Words that make me go hmmm: Care

Care.

We use the term all the time.

Care is described in a plan and delivered in a package.

Care has a start date and an end date. It comes in episodes. Time frames. Short-term. Temporary. Intermediate. Respite. Long-term. End-of-life.

Care has a cost. A fee. An invoice. A payment date.

Care has records and logs and notes and charts. Risk assessments. Rotas. Timesheets.

Care wears a uniform.

Care is a task. It’s done to, and for.

Care is a setting. Somewhere to ‘place’ ‘the vulnerable’.

Care is a service. A system. A sector.

Care is for ‘others’.

Care for others

Much of what makes me go hmmm about the term ‘care’ is encapsulated in the Department of Health and Social Care’s latest campaign to recruit more people to work in adult social care.

The campaign is called ‘Care for others. Make a difference’[1].

Let’s break that down.

‘Care for’ suggests ‘do to’. Look after. Protect. There’s no sense of any kind of reciprocity, or relationship, or choice. Care is a paternalistic one-way street. It’s provided and received.

‘Care for others’ perpetuates the ‘us and them’ narrative. The carers, and the anonymous, homogenous ‘cared for’. The helpless who must be helped. ‘Service users’. ‘Residents’. “Inmates’[2]. The separate, different others. Not even acknowledged as people by our Secretary of State for Health and Social Care, just “the most vulnerable in our society”. “Our most vulnerable”[3].

Why not ‘care for people’? Too real? Too human?

Why not ‘care about people’?

And ‘make a difference’? Yes – there’s huge capacity for people working in social care to make a difference, but what about our role in offering and enabling the right environments and connections and support for all of us to get on with living our own unique lives, nurturing our own relationships and making our own difference?

Care as a ‘setting’

Our practice guidance and public information is full of references to people’s “own home or other care settings”[4]. The phrase ‘own home or’ a care home/residential setting/care setting is used repeatedly in Government guidance, NICE guidelines, Care Quality Commission reports, SCIE resources and public information and advice from local authorities and voluntary sector organisations. These ‘other care settings’ are described as alternatives to people’s ‘own homes’. They’re beds. Units. Schemes. Facilities. Accommodation. Places – placements – for care, not for living. Not home.

Different, separate, other settings, for the different, separate others. Hidden away. A different world.

The care sector

The press release promoting the recruitment campaign references the ‘CARE’ brand, “which symbolises the entire care profession” and “aims to raise the profile of the care sector”. It also identifies key topics for training “on how to maintain good care in the midst of the coronavirus crisis” – one of which is “supporting care at home”. Not because it’s the right thing to do for people. Not because it’s the safest option mid pandemic. Nope, it’s “to reduce pressure on the NHS”.

A brand is undoubtedly low down on the list of priorities for people labelled ‘low-skilled’, working in minimum wage jobs, with zero hours contracts and – right now –  struggling to secure adequate protective equipment and tests to stay safe, and woefully over represented in statistics about COVID-19 deaths [5].

And in reality, this brand does not symbolise care in its entirety. It describes a sector in the shadows, the ‘and’ to health, the Cinderella service to the NHS. But it doesn’t reflect the families and friends and neighbours and community groups and voluntary organisations and micro-enterprises who care. Like health is much broader than the NHS, care is not, and cannot be, confined to a ‘sector’.

The narrative of ‘care’

Ultimately care is about people. Us. All of us. But the narrative of care is about them. Others. ‘The vulnerable’ who need to be cared for, in another setting. In another sector. A bureaucratic system, where decisions are made for and about ‘service users’, not by or with people.

The focus on care invariably concentrates on ‘personal care’: managing and maintaining nutrition, personal hygiene, toileting needs – and too often this becomes the focus of care plans. The life and limb care to ensure survival.

It also perpetuates the medical model – focusing on what’s wrong, grouping and labelling people by diagnosis and condition, prescribing solutions and looking after people in institutions. A narrative that convinces many that the answer to the ‘care crisis’ lies in further integration with health.

Prior to COVID-19, social care had little profile, largely absent from public consciousness and political discourse. In the early days and weeks of the UK Government’s response to the pandemic, the sector’s subservient relationship with health was apparent as care homes bore the brunt of the ‘protect the NHS’ message. And as the current crisis evolves, the true cost of those early political decisions is becoming increasingly, and heartbreakingly, apparent to those of us working in or closely with care homes, or who have relatives or friends living, and dying, in them.

Putting social back in to care

The Government’s badge says ‘CARE’. But what happened to the social element? OK so yes, it’s often absent from care plans which focus on personal care at the expense of personal relationships. And it’s increasingly absent from social work teams, as we hot-desk and work from home. But surely one of the glaring messages from the last few months is that we need each other – our families and friends and neighbours and colleagues. So many of us have experienced a loss of connection. An element of isolation. A feeling of loneliness. The absence of touch. The lack of hugs. We’re all hugely aware that there’s so much more to life than meeting our basic needs for food and drink, clothing, shelter and safety. We need to be part of a bigger whole. We need to belong. We need to love, and to be loved in return.

And during the pandemic, alongside the horrifying narrative of institutional care, there’s another narrative of social care. Of an amazing collective, collaborative, community response which demonstrates just how much we do care about one another.

Social care is so much bigger than the Government’s ‘CARE’ brand. As Mark Harvey wrote recently, “social care happens throughout society and communities, in living rooms, on street corners, at work, in colleges and even in the pubs and night clubs across the land.”[6]

We are about one another

In our exhaustive, exhausted use of the term, how often do we actually stop to consider care in terms of caring about, not for?

As we tentatively begin to look towards the future, we need to flip the narrative. Shift from “We care for vulnerable people” to “We care about one another”, or even “We are about one another”[6].

We need to reclaim the term ‘care’ – grasp it back from the realm of commissioners and providers and institutions, own it as an emotion and an action in our homes and our streets and our neighbourhoods – and make sure it has the term ‘social’ right up there with it.

Care is community.

Care is connection.

Care is collaboration.

Care is choice.

Care is listening, and learning.

Care is families and friendships and neighbours and colleagues.

Care is random smiles from strangers on the street.

Care is laughter and kindness and tears and messy and complicated and heart-breaking and joyous.

Care is about all of us, not them and us.

We need care.

We do care.

We are care.

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References

[1] Adult social care recruitment care campaign launched to boost workforce, Department of Health and Social Care, 23 April 2020

[2] Care home boss says hospitals are refusing to admit her inmates showing symptoms, Robert Peston, Twitter, 5 April 2020

[3] Adult social care recruitment care campaign launched to boost workforce, Department of Health and Social Care, 23 April 2020

[4] Care and support statutory guidance, Department of Health and Social Care, Updated 2 March 2020

[5] Covid-19 deaths among social care staff far outstripping those in healthcare, Mithran Samuel, Community Care, 11 May 2020

[6] Adult Social Work – 50 Years Young (and the Debate is only just Starting) Mark Harvey, Social Work, Cats and Rocket Science, 24 May 2020

[7] These times have truly brought into the foreground… Neil Crowther, Twitter, 18 May 2020