Some aspects of the report have been published over the weekend but it is worth reconsideration and reflection.
Time, as ever, hasn’t permitted me a full brief of the details but one of the most obvious thoughts to jump out from me through my initial glances is that race is important. Of course, this comes as no surprise to me, after all, I work in a Mental Health team in Central London but anyone who feels that discrimination and oppression is somehow invented cannot escape from the figures presented.
The study itself looked at different outcomes in various categories in terms of ‘
‘Age; Gender; Disability; Ethnicity; Religion or belief; Sexual orientation; Transgender status.
Where appropriate, the Review also takes into account the impact of socio-economic background, or class.’
(nb just if I happened to be a social work student or a student of sociology/social policy – I would hold onto this report and keep it dear, it will be absolutely priceless in essays and research!).
There is masses of data present in this report but I’m just going to pick out a few pieces which I find particularly interesting or of which I have particular experience.
In the Health section
The incidence of disability rises with age and older people (65 and over) also have a higher rate of depression than younger people. There is evidence to suggest that the health service sometimes deals with some older people in ways that they find humiliating or distressing.
This might sound obvious but it is crucial that the higher rates of depression in older adults is accounted for. Working in a specialist older adults mental health team, when explaining to colleagues in other teams who usually assume that most of my work is with people with dementia, I often have to add ‘depression’ into the mix. This is increasingly important as the ‘Payment by Results’ and outcome measures creep into Mental Health Services. I am well overdue writing a specific post about ‘Payment by Results’ in Mental Health but each time I think about it, my heart sinks.
This higher rate of depression needs to be provided for and I fear that through various means and changes that are taking place in the services, it may be lost to teams such as ours unless it is very severe.
The second part that notes the health service deals with older people in ways they find humiliating and distressing definitely bears out to my experience. I consider it partly because no-one in the health service knows what it is like to be very old – we are, of course, working age by default. We might have elderly parents or spouses but in a way that we all might experience ill health, we can’t obviously have experienced being elderly. As long as older adults are seen as ‘the other’ ‘someone else’ that almost allows a sense of different treatment and attitudes.
Even in my team, although it pains me to say it, I’ve heard some appalling language and assumptions made just because someone is old. The increasingly elderly population and the perception that people who have no economic output are less ‘valuable’ that people who work is a modern attitude that permeates not just the Health Service but society at large.
This ‘being a burden’ is an attitude that has played out in wider scales but it is always a challenge.
On similar lines
Overall, around 1 in 5 of us report a disability or limiting long-term illness (LLTI). The available evidence suggests that people who report a disability or LLTI are as likely as average to say that the health services treats them with dignity and respect.
So who is the health service treating with ‘dignity and respect’? Or are we more critical when we are more vulnerable? I am inclined to think that the more people are ‘like us’ the more likely other people are to treat them with dignity and respect.
Is the answer training? Possibly although there is already a lot of training. Personally I think the way to improve is through having good and strong managers who take to task firmly those who step out from the line. The difficulty is that if the attitudes are coming from GPs and consultants, who reins them in? The hierarchies within the health service are immensely powerful.
In the Mental Health Section
Groups vulnerable to pressures such as poverty and victimisation show high rates of mental illness. The risk of having poor mental health scores is higher for certain ethnic groups with high poverty rates.
which doesn’t come as a great surprise. The correlation between the stresses of poverty and poor mental health are very well established but put on paper
The risk of mental health problems is nearly twice as likely for Bangladeshi men than for White men
which is a massive proportion. I wonder how many specialist provisions exist for Bangladeshis within the Mental Health system. I know this is very much related to poverty and specific areas where the community lives but it is something that absolutely needs to be addressed.
Personally, I feel that tailoring services to particular ethnic and cultural groups is valuable within mental health services although of course, this tailoring has to happen on geographic lines where the needs are greatest – however, these services cost and tend to be less than popular among those of the majority who might feel excluded. I’ll be interested to know about what effect these figures and this report might have on the commissioning of services.
In the Care and Support section
Unsurprisingly, women are more likely to provide informal care than men.
Different ethnic groups draw on different forms of care to different extents. Black children are more likely to be in formal childcare than others; Bangladeshi and Pakistani children are much less likely. Meanwhile, Bangladeshi and Pakistani
people are significantly more likely than average to provide informal paid care (more than twice as likely as White people). Some literature suggests that this may, in part, be because formal care services are not always appropriate to meet the particular needs of some ethnic minority groups.
I thought this was a crucial paragraph. Black children are more likely to be in formal childcare than others. That starts a child off with so many more challenges throughout their lives. I know it is a generally perceived fact within the childcare system and I hope it continues to be a focus for support and evaluation of options.
The last sentence there is also key. Is there a difference in availability of specific services for people with particular ethnicities.
On a personal level, although theoretically our service should provide culturally specific services, it is sometimes hard to source carers with particular linguistic skills for example. This may be a matter of access to training from those within these particular communities and a lack of enthusiasm and active engagement by service providers. Specific services also cost more although to be fair, everywhere I’ve worked, this is something that has ‘been allowed’. The problem is not paying for the care but finding the care in the first place.
Britain’s demographic trajectory – in particular its ageing population – is creating new kinds of chronic disadvantage. Over the next decade there will be a steep increase in the demand for personal care for older people. At the same time, more people who might have cared for their parents will have dependent children. This often means a concentration of informal care provision falling on a relatively small group – the dutiful middle aged. Most carers are women although a significant number are also children.
I think this raises a massive ‘red light’ to services and a big push towards where we are heading. It’s no surprise that the ‘ageing population’ will demand more care and the issues of how that will be funded have not yet been resolved, however add to that people who might be having children later than previous generations and you do have the challenge of the dual caring role – caring for young children and elderly parents.
This will be an increasing issue not necessarily today, but in 10-15 years time when the people who are in their late 30s and early 40s have children and whose parents might need that support in their late 70s and 80s.
While the study talks of the ‘dutiful middle aged’ this will be a group of people who have grown up in a prosperous society and might not have been as well-adjusted to the nature of the caring role as their parents’ generation. Most important to note is how much of this care role may fall on children, especially as parents grow older.
We are still waiting for the outcome of the Commission on Funding for Care and Support but someone will have to pay either for care or to support carers more substantially. This is not an issue that will fade away – quite the opposite.
In the Power and Voice section
In the Westminster Parliament, despite some evidence of progress, most religious and ethnic minorities are still under-represented. However, lesbian, gay and bisexual (LGB) people, and some people from ethnic and religious minorities, are more likely to take part in other forms of political or civic activity and more likely to feel able to influence local decisions.
People with a disability or a long-term limiting illness are generally less likely than those without to say that they can influence local decisions, and a majority of polling stations at the last election presented at least one significant access barrier.
There are a few points there. The lack of representation in Westminster seems to point to a particularly privileged group of people who go into ‘career politics’. It’s interesting to contrast with local activism which is usually carried out by a different group of people. Perhaps there is a greater feeling that local decisions can actually be changed and influenced by active minority interests.
Worryingly the fact that polling stations have access issues is one that needs to be addressed immediately. I wonder if the lack of engagement with the parliamentary process from specific groups of people allows national politicians to increasingly stigmatise these groups.
people’s socio-economic background affects their sense of power and voice. Professionals are more likely to vote, more likely to hold elected office, and more likely to feel that they can influence local decisions than people from lower occupational groups.
This sense of entitlement should come as no surprise, perhaps the weakening of the union movement is changing perceptions or just the innate nature of the existence of the perception of a ‘ruling middle class’. I would hope that Citizenship classes at schools could challenge some of these assumptions but I have no idea what happens in Citizenship classes!
National engagement through local engagement seems like the obvious way to have different kinds of voices shouting at the highest levels.
The report identifies particular areas in which work and progress can be made but I think while some of the findings are not surprisingly, it is useful to see them placed in terms of data that can be analysed and measured.
Data means that the next triennial review in 2013 can be matched and progress can be matched.
The worries remain mostly about money and funding. Everything costs, including changing attitudes throughout society and creating a ‘fairer’ Britain.
I wonder how many of the challenges specified in this report will be picked up by both a government and an opposition couched in creating fairness across our society.
To me, it seems like the white, middle class earner is doing quite well out already in the ‘fairness’ stakes so more attention on the deficits of equality would actually be the way to go if we do want to create a ‘fair’ Britain.
But the rhetoric of fairness seems to be appealing specifically to the ‘haves’ – rather than the ‘have-nots’ but at least we have a baseline of what we expect a ‘fair’ government to be working towards.
Very apt timing for the report. Let’s see what the Government does about it.