Tag Archives: care

Ideas are cheap – volunteers aren’t . . .

I’ve previously praised the care minister, Norman Lamb, for saying that we need to look at the care in the home provided by care agencies – but today’s report, that he thinks Neighbourhood Watch should be involved in helping with the care of older people, nearly had me causing a motorway pile-up.

Now I’ll start by saying that Neighbourhood Watch are a great organisation and good at doing what they do. They are strong here in Bexley and are an excellent example of community minded people giving up their time to keep neighbourhoods safe.

So why did others drivers see me shouting at my radio? The simple reason is that this is another example of the thinking that volunteers are a cheap resource and a magic wand for providing services that the government can no longer pay for.

So here are some reasons why this is a poor idea . . .

Mission drift – however this starts out I can guarantee Neighbourhood Watch will start getting calls from hard-pressed social workers and care providers along the lines of, ‘Would you mind popping round to see Mrs Smith?’, and of course Mrs Smith will need a lot more than just a chat. She will need shopping done, meals cooking, forms filling in, bills sorting out, maybe even dressings changed. Which leads on to . . .

Boring but important – insurance, procedures and responsibility. Where does the responsibility lie if a volunteer visits a client and finds them with no electricity, in their night clothes in the middle of the day and clearly disorientated? And if the volunteer leaves them like that and they are discovered dead a few days later or wandering the streets? Anyone dealing with the more vulnerable in society needs to know what they are doing and where the responsibility lies, or else the older person is still in danger and the volunteer is putting themselves and the organisation at risk. Which leads on to . . . .

Looking after your volunteers – piling more responsibility onto volunteers is a sure way to lose them. Managing their expectations, thanking them and giving them the proper support is vital if you want to keep them. And to be effective, this support needs to be done by paid staff.

It’s already happening – this is the main reason why the Big Society has sunk without a trace is because it tried to brand something that has been going on anyway regardless of what governments do (or more likely, in spite of what governments do).

It’s already happening No. 2 – caring and the voluntary sector go hand in hand. There are so many existing organisations who are keeping a look out for vulnerable members of the community already, so does the Minister think we aren’t going the extra mile to alert other organisations when we find someone in need?

It’s already happening No. 3 – voluntary sector organisations are already using volunteers for supporting vulnerable people and we’ve got a lot of experience at it. If the Minister wants to talk about better ways to reach older people and have better impacts on their well-being, then why not talk to the people who are doing it already – local Age UKs and any of the many other excellent local charities who already do this work.

Reading this blog back, it does sound a bit whiny and negative. I don’t have any problem with Neighbourhood Watch exploring this with government and if they want to move into social care and they are using this as a foot in the door then I wish them all the best.

But the tone of this story is still about cutting care budgets – basically using volunteers to replace proper properly funded support for older people. Volunteers are a fantastic way of helping older people but whilst they cost less per person than paid staff, they aren’t free – or even cheap. To get good results from volunteers they need looking after so, Mr Lamb, why don’t you challenge us? Don’t try and get savings by assuming volunteers are free – pay voluntary organisations to support volunteers properly and we’ll reduce care bills by keeping older people away from statutory services for as long as possible.

Andrews Salts or a better diet? – if the government wants home care with dignity then it will have to find better ways of paying for it.

Care Minister Norman Lamb has announced that there is an urgent need to transform care in the home – highlighting the fact that, according to CQC, 25% of care is failing to meet basic standards. He’s right that this is an accident waiting to happen, but the solution is tricky.

The economics of the problem are quite simple. Carers get the minimum wage or just above, and the margins for care agencies are very slim. Local authorities are under pressure from central government to cut costs and so will look to cheaper providers and also make requests such as half hour or even quarter hour slots. Providers are in the position where if they don’t accept the local authority work on offer, then they have a serious hole in their income so they have to oblige. It also means their training and management costs are under pressure and there is no spare cash to invest in developing staff.

The upshot is that despite the local authorities and care agencies wanting to provide quality home care, they are forced to concentrate on the money rather than the people – and against their natural inclinations, clients can become “units” and care staff can become “resources”.

In terms of looking at the long term treatment of clients, it is also a false economy: by spending more time with clients and providing consistent care, the person receiving the care feels better, is happier and therefore more able to cope with life in general. This in turn means that any decline in health and well-being is slowed – which means that the costs to the local authorities for residential and nursing care are reduced. The current system is just storing up trouble for the future.

We need care providers to have the income to be able to employ and invest in staff, giving them the quality time with clients but also meaning that the care agencies are viable. In turn, local authorities would need to have clear contracts for the services they are funding and a high standard of inspection – none of this is difficult to achieve, and is largely what agencies and local authorities want to do anyway. The issue lies in where the money comes from . . .

However, it is no good just going to the Treasury and asking for more money – that is not going to happen. So the challenge here is how does Mr Lamb deal with the financial constraints on the one hand and the political and social care pressures on the other.

It is the difference between treating the symptoms or dealing with the cause. Tinkering around the edges and asking the care providers to work in different ways will only deal with the surface issues – the Andrews Salts to provide a burp of relief in the system. But this will only put the crisis off – what we need, and what I hope the Minister is going to look at, is a transformed way of paying for home care, because only a better financial diet will mean that we finally get dignity and proper care to those who really need it.

Co-operation in Care

This is a guest blog by Ed Mayo, Secretary General of Co-operatives UK

Age UK London would like to thank Ed for writing this blog post for us.

It is in the nature of people to care… and to know when not to care.

Many of the most important and fulfilling parts of our lives – such as parenting, neighbourliness and favours – fit within the description of care, even if they are not typically understood as economic activity.

When people are motivated by a need which inspires care, whether unpaid or paid, such as a care worker or nursing, there can be a richness in the motivation, because it is needs driven and sustaining of people and society.

It is in the nature of institutions that care can be a slot machine.

The welfare state plays a vital role in peoples’ lives and can be a life saver, a safety net or a transformer.

As one person explained to a friend of mine, Richard – “There are things that, if I didn’t experience them here at the day centre, I wouldn’t have ever done them in my life. Before, I never got out. I was a right scaredy-cat. Now, I’ve tried so many different things, I think “Yes, I can do it”. So that’s what it’s done for me’

But the welfare state can also lose a caring touch in random acts of thoughtlessness, pervasive bureaucracy or the demeaning nature of being assessed as in need. Talk to any parent over the years who has had to get one of their children ‘statemented’.

The language that is used to describe and plan care services mirror that confusion.

Richard, who I mentioned before, was doing research on people who use social care services. He wanted to explore the different ‘labels’ they have – citizen, consumer, client, customer, user, member of the public – all labels with slightly different connotations.

He showed the list of terms to one person and asked ‘How do you think the service providers see you?’ The man looked genuinely confused, and then replied ‘They just call me John’

The words that professionals use to talk about health and social care today, including that great ugly noun, personalisation, are no more than bits of Lego. Terms can be assembled, fit together and sound good, but they don’t capture the fundamentals of care. They don’t answer the question ‘why care?’.

At root we need to understand care as about meeting human needs and creating human dignity.

This needs to be good work. Fritjof Capra puts this as ‘we can’t be empowered by work that destroys the environment around us or creates systems of inequality. No matter how our work is organised, it cannot fully empower us unless we believe in its purpose’.

This is not how the care system, or the wider economy, works.

• In paid work, people are often being rewarded in terms of money and status when they are behaving destructively.

• Those who care at home or in the family that are unpaid suffer low status, poor conditions and often stress and personal costs.

• The burden of this work continues to fall disproportionately on women, whether they are out of or in the labour market.

• The entry of venture capital into the care of children and vulnerable people shapes the culture of providers towards an instrumental model of care, where service is means to an end in the form of a return on capital.

The co-operative model is now well-known and, thanks to the efforts of pioneers in the field, is increasingly looked to as an alternative, potentially better approach.

A co-operative is a business, owned by its members and there for no reason other than to serve their needs.

If the language is confusing, then yes, we can say that co-operatives are a form of social enterprise – something that is run commercially but with people in mind. What is distinct about co-ops is that the people in mind are not passive beneficiaries. They have a say. They have responsibility.

The Foster Care Co-operative, for example, gives a voice to foster carers. It can match pay and good working conditions, though not exceed them, but it adds a precious commodity – dignity.

The challenges of running a business focused on health and care, particularly in the context of local authority financing, are well known. The most impressive examples I know are long-standing health co-operatives and mutuals that in fact pre-date the NHS, such as Simplyhealth and Benenden, which has recently opened its services to all.

But when you talk to co-operatives like this, they stress that what makes the real difference is values and culture.

We are surprisingly unreflective as a nation about the institutions that serve us, surprisingly complacent about turning the care of vulnerable people into a market. To create an economy that cares for people in need, we should take a better road – the road to co-operation.


The generation game – and why the current debate over universal benefits for older people is irrelevant…

The coalition is currently split on the question of universal benefits for older people, such as the free bus pass and winter fuel allowance. This split is either healthy for democracy or a sign that the marriage is coming to an end – you decide. But the argument itself is largely academic, because reality is over-taking policy.

If my grandparents were alive they would be in their late nineties – they were the generation that fought in the Second World War, and came home to the promise that the state would look after them. The welfare state and the NHS were products of their time – but they were only a good idea for the situation that the country faced at the time, and certainly not future-proofed. The feeling of ‘I’ve paid into the system so it will look after me’ is very much of that era, as is the idea that this support would always be there.

My parent’s generation has some of the hangover from this view of the state, but they’ve also been influenced by living through the inadequacies of the state in the ’70s, the explosion of personal aspiration in the ’80s, and then the excesses of that coming home to roost in the ’90s. They are the ones slowly breaking down the old reliance and expectation of the state always being there.

My generation (anyone in their ’40s) probably has a more pragmatic view of universal benefits – given the economic climate and the pressures of population growth and demographics, I can’t see universal benefits being around in 20 years time. My guess is that, whatever happens, I’ll be personally paying for far more care and support than older people are at the moment, and because this expectation is already in the air it has become accepted.

My niece’s generation (anyone currently under ten years old) will be facing a different situation, because the pressures will have moved on – by the time she retires the NHS and welfare system will have been going for over a hundred years, and no-one can realistically expect a 1940’s solutions to a late 21st century problem.

Now you can argue that I’ve got my generations wrong because of course it is difficult to section society off in this way, but it does illustrate how far we’ve come and where we are heading.

So, universal benefits are going to go – either because future governments won’t be able to afford them, or because there won’t be a government because it will have been bankrupted by care and social security costs. The main question is what replaces it – private insurance? Means testing? An ‘opt-in’ benefits system? And this discussion had better start soon, because the rate at which these issues get tackled means that the future might be on us before we realise it.

Reinventing the wheel?

Age UK London recently hosted a presentation from an organisation called care4care, and when I saw it I thought this is something I have to look at. Partly because of the need to tackle the problem of future care for older people, but I have to confess mainly because it is fronted by Professor Heinz Wolff – the archetypal professor from ‘The Great Egg Race’ in the late seventies. Along with Johnny Ball (how did he get voted off SCD?) and Johnny Morris, he inspired many of my generation to have an interest in science and the natural world. So what did he have to offer?

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When will they grasp the nettle?

Older peoples, families and local authorities around the country are looking for leadership and certainty in the question of funding adult social care.

Every year the question of funding adult social care becomes more pressing, as pressures on budgets become tighter. The sooner a framework for funding and a timeframe for implementation are agreed, the sooner families and local authorities can plan for the future. Doing nothing is not an option.

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Time to care

Today’s report about the pressures on unpaid carers presents yet again the huge pressures on carers to underpin the social care system in this country. Unpaid carers need support; they need respite and they need recognition of their own health needs. Often in the day-to-day management of life of the person they care for, their own care needs get overlooked. Without unpaid carers’ huge contribution to supporting our most vulnerable people in society, the social care system could not cope. We need to ensure that carers are supported as they are the backbone of our social care system.

Paid carers can also be vulnerable, with unpaid travel time between clients, low pay and little recognition. Yet these people work with some of the most frail and vulnerable people in society. Often time to care is minimal and the costs of care are tightly controlled so that only the basics are provided. For some older people, their carers may be some of the only outside contact they have with life outside of their homes, yet time for care is rationed.

Everyone recognises times are tough, budgets are small, every penny is squeezed, but isn’t the lack of recognition for both paid carers and unpaid carers shortsighted? Recognition in the short term will mean a better and less crisis-ridden care system in the long term. Giving our carers the time they need to care and to continue caring must be a priority.

Don’t cut care in London!

It’s time to say “No” to any more cuts to older people’s social care services. Local authorities need to make spending cuts from somewhere, but maintaining frontline older people’s services needs to be a priority in 2012-13. There is no slack in the system, many older people already get pooor quality care services and any further cuts could harm vulnerable older people.

That’s what Age UK London and Greater London Forum for Older People have found anyway. We have just launched our research report, ‘Don’t cut care in London’, looking at the impact of the cuts so far and the possible impact in the future. You can download our report from www.ageuk.org.uk/london

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The scandal of older people’s “care”

The EHRC has published a shocking report highlighting yet another area of neglect and cuts in levels of service. This time it’s homecare, and reliable reports of people being left in wet and soiled beds for hours on end, waiting for a care worker to arrive and help them – often with just 15 minutes allocated for the work.

The temptation is to blame the care worker, who is surely recruited, trained and paid to ”care” . I have commented, raised concerns, blogged and generally got on my soap box about these issues many times. There are several pertinent points to make:

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Oh, the agony of choice…

With personalisation upon us, we’re hearing more about the benefits of the choice it brings. “Choice” is a great word for politicians. “Fair” is another one. “We’re giving you choice” or “a fairer system” may sound great, but because they mean different things to different people, political spin doctors rely on people interpreting them in their own way and then thinking that they’re getting something better. But precisely because these words mean different things to different people, they become meaningless.

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