Si’s latest Lent sojourn…

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My mate Si Smith has a new comic out for Lent. You can buy it here. A better way to journey through lent surely has not yet been invented…

There are lots of sample pages and ‘out-takes’ here which give a glimpse into exactly what it takes to put together something as ambitious and brilliant as this.

Those of you who don’t know Si’s work (what have you been wasting your time on???) he is an artist/illustrator based in Leeds, who has been coming up with stunning, creative, quirky and highly original work for years. His first major Lent theme venture was 40, which incidentally we used last Sunday;

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What is really happening in our social care services?

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The good old National Health Service. Even the Tories can not be seen to openly attack the principle of health care free at the point of delivery for all (despite the fact that Jeremy Hunt, the current Secretary for Health co-authored a book calling for the NHS to be replaced by an insurance based American kind of system in 2005.) The recent struggles the government had trying to impose a different contract on NHS doctors has also forced the Tories onto the back foot- never underestimate the power wielded by the medical profession. It could be argued that there are some other subtle political battles being played out in the media however- despite the massive success of the NHS in just about every international league table,  every story you read in the papers is negative.

What gets far less media attention however is something that our health system depends on entirely, so much so that we have been attempting to formally integrate for at least 30 years- I refer of course to the social care system.

I know about this stuff- I have worked in the system for years. I wanted to write something that described the reality of what the system is like so began typing this…

By any measure, social care systems in the UK are in crisis (and I do not use the ‘c’ word lightly.) Check out this from The Observer the other day;

Data from 98 of the 151 local authorities in England with statutory responsibility for social care show that they met only 218 (42%) of 515 targets to improve social care in their area and missed the other 297 (58%).

Under the Better Care Fund councils receive money, mainly from the NHS budget, in return for introducing schemes to reduce demand for hospital care. This is done, for example, by providing better care for people in their own home or in care homes. But the FoI responses reveal that councils met barely a quarter of their targets in 2015-16 for reducing non-elective (emergency) admissions to hospital…

…“Just at the point when the NHS desperately needs more out of hospital care, we seem to be going backwards in many places. That can’t be right,” Hopson said.

Stephen Dalton, chief executive of the NHS Confederation, said: “These figures are very worrying as we head into what could be a very tough winter for the NHS. We only need a significant dip in the weather, which has been mild so far, and people would become more vulnerable and we would see a big spike in demand. We have a perfect storm going on at the moment of unprecedented demand for care, the fact that we have reached a tipping point in terms of the demographics, and cuts to local councils that are among the biggest in their history.”

Leave aside the fact that not even The Observer seems to be able to find someone who works in social care to comment, the picture seems to be pretty bleak. We have an aging population, not only because of a population bulge that is maturing at the same time, but also because people are living much longer. The longer people live, the more likely they are to have health problems that require care and support, particularly people who develop some form of dementia.

The response from our health and social care system has been to increasingly care for people in their own homes. In general it is possible to argue that this is a good thing, but it is also much cheaper, allowing expensive in-patient and total care resources to be targeted at those in the most need. It requires effective and efficient co-ordination between hospital staff and community based care staff, who traditionally have different employers and work to totally different agendas.

My work experience over the last 15 years has been in Scotland, where the government has now required all health and social care services to become fully integrated, sharing a management and funding system- this has been far from a straightforward and integration looks very different in different part of the country. However in theory some of the boundaries and complex funding regimes have been simplified.

What is really going on then? Reflecting on my own experience, here is my list of what seems to be creating the problem;

Money

There is not much of it around. Social Care is funded by Local Authorities. The scale of cuts to local authorities is staggering- when you have (allegedly) secret deals between government and flagship Conservative councils to avoid them holding a crisis referendum, you know things are bad. Most Local Authorities have now faced year on year cuts to allocation of funding from central government. What happens is that most authorities will use ‘reserves’ to give them some breathings space and then a process of identifying savings will begin- typically along these lines;

  • Wages will be frozen, so that staff will not get any kind of inflation uplift
  • Vacant posts will not be filled
  • ‘non essential’ services will be targeted first- this includes all sorts of things that are precious to some- lunch clubs, libraries, sports facilities, public toilets, grass verge cutting etc. These cuts will often have unexpected consequences, in that a cut to one service increases costs to others.
  • ‘External’ funding, to voluntary groups, third sector organisations, even when these provide essential contracted services, will be hit hardest- this is always easier for councils as they export the pain of having to make the savings.
  • This will not be enough however, so councils will have to make staff redundant. They will start by asking staff to make themselves ‘voluntarily’ redundant- but this can be expensive, as typically those who will want to go are older, with more years of service.
  • Councils will have to raise Council Tax. The Government lifted the freeze, and most councils will have no choice. This is clearly a political game- preferable to a raise in income taxes.

If you want to know more about the projections of costs over the next few years- have a look at this document.

Change in actual provision of services

As well as the cuts above, increasingly key services that have been provided by Local Authority staff will be ‘outsourced’ to third sector organisations and businesses. This will be done primarily in order to drive down costs, but also because of a rhetoric around efficiency and change management. This in itself is not necessarily a bad thing- but brings a totally different landscape of service provision, particularly within social care.

Typically, the way services are commissioned within LAs has two main areas of development;

Firstly there is the identification of providers in an area- home care organisations for older people, specialist support for people with LD, Mental Health problems, children with special needs etc, care homes, nursing homes. Increasingly LA’s are not providing these services directly at all- they are entirely reliant on establishing and maintaining a local ‘marketplace’ of providers. They may do this by ‘tendering’ for specific block contracts, but these have to be commercially attractive and increasingly the margins are so small that many providers regard their businesses as no longer viable.

When you consider what social care providers have to undertake, the marginality of their survival is obvious. They operate in a highly regulated environment, with scrutiny from both independent regulators and Local Authority commissioning processes. They provide services in some of the most challenging and difficult circumstances, but because of the squeeze downwards of costs, are only able to pay very low wages (often minimum wage, with zero hour contracts) and provide minimum training.

Maintaining the ‘market place’ in a context of dwindling finances is a major challenge. IN some area of the country there are major gaps. This is particularly noticeable in nursing home provision.

Secondly, there is the commissioning process for individuals. This typically starts by an ‘assessment’ by a social worker or nurse, who will identify what specific needs an individual has and put together a ‘care plan’. This kicks off what can then be a bewildering bureaucratic process, involving the calculation of an ‘indicative budget’, often through the use of complicated formulas that make assumptions about contributions based on income. Some care will be free, other care will be chargeable. Also in Scotland the ‘Self Directed Care’ process will have to be discussed, giving people the right to commission their own services, using the indicative budget.

Remember that all this process is taking place at the point when most those in need of services are at their most vulnerable and potentially least able to provide necessary information. Most LAs have the ability to provide some emergency care, pending the completion of the bureaucracy, but this does not typically apply when someone is in hospital.

When I began my career in social work, most services were provided directly by LAs. If you needed a service, you sent a referral form. You checked the care was working by holding a review at six weeks then six months. The process is wholly different now- in some ways things are much better- there is much more choice and autonomy for those who are able enough to make use of it. There is a greater variety of kinds of care. Care is more typically at home.

At the same time however, getting the service you need remains to some degree a lottery- where you live in the country, how good you are at understanding your rights, how good your social worker is at manipulating the system in your favour. Navigating the complex bureaucracy is rarely straightforward and it is not surprise that things can go wrong- leading to delays and great stress for all involved.

Demographics

As well as having to cope with lower funding, LAs also have rising cost pressures, not least because of an increasing population of older people. This increase is in part a feature of the ageing of ‘Baby Boomers’, but also because people are living longer. The older we are the more likely we are to have health and care issues such as dementia. As well as in increase in people over 70, there has also been an increase in those over 80, over 90, over 100.

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(Image and more detail here)

Clearly this imposes a huge challenge on services. incidentally, this is one of the reasons why we need immigrants in this country- they tend to be younger, have higher birth rates, and their productivity has good impact on the economy.

It also means that people who have much greater needs (eg people who are bedbound, or people who need 24 hour supervision because of challenging dementia) are increasingly care for at home, with a mixture of home care type services and electronic aids. When things go wrong with these packages of care – as they are bound to for things like deterioration in illness, breakdown through carer stress, etc. – then the only fall back tends to be admission to hospital.

 

In summary,  Health Services do not operate in isolation. Increasingly they depend on a range of social care and community care services. Governments, for political reasons, have sought to defend core funding for the NHS, but have at the same time made cuts that continue to devastate social care. Unsurprisingly this has had a direct impact on NHS inpatient services, leading to the crisis that fills our newspaper.

One more point to make- we are being told that we ‘can not afford’ the services that we have been used to. Accepting that money may not always be the answer, it might be interesting to note the percentage of our GDP that we spend on health care in this country as opposed to other Western democracies. We are very much ‘mid table’.

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The left-to-die boat…

 

Civil war makes no citizens, only orphans.

So we set out on the sea in search of safety,

seventy-two souls on a ten-meter rubber boat;

men, women, children, mothers with babies clutched close.

Pushed more by hope than the asthmatic outboard

towards Lampedusa, island portal to paradise,

where lions would lay with lambs,

if they could but scale the razor wire.

 

The Smuggler said the swirling waters were closely watched.

A thousand electronic eyes scanned the surface of the sea,

so that when the engine coughed and died, we did not fear at first.

Someone was sure to hear the distress call. Someone was sure to come.

But we did not know that the digital waves would splash down only

on a civilisation made of stone.

 

Then came the days of drifting.

Days dissolving.

Some drank of the sea and it turned their brains to brine.

Some shouted and raved; others  went

quietly.

The young died first, theirsouls were liquefied.

 

I cried to God for salvation and he sent us a fishing boat

But we were a catch not worth landing.

I cried to God for salvation and he sent a helicopter

but the pilot took away only our photographs.

I cried to God for salvation and he sent a sleek NATO frigate

Which circled like a well-fed shark, but maintained proper detachment.

 

Not even the hands of God were strong enough

to save.

Hallelujah.

 

As if in contempt, the sea spat our bodies

onto the same hostile shore we once sought to leave behind.

Even the 9 souls still breathing

are  dead now.

 

This poem is based on the story of the so called ‘left to die boat’, whose story was plucked from many to illustrate the fate of people who set out on the open sea to escape war and poverty, heading for Europe. Despite their distress calls being received, numerous sightings by planes, helicopters, fishing boats and military craft, no one went to their aid. After drifting for 14 days, the survivors washed up in Libya, the country from which they had left 16 days earlier. Of the 72 who set off, 11 were still alive when they made land fall. Two more died on the beach.

Rethinking Economics…

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A long time ago, as an extremely un enthusiastic undergraduate, doing a degree in Social Studies, I studied Economics. I remember very little. However, from time to time I still dip into the edges of Economic theory after distant memories are fired by Robert Peston or a rather pompous politician fatuously attempting to make macro economics sound like household budgeting.

Economics matters. The people who undertake pure economics degrees do so because they know that it is one of the routes into power and wealth- working in the City, or making their way into policy making or work with influential think tanks. However the subject is a mystery to most of us. What are people taught on these courses? Are they prepared to use what they know for the good of people and planet?

Back in 2013, I blogged about an interesting rebellion by economic students (see here.) They called themselves the Post Crash Economics Society, as they were mystified at what to them seemed liked the ultimate failure of economic theory (the economic crash) had resulted in no change to the curriculums followed by the Universities, and the dominant (and apparently entirely fallible) economic theories continued to be taught with far to little critical engagement.

4 years down the road, those rebellious students have entered the world of work, but it seems that little has changed at the universities.

A new book, describing the journey of the Post Crash Economics Society and a network called Rethinking Economics has now been published.

The book, entitled Econocracy, challenges the core of how economics is taught around the world. Check out the review here in The Guardian by Aditya Chakrobortty, who wrote this;

The most devastating evidence in this book concerns what goes into making an economist. The authors analysed 174 economics modules for seven Russell Group universities, making this the most comprehensive curriculum review I know of. Focusing on the exams that undergraduates were asked to prepare for, they found a heavy reliance on multiple choice. The vast bulk of the questions asked students either to describe a model or theory, or to show how economic events could be explained by them. Rarely were they asked to assess the models themselves. In essence, they were being tested on whether they had memorised the catechism and could recite it under invigilation.

Critical thinking is not necessary to win a top economics degree. Of the core economics papers, only 8% of marks awarded asked for any critical evaluation or independent judgment. At one university, the authors write, 97% of all compulsory modules “entailed no form of critical or independent thinking whatsoever”.

Remember that these students shell out £9,000 a year for what is an elevated form of rote learning. Remember, too, that some of these graduates will go on to work in the City, handle multimillion pound budgets at FTSE businesses, head Whitehall departments, and set policy for the rest of us. Yet, as the authors write: “The people who are entrusted to run our economy are in almost no way taught to think about it critically.”

It is worth checking out the Rethinking Economics website too, which spells out their challenge to traditional economic theory, which in practice is almost always Neoclassical Economics, of a particular kind.  They describe a number of ‘problems’ with economics, including;

One of the most pressing issues of our time is climate change. To tackle it, we need all the good ideas we can gather. Yet academic economics is not helping. Take the UK, for example: of the 24 Russell Group universities that have economics departments, only nine have environmental economics modules. Of those nine none mention ecological economics or other alternative economic perspectives.

They also describe the way economics courses approach the issue of inequality;

Currently, economics education raises one perspective – ‘neoclassical economics’ – to the sole object of study, which has grave repercussions for the way economists view inequality. In basic neoclassical economics, the distribution of income is treated as a natural outcome of market forces, and interventions are deemed to disrupt these forces. Power and politics, and historical questions about how inequality has arisen, are rarely addressed.

What is more, there are ideas within economics that tackle these questions: approaches such as feminist or development economics do address the historical and cultural reasons for ingrained and persistent inequality, and take a more real world focused approach in which economics can and should try to intervene.

But, because curricula leave out these approaches, economists’ ability to understand or address inequality are limited. And because so many economics graduates go on to work in think tanks or organisations like the World Bank, this lack of pluralism has very real and tangible effects across the world.

They suggest this alternative approach;

Our campaign aims to change economics so that it will educate the next generation of economic decision-makers in a diversity of approaches. We believe that graduates will have a much firmer grasp of global, regional, gender and racial inequality were they exposed to a range of competing perspectives and required to assess their strengths and weaknesses. We also emphasise an understanding of the historical causes of inequality and the ethical implications of different policies.

These changes will shape a new generation of economists who are open, engaged and socially conscious. These changes will also mean that economists will be equipped with a variety of tools, appropriate to the shifting and complex factors that sharpen inequality in our society. Without a reformed curriculum, economists and policymakers repeatedly think within the same parameters and fail to devise policies or build economies that work for the good of everyone within society. To address inequality, the ‘Overton Window’ through which politicians, economists and citizens understand the world must first be opened up, and the first step towards this is a pluralist curriculum.

Power to ’em.

Submissions needed for Proost Poetry Collection 2…

I am really excited to be able to give this a plug. A couple of years ago I was involved in curating a poetry anthology called Learning to Love. We are now officially launching the opening of a new collection for submissions.
We would be really grateful if you can share, tweet, pass on this message as far and wide as you can- we really want to connect with people who would not normally find a wider voice…
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Following the success of Proost’s first Poetry Collection (see here for more details) – we are now seeking poetry submissions for our next collection!
As before, this book hopes to gather voices from in and around the margins of our organised faith gatherings, and is particularly interested in hearing from poets whose writing has not previously found a wider audience. The collection of poetry is intended to be a resource for worship, contemplation, prayer and faithful prophetic criticism.
Poems should fit broadly into one of the following categories/chapter headings;
  • Ordinary/Sacred (God in all things. Everything is spiritual. Heaven in ordinary.)
  • Everyone is welcome (Refugees. Belonging. Inside/outside.)
  • Resisting (Disagreeing well. Protest. Justice. Inequality.)
  • Whole (Restoration. Becoming. Healing. Authenticity. Vulnerability)
  • Wild (Creation. Evolution. Uncivilisation. Our impact on the natural world)
  • Post Truth (What is truth? Where is it? Who defines it? Trump and Brexit)
  • Lament (The absence of God. Unfairness. Loss. Pain. Doubt.)
  • Hope (Where does our hope come from? Where do we see it?)
Submission process
Step 1: Form Please complete this form to tell us a little about yourself and your work. Step 2: Submit poems You will receive a confirmation email following completion of Step 1 providing the instructions and guidelines for sending us your work.
The closing date for submissions is the 28th of May 2017.
We charge no fee for submitting work.
Notes on selection process:
We are looking for poems with something to say – poems that open us up rather than close us down.Poetry at its best can be challenging, disturbing, uplifting, transforming and much more. If you write poems like this we want to hear from you. We are not interested in reputation or CV- rather we want to encourage those of you with a poetic/prophetic voice and let others hear it.
We will select poems for the collection if they fit the broad (and generous) ethos of the book and if they are of a quality and spiritual depth that moves us. This means that some
very good poems may not beselected. We hope that you will understand that we lack the  resources to give feedback on the reasons for our editorial decisions.
We look forward to reading your poems!
About Proost
Proost is a small publishing outlet aimed at gathering together resources from the creative edges of Church. Most of the material is made available for download- although hard copies of books can be purchased via a print-on-demand service.
If you have not done so already, check out http://www.proost.co.uk which is chock full of great music, art, movies, worship resources and books.
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The Beatitudes, 2017…

 

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When Jesus saw the crowds, he retreated into the safety of his own penthouse suite and after he sat down his disciples came to him. Then he began to speak and taught them, saying:

Blessed are the rich, because their wealth trickles down like warm syrup and everyone else feasts like ants on the mess beneath their tables. Through them the heavenly economy surely prospers.

Blessed are those who are properly focused on the things that matter and do not get distracted by weak sentiment.

Blessed are the strong as they reach out to smite the weak and unproductive. Their nation will be the most powerful on earth. There will be no end to the wealth they accumulate.

Blessed are those who can control the message and shape it to their own demands. Blessed are their spokespersons. Blessed are the forks in their tongues.

Blessed are those whose charity is sensibly directed only to the deserving poor. May their tax burden be greatly reduced in gratitude.

Blessed are those who are stuffed full, for they will never scrounge from the rest of us. Blessed are those who are content, because they are obviously hardworking, responsible, decent people.

Blessed are those who are white, male and rich. They can make the world as they wish. They can take what they want. Any hole is theirs for the filling. Any pussy is theirs for the grabbing.. They can exploit whoever, whatever, to ensure their own advancement.

Blessed are the warmongers, for they will ensure our security. They will make our nation great and our enemies tremble at our feet.

Blessed are those who take no shit from anyone. May persecutions be heaped on the heads of all the small people who dare to question or deride those I have ordained for positions of power and wealth.

May no small slight be left unpunished, lest the proper hierarchy of all things be questioned. For heaven belongs to the rich and to them alone. All else should consume what they can, according to the riches they are able to grasp. Let the fire of aspiration burn in your souls so that the Kingdom might never be compromised; so that the economy might never lack confidence.