Category Archives: Health

How the housing safety net is shrinking further

As councils tighten eligibility criteria for housing at the same time as benefit cuts hit, charities warn of an increase in homelessness. With the trend growing for councils to overhaul their allocation policies, there are fresh concerns about people being forced into the unaffordable private rented sector or pushed out into cheaper suburbs. Read my Guardian piece here.

Dilnot: reaction round up

Today the Dilnot commission on social care published its conclusions in its Fairer Care Funding report. Among its findings are that care costs should be capped and the means-tested threshold increased under major changes to the funding of adult social care in England.

The report is a chance to finally fix a shattered system, there will be widespready reaction and analysis later today and beyond to what Dilnot himself calls a once-in-a-lifetime chance to overhaul social care but for now, here’s a selection of today’s responses which I’ll try and update throughout the day.

Sue Brown, Head of Public Policy at the national deafblind charity Sense: “Sense welcomes the Dilnot report, and in particular the key finding that additional public funding for adult social care is urgently required. But we are concerned that the media focus is only on older people which obscures some critical aspects. We believe the report clearly shows that not only can the Government afford to support disabled people of all ages, but crucially as a society we can’t afford not to. It is now up to the Government to fund adult social care so that it gives disabled people of all ages quality of life. For deafblind people social care means communication and mobility support, not just personal care.”

Julia Unwin, the Chief Executive of JRF and the Joseph Rowntree Housing Trust (a non-for-profit provider of housing and care services): “Today marks the most concrete and credible step for years. I believe that the proposed reforms have the potential to bring about a radical step-change in how we value social care, how we think about disability, and how we all – as individuals and as a society – plan and prepare for longer lives.
It is positive to hear commitments from all the main parties to set aside party differences and consider the Dilnot report with the consideration it clearly warrants.
The JRF now urges the Coalition Government to abide by its promises to deliver a White Paper in the next six to nine months. It would be a tragedy for this, one of the most pressing and defining issues of our age, to be kicked, yet again, into the long grass.”

Jeremy Hughes, Chief Executive, Alzheimer’s Society: “Today’s welcome report could bring to an end the scandal of the colossal Dementia Tax where every year tens of thousands of families are left to pay all their care costs whilst other diseases are paid for by the NHS. The government mustn’t miss this opportunity to right a wrong that is destroying lives. In a new system we must end the postcode lottery that gives different support depending on local authority. The Dilnot Commission has given the coalition government the opportunity to show that it is a caring government. Pending implementation they must also show they care, protecting social care spending in the way they are doing for health.”

TUC General Secretary Brendan Barber: “The TUC welcomes the increase in funding for the care of the elderly over the next few years, and the news that social care will be free for those who become disabled before the age of 40.
“The introduction of a national eligibility assessment should avoid a ‘postcode lottery’ and make it possible for those receiving social care to move around the country without losing their care provision.
“The TUC believes that social care should be provided free for those who need it, and funded from general taxation. The Dilnot Commission’s proposals could, however, be transformed into this NHS model by continually reducing the level of the cap on care costs. The government must not set too high a cap – a level above £50,000 per person would mean that families could still face losing their homes to pay for the vital care they need.”

Gordon Morris, managing director of Age UK Enterprises: “The Dilnot commission report delivers a clear call to action to the financial services industry to work with government to develop the innovative products needed to fund long-term care. Existing products, such as equity release and annuities, could present a solution, but far more has to be done to build flexibility into these products to increase access and ensure these products evolve to meet changing financial needs.”

Stephen Burke, founder of social enterprise United for All Ages: “Under the commission’s regressive proposals, the winners would be richer families whose inheritance will be relatively protected, while most families will face a more confusing and potentially costly care system. The proposed cap on care costs will still result in some older people being forced to sell their homes to pay for care and related costs.
“The proposals aim to reform the current inadequate system for funding care. But they would lead to a more complex, fragmented and confusing care system … This could be seen as a care ‘poll tax’ for the so-called squeezed middle.”

An interesting reaction from by social workerSarah Smith“: “It is local authorities that take the hit from policies devised by central government, and we can only hope that all parties are brave enough to act together for the country’s interests rather than consider of their own chances at the ballot box. We deserve much better than that.”

Labour leader Ed Miliband: “The last thing Britain needs is for Andrew Dilnot’s proposals to be put into the long grass. We three party leaders are of similar age and the same ­generation. This is a once-in-a-generation opportunity which our generation must address.”

Which? executive director Richard Lloyd: “Consumers tell us that long-term care is their top health care priority* so we welcome these recommendations and urge the Government to act sooner rather than later. If private insurance is to play a part in funding long-term care, then we need to learn lessons from the past, where products have either failed to meet people’s needs or have been mis-sold. This will be a new market with a clean slate so it’s important that strong consumer protection is in place from the start.”

Michelle Mitchell, charity director at Age UK, tells the Guardian that the report set out “a clear blueprint” for sustainable reform. Production of a white paper by next spring was ambitious but achievable, Mitchell said. But she warned: “Delay beyond Easter would be indefensible.”

Mark Goldring, chief executive of learning disability charity Mencap, said: “Now is the time for monumental change and it is vital that the government does not bury social care reform.”

John Adams, Voluntary Organisations Disability Group (VODG) general secretary: “Today is about more simply demanding more money – vital though additional funding is – it is about urgent reform of a broken system. The Dilnot commission has taken great pains to build cross-party consensus; ministers now need to match the warm rhetoric with which they greeted today’s report with swift action. The government must find the courage to put its money where its mouth is, succeed where previous administrations have failed and exploit what Dilnot himself describes as a “once-in-a-lifetime opportunity” to create a fair and sustainable system of social care.”

Senior Fellow at The King’s Fund, Richard Humphries: “The budget deficit should not be used as a reason for inaction. This is a long-term issue and questions of affordability go beyond the current economic situation. The additional public expenditure needed to fund these proposals is less than 0.25 per cent of gross domestic product – this should not be too high a price to pay for providing a care system fit for the 21st century….Where they have failed in the past, politicians from all parties must now seize the best opportunity in a generation to ensure that people can access the care and support they deserve in later life.”

Su Sayer, learning disability charity United Response’s chief executive: “The report’s recommendations are the first step towards creating a better system which ensures that people in need of care receive it, funded in a way that is not only fair, but seen to be fair….Whether viewing this economically or morally, we cannot afford to ignore these recommendations, which is why we urge all political parties to work together towards a better social care system for all.”

Guy Parckar, acting director of policy, campaigns and communications at Leonard Cheshire Disability: “The system as it stands is creaking at the seams, with more and more people missing out on the care that they need. This report must be seen as a clear call for action. All of the political parties must come together with one agenda and that is to agree a fairer settlement for social care. We cannot go on with disabled and older people missing out on care because of a system that simply cannot cope with the demands placed upon it…Too often disabled people with significant social care needs can be charged into poverty by our social care system. People are unable to work, unable to save, unable to buy a home as any income or assets will simply be taken to cover the costs of care. This is a critically important recommendation that could make an immense difference, and it is absolutely imperative that the Government acts on it.”

Domini Gunn, Chartered Institute of Housing (CIH) Director of Public Health and Vulnerable Communities: “In reforming the funding of social care, we urge the government to follow Dilnot’s recommendation to review the scope for improving the integration of adult social care with wider care and support system. This must include housing, and housing support, providers and could help drive a more preventative approach, incentivised through funding arrangements.”

Sir Stuart Etherington, Chief Executive of NCVO: “This review makes major strides towards identifying how we can achieve an affordable, sustainable and fair funding system for all adults in the UK. The challenge now falls to all parties to resist turning the review into a political football and to prioritise responding swiftly and decisively. It is the most vulnerable who will suffer if we cannot seize this golden opportunity to improve the funding of adult social care.”

Life stories: freeing the minds of dementia sufferers

It was only a picture of a gurgling baby. But to one elderly woman with dementia, it meant the world. “She had dementia, was in a care home and was past the stage where she could really have a conversation,” says Helen Bate. “But she just fell in love with that photo. She would try and wipe the baby’s dribble off, or feed it chocolate. It’s just an image – but it had the power to really engage her and she’s been able to talk to it.”

Bate is founder and managing director of Pictures to Share, an innovative social enterprise creating picture books and other resources for people with dementia. She’s a passionate advocate of people with dementia, who she argues shouldn’t be shut off from the world of books and art just because of their condition. “People make too many assumptions about people with dementia,” she says. “There’s often a lack of imagination in their care. If someone liked looking at good painting, they are not going to lose that when they are in a care home. They may not be able to read any more but they can still enjoy looking at the pictures in our books.”

Bate was inspired to start the business after her own mother, a dementia sufferer, enjoyed looking at a scrapbook Bate’s daughter had put together. “There was nothing else out there,” she says. her first three books were published in 2006 and, thanks in part to charitable sponsorship, she has now produced a total of 11, all designed to combat the isolation and depression which can so often be associated with dementia. The organisation has diversified into producing artwork and is now working on dvds.

“If you go into some care homes, it’s almost as if they assume that because people are old and have dementia, all they want to look at on the walls is pictures of the royal family, wartime or old street scenes. It’s pigeonholing everyone into a very narrow category.” The Pictures to Share books cover everything from sport to shopping and from the world of work to travel.

There’s diversity too in the choice of images: colour and black and white photos both old and new are mixed with reproductions of paintings. The key criterion is that all of the images should be powerful and easy to understand to prompt memories, a chat or simply a smile. “Because of their dementia, certain things won’t work if they are too complex,” says Bate. “And we have to be careful about showing pictures people might get worried about. For example, with a picture of children paddling in the sea where you can’t see any adults around, people could get quite distressed because they think the children are in danger.”

I tried out three of the books with my mother, who has multiple dementia. I was unsure how she would react, but I was delighted to find that the pictures inside captured her imagination. She used to be a great traveller, so it was perhaps inevitable that the biggest hit was the travel book. Its shots of the Taj Mahal and train, plane and ship journeys, really got my mum chatting.

The feedback from other users suggests my mum’s response is not unusual. “It opens the channels of communication that are a bit stuck,” she says. “Relatives find them really useful to get a conversation going, which can be tricky for people with dementia.”

For relatives and carers perhaps the most powerful thing about the books is that they remind us all that behind every person with dementia is an individual with their own interests, likes and dislikes and their own life story. They are not all the same, so let’s free our imagination – and theirs – as we care for them.

“Sometimes I get cross with my parents because we don’t have a normal life.”


Above, young carers talk about their role in a Carers Week film.

Next time you feel fed up with doing the household chores, think about Ryan. At 13, he cooks, cleans, does the laundry and helps both his disabled parents get around the house. His father has Crohn’s disease and his mother is disabled.

Aside from the physical requirements of his role as a young carer, Ryan shoulders a huge amount of emotional stress; life is unpredictable because his parents’ health varies from day to day. Getting ready for school in the morning, for example, is hard because he worries about leaving his parents alone and fears his dad will be in hospital when he gets home. The teenager gets frequent headaches, stomach aches and suffers from irritable bowel syndrome, all of which his GP says is stress-related. It is easy to see how being a young carer can adversely affect education, health and wellbeing and lead to isolation and anxiety.

Ryan, who is lucky enough to be supported by a young carers project run by the charity Action for Children, is one of an estimated 700,000 children and young people who have caring responsibilities. Young carers represent over 10% of the UK’s 6m carers, the group of people highlighted in Carers Week this week.

Action for Children is using Carers Week to demand that the government and councils do not ignore the plight of young carers. The charity has released new figures today which show that, in a survey of 23 Action for Children young carers projects, services supporting 1,192 young carers have had their budgets cut by up to 30%. A further 192 young carers are supported by services that have suffered budget cuts of 40% or more.

As Ryan says, he would be lost without support from his young carers project. “I really rely on that time with my support worker to express my worries. It’s amazing to share my experiences with other young carers who understand what it is like to be me. I love my parents but sometimes I get cross with them because we don’t have a normal life and I can’t do the same things as my friends. I used to feel guilty and bad about those feelings but after talking to other young carers I know that we all have feelings like that sometimes and its okay. The young carers project arranges all sorts of activities for us to help us relax and enjoy our time off from looking after our parents. It’s like having a little holiday away from all the worry.”

Budget cuts to support services for young carers save money now but run the risk of undermining young carers’ futures. As Hugh Thornbery, director of children’s services at Action for Children, says, there is already a huge danger that those who need care start relying on children and young people to support them even more as statutory service provision is decimated. This situation, as the charity stresses, effectively means young carers – many of whom spend up to 50 hours a week looking after a relative – bear the brunt of the country’s deficit and might end up paying for it with their futures.

* To find out more the impact of caring resonsibilities on the young, try also checking out the very good Victoria Cares site, a week-long campaign by children’s charity Spurgeons revealing a week in the life of young carer Victoria.

No voice for the vulnerable

Can you imagine being so desperate for affordable legal advice that you go on an eight-hour, 300-mile bus trip just to get help? I came across such a case seven years ago; a Welsh man facing eviction from his council-owned cottage when the area was being redeveloped found that the only housing legal aid lawyer willing to take on his case was in West London. So desperate was the man to stay in the cottage he had been born in and so great was his fear of homelessness, he made the trip.

Although this tale is from 2004, it highlights the vital safety net legal aid (when the state pays all or part of the legal costs for those who cannot afford them) provides to society’s most vulnerable. The number of solicitors who carry out legal aid work have been falling in recent years (hence the Welsh man’s 300-mile journey) thanks to uncompetitive pay rates, hours of unpaid work and red tape. But now, under government plans to cut the legal aid budget by £350m, the situation could get worse for those wanting to access affordable legal help. It is estimated that around 500,000 people could lose out on legal advice amid the planned cuts as the government wants to remove clinical negligence, family law, education, non-asylum immigration and housing cases from legal aid’s scope.

Today is Justice for All day, with marches and petitions planned by a coalition of 3,000 charities campaigning against the cuts and you can also oppose the cuts at social action campaign site 38 Degrees.

The Law Society, which represents solicitors in England and Wales, has also launched Sound Off For Justice, a campaign for alternative reforms that it says will save more than the government’s own proposals and protect legal aid funding. The campaign encourages the public to demand the government reconsider its plans and look at the alternative measures which it says would save £384m in the next 12 months. You can record a voicemail for Justice Secretary Ken Clarke against the cuts here. The campaign is supported by, amongst others, housing charity Shelter, the Refugee Council, lone parent charity Gingerbread and housing association Eaves.

Here’s the campaign’s latest video:

There’s something rotten going on when an endless glut of super-injunctions protect the privacy, reputations and careers of the super-rich but a lone parent, for example, is denied basic access to his children because he simply can’t get the afford the advice.

What no big society?

Amid the vibrations of doom and whiff of ennui surrounding anything stamped with the politicised big society seal, a new campaign tagged in plain terms as a grassroots effort to improve a neighbourhood is a bit of an attention-grabber.

Shockingly, no one’s claiming it’s part of some shiny new renaissance in volunteering that will allow the state to retreat on the sly, but a tried and tested idea, backed by an organisation that’s been doing similar, citizen-led work for years.

Quick – Dave’s on the line – he wants his big society back!

Today’s launch of Shoreditch Citizens – part of well-established community organisers programme London Citizens – follows an audit of 200 organisations in the east London area, plus 500 meetings to identify local issues that matter and train community leaders.

The Shoreditch arm is the latest chapter for London Citizens, an alliance of 160 groups representing faith institutions universities and schools, trade unions and community groups; the founding member is The East London Communities Organisation (Telco), the UK’s largest independent community alliance launched in 1996.

Shoreditch Citizens has high hopes in aiming to join forces to impact on poverty, poor housing and gang crime – around 75% of the area’s children live below the poverty line and four in 10 adults are unemployed. The campaign, funded by the Mayor’s Fund for London and £270,000 over three years from the community investment arm of Barclays Capital, also wants an alternative to the education maintenance allowance (EMA) to encourage young people to stay in education. There is also a plan to make Shoreditch a “Living Wage” zone, where everyone who works in the area can be sure to earn a decent amount to live on. The Living Wage campaign was first launched by London Citizens in 2001, which says it has won over £40 million of Living Wages, lifting over 6,500 families out of working poverty.

By December 2012, the Shoreditch engagement programme aims to train 300 community leaders from 30 civil institutions and hopes to impact on up to 15,000 families. All this is nothing if not ambitious, but if you don’t have goals…

The cuts: the worst is yet to come

An authoritative analysis in today’s Society Guardian of the deepest spending cuts in a generation, which start from Friday. The special issue inludes some sector by sector breakdowns of savings and job losses, including pieces I contributed to the in-depth coverage.

The cuts – an alternative

For those who’ve not already seen it, this powerful film presents an alternative to the government’s devastating cuts agenda. It features community groups and anti-cuts campaigners along with Bill Nighy, Radiohead’s Ed O’Brien and Zac Goldsmith MP. Worth watching ahead of this weekend’s demo in London against the cuts.

It Cuts Both Ways…The Alternatives from Oonagh Cousins on Vimeo.

The reality behind the mental health strategy rhetoric

Carrie Holroyd, writer and mental health activist

As someone who has experienced mental health problems since childhood I was elated to discover, on February 2, deputy prime minister Nick Clegg waxing lyrical about the importance of mental health on breakfast television. It was the new mental health strategy in England, No Health Without Mental Health, a cross-governmental approach to mental health and wellbeing, putting particular emphasis on talking therapies, early intervention and children/young people’s mental health.

£400 million is being invested in mental health services and I applaud the move to improve access to psychological therapies (often described as a ‘Cinderella service’) such as Cognitive Behavioural Therapy (CBT), a type of therapy which works to gradually change a person’s negative thought patterns and behavioural responses over a set period of time.

These types of therapies have been proven to work extremely well for people with mild mental health problems, such as short-term reactive (caused by an external trauma, such as a bereavement or job loss) depression and anxiety. Allowing people access to this type of support at the first onset of symptoms can prevent mental health problems spiralling into more severe forms of mental illness and, if it works, will save the government money as mental health problems are estimated to cost £105bn a year, according to the Centre for Mental Health.

I am pleased children/young people’s mental health is at the forefront of the strategy. Mental health service provision for young people is woefully inadequate, despite research showing half of all people who develop a lifetime mental health problems start to show symptoms at the age of 14. I can attest to this and perhaps with early intervention my mental health would not have deteriorated. Not mentioned, and something which is close to my heart, is how schools can assist with early intervention by training staff in mental health and employing in-school counsellors. My mental health problems were exacerbated by the deficit in knowledge about mental health in my school and as such I feel schools need to be included in discussion on early intervention and preventative measures.

As my elation waned and cynicism set in I pondered some questions: what about those with severe or enduring mental health problems? A short course of CBT is rarely enough when your problems are embedded or not easily identifiable, and I can’t stress enough how difficult it is to get sustained support. Regrettably for the government mental health problems are complex and unwieldy; they can accost you unannounced, be rooted in indescribable traumas and take years to recover from or even manage on a day to day basis. They are highly subjective and as such what is required is a subjective approach, there is no therapeutic panacea.

Talking to other young people, who like me have had mental health problems since a young age, there is a worry psychological therapies will be skewed in favour of CBT over other forms of talking therapies such as psychotherapy, art therapy and group therapy, to name a few. There are myriad treatment options out there but it can be extremely hard to gain access to many of them; perhaps they are not available widely in your area, are expensive or you’re simply told you’re not ‘unwell enough’ yet. The latter can be especially disheartening to hear when you have been physically unable to function for months on end and are desperate for even a semblance of support. There is not one cause for someone developing a mental health problem and while CBT works for many people it is important to note it does not work for everybody and there needs to be access to an array of psychological therapies if these proposals are going to work.

Another question I had after reading about the strategy was about how it can possibly succeed with council cuts affecting mental health services the way they are. In my last blog post I expressed concern about how cuts are affecting voluntary sector mental health services and I come back to this point now. With day centres closing around the country, jobs being lost and the lack of psychiatric beds available mental health provision is not in a good place and I’m left wondering how the government think the NHS can compensate for all these crucial losses.

As a resident of Leeds I was dismayed to hear of the decision to close the Leeds Crisis Centre, Leeds’ only instant access counselling service for people needing immediate support. The rationale behind this is that the service itself isn’t unique and is duplicated within the NHS. With GPs and mental health professionals regularly referring people deemed too ‘high risk’ for NHS services they have come out in force to support the crisis centre and postpone the decision until a rigorous consultation has taken place. I have to wonder how serious the government is about helping people suffering mental distress. Will the rhetoric become reality? Or will, as has become the norm, those of us with mental health problems be left floundering about desperately searching for any kind of support?

Growing old gracefully; shelter with style

London's 'best place to live' according to town planners
With bursts of retro orange shooting through its autumnal colour palette and wooden floors framed by bright white walls, the purpose-built accommodation pictured here wouldn’t look out of place in some interiors magazines.

Beneath the well-appointed rooms lies a bistro and a health spa where you can get your hair cut and styled or enjoy a pedicure.

The building, which opened in November, has achieved code level four for sustainable homes. It is heavily insulated, rainwater is harvested for reuse and heating is sourced from photovoltaic and solar thermal technology. A combined heat and power source also produces electricity, with any surplus sold to the national grid. The entire complex is wired for super-fast broadband.

Little wonder Ewart House has just won a ‘best place to live in London’ award in the Royal Town Planning Insitute’s annual London Planning Awards.

Ewart House's hair salon

A boutique hotel or maybe the latest urban eco-housing?

The only giveaway that Ewart House might in fact be sheltered housing is the fact the ground floor ‘spa’ also offers assisted bathing and the pedicure is really, well, more chiropody. Look more closely and you see the handrails lining the walls and the discrete pacing area for vulnerable residents. The decor and furnishings are also colour coordinated to enable residents with limited vision and dementia to recognise which part of the building they are in; no institutional signage here but subtle ways for residents to get their bearings. In a separate wing with its own entrance are seven flats let to younger people with disabilities and the building is intended to act as a community hub.

Ewart House appears to have substance as well as style; this isn’t just fashionable living for the frail. The extra care sheltered home for frail older people, including people with mild dementia, contains self-contained flats for 47 residents. Almost all flats have a private balcony and some are designed for couples whose fragile health prevents them from sharing a bedroom.The weekly rent and service charges are £135.

The ground floor bistro, Ewart House

The project is a partnership between housing association Harrow Churches (HCHA), which manages the building and provides day time support, and the charity Creative Support, which provides specialist support staff on call 24-hours a day.

With a recent report by the Alzheimers Society suggesting that 50,000 people in the UK are being forced into care homes prematurely, Ewart House has three flats designed for people with mild dementia and the staff are trained in dementia care.

The three-storey building, designed by architects JCMT and styled by interior decorators Stanbridge Interiors, was built using a £6.3m loan from the Homes and Communities Agency, a £3m loan secured by HCHA from Santander and money raised by leasing part of the land to development partner Octavia Housing. Harrow Council pays for employing two teams of staff providing personal care and support while housing support staff are employed by HCHA.

Despite the obvious benefits and official plaudits, HCHA warns the funding climate is a massive threat to creating similar schemes. Chief execuitve Chris Holley says: ‘We’re extremely worried that funding will not be available for more schemes like this despite the substantial social and financial advantages it offers over alternatives like residential and nursing care.

According to one elderly resident, William Fordham, Ewart House is a breath of fresh air: ‘The best thing is the freedom. It’s magic – I have my own flat but carers coming in and out. I didn’t know places like this existed.’ As William’s words suggest, why should losing your youth mean losing your desire for decent décor?

* Images by photographer Lucy Baker