Tag Archives: social care

Ticking boxes is on the way out in the NHS… but there is a need to think wider and deeper to change it.

The idea of giving the million most frail older people a named GP to look after them was trailed last week by the Health Secretary and on the face of it seems like a good idea – the aim is to get away from a box ticking mentality and to focus more on the needs of the older person.

My worry here is with some practical problems – not least that older people themselves can be quite stubborn when it comes to their GP and might not take kindly to this idea if it involves the local practice changing their contact. GPs also report that older people come to see them over trivial matters when all they really want is some company – having a named GP might actually make this significantly worse, if older people believe they now have a real right to see the named person.

I’m also wondering what will happen within GP surgeries? Will the named GP actually become a dumping ground for all the patients no-one else wants? And what is the betting that this will be the newly qualified doctor rather than the managing partner? And let’s not forget that most GP surgeries operate on a tight timetable of appointments – I’m not sure this idea will help that time-scale and will probably put more pressure on it.

However, I’m quibbling here and the emphasis on needs rather than box-ticking is a very positive move.

But is it enough?

Er, no.

There are some real basic cultural problems with the NHS that mean the turning of this particular supertanker may take longer than any of us may have left to live. The main one is the medical focus of the NHS…

Medical focus of the NHS? Isn’t that what it’s there for? Well yes, but the problem here is that NHS care is far too blinkered when it comes to other treatments and interventions that may help a patient.

And I can see where this comes from – doctors and nurses train hard for many years and experience things every day that most of us would lose our lunch over, so they are right to be protective of their expertise and dedication. And they are also pushed for time – GPs have 5 minutes to see a patient and five minutes to write up the notes? Does this seriously give them a chance to really engage with a patient?

Given the time available, they have to see a condition and then prescribe a pill or some tests, without maybe looking at the whole person and what else is going on in the patient’s life. What about the patient’s finances? Or the falling out they’ve had with their only living relative? Or the fact that they are 87 and also a full-time carer? I think this is what Jeremy Hunt is getting at with the line about returning to the “old fashioned family doctor”, but it actually needs to start with the doctors themselves.

Doctors need to have it ingrained into their daily practice that social care solutions can dramatically improve patient health, and that the combination of health and social care solutions can bring benefits to patients greater than the sum of the individual parts. Here in Bexley, tentative steps are being made in this direction, with the Council and CCG working together on an integrated care pathway for hospital discharge. It is early days, but the fact that it is happening and that both health and social care professionals are committed to it means that patients here will benefit.

We don’t want doctors to become social workers, but how do we get them to appreciate the social care side of improving a patient’s life?

My solution? Every GP and nurse should have a social care module as part of their training, that they have to pass in the same way that they would with medication and anatomy.

If anyone wants help writing this course, give me a call.

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.

 

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.

Learning disability, ageing and dementia

Recent research seems to be indicating an emerging new issue in social care. As is often the case, a medical triumph – people with learning disability living longer – is coupled with the challenge of meeting new needs in older age. It is now estimated that up to 50 per cent of people with Downs Syndrome, for instance, may develop dementia as they age. Are we ready for this new challenge? Will people who have grown up in the adult social care “system” be adequately supported into older peoples services? And crucially, will the money be available for their needs to be met properly?