing the best possible care services yet perhaps the most important thing we need to develop is “CONNECTED UNDERSTANDING”.

Because different aspects of the care system work in different ways it means barriers are created through a lack of understanding how other elements of the system work and because social care is such a fragmented wide-spread system it means opportunities for not understanding are immense as points of view differ drastically.

An example, some see social care as a public service. In one sense this is right, social care is organised by central Government, commissioned and paid for through local Government, Social Workers, employed by local authorities are public servants etc. Yet the bulk of social care is actually delivered by private sector organisations, where the motivation of those who own the companies is, ultimately, profit and compliance with regulation about achieving it at the lowest possible cost in order to protect profit. Those, usually low paid workers, who are actually responsible for delivering intimate care services would hardly class themselves as public servants, a term which is generally associated with better working conditions (e.g. pensions) than those in the care work sector.

Another aspect to this gap is that those who receive care services funded by local authorities may well be receiving a public service, albeit provided by the private sector, but there are many more people receiving care services from the same providers who are having to pay for it themselves, and often paying more to make up the LA shortfall in funding. How does their care equate to public service provision?

Yet even between ‘public service’ elements of care provision similar barriers of understanding exist. Not simply because of different ways of working between sectors, e.g. between Social Service departments and the NHS, but also current economic conditions which create misunderstanding. Local authorities are having to cut their spending yet NHS funding is not under the same pressure and it is important that both sides understand what the other are doing and, more important, are able to do over the coming few years.

Beyond this is the fact that public service integration needs to go beyond just health and social services, it needs to include housing, welfare etc, again a lack of understanding which can create barriers that impact on the lives of those who actually need to access services.

Obviously this nit-picking difference between those various elements who deliver social care services pales into relative insignificance compared to the lack of understanding faced by the general public about social care, a situation generated by the fragmented system which sends out mixed and confusing messages. Who is eligible for care? What is the difference between Local Authority funded care and NHS Continuing Care? How much do I actually have to pay?

If we are to really deliver quality care services we really need to begin to start working on connected understanding, we need those at the top of the chain to have a greater understanding of actual care delivery and we need those who deliver care to understand why Government, Local Authorities and Health Services operate in the way they do. Naturally the most important thing is that those involved in all aspects of care delivery understand the needs of those who need care services and understand how to connect with them.

Residential Care Providers Outperform the NHS.

Residential Care providers outperform the NHS.

That is, of course, a blanket statement but backed up by the State of Care report published by the Care Quality Commission last week. The headline figure when the report was published was the fact that 15% of hospitals failed to meet the standards on making sure patients had the right food and drink and the help they needed, yet for residential care – i.e. non-nursing care - the figure was 11% of homes failing to meet these standards.

It was not just this standard that saw a difference. On meeting standards on respect and involvement 9% of NHS hospitals failed to meet this standard compared to 7% of residential care homes and on meeting standards of effective care, treatment and support 19% of NHS hospitals failed to meet the standards compared to 18% of residential care homes.

Obviously this is a very simplistic and selective view, in general, nursing homes were worse than hospitals and the complexity of health service provision is different from that of a residential care home.

Yet these figures should not be totally ignored and lessons must be learnt.

The health service must, for a start, consider what it can do to improve performance and what it can do too learn from the residential care providers which outperformed it in a number of areas. Why are residential care providers better at providing food and drink, what lessons can be learned in improving respect and involvement. There has to be a system in place where the NHS can draw on the best practice of social care to improve its performance with its patients.

There must also be a look at the significant difference in performance between nursing and non-nursing residential care where the contrast is quite startling. In nursing homes 20% failed to meet the nutrition standards, 15% failed on respect and involvement and 28% failed on effective care, treatment and support. In just about every standard nursing care fell behind residential care the most surprising of which was management of medicines where 33% of nursing homes failed to meet the standard compared to 26% of residential homes – surprising because nursing care should have trained nurses on their staff whereas this is not necessary in purely residential care.

The Care Quality Commission report gives us a snapshot of the state of care but we need now to act upon its findings and this is where we need national leadership to make improvements.

The fragmented nature of social care provision, around 25,000 different nursing and residential care homes providing services across 152 councils with social services responsibilities, means that there is little coordination over the country to draw together what lessons can be learnt from the report, how to implement the changes needed and how to engage with the vast myriad of providers to ensure ‘best practice’ becomes the social care standard.

The fragmentation of social care means that those at the top can frequently pass the buck and abrogate responsibility but with the increasing need for social care as the population ages and the increase in the complex needs of social care users we, as a nation, need those in Westminster to take full responsibility for the services provided to the vulnerable in the country.

The route to improvement is learning, learning where the failures are and learning the best way to decrease those failures. The system is never going to be perfect but we need national leadership to reassure the public that all possible action is being taken to ensure health and social care provision the best it can be and the lives of ALL those who need care services are paramount in that.

Calling for a Cabinet Minister for Social Care

I have set up an online petition calling for a Cabinet level Minister to be appointed for Social Care (click here) which I hope  you will sign  and which I hope  you will pass on  to friends and colleagues.

Why?

Around one in five of the population is affected by the decisions made by Government on Social Care and given that such a large portion of the country is involved it seems only right that they should have the appropriate representation at the highest level.

I say around 1 in 5 because the figure is hard to estimate and it could well be higher. Carers UK estimate that there are 6.4 million people in the UK providing unpaid care for loved ones (details here) and, naturally, there are a similar amount being cared for. The latest figures from the NHS Information Centre state that there are 1.4 million people in England receiving local authority funded care services, although this figure does not include those receiving continuing care funding from the NHS, additionally these figures are for England only, so the number is increased when the other countries are taken into account. They are then increased further by the unrecorded numbers who fund their own care services.

In addition, the latest figures from Skills for Care tell us that there are 1.6 million paid workers in adult social care. So, in a Nation that has a population of 62 million, one in five may well be a conservative estimate.

At present Social Care is presided over by a junior minister within the Department of Health and, whilst there is no doubt a strong link between health and social care, this fails to encompass the greater range of social care requirements of the people that need social care services.

Social Care is not a homogenous service. It includes services for the elderly, for those with learning disabilities, those with mental health issues or those with physical disabilities, yet, at present all these services are the responsibility of a junior minister.

Social care also encompasses much more than just health services, it includes housing issues, benefit payments, community issues, for those under the age of 65 employment services come into the equation.

As the population ages social care will be a greater part of life with even more people either using or providing services. It is time now for Government to fully recognise social care as a major part of social policy in this country and appoint a Minister to the Cabinet to take responsibility for it.

The e-petition link again - http://epetitions.direct.gov.uk/petitions/39701 I hope  you will  take the time to sign it and that  you will spread the word  to your colleagues and friends

Thank You

New Ministerial Team MUST Act on Social Care Now

The latest figures from the NHS on council funded care services show, one again, that there has been an overall fall in the numbers of people receiving services. 110,395 less people received services in 2011/2012 a drop of 7%.

At the same time the Royal College of Physicians warn that acute hospital services are on the brink of collapse because of the increasing number of elderly patients, particularly those with dementia, they claim that many feel that older people ‘shouldn’t be there’ and are calling for a redesign of services to better meet patients need (click here for RCP press release).

In other words it appears we are seeing a reduction in community care services resulting in increased pressure on the NHS and this is an issue that needs to be tackled immediately.

This situation is one that can only get worse if left unchecked by the new Ministerial team at the Department of Health.

Kent County Council, for example, are proposing (in their 2013/14 budget consultation) to reduce spending on adult social care by £18m, a cut of 5% and while they claim to be able to do this without harming care services it certainly seems the reduction in council led services is only increasing those in the NHS. Undoubtedly other councils are proposing similar cuts in the adult social care budgets which will lead to more elderly people entering hospital.

The popular press has lead the campaign on who should pay for social care and it seems likely that the Dilnot proposals will be introduced. However this does not solve the issue of how much social care costs and, it seems now, we have some evidence that lack of funding in social care simply transfers the issue to the NHS and, undoubtedly costs the state more in the process.

Care for older people in England, particularly those with dementia, needs to be examined properly and the costs of providing the best possible care acknowledged.

It is only by properly assessing the cost of social care that the issue of who actually pays for it can be sorted.

We have a new Ministerial team in the Department of Health and they must put the care of the most vulnerable in society at the top of the list otherwise the crisis in care will only continue and lead to a greater crisis in health provision.

Why Prof Robert Winston Saddened Me

A few people may have noticed that I had an issue with Professor Robert Winston’s Party Political Broadcast on Wednesday night on behalf of the Labour Party.

As the restrictive limit of Twitter means it is difficult to fully express issues I thought I would take the opportunity to set out why I think the broadcast was misleading and why Professor Winston’s role was ingenuous.

The main thrust of the broadcast was the broken promises on the NHS by David Cameron and the Coalition, the ‘top-down’ reform imposed on the NHS by the Health and Social Care Act, the loss of nursing jobs and the cuts in NHS services in general. I have no disagreement with any of this and it is the normal cut and thrust of politics.

What I did disagree with was the implication that voting Labour in the forthcoming Local elections would help improve the NHS.

The fact is Local Councils have no executive power when it comes to the NHS, Councils cannot reverse cuts, Councils cannot employ more nurses in the NHS and Councils do not have the power to initiate any reforms of the NHS.

If you read the Health and Social Care Act (which I have) there is a significant increase in local council involvement in Health, particularly in terms of public health, integrated services (e.g. social care) and through Health & Well Being boards, but none of this gives local councils power over the NHS.

Now if Ed Milliband had been touting that voting Labour in May the NHS would be improved in the areas where Labour held the council I probably would not have batted an eyelid. I (and I expect many people) expect politicians to try and mislead me in order to  seduce me  to vote for them.

However when a well-respected, well-known figure of authority does this, it should be of major concern. I spoke to someone today who saw the broadcast and asked them what it meant, and they told me that if Labour won the council elections they would make changes to improve the NHS. When I pointed out that, actually, that would not happen I was told I was wrong because Robert Winston had said it.

It is somewhat ironic that the Party Political Broadcast that complained about the broken promises by one politician was actually implying promises that it could not keep!

Political spin will always exist but I am saddened when figures of authority indulge in it as it will, inevitably, diminish that authority.

Are we too focused on service user involvement?

Are we too focused on service user involvement in care services?

I know that is a controversial question but make no apologies for it because I think it is a debate worth having because while we  focus  on that we may be missing some of the essential ingredients to  truly personalised  care and support provision.

The idea of service user involvement is a natural extension of the theory of Social Role Valorization (or normalisation or an ‘ordinary life’ which ever term you choose to use). The idea behind this is that all people with disabilities should have the same conditions in life as are offered to the general public and that they should have the same should have the same opportunities in housing, education, health and freedom of choice. It does not mean that we should try to make everyone ‘normal’ but it does mean the same conditions of life should allowed to occur.

So why could we be too focused on service user involvement? Let’s take two areas where it is touted as a good thing for users to be involved in, recruitment and supervision.

The aim is to create an ordinary life, the same as the general population but at what point do the general public get involved in the recruitment and supervision of people in the services that they use? When was the last time you were given the opportunity to sit in on the recruitment process of your bank, your G.P. or your local NHS Trust or, indeed, have the opportunity to sit in a supervision session at your local council, supermarket or energy supplier?

The fact of the matter is we are all service users in one way or another, the principle difference being the majority do not use care services but if people are to be given the opportunity of an ordinary life then, surely, care services (in this sense) should be treated the same as any other service.

This is where the true difference occurs and where social care fails in providing the opportunity for an ordinary life. What do the general population do if they are really unhappy with a service they receive? Simple, they change the suppliers if they are able to or, if not (as in NHS services), they will challenge the quality of the service.

What many service users lack is the opportunity of freedom of choice in the service they receive and it is the denial of freedom of choice that needs to be addressed.

How much choice to service users get in the social worker ‘allocated’ to them to assist them in sorting out their care package? An unfair question because we would not expect any other service to give us the choice yet if we were unhappy we would be able to move to a different provider, something not available to care service users or we would be able to make a specific request about the type of person we wanted to help us – how many service users are given that choice?

And what about the choice of actual care services? Is there a real choice or are service users again ‘allocated’ the approved local authority contractor? Given that we are talking about vulnerable adults, is there really an adequate mechanism for challenging the quality of the service and a choice of care provider available?

Service users should be involved in their care but rather than the somewhat tokenistic concept of involvement in recruitment, supervisions etc. the real involvement should be in the choice of services they receive in order that they can have the ordinary life opportunities available to the rest of us.

Social Care: The Public Perception Hurdle

Social care is something that impacts on the lives of millions in the UK, those who use services, those who provide or commission services, those who care, unpaid, for family members and those who work in providing care. Yet the general public and, more particularly, the national media seem less than enthused about the subject.

One clue to this may be found in the health/NHS debate that has been vigorously contested in Parliament and through the media.

A few days ago the Guardian published a list of 30 odd organisation connected with health and where they stood on the Health & Social Care Bill. Of this only 1 was an organisation that directly represented patients yet there were 10 ‘Royal Colleges’ representing various healthcare professions.

The Royal Colleges do, of course, command tremendous respect and it is easy to understand why. These organisations represent the people whom we may need to save our lives and while there may be a general social decline in the trust of ‘experts’ the Royal Colleges carry a lot of weight in terms of public opinion and media attention.

While there is a multitude of organisations connected with and campaigning for social care none carry the same weight and gravitas as those connected with health.

Naturally part of this has to do with history the Royal College of Physicians dates back to 1518 and even the relatively young Royal College of Nursing is fast approaching its Centenary. Yet social care, in its current form detached from the ‘medical model’ is relatively new and there are relatively few ‘professional’ organisations connected with it.

Obviously the College of Social Work has just come into existence and, perhaps, its most immediate task is to embed itself in the public domain as an authoritative voice on social care.

Aside from this though other organisations may be too detached from the public perception of the immediate issue, for example the Association of Directors of Adult Social Services represent the councils commissioning social care rather than being directly involved in delivering it. Compare a Social Services Director (essentially a civil servant) to a Surgeon or Physician who gives hands on (literally!) health care, we have to have more faith in the medical professional because their actions will directly affect us.

Aside from these ‘professional’ organisations most of the others either represent the care users themselves or the organisations providing care services. With the former the Guardian list has shown users groups do not command the attention that they perhaps should but unless the public attention is grabbed by social care it seems unlikely that the users of social care will either. Trade organisations will suffer from the same inertia of public interest particularly as the predominant coverage of social care is where the system goes wrong and providers fail.

The Royal Colleges also act as centralised points for dissemination of research and innovative practice and whilst there is an abundance of excellent research available in social care and many academic institutions carrying out that work the route through to public perception appears fragmented.

Even in terms of ‘think-tanks’ representation of social care is limited. The Kings Fund and the Institute of Public Policy Research both, certainly, provide excellent contribution to the social care debate but their primary focus is elsewhere.

Social care is diverse but no more so than health provision and obviously the two overlap in significant areas. We need to achieve greater public awareness and interest in social care but, at present, lack the structure and gravitas to engage the attention of the majority of the mainstream media and, through them, the general public.

Perhaps we need a Think-Tank solely dedicated to social care to disseminate research and practice, command media attention and generally raise the profile of social care or, perhaps, more professional recognition of those who work in front line care (a College of Registered Social Care Managers?) to add to the College of Social Work.

Putting social care high on the national agenda is important and we need to look at how this can be best achieved for the benefit of the millions involved in social care.

It's not just about who pays for Social Care but How We Talk About It

                Politicians of all parties have a tendency to view social care as a matter of cost. The endless consultations we have had over the past few years have focused on how social care is paid for and who should pay for it.

Yet it is not just a matter of cost but of how society views its provision care and support for those who need it.

To really improve the social care system society first needs to start changing the discourse of social care. Public views and opinions are always based on the way politicians and the media talk about different issues and social care is no exception. Those who have no contact with the social care system could be forgiven for thinking that social care is delivered in a completely haphazard manner, leaving all those who need it at risk and that care and support is delivered by individuals who are completely incompetent or, worse, evil people who prey on the vulnerable.

This view is very far from the truth yet it is a persistent cloud that covers the areas where social care shines and it is this cloud which needs to be blown away before we can make any real progress in improving social care.

Firstly we need to tackle the image of working in social care.

Social care workers are low paid, work unsociable hours and receive little reward for the work they do – yet they do it. But the entire workforce is often told it needs to ‘professionalise’.

Imagine the effect on any workforce that is constantly bombarded with the implication that they are unprofessional. Think of the impact on staff morale and performance. If you were to hear that phrase used about you, how would you feel?

To add to that there is the constant comparison of social care workers to the retail sector in terms of wages and conditions. Yet how can the two types of work be realistically compared? In truth the closet comparison would be to that of Healthcare Assistants in the NHS but that, perhaps, would raise to many questions in relation to pay and conditions.

The portrayal of social care workers as unprofessional and low paid naturally has an impact on recruitment and retention in the sector. What incentive do younger people have to enter social care other than as a last resort job?

Pay and conditions are not going to change overnight, the way the system works at present means that many care providers are small businesses who do not have the funds to improve wages without making cuts in other areas of care provision or, and lets be blunt, cuts in their profits but it is time to really start talking up social care workers and making realistic comparisons about the work they do.

Politicians also need to tackle the perception of haphazardly delivered care, yes there is a postcode lottery where care and support provision depends on the Local Authority that delivers it but are those services so significantly different from one area to another? If so, then surely we need Government intervention, to discover why and to take action to rectify this and to be seen to do so publicly. Too often, in recent years, there has been a tendency for Government to brush of social care delivery as the responsibility of local authorities yet, in truth, social care is still funded by central government and they should take responsibility for it.

Perhaps the hardest issue to tackle is that of the risk of abuse. We need to be constantly vigilant in the fight against adult abuse but the public also needs to be informed of the reality of vulnerable adults and abuse. Abuse is not limited to social care workers, in fact in home care abuse is far more likely to be committed by family members than by care workers but it is where a care worker has committed abuse that is far more likely to hit the headlines.  In many cases it is the social care worker who identifies and reports abuse committed by others yet such work goes unreported.

How social care is viewed depends on how social care is talked about and it should now be time to start talking about social care openly and honestly, identifying the real issues, talking about them and taking action to deal with them.

Improve Dementia Care Sooner Rather Than Later

Dementia is a disease, or rather the generic term for a group of diseases that are classified as degenerative diseases of the nervous system. The World Health Organisation classifies these diseases, Alzhiemer’s Disease, for example, is listed as “a primary degenerative cerebral disease of unknown etiology with characteristic neuropathological and neurochemical features. The disorder is usually insidious in onset and develops slowly but steadily over a period of several years” in the WHO International Statistical Classification of Diseases and Related Health Problems 10th Revision, more commonly known as ICD-10.

Given that the various types of Dementia are a disease it seems surprising, yet deeply disturbing, that the NHS is failing to provide adequate care for those who have dementia http://www.bbc.co.uk/news/health-16206169

One of the reasons could be that care for those with dementia in the UK falls under the social care remit rather than the health care one. Therefore the expertise in supporting people with dementia is detached from front line health care.

The problem is, perhaps, exacerbated by the fact that few people access hospital services because of their dementia. The reason for being hospitalised is for other health reason, yet it has to be born in mind that these reasons can be related to the dementia, for example a cut or burn could be the result of failing to remember something, so true, holistic care needs to take into account all aspects of the persons health.

One of the answers being touted is training for NHS staff, while this can only help it may not be enough to solve the problem. Training imparts knowledge but that is all, how that knowledge is used in practice is a completely different matter. To ensure that the knowledge gained through training is used effectively their needs to be both good staff development and effective leadership at all levels of the NHS. And to achieve this, managers and supervisors, at all levels, need both effective leadership and communication skills along with a knowledge of dementia themselves.

An additional area highlighted was communication between hospital staff and relatives of the person with dementia. This is an important area to be addressed. Dementia is a disease that can have a great impact on a family, the worry about a loved one can be tremendous, along with the guilt of feeling inadequate in caring for them. If this is made worse by a) poor care & b) poor communication then it is not only the patient that the hospital is failing.

Again the solution is better knowledge, better practice and better communication skills.

Perhaps it is now time to take a fully integrated approach to health and social care. Why not have social care specialists on elderly wards? Why not recognise that social care is best placed to provide the support for people with dementia in hospital. This is particularly important in ensuring there is sufficient after care when the person leaves hospital, especially if they are returning to their own home.

The numbers of people with dementia are predicted to rise sharply and unless action is taken soon the situation will only get worse, so let’s hope we get action sooner rather than later.