Crisis? What crisis?

Our social care system is in crisis, according to the annual review published by the Commission for Social Care Inspection this week. Disabled people and the frail elderly face a postcode lottery as local authorities tighten the screws ever further on the provision of social care. The report revealed that councils are implementing increasingly strict eligibility criteria, excluding many vulnerable adults who would previously have been eligible for support.

Fewer frail elderly people are being supported in their own homes, despite a 3% increase in those over 75. Shockingly, some local councils are excluding those who are unable to either wash or dress themselves independently. The burden of care is falling on female relatives families who are under increasing pressure to provide both social and personal care for their elderly relatives.

The social care minister, Ivan Lewis, has made loud noises about the system being both ‘unfair and inconsistent’ and has announced a government investigation into the findings. You might even be convinced that the government was unaware of the shambolic way we support those with social care needs, although personally I think he doth protest a little too much. Try a little experiment. Google ‘social care crisis’ and you will see similar reports going back at least a decade. Or ask a social worker.

Why are we failing so spectacularly to support those members of our communities with high care needs?

As an ex-social worker I have heard many, many (and then some more) complaints and back-of-a-fag-packet explanations from people who are appalled to find that they fail to meet the eligibility criteria for support. A small selection:

• This bloody tory council doesn’t give a toss about disabled/elderly people.
• This bloody labour council is too busy giving its money to lesbian basket-weaving classes.
• This bloody lib-dem council couldn’t organise a piss up in a brewery.
• Various explanations involving anyone in possession of a foreign accent or dark skin.

I suspect the real reason is more complex, and one that we all ultimately have to take responsibility for.

Anyone over 40 may remember a quaint old thing called consensus politics. Between 1945 and 1979 the major political parties had a tacit consensus regarding the role of the state and its responsibilities. The welfare state and the national health service were born, and subsequent governments understood that the state would provide social and health care to all its citizens, to be paid for through direct taxation and national insurance contributions.

In 1979 we voted overwhelmingly for a woman who sought to abandon the political consensus with her zealous commitment to free-market monetarism. ‘There is no such thing as society’ declared Thatcher, and then proceeded to dismantle the mechanisms which supported it. Rampant individualism replaced the concept of a co-operative society in which the economically active members support the needs of those who are vulnerable through frailty or disability. Apparently we were only interested in government's ability to run an efficient economy. Apparently, we still are.

The simple truth is that as a society we appear to not want to pay the taxes required to maintain a half decent standard of social care. We complain bitterly at increases in our council tax, and vote according to who will give us the lowest tax burden and maintain an efficient economy. We just don’t seem to care about the frail elderly or disabled people, and local government becomes the scapegoat as it struggles to manage with increasingly tough settlements from the centre.

Social care has been in crisis since case law established that local authorities have the right to meet the needs of vulnerable adults within available resources. This was roughly 16 years ago. Perhaps it is time for us to have a full and frank debate as to whether we are genuinely willing to pay for a decent social care system. And if we aren’t, please let's be honest and quit the disingenuous whingeing.

The End Of Spin...?

"...I haven't got an autocue, I haven't got a script, I've just got a few notes so it might be a bit messy; but it will be me..."

David Cameron

What an incredible feat that was, to deliver a carefully written and well rehearsed off-the-cuff, straight-out-of-my-pretty-head speech like that.

I now realise what British politics has been missing these long years, the ability to memorise something clearly being a much more desirable quality in a leader than the ability to read out loud.

Personally I would rather vote for Chris Lyons, the Melbourne man who can recite the first 4,400 digits of pi from memory. And I don't even know what his politics are.

The end of spin....? Pah.

More Drivelling Nonsense From The Conservative Party...

Whatever happened to Ian Duncan Smith? Since his whimpering demise from the top job IDS has apparently been heading up The Social Justice Policy Group, a think tank charged with meeting the challenge of social exclusion via policy recommendations to the Conservative party. He has clearly been a busy, busy man because today saw the publication of Breakthrough Britain, a 691 page report rehashing the same old family values toss outlining some truly groundbreaking ideas for tackling Britain's social problems.

My particular favourite is that the government should incentivise marriage through the tax system. Apparently this would work wonders, because there is considerable evidence that children of separated parents do less well at school and are more likely to become involved in petty crime.

My psychology training has led me to believe that children require a stable, loving relationship with at least one parent in order to develop a secure sense of self. Add to that a healthy mix of respect, security and boundaried parenting and you are unlikely to produce a granny basher or drug dealer. But apparently not. My training has it all wrong. All you require is for your parents to be married, and to stay married, and what better way to do that than offer incentives in people's pay packets? God knows, I would definitely stay in a miserable and unloving marriage if the government were willing to pay me fifty quid a month to do it. Well worth it, don't you think? And so good for the children. "I know you are deeply traumatised by the misery of our family life, darling, but don't worry, I am putting the fifty quid away in your post office savings account and it will pay for your therapy when you leave home."

Do you think we will ever again see a government that can actually do joined up thinking? Are there any politicians left who know how to have an intelligent, serious and insightful debate into why we have some of the most serious social problems in Europe and a generation of young people who believe that social exclusion is the norm? Does IDS really, really believe that incentivising marriage will go anywhere towards addressing the deep rooted problems of people living on the margins of society?

I think Betsy has been putting something in his tea. If not, perhaps she ought to.

Captive In Iran...

Is it just me, or do the British Marines held captive in Iran look like a bunch of kids who have missed the coach home from their school trip? And does this make you feel unbelievably sad too?

photo from telegraph.co.uk

Who Is Defending Our Civil Liberties? (Pt II)

Today has seen the House of Lords effect more amendments to the government's Mental Health Bill, and some pretty poor reporting of it too on Radio 4. The principle of treatment is not something that the Lords are plucking from nowhere in order to elevate civil liberties over public safety, as you may think if you listened to the report on PM tonight. This principle is already enshrined in the 1983 Mental Health Act, and pretty damn important it is too. I refer you to a previous post on this bill. (And I also offer on a plate the opportunity for the Periodic Englishman to make his Tardive Dyskenisia joke....which is actually quite funny.)

Bird Flu Pandemic Imminent!!!

Overheard on tonight's Any Questions on radio 4 - John Selwyn Gummer complimenting the government on their handling of the bird 'flu outbreak at a Bernard Matthews turkey farm, and reassuring the public that they cannot catch the disease from eating poultry. Just one small thought: wasn't he the Minister for Agriculture during the BSE episode who attempted to convince the 'meat-eating public' that beef was safe by stuffing a hamburger down his unsuspecting daughter's mouth in front of a hastily assembled TV crew? Shortly before infected beef was found to cause Kreutzfeld-Jakob disease in humans? I'm not suggesting we panic, but the signs are not looking good.

Who Is Defending Our Civil Liberties..?

The House of Lords may look like a bunch of old duffers, but they are currently doing a sterling job of preserving our civil liberties by forcing amendments to the government’s Mental Health Bill. There are two key proposals in the Mental Health Bill that we should be extremely concerned about: the removal of the ‘treatability’ clause and the extension of powers of compulsory treatment to those who live in the community.

The Mental Health Act is already quite a scary piece of legislation. It enables a doctor and a social worker to admit those with mental illness to hospital against their will, and a psychiatrist to extend that period of detention for an indefinite amount of time by applying different sections of the act. It is without doubt the most draconian piece of legislation on the statute book, in that it permits the state to lock up a person who has not committed any crime for an indefinite period. It could be the stuff of Kafka’s nightmares. Thank goodness, then, that enshrined within the act are the core principles of assessment and treatment which ensure that the sole purpose of the detention is to ensure asylum and treatment for the mentally ill person who poses a danger either to himself or others. It is this ‘treatability’ clause that the government wishes to remove.

The government has set its sights on removing the principle of treatment as it is this principle that makes it difficult to use the Mental Health Act to detain people with a Severe Personality Disorder. Psychiatry believes that such people cannot be successfully treated, and therefore fall outside of the compulsory powers of the Act (although the Act does specifically include people with Severe Personality Disorder in its criteria of mental illness.) Most people with a severe mental illness are treated with neuroleptic medication. This medication acts on dopamine receptors in the brain and is rather akin to using a sledgehammer to crack a nut. It does have the effect of minimising the auditory hallucinations that are characteristic of psychotic illness, however, and, however crude its workings, neuroleptic medication enables people with psychotic illness to function relatively normally with reduced symptoms. (There is a whole different post to be written on the use of neuroleptics which I shall, thankfully, save for another occasion.) This medication has no therapeutic effect for those with Severe Personality Disorders, as they do not experience the flight of ideas and auditory hallucinations characteristic of psychotic illnesses. Hence psychiatry’s argument that they do not respond to treatment and therefore cannot be compulsorily detained under the terms of the Mental Health Act for psychiatric treatment (although they can be detained for 28 days under a Section 2 for assessment.)

The government is extremely keen to encourage psychiatrists to detain people with Severe Personality Disorder, following the murder of Lin and Megan Russell in 1998 by Michael Stone, a man with a SPD who was known to psychiatric services. I am sure that the terrible circumstances of their murder affected us all at the time. But mental health campaigners, including prominent psychiatrists, believe that the danger posed by those with severe mental illness is greatly exaggerated by the media and that the government is currently using scare tactics to try to rally public support for its mental health bill. Tom Hamilton has already written an excellent post on the facts and figures of the ‘dangerous mad man at large’ scenario, so I won’t repeat the argument here. Suffice to say, most people in the field do not believe that the danger posed by a very small minority of people with Severe Personality Disorder in any way justifies the removal of the core principle of treatment.

This principle of treatment should be paramount in any law that permits the mentally ill to be held against their will. (Let’s be generous and overlook the fact that ‘treatment’ consists of little more than being held down by one nurse whilst another jabs a hypodermic needle in your buttock.) Because if the state assumes the right to detain people for 42 days without treatment, then psychiatric hospitals cease to become places of asylum and instead become prisons, with psychiatrists acting as unwilling jailers. So rather than remove the treatability clause, which is the only thing that affords the Mental Health Act its humanity, perhaps the psychiatric system could get just a bit more creative about what ‘treatment’ might actually mean for those with a Severe Personality Disorder? Most people with mental illness would welcome a more therapeutic approach to their disorder, and any steps in this field would render the removal of the treatability clause redundant.

The second issue at stake is that of Compulsory Treatment Orders in the community, which would enable community psychiatric services to compel those with mental illness to receive antipsychotic drugs, with the threat of a compulsory admission to hospital if they refuse. This seems to me to be an open and shut case of undermining our basic civil liberties. If I am diagnosed with a treatable cancer, which is likely to become terminal if I refuse treatment, it is still my inalienable right to refuse such treatment. Many people with mental illness believe that antipsychotic medication has a detrimental affect on their quality of life, and successfully manage their illness without resort to a drug regime. (And I haven’t even mentioned the terrible side effects such as tardive dyskinesia, ocular gyro crisis and the strange loping gait characteristic of long term neuroleptic use.) What people with severe mental illness really require in the community is more intensive support, regular monitoring and therapeutic intervention when symptoms become florid. This would necessitate an injection of cash to allow the community psychiatric services to provide the kind of therapeutic service they are both willing and able to provide. The current Act allows for compulsory intervention should individuals become a danger to themselves or others. I can't think of any clinical justification for favouring a weekly compulsory injection of a mind altering drug over a more therapeutic regime. Indeed, most clinicians - including psychiatrists - do not support the use of compulsory treatment orders.

The House of Lords is to debate the Mental Health Bill once more next week. Let’s hope they maintain their common sense.

Blair's cynicism: part one...

You could be forgiven for not knowing that this week the government announced wide scale closures of urban Post Offices. Perhaps this was the Bad News that they have been apparently burying all week, although given that these closures will primarily affect the frail elderly and the disabled I somehow doubt it.

Small, local post offices provide an essential community service: for many isolated, elderly people they are a social centre, an opportunity for face-to-face relationship and contact, a source of community information and a place for advice and support. My local postmistress assists a number of her frail/forgetful elderly customers with official correspondence and paying of bills and is an informal monitor of their general well-being. I have even known her to call out a GP if she is worried about their health. (In fact, she provides exactly the kind of service that social workers used to provide, before they were chained to their desks and forbidden from actually visiting their elderly clients.) The walk to the post office keeps elderly people ambulant and socially active, thus holding back both physical and psychological decline.

Thus we can see that closing these post offices is a Very Bad Thing Indeed, which will eventually cost us in terms of increased demand on health and social services.

The bit that really, really hacks me off, though, is Blair’s defence. In a marvellous example of doublethink, he argues that these post offices are closing due to lack of public demand. Because for the past five years the Department of Work and Pensions has been bullying (yes, bullying) pensioners and people on benefits to have their weekly money paid into a bank account. Bank accounts that most of these people have never had and don’t want. It may come as a surprise to most middle-class professionals that the vast majority of people who live solely on benefits prefer cash in their pocket, as it is the only way they can budget on the miserly amount that the state permits them. Honest, its true. Some people just do not want a bank account. They want to take cash from the post office, and pay their bills in cash over the counter (or put cash on their electricity meter cards, which are quaint things that only very poor people have.) But now they can’t. And Blair can happily close these post offices because the only people that use them have no political clout.

Mr Blair, your cynicism appals me.

Postscript: Go Go Hutton...

I read a post recently on a Labour blog (I would reference it if I could remember where I read it) arguing that it is too easy to just be cynical about government policy, and we should therefore take the time to partake in a more considered and intelligent debate. Therefore, in the spirit of constructive debate I refer again to John Hutton’s move to oblige women legally to name the father of their child on its birth certificate.

Let’s not be coy here. Hutton’s targets are unmarried mothers who claim benefits and his motivation is to reduce the burden that these children place on the state.

For some time I have facilitated development groups for young, lone mothers who claim benefits and who live in socially excluded communities in inner cities. SureStart commission the work and their aim is to both build community capacity and to facilitate a more stable and secure environment for pre-school children in these communities. I work closely with these women and get to know them well. I can think of a number of reasons why they would choose not to name the father of their child on the birth certificate, none of which Hutton would consider a suitable reason for exemption. Primarily, they would not want to be forced into an economic relationship with the man who has already refused to take responsibility for his actions and has usually behaved in a humiliating and cavalier way towards them. These women don’t have much, but at least the benefits system allows them a measure of independence and freedom of choice to be or not to be in a relationship with the father of their child.

The devil is in the detail. Hutton will have no idea of the difficulties women on benefits face when their ex-partners cease their CSA payments because of a change in circumstances (and these men are often very chaotic which means their payments stop and start like a game of musical statues.) In addition, enforcing a relationship with the father of their child, however tangential that relationship, will only serve to foster further acrimony and hostility and that is VERY BAD for the child. (Particularly if he has insisted on a paternity test, which no doubt most of these absent fathers will do.)

There are many, many reasons why women choose not to name the father on the birth certificate but it is never because she just couldn’t be arsed to include him.

I agree, by the way, that men should be encouraged to take responsibility for the offspring that they randomly sire. I agree that young women should be far more discriminating about whom they choose to have children with, and should not see having children at 16 as a career choice. I agree that children (and parents, for that matter) are better off in families with 2 parents and that all parents should take their job very seriously indeed. I agree that the welfare of the child should come first. I hate the fact that these young women feel so abandoned by wider society that they have children in order to raise their own self-esteem, and then have absolutely no idea how to parent them successfully. I agree that we as a society have a problem here, and I know it is not a popular thing to say in liberal company.

However, attempting a solution through legislation is oppressive and divisive, and, trust me, these women don’t need reminding that they are on the margins of society. We need good, old-fashioned, empowering and respectful community work such as that provided by SureStart. So why is the government reducing its funding?

Go Go Hutton...

John Hutton has apparently won a ‘Whitehall battle to require the law to be changed to require both parents to be named on a child's birth certificate.’ This means women will be required to name their baby’s father with exemptions for only the most exceptional of circumstances.

I think our leaders have come up with another simply marvelous idea here. May I humbly offer some further suggestions?

• Unmarried, pregnant women could be encouraged to give birth in special mother and baby homes – I’m sure many religious groups would be willing to run them – and the babies could be handed over to nice, middle-class, childless couples after birth. This would reduce the burden on the state.
  

• We could actively discourage unmarried women from getting pregnant by ensuring that it is a shaming and humiliating experience resulting in social isolation, abandonment by one’s family and a lifetime of poverty.
  

• We could invent a time machine which would spirit us all back to 1953.
  

Any other suggestions warmly welcomed. Please send to John Hutton c/o ‘Regressive Social Policy ‘r’ Us’.

And a Merry Christmas to you too....

In a fantastically ignorant misunderstanding of multiculturalism, up to 70% of UK businesses have advised their staff against indulging in ‘Merry Christmas’ type conversations with their customers. (By the way, have you noticed how the term ‘customer’ is now used to describe anybody from the person at the pick ‘n’ mix counter at Woollies to the person with schizophrenia at the end of the housing list? But that’s another post for another day…) As I was saying....how do supposedly intelligent people have such a monumental capacity for missing the point and, in the process, handing on a huge silver platter the opportunity for small-minded Middle England to go “ooh, look how oppressed we white middle classes are. Why, we can’t even wish each other a merry Christmas anymore”?

Apparently this advice is based on the misguided notion that ‘people of other faiths’ may find it offensive and even sue - for what? You hurt my feelings? - by which they transparently mean that ‘people of Muslim faith’ may find it offensive. I am not Muslim, but if I were, I would be deeply offended at the thought that someone might possibly imagine that wishing me a Merry Christmas would offend me. So well done to the Christian-Muslim forum for politely pointing this out.

In a previous incarnation I worked for a provincial Local Authority and got mightily hacked off with this annual piece of lip-service to anti-oppressive practice, which seemed to allow the powers that be to ignore the year round parade of discriminatory practice towards any number of minority groups. So listen up there, you stupid corporate people: there really is plenty of institutionalised discrimination out there for you to get your teeth into, should you really want to, without getting all sensitive about a bit of seasonal good cheer. God knows, we all need it.

Cameron and Relative Poverty...

So David ‘Diddy’ Cameron tentatively acknowledges the significance of relative poverty. Mmmm. I suppose we should be pleased, but for some reason all it does for me is trigger a residual bitterness from the Thatcher years.

The Black Report, published in 1980, was a monumental piece of research that proved - in as much as a piece of research ever proves anything - the link between social inequality and ill health. I am no expert on this (and I trust that there will be someone out there who will correct me if I am wrong), but my understanding of this research is that it showed conclusively that it is the gap between rich and poor that is the most significant indicator of ill health, not the absolute conditions in which poor people live (ie poor diet, poor housing etc). As the gap increases in modern capitalist societies, the health of the poor correspondingly decreases. The Black report argued that once a basic standard of living is achieved by a society, the health of the nation will only be improved by reducing inequalities.

Thatcher, unsurprisingly, sought to repress the report. The London School of Hygiene and Tropical Medicine – that well known hot-bed of socialist radicalism – suggests that ‘the 1980 Black Report on inequalities in health has attained almost iconic status as the textbook example of a Government 'cover up'.’ Heady stuff indeed.

So I suppose I should be grateful, Mr Cameron, that you are bringing a long awaited touch of humanity to the Tory party. But somehow, I’m not.

Inspired by Angela Sinfield...

I heard Angela’s story on the radio today It might have been just one more story of a working class young person going off the rails and a mother at her wits' end. But it isn’t.

Angela is the mother of a young woman/girl (which?) who, at the tender age of 12, became involved with a group of older boys and men who plied her, along with several of her friends, with gifts, money and finally drugs in exchange for sexual favours amongst the group. Hers is, sadly, a common and unremarkable tale of social exclusion, poverty of opportunity and hierarchy of exploitation. Angela involved Social Services and Barnardo’s in an attempt to rein her daughter back in. She discovered there was a name for what was happening to her daughter – grooming – and that it was happening to young women and girls up and down the country. Between the ages of 12 and 15 Angela lost her daughter to this culture of exploitation, powerless to prosecute her abusers without her daughter’s co-operation.

The story does have a happy ending – Angela’s daughter eventually went to college to make up for the missing years and mother and daughter are now reunited. But this is not necessarily the remarkable part.

Angela anonymously took part in a Channel 4 documentary to raise awareness of the issue: several months later, the BNP used Angela’s (anonymous) evidence to stir up racial hatred in the run-up to the local elections in Keighley, West Yorkshire. Why? Because some of the men involved in her daughter’s exploitation were Asian.

Angela could have kept her anonymity and refused to comment. She was incensed, however, at the far right using her daughter’s experience as a convenient peg on which to hang some knee-jerk racism. Angela took the incredibly brave step of stepping out of the shadow of anonymity and decided to stand in the local elections in opposition to the incumbent BNP councillor. Angela is not an educated, middle class woman. She is a very ordinary, working-class, single parent who simply knew that stirring up racial hatred was wrong. The issue, she argued, was one of criminality and not race. Angela whupped their ass in the election – a swing to labour of 11.4% in an election where the national trend suggested a protest vote against Blair’s war in Iraq. Voter turnout was 58.8% - one of the highest in the country in an area where political apathy is high. And since her incredible victory she has, along with local MP Ann Cryer, affected a change in the law so that ‘hearsay’ evidence can be used to prosecute men who groom and abuse young women.

I don’t know Keighley, but I know the culture. It could just as well be the place where I grew up: a small, industrial town, decimated by the decline of the manufacturing industries; a working-class culture marked by poverty of opportunity and a melee of cultural tensions. I was lucky. I got myself an education. But for all her lack of qualifications and formal political philosophy, Angela is the one who has really made a difference in the world.

I applaud Angela Sinfield for her courage and integrity. I applaud the people of Keighley for having the good sense to vote for her.