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Who Cares?

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Is there a crisis of compassion in health and social care? If the shocking scenes featured in Panorama's Undercover: Elderly Care are anything to go by, the answer is surely yes. The interim report from the Commission on Improving Dignity in Care for Older People, the latest official response to various scandals in care homes and hospitals, suggests that this sort of thing is - if not widespread - then certainly more common than we might like to think.

As Alka Sehgal Cuthbert argued at a recent meeting of the Social Policy Forum, the report barely scratches the surface. She questions whether new improved national quality standards can make any difference. Such a managerial response is part of the problem not the solution, she suggests. Improving the so-called performance culture will do nothing to address what is going wrong with care. Indeed, if she is right, this sort of approach might make things worse by further undermining the caring ethos.

Instead Sehgal Cuthbert takes us back to first principles. We need to ask 'what does it mean to care or be a caring person?' she says. Those who work in the caring professions whether as a care worker, a nurse or - like her - a teacher, don't necessarily have to even like those they care for. They have what my social worker colleagues like to refer to as a 'duty of care' to the people they work with. This relationship between carer and client is part of a wider web of relationships with strangers with which 'we have a world in common', she says. Or rather we would, it seems to me, if we weren't so estranged from and suspicious of each other. As I have argued myself, we tend to exaggerate the extent of abuse in Britain, not only of older people, but of children and people with disabilities too. The fear-mongers have been crying wolf in this respect for so long, that some of us have had to hold in check our own scepticism this time around.

Could it be that these instances of neglect and abuse in care settings are a consequence not of inadequate procedures or the dark motives of unsavoury individuals coming into the profession; but of the very attempt to manage the perceived threat of neglect and abuse in the first place? Perhaps this is the lesson we should be learning. It doesn't really matter how many supposed safeguards, regulations or vetting arrangements are put in place. They can't make carers care. As Sehgal Cuthbert says, there is little point in the authorities deciding to 'put empathy on the checklist' too. It would be just one more thing to tick off the list. But how else do we go about addressing the crisis of care that she describes and that we keep hearing about? Shouldn't we be doing something? How do we ensure that those we trust to look after our relatives when they are at their most vulnerable are not mistreating or abusing them? Should we just do nothing?

In a way, perhaps the answer is yes. In order for carers to care they need to be allowed the autonomy to act according to that combination of instinct and experience that allows them to fulfil their caring role. Not, that is, according to the criteria set by performance managers and regulators. This means carers debating the issue amongst themselves perhaps, and coming up with their own criteria for what it means to be a good carer. Logically enough this also means not relying on the Care Quality Commission or the Commission on Improving Dignity in Care for Older People to do it for them; and challenging not only poor care but those who undermine good care by promoting unfounded anxieties. Indeed if both Commissions were to, as it were, decommission themselves, carers might be able to get on with the business of caring, without having to worry about meeting their managerial requirements, and begin to embody the standards that society as a whole expects of them.