Catherine Needham, University of Birmingham
For three weeks in a row, BBC Panorama has shown how high quality, immersive journalism can lift the lid on the otherwise hidden aspects of social care – the things that go on in people’s homes and in secure units, places that commissioners, regulators and even researchers find it hard to see.
The first of these, set in Whorlton Hall, a secure psychiatric hospital, showed one kind of horror – staff effectively torturing residents with learning disabilities and autism. The second two episodes (detailing the impact of care budget cuts in Somerset) showed a different kind of distress: staff, families, commissioners all doing their best, but exhausted and burned out by an inadequately funded system.
We may read about the toll caring takes on families, but nothing is as powerful as seeing it up close. It offers a powerful corrective to those who say that families must do more, must take up their responsibilities. Here we saw family carers pushed to the brink, exhausted, unable to care for themselves, needing support in order to be able to continue to give the care they willingly give. It shows how far away we are from a care system that supports wellbeing or is sustainable.
Money lies at the heart of many of the problems revealed by Panorama, with the cuts to local government funding going deeper each year. As Somerset sought to make cuts of £13 million from its budget, dementia day centres were closed to the visible distress of attendees and family members. There were dramatic scenes at the town hall as the budget cuts were about to be signed off, and the chief executive fielded a call from Whitehall. I half expected an eleventh hour reprieve from the Ministry (it was TV after all), but no: there was to be no more money for Somerset.
If we are serious about good care as a way to support people’s wellbeing we have to look beyond Panorama’s cash crisis narrative and recognise that this is only part of the story.
Bad care can be expensive. Inpatient hospitals like Whorlton Hall provide ‘out of area’ placements at a huge cost to commissioners. A closer to home arrangement would almost certainly save public money while enabling families to keep in regular contact with loved ones. But those facilities do not exist. Seven years after the Winterbourne View scandal, and the promise such units would close, an estimated 2,300 people still live in such units, with staggeringly little progress on the government’s Transforming Care agenda.
The one positive story coming out of Panorama’s Somerset coverage was a relatively cheap model of care: the emergence of micro-enterprises, offering localised person-centred care in rural areas at a lower hourly rate than larger care agencies. These micros are often sole traders and aren’t usually regulated by CQC, as Twitter critics were quick to point out. When you recall that Whorlton Hall had a good CQC rating you may feel regulation has its limitations and cannot be all we rely upon to deliver good care.
Money was a key issue, but was far from the only help needed by Pat in the third Panorama episode, whose haunting isolation felt complete after she revealed that even the cat had moved out while she was in hospital. By the end of the episode, social services seemed to be finding some money to pay for daily visits from care workers to help keep her fed, clothed and safe, but none of those will really address her loneliness.
So the link between care and wellbeing is not only about money. I was struck by a comment from Professor Andrew McDonnell, one of the academic experts brought in to comment on the Whorlton Hall footage, who said that the best defence against abuse in an institutional care setting is for it to be like Piccadilly Circus: lots of people coming and going, so there is a gentle but constant sense of visibility. Of course no-one wants their home to be like Piccadilly Circus, but they do want to keep people coming into their lives. Often when people need care their lives shrink – like Barbara from episode 2 of the programme, who cared for her husband Michael with encephalitis, and talked about how no one comes to visit anymore.
The care innovations that I’m most hopeful about are the ones that try to keep people in a multiplicity of real relationships, some of which are summarised here. They emphasise what McGregor and Sumner call ‘relational’ wellbeing. It was the lack of this in Whorlton Hall and in the Somerset examples that really made me cry watching Panorama.
Professor Catherine Needham
Professor Sue Yeandle, Sustainable Care programme Principal Investigator comments:
“The problems in Somerset shown in the Panorama programmes on adult social care can be seen across England. Families, care workers, local authorities, care providers and regulators have been voicing their concerns for years. The law on care was reformed in 2014, but key provisions were not implemented, and financial pressures on local authorities have led to rising unmet need. Difficulty in obtaining support, and the baffling complexity of assessment and charges, now trouble families nationwide.
Our team, supported by the Economic & Social Research Council, is exploring how arrangements for care need to change to be sustainable for the future. Learning from experience across the UK, and seeking inspiration from positive examples around the world, we are determined to make a difference. The care crisis is a formidable challenge, but better ways of supporting older and disabled people and their families are possible, and must be found.”
For the Sustainable Care programme, Catherine leads the work on ‘Comparing UK care systems’, to learn more about her work, click the image below