Dementia Friends

The Department of Health has, today, launched the Dementia Friends scheme.

It’s a lovely scheme to promote greater awareness of Dementia by recruiting an army of  volunteers. These volunteers will be trained to have an ‘understanding of dementia’  As the website itself says, if you become a ‘Dementia Friend’

We’ll equip you with an understanding of dementia and how you can help, and the rest is down to you. We want Dementia Friends in every community – in every hospital ward, post office, place of worship, and on every street. Our target is to reach a million people by 2015, and we’re confident we’ll not only meet this target but will beat it

Wow, that’s great. Really it is. I’m (for once) not being sarcastic. I work with a lot of people with dementia and having to explain it to them and their family members, I see the fear and lack of understanding and I wish that there were a greater knowledge in dementia in the community and this seems to fit the bill.  In my social work training course, over two years, I had one lecture on older people – I can’t even remember if dementia was mentioned. That’s plain wrong. It needs to be a meaningful part of every training programme and on many courses.

First I thought Dementia Friends would be like a massive new befriending scheme for isolated people without family and friends and excluded by community  as the site says

Alzheimer’s Society research found that nearly two thirds of people with dementia feel lonely, and almost half reported losing friends following their diagnosis. With one in three people over 65 developing dementia, it’s vital we change this picture.

But reading more I see its  about encouraging people who are Dementia Friends not to abandon those of their family, friends and social circles who have dementia and  not to ‘drop’ them as the illness progresses. Which is also a very good goal.

I guess I just see a disproportionate amount of people who don’t have family/friends/social networks or maybe I’m seeing them after their networks have abandoned them.

Early Diagnosis

One of the aims of this scheme is apparently to encourage earlier diagnosis of dementia. Again, a very laudable aim. The Guardian previews Cameron’s announcement

Cameron will say: “Through the Dementia Friends project, we will for the first time make sure a million people know how to spot those telltale signs and provide support. There is still a long way to go in fighting the disease, but together we can improve the lives of millions.”

The scheme will provide free coaching sessions on how to spot the signs of dementia and provide support to people with the condition.

Each Friend will be awarded a special “Forget-me-Not” badge once they have completed their training, so that they can be easily identified as being able to assist people with dementia.

So when the dementia (and remember there are lots of causes for forgetfulness and confusion other than ‘dementia’)  is ‘spotted’, I imagine the hope is that the Dementia Friend will encourage the person they have potentially ‘spotted’ to get screened.

All good. Again back to the Guardian which says

The rate of successful diagnosis is expected to double from 42% at present to 80% – a target set by Cameron earlier this year when he launched his challenge.

Healthcare professionals will also be required to ask all patients aged between 65 and 74 about their memory as part of their standard health check. Simple diagnostic tests will be expected to be done on site, cutting waits that at present can be as long as 18 months.

Post Diagnosis Support

So we are able to identify and diagnose dementia earlier. Really that’s great. It allows people to have more time to adjust and to make plans regarding their needs in the future. We have more people who are aware of the needs of people with dementia in their own social circles and prepared, we hope, to be more tolerant and supportive.

However we can’t allow the happy clappy Department of Health talk to get away with the fact that dementia services and provisions have been slashed to bare bones. There is little left to provide to people who have early diagnoses, particularly if they don’t have that family support because the resources just are not there.

I’m all for early diagnosis if people want that (and not everyone does but that’s an individual thing) but if this is the same government that has launched a savage attack on local authority social care services which were barely fit for purpose at the best of times then I can’t help but be cynical about some of these provisions.

I’d like to see more research and provision of different types of care both in residential settings and at home so we aren’t at the mercy of large private companies creating ever larger residential and nursing homes in suburbs where the cost of property is low that house up to 80+ residents with dementia in places that are difficult for family to access without cars.

I’d like to see some of this ‘dementia challenge’ money put into allowing local authority assessments to build cost of non-directed advocacy into support planning – that would make an immediate change in the quality of life of those with dementia.

I’d like to see some honesty around the poor quality care for people with dementia currently in social care and hospital settings. Maybe some of that money could be invested in paying care staff better and more importantly improving training.

Big Society

This is very much a ‘big society’ volunteer type role. Good luck for those who participate. I’ll likely join up myself but lets not forget that this means distribution of volunteers may not be equal and those who have no community as such will not have the same benefit of access to these who volunteer.

So a good initiative and well done but lets not forget that if the government aim is to increase diagnosis, they have to be prepared to put more money into improving what happens and what support is available after diagnosis.

Strivers and Strugglers

As the Conservative Party Conference begins in Birmingham, Cameron has set out his agenda of further benefit cuts and a focus on the ‘strivers’ in society.

Who are these ‘strivers’? They are people who ‘work hard and want to get on in life’.

The issue is that I believe Cameron’s definition both of ‘working hard’ and ‘getting on in life’ is probably vastly different to my reality and the realities I’ve seen at work.

The ‘benefit claimants’ v ‘hard worker’ dynamic is a very toxic one. The government has become very used to divide and rule and this is a further demonstration – and is particularly nefarious in a time of high unemployment and particularly high youth unemployment.

Cameron seems to work on the assumption that all people who have jobs ‘worked hard’ to get them and ‘work hard’ at them. I would challenge that. I wonder  how ‘hard’ the Duchess of Cambridge works at her job.

And looking for work can be an exhausting, demoralising and exceptionally difficult piece of ‘work’. As can caring full time for a family member (with a paltry ‘carers allowance’). Are these people counted as ‘strivers’ in Cameron’s books? What about people who contribute to a community? What about people who overcome challenges and difficulties, including health-related ones for whom actually just getting through the day is an enormous challenge – are they ‘strivers’?  Do they really not work as hard as some people who drive buses, work in social services offices, work in banks etc?  There are hard jobs, of course, but there are also hard lives that exist outside jobs.

The best thing we can do is bat back this ‘striver’ agenda. I don’t want to live in a society that grinds down on those at the bottom without making further expectations of those who have been able to make a success of their lives – and I include myself in that.

Punishing people who don’t, can’t or aren’t able to work seems to be a populist agenda but one of the key things as a social worker I feel a need to challenge are the assumptions made from the safety of the Westminster village about the day to day effects that their policies and their discriminatory rhetoric has on the lives of those who DO strive. Strive desperately – but strive without economic recompense and strive for different goals.

Compassionate Conservatism? It was never anything but empty words.

Tell Tim He’s Sacked

One cold evening a couple of years ago I went to hear Tim Loughton, the former Children’s Minister shuffled out of the pack yesterday, speak at a meeting of the All Party parliamentary group for children in care. We queued to the sound of shrill chanting and ominous bullhorns. The Comprehensive Spending Review was being debated in the House, the first indication of the true extent of the government’s spending cuts and Whitehall was closed to traffic as a protest rally gathered.

Accompanied by two young women in foster care, we dawdled through Westminster Hall and the corridors of power. It’s a privilege to be so close to government, never to be rushed. As we hung around in the lobby, the division bell sounded. Members appeared from all sides and dashed into the Commons chamber. They left the door open for a while so we could peer around the corner to see democracy in action.

Given the significance of the evening’s events he could have easily been excused but to his great credit, Loughton appeared as scheduled to address the packed committee room full of young people from all over the country. His speech was a characteristically robust endorsement of the value of foster care and the rights of children and young people in care to the same opportunities as their peers.

With the eloquence of experience, a succession of young people politely but firmly pointed out the flaws in his argument. You say education is important for children in care but you’ve just voted to do away with educational maintenance, the money that supports us. You say jobs are important but unemployment for young people is rising. You say we all deserve good foster carers but there’s a chronic shortage of resources to recruit them. Thanks for coming, though.

And that’s Tim Loughton in a nutshell. Unfashionably sticking up for children and young people in care and defending the social work profession whilst simultaneously his Cabinet eviscerated the resources he claimed were in place  to support them.

That night Loughton bobbed and weaved with the skill of an experienced politician, riding out the storm without properly satisfying anyone in his responses. Most ministers would have ducked out: he was there because he wanted to stay. Loughton is no placeholder or careerist. Shadow Children’s Minister for several years before coming to power, this is the portfolio he sought and prepared for.

The former minister is extremely well-informed about fostering, adoption and children in care. Unusually his main source was the people involved rather than his civil servants. Over an extended period he’s taken the time to understand the sector by making himself available to children, young people and carers. He created a telephone hotline, “Tell Tim”, and met regularly with organisations representing young people and carers, offering an unprecedented degree of accessibility. Last night on twitter they lined up to thank him and praise his commitment. For a group who voice is seldom heard, his willingness to listen meant an awful lot.

One of the things children and young people in care told him was that they were fed up with needing to get permission from social workers for school trips, holidays, activities and sleepovers with friends. You couldn’t mark them out as more different from their peers if you felt-tipped a red cross on their foreheads. A group of young people confronted him on television about this. Loughton shifted uneasily under the pressure, yet he delivered on his promise to respond. His first act as a minister was to write to local authorities to remind them that they had the power to give foster carers discretion on these matters. I showed a copy to one of the young women who appeared in the programme – “You did this,” I said. Now it’s enshrined in the revised Fostering Standards. The fact authorities have still not got the message is not his fault.

It’s not all so positive. He defends social work yet I’ve heard him dismiss the content and nature of assessments with the sarcastic panache of a Daily Mail leader writer. His promised fostering action plan is still to materialise. Hearing him several times subsequently, I continued to admire his grasp of the fostering task whilst growing weary of disingenuous references to the deficiencies of authorities he knew full well were tottering under the burden of  his government’s cuts.

Ultimately his departure may say less about the man and more about the government’s perception of the sector. The adoption agenda has been dominated by Gove and Cameron. Martin Narey joined the chorus of praise and regret but in terms of policy creation made him largely redundant.

They have seized the big issues, relating it to other props of Tory policy around the family and budgets cuts. In this world, an understanding of the details, of the everyday problems facing children, carers and social workers, gets in the way. The struggles with resources, with finding the right placement, with whether a child can stay with her friend this weekend, have little significance. More than this, they may actually obstruct the agenda for change because they don’t fit together with policy as neatly as the Department may wish.

Yet these are the issues that make life better for children and young people in care. For children and carers alike, nothing is more important. Gove’s distance from this awkward day-to-day reality leads to dogmatic policy. It leaves you to wonder if there is ever a place for any minister who thoroughly masters not his brief but an understanding of the people affected by it. It’s hard to understand social work. Loughton did, but in the end all it got him was the sack.

Betraying vulnerable young people

The more I listen to the unpleasant guff that comes out of David Cameron’s mouth, the more I’m convinced that he just doesn’t get what it’s like to be poor. He and his old Etonian chums have never had to live on the breadline, and I suspect don’t know many people who have. It’s simply another world to them.

If my assumption is correct, it might go some way to explaining his latest brainspew which is a proposal to scrap housing benefit for the under 25s, on the grounds that they can just move back in with their parents if they fall on hard times.

Well, yes, that’s what people are able to do, yes? Just clear out one of the spare rooms. Maybe ask one of the servants to move out? Or perhaps let young Tarquin borow the summer retreat for a while. It’s what all the everyday folk have the capacity for, eh what?

Sarcasm aside, what on earth does Cameron think these young people will do if their parents, for whatever reason, can’t or won’t support them? Apparently the proposal will have exemptions for special cases, such as people fleeing domestic violence. No doubt people claiming such exemptions will be treated every bit as fairly as those trying to claim disability benefits.

Go to a homeless hostel? Most of them charge rent, which they expect residents to pay by claiming housing benefit. Where else are they likely to go? A cardboard box in an alleyway seems the most likely answer.

There’s been a fairly sensible response from Liam Byrne, the Shadow Work and Pensions Secretary, who points out some of the pitfalls.

This is a hazy and half-baked plan when we need a serious back to work programme for young families.

“Many young families with their first foot on the career ladder will be knocked off if help with their rent is taken away. And young families that want to work won’t be able to move where the jobs are.

“The way to get the spiralling benefits bill down is start getting young people and young families back to work.

Cameron has said that he won’t try to implement this until after the next election, presumably because the Lib Dems would be likely to hit the roof if he tried it now. Or possibly this could be a bit of mouthwash to play to his base of pig-ignorant right-wing bigots, rather than a serious policy suggestion.

Either way, if he’s saying this won’t be done until he wins the general election, you know what to do, eh?

Adoption Reform Isn’t Just Common Sense

Around 18 months ago, I offered some consultation to a small project that planned to set up activity days where children in care met prospective adopters. Last week I saw a DVD of the first event. There was no sense of the controversy that surrounds these so-called adoption parties. Children, their social workers and adopters mingled happily during the course of a day’s outdoor activity and lunchtime entertainment. The adults acknowledged some awkwardness from their respective standpoints but all agreed this was outweighed by the positive experience, not only of meeting children but also of feeling part of something larger and important.  All valued the careful preparation that had preceded the event.

Seven children were subsequently matched and two more were in the pipeline. One, a severely disabled young girl, had been waiting almost as long as the project had taken to reach fruition. On the day, some carers met her, a real person now rather than a case or a prognosis, and an emotional bond began to form. In the carer’s words, “We just clicked.”

It’s an innovative approach not without its risks and detractors and it’s not right for everyone, but it worked. Other opportunities could and should exist for finding more carers for siblings, disabled children or black children, where shortages of adopters exist. Or just for children full stop. Yet the government is not supporting such practice-based local measures in favour of grander solutions to address long-standing problems in the adoption system.

There’s no doubt that something has to be done and the government’s drive for action comes from the very top. Michael Gove has taken the lead and adoption reform is one of Cameron’s top ten priorities in the life of his term of office. Those in the profession who are involved can barely keep up with the breakneck pace of consultation meetings and unpredictably changing policy drafts.

The result – everything is going to be quicker, including the point at which children are taken into care. The headline news was one measure in particular, that culture and ethnicity is to be of secondary importance to finding a good home. The announcements were accompanied by powerful and moving testimonies from parents who had successfully adopted children from a culture different from their own. Those who have not had such a positive experience were conspicuous by their absence, although articles did emerge as the days went on.

Whatever your views, it’s disconcertingly easy for the evidence of the lasting effects of culture and background to be shunted into the sidings in favour of the ‘common sense’ conclusion that children are better off in a home than they would be in care, regardless of the consequences later in life.  The seductive comfort of common sense in adoption provides a measure of security and sanctity for almost everyone involved in the adoption process, except for the child who has to deal with this, now and for the rest of their life, and has nowhere to hide.

Many decisions about what constitutes a cultural match are absurdly arcane and are based not on a proper understanding of the child’s history and perceptions of their own identity but on a skewed, mechanistic process that equates ‘culture’ to a sum of their parents’ ancestry and distorts complex reality as much as the common sense approach. I’ve come across siblings who waited and waited because their maternal grandparents were Polish and no white family was considered unless that box was ticked, or black prospective adopters rejected because they lived in an area of London that was predominantly white.

Of course there is some truth behind the government’s apparent wish to relegate culture and background to a minor role. The remedy, however, isn’t an arbitrary shift based on ideology and expediency. Rather, it is about better practice, better assessments and a more preceptive insight into the subtleties of identity. This in turn leads to improved matching, including both an acceptance that perfection is not possible every time but also what does and does not constitute an acceptable deviation from the vital principle of a cultural match, what the evidence is for such a conclusion and how this will be handled, now and in future. None of this is encouraged by the proposals.

Which brings me on to two other problems that I have with the government’s suggested reforms. One is that it views carers as static and unchanging, rather than individuals who can learn, develop and grow into the task of being an adoptive parent. How might they develop, what is their potential and how can this be nurtured? And here’s point two, the thorny question of more post-adoption support, which adopters’ organisations will passionately say is the biggest problem we have at the moment, as opposed to dog assessments or paperwork that the government would prefer to focus on. Both these suggestions, extra training and support post-adoption, taken together require considerable extra funding, so they are not a priority.

Of more interest is the idea that children can be placed with their prospective adopters and effectively fostered until the order goes through. This could make transitions easier and create less change for children. However, it is not without its problems. As Adoption UK point out, adopters want to do just that, adopt. The fact that children may have contact with the birth family while they wait or may be removed if the order does not go through could act as a deterrent to carers coming forward.

As I have mentioned in previous posts, the proposals appear to take little account of the court process. Changes are in the pipeline but parents and members of the extended family will still have the opportunity to prove they are a worthy alternative to adoption. These issues and the time-consuming and resource draining assessments that accompany them can delay an adoptive placement extremely effectively.

I desperately want the system to make good placements for children and young people, and to make more of them. It’s needed now more than ever before. My fear is that the complexity of meeting the needs of vulnerable children hopeful for a stable future will become lost amidst the targets, league tables and rhetoric.

 

 

To the Commons

Today the Welfare Reform Bill heads back to the Commons with a bloodied nose after a succession of defeats in the House of Lords. I’d like to think our elected representatives conduct themselves with as much dignity as their ennobled colleagues but have doubts considering the attention to the party whip seems to be more appealing than pleas of social justice.

Houses of Parliament

Houses of Parliament

My disillusionment with Labour has increased through the process of this Bill through Parliament, not least their eagerness to jump on the idea of a benefits cap without thought of the realities that they create for families who face potential homelessness, people with disabilities who face castigation and poverty and the almost gleeful stigma of ‘being on benefits’ that they are happy to paint on millions who have no choice in the matter because there may be a handful who are caught in a trap of benefits. Continue reading

Nurses to Teach David Cameron How to be a Smug, Careerist Tory

Following last week’s comments by David Cameron on nursing practice, a team of nurses has been set up to return the favour by showing him how to do his job.

Several surgical nurses have been despatched to a corporate function to ensure sufficient loud braying about stock options. Meanwhile, a health visitor will conduct hourly checks on the number of times Cameron mentions “benefit scroungers” while completely ignoring the Spartacus Report.

Some nurses expressed concern about the way Tories are being trained. One A&E nurse said, “We are seeing worrying moves away from the traditional training grounds of Eton, Oxbridge, then being parachuted into the life of a career politician, with maybe a stint in a PR consultancy or an investment bank. Some of the recent crop of Tories have actually had jobs in the real world. This undermining of standards simply won’t do.”
Continue reading