The Changing Face of Community Care

 

Many of us have struggled for years to try and obtain a decent level of care and support through social services and domiciliary care agencies.  It seems to be the common experience of people with ME that the whole thing is stressful and exhausting, leading some to give up altogether (the alternative direct payments system is not suitable for everyone) and others to have a constant burden of anger and distress to cope with, on top of our illnesses.

 

In 2000 the Care Standards Act was passed, and I am just beginning to allow myself to feel a little more optimistic about the future of care in the community.  The industry is now regulated.  Whereas in the past care agencies only had to agree on a voluntary basis to adhere to standards, the new National Minimum Standards are now legally enforceable.  This seems to have led to a considerable improvement in attitude and practice already in the particular agency which supplies my care.

 

The new Standards do make for interesting reading.  The emphasis is on greater involvement of service users in all aspects of their care, and a quite considerable shift of the power basis – “the needs of the service user lie at the heart of the provision of personal care” – so that in theory anyway we should now have far greater clout to challenge neglect, abuse and poor standards of care.  It is still an uphill struggle – I still have to often nag carers, for example, to follow basic hygiene principles, and to remind managers that they should only send carers to me within my specified time band – but I feel as if slowly and steadily I am making progress.  I can only hope that the same is true for other service users.

 

I have recently done some research on the Internet, and found several informative and relevant web sites.  I am heartened to find that the General Social Care Council has launched a Social Care Register, which will eventually register and regulate all social care workers, whether they are directors of social services or grassroots care workers.  Qualifications, health, previous employment records, and good character will all be checked before a worker can be registered.  Those with certain criminal records, substance dependence and serious mental health problems will be barred from care work.  This Council has also produced enforceable codes of practice and conduct and will be able to investigate allegations of serious misconduct.

Other very welcome changes include the introduction of comprehensive training, with NVQs in social care at levels 2 and 3 for care workers and level 4 for managers; also a Registered Managers Award.  So far as I can tell, this training is very practical and work based, so it is a useful first step, although personally I feel that managers need a far higher level of general education than they seem to have at present, together with proven organisational, personnel management and IT skills before they are taken on.  A background in care work is not sufficient on its own.

 

The Care Standards Act also set up the National Care Standards Commission, which was replaced this year by the Commission for Social Care Inspection.  The big improvement here is that this body is independent of social services, and is responsible for inspecting and regulating them as well as care agencies. They have wider powers than any previous body and can therefore see the whole picture of how social care fits together.  They are answerable to Parliament itself, and include amongst their commissioners one service user and the Chair of Action on Elder Abuse.  They have a helpline (see below) and will deal with complaints from individuals.

 

Action for Elder Abuse is a charity which was set up some years ago; they say that the abuse of older people in our society is a “serious and major problem”, and that this sometimes includes abuse and poor practice in community care.  As a result of their work a Parliamentary Health Select Committee produced a report which has made 40 recommendations for improvement.  There has also been more attention paid over the last year or so in the media to this problem; 2 or 3 “Panorama” programmes and a weeklong series of “Britain’s Secret Shame” highlighted several cases of abuse in care homes and community care, while the Daily Mirror launched a campaign in April (“Britain couldn’t care less”).  Although most of us don’t come into the category of older people, I feel hopeful that the work of this charity will have a beneficial knock on effect for the rest of us, as the vast majority of service users are older people.

 

Cynics would say that a lot of this is little more than propaganda and that the reality is that the “workhouse mentality” still exists and that we are made to feel like Oliver Twist who dared to ask for more if we complain or question the provision of our care.  But I would like to give the benefit of the doubt to the policy makers and assume that most of them are sincere in wanting to improve standards of care.  It has long been recognised that it is in the interests of all members of society to tackle social problems, not just the interests of those who are suffering from them; if problems are ignored for too long it can lead to serious social unrest.  But I feel it is up to us as well, as grassroots service users, to play our part as far as we can in bringing about transformation.

 

If you feel that it is necessary to make a complaint about your care, it is best in the first place to contact one of the managers at your agency.  If things are not put right, you can then ask to speak to their senior manager.  Most organisations have a formal complaints procedure, should it be necessary to take things further.  If you are still not getting anywhere, it is worth looking around for allies; social services, the Commission for Social Care Inspection, your MP or local councillor (your local library can give you their name and address) may all be able to help.  Making a complaint is scary, and time and energy consuming, but in my experience, well worth it in the end.  It is important to keep brief notes of anything and everything that goes wrong, so that you have facts and figures to back up your claims.  It is also important to keep calm and reasonable, and if you are not listened to by one person, to keep going up the chain until you get results.  Once care agencies see that you are serious they will begin to take you seriously.

 

Useful Information

 

Action on Elder Abuse:

www.elderabuse.org.uk

Helpline 0808 808 8141

 

Commission for Social Care Inspection:

www.csci.gov.uk 

Helpline 0845 015 0120

 

General Social Care Council:

www.gscc.org.uk 

 

Social Care Institute for Excellence:

www.scie.org.uk

Useful Books:

‘Social Care Practice’ by Janet Miller

’The Development of Social Welfare in Britain’

by Eric Midwinter

‘Understanding Poverty’ by Pete Alcock

‘The Politics of Disablement’ by Michael Oliver

‘Introduction to Social Administration in Britain’

by M Brown and S.Payne