Author: John Burton
John Burton spoke at the It's Our Community event organised by the Centre, in partnership with the Socialist Health Association and Opus Independents. The event is part of the Centre's work to outline a detailed progressive vision for social care in Sheffield alongside disability leaders in the city.
Here John Burton argues that we've lost sight of the true meaning of care and what a real care home should look like. Instead our failed system of regulation and centralised management has turned care into a parody of itself, promoting privatised, dangerous and isolated care homes - far too far from our communities.
Many of you may think that any sort of care home is not where you or any of your friends or family would like to live - ever. I want to tell you that they can be great places to live in and very much part of their community. They can also be awful. In the UK, national regulators - like the Care Quality Commission - set the standards and they tell us which are good and which are inadequate.
I’ll describe 4 different places and I want you to think about which you might be willing to live in.
6 men share this house - it’s a family or small community in the North East of England. It’s just a house in a street in a small town. All of these men have interests and things they need to do. They have friends, neighbours, and families. People come in to help with the things they can’t do for themselves. The couple who actually own the house are a bit like older parents who keep an eye on health and happiness, and make sure there’s food in the fridge, and pay the bills, but they’re not brilliant at the paperwork. They all have a really good main meal together each day. Each resident has his own life to live. One man does his mother’s shopping and laundry. She lives nearby. The group go out together to the pub or club where they are known and welcomed. They live a full life. They are important and valued for themselves.
A dozen women and men living in a small care home in a West Country town. Most of them need a lot of help - with showering, getting in and out of bed, some even need help to eat their meals. Some can forget where they are until a familiar face, a friend or neighbour, or a granddaughter, holds their hand, reassures them and reconnects them with their surroundings. It’s a warm, friendly, neighbourly place, and the people who live and work there are proud of it, and so is the town.
It looks like a castle. It’s in the countryside and some of the people who were in the first home I described, might have been sent here had they previously lived in a place where they weren’t understood or loved, and in despair they began to hurt themselves, damage property or threaten other people. In this highly specialised place, people are not understood at all and when they resist compulsion or stand up for themselves. they’re subjugated, they’re restrained and sedated. This place is run for profit by an American firm and the patients or residents are worth £200,000 a year, so they like to keep it full.
A large modern building, housing 120 old people. It’s in a suburb of a large city. There are 150 staff. Most of the residents need a lot of help but most don’t know the area, and they don’t know the staff or the other residents. Doors are locked to stop people “wandering”. There’s a programme of activities and a cinema, now used as a visitors room. The care that people get is routine; there’s no time for anything else. The staff are there to carry out their tasks not to chat. They wear uniforms, have scheduled breaks and they clock in and out. This home is run by another international company which pays almost no tax in this country but makes fat profits for their shareholders.
Now, I’m sure that you’ve detected the ones that I would like to live in and the ones I would hate to live in. It’s obvious isn’t it? Yes, the first two fit the description - our home in our community, but the third and fourth are simply horrible and we should be ashamed of them.
But, some of you may be surprised to hear that the Care Quality Commission don’t agree. Yes, the third and fourth are deemed to be “Good” because they meet the standards. Rated “inadequate”, the first has closed, and the second is about to close because they can’t afford to bring it “up to standard”. But, by whose standards are they judged? Not the residents’ and workers’, not the relatives’ nor the local community’s.
Government itself must be less authoritarian, less standardising, less centralising, more willing to allow people and communities to create and organise their own care.
Care homes should be judged by their residents and their community not by imposed standards that have little to do with living a good life, and much more to do with privatisation, protecting Government and blaming the workforce.
The publisher is the Centre for Welfare Reform.
Our Care Home in Our Community © John Burton 2021.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.
John Burton explains why the Care Quality Commission (CQC) is unable to effectively safeguard standards for adult social care.
John Burton describes how changes in the regulatory regime are forcing the closure of genuinely human homes where people live together as friends.