Britain must invest properly in adult social care

http://www.theguardian.com/society/2015/aug/12/britain-must-invest-properly-in-adult-social-care

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Zoe Williams’ article (Adult social care is not a problem – it is a human necessity, 10 August) highlights a failure of political leadership. There is a mysterious gap between the welcome and widely shared concern that disabled and older people should receive good quality care and the lack of action to ensure this becomes a reality.

It is wrong for the Department of Health to say “treating someone with dignity and compassion doesn’t cost anything” because if there is only sufficient funding for a 15-minute care visit, it is simply impossible in many cases to treat someone with dignity and compassion. And it is wrong to blame the care worker for that. All they can do is their best in an impossible situation. Many already work unpaid overtime to make good the care that they know is rushed and inadequate for the disabled or older person.

For too long now the government has blamed councils for insufficient funding and vice versa. It’s time for the blame game to stop, and for leadership to begin. It’s time for someone to put the person receiving the care first and take personal responsibility for ensuring that disabled and older people are properly cared for. The question is whether the chancellor will take up that responsibility in the upcoming comprehensive spending review. Clare PelhamChief executive, Leonard Cheshire Disability

• I am delighted to see so many articles on the provision of care of elderly people in their homes. I am one of those elderly and have motor neurone disease. I can no longer stand but still have some strength in my arms and back. There are several things I can manage at a pinch for myself, though sometimes it can cause excessive tiredness.

My care worker, Ann (not her real name) makes an immense difference to my life. She has become a friend and we both look forward to our sessions – one hour in the morning, and 30 minutes in the evening. We live in inner London. Ann is employed by a “for profit” agency which pays her the national minimum wage of £6.50 an hour – which is £2.65 below the living wage for London. She has to pay her own travel expenses and is not paid for the time she spends travelling from client to client. She is required to attend regular training sessions but is not paid for attending.

Ann’s attendance on her clients is good but obviously there are times when she cannot come due to illness etc. She rings to let me know and also informs the agency that I will need a substitute, but the agency does not contact me and more often than not, no replacement arrives. This is bad enough for me, but other clients she has are bedridden and completely dependent on a carer for really basic necessities.

I understand from the care worker’s point of view why substitutes rarely turn up. Ann will sometimes work as a stand-in only to find her pay is less than the cost of getting there.

Ann’s work for me includes an all-over strip wash in the morning (she is not insured for carrying me into the shower), dressing me, making my bed, recharging my Bi-pap (breathing machine), making my breakfast, opening my windows, emptying or loading the dishwasher and a general tidy-up of the kitchen. In the evening she helps me undress, prepares my evening meal, closes the windows. All the time she is cheerful, and we do a lot of laughing.Name and address supplied

• Top marks to Zoe Williams for highlighting the problems facing social care organisations and workers. The government’s recent decision to postpone (abandon?) the funding cap in the 2014 Care Act underlines the low priority policymakers attach to work with older and vulnerable younger people.

Leaders in social care need to work out how to answer the underlying assumption that, since social care will not contribute to the export-led growth beloved by the chancellor and others, it deserves to remain a low-status, low-paid activity. Any suggestions?Robin BoucherAshby-de-la-Zouch, Leicestershire

• Zoe Williams is right that social care is highly skilled and should provide rewarding careers. But that in turn demands a radical rethink of its design.

The core problem is commodification, the fragmentation of the care relationship into standardised tasks that objectify the client.

Person-centred care, by contrast, demands that care workers focus – as most wish to – on the unique and changing needs of the human being to whom they offer support.

Social care of the future will be a professional vocation in which care workers have the freedom and responsibility to provide appropriate supports to strengthen and complement the capacity of the client and her networks – a rewarding career indeed.Brendan MartinManaging director, Public World

• The most dispiriting aspect of Zoe Williams’ article is that it could have been written at any time over the past 25 years. I fear that her “social policy nostalgia” may not reach back as far as the introduction of market economics into care, when Ken Clarke was health secretary, with claims that such “discipline” would shake up care for the better – raising standards, putting those in need of care and support at the centre of all discussions about services, and dealing with the uneven distribution of residential care homes across the country. Bad services would be forced out of business, while good ones would be encouraged and supported to start up and flourish.

The early years of the first Blair government saw the establishment of a royal commission on the funding of long-term care, whose thoughtful report was ignored because it was deemed unaffordable. On the plus side, the introduction of the national minimum wage, was very good news for the huge army of low-paid workers whose dedication was vital to prevent the collapse of an already overloaded system and these same people were also grateful for the implementation of the European working time directive giving them the statutory right to paid holidays and altogether better conditions of service.

Throughout this time politicians of all stripes have shared their visions – often quite blurred and in need of perspective, but those who have held the power have never been prepared to commit the money to deliver the changes. The ease with which cash appears to be found for capital projects like HS2, the “northern powerhouse” or the Olympics suggests that money is not the issue, it’s political will – or, more worryingly, political calculation that voter disaffection with the system is a transient thing that never has the same power or attraction as a low-tax economy and crackdowns on welfare.Les BrightExeter, Devon