As most who work within health and social care, private or NHS, will know, the new ‘Care Act’ is coming into official law from April next year, whether we like it or not.
Within healthcare I’ve encountered a variety of different responses to this.
Some health workers are relieved that adult care is now going to be enclosed in a single piece of legislation and that professionals will not be scurrying around different huge folders daily. They are relieved that nothing seems to be contradictory and that the guidance will be in black and white.
Others have a sense of disbelief that something this complex can be set out so directly.
Although there is clearly a need for a single act with a specific guideline to adult care, I believe this act is not the answer.
Supporting informal carers
When trailing through the however-many-hundred page act that could compete with the Harry Potter saga, I can hear the voice of David Cameron belting out speeches on his ‘big society’ and families. When reading between the lines, however you wish to dress it up with moralistic and even herculean language, he fools no one that this act is not about care, it’s about cuts.
The act focuses on the need for social services to consider and help informal carers; with the long-term focus being that this is a cheaper option to paying for agency staff to cater to the sick, elderly and vulnerable.
“By ‘supporting’ carers, the act gives a little without having to pay out a lot”
By ‘supporting’ carers, the act gives a little without having to pay out a lot, but this is a façade.
If the government really wanted to support carers and give them the credibility they deserve then they’d be more concerned with increasing the £61.35 they are currently given in carer’s allowance to a liveable figure.
I myself would love to be able to care for a parent when they are ill or in the last few months of life; but the financial demands make it completely impossible for anyone with any sort of commitments such as children, a mortgage, or private rent.
Domiciliary care is becoming heavily privatised by most boroughs who are handing out contracts to local social/home care firms, supported by the prime minister’s repetitive idea that social care competition will lead to private firms having to provide a better service in order to compete for contracts.
“Private firms don’t have to be better; they simply have to be cheaper “
But they don’t have to be better; they simply have to be cheaper.
And what methods do firms use to offer cheaper services? They cost cut – usually employee salaries, so stereotypically badly paid roles such as a healthcare assistants, will receive even less pay. Probably leading to these posts being filled by workers who are less skilled, as the current healthcare assistants move into better paid unskilled work. And the expectation of them by the government is to be better than before?
Even my B grade in economics A-level (which is almost rusty at this point) is enough to know that when free markets are allowed to fluctuate, the biggest cost will always be social; which is why it doesn’t work.
The government has intervened in almost every other area of society: banking, education and employment. Yet social care is left to ride the rapids of cost-cutting firms and it is up to regulating bodies like the CQC to sort out these foreseeable issues.
When I attended training on the new care act, as many in health and social care probably will, I found parts of the act completely identical to other existing types of legislation, and baffling in other parts.
There was a focus on non-assessment.
The trainer himself gave an example of how the government could set up a ‘drop in stop shop’ where individuals could drop in and self-assess and leave with minor equipment and a bit of what sounds like common sense advice.
What I debated profusely is that we train professionals specifically to make these kinds of assessments for a reason, we haven’t just been doing it the last couple of years for nothing. I have done home visits with occupational therapists pre-discharge for stroke patients and some of the adjustments and assessments they carried out wouldn’t have personally occurred to me at all as a bystander without being told.
They also make the decision on equipment because that is what they are trained to do.
Allowing people to just come in and casually self-assess sounds like a good idea; putting the power into the person’s hands and letting them control their treatment.
But look at it another way, for example an older gentleman (let’s call him Mr Cameron) who is unsteady on his feet with advancing arthritis. He goes to one of these stop offs and comes away with grab rails because that is what he believes he needs. However, without the person (whoever this special professional is) seeing his house, they don’t know that in fact he has a bath and that the arthritis will soon stop him from being able to pull himself out of the bath.
“The risk is never seen, never assessed and never minimised”
A professional would’ve probably said he needed a wet-room or walk-in shower because of this risk. But because the risk is never seen, never assessed and never minimised, poor Mr Cameron tries to get out of the bath and can’t clutch the grab rail, loses his footing and falls and hits his head on toilet and is left lying on the floor with a head injury – ‘armitage shanks’ printed on his forehead.
This could also go in the other direction, someone for instance who has a disability may choose to use a hoist because it is easier for them short-term but someone qualified may argue that this does not promote independence and self-efficiency for as long as possible. If someone just takes equipment for the ease instead of doing what they can do, they quickly stop being able to do it and now the lack of assessment has meant that person’s symptoms might develop faster than they might have done otherwise.
Another highlighted issue that I didn’t like was that you cannot necessarily ask for an assessment for bigger/more expensive equipment or services. Individuals with mental health difficulties or learning disabilities will end up with the short straw, as their needs and evidence of their difficulties is not clear cut and cannot necessarily be clearly identified (I understand that some may argue that the current system is exactly the same; but at least one could ask and present a higher possibility of raising their standard of care).
In essence: the NHS works off the baseline belief of the entitlement of all despite class and cross-culture to have equal access to healthcare and social care to an extent and is fundamentally a moral societal decision. Moral dilemmas cannot be solved with monetary policies.
Helena King is in her 2nd year of studying mental health nursing at London Southbank University and works with the CQC; she has also been a service user for seven years
 Gov.uk. 2014. Carer’s Allowance. [https://www.gov.uk/carers-allowance/overview] [accessed: 22:55 6/11/2014]