Category Archives: politics

Docking Benefits and Blaming the Poor

I know I covered this more generally on Monday in my rant about ‘benefits’ but it’s worth coming back to with the proposals explained in the Guardian

Magistrates and crown court judges could be asked to dock benefits from convicted criminals under preliminary proposals being drawn up by the government in response to the riots, the Guardian can reveal.

Ministers are looking hard at how benefits, or tax credits, could be taken away to show criminals that privileges provided by the state can be temporarily withdrawn.

Under the proposals anyone convicted of a crime could be punished once rather than potentially facing separate fines – first by a magistrates court and then a benefit office. By giving powers to the courts to strip benefits, the Department of Work and Pensions would not be required to intervene in the criminal justice system.

Yesterday, a little tardy, I know, I listened to the podcast of Pienaar’s Politics which I tend to really enjoy and I did except for the presence of Kelvin McKenzie and an odious interview with Iain Duncan-Smith in which he discussed this.

(Iain Duncan-Smith who, incidently, laughingly claimed at his constituency of Chingford and Woodford Green was ‘inner city’. Really? Waltham Forest is inner city? Really? Have I missed something? Anyway, back to the programme).

Let me explain why it is so odious if I need to.

Firstly there are the assumptions that all those who rioted are claiming benefits. Yes, I know there are links to poverty but will how will there be an equivalent punishment for someone who commits a crime and does not claim any money from the State. This is an intentional scapegoating and targeting of poverty.

The riots were awful but the causes run much much deeper and broader than ‘gangs’ and ‘benefit fraud’.

Duncan-Smith in a truly odious and preaching manner seemed to make links between ‘generations of joblessness’ and the feckless claimants. He emphasised his joy in ripping away support for those who received Invalidity Benefit and while me gave a cursory nod to those who might have caring roles – he mentioned them solely in terms of the money that they save the government.

How about truly visionary leaders that display integrity and leadership rather than those who pander solely to  the lowest common denominator of cheap ‘kicks’ at those who need to claim money for support and those who are not able to afford the lives they see the privileged lead.

This week we have seen our millionaire cabinet members talk about the ‘feral underclass’ (Kenneth Clarke who was one of the few Tories I had a smidgeon of respect for previously).  Really?

Yes, the people involved in the riots may well have been some of the poorest and most disengaged but that doesn’t mean the cause of the riots needs to look solely at those who were out on the streets looting. If it does, it allows the cosy middle classes to look on from the suburbs (or in IDS language ‘inner cities’) to preach from their own comfortable positions of superiority.

These riots, this inequity, it is the problem of ‘other people’.

Surely the riots, the way that culture has become so consumerist in its nature, the dishonesty and the lack of censorship of anything other than ‘getting away with it’ the lack of inherent understanding of right from wrong in any other terms – that is not a problem of the poor and it is not a problem which is solved by taking away ‘benefits’. That merely pushes all the problems of a society onto one particular class that will match with the photofit of ‘problems’ that rest most easily in the middle-class heads. By looking at analysis of ‘who rioted’ or rather ‘who was caught‘ and looking at lists from magistrate’s courts we provide a very narrow view of what was responsible in our society for creating a moment when people thought they could ‘get away with it’.  The riots were not about who was rioting. They were about what is and has been happening within our society from top to tail and by concentrating reasons and solutions on the lower end, we allow those more privileged  to get away with all kinds of poor behaviours and excuse the problems that their behaviours have caused which have led to such strong feelings of disillusionment.

Personally and I base this on no research base other than my gut feeling, I think the problem  and the problems in society must be examined in a much deeper and more fundamental way. In England, at least, we have seen successive scandals and betrayals from the finance services through the collapse and deceit in the banking system, the MPs fiddling expenses compulsively, the Press through the phone hacking scandals and the police for bribery.

While politicians lament of a world where people loot ‘because they can get away with it’ and only refrain from crime not because of an inherent ethical desire but because they will not be caught, it is impossible to separate those who loot shops from those who loot the public purse. Those who sit in their comfortable suburban (sorry, inner city) homes.

How can we, as a nation, allow our poorest people to be scapegoated by an establishment (financial/political and media) that has been equally deceitful but who will never feel ‘benefits’ being taken away because they are all wrapped up in each others’ collective pockets. They will never be evicted from their council houses because of the behaviour of their children because they are fortunate enough to own their own homes and they will never suffer from having child benefit withdrawn when their kids truant because they aren’t reliant on child benefit and their children have trust funds.

How can we allow this to be the voice of ‘reason’ in the country?

I truly can’t understand it but I know it makes me angry.

RIP NHS?

Andrew Lansley, British politician and Shadow ...

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A truly national health service as conceived in the post-war years has been tottering on the brink for a number of years.  As the previous Labour government sowed, so the Liberal Democrats and the Conservatives will reap today as the NHS and Social Care Bill reaches its last stages in the House of Commons  and the Conservative Party  institute their idealised version on a market-led health service which will deliver profits into the hands of investment companies and will place efficiency above effectiveness in treatment delivery methods.

Yes, I feel bitter, very bitter. I don’t see the Labour Party hauling us out of the mess that the both the Liberal Democrats and the Conservative Parties have conspired to leave us with because the Labour Party in their previous guise very much laid the groundwork for this to be done.

I find it hard to believe the audacity and the incompetence of our political elite as they push through a hugely unpopular bill tonight but then, as I pause, I wonder if it is truly incompetence as they are ‘getting away with it’.

We have been confused by details and have been tricked into believing a ‘consultation’ process has taken place. It has taken place very much on the government’s own terms and the listening that has been done has been very selective.

I try not to have a blanket opposition to the ‘private sector’ and ‘profit-making’ in the health and social care sectors but I’ve been burnt by experience. There are some companies that may well be able to improve some aspects of service delivery and I completely accept we all need to move away from the blind public/private being good/bad depending on where you stand on the political spectrum. That’s quite hard for me to ‘get my head around’ as I feel instinctively that profit should not be made from ill-health but equally the government’s obsession with public being bad is equally short-sighted and damaging.

What really sticks is the way that Cameron has blatantly misled the country in the quest for votes. ‘No top down reorganisation of the NHS’ he said, lying openly to the nation and yet we have to accept the mishmash garbage that he is now leading through Parliament as the Health and Social Care Bill and it moves towards it’s Third Reading in the House of Commons today.

I feel angry at the way that language has been turned and stolen from us.

‘Choice’  has become a catch-word but as I have discovered through the ill-spirited and contemptuous way that ‘individual budgets’ have been delivered in social care – choice mostly a luxury of the ‘worried well’ or the more affluent middle classes – in whose ranks sit all those MPs who vote on these changes today.

Choice means very little if you are not in a group that can cost a company money rather than increase their profits.

We have been hoodwinked into believing that ‘choice’ will genuinely exist when these private companies rip up our public services to deliver profit to their shareholders? I think we should ask whose ‘choices’ is it that the government and the health companies that support then, they will be?

Let me turn to the social care sector again because that’s an area I am familiar with. I am very familiar in the ways that privatisation has worked or rather, not worked and the way that ‘choice’ has been promoted – falsely – as the achievable outcome for all end users.

The pushing of the public sector from social care delivery has decreased ‘choice’ in many instances. In the areas I’m familiar with, local authorities have been pushed out as providers of residential and home care services to be replaced by companies such as Southern Cross (RIP), Bupa, Care UK (always worth repeating that they donated to fund Andrew Lansley’s private office)  and homes have closed, block contracts have been signed to provide care at the cheapest costs which increases profits for the private companies of course and limits choice for individuals who need these services.

Anyone who claims that the roll out of personal budgets has or will change this and has increased ‘choice’ I will point to those who have capacity issues – those without family or friends to support them – those who are more marginalised have far fewer choice than the ‘mainstream’ who are able to engage in the process and that suits the government and the propaganda machine just fine.

That is what I fear for with the Health Bill (I am not sure why it’s even called the Health and Social Care Bill as Social Care is so obviously a troublesome ‘aside’ for the government).

Choice may well be nice for making decisions about which hospital is most convenient for a scan but what is being done to assist, support and advocate for those who are not able to make choices?

We are all in this together? Really? I doubt it.

As for me, I’m off to the vigil outside the Houses of Parliament tonight with my local Unison branch.

The TUC have also organised an ‘online vigil’ to oppose the passage of this Act.

And then.. to the Lords. But I will take careful note of the voting as it happens tonight. And I won’t forget.

Consultations

I was interested in this article on Community Care website yesterday that more than half local authorities did not comply with the twelve week period for consultation when setting their adult social care budgets for 2011-12.

I had to stop and think whether the authority I work for did this. I think they did. I have vague recollections of something like a consultation being circulated but we’ve been subject to a number of different consultations for a whole variety of things and I’ve lost track of which were for what.

Facilitator works with participants for final strategies

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I’ve probably been directly party to more consultations over the past 18 months than I have at any other point in my career and to say I’m disillusioned is an understatement.

Consultations, in my experience, are never about actually consulting. They are about presenting decisions that have been made in smoky rooms, behind closed doors as a fait accompli.

These ‘management consultants’ who are engaged at high cost to produce these consultations only do so to meet statutory guidelines about what ‘consultations’ should be but I’ve been party to consultations which seem to arrive during the Christmas period, at Easter, over the summer holidays – whatever time seems to be the least convenient to actually gain the opinions of those directly affected and in whatever way seems to stymy any kind of criticism the most.

Do I sound cynical? Well, maybe just a teeny bit. It’s because we’ve been blasted by some massive changes presented through consultations-that-are-not-real-consultations and I’m bitter. I’m very bitter.

One of the major issues I’ve noted is the short periods of time between the ends of the consultations and the publishing of proposals as if, by magic, all the submissions could be judged within a week.. oh, not many responses? Well, that’s awfully convenient.

I’ve seen documents accompanying the consultations which don’t even try to disguise what the final outcome to the so-called consultation will be.

I have no doubt whatsoever in  my mind that consultation is about the most misused term in local government and the NHS that I have ever come across and that’s saying a lot.

Large organisations don’t want to consult. Or rather, they want to consult with their own consultants. They want to consult with the same group of people whom they can explain and describe to at detail. Thinking about creativity, if there was a real desire to consult about changes rather than impose them, the organisations should be forced to use more creative means to garner responses. Questionnaires don’t always work. Public meetings attract the same time-rich people who will always attend. What is done in a consultation to seek out those who are least likely to respond? Is three months really sufficient time for this?

As I said, I’m a cynic. I can’t see the work ‘consultation’ without laughing cynically and reading the end of the document to see what is proposed and what will, no doubt happen.

I’d love more openness in the process of putting together proposals and garnering ideas rather than being given consultation documents which appear to be vastly resourced ‘fait accompli’ type documents justifying why ‘we’ are changing what ‘we’ are changing.

Does anyone have any positive experiences of consultations? I’d really be interested in hearing.

Fixing the Broken not Healing the Wounded – a wrong-footed Government response

DAVOS/SWITZERLAND, 29JAN10 - David Cameron, Le...

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Our wise leader, David Cameron, clearly being an iconic Philosopher King, spent many days studying the possibly causes for the devastating riots in London and across England. He concluded after much intellectually rigorous pursuit, that the causes of the ‘sickness’ of Britain are – single parents and gangs aka ‘other people’.

Oh well, maybe he didn’t put quite as much thought into his words as I credited him for after all, he’s been toting those policy aims for decades. What more could we expect of him? Complex thought processes and analysis? Don’t be silly, he’s a politician who thrives on sound-bite politics that blames others.

I’m going to share a tiny bit of my own obviously clearly thought through analysis and that is this. There are no ‘easy’ solutions to the endemic problems that created a culture where people feel they can take what they want. This was not about ‘gangs’ although I’m willing to concede that might have been a fraction of one part of a ‘problem’. This is not about single parent families although yes, there may be people who are labelled that way. It seems that when our leaders set about scapegoating some of the voiceless citizens, we are heading for more divisions and damage than healing and unity which is what we really should be seeking. I’m not saying people should not be punished according to the law but they should not have new punishments invented specifically for them just to satisfy the vengence of the middle class who suffered for the first times when Ealing and Clapham burned.

These were Cameron’s words yesterday

Social problems that have been festering for decades have exploded in our face … Our security fightback must be matched by a social fightback,” Cameron said as he described the violent disorder as a “wake-up call” for Britain.

“Irresponsibility. Selfishness. Behaving as if your choices have no consequences. Children without fathers. Schools without discipline. Reward without effort. Crime without punishment. Rights without responsibilities. Communities without control. Some of the worst aspects of human nature tolerated, indulged – sometimes even incentivised – by a state and its agencies that in parts have become literally de-moralised.”

Setting out his personal priorities for government the prime minister promised he won’t be “found wanting”: “In my very first act as leader of this party I signalled my personal priority: to mend our broken society. That passion is stronger today than ever.”

There’s a lot here to get our collective heads around. A lot of dangerous assumptions and a clear view into the simplistic mind of someone who is supposed to be a leader and has proved himself beyond inadequate for the task.  The Financial Times for example, explains that these riots happened in a period where crime figures had been falling consistency? A moral breakdown? Perhaps not.

Irresponsibility? Like appointing a press secretary whom you have repeatedly been warned not to appoint and to continue to give him ‘second chances’ when you don’t consider second chances for the person who steals a bottle of water.

Selfishness? Like the MPs who gorged themselves on expense claims.

Behaving as if your choices have no consequences? Oh, well, for this one I have to reference the Iain Duncan Smith story from The Broken of Britain

Now, all those platitudes, we get onto the real meatiness that Cameron is gagging for.

Children without fathers? Excuse me? Does he realise how he stigmatises and chastises all the fine families that are raised by a single parent? Does he really think the presence of a man and a woman in a family unit regardless of whether they actually want to be together (the usual reason that splits take place) will ‘help’ the children? He is a fool and it is a dangerous message. Male or female role models do not have to be parents and unhappy parenting is not a useful environment in any circumstances. Cameron has his ideal of the perfect ‘Chipping Norton’ family just as he has his ideal of the perfect ‘Chipping Norton’ community. It is damagingly false and it seeks to further stigmatise and alienate those who for very many good reasons, do not conform to his traditional family view. Does he refer to families with two mothers or two fathers or single-father families? What about communities with extended friends as support? He is finding it too easy to paint ‘poor people’ with a brush.

Schools without discipline? Again an easy target. How about actually putting money and effort into the schools that exist then rather than trying to hive them off into ‘free schools’.

Reward without effort? Um.. Mr Cameron.. you know, you with the inheritence of millions. Can you tell us exactly what effort you put into the accident of your birth?

Crime without punishment? – Well, I suppose that depends on definitions but an awful lot of crimes seem to be getting some mightily grand punishments at the moment. Unlike the bankers who ravaged the finances of the nation.

Rights without responsibilities? Dangerous stuff here. See, he has been quoting that awfully subversive Human Rights Act. Possibly because he, in his privileged position would never have need to refer to it.

Communities without control? Interesting one. I wonder what exactly he means. Which communities are these? Poor communities? Communities of people with different minority ethnic backgrounds? Gangs? It’s pretty rhetoric and a nice alliteration but it is meaningless.

You see, I don’t believe Britain is ‘broken’. I think she is functioning as well as she can despite the government though. I think the more that the rhetoric fixes on the ‘sick pockets’ and less on the body politic the more she will begin to sicken though.

Cameron’s ‘solution’ to help to fix (note fix not heal)  this country is to bring in Emma Harrison from Action for Employment as a ‘Families Champion’. Really? That’s a bit patronising and it seems to dictate to us as adult citizens what ‘families’ the government approves of and disapproves of but back to Emma Harrison who has built her millions on the back of the government’s ‘Welfare to Work’ programmes. Is this really a call for more private profit-making?

What message does it send about making money off the back of so-called ‘broken families’ and trying to fix them?

For me, Cameron’s heavy-handed and quite frankly ignorant response to the riots is a sign of a far more broken element of British society. The ruling classes and their detached empathy sensors. That has already caused a lot of damage and is likely to cause far more in the future and we need to be wary of it and try and push the agenda towards healing rather than fixing.

Riots, Poverty and Assumptions

It would be remiss of me not to mention the rioting that took place in London over the weekend. I work and live in some of the poorer areas of the city and felt, indeed, still feel desperately saddened by some of the pictures and reportage coming from Tottenham, Enfield and Brixton among other places.

I can’t begin to make sense of it. I know the initial trouble grew from anger against the police after the shooting of a local resident last Thursday.

Regardless of the details of the initial spark that lit the tinderbox of malcontent across London, my sense is that it was, for many an excuse to cause trouble.

That isn’t to say there may not be real reasons for anger against the police and against the ‘establishment’ but the way the anger was expressed through mindless violence and looting seemed to indicate that there was also a wish to express anger and rage against lots of other things as well.

The places the riot went, so went the Twitter messages, Facebook posts and groups and the less ‘keyed in’ SMS messages letting others know where to come for random violence. Where to come for looting ‘opportunities’. Where to express ‘anger’ even if sometimes it was unclear what the anger was about or to whom it should be directed. It seems harsh that the ordinary citizens of Tottenham will be the ones to bear the deepest repercussions of the violence and aggression – for whatever reasons.

This morning I was listening to the radio. I heard the host say, ironically I suspect that the people of Tottenham deserved this for not ‘parenting their children’ correctly. For allowing their children to run wild. He said, again, I think it was intended to be ironically – ‘Where were their parents? Or rather, where were their mothers as I’m sure most of them don’t know their fathers’.

Wow.

Let’s just think about the way that we perceive people who live in poverty and poor areas for a moment.

I’m no sociologist. I have though been living and working cheek by jowl with poverty. It doesn’t make me an expert and I am fortunate enough to say I don’t have a lived experience of poverty. I’ve had periods of debt problems.  I’ve had periods of difficulties.  I lived in a single parent family but I haven’t experienced poverty.

Even so, I think that poverty is not necessarily one of the flames that fuelled the protest.  I think there’s an element of wanting excitement, wanting danger, perhaps even – wanting to change the way things are in society that lead to so many and so much injustice, discrimination and pain.

The ‘order’ of things that makes some people own and other people beg. A governing class that can take fancy foreign holidays while the streets of Tottenham burn.

Then there is the looting. Wanting something for nothing. The politics or rather the sociology of envy. The kinds of programmes that fill our evenings of reality star mania that make fame and wealth so easily accessible without the commensurate effort. Without seeing something grow. Without working.

Without work. That’s another element. Can it be a sheer coincidence that the levels of joblessness around Tottenham are some of the highest in London?

Probably not.

While Cameron holidays in Tuscany and Osbourne enjoys the delights of Disneyland (or DisneyWorld or wherever he is), I genuinely wonder if they can ever understand the fears and concerns of the people of Tottenham.

We’re all in this together?

Sticks a little in the throat to say it while statements are returned to the country from exotic foreign climates.

There needs to be a real effort and a real desire to make this world and this country better.

As for those who proposed, instigated and enjoyed the riots. Those who looted and ruined local communities already hurt by poverty. I hope they are caught and punished. I’m a social liberal and my views tend to drift leftwards but I have no time whatsoever for mindless destruction.

The pictures I’ve seen have been ones of mindless destruction and people enjoying violence. That needs punishment.

As for now, we need to think about these communities. We need to care about the people of Tottenham and places like that. We need to think about the effects of the cuts programmes in areas like this and why the levels of disengagement and disaffection are so high.

We need to heal this city and this country.

No, violence should never ‘win’. Destruction and crime must be punished.

But creating a better community, society and country need to be the goal.

As for today, I’ll share a thought or two with those caught up in the violence, fear and disorder. The people who live in the communities and particularly the people of Tottenham.

I wish them healing and time to build their community back up stronger and better.

Fear and Loathing in the Public Sector – Or Why I despise Oliver Letwin

Oliver Letwin, United Kingdom Conservative Par...

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Yesterday I read this article about Oliver Letwin, who, according to the Guardian article

..warned that it was only through “some real discipline and some fear” of job losses that excellence would be achieved in the public sector.

Letwin added that some of those running schools and hospitals would not survive the process and that it was an “inevitable and intended” consequence of government policy.

A little background about Oliver Letwin. I’m always a little wary of using Wikipedia as a source but a few choice verifiable ‘quotes’  jump out.

He is the ‘architect of modern Conservative party policy’.

He would rather ‘beg than send his children to an inner city school’

Oh and earlier this year he said did not ‘want more families from Sheffield taking cheap foreign holidays’.

So do we have a picture of the man? The Eton-educated man who would not know the real effects of true fear in the workplace? That encompassing, sleep depriving fear of not knowing if you can afford your next mortgage payment or if your job will be there next week, next month or next year.

Does fear drive excellence?

Let me tell Mr Letwin exactly what it means in the working environment that I am based in.

I work in a Community Mental Health Team – our team has been decimated – actually to use that word literally, it is far worse than decimation – over the past two years. No, I don’t restrict the blame to the current government but include changes under the previous government in my criticism.

We have piles of unallocated ‘virtual’ files while we are pushed to the limits by increasing expectations regarding recording and inputting data which is supposed to ‘prove’ our efficiency.

We have had wards closed at the local hospital such that people who need emergency hospital admissions to psychiatric hospitals are placed away from their communities or on ‘inappropriate’ wards. I have police unable to provide assistance because their services have been cut.

Fear drives efficiency, he says? In our service we have been told there will be job cuts including possibilities of compulsory redundancies. Yes, I’m fearful.

The ‘consultation’ about what will actually be proposed for our jobs will probably be announced soon but we’ve known it has been coming for months. We’ve heard rumours. We’ve heard gossip. We’ve heard absolutely zero from our managers though. Nice. Way to generate lots of fear. All boxes ticked.

So what has this fear done for our efficiency? We are beyond demoralised. We have more people leaving and taking jobs elsewhere and  people are  taking longer periods of sick leave.

I know that Letwin wasn’t referring to the ‘front line’ staff in the public sector – oh no, he meant the managers because he is of a class and a mindset that probably finds it hard to hold a conversation on a human level with anyone who earns under £100,000 per year.

The distinction between ‘frontline’ and ‘backroom’ is a false one though as it is impossible that can operate without the other.

Hospital wards are closing. Cuts are being pushed through. We feel your ‘pressure’ Letwin. We feel your fear. But I could not possibly despise  you any more than I do for your ignorance and self-serving words that for me, epitomise what the Conservative Party and their ideology-driven cuts want to do to this country.

I would like to ask Letwin if he is happy to condone a country of Castlebecks. Well, you see, coming from someone who would ‘rather beg than send his child to an inner city school’ – he would never be in a position to actually know or understand the real concerns of people who are dependent on public services because he can always choose the private course for himself and his family.

I know he wants to ‘make a name for himself’. He likes to garner attention and oh, how clever he is to want to drive ‘fear’ into the public sector but that, to me, sounds close to cruelty.

Efficiency? I think we can do with  fewer MPs who feel the need to make claims for repairs to their tennis courts and to have their Agas serviced.

What kind of society have we become when we feel it is appropriate for a Government ‘Policy Minister’ to drive a disdain and almost bullying approach to a public sector that provides services he will never need?

Oh and the speech he made these remarks in?

It took place

at the London headquarters of KPMG, one of the biggest recipients of government cash, which won the first contract for NHS commissioning following the decision to scrap primary care trusts and further open the health service to private companies.

Nice work, Letwin. Roll on, executive consultancy. You are all in each others’ pockets.

Meanwhile I have work tomorrow.

You enjoy your private tennis court today.

Sadness, Sympathy and Self

Sometimes, some days feel filled with sadness. I had one of those days this week. I don’t like to use the word ‘hardened’ but to put it this way, in over 10 years of frontline social work practice in some of the most deprived areas of the country and in the inner city, I’ve seen a fair bit of what society has to throw in terms of crumbs to those who are some of the most vulnerable members of it.

I look at the high rises that skirt around the cities and I see hundreds of lives being lived, families existing and stories being told. Some with hope and pride. Some with desperation and despair. All different, all a part of this community and society we live in. Poverty is real. Despair is real. The two don’t have to go hand in hand though.

I have a strong stomach and don’t bat an eyelid at all sorts of things when I walk into a house. I’ve probably seen worse.

In some ways, human misery is a part of my trade. Not always, of course, because there are the wonderfully reassuring smatterings of hope but difficult social circumstances and social deprivation run a theme through my career.

Although I often emphasis that mental ill-health is certainly no respecter of social class or financial assets, it is sometimes the level of deprivation and the difficulty and shame of poverty that I see that reminds me of the way that this political class intentionally ignores and isolates some members of the community.

Perhaps the most difficult part of  my job is wrapped up in the AMHP (Approved Mental Health Practitioner) role. It is a mirror into my ethical compass and while I enjoy the aspects that were involved in training and the support and development and even community feeling I have with other AMHPs, the process of making a decision about someone’s forced detention in hospital or a forced medication regime is never one that can be taken lightly and I don’t think it is one that should ever be ‘enjoyed’.  It is power, writ large. It is control.

Sometimes people thank you retrospectively for ‘making the right decision for me at the time’ but more likely that isn’t going to happen.

This week, I carried out a Mental Health Act Assessment in a hospital. That is very far from unusual. When I read the background and the circumstances, when I conducted the assessment and made the application for detention, which I did, I was overcome with a feeling of sadness for the action that I had taken and for the life that it predominantly affected.

For obvious reasons  I won’t go into details – anyway, even if I did they would possibly sound fanciful and unrealistic. To people who think that I have a ‘difficult’ job, I would say I  have had a walk-on part among some fine and very strong people who have had to contend with sickness, pain and family circumstances that have rolled all the dice against them in the lottery of life.

And when I sign the papers and write up the report, I don’t forget. I think, I reflect and I try to learn. What could we have done to prevent this situation from having occurred? Sometimes the answer is nothing but sometimes there might have been a different path, a different action or different guidance that might have led to a different outcome.

Sometimes, some days, I just feel overcome with sadness. Sadness at the injustices that are meted out by life, fate and circumstance. Sadness at the way that this society perpetuates and builds on those injustices of circumstance. Sadness at my role my own complacency in accepting that we have created such an unequal and unfair society.

In a community where people who live on state benefits are treated with an intention to humiliate and scorn and where the government not only condones and supports this, it tries to create further barriers between the ‘haves’ (with ‘have’ meaning working tax-payer) and the ‘have-nots’ (meaning those who depend on the state for income) it sickens me as I know that the rhetoric of ‘choice’ and  ‘community capacity building’  are empty words which mean nothing without the world of privilege. By privilege I don’t mean money, necessarily, but include the privilege of having family or friends around, the privilege of being well enough to build up networks of support, the privilege of being a part of a community. There is so much more to privilege that cash assets or income.

Sometimes I want to shout against the system that I am a part of. The social care system in this country is not ‘fair’ – it reeks desperately of unfairness and the pushing of ‘choice’ in very narrow terms onto a wide range of people who in reality have no choice whatsoever further marginalises and discriminates against poverty, incapacity and isolation.

But I continue in my job. I go into work and ‘buy into’ the system. In my own defence, I fight as hard as I can from the inside and I don’t forget the names, the faces and the stories of those whose lives touch mine.

I remember, I note and I learn and sometimes, that just fills me with sadness – but when I stop feeling that sadness, I stop learning, growing and trying to create a better world. One person at a time. In spite of the system I work in and with rather than because of it.

Selling the NHS – The Beginning

The National Health Service Norfolk and Norwic...

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Yesterday, while most of the media, fixated self-referentially on the Murdoch hearings and Cameron was flying back into the country,  Lansley began to dismantle the National Health Service.

As The Guardian reports

In the first wave, beginning in April, eight NHS areas – including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children, and primary care psychological therapies for adults – will be open for “competition on quality not price”. If successful, the “any qualified provider” policy would from 2013 see non-NHS bodies allowed to deliver more complicated clinical services in maternity and “home chemotherapy”.

So we are led to believe that being open for ‘competition on quality not price’ will act to pat us on the head, reassure us, and direct us back to the ‘big media story’.

It worries me and it worries me for a number of reasons. Lansley’s words are couched in the words of ‘choice’ but I wonder exactly whose ‘choice’ it will be to make these commissioning decisions for which, no doubt, large amounts of money will change hands and profit-making publicly listed and private companies will be able to partake.

I admit to a bias having been exposed and having experience in the adult care sector which was subject to a similar rollout of competition which was supposed to increase choice and quality.

I’ve written many times about the end result and how it is one that has inherently favoured larger providers and companies that have been able to deliver on economies of scale rather than the poetic vision of small scale providers delivering local services. Those small scale providers were quickly priced out of the market and I fear this will happen again.

But wait, I hear, ‘quality not price’ Lansley says.. to which I reply, ‘nonsense’.

Why? Because there will probably be minimum standards of ‘quality’ that a service has to reach and beyond those, it will be a price competition. That’s what is supposed to happen in care – but who checks the standards? who will check the standards? How can we have confidence in a well-resourced and well-delivered service when regulators are so weak.

I do not want any private company to make a profit on my potential need for services for my back pain, my hearing or a child’s wheelchair.

Of course, making the publicly delivered service is clearly both too expensive and veering against the government doctrine of handing the healthcare to private companies.

I am sure the first few providers will intersperse local voluntary organisations with large multinational corporations in their delivery methods. Again, I point to the adult social care sector. We started along the path with the NHS and Community Care Act (1990) having a lot of local providers together with a few Southern Crosses and Care UKs. The local providers were eventually priced out.

Of course in the case of podiatry and hearing services as well as primary care psychological therapies, we can see these as almost discreet services. The ones that will potentially be easy to deliver and it will always be possible to find wonderfully successful outcomes for people choosing Boots rather than the local NHS for their podiatry appointments because it is more convenient. And I’m sure it seems to pave the way for Individual Health Budgets where people  are given the money to ‘spend’ on the services that they need. Choice you see. Choice is what it’s all about.

I turn back and look at what has happened in social care. Choice has been extended in wonderful ways to those with the loudest voices but in some ways those with the highest needs have been left behind. That is my main concern about the introduction of private into public.

For some people, the people in the comfortable middle classes of Chipping Norton, this is fantastic news – they can access their IAPT (or equivalent) by a local provider when they are feeling a bit down. They can have their feet checked in a local branch of Boots instead of having to travel into Oxford. All’s well.

Those will be the areas where both competition and choice are the highest.

My concern is that people who experience the degradation of poverty will have quieter voices and less choice because there may be higher multiples of health difficulties and choice is determined through power. I can’t help but think of people who are restricted in their choice by issues of capacity. Will they be given advocates to assist with the process or will they just be ignored? Will the choice by made by GPs who are courted by these private companies, just as they are currently courted by drugs companies?

How equitable will the ‘new’ system be?

If we are extending choice, we have to extend safeguards and checks.

If we are extending choice, we have to extend quality.

It hasn’t happened in social care – there is no reason to believe or trust that it will happen in healthcare.

It does make me wonder – Are we all in this together? Really? With the impact analysis projects that are carried out to ensure equality, I know there are provisions to look at ability and disability, gender etc but are social class and income level also considered?

And think – Lansley considers putting ‘quality’ in as a concession – he was happy to go ahead with the Bill and with a pure ‘cost’ factor. This is his so-called concession but it is no concession at all if we don’t have a definition of what ‘quality’ is. After all, the CQC – too look at the Health Care regulator – defines ‘quality’ on the basis of paper documents and paper inspections given to them by provider services.

If that doesn’t wave any red flags, I don’t know what will.

This is a government of interests rather than representatives. The shame is that the last government was too and likely all the future ones will be as long as we allow our heads to be turned more quickly by celebrity gossip than the tragedies unfolding in our adult care services.

Goodbye Southern Cross, Hello Open Public Services

So Southern Cross – the largest private care home provider in the UK will be closed.

What of the 31,000 residents who live in their properties? Well, the government has given us its assurance that they will be ok so that’s alright then.

Or not.

Goodbye, Hello

m kasahara @ flickr

On the day that the Open Public Services White Paper was published  (which can be found here – pdf) – which couched in the comfort of positive words like ‘choice’ , we would do well to heed the warnings of the way in which social care was sold off in chunks, from public to private and reflect on whether it is better to allow care homes to ‘fail’ in order to prove that the strongest will rise to the ‘top’.

The problem is that Southern Cross WAS the strongest. It did rise. It also speculated on property and ownership transferred away from the core business base of providing care and homes for those who needed both.

But on a more pressing issue, what will happen to those who live in Southern Cross homes and work for Southern Cross homes.

As the Independent says

Analysis by the GMB union revealed the names of 80 landlords who own 615 of the homes, many of which are subsidiaries of larger companies registered overseas. This makes it much harder to obtain financial information about the companies as rules governing accountability and transparency, especially in “tax havens” such as Jersey, Cayman Islands and British Virgin Islands are significantly more lax.

In addition, the GMB was unable to trace more than 120 landlords, which mean thousands of people are living in care homes where the identities of the owners and directors are unknown.

In the absence of full company accounts and other relevant information, such as the names of directors, it is “nigh on impossible” to assess whether they are suitable to run care homes funded in large part by public money, according to Andrew Craven, GMB statistician and researcher

At least the ‘Department of Health’ spokesman says

“Whatever the outcome, no one will find themselves homeless or without care. We will not let that happen. Today’s announcement does not change the position of residents. The Care Quality Commission will continue to monitor the services provided… We have been in constant contact over the course of discussions and remain ready to talk to all parties.”

That’s reassuring. Or not. Would that spokesman or anyone in the Department of Health want that level of uncertainty lying over their head or the heads of one of their parents? The residents of the homes will not know who their landlords are or whether they are fit to run care homes at all. Of course no-one will find themselves homeless – it will be the local authorities, the elected local authorities who will have to spend and fret themselves out of this one – nothing to do with the Department of Health’s reassurances – unless the Department of Health is going to compensate those local authorities for the time and cost they spend to ensure the welfare of residents of Southern Cross homes that may close.

As for the CQC, I think we have established that it is unfit for purpose and unable to regulate a care industry that has grown too large and too costly to be regulated efficiently. How about an idea? The Department of Health invests very heavily directly in the CQC so that they can provide at least twice-yearly, unannounced inspections together with a host of lay visitors attached to every single residential and nursing home?

No, the Department of Health is weedling out of this crisis as it will weedle out of the cost of ensuring that the residents of Southern Cross Care Homes are not made homeless.

Now, I want to link some of these issues to the Public Service White Paper that was published yesterday and particularly one or two sentences I picked out.

Firstly

In the context of rolling out more extensive ‘choice’ in other areas of government, the paper says

‘We will ensure that individual service providers are licensed or registered by the relevant regulator for each sector (e.g. the Care Quality Commission) so that those choosing services can known that providers are reliable, without stifling cost”

Does that not lead to a tiny little shiver down ones spine? The CQC is being held up as a reason to trust in this extension of ‘choice’.  Has noone mentioned the cost of good quality regulation, either.  It’s worth reading this post at The Small Places for more consideration of the way the CQC regulates social care services. The CQC has failed to regulate and the care sector is failing to deliver on personalisation so far. The care sector has had time to learn as well. We had direct payments for many years and before that the ILF (Independent Living Fund) which allowed payments to be made directly to adults with disabilities to choose care. The system should be sophisticated enough by now to deliver good quality, equitable services but it has taken many years even to reach this point. There’s a long long way to go.

Secondly

“The wider public sector has much to learn from local authority successes in commissioning, for example, in adult social care”.

See, look at us, government, we’re a success! Success. This is the end-result of success. Adult care commissioning is not a success. It has not extended choice unless of course (and I think I’ve found the key) success is based on the principle of privatisation and provision of contracts to the those who deliver at the lowest cost regardless of quality. That is the adult social care ‘success’ that the government is lauding in the Open Public Services White Paper.

We are dazzled by words such as ‘choice’ and ‘open government’  but they have no meaning outside ‘lowest cost’ and ‘discharge of responsibility’.

Think of Southern Cross. Think of Adult Social Care. It’s coming to our homes, our hospitals, our high schools and our highways.

So much for my week of positivity!

Making Adult Social Care Better 1

I think I’m fairly good at griping and raising ‘problems’. For the next week, I want to try and take a positive approach and look at solutions as well as problems.

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A few conversations I’ve had over the past week have focused on what is wrong with adult social work and mental health social work at the moment but more importantly what can be done to make things better.

My frustration is that for all the discussions that take place in the sector, so few seem to focus on those of us who have worked and are working at the so-called ‘front-line’. A home carer knows about the ways that contracts have been managed and awarded at the lowest cost and they will be able to tell you with far more insight than any contracting manager about the effects of 15 minute ‘spot’ visits and the lack of dignity present in the care for older people. They would also be able to give you an amalgam of ideas which branch from consideration, knowledge and experience of a wide range of service users.

Are employed home care workers ever invited to discussion forums and debates about the future of care? No. But you know, maybe the feedback would be the most valuable.

On a more personal level it feels as if the conversations about service design and delivery take place around and above us – with us being the people at the front line of support. Yes, there are discussions  with service users and carers but how much effort is made to seek out opinions that do not fit in the model that the consultants want them to express? How many of the people who attend these meetings, discussions and debates become self-selecting.

If you create a service user group, for example, in a particular borough, it seems to me obvious that you are most likely to engage will be those whose voices are already heard through different means.

I like to set myself up as some kind of advocate in terms of having an understanding of the needs of people who don’t often have their voices heard in these kinds of meetings and debates because the discussions I have are mostly with people who are at their lowest ebbs on the scale of health and need.

For me, it is crucially important that these people are not left behind by commissioners and service design but my experience and understanding of the sector suggests that they are.

I don’t want to keep harking back to the roll out of personal budgets on the back of the model of direct payments but I will. The voices of those without support and without advocates are understandably quieter and the way that the services have been designed focuses quite rightly on choice but what is not present is a way for an equitable service to be delivered to those who aren’t for some reason able to express choice.

So things that can make things better

- Use of advocates in a more formalised manner throughout the system. Volunteer advocates have a role but I see more mileage in professional advocacy with extensive investment in non-directed advocacy as that is potentially where the greatest need lies. If I weren’t so tied to my job in terms of needing a salary to pay the bills, I would, at a flash, try to establish some kind of enterprise to focus specifically on support planning and advocacy for adults with dementias. I hope there is a role for independent social work in this area in the future – in the meantime, if anyone wants to jump on my idea and run with it, I am happily ‘open sourcing’ it.

- involving front line practitioners in conversations, debates and discussions with the local authorities relinquishing some of the reins of power in respect to conversation. Recognise our professional vigour and competence. We see people and have discussions with people that will never attend forums collectively. We can signpost and support commissioners and contracting officers but we are never asked and never given the time to think more creatively outside our little boxes of control. We have ideas and a happier, more connected workforce is an engaged and interested one.

- speak to home care workers too – those with agencies and where in-house services still exist, with them. They will have good ideas about the ways that their services are failing.

- home visits to facilitate discussions – why have all meetings in a central hall when it can be limiting regarding those who have greater physical and mental health needs.

Technology can facilitate greater conversation and communication with two-way flows but face to face discussion is still very important as technology and keyboards can alienate some people – perhaps exactly those people whom it is most important to connect with.

-Practitioners have to be more engaged with developments in the sector and unfortunately I don’t see BASW or the embryonic College of Social Work being particularly engaged with social workers. Why have social workers become so disengaged from professional organisations and unions? Is it to do with a fear of employers? I think some more group action could really build the strength of social work but it is hard to shrug off the feeling that we are a disengaged and disenfranchised profession that like to feel sorry for our collective selves and wallow in our diminished status. I think if we took a stronger political stance and stood up to our employers and their political agendas and displayed more independence of thought, we would be able to demand more respect.

I have decided that while I can moan and groan with the best of ‘em, coming together with ideas for improvement is by far the best way of making our voices heard.

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