The image of care

The dear old NHS has come in for plenty of stick lately – today’s report on reforms the latest in a long line of bad press ( The Guardian: NHS reforms criticised by leading healthcare publications ).

So with great pleasure I can report that my first ever operation procedure in the middle of my sixth decade was an extremely positive experience. True, the surgery was a no-nonsense Hernia procedure which these days is completed in one day. And the way I was treated by the wonderful staff at Hackney’s Homerton Hospital made me feel like a million dollars. From the receptionist who booked me in, to the wonderful nursing team, anesthetist and surgeon, an experience that I was not looking forward to turned out to be painless and worry-free (although I’m pleased to have been given painkillers for the after-effects!)

Here was the NHS at its very best; a group of superb health-care professionals who worked as a team ensuring my comfort and well-being and despite the pressure they work under, always had a time for a smile and a reassuring word. And they represented all that is good about our society, a wealth of nations represented on both sides of the operating table, giving and receiving care. This is what we pay our taxes for, so that we can be given help when we need it and that help is not provided on the basis of wealth, status, colour, creed or background. Compare this to the ‘show us your credit card’ model of healthcare in the USA and tell me which is superior.

So thank you to the staff at the Homerton; despite all the problems in the NHS with funding and reform, you proved that on the ground it is a health system of which we can be immensely proud.

Shock, horror is at it again regarding care. The review of home care by the Equality Commission has found that care supplied by agencies to people’s homes may be breaching their human rights.

Half of the 500,000 people receiving such care reported they are satisfied with the care provided, half are not and there is no shortage of shock, horror stories.

We have been down this road before in the treatment of vulnerable people in care homes, now we see the problem is endemic in private houses.

It is too easy to suggest that it is because the providers are mainly private companies and are stretching their resources to squeeze as much money out of the time provided for each home visit. After all, local authority provision has been found out in these areas many times. But it does leave a bad taste when you realise that profits are not only coming before people, they are also dependant on the misery of people.

I know about this first hand. Two years ago a private company bought the adjoining terrace house to us and made it into a small care home for five women with mental health problems. Having worked in this area myself when I was a social worker I know the problems associated with placing people in the community who cannot cope with the everyday pressures this change of lifestyle brings. The result, one resident had to be moved back to secure accommodation after a litany of abuse, screaming and inappropriate behaviour culminating in her hurling a heavy object into our garden and so threatening the safety of our children. And now we are being forced to complain about another resident who presents similar behaviour. Having bought such services when I was a commissioning manager, I know the kind of riches that can be made from working with vulnerable people coming form a secure or semi-secure environment. It does not take much of a mathematical brain to see why the company in question is prevaricating on our complaints.

I do not have a problem with companies which provide a good service being able to manage care services but too often ‘good service’ takes a back seat to ‘healthy profits’ with the subsequent shock, horror reports of neglect.

The answer to these problems is actually quite simple; registration, inspections and follow-ups should be much more rigorous than they are. CQC on taking my complaint, made an unannounced inspection, found the resident was out and left it at that. It is this kind of intransigence that leads to shock, horror headlines.

There is a joke among chess players that goes like this; two players are embroiled in a game and one says, ‘let’s make it interesting’ to which his opponent replies; “OK, let’s stop playing.’ I own up to being a lower than average club player who enjoys playing in leagues and tournaments with no illusions of grandeur. My ambition is to write a chess book, “My sixty cr*p games” a reference of course to the masterpiece by the late and more than great Bobby Fischer whose 60 memorable games is one of the greatest ever books on chess. From my archive I will have plenty of losing games to choose from!

So what has chess got to do with the image of care? Well, the charity Chess in Schools and Community, CSC, has had success in helping young people from disadvantaged areas and communities improve their lives. The charity is pushing the game in primary schools across the UK and youngsters who have been involved in negative types of battles in gangs are now enjoying the endless possibilities offered on the 64 squares.

Chess is second only in participation to football, an estimated 500 million people in 167 countries play the game and in some countries it is on the national teaching curriculum. Chess’s unique selling points are that it is universal, with no barriers of age, gender, race, physical disability or language; it has a positive image and that it has educational and social benefits backed by academic research. And those of you reading this who have enjoyed the occasional game on the beach will testify that it is a cheap, fun pastime that can be relatively easily picked up and enjoyed.

CSC are making an impact with coaches helping a range of primary school kids across the country and from different backgrounds and the feedback from headteachers has been very encouraging. A similar scheme in the USA was adapted as a feature film Knights of the South Bronx

Chess may not seem ‘cool’ but the world’s number one player, Magnus Carlsen from Norway, starred in a fashion shoot for G-Star and plays matches with Formula-1 style sponsorship on his shirt.

So I applaud this initiative by CSC and wish the charity well.

I sometimes wonder if there is a semblance of a society or whether we are just a piece of land inhabited by 60 million-plus people. We are all struggling in this recession; it’s hard to make ends meet at the best of times but at the moment it’s becoming a harsh, mean society we live in. On a morning radio phone in this week we heard how some people are waiting a day to eat between meals so as to save money, two days later we heard how an elderly man in hospital was forced to lie in his soiled bed as the nurse on duty refused to clean him, or indeed the bed. These snapshots are not sensationalist; they are happening just as footballers paid £250,000 a week are stumbling out of night clubs and while MPs are filling out expense forms with varying levels of honesty.

The material gap between rich and poor is obscene but nowhere near as obscene as the way poor people are denigrated by the rich. I’m not a political activist but even I’m moved to anger when I see poor youngsters priced out of the education market by the obscene rise in tuition fees while the scum who screw us for outrageous amounts of money to buy our gas and electricity are allowed, even encouraged, by this government to rip us off even more as prices go through the roof. All in the hallowed name of the free market, of course. Those talented and spiv-like enough to play the markets laugh at the rest of us trying to eke out a living.

There is of course a very simple solution to this kind of gangsters-in-suits mugging; tax these spivs to the extent that they bugger off to a tax haven thousands of miles away. Put government money into universities so poorer kids can study and pay nurses a decent wage so they have enough pride in their job to clean a bed full of an elderly person’s s**t while he lies in it. This is not socialism, it’s common sense for God’s sake.

Care Images encompasses all areas of care and community in the UK, and dare I say, warts and all. We’re not afraid to shy away from more negative issues – clients give positive feedback on our realistic images portraying violence and issues of troubled children and young people. We were shocked and dismayed by the horrific events this week and we commissioned photo-journalist Julio Etchart to attend the scenes of devastation in Tottenham and Hackney. His work is indeed a mirror on our troubled world.

The events of the week have left a terrible scar on our community. The poor Malaysian student, already dripping with blood after having his jaw broken by a mindless thug, then being comforted by another hoodlum while yet another looter emptied the student’s bag of whatever remained. The poor father having to bury a son; the pensioner beaten by a gang of hoodlums; the parents running terrified from a burning building carrying their baby to safety.

A once proud nation who defied Hitler’s Nazi thugs was left powerless by social media columns of thugs of all races, creeds, ages and it seems lifestyles (would you employ the graphic designer or classroom assistant caught extending their white goods range?) And the same old same old on radio and TV as hang ‘em Tories sparred with tree-hugging criminologists as to where the blame lay, and to boot, a revolting new word ‘criminality’ entered the lexicon. If it makes you feel better we can employ water cannons, the military, even lock them up in Wembley Stadium as one gentleman suggested on a phone-in, (I think The Emirates is a better option, at least it will give those poor Arsenal fans something to get excited about). We can shoot them, hang them and bring back the birch. We can ‘understand’ them, have a group hug with them, maybe send them on a re-birthing weekend before enforcing them to join a ‘book group’ and sign a contract to eat organic rice cakes until they mend their ways.

Or we can recognise that we are ostensibly at war with our own youth and find a long-term uneasy truce as we did in Ireland to relative success since the Good Friday Agreement. The ferocity of the hatred and venom among the perpetrators of the disgraceful mob violence tell me that this gulf in understanding cannot be mended for at least a generation. And that, along with the young people who have lost their lives and the older people fighting for theirs following the mayhem, is the real tragedy.

And when the government, along with the economic and chattering classes come to make this truce with the thugs, they might like to consider how they have been looting from us in a less violent but similarly smug way. Are the scum who looted our banks and then stuck two fingers up at us after we bailed them out before walking off with millions more in bonuses a better class of thug? What about the MPs who were lining up to pull the electric lever on all the hoodies this week? Presumably these are different MPs to those who thought it perfectly acceptable to steal hundreds of thousands of pounds on porn, duck ponds and London love nests under the hoods of expenses.

Broken Britain, yes. The rioters have no moral compass; they are a disgrace and I’m angry with them. But please don’t tell me that the behaviour of looters in suits is a more acceptable style of a robbin hood.

I must admit to having a bit of a soft spot for the News of the World …until all the allegations about the disgraceful phone-tapping and illicit payments to Mr Plod. To be honest, I’m pleased about its closure, this kind of sleazy, spiv-like behaviour has no place in a society that prides itself in a free press.

That said, it is remarkable how in a 168-year history, NOTW transcended class and political divides. Aside from the white van man that the likes of the Guardian believes to be NOTW’s readership, the paper was read by Winston Churchill, George Orwell and a raft of liberal friends of mine who hid it under their copies of the Observer on the way back from the newsagent before reading the sports pages on the khazi. I think it’s fair to say NOTW was a brand that enjoyed a love-hate relationship with British people, a Fleet Street jar of Marmite, so to speak.

And I think I know the reason why. The British are a prudish, reserved people so the NOTW’s Sunday titillation was welcomed on kitchen tables which for many years had creaked under the weight of ‘we don’t talk about s-e-x’. How nice it was to read about cabinet ministers’ sexual preferences and the shopping habits of footballers’ wives. So while the broadsheet-reading paragons of virtue were putting the world to rights over Sunday breakfast, NOTW readers were enjoying a real Sunday roast of sex lies and videotape.

After the current round of allegations, the ubiquitous Mr Mudoch had no choice but to shut up shop. The staff in question have brought shame and disgrace to journalism in the UK and have consigned a much-loved British institution to the dustbin. Shame on them.

I’m not what you might call a political activist. As I get older and hopefully wiser I can see how my earlier flirtations with political issues could be filed under ‘naive’ at best and ‘plain stupid’ at worst. When I set out on my career in care, Corrigan and Leonard’s ‘Social Work Under Captialism, a Marxist Perspective’ was the reading order of the day. Now, to get anywhere in the profession you need an MBA and a track record in buying and selling.

So today’s demonstration by teachers and other public sector workers should not have had the effect on me that it would undoubtedly have had thirty years ago. But I have to admit a frisson of solidarity with those on strike, not so much for any political agenda they have, but rather for the fact that low paid public sector workers are being made to pay for the greedy antics of the spivs, rogues and degenerate bankers (another word that rhymes would also suit) who have messed up the UK economy.

Why should a teacher be expected to work more years for a lower pension when the *ankers walk off with obscene bonuses? I suspect the reason is that governments of all colours are reluctant to take on the said *ankers in the same way that one Mrs Thatcher was prepared to take on and break the unions of thirty years ago. On radio today, Francis Maude, who has overall responsibility for Cabinet Office policy, was left like a rabbit in the proverbial headlights:

Listen: BBC – Serwotka and Maude clash over strikes

There is indeed a debate to be had on the merits of some public sector jobs in the present economic climate; but to let the *ankers pursue a life of greed while those who serve us are left to work themselves to an early grave is a national disgrace. So today, I’m with the strikers and may the *ankers look down at the demonstration in London from their glass tower blocks and hold their heads in shame.

How much more can go wrong for the poor residents of Southern Cross? The once mighty care home provider is grovelling to its landlords and our government both of whom are willing to keep the homes afloat despite horrendous losses and poor standards of care. I’m not so naive as to expect that murky venture capitalists and company directors of care companies are in the provision of care to, er, provide care. But come on folks, even in today’s materialistic age, one might expect a bit less of blokes in £2000 suits milking the cow while the residents are left with the bull.

Actually there is a model that works very well. Would you believe that there exists a raft of charities and not-for-profit organisations, along with small private providers who run excellent care homes? There is nothing wrong with making a profit from running a good care home, but there is everything wrong with making a killing from running a raft of poor care homes.

I’m getting a tad tired with sounding off on crucial institutions being bailed out by the government; from banks to train operators to care homes, the public are badly served. Never mind all the stuff about buy-back-lease-back-bags-of-money-back which has put Southern Cross in the news; the one item that should have had everyone involved in care banging on the doors of the company’s directors is detailed in this Guardian article.

My business brain might not be at the level of a venture capitalist but I’ll bet my bottom dollar that the spivs who made millions out of Southern Cross were not too concerned about 28 per cent of its homes being sub-standard.

Pass the sick bag.

Difficult viewing last night of the Panorama expose of brutality and abuse of patients at Winterbourne View residential unit run by Castlebeck, (watch it on iPlayer).

The psychologist brought in by the BBC to give an expert opinion was spot on in describing the treatment of vulnerable adults with learning disabilities as ‘torture’. The systematic abuse filmed by the BBC undercover reporter would have been out of place in a prison, never mind a £3.5k a-week-per-resident facility. In fact, had it happened in a prison, the torture would have been stopped in its tracks. That it wasn’t, even when a brave whistleblower nurse exposed the institutional (sic) brutality, every level of management in Castlebeck ignored it.

We’ve been down this rocky road before and unless there are drastic changes to provision, the inspection system and accountability, it will happen again and again. Former Health Minister Stephen Dorrell was correct in saying on radio today that it’s not because the system is privatised that abuse like this happens, there was no shortage of abuse when local authorities and the NHS ran hostels and long-stay ‘subnormality’ hospitals as families of former residents of St Lawrence’s in Surrey, closed long ago, would testify. However, the very nature of private provision means that companies are motivated by profit before people, which is why, of course, Castlebeck employed tattooed thugs on minimum wages rather than appropriate carers at £10 an hour to provide intimate care for the most vulnerable members of our society.

For me, however the most significant aspect of this disgraceful saga was seeing Castlebeck’s chief executive Les Reed, obsequiously squirm in front of the Panorama cameras offering a meek apology. Here is a man who has presided over a regime of brutality, and even if we take his word that he didn’t know what was going on in that particular unit, he ignored the whistleblower who brought the thuggery to the attention of the company some months ago All this suggests to me that Mr Reed is unfit to hold the office of chief executive of a company supplying care. After Castlebeck were presented with Panorama’s findings on May 12, they had almost three weeks of media and crisis management training to deal with the issue. Mr Reed’s performance on camera, along with a pathetic apology on their website
www.castlebeck.com suggests to me that just as they have been mugging local authorities of £3.5k a week while abusing the residents, so the media training and crisis management companies have been mugging them.

And what of the ubiquitous CQC (Care Quality Commission) whose job it is to regulate care providers and whose inspectors managed to miss a regime of terror? Their regional manager Ian Biggs was wheeled in front of the cameras and seemed completely out of his depth. Of course, what we really need to know is why Cynthia Bower, the chief exec of the CQC, left poor old Ian to take the flak while she continues to pick up her hefty salary. Presumably Ms Bower will follow the former Haringey Director of Social Services Sharon Shoesmith line of ‘why should I lose my job – I didn’t kill Baby P?’

But you know what; this confederacy of dunces that left the most vulnerable people in our society to have their eyes gouged, to be thrown into a shower dressed, to be insulted, to be left to the baying dogs on £6.40 an hour are but bit players. The most culpable of all the cretins that enabled the degradation to take place are the local authorities who purchased the service.

Consider this: If you paid £3.5k for a holiday where instead of being looked after, you were tortured for a week, might you just enquire as to why you were not getting value for your money (and in this case it’s worse because it’s our money). Might you just want evidence that the £3.5k a week is being used in a way that helps the service user get the most from his or her life? Might you just send the referring social worker round say every two months instead of every year? Might you just enquire from the providing company if there have been any internal complaints by staff? Might you just send a senior manager round every so often, unannounced, to see what is going on? Leaving the abuse to one side for a moment, might you just not think that residents sitting around all day doing nothing is not exactly getting £3.5k a week value for money? Might you just consider that a smaller unit of say four or five residents in a home with brilliant, creative care at £1k a week less is a better way of spending council tax payers’ money (I know of such a unit). Might you consider going to providers from the charity and not for profit sectors who are not motivated by greed? Might you just sit in front of the TV last night think, ‘it was we who failed these people’?

It’s good that the government have acted swiftly and are cracking down on CQC to get a grip. But lets put it as it is. The people who buy care from the so-called providers like Castlebeck are no different from the thugs who administer the regime of torture and the executives who live a five-star lifestyle from the proceeds.

We are constantly being told that we live in a ‘fractured’ society (some would have it that there is no society at all). The red tops have us believe the country is made up of feral gangs of hooded youths randomly looking for prey while we cower in our living rooms terrified of leaving the house.

While it is true that the perception of crime and anti-social behaviour is on the increase, acts of kindness, civility, politeness are as much a part of our society as they always have been. Two weeks ago my wife was driving home around midnight when the car suddenly stopped, literally. Before she had the opportunity to call the roadside assistance, two people had stopped to help, offering advice, jump leads and a lift to near the house. In the end, thanks to the help of these two strangers in the night, she made it home safely and the car was rescued the following day.

Recently, I re-read the late Richard Titmuss’ classic work on giving The Gift Relationship. The book, which is still a sociological classic, looks at blood donating in the United States, the former Soviet Union and Britain. Titmuss compares the UK system of altruistic donation with the US system of payment for the donors. The work shows that the altruistic method is more effective than the ‘bottom line’ motivation of the US.

The reality is that people get pleasure and benefit from helping others but it’s the bad news of the feral gangs that gets the reaction the newspapers want. Rather like my reaction when I first read Titmuss 40 years ago; as a UK donor I was astounded to learn that people actually sell their blood in the USA.