More inspections won’t solve the care crisis

The Conservative Party might want to forget the ‘dementia tax’ debacle that haunted its General Election campaign, and marked the beginning of the end of its parliamentary majority. But the social-care crisis is not going away. An ageing population, rising costs (as providers are forced to pay care workers the National Living Wage), and cuts to local authority funding (estimated at £824million in England in 2017/18), are putting 12 per cent of the UK’s care homes at serious risk of going bankrupt, according to the latest research.

The pressure is expected to increase, with an anticipated growing demand for places (with one study in the Lancet identifying the need for 70,000 more by 2025) and a longstanding shortfall in staff – predicted to worsen with the much-cited Brexit effect supposedly putting off foreign workers coming to an allegedly hostile UK.

Care homes have been closing at a rate of around 500 a year, and for those that remain – it is not unreasonably argued – care standards can only suffer.
HMRC is currently chasing care providers for millions of pounds worth of back-payments for workers who were paid below the minimum wage for ‘sleep-in’ shifts. This will make further closures even more likely, argue those in the sector.

But do these factors fully explain the crisis in our care homes? It is certainly the case that local authorities are running out of options to deal with the crisis – other than raise council tax and make better use of the Better Care Fund (aimed at integrating local health and social care) – as central funding dries up. The Department of Health has responded by saying it will toughen up the inspection regime. But is the problem really that the Care Quality Commission (CQC) is too lax in its monitoring of care homes and the quality of the care that takes place in them?

I don’t think so. While there is a place for ‘light touch’ visits to weed out the worst offenders, it is the public-sector audit culture itself that is making a solution to the social-care crisis so hard to find. Notwithstanding ever-increasing demands and historic under-resourcing, the focus on meeting targets and pleasing inspectors crowds out a culture in which a commitment to care, and the autonomy of cared-for older adults, might otherwise be allowed to flourish.

‘What’s it like to live in a care home?’, published this month by consumer rights body Healthwatch, gives a sense of how bad things have got. In over a third of the nearly 200 care homes its volunteers visited across England, conditions were poor – from peeling wallpaper and rotting pot plants to being so generally dirty that a ‘deep clean’ was insisted upon. Some residents reported having no internet access or not having the opportunity to get some exercise for weeks on end; and others complained that they ‘didn’t get enough time to connect with those caring for them’.

For all policymakers’ high-flown rhetoric about ensuring older people are given more independence, choice and control over their lives, too often care homes were found to be failing even to uphold residents’ dignity or just ‘get the basics right’. As national director, Imelda Redmond, put it: ‘Care homes are not institutions, they are people’s homes.’ The sooner the managerial ethos is abandoned, and those who live and work in these homes are able to take control of decisions about care, the better.

First published in sp!ked

Lou the transphobe? Please!

‘Walk on the Wild Side’ Lou Reed’s most famous song, hit the headlines recently courtesy of the University of Guelph Central Student Association in Canada.  Originally recorded for his bestselling classic album Transformer produced by David Bowie and Mick Ronson (formerly a Spider from Mars to Bowie’s Ziggy Stardust), it somehow slipped a line about ‘giving head’ past the censors in 1972. This time around, 45 years later, the would-be censors published an apology for the song and its ‘transphobic lyrics’ finding its way onto a playlist at one of its events.

Apparently ‘the person making the list did not know or understand the lyrics’. They weren’t the only one. The rush to seek offence – a regrettable feature of contemporary life, both on campus and in the field of identity politics – is such that all is swept before it, even a song written by somebody who was no stranger to transgressing the norms of his day. ‘Bi? The fucker’s quad!’ one roadie was reputed to have anwered when quizzed about Reed’s sexuality. While David Bowie with that album had brought him renewed fame, it was Reed and the Velvet Underground, and the mifits that populated Andy Warhol’s Factory, that were the original gender-benders.

Candy Says, from the Velvets’ third album and also written by Reed, is a sad and tender song about Warhol muse and trailblazing transsexual drag-queen Candy Darling, who died tragically at the age of 29.  Reed even dedicated his sometimes overlooked gem of an album Coney Island Baby to his drag-queen lover Rachel. He was transgressive to the end, with his critically panned project with Metallica, Lulu, based on a couple of obscure German plays, with sexually-shocking lyrics sung by a 60-something Reed from the perspective of a female stripper-cum-prostitute.

But lets go back to the song in question. According to Hal Willner, who produced Lulu and Reed’s other late albums: ‘This song was how the world first heard about these people. It’s a song about love.’ Not least Lou’s love for the New York misfits he knew and wrote about. A world away from the curiously conformist one inhabited by today’s students and activists. What’s good about this bizarre controversy is that Lou Reed is back in the news. Dying just a couple of years before Bowie, I’m not sure enough people really know what a genius he was. And so influential too. Bowie wouldn’t have been Bowie without him.

He’d no doubt have dispatched his critics with a monotone-delivered but deadly one-liner if he was still around. The least today’s generation can do is take Lou’s advice. Take a walk on the wild side.

Don’t use nurses as fodder in the NHS war

Increasing numbers of nurses are leaving the NHS, choosing to take jobs stacking shelves in supermarkets instead. That’s according to NHS Providers chief executive Chris Hopson, who is responsible for most NHS hospital, mental-health and ambulance trusts in England. He said on Monday that nurses’ pay is so poor – pay rises have been capped at one per cent in recent years – and their working conditions so stressful that many are simply giving up. Hopson’s intervention follows claims by the Royal College of Nursing that more and more nurses are relying on foodbanks to get by.

But the problem with the NHS isn’t as black and white as it seems. Whether or not nurses are so underpaid that they’re actually going hungry, or are so demoralised they’d rather work in a supermarket, it is true that there is a crisis in the NHS. Prime minister Theresa May’s response to Copson – pointing out that there are ‘more doctors, more nurses, more midwives’ in the NHS than ever before – did nothing to address the fact that there still aren’t enough, and that the Tories are starving them of funding. Of course nurses should be paid more – they do an incredibly important job. And despite May’s cheery outlook, the NHS needs more funding to meet the increased demand on services from an ageing population, exacerbated by service dysfunction and the cuts to social care.

Solving the NHS crisis won’t be as straightforward as simply raising taxes, but without a greater funding commitment it won’t be possible to implement the changes needed to put things right.

In response to Hopson, May said that ‘you can only put extra funding into the NHS with a strong economy’. It was, of course, a jab at Jeremy Corbyn. But the problem is that the Tories have not produced a strong economy. This is why they’ve pursued public-sector cuts as part of their obsession with slashing the deficit. They’ve been incapable of fostering real growth.

But rather than challenging the government’s cuts to the NHS on economic grounds – arguing for more growth as a means to more funding, and a much bigger overhaul of the care system – the Labour Party and health-sector lobbyists have opted for emotive electioneering. They have framed the discussion about the NHS as a war between angelic nurses and cruel austerity.

Such cynical tactics won’t work. Instead of trying to shame the government with spin about impoverished nurses, critics would do better to challenge the NHS love-in, and ask if this aged institution is fit for purpose. The crisis in the NHS isn’t just about funding and wages. It is about the way that the NHS is run. Given the targets it is burdened with, you would think its purpose is to populate spreadsheets with agreeable figures rather than make the sick well again. It is this culture that is responsible for driving down morale, and undermining the sense of public duty among staff.

Groups that represent health workers should be offering up solutions as to how the NHS should be run better, rather than leaving it to the NHS’s target-obsessed managers. Instead of holding them up as objects of pity, why not urge nurses to take inspiration from the junior doctors, and lay down their bedpans until they win a better deal from the Department of Health?

Published in spiked