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.

Politics, Passion & Social Care

In the classic sociological text “The Profession and Vocation of Politics” Max Weber states that ‘three qualities are pre-eminently decisive for a politician: passion, a sense of responsibility, judgement’. Passion, Weber argues, is not the romanticism of the intellectually interesting lacking all objective as ‘simply to feel passion, however genuinely, is not sufficient to make a politician unless in the form of a service to a cause. There has to be responsibility to that cause and judgement maintaining inner composure whilst being open to realities.

Weber warns, however, that ‘the politician has to overcome a quite trivial, all too human enemy which threatens him from within: common vanity, the mortal enemy of all dedication to a cause’.

Yesterday’s elections had another low turnout and the debate on voter apathy roles on with debates on ways to improve turnout but if we take Weber’s view the voter apathy can be explained by the lack of passion and responsibility of a cause to inspire voters in to the voting booth.

Over recent years Party Politics seems to have become just that, politics focused on which party can win, can they get enough seats to maintain a majority and what action can they take to maintain power. This is the common vanity that has best our politics, the passion for party success rather than passion and responsibility for a cause that will inspire the electorate.

What our politicians, at all levels, need to do is find the cause that impacts on their voting base and fight with passion for that cause and, if elected take responsibility for that cause. Those who simply get elected, then either settle into the party compliant role or who tilt at windmills on subjects that have little or no effect for the people who voted them into power will simply generate more and more apathy as voters fail to understand the point in electing anybody.

There can be many causes to promote but the ultimate goal has to be a cause that acts for the betterment of the people and, surely, there can be no greater cause than the one that seeks to help the most vulnerable in society to maintain their place in that society with dignity and respect.

Social care is a cause that has largely gone unsung by politicians, primarily because it is not a traditional policy area, and its increasing importance to society is grossly under-estimated as the population ages and we see an increase in age related conditions which will need greater numbers to provide services.

After years of prevarication and tinkering around the edges social care is crying out for a political champion to fight for the cause affecting so many people, social care is crying out for politicians to take responsibility for the care and support of the vulnerable in society and social care is crying out for passion in raising awareness of the needs of those who use care services.

The politician that can show genuine passion for helping the most vulnerable, who can take responsibility for ensuring the social care system is the best it can possibly be and show that the passion is directed at the people who need support rather than just a reason to be elected is the politician who can attract voters to the polling booths and the type of politician this country needs a lot more of right now.

Let's Get Social Care Out of the Darkened Corner

The Health & Social Care Act 2008 received Royal Assent on 22^nd July 2008 but the bulk of the provisions relating to social care where not put in force until 1^st October 2010. So, in essence, there was a two year gap between the final stage of the Parliament and the implementation of the Act. Of course, this is just the end of the process, a bill has to travel through the parliamentary process. For example, the controversial Health & Social Care Act 2012 had its first reading in Parliament on 19 Jan 2011 and received Royal Assent on 27 Mar 2012, probably an extreme example but it highlights the length the process can take.

What’s the point of that little tour of the Parliamentary process?

Simply speaking, the current Government has three years, at the most, left and unless they take action soon on social care there will not be any changes to the current system while this Government is in power, if they do, eventually, legislate it will be left to the next Government, whoever they are, to implement any changes made. And, more importantly, it could be close to three years to see any substantive change in the social care system (always assuming the Government put any substantive changes in a bill!).

To most of us in the sector such prevarication on social care is not unusual and not just limited to the Government in power at present. I won’t repeat the gist of my previous blog (Politicians Seem Clueless About Social Care) but suggest what we need is a radical approach to reforming social care at the very top.

When Ivan Lewis was named care minister in 2006 he promised a radical review of social care, unfortunately that never happened and the first announcement of a consultation on social care came only once Alan Johnson took over the role of Health Secretary from Patricia Hewitt a year later. This suggests that any real action on social care is decided by the senior minister who sits on the cabinet.

Obviously the Health Minister is generally more concerned about Health Care rather than Social Care as evidenced by this Governments pushing through the 2012 Act despite opposition from many health professional organisations. Social Care seems to occupy a tiny corner within the Department of Health thinking.

But why does social care sit in the Department of Health?

Social Care is not a minor area of public policy to be handily attached to what appears to be the most appropriate Ministry.

The number of people receiving local authority funded services in 2010/2011 was 1.6 million and this excludes people who pay for their own care and people deemed by social services as not having sufficient need level to qualify for support and who are cared for by unpaid family members etc., so true figure of those who may need social care services is considerably higher.

Skills for Care estimate that the social care workforce also numbers 1.6 million. So, at a minimum, 3.2 million people are involved in social care services. Add to this the fact that Skills for Care also “work closely with the 40,600 organisations that offer social care people who use services, carers and with other key stakeholders” and it is hard to see why social care does not get much more attention than say the Department of Culture, Media & Sport which has a Cabinet Minister in Charge.

It is also important to remember that social care is not just about health, although that may play a significant part in end of life care etc. the role of social care is to support and care for individuals in their day to day living and health remains the responsibility of health professionals. The public often only connect social care with elderly care but it goes beyond this and beyond the remit of health.

For adults below the age of 65 who need social care services much of the focus is on appropriate housing, employment opportunities and living independently. The latter of which is also a focus of social care for the elderly. Social care is about maintaining links with society and maintaining social well-being in addition to health well-being.

We need action on social care and we need political consensus rather than political paralysis. Let’s start by achieving consensus that social care should not sit in a darkened corner of the Department of Health and it deserves its own Ministry with its own Minister who sits on the Cabinet and has the opportunity to bring forward legislation but more importantly to show that Westminster is truly serious about working for the millions in the country who receive or are involved in delivering, social care services.

Politicians Seem Clueless About Social Care

It seems evident that politicians do not know what to do about social care. The predominant method over the last few years appears to be simply to avoid doing anything substantial by having endless consultations and a constant tinkering around the edges (e.g. we are on the third regulator since 2003). It is not a political party specific phenomenon as all three main parties seem to be struck by the same malaise.

But why? Political parties are, generally, very sure of the best ways to do things (whether the public agree with them or not) and will forcefully set out their agenda to improve aspects of public policy for the greater good. Education, Welfare & Health, for example, have all been dealt with by the current Government and dealt with early in the terms of previous administrations yet social care has, and continues to be, something that eludes substantive action.

One of the reasons for this is, simplistically, the time factor. At the inception of the ‘welfare state’ post World War Two social care was a small consideration to those in power. After all in 1950 life expectancy was around 68, therefore those who drew from the state pension scheme aged 65 were only expected to draw on the state for three years or so. Similarly the impact of older people on the National Health Service was much more limited. In addition those with physical and learning disabilities were not expected to have much impact on the state because of their poor life expectancy.

So, in essence, social policy has largely focused on the under 65 population and political parties have, and continue to, have that as their primary focus.

Unfortunately for them the real world has crept up on them and now they seem at a loss how to respond.

Life expectancy today is around 79 years of age and rising. The life expectancy of people with disabilities has risen even more dramatically and we now have a greater need to support and care for people with age related illnesses, diseases such as dementia and provide suitable care and support for people with disabilities to meet their needs as they age.

In fact figures suggest that the UK has (or will soon have) more people over the age of 65 than under 16. Something that politicians have not quite grasped yet and something society has not yet come to terms with, as, it seems, we need to gear our society towards the needs of older people.

Society has changed and social policy needs to change with it but all politicians seem to be clueless in how to achieve this and afraid to make bold policy decisions. Now, obviously they are afraid that such boldness may cost them precious votes but until bold measures are taken, and social care bought to the fore of social policy the people who will suffer are the people who most need societies help.