Intermediate care

Alcock (1996) recognises that welfare provision can be experienced as highly oppressive by many black people. Those people who migrated to Britain from the New Commonwealth in the 1950s and 1960s to supplement the labour force, are now older people who did not intend to stay here. The work was poorly paid so those people were, and often still are, impoverished. The Department of Health paper “They look after their own, don’t they?” (1998) found that the group suffered racism, low income, poor housing, social isolation and relatively poor health. Research also shows that over one third of older Asian people have not qualified for pension or benefit.

Racism profoundly affects public services including social care. I worked with an older Asian woman who was required to produce her passport and documents from the Home Office before being considered for Income Support. I think it unlikely that a white woman would have been asked for these things. There is an under-representation of black people in service providing agencies – especially higher up in the organisations. The agency with which I was placed has a policy of raising the profile of professional caring as a career in the Asian community and works with Asian people to support them to gain employment as carers.

In response to the Stephen Lawrence inquiry, Manchester City Council has produced a race action plan for each department. In a report to the Best Value Committee, Hussain et al (2000) tells us that social services’ race action plan contains an intention to “identify 20 new carers from the Asian community” and “establish two ethnic minority home care agencies” in 2001. In this Race Equality Program Report Hussain et al announced a detailed review of funding to the black voluntary sector will be undertaken, as many active groups are not in receipt of support from the central revenue grants budget. Manchester City Council requires those groups applying to it for funding to operate an equal opportunities policy. The Project with which I was placed receives funding “under a coontractual agreement from Manchester Social Services.”

The Project has an equal opportunities policy both as an employer and provider of services. This policy states that no discrimination will occur on the basis of an individual’s “age, race, disability, gender or sexual orientation.” This is to be achieved by ongoing monitoring of the Agency’s service provision and by operating internal procedures for staff grievances. The DoH Inspection of Community Care Services for Black & Ethnic Minority Older People (1998) proposes that “…black organisations are disadvantaged in competing for contracts and have access to information, advice and business planning expertise.” This is another area in which the Project is active – capacity building with other Asian organisations. This is likely to be welcomed by users of services who might see the services currently provided as “belonging to a Eurocentric perspective of caring.” (DoH, 1998) rather than offering support tailored to their cultural traditions.

Over the past two decades there has been a shift from assimilation and the provision of common services for black and white towards an appreciation of cultural diversity. This is a step towards overcoming institutional racism but will require targeting of specially designed services at various groups – this could be seen as conferring “special treatment” on some users. However, I would defend it as “appropriate treatment.” This policy of developing services specifically targeted at e.g. minority ethnic elders is one best pursued by encouraging black organisations in my view. In the Department of the Environment Strategic Framework for Older People’s Housing (1998), there is a recommendation that authorities support “…community organisations to enable them to support their elders.”

The Macpherson report into the Stephen Lawrence case highlighted historical disadvantages experienced by black people. The subsequent Race Relations (Amendments) Act 2000 requires that public bodies be able to demonstrate that their policies work towards equality. To this end Manchester City Council has launched Agenda 2010. Agenda 2010 “…is a policy to deliver the eradication of racism in all forms in the city of Manchester by the year 2010.” (

The Agenda 2010 action plan details measurable actions and named responsibilities along with identified time scales. This is rather reminiscent of social work’s task centred approach. Writing in Community Care, policy analyst Maria Duggan (2002) tells her readers that people receiving and working in services are becoming increasingly hampered by “…quantitative targets and inspection regimes…” due to the government’s “technocratic considerations.” During my placement I have wondered about the effect of “quantitative targets” on the quality of service provided by organisations.

I am conscious of the difficulty of collecting qualitative data and I acknowledge the need for services to be monitored – to protect people using them and to ensure Best Value. Nonetheless whilst working as part of the team at the organisation with which I was placed I felt on occasion that the nature and quality of the work done by students and outreach workers with service users was regarded by the organisers as being of secondary importance to the number of service users allocated to students and workers. It seemed to me as though maintaining or increasing the number of older Asian people referred to the agency (and subsequently assigned outreach workers) was paramount, as it secured funding. I am not able to substantiate this but it is a view expressed by several students on the project and by a young carer who informed me that she felt that “…they [the agency] don’t really care about us, they just want to get loads of people on their books.”

Once again the conflict between care and cash is evident. It has already been stated that the Race Relations (Amendments) Act 2000 places a duty on public authorities to promote racial equality. This is to be pursued in three ways: 1. a general duty to work towards the elimination of unlawful discrimination and promotion of good relations between persons of different racial groups; 2. Specific duties to be undertaken by some public authorities – to be enforced by the Commission for Racial Equality; 3. The following of CRE codes of practice.

In the 1976 Race Relations Act it is stated that it is unlawful for the provider of a service to refuse or omit to provide a person with “…services of the like quality … and on the like terms as are normal … in relation to other members of the public” on the grounds of race (i.e. grounds of colour, race, nationality or ethnic or national origin). Thus those providing services for Asian elders must provide care of the same quality as we could to older white people. This includes, for example, providing people with food they can eat (so no roast pork for Muslim service users) and addressing people in the way they prefer (this requires thought and effort from white workers as Asian naming practices differ from white western ones). When in the National Service Framework for Older People (2001) it is stated that action will be taken to ensure “…older people [are] treated as individuals, with respect and dignity,” I feel that this can be applied to the culturally appropriate support of older Asian people (

The National Service Framework resulted from “a top-level inquiry” which looked at good and less good practice and “…consulted with a wide range of outside organisations including older people and their carers.” The National Service Framework for Older People is a response to the aging of the British population, the likelihood of greater demand for care, and the necessity for that care to be of the same standard as that received by people of all other ages. To this end the NSFOP has set eight standards:

1. Rooting out age discrimination – services will be provided on the basis of clinical need, not age. 2. Person centered care – treating older people as individuals and allowing them to make their own choices. 3. Intermediate care – enhanced services from the NHS to maintain independence and prevent unnecessary hospitalisation or premature entry into residential care. 4. General hospital care – delivery of appropriate specialist care. 5. Stroke – NHS action to prevent strokes. Appropriate specialist treatment for people who have suffered strokes.

6. Falls – working in partnership with councils, NHS action to reduce the risk of falls. Appropriate treatment and rehabilitation for people who have fallen. 7. Mental health in older people – specialist treatment for older people with mental health needs and support for carers. 8. Promoting an active, healthy life in older age – to be promoted in partnership between NHS and councils. As the title of the DoH report “They look after their own, don’t they?” suggests, there is an assumption that all older Asian people are cared for by large extended families. It is dangerous to assume this as there is a risk of leaving vulnerable people unsupported.

Nonetheless in my experiences on placement it is the preference of the particular people with whom I was working for elders to be cared for by family members. Mrs. NJB, carer of her 79 year old husband who has both physical and psychological needs, told me that she would feel it shaming and immoral if her husband were to go into residential care. She told me that she and her family did not want “strangers” (home care staff) in the family home as she and her family knew how best to care for her husband. This is in line with the thrust of the NHS & CC Act which promotes informal care. Mr. AM, for whom she provided care, also wished to receive care from his family.

An outreach worker with Project expressed dismay that the policy statements made (e.g. in the NSF) took such a long time to have any effect “on the ground.” This person felt that although there seems to be greater emphasis on recognising the cultural needs of service users, “things are moving too slowly.” Social work must be carried out within a framework which is dictated by government social policy. However this policy is acknowledged to be oppressive and this oppression is echoed through our welfare system. Initiatives have been launched to counter this institutional racism (e.g. Agenda 2010).

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