When up to 2,000 protesters joined UK Uncut and blocked Westminster Bridge for two hours on Sunday, they were seeking to stop a bill which will be the last nail in the coffin of our National Health Service. This is just the latest legislative Frankenstein from this government. We’ve been descending down this slope for years.
NHS care workers have been trying to stop waves of privatisation drowning their department since 2007. In many respects the new bill represents a monolithic expansion of the spirit of structural adjustment. In Middleton, for example, the so-called ‘re-ablement scheme’ promised to save the council £8.5 million: about as much as it costs us to run each of the Eurofighter Typhoon bombers in Afghanistan for three days.
According to the Department of Health, the introduction of the scheme in care for the elderly was part of a new ‘Putting People First’ approach. It defines re-ablement as the ‘timely and focused intensive therapy and care in a person’s home to improve their choice and quality of life... so they achieve their optimum stable level of independence with the lowest appropriate level of ongoing support care.’ Re-ablement, which occurs during the transition from hospital care to the home, can go on for up to six weeks, though care workers are often re-directed before then.
So what does this NHS service look like four years later? And does it tell us anything about what we can expect if the new Health & Social Care bill is passed?
I spoke to Rebecca Hoving, a care worker for over 15 years, who said: “This is a financial move. It has nothing to do with care quality. The aim of this seems to be to cut patients off as soon as possible and either leave them to their own devices or channel them through a private care company.”
Before these reforms, care workers were responsible for providing holistic and individualised care, usually after being approached by and consulting with the family. They performed simple tasks like pouring the kettle and helping someone into bed. They also administered medication and maintained constant written and verbal communication with supervisors and families, which brought a sense of security to patients, seeing the same faces every day. Most care workers seemed to view this as an effective system of accountability and collaboration – not qualities the free-market approach has been noted for.
While re-ablement is a free service, its primary function is to encourage ‘self-sufficiency’ by re-routing patients to private care companies; in practice, the service prefers private companies ‘on their books’. As things stand today, paying for private care can often be cheaper than coughing up the required subsidies to continue NHS care, leaving poorer patients with no real choice.
Staff turnover is rapid in the private sector, hindering the development of patient-carer bonds which help ensure the incentive to provide a high standard of care. Before being channelled into the private sector, patients are presented with the option to purchase ‘re-ablement equipment’, which someone who clearly never studied psychology or cared for a disabled person thinks substitutes the routine, interaction and consistent care provided by the old service.
It is generally assumed that the private sector provides higher standards of care. I spoke to one Bupa employee whose experiences working with the elderly for the past couple of years suggests this is wrong. She reported having worked as an assistant in a Bupa care home for three months before receiving any training, and was given no training on managing challenging behaviour or how best to behave towards different patients for the first eighteen months.
She reported that accountability and record-keeping is often lax, and that family members who raise concerns are generally demonised by the staff. She said: “Management is very much absent, they never come in contact with the patients, which leads to the promotion of people not suited to senior positions. They’re not the most caring of people.”
She reported that it is not uncommon for residential carers to work for minimum wage along with the assistants. Since so little training is apparently required, this seems unsurprising, but attempts to verify this with Bupa led to my being hung up on.
Rebecca Hoving says: “The scheme doesn’t re-enable anyone. There’s no therapy, no holistic care at all. We’ve been taken out of that role. Any caring input must be secretive, we can’t even write it down.
Supervisors have become policemen. They don’t visit my patients, but they tell me I’m not allowed to put Mr. Abbot’s socks on for him anymore. Watching a man in his eighties, riddled with arthritis in his legs and shoulders, lying on a bed in great pain, struggling to get his socks on, is not outside the purview of a care-worker. To me, that is a great indignity to the patient, who desperately needs the community support work we used to provide.
We’re being used to suck patients into the private sector. I did not sign up for this. I am a care worker; now they ask me not to care.”
As early as January this year, the Tory ministers were admitting there would be ‘no limits’ on private care firms invading the system under their reforms. This expansion has now exploded into the public consciousness, but the way such structural adjustment impoverishes the most vulnerable members of our families and communities has been observed in the developing world for decades.
What will be more immediately obvious, however, is the erosion of the cohesive and vital relationship between the patients and the professionals, once charged with their care but now with cost-cutting. Because salesmen embellish, elaborate, even lie; if they don’t, they go out of business pretty quickly. That is how the market operates.
After my interview with Rebecca Hoving, I was contacted by another young care worker who wanted to share his story. “There was an elderly woman I used to visit when I first started working here, before the re-ablement scheme. I used to go there most nights to help her go to the bathroom, replace her incontinence pad and put her to bed, since she couldn’t raise her legs.
When I was assigned to re-ablement, someone else was assigned to her. I met her daughter recently, who told me she passed away recently, after a long period of deep dissatisfaction with the private care company she’d been encouraged to go to – the supervisors always get ruffled when a patient wants to choose a different company. There’s definitely pressure there. It turns out they weren’t changing her incontinence pad, which caused painful sores.
Perhaps more important is the psychological effect of neglect like this. She lost her self-confidence, and when you do this job long enough you learn that that can be the difference between life in death. I wouldn’t be surprised if it contributed to her decline. I’ve been so angry about it... but we’re unemployed unless we toe the line.”
That’s something which has been reported up and down the country. Those fighting to keep day centres open or taking action against re-ablement are being actively discouraged from attending community meetings.
Unfortunately, this institutional policy has forgotten that once upon a time, medical professionals were encouraged to prioritise the interests of their patients over everything else. But that’s not dynamic, competitive market thinking: it’s just compassion and common sense. And there’s no room for that kind of outdated nonsense in the new NHS.
All names have been changed for anonymity. Marienna is running in Monday's elections for NUS conference delegate at the School of Oriental and African Studies (SOAS) in London. Her manifesto can be found here.
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