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11 Mayıs 2017 Perşembe

Social media and bullying: how to keep young people safe online

For all the benefits to mental health a digital world can bring, such as a sense of belonging and information and support for those with problems, there are also myriad dangers associated with online activity. In the very worst cases, people have live-streamed their suicide and had people cheer them on in the comments section.

Meanwhile, cyberbullying and trolling, along with communities and groups on social media that foster, glamorise or even encourage self-harm are pervasive. Stephen Buckley, head of information at the charity Mind, acknowledges these risks: “It is vital to recognise the huge danger created by any site or social media trend that promotes self-harm, suicide or eating disorders. They can be hugely damaging and possibly dangerous to someone in a crisis.”

This has come to the forefront over the past decade as more and more children use smartphones and tablets. A Young Minds report, Resilience For the Digital World, says half of Europe’s nine- to 16-year-olds now own a smartphone; the vast majority go online at least once a week, and most daily.

Buckley says that people are now used to following their friends on social media and sharing news of a new job, relationship, or a holiday presented in the best possible light. But this can have an impact on individual self-esteem. “While low self-esteem is not a mental health problem in itself, the two are closely linked. If lots of things are affecting your self-esteem for a long time, this may lead to depression or anxiety,” says Buckley.

Pressure on young people may also come from situations where they are being bullied in daily life that then cross over into their digital lives, says Marc Bush, chief policy adviser at Young Minds. “For instance, victimisation in the school playground is replicated on their Facebook pages or their WhatsApp or Snapchat groups, so they relive the distress they’re experiencing in real life on the digital platform.”

So, what’s to be done? Bush says industry has an important role to play. Today, if you search certain hashtags on Instagram, for example, a helpline pops up. He also cites the report from the House of Lords communication committee, Growing Up With the Internet, which calls for a national digital champion who can look at the rights of young people online, educate parents and teachers on how to look out for warning signs, and support young people to understand the consequences of bullying someone online.

The greater part of the solution, though, lies with young people themselves. “Ultimately,” says Bush, “young people are active in the creation, consumption and distribution of these images or forms of behaviour, so they have to be part of the solution.”

Tamanna Miah: ‘I developed severe anxiety after being bullied online.’

10 Mayıs 2017 Çarşamba

The high social cost of downsizing the state | Letters

In your report on the mayoral elections in Greater Manchester (Manchester mayor puts focus on homelessness, 9 May) you highlight the financial challenges facing the region, including that local authorities have undergone cuts of around £2bn since 2010. We have just completed a study of the impact of austerity on devolution and growth in Greater Manchester and we find that, in addition to local government cuts, the post-2015 welfare reforms will take almost £13bn from claimants in the region by 2020-21 as a result of benefit cuts and changes. This is the equivalent of £690 per working-age adult per annum. And there are other cuts which devolution has to manage, such as to adult skills and health and social care, where there is a £2bn funding gap.

Andy Burnham’s intention to prioritise homelessness is important and is to be welcomed, but to donate some of his salary to a new fund can send out the wrong message. It is austerity which is reinforcing social inequalities and homelessness in Manchester and elsewhere. We propose that Andy Burnham should argue for a different type of devolution model that is not about devolving austerity, but genuine local control over policies, finances and resources that will realistically address the economic and social problems of Manchester. We argue for a public services and investment case for addressing both growth and social disadvantage, which, combined with more local control over finances, will go some way to addressing not only homelessness, but also poverty and inequality.
Dr David Etherington Middlesex University
Professor Martin Jones Staffordshire University

• The concerns of Hartlepool residents at reductions in police numbers are well founded and regularly featured in over 430 community meetings I have attended in the area since my election in 2012 (Voices and votes, 9 May). The simple facts are that since 2010 the Cleveland area has lost £39m, or 36% of our policing budget, and the government, despite comments on ringfencing police spending, has taken another £1.2m off our grant settlement for this coming year (2017-18). We have implemented economies and efficiencies to maximise investment in neighbourhood policing, and to protect vulnerable people, but it is within a context of seven gruelling years of government-imposed austerity for communities like Hartlepool that impacts on the quality of life here.
Barry Coppinger
Police and Crime Commissioner for Cleveland

• While Polly Toynbee and David Walker are right to bemoan the cuts in services (Disparage, downgrade, downsize, G2, 9 May), surely the underlying issue is how to revive the local state – and in the process restore faith in building a fairer future? This means finding better ways of funding local services, rather than depending on unpredictable government grants. Most of the countries in the OECD do this by raising significantly more funding locally, from cities that cover much larger areas.

This can be achieved quite easily by reforming our anachronistic property rating system. Those with large land ownerships need to pay more, while small businesses, for example, should pay less. As a start councils can use parking charges to shift behaviour, as Nottingham has done in funding a third of the costs of its tram extensions through its workplace parking levy. Similarly, by building many more homes on public land, councils could plough the increases in land value back into improved local services, as Croydon, for example, is starting to do. People may no longer trust the national state to build utopia, but they will support measures that make sense locally.
Dr Nicholas Falk
Executive director, Urbed Trust

• Polly Toynbee and David Walker’s article on shrinking the state was right to mention evidence of rising child poverty. Our recent research shows that Britain has the third worst relative poverty of 21 developed countries, the fourth highest child mortality rate (CMR, 0-4 years) and an underfunded health service, as health expenditure fell from 9.4% of GDP in 2010 to 9.1% in 2015.

While CMR fell in every developed country, nine other nations had significantly bigger reductions than the UK, so we have an excess of child deaths. If we had the same CMR as Portugal, which previously had the highest rate, but which is now considerably lower than Britain, then we would have 1,300 fewer grieving parents. The link between relative poverty and CMR is again confirmed by our and other international research. Every parliamentary candidate should be asked what will they do to reverse relative poverty in Britain and perhaps match Portugal’s child mortality rate.
Professor Colin Pritchard
Bournemouth University

• It is government policy to reduce state spending, but billions of pounds of taxpayers’ money being channelled into private hands. Would a government really committed to lowering taxes and an economy based on free-market competition, spend £10bn a year to subsidise wages in private companies? Why would it be willing to give about £27bn a year to landlords, rather than imposing rent controls or building more homes? Why would it pay through the chancellor’s nose for private finance initiatives, now crippling NHS trusts? Plainly the government is only against state spending when it is on public services, not when it increases the private sector’s ability to make bigger profits.
Derek Heptinstall
Westgate-on-Sea, Kent

• Join the debate – email guardian.letters@theguardian.com

• Read more Guardian letters – click here to visit gu.com/letters

The high social cost of downsizing the state | Letters

6 Mayıs 2017 Cumartesi

Lib Dems pledge 1p tax rise to "rescue NHS and social care"

The Liberal Democrats have pledged to increase income tax by a penny for every earner to fund a £6bn-a-year cash injection for the NHS and social care.

In what was described as their “flagship” spending commitment of the general election campaign, the party’s leader, Tim Farron, said voters recognised the need to “chip in a little more” to address the “chronic underfunding” of healthcare.

Under the Lib Dem plan, 1p would be added to the basic, higher and additional rates of income tax and the rate of dividend tax from the next financial year, with the £6bn raised being ring-fenced for the NHS, social care and public health.

The proposal – which echoes the Lib Dems’ pledge from the 1990s to put a penny on income tax for education – will be seen as a clear attempt to capitalise on public concerns about the state of healthcare.

Theresa May has insisted the Conservatives have no plans for tax rises while appearing to back away from a previous pledge not to put up income tax or national insurance.

Farron said: “Theresa May doesn’t care about the NHS or social care. People are lying on trolleys in hospital corridors and she has done nothing.

“The Liberal Democrats will rescue the NHS and social care. We are prepared to be honest with people and say that we will all need to chip in a little more.”

The party’s health spokesman, Norman Lamb, said: “The NHS was once the envy of the world and this pledge is the first step in restoring it to where it should be. A penny on the pound to save the NHS is money well spent in our view.”

The Lib Dems pointed to an opinion poll finding from last year, which suggested 70% of voters would back a 1p rise in income tax if the money was guaranteed to go to the NHS.

According to figures released by the party, the rise would mean an increase of £33 a year – or less than £1 a week – for someone earning £15,000 a year, rising to £133 a year – or less than £3 a week – for someone earning £25,000.

At the top end, someone earning £150,000 would pay an extra £1,500 a year – or £29 a week – while someone on £250,000 would pay £2,500 a year, or £48 a week extra.

In the longer term, the Lib Dems said they would introduce a health and care tax to bring spending on both services together in a collective budget, and make clear on people’s payslips what was being spent on those services.

The party said it would seek to establish a cross-party health and care convention to review longer term sustainability of the health and care finances while setting up an office of health and care funding, similar to the Office for Budget Responsibility.

Lib Dems pledge 1p tax rise to "rescue NHS and social care"

11 Nisan 2017 Salı

What we need is a national social care service | Anne Perkins

Neil Kinnock was on the radio at the weekend, talking about his hero Aneurin Bevan with the journalist Matthew Parris and one of Bevan’s biographers, John Campbell. Any conversation about Bevan’s life is mostly about the NHS and so it was this time, too. But it was a useful reminder of how, among all the battles fought over its creation, among the fiercest was the question of replacing a patchwork of local provision with a single centralised structure that tried to guarantee that everyone got the same level of care wherever they lived. At that the point the radical, big-government approach petered out. Social care was left where it always had been, with local councils.

Now the Institute for Fiscal Studies (IFS) has published a study looking at the difference in social care provision across England that raises the question of whether it too should be centrally funded. After all, whether it’s soaring demand for A&E or delayed discharge from hospital, the impact of inadequate or ill-designed social care services on the overall state of the health service has become the stuff of daily headlines.

Then there is the ageing population. Although we are all healthier in old age, the need for care doesn’t track changing demography exactly: men’s life expectancy is growing faster than women’s, so there are more old couples looking after each other rather than relying on formal care.

George Osborne’s response to the incipient social crisis was to set in motion plans to shift the entire cost of locally incurred spending to local taxes, with a system of equalisation that has yet to be explained. He introduced a social care precept allowing an increase of up to 2% in council tax to be spent on social care.

Since the amount councils can raise through council tax depends on their tax base, these changes are – as the IFS points out – hitting poorer councils much harder than well-off ones, even though in theory, the introduction of national criteria for eligibility for paid-for social care should mean a reasonably equitable approach. The IFS study found that cuts in social care were much steeper in metropolitan areas such as Greater Manchester, Tyneside and Greater Birmingham, which typically have significantly higher levels of need, than in the south of England (although that may be partly because there are more older people in the south).

But the distinction between what we pay for and what we expect wider society to support is more than just a matter of an arbitrary geographical divide. We are so familiar with it that we rarely ponder the palpable inequity between providing free care for, say, a cancer patient, regardless of their wealth, while charging someone with dementia who also has some modest assets.

Councils argue that keeping older people well is about much more than care homes and clearing hospital beds

Because social care is provided locally, the national focus is always on the NHS. So although last month’s budget made another £2bn available for social care, it is being delivered in a way that ties it in to supporting the kind of services that will ease pressure on the NHS. Councils rightly argue that keeping older people well is about much more than care homes and providing a bed clearance service for their local hospitals. It’s about wellbeing in the widest sense of the word, and the NHS’s provision of community services like stroke rehabilitation also have a significant role to play.

In some ways, NHS England chief executive Simon Stevens’ sustainability and transformation plans with their objective of integrating health and social care in ways that meet local priorities are an attempt to synthesise the national with the local. Yet there is such an inbuilt conflict between a free-at-the-point-of-use NHS and means-tested social care that it is hard to see how they can continue to coexist.

It comes at a high cost to patients. When hospitals are in effect incentivised to shovel the old lady who’s had a fall out of bed and off their books pronto (I exaggerate, a little), leaving her local authority to pick up the bill for getting her back on her feet, it seems the two arms of care that ought to be wrapped protectively around her are instead locked in a standoff. It is more arm-wrestling than hand-holding.

The government now promises (another) green paper on paying for social care in the autumn. But successive plans, each of which points to more central government funding, have crashed and burned on the runway. Oh, for a Bevan (and a Clement Attlee) with the courage and determination to sort it out.

Anne Perkins is a leader writer

What we need is a national social care service | Anne Perkins

928 carers in England quit a day as social care system "starts to collapse"

More than 900 adult social care workers a day quit their job in England last year, figures reveal, as homecare providers warn the adult social care system has begun to collapse.

Analysis by the BBC of data released by a charity, Skills for Care, shows that in 2015-16 about 338,520 adult social care workers left their roles, equal to 928 people leaving their job every day. There were more than 1.3 million people employed in the adult social care sector in England in the period.

Of those leaving a job, 60% left the adult social care sector altogether, the figures showed, while there was an estimated shortage of 84,320 care workers, meaning about one in every 20 care roles remained vacant.

The average full-time frontline care worker earned £7.69 an hour, or £14,800 a year, according to the data, and one in every four social care workers was employed on a zero-hours contract.

The figures come as the UK Homecare Association wrote a letter to the prime minister warning of the crisis facing social care.

Mike Padgham, the chair of the UK Homecare Association, said: “My biggest fear is that we will soon run out of capacity to provide care to those who cannot fund themselves. I agree wholeheartedly with Age UK’s warning that the social care system will begin to collapse this year, but I would go further and say that the system has already begun to collapse.”

The Skills for Care figures show that the industry has a staff turnover rate of 27%, which is nearly twice the average for other professions in the UK, according to the BBC report.

The government has said it will spend an extra £2bn on the social care system and permitted local authorities to raise council tax bills in order to fund the gap in social care budgets.

The Department of Health said: “Social care jobs have increased at an average of 3% a year since 2010, but we want to see improvements in turnover rates, with talented staff attracted to a robust sector backed by an additional £2bn over the next three years.

“Meanwhile, we’re investing in the workforce of the future, with a total of 87,800 apprentices starting last year – up 37,300 compared to 2010.”

928 carers in England quit a day as social care system "starts to collapse"

10 Nisan 2017 Pazartesi

How we can start a social care revolution in seven easy steps | Katie Johnson

The government’s commitment to provide an additional £2bn for social care in the spring budget was presented as a solution to help ease pressure on the NHS and councils over the next three years. While the measure has addressed the immediate funding crisis, there is concern that this is no more than a short-term fix. The announcement risks masking the true scale of the challenges ahead and the radical surgery required to reform social care.

In all likelihood, the extra money will be used by local authority and NHS commissioners to block purchase places in residential care homes. This is not the answer.

Spending money in this way will do little to tackle the fundamental problem: we are admitting too many older people to hospital, keeping them there for too long and failing to give them the care they need in their own homes.

While cheaper than a hospital bed, a place in a residential care home is still more expensive and, crucially, less effective than care and support in the community.

There needs to be a transformation in the way that social care is commissioned and provided, to improve the quality of care, but also to make services financially sustainable, without the need to raid other budgets for extra funding.

A strategy for reform would have seven key elements:

1. Champion independent living

We need to engineer a dramatic shift away from residential care towards the kind of support elderly people actually want and need. That means better support for people to live independently in their own homes, with a skilled, professional workforce to provide the advice and assistance they need. We need to invest in a model of care that involves greater collaboration between the person being supported and those providing support.

2. Support families and carers

There needs to be stronger provision of advice and assistance for families and other carers, and more effective liaison with voluntary and community organisations that are skilled in providing support to older people. This means creating partnerships that can empower volunteers and deliver more professionalised community care.

3. Shift the funding focus to community-based care

Local authorities need to switch their focus away from expensive residential provision to support family, carer and community-based services. This funding shift is necessary if we are to create a fundamentally new system that offers holistic care in the home and keeps older people, wherever possible, out of hospital and residential care.

4. Incentivise local authorities

Local authorities should be incentivised to purchase individually tailored packages of care. Why are we so afraid of asking people, and their relatives and carers, what they really want and need? Many councils want to do this, but their options are limited by what the market can provide or by a lack of imagination. They should be rewarded when they invest in transforming the way providers think about services.

5. Prevention rather than cure

Transforming the social care system, rather than simply shoring it up, would address the problem of delayed discharges from hospital, but also reduce the flow of older people into hospital in the first place. It would prioritise prevention, rather than waiting for problems to arise and then attempting an inadequate cure. The best local authorities are already using their resources creatively, such as looking at predictive analytics to anticipate demand.

6. A better alternative to ‘integration’

There is plenty of talk about the need for an integrated health and social care system, or even a “National Care Service”. There is a much simpler solution. NHS providers and local government need to co-operate better to find the right kind of care for elderly people.

Liaison between hospitals and local authorities will never be truly effective if it is just one more item on the to-do list of hard-pressed nurses and social care workers. It requires dedicated resources – well qualified people whose full-time job it is to ensure that the hand-offs between hospital and community care are speedy, efficient and driven by the individual needs of the patient. Creating these vital liaison roles should be only the first step in a programme to transform the skills and role of the social care workforce.

7. Pool resources

Just as the NHS and local authorities should look to share resources, there is a key role to be played by combined authorities and other city and county partnerships. They should be encouraged to pool their money to fund the transformation of social care.

The budget has already seen one U-turn. It is not too late to redirect the £2bn and make a real difference to health and social care in the UK.

Katie Johnston is director at KPMG

Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) and like us on Facebook to keep up with the latest social care news and views.

How we can start a social care revolution in seven easy steps | Katie Johnson

Crisis looms for social policy agenda as Brexit preoccupies Whitehall

Ever since Theresa May set out her vision to govern for everyone and not just the privileged few last July, those in the charity sector who work to reduce poverty and inequality have waited patiently. Campbell Robb, the chief executive of the Joseph Rowntree Foundation, was one of many charity leaders who hoped for progress. He wanted to see a revamp of the government’s much-criticised “troubled families” programme, a £1bn scheme set up by David Cameron in 2011 and billed as the Tories’ flagship social policy initiative.

But when the Department for Communities and Local Government issued its first annual report on the programme , the charity sector was hugely disappointed. Robb described the document that emerged as “thin” and a “testament to the vacuum” that exists where we need to see “big political and social change”. It was barely noted in the media, which focused instead on a range of austerity-driven changes to the tax and benefit system, announced originally by George Osborne, which came into effect at the beginning of the new tax year. The changes hit the poorest hardest, while helping millions of the better off. The view increasingly held by thinktanks, and across the public sector, is that May’s government – even if well intentioned in wanting to reduce inequality and enhance opportunity for all – is too distracted and too constrained by the state of the public finances to do so.

“There is a danger that Brexit could suck the oxygen out of attempts to implement a sweeping programme of social and economic reform that is badly needed at home,” Robb said.

Even within parts of the Tory party, MPs and others worry that Brexit is now the only show in Whitehall, one so all-consuming, so draining of civil service and ministerial energies that everything else – the May agenda included – is on the back burner.

“David Cameron came into office with a new social vision of Conservatism and promptly sacrificed it on the altar of austerity,” says Phillip Blond, director of the ResPublica thinktank. “It is vital Theresa May does not let her one-nation Conservatism experience a similar sacrifice at the behest of Brexit. The trouble with Brexit is that those who voted against the EU as a proxy for globalisation and its general destruction of working-class security, risk finding May’s ‘global Britain’ to be far, far worse for them.”

Ryan Shorthouse, director of the liberal conservative thinktank Bright Blue, says he always suspected Brexit would syphon the energy out of Whitehall and voted against it partly for that reason: “A persuasive argument for voting Remain, I thought, was the lengthy and disproportionate focus that would be required of politicians and policy-makers to undertake the process of Brexit, which is indeed what we are now experiencing. There are other important and pressing issues that urgently require deeper thinking and discussion: the affordability and quality of social care, the upskilling of those on the lowest incomes, the financial sustainability of the NHS, and decarbonising our economy.” The green agenda, once central to May’s predecessor, hardly registers these days.

When the financial crisis broke in 2008, Nick Pearce, now professor of public policy at the University of Bath, was in charge of the No 10 policy unit under Gordon Brown. “It was the biggest economic shock the UK had faced since the second world war,” he says. But it did not preoccupy every government department as Brexit does. “It was largely dealt with by the prime minister, his advisers, the chancellor and Treasury officials, and the Bank of England. It was not like Brexit. Most of Whitehall now has Brexit at the top of the in-tray.”

It has already been decided that the next Queen’s Speech will be dominated by Brexit-related bills. Ministers have been told to limit their bids for domestic legislation so the way is clear for parliament to focus on the “great repeal bill”, which will incorporate the mass of EU law into UK law, and on other Brexit-related bills including one on immigration. A recent report by the National Audit Office says the civil service has already created more than 1,000 extra roles in the two new Brexit departments – for International Trade and for Exiting the EU.

‘Lego bricks and boiled eggs’: the three Brexiteers explain everything

And that is just the start, as the search for trade experts – outsourced over the last four decades to Brussels – intensifies. Many civil servants have shifted from domestic roles to Brexit posts in a huge, destabilising, but necessary, reconfiguration of Whitehall. Jeremy Heywood, the cabinet secretary, has described the task of managing his Brexit troops in Whitehall as “the biggest, most complex challenge facing the civil service in our peacetime history”. The NAO says new skills have to be learnt and found – a process which inevitably means less use of expertise gathered over decades by senior mandarins.

The poorest third of households are faring even worse than they did after the 2008 crash

The Resolution Foundation

Its report says: “Departments which have had large amounts of EU-derived funding and legislation, for example, will need legal, economic and sector experts to deal with the implications of leaving the European Union, and will have to do so using their remaining staff while also seeking to achieve pre-existing priorities.” Lord Kerslake, a former head of the civil service, says it is entirely right that the focus is on delivering a successful Brexit, but he fears problems will develop down the line in unrelated but vitally important areas as eyes are taken off the ball. “Nobody has quite got the measure of this because of the dominance of Brexit,” Kerslake says.

“Of course there is a need to equip government for Brexit but there is also a need to carry on with the rest of the business of government. There is a risk for the government in this: that things that would have surfaced through being debated and being challenged in normal times will now not surface early, and not until they become crises.”

The Angel of the North statue. The fate of English devolution – formerly a priority – is in question. Photograph: Christopher Thomond for the Guardian

6 Nisan 2017 Perşembe

Social care reviewer condemns UK system and calls for new tax

Andrew Dilnot, who carried out the government review into the funding for care and support in England, has condemned Britain’s social care system as “the most pernicious means-test in the whole of the British welfare state” and called for a new tax to fund adult social care for everyone who needs it.

The chair of the Dilnot commission on funding of care and support said a tax was needed to provide lifelong adult social care that was not means-tested.

The average person will need social care worth about £20,000 during their lifetime, with slightly more than a fifth of the population dying before they require any support. But for 10% of the population care costs are high: a couple with arthritis requiring residential care for the last 20 years of their lives will need care costing over £1m.

Andrew Dilnot believes social care should not be means-tested. Photograph: David Levene for the Guardian

21 Mart 2017 Salı

Good social workers are invaluable. So let’s give them proper support | David Brindle

About three in every 10 people in Britain think social workers help with household chores like cooking and cleaning, with personal care like washing and dressing, and with childcare. Two in 10 reckon they will nip to the shops for you. Asked to choose from a given list of professionals they consider important providers of mental health support, 69% of people identify psychiatrists and 65% GPs – but only 41% pick social workers.

These findings come from a ComRes survey commissioned by Think Ahead, the fast-track training graduate scheme for mental health social workers, to mark this week’s World Social Work Day. As Lyn Romeo, England’s chief social worker for adults, comments with a certain understatement, “there is still more to do to communicate the crucial role of social workers”.

That was to have been the role of the short-lived College of Social Work, set up by ministers in 2010 with plans for it to grow to become a royal college on a par with those for the most esteemed professions, but shut down in chaos five years later. News that the College of Occupational Therapists is to become royal – richly deserved, by the way – has rubbed a good deal of salt into that wound.

There is a fresh plan, however. From 2018, part of the brief of a proposed new regulator for social workers in England will be “to promote and maintain public confidence” in the profession. The mandate for the organisation, provisionally titled Social Work England (SWE), is contained in the children and social work bill currently before parliament. After a rocky start, it enjoys broad support.

One reason SWE is being welcomed is that it will give social work its own regulator again after six years under the generic Health and Care Professions Council. A second is that ministers accept it cannot be self-financing, at least in the short term, and are underwriting it by £16m in its first two years. And the most significant reason is that an initial idea for it to be run direct by Whitehall has been ditched.

Just how independent it will be remains moot: a quango accountable to government, not parliament, it will need ministerial approval of the professional standards it polices. But the social work world sees the lifting of the spectre of regulation by a government department as a clear win.

Another success being celebrated is the withdrawal of clauses from the bill that would have allowed councils to seek exemptions from children’s social care law to test innovative ways of working. Critics saw the idea as erosion of vital safeguards and mounted a strong, successful campaign against it – but the issue was almost certainly settled when Eileen Munro, the leading social work academic often cited by ministers in support of professional reform, opposed it.

However, real tensions remain between the government’s social work reform vanguard led by Isabelle Trowler, chief social worker for children, and the bulk of the sector establishment, with plans for accreditation tests for children’s social workers looming as a new flashpoint. But there is a sense of a thawing in relations.

Herbert Laming, sector elder statesman and crossbench peer who led both the seminal inquiry into the death of Victoria Climbié, which published its report in 2003, and a review of child protection six years later following the Baby P affair, hopes the thaw continues. He tells me: “What social work needs above all at this time is a bit of tender loving care.”

In a lecture on Wednesday at the University of Suffolk, Lord Laming will spell out the enormously high expectations that society has of frontline workers’ skills and judgment when dealing with vulnerable children and adults. The task, he will say, has been made infinitely more difficult by austerity, which is why he joined the call for withdrawal of the exemption clauses at this point even though he understood and backed the case for innovation.

Social workers are crying out for support and encouragement, Laming says. He is surely right. There has been too much stick and not enough carrot in the mix of late.

Good social workers are invaluable. So let’s give them proper support | David Brindle

14 Mart 2017 Salı

Disabled people are confronting the spectre of social death | Jane Campbell

On Monday, disabled representatives from disability organisations across England, Scotland and Wales presented reports to the UN Committee on the Rights of Persons with Disabilities in Geneva. It is now eight years since the UK ratified the UNCRPD with cross-party support and this is the committee’s first full examination of the UK’s performance.

So how are we doing? The government is fond of claiming that the UK is a “world leader” on disability rights. Superficially, this claim remains fairly accurate. We have the most comprehensive and proactive equality law anywhere in the world; social care legislation and practice that embodies the principle of choice and control; a social security system that claims to recognise the extra costs of disability; and law and regulations to advance accessibility. It is important to remind ourselves of what disabled people have achieved over the past 30-40 years of disability rights activism, as we have charted our journey from objects of care and charity to becoming active, contributing citizens. But any assessment of progress cannot be confined solely to what we now have, or where we were in the past. And judging by the UK’s direction of travel, the government’s claim of world leadership quickly unravels: we are seeing big cuts to services and watering down of rights and opportunities of disabled people.

Last year, I served on the House of Lords select committee, reviewing the impact of the Equality Act on disabled people. We found that this government’s deregulatory zeal and spending cuts significantly undermined the intended effect of the act. Employment tribunal fees, legal aid cuts and loss of advice services have put the act’s protection beyond the reach of most disabled people. And colossal cuts to the Equality and Human Rights Commission’s budget have left the act under-promoted and unenforced.

The UK’s mental health and mental capacity laws fail to comply with the CRPD, which stipulates that disability cannot be grounds for denying people equal recognition before the law or for depriving people of their liberty. Yet in England, there has been a 10% rise in detention each year for the past two years. More than half of these cases related to people with dementia, and a significant minority to adults with learning disabilities. The sanctioned use of restraint, seclusion and anti-psychotic medication remains commonplaceon mental health and learning disabilty wards, violating people’s rights to physical and mental integrity and to live free from torture, inhuman or degrading treatment. NHS benchmarking data revealed that there were 9,600 uses of restraint during August 2015 in mental health wards in England, while the Learning Disability Census 2015 found that one-third of patients with a learning disability were subject to the use of restraint in 2015-16.

Unexpected deaths of mental health in-patients, or those cared for at home in England, are up by 21% yet, unlike deaths in police, prison or immigration detention, there is no system of independent investigation. Since 2011, hospitals in England have investigated just 222 out of 1,638 deaths of patients with learning disabilities. Among deaths they classed as unexpected, hospitals inquired into just over a third.

The Care Act fails to ensure disabled people’s right to independent living, and swingeing cuts in health, social care and benefits are eroding the availability of support and people’s right to exercise choice and control. Disabled people are confronting the spectre of re-institutionalisation as councils and clinical commissioning groups limit the amount they spend on individual packages of support.

The UN disability rights committee has already reported on the negative impact of the UK’s measures to cut social security spending. Yet further disability benefit cuts continue to be implemented and the extension of punitive sanctions to those hitherto assessed as unable to work is being proposed on the back of declining investment in employment support.

“Nothing about us without us” is the international motto of the disability rights movement, but there is little evidence of disabled people being involved in policy development. The last 10 years have seen the proportion of public appointees with a self-declared disability halve in number, while helpful measures to support more disabled people into politics, such as the Access to Elected Office Fund, have been suspended in England.

Advancing the rights of disabled people requires good leadership to establish coherence and coordination in Whitehall, and in devolved and local government. The Office for Disability Issues was set up for this very task, but has become a shadow of its former self. But in Wales and Scotland, things are more positive, with the convention firmly embedded in policy and strategy.

If the UK wants to maintain the mantle of world leader on disability rights, it must see the forthcoming examination as an opportunity to listen and take stock. If it fails to do so, current and future generations of disabled people face the slow, inexorable slide back towards social death once again.

Disabled people are confronting the spectre of social death | Jane Campbell

13 Mart 2017 Pazartesi

Why is there so little social diversity in medicine? | Zara Aziz

Medicine in the UK has traditionally been deemed an elite profession that excludes those from low socioeconomic groups. A mere 7% of students are privately educated, but 26% of medical students went to fee-paying schools.

However, when you look closely at the figures, many students leave school at 16, and 18% of 16- to 18-year-olds are in fact privately educated; the proportion is even higher for those studying science subjects. Suddenly, the figure of 26% of privately educated medical students seems to reflect numbers studying sciences at school. It is not surprising that the majority of doctors come from more affluent backgrounds.

I do not come from a privileged background. But I had opportunity. I did not attend a state school but was awarded a bursary to study at a private school. My husband, a hospital consultant, was state educated. His father was a bus driver and arrived in the UK as an immigrant in the 1960s. In many places in the world, perhaps neither of us would have been given such opportunities.

It is opportunity that social mobility organisations and medical schools themselves are asked to create, in order to remove this disparity in entrants. Universally, access to medical school is limited due to a lack of places; this generates stiff competition and entry criteria tighten every year. Historically, selection for medical school has consisted of exam performance and interview scores (most medical schools will interview their applicants). In recent years, we have seen the introduction of a national UKCAT aptitude test, which all candidates complete. Universities are also moving away from a single interview, which can be an arduous experience for candidates.

The new multiple mini interviews (MMIs) consist of several short stations, which test candidates on standard questions (Why do you want to study medicine?), ability to complete a practical task, communicate effectively or explore an ethical dilemma. These seem to be a fairer way of judging students, who may otherwise perform badly through nerves or even assessor bias.

It has been surmised that MMIs favour state students, but in my experience as an assessor this is not always the case. MMIs favour those who are confident, communicate well and display empathy: all the qualities we would expect from a good doctor. Often students from failing schools do not perform well, if they have had neither coaching nor exposure to similar situations. And modifying the selection process further is unlikely to have major impact as few students from less affluent backgrounds apply in the first place.

Many of the widening access to medical education programmes promote initiatives, such as arranging mentoring or work experience with doctors, and by introducing summer medical schools for sixth formers. This is certainly showing some encouraging results but it does not get to the root of the problem, and you only have to look at school dropout rates to see why: one in five students will leave school after GCSEs; of those who continue in education, few will study core academic or science subjects.

State-educated medical students are usually from good comprehensive or grammar schools, which operate within narrow geographical boundaries. These are often in affluent areas, with little chance of access to those from broken families or challenging neighbourhoods. Many of the independent schools’ bursaries, such as the one I was educated on, have since been abolished.

University tuition fees have also changed the demographics of students. Medicine is usually a five or six-year course, or even longer if students undertake foundation or catch-up medical courses. Students from low-income families are discouraged at the prospect of spiralling debt, which can run into hundreds of thousands of pounds. The government’s controversial plans to change the junior doctor contract and to consider tying newly-qualified doctors to the NHS for four years is unlikely to increase diversity in applicants.

A mix of poor schooling, lack of aspirations and financial deprivation limits access to the medical profession. It is simplistic and even detrimental to try to tackle it through university or social mobility organisations alone. Our aim should always be to have competent and empathetic doctors from different social and cultural backgrounds who reflect our society.

One way of improving diversity is by having doctors from EU and non-EU countries as well, but we still need to increase access to the professions within the UK to young people from all social backgrounds.

The solution to this societal and educational problem is complex. It requires a wider commitment from us and the government towards our children, their education and wellbeing.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Why is there so little social diversity in medicine? | Zara Aziz

8 Mart 2017 Çarşamba

Hammond"s budget bows to demands for social care cash injection

Philip Hammond responded to the growing crisis in social care in England by pledging to put £2bn extra into it over the next three years and also produced an unexpected £425m to help the NHS cope better with winter and transform how it works.

Additional money for social care was necessary both to improve the help older people receive as the number of over-75s grows quickly in the coming years and also to ease the huge pressures the NHS is under, the chancellor said in his statement.

He also promised that a green paper, due late this year, would set out options for resolving the financially and politically pressing question of how to fund social care in the long term, given the population is set to continue ageing.

The cash boost, £1bn of which councils will receive to use in 2017-18, follows dramatic warnings from charities, health organisations and the care regulator that England’s social care system is reaching “a tipping point” after years of budget cuts.

“Today, our social care system cares for over a million people and I pay tribute to the hundreds of thousands of carers who work in it. But the system is clearly under pressure. And this in turn puts pressure on our NHS,” Hammond told MPs.

“Today there are half a million more people aged over 75 than there were in 2010 and there will be 2 million more in 10 years’ time. Today I am committing additional grant funding of £2bn to social care in England over the next three years, with £1bn available in 17/18.”

Hammond made clear that he expected “local authorities to act now to commission new care packages” for the coming financial year. Those would enable mainly frail, elderly people to be better supported in order to keep living safely at home and also, in particular, help reduce the number of older patients trapped in hospital – sometimes for many months – despite being medically fit to leave, because social care in their area is inadequate.

The £2bn was significant because Hammond had rejected widespread cross-party appeals for a cash injection for social care ahead of both his autumn statement last November and the local government finance settlement a few weeks later.

But health, social care and older people’s organisations gave the £2bn a lukewarm response. It was much less than was needed to ensure all older people got the care they needed, they said.

“Although we warmly support the chancellor’s announcement of a social care green paper in the autumn, this is tempered by some anxiety that today’s emergency funding package, welcome though it is, may not be enough to keep the system going until a new, sustainable approach is put in place,” said Caroline Abrahams, Age UK’s charity director.

Experts’ recent estimates of the amount needed between now and 2020, after six years of Whitehall cuts to town hall budgets, “were all higher than the amount announced today”, she said. “We also need to know more about where the additional £2bn is coming from and whether it is genuinely new money or not,” she added.

“Our concern is that there could be big trouble ahead in some places for older people needing care and their families if providers continue to shut up shop and councils find it impossible to spread the jam any thinner to meet rising demand.”

Nigel Edwards, chief executive of the Nuffield Trust health thinktank, said the £1bn would plug only half of the £2bn funding gap it expected in 2017-18. “More and more vulnerable people are therefore going to be denied the help they need in the next year,” he said.

Doctors welcomed Hammond’s announcement of £100m to pay for more GPs to work at hospitals in order to help take the pressure off A&E units by triaging and treating less seriously ill patients. Expanding such schemes, which already operate at some hospitals, would help the NHS cope better with next winter, the chancellor said.

“Having primary care on site will undoubtedly benefit patients,” said Dr Chris Moulton, vice-president of the Royal College of Emergency Medicine, which represents A&E doctors. But the British Medical Association and NHS Providers said they doubted there were enough GPs to staff such services, given the chronic lack of family doctors.

Hammond also found £325m of extra money for the NHS’s capital budget to help turn the first batch of NHS England’s controversial sustainability and transformation plans (STPs) into reality. It will enable six to 10 “pioneer” STPs, which the NHS chief executive, Simon Stevens, will identify later this month, to go ahead, shaking up how care is delivered in their area, particularly by providing many more services outside of hospitals.

However, the £325m comes after Jeremy Hunt moved £1.2bn of the NHS’s capital budget into its revenue budget this year, in order to help struggling hospitals. He plans an identical £1bn switch in 2017-18 and, the Health Service Journal disclosed on Wednesday, further raids of £500m and £250m in the two years after that.

Hammond"s budget bows to demands for social care cash injection

But health, social care and older people’s organisations gave the £2bn a lukewarm response. It was much less than was needed to ensure all older people got the care they needed, they said.

Hammond"s budget bows to demands for social care cash injection

7 Mart 2017 Salı

Government abdicating responsibility for social care, say providers

The head of the organisation that represents adult care providers in England has accused the government of abdicating responsibility for social care and claimed that ageism is affecting treatment of the elderly.

Speaking to the Guardian, Martin Green, the chief executive of Care England, warned the care home sector is at a tipping point and accused the government of lacking leadership on the issue. .

Philip Hammond, the chancellor, has bowed to widespread pressure over funding and will use Wednesday’s budget to invest an extra £1.3bn over two years in social care, including care homes. However, the spending gap in social care is expected to reach at least £2.6bn by 2020, according to the Local Government Association. Record numbers of care homes are already closing and more than 400 care home businesses have been declared insolvent since 2010, official figures show.

Critics of the industry claim it is financial difficultly due to private companies racking up huge debts and failing to invest. However, Green blamed the government for the crisis facing the sector.

“The government is abdicating responsibilities for social care to local authorities,” he said. “I think it owes more to the protection of vulnerable politicians than it does to the protection of vulnerable adults. My view is that if you ask me who is to blame it is the government. The government should be delivering a very clear vision for what social care is, they should be giving clear expectations to citizens about what they should expect from the system and what they should expect to pay for and none of that is happening.”

Green warned that the small businesses in the sector – the so-called “mom and pop” operations which account for the majority of homes in the UK – are under unprecedented pressure due to a rise in costs and a fall in the price that local authorities pay towards caring for residents, which can now be as little as £2.24 per hour. Care England’s members include independent care providers ranging from single care homes, voluntary organisations providing homecare, and multinational companies such as Bupa.

Green claimed that a culture of ageism has become a serious problem for social care. He said that the care for the elderly is treated differently to other health issues.

“The amount of ageism in the system is quite outrageous,” he said. “I was giving a talk to some older people and a lady said a really killer question to me: ‘Can you explain to me why my husband’s disease, Alzheimer’s, has been classed as a social care problem while my brother-in-law who has got cancer gets everything from the NHS?’ My answer to her was ‘I will tell you why, because your husband is old and because they want you to pay for it’.”

He added: “Remember we have an equality and human rights act where age is a protected characteristic. What has the Equality and Human Rights Commission done on this issue? They have done very little on age. They are obsessed with race, gender, sexuality and disability and they completely ignore age. Actually I would say ageism is probably the most prevalent form of discrimination in our society today.”

Green said that the government needed to ensure that any financial support for the sector in the budget made its way to care providers, rather than getting stuck inside local authorities. He claimed that some of the cash raised by local authorities through a council tax precept last year has not made its way to care providers, despite the government insisting that social care should be the recipient of the tax hike. “They need to have an mechanism to absolutely be clear that it goes to the frontline,” he said.

Green, who has run Care England since 2015, said he agreed with the warning last year by the Care Quality Commission, the industry regulator, that the industry is at a tipping point. “What we will start to see is far less services at a time when we have got far more need,” he added.

Despite the pressure on the sector, Green defended the large companies in the industry, such as private equity-owned Four Seasons, which have significant debts and are paying millions of pounds in interest ever year.

“I have politicians that sneer at me about venture capital taking over the sector. My response is ‘Well, it’s a good job someone is because the government is not putting any money in’.”

Hammond is expected to say that the £1.3bn for social care should directly benefit the NHS, by reducing the number of patients who end up stuck in hospital despite being medically fit to leave, because social care in their area is unavailable.

It is likely to be directed at schemes that aim to tackle what the NHS calls delayed transfers of care, or “bedblocking”, and the risk of mainly older patients being admitted or readmitted to hospital.

However, the chancellor is set to face down demands from Labour, the British Medical Association and many NHS bodies by refusing to increase the health service’s budget beyond the sums already agreed.

The BMA has called for an extra £10bn a year for the NHS, while Labour has demanded £12bn for health and social care. Hammond will trigger claims that neither he nor Theresa May appreciate the full extent of the NHS crisis, which saw unprecedented numbers of hospitals declare themselves unable to cope over the recent winter.

But he is expected to make an extra £200m available for NHS capital projects in 2017-18, after warnings from NHS England chief executive Simon Stevens that his planned “transformation” of the health service in England would struggle unless local NHS bodies had more money to spend building and repairing premises.

Jeremy Hunt, the health secretary, controversially moved more than £1bn from the NHS’s capital budget to its revenue budget in an attempt to give hospitals more money to spend amid an unprecedented financial squeeze.

Government abdicating responsibility for social care, say providers

6 Mart 2017 Pazartesi

NHS staff: tell us about the impact of social care cuts | Sarah Marsh

The government’s austerity programme is squeezing funding to both social care and the NHS – leading to serious problems in both. The Care and Support Alliance this month has found almost 9 out of 10 GPs think reductions in social care are leading to extra pressures in their surgeries. Even more (93%) think that the lack of social care is leading to extra pressure on A&Es and contributing to increased delayed hospital discharges.

We’re looking for NHS staff who have been affected by the cuts for Frances Ryan’s Hardworking Britain column, which looks at the stories of individuals whose lives have been negatively impacted by government policy.

Share your experiences

Are you a GP seeing the impact of social care cuts? Or do you work in A&E and cannot discharge patients because there’s no support for them at home? Share your stories and views.

NHS staff: tell us about the impact of social care cuts | Sarah Marsh

5 Mart 2017 Pazar

Friends’ pictures on social media have biggest impact on body image

Seeing friends’ carefully curated selfies on Facebook is more likely to induce feelings of guilt or shame among young women, and lead to unnecessary dieting, than images of models or celebrities they see in magazines.

Academics found that young women are more likely to compare their appearance with that of their peers’ images on social media than they were with celebrities on TV, adverts or other forms of traditional media. When they then make an unfavourable comparison with the other woman they are looking at, the impact is more pronounced when the image is on social media.

Women are also more likely to diet and do exercise when negative comparisons take place on sites such as Facebook or Instagram, the research found. The vast majority of study participants were not overweight and did not need to diet.

Researchers said the study, which will appear in March in the journal Body Image, has implications for how schools should teach young people about the influences that might affect their self-esteem.

Jasmine Fardouly, lead researcher at the centre for emotional health at Macquarie University, Sydney, said there are several reasons why social media may be more damaging than traditional media. “Celebrities may seem more distanced and their appearance may seem less attainable than people you work with or see regularly.”

The study, which questioned about 150 young women who completed five daily surveys over a five-day period, found that participants overwhelmingly considered themselves less attractive than the people they saw both online and in traditional media.

The negative impact that thin models and airbrushed adverts have on young women has been a source of concern for decades, but increasing attention is being paid to the role of social media. Around 70% of women aged 18 to 35 regularly edit their images before posting them – as do 50% of men in the same age group, according to research by the Renfrew Center Foundation, a US organisation that specialises in tackling eating disorders. Airbrushing on social media has become commonplace: Samsung users have reported that their phones default to a “beauty” mode that alters their faces and smooths out imperfections.

Last month Be Real, a national campaign, was launched to improve body confidence by providing resources to schools, as well as calling on the diet industry, media and businesses to promote different body shapes and sizes. The campaign was launched in response to a report by the all-party parliamentary group on body image which found that girls as young as five were worrying about their appearance.

Natasha Devon, the former children’s mental health champion, and co-founder of the Self-Esteem Team, said that PSHE (personal, social and health education classes in schools) – which cover topics such as body image – should be made compulsory, if these issues are to be taught properly.

Friends’ pictures on social media have biggest impact on body image

16 Şubat 2017 Perşembe

English social care system for elderly facing "complete collapse"

Social care in England is at risk of imminent collapse in the worst affected areas unless urgent steps are taken to address the crisis engulfing the sector, Age UK has warned.

The charity’s latest report on the healthcare of older people calls for a cash injection into the adult social care system in the spring budget and the development of a long-term solution to a problem that will otherwise become more acute.

Analysis previously published by Age UK suggests almost 1.2 million people aged 65 and over do not receive the care and support they need with essential daily activities such as eating, dressing and bathing.

That figure has shot up by 17.9% in just a year and almost by 50% since 2010, with nearly one in eight now living with some level of unmet need, it says.

Age UK’s charity director, Caroline Abrahams, said the report makes for “frightening reading”, adding: “Unless something changes the crisis will certainly deepen this year and next, and we think there is now a real risk of a complete collapse in social care in the worst affected areas. If this happened it would be a disaster that would threaten the health and even the lives of the older people affected. It would also greatly intensify pressure on our hospitals.

“Some older people and their families are already telling us that they simply cannot find any carers where they live, and we are also hearing of vulnerable older people receiving council-funded care whose help has been significantly reduced, leaving them to manage alone for many hours at a time.”

The charity says the government’s three ways of propping up the system – financial transfers from the NHS, a social care precept in local areas, and calling on families and friends to do more – are inadequate and cannot make up for a “chronic” shortfall of public funds. The report, published on Thursday, says the NHS can ill-afford to bail out social care, the amount the precept (an additional council tax charge) can raise does not match the needs in every area, particularly poorer ones, and the number of families and friends becoming carers is not keeping pace with a rising ageing population.

It concludes that the government’s strategy for keeping the social care system from falling apart is not up to scratch. The charity warns that the situation will only deteriorate further as rising demand is accompanied by budget cuts and more care home providers pulling out of the market.

Margaret Willcox, president-elect of the Association of Directors of Adult Social Services, said the report “reflects the concerns of the whole sector united in the belief that adult social care is at risk of failure to chronic underfunding”.

A government spokesman said it was making £7.6bn of new money available for adult social care: “This government has gone further to integrate health and social care than any other before it. We have brought budgets together for the first time through the Better Care Fund and given the NHS an extra £10bn per year by 2020/21 to fund its own plan to build a more responsive, modern health system.”

English social care system for elderly facing "complete collapse"