The Moral State We’re In

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Julia Neuberger. The Moral State We’re In

CONTENTS

INTRODUCTION

ONE THE ELDERLY

Poverty

The Very Old and Frail

Euthanasia/Assisted Dying

Advance Directives

Discrimination and Rationing

Nursing Homes and Care Provision

Grey Power

Abuse

Care Workers

Regulation of Care Homes and Nursing Homes

Palliative Care

Conclusions

TWO THE MENTALLY ILL

Psychiatry as Social Control

Historical Reflections

Twentieth-Century Policy and Practice

The Era of Inquiries

The Blofeld Inquiry into the Rocky Bennett Case

The Michael Abram Case

Dual Diagnosis

The Carol Barratt and Kevin Rooney Cases

The Christopher Clunis Case

The Michael Buchanan Case

The Andrew Robinson Case

The John Rous Case

So Where Does All This Lead Us?

The Race Issue

The Irish Community and Mental Health

Inpatient Care

Continuity of Care

Activity and Employment

Homelessness

THREE THE YOUNG AND VULNERABLE

Concepts of Childhood

The Frank Beck Scandal

Runaways

Drugs and Poverty

Anti-Social Behaviour

Unemployment

Mentoring

Mental Health

FOUR THE PRISON SYSTEM

Women’s Prisons

Conclusion

FIVE THE OUTSIDER

Historical Background

New Legislation

Racism Rears its Head

New Asylum Legislation

Things Get Worse

Press Views

Children

Unaccompanied Children

Political Views

Detaining Asylum Seekers

Failed Asylum Applicants

Health Issues

Work

Returning Failed Asylum Seekers ‘Home’

Rethinking Asylum Policy

Immigration in General

BIBLIOGRAPHY

INDEX

ACKNOWLEDGEMENTS

Copyright

About the Publisher

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THE MORAL STATE WE’RE IN

A MANIFESTO FOR A 21ST CENTURY SOCIETY

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There is the additional likelihood that cases of abuse will rise as the population grows older and the number of people with Alzheimer’s disease increases. Though we may not be ill for any longer than previous generations, the nature of our illnesses is changing. The increase of Alzheimer’s disease has huge implications for the kind of care we will need, and the amount of patience that will be required to deal with often very difficult, irrational, older people. Ironically, it will be even harder to detect abuse, for often the complainers will not be believed, even if they are telling the truth, simply because of the nature of the disease. Caring for those with dementia requires such a degree of patience and skill, and can lead to such frustration, that the chances of abuse increase and the levels of care needed will be much greater-for instance, more and more lengthy home visits will be required. Present provision is patchy at best, and often simply unsatisfactory, as Tony Robinson reported in his story in the Daily Mail about the care his parents received:* ‘The NHS still fails to recognize the special needs of people with dementia, and won’t pay for their long term care…If we want a dignified old age for ourselves and our parents, it’s up to us to do something about it.’ Meanwhile, research suggests that some 22,000 old people are being given drugs to sedate them, to make it easier for care staff to manage them, according to Paul Burstow, the Liberal Democrat spokesman.† If anything, this figure seems on the low side.

Yet on this whole question of abuse of older people there are detectable signs of change-most notably in the fact that considerable numbers of older people have raised the issue themselves. They have told district nurses, social workers and others, including friends, that they are being abused-despite the difficulties involved for those who may not have access to a telephone and the fact that those committing abuse may be close family members, as well as professional carers. Action on Elder Abuse suggests that there is a category of carers who hop from one agency to another as soon as suspicions about their abusive behaviour become known, with the result that they are able to move to another care home, to another group of vulnerable older people, and perpetrate their abuse all over again. To compound the problem it will be a long time before the National Care Standards Commission will be able to register all care workers. Action on Elder Abuse:‡ argues that it may take anything between ten and eighteen years before care assistants and home helps are registered by the General Social Care Council; yet, as Gary FitzGerald, Chief Executive of Action on Elder Abuse, argues: ‘Less than three per cent of the identified abusers are social workers, whilst 36 per cent are home helps. There is clear evidence that we need to look at the other end of the scale.’ Despite this, the General Social Care Council is starting with the registration of social workers. Even when it reaches all care workers, registration will not give us all the answers because there will always be staff shortages and employers may well believe-understandably-that it is better to have some staff, even if a bit dubious, than none. Whilst the government wants half of all care home staff to have achieved NVQ level 2 by 2005, it must be questionable whether care home owners will pursue that goal as hard as they might, given how hard it is to get staff at all. It must be equally in doubt whether individuals who might have thought about becoming care staff will bother to go all out to be recognized as capable and reliable in these circumstances, given the numbers of hoops they will now have to go through.

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