Can abuses in social care be tackled from within?
If a measure of a society is how it treats its weakest members, how would the UK currently fare? Judging by last night’s Panorama investigation we would certainly be below par. The episode showed hidden camera footage of an elderly lady with Alzheimer’s being mistreated, ignored and occasionally physically abused by not one but numerous care staff that visited her on their rounds. All bad enough on its own, but what makes this story truly depressing is that it wasn’t presented as a high-profile scandal per se, but rather something which is run-of-the-mill, everyday behaviour. A cursory glance would suggest we’ve become casually acceptant of abuse and dulled to stories of neglect.
All of that said, it would be both lazy and unwise to attribute such behaviour to ‘bad’ people or to see this as just another sign of a moral collapse in society. First, this account simply doesn’t ring true for other care homes across the country where the quality of care and carers alike is often superb. Just last night I came across a great initiative called My Home Life which shows the great things that can be done to improve the quality of life for older people in care homes. Second, there is a danger that in dismissing certain individuals and institutions as inherently abusive we neglect the underlying, often systemic, drivers of such behaviour. As one Twitter observer put it, “enough of the voyeurism, let’s have an intelligent discussion about the underlying problems of #ukcare”.
Such an intelligent discussion would no doubt have to include a fair analysis of the current care investigation processes led by the Care Quality Commission and at least some exploration of what effect the move to private sector care provision is having on service standards. But above all any conversation about the root causes of maltreatment in care homes or outside of them would need to look at how carers are recruited, how much they are paid and what kind of pressures they are under in their working environments. In short, do we care enough for the carers?
When it comes to rewarding carers for the demanding work expected of them, probably not. According to a recent study cited by Gavin Kelly of the Resolution Foundation, there are potentially between 150,000 to 220,000 care workers in the UK who are on less than the minimum wage. This is an astonishing figure. Even for those whose employers do everything above board, their pay rarely sits much higher than the £6.08 minimum and many have to cover the costs of long distances of travel to and from work themselves. On those kinds of wages, how does anybody expect to recruit truly caring individuals who are willing to invest themselves in their work?
Likewise, similar problems are witnessed in the recruitment and general management of care workers. In a piece of research into risk and caring published by the Joseph Rowntree Foundation last month, it was noted that the private agencies supplying carers as personal assistants did not know enough about the background of the workers on their books. As one lady who was interviewed in the research put it, “I needed a personal assistant and advertised through my local care provider. They sent me a list of ‘suitable’ people to interview. One of the candidates was a young lady… who I had known when in hospital and knew how potentially disturbed and violent she could be. The care providers who recommended her had no idea of her background and her care manager was pushing her to get work.” Incentivised by payment-by-results schemes, this push by private contractors to get people back into work may worryingly lead to more ill-suited and undertrained individuals heading into the care sector.
All of this seems to be symptomatic of a social care system in the UK which is, to use a clichéd term, not fit for purpose. The obvious solution is that care needs to be more highly valued, the wages of care workers increased, and the recruitment and management of workers reappraised. But this will no doubt take time and effort. Nor will fixing the systemic processes necessarily address what is often a cultural problem on the part of a few care workers, although the two of course overlap.
What is needed instead is something that draws upon the ability of those already doing great work in care to mitigate the actions of those who aren’t. One option is to encourage more whistle-blowing in the sector. But this comes with several caveats, not least that it can take months if not years to follow up on the calls made by concerned care workers. A different, more direct approach would be to train the most diligent care workers in an organisation to look out for potential signs of abusive care in their organisations and to mollify them before they escalate.
The emphasis here is on prevention of abuse rather than identifying and punishing people after it has occurred. Like ‘the interrupters’ who prevent violence from escalating on Chicago’s roughest estates, the care workers charged with such a role would take subtle steps to encourage a better culture of care among workers. In practice, this could mean taking conscious steps to change the tone of the conversations between their colleagues, stopping them from reaching a situation of group-think where they blame older people for things affecting them.
This seems like a particularly soft way of addressing what is a serious problem, and it would also ask a great deal of the individuals who were to take on such a role. But such a highly localised approach would be able to get to where regulation and other system changes cannot. Above all, it recognises that there are exemplary care workers out there and would try to make the best use of their abilities to turn the tide in poorly functioning care homes.