Tuesday, 29 January 2013

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

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

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

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

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

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

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

The perception of care homes is, perhaps, outdated. The image of a home for retired genteel folk is outdated and the reality is that those who do go into residential or nursing care do so at a much later age and those care providers are having to become increasingly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

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

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

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

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

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

Thursday, 24 January 2013

Front Line Social Care Health & Well-Being

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

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

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

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

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

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

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

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

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

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

Wednesday, 23 January 2013

Dilnot or Not Dilnot - The think tank question

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

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

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

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

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

So is Dilnot the solution for social care or not?

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

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

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


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

Thursday, 17 January 2013

Isolated and Under Funded

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

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

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

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

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

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

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

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

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

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

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

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

Monday, 14 January 2013

Let's Not Forget Physical Decline

There is some fantastic work and developments focusing on the needs of those who suffer with Dementia. We have had the ‘Christmas to Remember Campaign’, the Department of Health announcing £22 million being made available for dementia research projects and the work of the Dementia Challengers has been outstanding in raising the awareness of the disease which impacts on the lives of millions.

Yet while dementia is the most prevalent of the age related conditions that could impact on the life of an older person there is, perhaps, a danger that the discourse of elderly care becomes one where adult social care for the over 65’s is solely equated to dementia . Whereas there are many other age-related conditions which are debilitating for individuals and which also need to be fully addressed.

Parkinson’s disease affects around 127,000 people, the majority of whom are over the age of 65. It is a disease which leads to physical, rather than cognitive, decline as the disease progresses but can also include other problems such as depression, pain and constipation. As the physical deterioration progresses it becomes harder and harder for the individual to make the tasks of daily living and increases the need for help and support.

Naturally it does not take a huge leap in imagination to think about how you would feel if your body no longer functioned properly, yet you retained you cognitive awareness, imagine the frustration and potential effect on your mental health. Being unable to undertake the simplest daily tasks without help can be frustrating, I know, from personal experience how embarrassed my Nan feels when she cannot even make a cup of tea for guests when they call.  

Other physical deterioration may also affect an individual. Sight, in particular, is subject to deterioration through many different conditions such as macular degeneration, glaucoma and cataracts. As people lose their sight they may need social care support to help them in their everyday lives to make adjustments in how the undertake daily tasks and to reduce the risks of physical injury.

Sight, obviously, is not the only physical deterioration that can come with age and we need to ensure that anyone who needs physical help receives the support they need.

Naturally all of these physical conditions can also affect those who have dementia. There is always a danger that those who provide care and support only see the dementia rather than the range of issues affecting an individual. It is easy to focus on the one condition of cognitive decline yet ignore the other issues that a person needs to be supported with.

Yet we also need to ensure that those who do not have dementia but have other age related conditions of physical decline also receive the correct level of support. Physical decline can lead to other issues, such as being prone to falls, which then further impact on a person’s life.

Social care services must focus on all needs and it is important to ensure that alongside the excellent initiatives for dementia people with other conditions and diseases are recognised and supported.

Wednesday, 9 January 2013

Social Care: A Simple Philosophy

Social care exists because people need care and support in their everyday lives. The type of care and support may vary, those with learning disabilities will have differing needs from those with physical disabilities and older peoples care and support will vary depending on the age related conditions affecting them but the bottom line is social care is about supporting those individuals who need some form of help in their everyday lives.

Policy, bureaucracy, regulations etc. have no real meaning in social care unless the directly benefit those individuals who need care services.

So a simple philosophy should begin with a simple question, “how is what I am doing benefitting those I am providing care and support for?”

This simple question can be applied at all levels of social care provision.

At the front line of social care the question is more simplistic and, perhaps, applied more easily.  So, for example, maintaining effective infection control routines benefits the individual from reduced risk of infection or supporting an individual to attend community events benefits their social well-being. There are, of course, examples of where the question is not applied. I am sure we have all heard of tales were care staff take those they are supporting out to places that are of more interest to the staff than the people they are supporting and, at the extreme end of the scale, the behaviours of staff at Winterbourne View were abhorrent and bear no reality to providing care.

Yet at the point of care delivery the philosophy has to be “how is what I am doing benefitting those I am providing care and support for?” the question should also be the basis of care inspections by the Care Quality Commission, or other inspectorates. Not every care provider works in the same way and they should be able to show that their care and support works in a way that benefits those they are delivering a service too.

As we move up through the levels things become a little more complex but the same simple question should apply. The Care Quality Commission should base their work on the same principle. How does their inspection system benefit the individuals who receive care services. After all social care inspectors exist only because social care exists and social care is about those individuals.

At local authority level there is a multitude of bureaucratic levels but each must apply the question to their work. The most obvious level of local authority work is done by social workers and social work assistants (or whatever the preferred term is in a particular authority!). Social workers/assistants have direct contact with social care users but they are subject to systems and procedure and it is those that need to be looked to see if they are designed to benefit those who need care services or if they are designed to benefit the local authority. There is a need for a certain amount of red tape, reporting and recording are essential but each part of that red tape needs to be challenged to find out who it benefits and whether or not it enhances the life of the individual who needs support.

The back office functions, commissioner’s, funding panels, payments etc. must all exist only to improve the lives of those who need care services and their functions must be a benefit to the rather than the local authority itself. Elected councillors should learn to challenge the social care departments and asking how working practices, policies, procedures etc. actually benefit those who need care services.

Even at the highest level of Westminster ministers and civil servants who deal with social care should ask themselves how their work benefits the needs of social care users. As with local authorities the multiple levels of bureaucracy must have the question in mind as they prepare policies and reports, in the edicts they send out to local authorities.

Naturally there are many thousands of people and organisations involved in social care but each should ask themselves how what they do benefits the lives of the individuals who need care services and apply this question to every aspect of their work.  How does this process benefit, how does this terminology benefit, how does this job role benefit etc.

People do, unfortunately, often justify themselves in ways that satisfies their own actions therefore it is important that, at all levels of social care that we challenge people by asking “how is what you are doing benefitting those who need social care service.” David Cameron should be asking Jeremy Hunt who should be challenging the Permanent Secretary right the way through the Department of Health. The Department of Health should be challenging local authorities and national social care organisations who receive Government funding. It should a question that commissioners ask providers, and vice versa, it should be a standard question in every supervision of a person employed, in whatever capacity, in social care. It is a question that should be asked in every meeting and every time procedures are reviewed. It is a question that should be at the heart of everything to do with social care.

Social care does not exist to create jobs, those jobs exist because people need care and support. Social care does not exist to satisfy bureaucracy those systems are in place because people need care and support. Social care exists because people need care and support in their everyday lives and everything we do must be centred around those people.

Ask yourself now – “how is what I am doing benefitting those I am providing care and support for?” 

Monday, 7 January 2013

The Social Care Capping Debate MUST be Wider

Whilst the social care debate on funding has once again been raised by Paul Burstow and Centre Forum, calling for the implementation of the Dilnot proposals with funding from means tested winter fuel allowances the fact remains that this is only one side of the debate and, arguably, unanswerable without tackling how much social care actually costs and who is eligible for funded social care.

One issue largely glossed over is who will be eligible for social care services and state funding under any new scheme.

Over the last few years those entitled to funded support have been needing to meet ever tightening criteria meaning many thousands have not been entitled to support even when they have high (but not critical) needs. This naturally has led to a fall in the numbers of older people receiving supported care services and increased the numbers either paying for themselves or relying on family and friends for support in everyday life.

The debate on the Dilnot proposals must include the level of need at which people are entitled to state support. For those not quite meeting the criteria but with little other option may well still need to sell their homes in order to pay for necessary care services and it is essential that this element of the proposals is equally publicised before many thousands are led into a false sense of security believing that their care needs will be met by the state after the cap.

Local Authorities have, over recent years, continued the practice of increasing fees to providers at less than the rate of inflation and over the last two years many have given no increases at all. The shortfall is often made up by care service providers by charging top up payments which individuals pay themselves or by the level of fees they charge private paying users.

While the Dilnot proposals state that no one should pay more than £50000 for their care costs it does not mention the level of fees in the equation.  So once an individual has reached that cap will the Government/Local Authorities pay the higher rate normally charged by providers or will they only pay the reduced fee associated with the current system.

Additionally Dilnot proposed a rise in the means testing threshold to £100,000 if introduced this will immediately move many of those who currently pay private fees to being on local authority fees, dramatically reducing the income of care service providers

If there is a dramatically big drop in what providers are receiving then how will care providers survive with radically reduced income and what impact will that have on the quality of care services.

Of course that debate is somewhat mitigated by the fact that the Dilnot proposed cap only applies to care services not to accommodation or food. On this issue the recommendation is that individuals be charged between £7000 & £10000 a year to cover such costs.

The debate needs to be wider than the proposed cap and include exactly who will be eligible, how the cap will impact on the quality of care provision and the impact it will have on the lives of those not eligible for state funded care services.