The Time to End Poor Care is NOW

The morning after yet another Panorama expose on appallingly bad care the media response is, as usual, distinctly underwhelming. No loudly broadcast calls for the resignation of senior civil servants, no demands for inquiries into the care system, in fact, nothing.

One particularly difficult issue with social care is that it is far too easy to spread the blame and for nobody to take responsibility.

Commissioners, Regulators and providers can all blame each other and the Government can blame all three! Yet, ultimately, the responsibility for regulating social care lies in Westminster and it is the responsibility of politicians to ensure safe, quality care is available to all.

Yes appallingly bad care exists but good quality care also exists. The quality of care is solely dependent on the care provider and good care providers have to struggle in a system that treats both good and bad care equally. Both are allowed to thrive in a system that is, currently, more focused on money rather than quality and the needs of individuals.

Of course bad care providers are to blame for the care they provide and such providers need to be shut down and banned from providing care services again yet the system allows them to carry on. Regulators can be blamed for not spotting the bad care being provided yet they are constrained by the regulations they regulate and inspections can only provide a snapshot of care provision and inspecting home care in particular is challenging. Commissioners can be blamed for buying services based on price rather than quality and, perhaps, they rely on information provided rather than going out and inspecting the care services they are commissioning services from.

But all of this can only happen because of the framework in which everyone operates.

Contrast this to the NHS and the calls for action following the Mid-Staffs enquiry. Those who stoutly defend the NHS and campaign for better quality do so because the NHS is a single, national, entity yet few of those people so stoutly campaign the fragmented social care system.

The ultimate responsibility for social care lies with Westminster, it is no use politicians blaming other elements within the system because it is the system itself that is broken and urgently needs to be reformed. There increasingly needs to be a system that promotes and rewards good care providers whilst ensuring those who provide bad care are eradicated.

We are promised a new care rating system soon, which is welcome, but it must, obviously, be one that can be trusted, one that will influence commissioning and one that reflects the care individuals need rather than what bureaucrats believe is essential in terms of paperwork!

Yet beyond this we also need a system that has real accountability. The ability of all parties to pass blame on others MUST STOP NOW. Ministers must admit their responsibility for social care services, commissioners must accept they have a responsibility to ensure the services they are commissioning are quality services, regulators must accept their responsibility to rigorously act and eliminate poor care and care providers must be held fully accountable for any failures in their duty to care.

The time to end poor care is now and this has to start with ending the blame game and all those responsible for social care to stand up and shoulder that burden.

Shift from Care Service to Customer Service

I am fairly certain that you, like me, have been to a restaurant at some point in time where the staff rushed you through your meal and that you, like me, found it irritating and uncomfortable. I am also pretty certain that you, like me, would think twice about using that restaurant again and that many people who experienced that would, like me, probably tell any number of people about that bad service.

Now transpose that scenario to social care.

The now infamous 15 minute care visits are just one aspect of this, longer visits may equally involve care staff having to rush around leaving the individual who needs the service bemused and bewildered at the very least. At the worst it will leave the feeling a burden, someone in the way while the care staff do what they have to before shooting off to the next person. Add to this the times when the individual never knows who is going to turn up to help as staff rotation is based on the needs of the provider rather than continuity for the individual.

Of course this is not limited to home care, many care homes I’ve seen have a task-orientated culture where staff rush around trying to get jobs done and individuals merely become another box to tick on the endless ‘to do’ list and in the worst cases, as demonstrated on the Fiona Phillips’ Panorama programme last year (http://www.bbc.co.uk/programmes/b01gybn7) sometimes staff even fail to acknowledge the individual when they are undertaken their jobs.

The crucial issue here is that the person who needs the care service cannot just suddenly stop using the service because they are unhappy with it and if they are left feeling like a burden to the care service then they are unlikely to complain anyway and, equally, there may be a lack of opportunity for them to mention the bad service to anyone else.

Unfortunately we do not look upon those who need care services as customers. Look at the terminology, ‘service-user’, ‘client’, ‘resident’ or even ‘patient’.

Could you honestly imagine sitting down with your bank manager and having a ‘co-production’ meeting about your finances?

People who need social care services are getting a service and, as such, should be treated as customers no matter how that service is paid for. In many instances of course they are paying directly for that service.

We need to become a customer focused service which starts with acknowledging the individual as someone who has the right to be treated as a paying customer. Social services departments need meet the needs of customers rather than ‘commission’ services and regular reviews should not be just about immediate care needs but should also focus on customer care and the level of customer service that goes with the tasks being provided.

The needs to be a culture change in social care with a shift from task based commissioning to real customer service and customer service skills need to be high on the training list for all staff of undertake services for their customers. Personalisation must mean the customer comes first and what we want as customers will always vary. Some may like short sharp visits just so they can get on with their lives without strangers getting under their feet, many others will prefer visits that include a chat about what’s happening in the world, especially if they are isolated and unable to leave home. Whatever they want though it should be at the top of the list of services provided, after all, the customer is always right.

We shouldn't gag the BBC

Newsnight had two stories of child abuse, one they suppressed and one they failed to verify the facts. The result has been a total breakdown in the BBC news department with resignations aplenty and the entire news agenda dominated by the BBC.

Yet we must be careful.

Firstly the fallout at the BBC has obscured the very important issue of systematic and institutional abuse of young people in care, as well as the abuse by celebrities who held a position of trust. And, while the horrendous events reported by Newsnight are described as ‘historic’, the fact remains that abuse can scar people for life, impacting on their lifelong mental health, ability to form relationships etc.

There are still unanswered questions about the events at the homes in North Wales but these questions have been eclipsed by the frenzied call for heads at the BBC. The real story revolves around the original investigation in the early 1990’s yet, it seems, the truth will be buried beneath the bodies of those falling on their swords at the BBC.

In the second instance we need to be careful about this fevered attack on BBC News. After all, what percentage of news output at the BBC do these two Newsnight programmes amount to? Probably very little and we must not frighten BBC News into ‘playing safe’ with such stories in the future.

Without BBC reporting the Winterbourne View abuse could still be going on, elderly people could still be abused in certain care homes etc. Although these were Panorama investigations they still come under the BBC News banner.

We have more to commend BBC News for than we have to dismiss it with the fervour shown by many in high places and we need it to continue to investigate the wrong doings in society and expose abuse wherever it happens. The danger is BBC News producers will become too afraid of the ramifications of being too controversial and facing the wrath of those who disagree.

Newsnight cocked-up yet, if you read the circumstances, they were GIVEN the high profile name, further reading tells us that the victim in question was told that name twenty odd years ago. Reporters should have gone further in verifying the name and that is the only failure causing the BBC frenzy while the real story goes unreported and, possibly, uninvestigated.

The majority of the BBC News output is good, their exposure of injustices must continue and we must not allow this current mistake to stop this.

Craving Connection, Fulfilling Personalisation

Part of being human is the craving for social contact. You only have to look at the way modern technology has evolved over the last few years a social networking sites have evolved (remember that time when Friends Reunited was all the rave!).

We now Twitter, Facebook, LinkedIn or whatever to maintaining our social circle and, to some extent expand it. Of course it is not just our P.C. that allows us to do this, the vast array of mobile devices allow us to tell the world where we are, what we are up to etc. as well as giving us the chance to check on what are friends and wider social network are doing.

The technology, however, only facilitates this inner desire, this craving for relationships and social contact that is present, to some degree in all of us and has existed since the emergence of man. Family, community, society are hardly the constructs of those who crave isolation.


And if we need to identify  the truth of this  we only need t look at how we punish people - we "send them to Coventry", we ignore them, in prison we use solitary confinement.

Maslow puts this need for connection firmly in the middle of in his classic Hierarchy of Needs, Professor Stephen Reiss identified social contact as one of the 16 basic desires that define our personalities and motivate our actions, the New Economics Foundation identify connecting with people as one of the five ways to wellbeing.

So why don’t we focus enough on this in social care?

Remember the recent Panorama programme where the two care workers roughly washed the resident? When they were doing this they busily maintained their own social relationship by talking in their own language while failing to talk to the individual they were supposed to be caring for? Maybe an extreme example but how many times do we hear of care home residents all sitting around in large lounges in silence? How many times do we hear of cases where care in a person’s home is restricted to 15 minutes or so giving the care worker little or no time to interact with the individual or complaints from care service users that they never know who is going to turn up to care for them?

Part of the problem is, perhaps, that some elements of social care are still to firmly rooted in the medical model of care. Clinical detachment in the health professions serves a purpose, it helps to insulate health professionals from the trauma of getting to attached to people likely to suffer great pain or die, it prevents the psychological transference of distress from those suffering to the professional who, for their own sanity, must remain outside the constant bombardment of anguish and agony not only from the patients but their traumatised families.

Yet can this clinical detachment work in social care? No, for many different reasons. Firstly the clue is in the name SOCIAL Care, social care is not the same as health care, that is the responsibility of the health professionals, social care is about supporting people in their everyday lives, helping them maintain connection with the wider world or, if that is not possible, ensuring that they are able to live as full and active life as possible in their individual circumstances.

We are, by nature, social creatures and while the degree that socialisation is needed by individuals vary, quality social contact still forms an important part of our lives. How can we know what level of social relationship individuals need unless we make the effort to establish a significant relationship to find out?

Personalisation is the social care buzzword at present and it is a goal that we should strive to achieve but how can we provide personalisation through clinical detachment? We need to build relationships with care users to understand their personal needs but more importantly to provide them with the type of social relationship that is cornerstone of being human.

Why Care Can't Wait

Panorama has discovered a series of cases in which elderly people have been unsafe and unprotected in nursing homes. Instead of being looked after, vulnerable, elderly people were insulted, neglected, roughly handled or physically assaulted.

Sound familiar?

Yet it is not the episode aired on 23^rd April this year where Fiona Phillips exposed the treatment of Maria Worroll at Ash Court. It is an episode that was aired on 12^th February 2007. So, in five years, why has nothing been done to prevent these things occurring?

We have had other exposés in between most notably the abuse of people with Learning Disabilities at Winterbourne view but none of these seem to be able to make politicians care enough about social care to take real action on improving the lives of the most vulnerable.

We cannot solely blame the politicians, the national media must take some responsibility. Such events soon disappear from the news agenda and while Panorama will provide us with regular exposés they seem to lack the inclination to ask WHY is this still happening?

I was reminded of that Panorama episode when I was flicking through my copies of the magazine I used to write for. Ironically my column in that same edition focused on the success in care training that had been achieved as had been highlighted in that years “State of Social Care” report from the CSCI. At that point the National Minimum Standards required all care providers to have at least 50% of their staff with NVQ level 2 and real progress was being made on that. Unfortunately that requirement was dropped in 2010 and, in fact, there are no specific requirements at all for care providers to have qualified staff.

In that same column I also raise concerns about whether the level of success in training care workers can be sustained because of diminishing fee increase from Local Authorities and question the effect that proposed registration of care workers may have on the sector. Five years later those fees have continued to be lower than inflation (in the last few years there have been no increases at all) and the registration of care workers has evaporated into thin air.

My reason for looking through those back copies was to try and find when it was that Ivan Lewis faced a question from a backbencher on the practice of local authorities not raising fees to care providers or, if they were, at a rate below inflation. This was in March 2008 and he condemned the practice stating that care providers should, at the very least, expect an increase in fees that kept pace with inflation. Of course this has not happened and the amount being paid to provide care and support has fallen behind in real terms.

So, in essence, nothing has happened to tackle the issues facing social care over the past five years, now we face another delay to action on care.

In five years we still have Panorama exposes on care, we still have no actions on care worker registration and the amount paid to provide care and support to the vulnerable continues to fall behind and while we have had tinkering around the edges with changes in regulator etc no substantive political act has been taken in that time. 


We have had a consultation in 2008/2009 which led to a Green Paper in July 2009 followed but another consultation and a White Paper in March 2010. Then, with the change in Government, we had the Dilnot Commission launched in July 2010 and the Dilnot Report published in July 2011.


Surely we have had enough talking. 

This is why care can’t wait and we need action NOW not later