Caring for the elderly in an ageist society

In his 2019/20 Budget, Philip Hammond, the UK’s Conservative chancellor of the exchequer, announced £650million additional grant funding for local authorities in England to spend on services for older people and adults with long-term disabilities.

This will help ease the ‘immediate pressures’ they face, he said. Only £240million of this money is earmarked for propping up the social-care system, however. And the Association of Directors of Adult Social Services has been lobbying for £2.35 billion after enduring year-on-year funding shortfalls.

According to Labour MP Frank Field, co-author of A New Deal to Reward Kindness in a Forgotten Profession, cuts to local-authority budgets have resulted in a ‘race to the bottom’ in the commissioning of paid-for homecare provision. The inevitable result is poor-quality, rushed personal care.

Emily Holzhausen of Carers UK says unpaid carers, some of them pensioners themselves, and typically looking after other elderly family members, are ‘exhausted, demoralised and have lost vital community connections because there is not enough good-quality care’. They are ‘the backbone of the care system’ without whom ‘the system would collapse’, agrees Ian Hudspeth at the Local Government Association.

The King’s Fund says the system not only needs to make improvements in the quality of care that is provided, but also needs to find more resources. These will be needed to address an estimated additional 1.2million people’s unmet care needs, and to find an expected 700,000 more social-care workers by 2030 as the ageing population continues to grow.

New, more efficient and innovative ways of providing care do need to be found. This needs to go alongside a better way of managing the demand on services, with an approach that is more preventative and also integrated with health, housing and benefits systems. A balance needs to be found between formal support, provided or commissioned by the state, and informal support that comes from family- or community-based care.

These are not just technical questions for the social-care sector to grapple with. They are far bigger than that, touching upon the issue of what kind of society we want to live in, and what we expect of each other. At root, there is the issue of what we regard as individual and collective responsibilities; and what the duties of the young are to the old; and the question of how elderly people come to decide for themselves how they should be cared for later in life.

More than that, the problems facing the social-care system need to be understood in the context of a wider generational hostility that is compounding, if not driving, a longstanding official neglect of older people’s care.

The bookmakers Paddy Power have been criticised for its adverts portraying old people as zombies, albeit as part of its UK sponsorship deal with the TV series The Walking Dead. It is meant to be a joke, but older people’s charities didn’t find it very funny. Such ‘inaccurate stereotypes’ are described by Independent Age as ‘crass and utterly disrespectful’.

Some of us might be tempted to laugh this off as yet another overreaction from the permanently offended. Ofcom has yet to decide whether the four complainants (yes, four!) about the Paddy Power ad are enough to justify an investigation. And yet, this depiction of old people is not an isolated incident. It reflects a broader prejudice today.

‘Negativity about ageing and older people is pervasive in our society’, says Caroline Abrahams at Age UK. Whether it’s the nasty sentiment that Brexit voters are a bunch of selfish old bigots whose demise can’t come too soon, or that Baby Boomers have been piling up problems for moaning millennials, or that old people are just getting in the way with their ‘bed-blocking’ and their unreasonable expectation that younger folk should subsidise their state pensions, free bus passes, TV licences and winter fuel allowances – again and again, we see generational disdain for older people.

Add in the damning inspections, abuse scandals, cuts to services, underpaid care workers and the ‘dementia tax’ debacle that have so plagued the social-care sector in recent years, and it is hard to escape the conclusion that elderly people are increasingly regarded as a burden on society and a drain on resources. Once, they were seen as the repositories of wisdom and a source of support for hardworking families – now they are talked about as a barrier to youthful flourishing and of course to Britain’s continued membership of the EU.

So, addressing the crisis in older people’s social care is not just a matter of figuring out how we pay for it, or even how we organise it. It is also about rethinking our relationships with each other and with the state. And it is about taking on the ageism that is currently such a stain on policymaking, popular culture and public life. Social care for the elderly will not be taken seriously so long as hatred of old people is borderline acceptable in polite society.

First published in spiked

Too much safeguarding

There is an awful familiarity to the guilty verdicts given to 20 men in Huddersfield in the north of England for raping and abusing girls. These ‘grooming gang’ offences committed between 2004 and 2011, by men operating in the nighttime economy of taxi ranks and fast-food takeaways, are just the latest in a series of similar horrendous accounts of what has been happening on the streets of Rotherham, Newcastle, Telford and Oxford, among other places.

As Barry Sheerman, Labour MP for Huddersfield, put it, ‘No one, local authority leadership, police, many of the people that should have been taking this more seriously earlier, did’. And yet this is in stark contrast with what is going on when it comes to ‘safeguarding’ children from other supposed threats, or from their own families.

‘We are failing our children if we don’t put them at the heart of government spending’, says Anna Feuchtwang, chair of End Child Poverty, in an open letter to Theresa May and Philip Hammond in the run-up to next week’s Conservative government budget. The alliance of a hundred-plus organisations concerned with the lack of what Feuchtwang describes as ‘concrete financial commitment to the welfare of children’ was echoing the Children’s Commissioner’s warnings about the ‘catastrophic consequences’ of local authorities failing to meet their statutory duties to vulnerable children.

But it is not as if money is not being spent on far-reaching interventions into children’s and families’ lives. The number of children referred to social care every year has increased by 100,000 in a decade. The numbers of care orders granted to local authorities to remove children from their families has doubled. Child-protection inquiries have more than doubled. It is just that at the same time as all this has happened, central-government funding has been cut quite drastically, putting children’s services in crisis. The LGA says there will be a £2 billion funding gap in 2020; £3 billion by 2025.

This is a crisis of our own making. There is relentless ‘awareness-raising’ about the alleged multiple and worsening threats to children’s wellbeing; and yet the small minority of children and adolescents with serious problems, such as those who are self-harming or suffering from serious eating disorders, are waiting for months on end to be seen because services don’t have the resources to cope with the extra demand.

Javed Khan, chief executive of Barnardo’s, has described it as a ‘perfect storm’. But he blows something of a gale himself by talking up all the risks he thinks young people face. He talks of cyber-bullying and gaming addiction alongside online grooming, as if some sort of continuum exists between playground unpleasantness, Playstation and predatory paedophiles. These hazards or threats ‘apply to everyone’, claims Khan.

This is the problem with child protection today. In an effort to safeguard ‘every child’ from every danger, the particular child facing particular risks no longer matters as much. The response of services is disproportionate – intervening far too much or hardly at all. There is an overreliance on top-down procedure rather than trusting people on the ground – whether it be the youth workers who were so important in uncovering what was going on in Rotherham, or people in their communities just keeping an eye out for anything untoward.

In a parliamentary debate on the recent Care Crisis Review, Lucy Allan MP said, ‘If we believe that families do a better job than the state, we must work with families to support them, not just judge them and find them wanting’. She’s right. The state shouldn’t be needlessly taking kids away from their parents. But who still believes that families do a better job than the state does? At a time when parents in general aren’t trusted to bring up their children without expert advice, what prospect is there of the authorities working in good faith with parents who are struggling, neglectful or even abusive?

The Independent Inquiry into Child Sexual Exploitation in Rotherham conceded that cases of child sexual exploitation are a ‘tiny proportion of referrals and contacts to children’s social care, but they constitute a very significant proportion of the children at risk of serious injury and harm’. But between 1997 and 2013, the at least 1,400 girls estimated to have been sexually exploited by grooming gangs in the town were not protected. And yet, over that period, the inquiry report tells us: ‘Inspections frequently commend[ed] the council for its commitment to safeguarding young people.’

If we are to prevent another Rotherham, Banbury, Halifax, Rochdale or Huddersfield, we need to challenge the constant top-down panicking and obsession with process, re-focus child protection on the avoidance of significant identifiable harm, and re-establish trust in those best placed to look out for children in their communities.

 First published in spiked

The phoney debate over Universal Credit

The government’s flagship welfare reform, Universal Credit, looks to be in serious trouble. It was intended to simplify the social-security system to help welfare claimants into work, but is instead charged with causing them even more hardship. It has been beset by problems, from controversies over an eye-wateringly over-budget (and subsequently abandoned) IT system to delayed payments to the excessive use of sanctions.

Some Tories have threatened to rebel against the government in parliament unless the Treasury finds more funding for it in the Budget this month. The BBC reports that ministers are bowing to the pressure, and planning to delay the rollout once again.

There are ample reasons to criticise the Tories’ handling of this. It is projected that 1.1million households could gain £53 per week as a result of the introduction of Universal Credit, but as many as 3.2million could lose £48 per week. The impact of the introduction of Universal Credit on those dependent on benefits is real enough, not least as over a quarter of claims fail for one reason or another.

But the debate is phoney. Leftish commentators have been complaining about how awful Universal Credit is since it was first introduced by Iain Duncan Smith back in 2013, when he was work and pensions secretary. And yet they lack any substantive arguments against it, never mind any alternative proposals. After months of merely saying it would ‘review’ Universal Credit, the Labour Party for a moment suggested it would scrap it, but has now backtracked once again.

The Universal Credit row has also become a proxy for the Tory civil war over Brexit. Brexiteer Duncan Smith openly blames former chancellor and Remain campaign leader George Osborne for Universal Credit’s woes: Osborne raided the £2 billion of funding that, Duncan Smith claims, would have made all the difference. Meanwhile, former prime minister John Major, another vocal Remainer, has compared the Universal Credit debacle to the poll tax.

But as badly designed, implemented and funded as Universal Credit no doubt is, we shouldn’t just discard the ideas that underpinned it. Iain Duncan Smith’s ‘better benefit’ was intended to ensure that people aren’t penalised for moving from welfare to work. There is something to be said for that, even if this technical solution hasn’t matched up to the scale of the welfare problem.

We need a proper debate about welfare, and why so many people are so reliant on it. For all the mock outrage about Universal Credit coming from Labour, the truth is that this new programme, properly implemented, would hardly be any worse than what already exists. Labour, besotted with the status quo, seems suspicious of any attempt to question, let alone do something about, the fact that so many today are so dependent on the state to get by.

First published in spiked

Young people are not mentally ill

‘We know that young people face a huge range of pressures, including exam stress, bullying and concerns about body image’, says Jade Zelkowicz, community fundraising manager for YoungMinds. As part of the charity’s #HelloYellow campaign, timed to coincide with World Mental Health Day, thousands of young people will wear yellow to spread the word that ‘whatever you’re going through, you can talk to someone if you’re struggling to cope’.

So how big is the mental-health problem? According to YoungMinds, the ‘research shows’ that three children in every class have a diagnosable mental-health condition; 90 per cent of schools have reported a rise in anxiety, stress or depression among their students; and the number of children arriving at A&E with a diagnosable condition is twice what it was in 2010. A rise in hospital admissions and growing pressure on schools are certainly a cause for concern. These figures aren’t to be taken lightly — but nor should they be taken at face value.

I wrote a piece two years ago questioning the extraordinary claim that 1 in 10 children – or 3 in every class as YoungMinds put it – have a diagnosable mental-health condition. The claim is based on a study in which diagnoses were made by clinicians who never even met the children concerned. I remain unconvinced.

Besides, if the results could be trusted at all, they only confirmed that whatever the mental-health problems young people are supposedly suffering, there is no mass outbreak of serious neuroses and psychoses in our schools. Rather, it is emotional and behavioural problems like anxiety, ADHD and so-called ‘defiance disorder’ that predominate. This could tell us that something is going badly wrong with the way children are being educated and socialised – not to mention diagnosed – but it doesn’t necessarily point to a mental-health crisis.

YoungMinds is part of the Heads Together campaign, fronted by the Duke and Duchess of Cambridge and Prince Harry, with the stated aim of ending ‘the stigma around mental health’. The young royals want us to open up and get talking about our mental health. But in truth, we seem to talk about little else these days.

Mental health is no longer the taboo it is made out to be. Celebrities have long flaunted their traumas, addictions and syndromes. Mental health is in the frontline of the culture war against the stiff upper lip, ‘toxic masculinity’, and – the biggest crime of all – bottling it up. It is one of the main drivers of therapeutic policymaking, from schools to the workplace.

But far from helping those struggling with serious mental illness, spreading ‘awareness’ of the nation’s mental-health issues diverts resources away from those that need it most. Children and adolescent mental-health services have long been in crisis. Young people, some with life-threatening conditions, are sitting on waiting lists for months on end before they see anyone.

This is in the context of what Javed Khan, chief executive of Barnardo’s, describes as a ‘perfect storm’ in children’s services. The UK’s children’s commissioner recently expressed concern that local authorities are struggling to meet their statutory duties to vulnerable children. Services are squeezed between ever-dwindling central government funding and large increases in the numbers taken into care or suspected of being abused. (The wisdom of these interventions has also come under questioning.)

‘From cyber-bullying to gaming addiction to online grooming, the risks are all too real – and they apply to everyone’, says Khan. The onslaught of multiple and supposedly widening threats to children’s wellbeing appears relentless. And the perception of these risks certainly creates demands that must somehow be met by services under strain. But is this a crisis of our own making, and do these risks really affect ‘everyone’?

It is no wonder young people feel their mental health and emotional wellbeing are under threat when they are constantly told that they are. This also causes them to feel vulnerable to events and experiences that would have seemed unremarkable to previous generations. Should we really be surprised that children’s services are under unprecedented pressure as a result? As a society, we urgently need to grapple with these questions if we are to avoid the self-fulfilling prophecy of making a whole generation of kids unwell.

 First published in spiked

No, Brexit Is Not A Distraction From NHS Or Housing Crises

According to John Rentoul, writing in The Independent at the weekend: “Brexit is distracting the centre of Government – No 10, the Cabinet Office and the Treasury – from attending to the pressing problems facing the country.” You can see his point. The demands exerted by negotiating a Brexit deal in Brussels that neither party wants, while fending off a Remainer-dominated parliament in London, is hardly conducive to solving big and worsening domestic problems.

He is rightly sceptical about the government’s ambitions to build the millions of houses the country needs; and who isn’t outraged that 22,800 elective operations were cancelled in England as a consequence of ‘winter pressures’? But neither is the fault of Brexit. They are just the latest instalments in a long line of policy failures that existed long before that delicious jolt to the system intruded on the banal politics that existed before 23 June 2016. Does he really think that government would have got its trowel out by now and built the 250,000 homes a year it has been promising? Or that it would have got its act together and solved the social care crisis, and in turn solved one of the underlying causes of the NHS crisis?

No, Rentoul is wrong. Brexit isn’t a distraction from more pressing matters. However big the crises of housebuilding and in the NHS – and they are as considerable as they are longstanding – Brexit, and the crisis of democracy we face if it is not implemented will be that much bigger. But if we get it right – and it is a mighty big ‘if’ given the concessions already made by the UK negotiators – and those who seek to undermine it fail in their attempts to sabotage the popular will, Brexit has the potential to genuinely transform the agenda across public policy.

Even if it is thwarted as sovereignty and independence are sacrificed in the name of maintaining a relationship with the supranational body we are supposedly trying to leave, the popular sentiment behind Brexit can’t so easily be put back in its box. Whatever happens over the coming weeks and months, it has the potential to be the catalyst for replacing the managerial target-setting that has plagued public services for decades with a culture of political contestation over competing visions of our collective future. Policy-makers, once deprived of the shelter provided to members of the EU from their respective citizenry, will become more exposed – as they should – to the pressure to act that comes from the questioning and debate generated by the public’s critical engagement with those who govern in their name.

None of this is automatic of course. The disengagement of the masses from politics in the UK has been a decades long process with its roots in the failure of past political projects of left and right. Also, the technocracy, restraint and risk-aversion that played a part in voters rejection of the elites at home and abroad and their reawakening as political subjects, continues to dominate public life. And it continues to stifle progress in building lots more houses and ensuring fewer beds are blocked, as surely as it inhibits those negotiating our exit from the EU or failing to plan for our post-Brexit future. The stasis that was with us before the summer of 2016 is still there if less seemingly immovable. It is only by truly involving the people in the policy process – an old mantra amongst policy wonks curiously absent of recent – that we can finally shift it.

First published in Huffington Post