THE NEW SOCIAL CARE PARADIGM
The term Health and Social Care implies that there is spectrum of services for older people but in fact there are two distinct paradigms. There is discussion as to whether the ‘health service’ is better thought of as a disease service and indeed whether it is being used by the public as a wellbeing service for social problems which they cannot solve, and which the NHS cannot solve either, often leading to the inappropriate prescription of anti-depressants. Similarly the term social sare is related to Social Work, a professional practice currently practised mostly one to one with ‘clients’ and social services , a range of different services for people who have problems with self-care with the najor part of social care now being provided by families or by private companies, with Local Authority departments also very important.
Traditionally the term ‘care’ has implied doing things for older people. Indeed the 1948 National Assistance Act stated that for younger disabled people or, to quote Section 29, “blind, deaf, dumb and crippled persons” the Local Authorities were required to provide ”instruction in their own homes or elsewhere in methods for overcoming the effects of their disabilities”. Those who were in need “by reason of age, infirmity or other circumstances” were simply to be provided with “care and attention” in “residential accommodation”. Local Authorities were also empowered to make contributions to “voluntary organisations whose activities consist in or include the provision of recreation or meals to old people “ but there is no hint that the term recreation on was being used as meaning re-creation, or restoration of ability, but simply to mean entertainment of some sort.
The 2014 Care Act attempted to change the culture but the prevailing culture remained one in which it was assumed that ‘care’ meant doing something for some one else, and of course removing or reducing even simple tasks like cooking accelerates Deconditioning, first described by Amit Arora as a consequence of hospital admission but now recognised as a consequence of reducing the number of tasks a person performs daily
These are significant trends but perhaps are not yet as radical as the social work paradigm called social pedagogy defined by Ali Gardner at a reception on ‘social work and adults’ in the House of Commons as “a holistic and relationship-centred way of working in care and educational settings with people across the course of their lives…it has a long-standing tradition as a field of practice and academic discipline concerned with addressing social inequality and facilitating social change by nurturing learning, well-being and connection both at an individual and community level."
The same principle was clearly discussed in a report for Camilla Cavendish from Harvard (8) with the paradigm being expressed in her Financial Times Column as being one that
“requires a mindset of staff to move from a mindeset of “doing to” to “doing with”
This has been developed in residential childcare but there is little evidence of its use with older people with frailty or dementia who will still receive ‘care’, expressed by having a meal cooked for them. The social pedagogy paradigm would require the person called the carer and the older person working together to cook a meal, with the person called the carer learning how to make better puff pastry as they worked how together, and the working together on the puff pastry would be what is termed the Third Element in the social pedagogy paradigm. There have been calls for the term care to be discontinued, one as long ago as 1980 in the Lancet in an article titled Do we care too much for our elders? (1)
This obviously requires a paradigm shift and the creation of a new style of social care and social work practice being launched in Kingston University which emphasises the need to do things with the client rather than for the client. The new Graduate Diploma also gives the social care professional imbued with this culture to ensure they influence not only those staff and older people with whom the social services department are directly involved but also the many thousands of ‘carers’, paid carers and family carers, in the population of their local authority and to bring together all the key local authority departments such as housing, parks, fitness and libraries
1. GRAY J A M (1980)
Do wecare too muchfor our elders?
Lancet 1: 1289-1291
The term Health and Social Care implies that there is spectrum of services for older people but in fact there are two distinct paradigms. There is discussion as to whether the ‘health service’ is better thought of as a disease service and indeed whether it is being used by the public as a wellbeing service for social problems which they cannot solve, and which the NHS cannot solve either, often leading to the inappropriate prescription of anti-depressants. Similarly the term social sare is related to Social Work, a professional practice currently practised mostly one to one with ‘clients’ and social services , a range of different services for people who have problems with self-care with the najor part of social care now being provided by families or by private companies, with Local Authority departments also very important.
Traditionally the term ‘care’ has implied doing things for older people. Indeed the 1948 National Assistance Act stated that for younger disabled people or, to quote Section 29, “blind, deaf, dumb and crippled persons” the Local Authorities were required to provide ”instruction in their own homes or elsewhere in methods for overcoming the effects of their disabilities”. Those who were in need “by reason of age, infirmity or other circumstances” were simply to be provided with “care and attention” in “residential accommodation”. Local Authorities were also empowered to make contributions to “voluntary organisations whose activities consist in or include the provision of recreation or meals to old people “ but there is no hint that the term recreation on was being used as meaning re-creation, or restoration of ability, but simply to mean entertainment of some sort.
The 2014 Care Act attempted to change the culture but the prevailing culture remained one in which it was assumed that ‘care’ meant doing something for some one else, and of course removing or reducing even simple tasks like cooking accelerates Deconditioning, first described by Amit Arora as a consequence of hospital admission but now recognised as a consequence of reducing the number of tasks a person performs daily
These are significant trends but perhaps are not yet as radical as the social work paradigm called social pedagogy defined by Ali Gardner at a reception on ‘social work and adults’ in the House of Commons as “a holistic and relationship-centred way of working in care and educational settings with people across the course of their lives…it has a long-standing tradition as a field of practice and academic discipline concerned with addressing social inequality and facilitating social change by nurturing learning, well-being and connection both at an individual and community level."
The same principle was clearly discussed in a report for Camilla Cavendish from Harvard (8) with the paradigm being expressed in her Financial Times Column as being one that
“requires a mindset of staff to move from a mindeset of “doing to” to “doing with”
This has been developed in residential childcare but there is little evidence of its use with older people with frailty or dementia who will still receive ‘care’, expressed by having a meal cooked for them. The social pedagogy paradigm would require the person called the carer and the older person working together to cook a meal, with the person called the carer learning how to make better puff pastry as they worked how together, and the working together on the puff pastry would be what is termed the Third Element in the social pedagogy paradigm. There have been calls for the term care to be discontinued, one as long ago as 1980 in the Lancet in an article titled Do we care too much for our elders? (1)
This obviously requires a paradigm shift and the creation of a new style of social care and social work practice being launched in Kingston University which emphasises the need to do things with the client rather than for the client. The new Graduate Diploma also gives the social care professional imbued with this culture to ensure they influence not only those staff and older people with whom the social services department are directly involved but also the many thousands of ‘carers’, paid carers and family carers, in the population of their local authority and to bring together all the key local authority departments such as housing, parks, fitness and libraries
1. GRAY J A M (1980)
Do wecare too muchfor our elders?
Lancet 1: 1289-1291