Money versus culture in care

Picture of Oliver McGowan, a young white man with light brown hair combed from a parting on the left side, wearing a blue and white patterned shirt and a tweed waistcoat, standing in front of a large parasol.In the light of two recent inquests into the deaths of young men with learning disabilities, one in an NHS hospital (Oliver McGowan, right) and one in a Mencap-run care home (Danny Tozer), both of which resulted in very bitterly disputed findings of no neglect and no suggestion of error in Oliver’s case, Rosi Reed (mother of Nico Reed whose death in 2012 was the subject of an earlier campaign and inquest) retweeted a link to a blog entry she wrote in 2015 titled “What does good look like?”. She quoted at length from a speech in 2011 by Jim Mansell, a professor of learning disability in Kent who had pioneered living in the community for people with learning disabilities and had managed the closure of long-stay hospitals (such as Darenth Park in Kent), in which he said that “good services cost the same as poor services. Good services are not more expensive, they’re just better”.

He is right, up to a point. It’s certainly possible to spend lots of money and still deliver bad care, and the consultant who ignored multiple written warnings and administered the anti-psychotic to Oliver McGowan, who was suffering a seizure (not psychosis) and was understood to be allergic to the medication in question after a previous reaction, resulting in his death, was not an underpaid care worker but a senior medic likely earning a six-figure salary. Furthermore, such people are more likely to be given the benefit of the doubt when they make a fatal mistake in their work than someone in a less prestigious occupation, such as a chimney sweep, a gas fitter or a truck driver — such people have received jail sentences for mistakes of forgetfulness which have led to someone’s death. Monica Mohan, the doctor responsible in this case, is unlikely to face any sanction, because the coroner deferred to her ‘expertise’ rather than entertaining the family’s view that it reflected arrogance.

Money is no excuse for neglect, and the boards and managements of the institutions responsible often have enough money to pay themselves very generous salaries and to spend it on pointless PR and development seminars and so on. The novelist Diana Athill, when writing about her experience in a women’s retirement community in London, wrote that she was aware of care and nursing homes which charge fees much higher than hers (which, admittedly, was not a nursing home and was for generally healthy older people) but were much worse places in which to live. However, it is not the whole picture and to say that “good care is not more expensive, it is just better” lets the people who pull the purse strings off the hook. Underfunding often results in wages taking the biggest hit because mortgages, fuel bills and so on are less likely to give, and poor pay means it is difficult to attract and staff and especially the right calibre of staff. I have known people who had carers they trusted but who left because they were offered better pay in a care home or in another industry entirely; others left the area because they could not afford to live there on a carer’s wages; needless to say, this is a particular problem in areas such as London with high rents and house prices. It also means that there is less money for training and often less time to make sure a newcomer knows how to do some of the caring tasks and is aware of common hygiene practices. I have also been told by friends that carers who worked for agencies did not know some of these things.

It is a fact that capitalism tends to reward jobs that are most closely linked to making money with the most money; jobs that simply need doing but which do not make anybody any money are often paid as little as the employer can get away with. People resent paying taxes; a party promising a tax cut is more likely to win votes than one promising an increase, while there have been incidences of local councils running consultations, asking people what they would not mind paying more council tax for, and the people respond that they just want to pay less. In addition, the personal budgets which are now regarded as important to facilitate a disabled person’s independence can easily be portrayed, politically, as a large handout to an individual (even if wrongly). People might assume (certainly wrongly in a lot of cases) that a corporate body such as a care home (or a whole chain of them) might spend the money more responsibly and these bodies are better able to lobby politicians than disabled individuals and their families. There is also pressure from councils to double down on conditions for employed carers, by using zero-hours contracts instead of regular employment.

Many of the things Professor Mansell advocated in that speech — services being person-centred, treating the family as experts rather than as an annoyance or obstruction — are not things money can buy on its own, and the signs of a badly-run home such as staff talking to each other rather than with the residents and not knowing what to do unless they are told, can be found in places which charge high fees as well as those which charge less. However, to maintain a culture of person-centredness and empowerment, especially in this day and age when those things are not yet the norm, it is necessary to have the resources to pay staff so that there will not be a high turnover of staff as people find better-paid jobs elsewhere or leave a region because of unaffordable costs of living.

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