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.

Social Care Users are Not All Elderly

Half a million people under the age of 65 receive council funded social care services. That is around a third of all those receiving services and there is a danger they become excluded in the wider social care debate.

We have seen some excellent initiatives in dementia recently, albeit maybe not going quite far enough, but we need the social care debate to encompass all those who need societies support in life. The funding debate in social care has almost exclusive focused on the Dilnot proposals and how elderly care is paid for. How much should older people contribute to care they receive, what should be the threshold for capital etc. This debate has little to with those under the age of 65.

Similarly we have seen the debate of health and social care integration. There is no doubt that the two are related but more so in relation to elderly care than the support needed for those under 65. Those with physical or learning disabilities and those with mental health issues do need support in health but they need support in daily life, support with housing needs and support with employment and welfare in order to live as independently as possible.

The number of those under 65 receiving council funded services has, in line with the general trend, declined slightly but this does not mean there are less people needing societies support, simply that the eligibility criteria for receiving support has tightened and the fact that support centres have closed because of the budgetary constraints on local authorities meaning less support being available to many.

As with all areas of social care there are many who do not appear on the statistics but that does not mean they are any less deserving of societies support. In addition there are many families who provide support for individuals who also need our help. The changes in demographics and the ageing nation applies to those with physical and learning disabilities as it does to the general population and there are an increasing number of elderly parents still caring for a child without the support of society.

Social care is wider than just health and should be treated as equally as any other area of social policy.

The health and social care integration debate and the focus on elderly care detracts from this wider function of social care and marginalises those who are under 65 and who need more than just health support in social care settings.

We need to raise ALL social care into the spotlight and social care needs to have the same Government input as Education, Welfare, Health and Employment therefore it needs a cabinet minister for social care as this will put it on an equal footing with these other areas of social policy.

Please take the time to sign my e-petition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

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

Not Long-Term Care But Services for Life

When people think about long term care they often think of the time older people spend in care homes or receive care services at home. They may also consider learning disability care homes but it is unlikely they will consider the true nature of long term care for people with learning disabilities.

People are born with or acquire learning disabilities early in life and, dependent of the nature of the disability need care and support services from that time. With a learning disability other conditions are more prevalent than in the general population, for example autism and epilepsy, which, in turn defines the type of support needed for an individual. In childhood support is needed for education, health etc which is dependent on individual needs and social circumstances and this is followed by transition services which support the individual in the move from child to adult services.

Although ‘adult services’ is the last stop in terms of the catch-all bureaucratic terminology the reality is individuals need support on their journey through life, and their journey is not really any different from the rest of us.

In our twenties and early thirties we are in our physical prime and we reach the pinnacle of physical achievement, obviously that achievement is dependent on lifestyle etc. but it still, for every one of us, it is where we reach the peak and where we are at our fittest. As a general rule we are more ‘immortal’, life’s goals lay ahead of us and achieving our dreams seems easy, old age and death seem so far away as to be almost non-existent. Many people with learning disabilities are not so different and they need support in achieving the goals and dreams and in maintaining their physical well-being.

As we tip over our mid-thirties and head towards the big 50 we start to deteriorate! Obviously we are all individuals and the rate of change varies greatly between people but generally we are not quite as physically fit as our minds think we are! Some people start having mid-life crises while others simply accept that life is moving on and they must move on with it. We become more settled in our lives and readjust our long term aims and ambitions to a more realistic level.

For people with learning disabilities this can be a crucial time of life, many age related conditions that we would normally expect to have in the latter years of our lives can begin to impact on the lives of those with learning disabilities. There are also many social changes for them too. Those who live with parents face issues of their parents becoming older and the possibility of becoming a carer for those who care for them creating a complex co-dependent relationship.

After this point we do come to a split, older peoples services generally start when people reach the age of 65 but way back in the days of Valuing People the government recommend that for people with learning disabilities older peoples services may need to include those aged 50+. Conditions such as dementia can strike much earlier, particularly for those with Down’s Syndrome and issues of continence can also occur earlier than in the general population. As the population is getting older and people with learning disabilities are living longer there are also social issues that need to be supported, people are more likely to lose parents and siblings will take over as primary carers or significant people in providing care and support.

For most of us, as we get older we make adjustments in our lives, we adapt our lifestyles when our health needs change, we find ways of coping when we lose special people in our lives and we adjust our circumstances to what is best for us. We do our best to cope with the extra stresses that ageing can bring.

In other word we LEARN to live with it.

But was happens when the ability to learn is impaired? How easy is it to cope when you don’t fully understand the changes to your body or to your life? That is why it is so important that older people with learning disabilities have the right support as they age, support that will be different from earlier in life.

There is a tendency to focus on older peoples care because of the numbers involved and what is neglected is the fact that many of those with learning disabilities need care and support services for their entire lives and there is a need to recognise the importance of those services alongside those for older people.

Learning disabilities is not about long term care, it is about services for life.

Lets Work to Support Success in Social Care

“Success breeds success” is one of those quotes that we all know but rarely think about what it means yet ‘success’ is big business – just type ‘business success’ into Amazon and see how many thousands of books are available on the subject.

There is some science behind the idea of “success breeds success” for example, Euro 2012: England v Ukraine - The science of home advantage, and while this deals primarily with football the science can apply to many other areas, including social care, especially in learning disability services.

Where the main focus of success is on achieving wealth, power and status the reality is success is any achievement that you make, no matter what level of status it is and success brings about its own rewards. For example, remember back to when you first did something you thought would be impossible, whether it was riding a bike, passing your first exam or baking your first edible cake! Then remember how you felt as you achieved that success, the pride that swelled inside you and the confidence it gave you to undertake that activity again and spur you on to be a little more ambitious next time.

Equally important is what it did to your previous failed attempts at that activity, the pride and feeling of success pushed those failures away from your mind, consigning them to distant memory or erasing them from your mind completely.

In social care services we have many different buzzwords for providing support services and what we want to achieve, we talk about personalisation, independence, outcomes, etc. but, in reality, what we need to talk about is success. We need to support people in becoming successful in independence, personalisation is about achieving success in individual goals and outcomes are only of use if they are successful ones.

I’ve written before about visions, targets and goals in relation to leadership in social care  (http://socialcareinsight.blogspot.co.uk/2012/02/social-care-leadership-visions-targets.html) but the principles also apply to working with individuals to achieve the highest possible level of independence  and these principles are, perhaps, more important in terms of personal support for individuals than anywhere else.

The big vision must always for the individual to lives as independently as possible but to get there people need targets and goals to act as milestones to mark the way to the ultimate goal.  The small ‘wins’ are so important in bolstering confidence and achieving further success, it does not matter how small that success is it helps people understand that success is achievable at any level and spurs them on to achieve the next goal.

The achievement of individual success is also important for people working in learning disability services, if they can support an individual to be successful then they too have achieved success and the same feelings of pride and confidence are imbued in their work.

Success does breed success and we should start talking about achieving success in care services to ensure that helping individuals become successful in their lives is one of the main goals for care providers.

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.

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.

Dear MPs - Why Social Care IS Important

Anyone catching the Future of Social Care debate in the House of Commons yesterday must have been struck by the lack of MPs bothering to turn up to discuss on of the most important issues facing the country at the moment.

Perhaps every MP should look to their own constituency and take a real look at the demographics and data of those  they are paid to represent  in order to  realise the importance of social care  in their community.

I live in the district of Shepway and delving into the data makes startling reading. I would hasten to add that the local MP (Damian Collins – Folkestone & Hythe) did attend the debate and make a contribution through an intervention, but I think it is important to share some of the facts and figures to demonstrate why MPs need to look to their own constituency to  realise the importance  of focusing on social care.

Shepway has an estimated population of 101,200, not a major metropolis but it does have one of the largest care sectors in the county of Kent and, despite persistent rumours of affluence in the south east, is in the top 100 most deprived districts in the country.

Of that population 15% is over the age of 70 & 6% over the age of 80. Many of these will be recipients of some form of social care services either at home or in care home settings, of which there are 110 in Shepway (the same number as registered in Brighton & Hove despite the huge population difference). Obviously with a huge amount of care provision there is an equally large social care workforce, all of whom are affected by social care policy set out by Westminster and the policies of Westminster therefore have an impact on the local economy.

Naturally paid for social care provision is not the only aspect of social care. Data from 2001 suggests that around 10% of the districts population are providing unpaid care to family or friends, with 279 of these being under the age of 18. Again decisions made in Westminster have a direct impact on the lives of these people and on those people they care for.

Around 10% of the people who live in Shepway claim Disability benefits (2011 figs) the majority of whom have physical disabilities but it also includes 1365 people with learning disabilities and 1071 with mental health issues.

Social care should be about people not about facts and figures but it is important that those  we pay to represent us  are aware of the importance on social care and just how much social care impacts on the lives of their constituents.

There may be many demands on an MPs time and there may be many areas of policy the promote or prefer to be associated with but the bottom line is they  are paid to represent us  and they should especially be representing the most vulnerable section of the community they have been elected to represent.

There has been much emphasis on leadership in social care of late and one key element of leadership is acting as a role model. Members of Parliament need to act as role models in supporting the vulnerable in society, that means visibly showing active interest and that means turning up for debates in the House!