Reflections on health and social care

Article by Rachel Barber, Managing Director, Living 4 Moments Ltd
I had a perfect Easter break in Brussels, seeing my family. We enjoyed exploring Brussels’ fine art nouveau buildings, art galleries, Bois de la Cambre and exquisite chocolate shops. The city was alive with spring and busy with people in the arcades, streets and squares. It was good to see and hear the vibrancy. It was a nice change after being denied the opportunities so many times due to travel restrictions etc.

Article by Rachel Barber, Managing Director
Living 4 Moments Ltd

I had a perfect Easter break in Brussels, seeing my family. We enjoyed exploring Brussels’ fine art nouveau buildings, art galleries, Bois de la Cambre and exquisite chocolate shops. The city was alive with spring and busy with people in the arcades, streets and squares. It was good to see and hear the vibrancy. It was a nice change after being denied the opportunities so many times due to travel restrictions etc.

Yet many people are still being denied opportunities to go out, see family etc., because of where they live or circumstances where one becomes vulnerable through ill-health. Too many care homes in the UK have become more like prisons because managers/owners are gatekeepers of these places, which have been medicalised by the regulators such as CQC and local authorities.

I am still staggered by the lack of awareness and understanding of existing legislation that should prevent what is happening in these places. I provide Empowering Choices training to social care professionals for this reason.

The lack of awareness is not just a social care problem, and I have heard and read many stories within medical/health settings. The voices and aspirations of individuals should be listened to. The Mental Capacity Act is powerful and requires (enables) providers, regulators and health professionals to take the wishes of patients/residents seriously. One example from this week is the horrifying story shared by a woman suffering from a toothache (Guardian 20/04/22). No one was willing to listen and take the action she was asking for. The suffering and long-term deterioration of her health because of inaction from dentists and doctors were all so avoidable.

The Mental Capacity Act alone would have been enough basis for professionals to carry out her wishes. If her requests have been recorded and the potential risks shared with her, she could have her tooth extracted when she wanted. We need to move away from excessive fear of litigation to respect and listen to all in positions of vulnerability because of their health and/or where they live.

Other legislation that recognises the importance of users’ voice of services is the Care Act. There it spells out that the users are the experts. “You know best”, etc. Yet the reality is that patients often lose their voice through the arrogance and assumptions made by professionals.

Coming back from Belgium, where individuals can be seen promptly and for far less money than in the UK, highlighted the stark contrast with our health service. The UK has a serious problem with health because of the lack of preventative services or timely responses. For example, why does it take five weeks to see a physio? Or someone suffering from ill mental health waits six months or longer? Nor do we appear to have routine checks, as in Belgium. In waiting so long, more damage can occur, making cases more complex and long-lasting than necessary. The inequalities in our health services are growing because those who cannot pay for private treatment worsen their health because of the delays.

The idolisation of the NHS and the medical profession is dangerous and has led to abuse. We have heard about the maternity scandals that went on for decades. The balance of power is part of the problem in these settings.

The legislation is meant to protect us from these abuses of power. Far too often, the legislation is ignored, and the situation is not helped by the regulators themselves, focusing on processes instead of people. CQC, for example, so often judges homes and hospitals by processes without actually talking or spending time with residents or their families. The voices of individuals and their families need to be heard for any real change.

We must urge regulators to respect and follow existing legislation as part of any inspection framework. The MCA, Care Act, Human Rights and Equality Acts are eroded by the failure to hold professionals to account when the legislation is ignored.

Please encourage more people from regulators and health settings to attend our ‘Empowering Choices’ workshops, where we explore control, attitudes to risk and the legislation together with risk assessments. Together, we can change the culture where individuals have more control and choices in their lives, improving their physical and mental health.