1146 Institutional Care

The necessity of my mother having to enter hospital raises once again family and my own personal and professional experience of Hospitals and the health and welfare services, and which overall reflects the professionalism and dedication and commitment of all the staff involved. As in all professions and occupations there are exceptional people who provide an exceptional quality of service just as there are others who do not, and a majority who work hard, find the task stressful and rewarding, and who are usually not recognised and appreciated, except by those with whom they come into direct contact. As with all the caring professions we often forget that they too are human, like the rest of us, and who have to cope with similar problems, disappointments and tragedies in their lives.

My personal experience has been limited, having never required admission and avoided the occasion when it was said that I should have my tonsils and adenoids removed, having got as far as the hospital on admission day and persuading the aunt who accompanied, to take me home. Whether this was a good or bad decision regarding my subsequent health I have no idea except that children are no longer routinely sent for such operations. I dreaded going into hospital after having nightmares from the gas administered at the dentist coupled with the insecurity I felt on being on my own in unfamiliar surrounding. That, as when early on the adults had just gone to the toilet at the end of a train journey to change into bathing costumes for the pebble beach at Brighton, the separation was only a matter of minutes, is irrelevant to a young child. Some children thrive on being left to their own devices while others experience terror.

My first experience of going to a hospital occurred when I was under five years, during World War Two when nights were regularly spent in the air raid shelter as German bombers headed over for Croydon and its airport, or onto central London. As I was being lifted in or out of the Anderson shelter built into the garden my inside left leg was pierced by a rusty nail to an extent that I had to be taken for the wound to be cleaned and dressed and the scar remained with me. Then when I was between 12 and 14 I attended a hospital once a week to undertake exercises to correct flat feet spread over at one school term although it may have been longer. And that has been that apart from out patient visits for tests which all have been negative four or five times in half a century. My interest in all aspects of the health services has two origins. I have always had an interest in British History, especially Social History passing the subject as a General Certificate of Education subject, then passing British Constitution at Advanced level when I found that the syllabus was similar to work undertaken for a local government examination, and then studying economic and social history, first as part of a politics and economics diploma which I did not complete and then as part of a post graduate Diploma in Public and Social Administration at Oxford University while at Ruskin College. As a school boy I had read the official reports of the Nuremberg War Crimes Trials on two concentration camps, and one of my first books was Odhams two volume history of the Second World War. Later the interest switched to social history with an emphasis on Labour and Trade Union History and on the reasons for the creation of the National Health Service and the problems of managing a service where you attempted to nationalise the staff rather than the service.

On one hand if you are poor because of parental and environment circumstances, or because of mistakes made during the early part of your life you should not be deprived of the best available health care, or have to undergo the forms of humiliating and arbitrary means testing which local petty officials and self appointed worthies would inflict, and in this there is evidence that those from the same background could be more ruthless and less sympathetic and flexible than those who traditionally administered such decisions from the gentry and landed classes. The same applies to the magistracy when I have known those of working class origin, and sometimes professing Christians, to demonstrate little understanding or charity for their neighbours.

Within the breadth of services which cover the national health and welfare services in the British Islands I have had many objection at the way services have been organised, especially in relation to institutional services of all kinds, I believed that services have suffered because of male supremacy in professional and general management, and because many medical doctors give the impression of believing that they are superior to other service providers, and finally those Labour politicians who have lacked the ability to understand and take control of the system in such a way to make it work in the interests of patients, when there was opportunity to make radical changes, and to do so in an evolutionary way with the support of those needed to make the changes work.

The best example where society through its media and politicians accept spending fortunes for a system which does not work is prison. It is within the last decade that top professional footballers started to earn in a week more than it cost to keep a young offender in a specialist institution, but it still costs more than most footballers are paid, let alone all those whose lifetime behaviour has never brought them close to being sent to prison. There is much talk in the media about the cost to state of keeping a young single mother at home with her children and there are proposals now to require her to take employment when the child reaches a certain age, yet she receives significantly less than it will cost to care for her son when because of the absence of his father who he may have never known and her ongoing supervision joins a gang and quickly graduates to an offenders institution.

Some young people, and unfortunately many adults need to be prevented from doing physical harm to others, including other offenders who have not committed crimes of violence, and only those who demonstrate the capacity to be reformed over a period of time should be reformed. Their regime and conditions of living should be no better than those provided our armed forces. I wish we would stop using the term abuse, especially when it is applied to children and use the correct description of violence against the person. Smacking a child regardless of why is physical violence against that child. Once we have accepted what is violence and what is not then we can begin to get down to working out how to prevent children developing into violent children and violent adults and we can also begin to reach agreement about how to deal with anyone child or adult who commits violence. Any society that does not make being a good child, a good adult, and a good future parent and living as a good citizen as the priority responsibility for school education deserves the horrors then inflicted on its self.

The most extraordinary political hypocrisy of recent years is the call that new residents to the British Islands should have to learn citizenship when in all probability they have in their previous lands and where there remains no programme for native born children now although there used to an which used to be civics classes in secondary education and a few classes on sex education. The understandable post war British way was to believe this responsibility should be left to parents, because of the experience of fascist and Nazi regimes. The problems is that we have confused bringing up in a particular ideology or with particular views as prejudices with bring children up to respect their parents and adults, to respect each other, to understand their own behaviour and the behaviour of others, to understand what is acceptable and unacceptable behaviour and so on

This failure also extends to the notion that all children from different backgrounds can be taught in the same class when all the evidence has been that you need to stream children but keep any streaming under constant evaluation. The hospital is getting what needs to be done right. You all go through the same door to casualty or these days in an emergency the acute admission ward for observation and assessment, and you bring all the expertise you can to that process in a team work structure. You then move the individual back home or into a specialist ward and try and ensure that you have the best team available to attend that individual according to their needs and circumstances. It is a system which has many deficiencies and some will take generations of training and practice to eliminate, but at core it is about recognising individuality, assessing need and bringing the right mixture of help to the problem.

For too long in education the assumption has been you can make an arbitrary assessment about education ability at one age and then compartmentalise for the rest of that child's life, or you pretend that children of different abilities and different needs can be taught by generic teachers in same classes hoping those with an academic or a sporting or artistic ability will come to the surface.

It was the product of the same mentality which in 1971 made specialist social work professionals in child care or mental health, medical social worker and family therapy undertake each other's work or worse still work with the elderly where there was no professionalism, or with mental disability or physical disability where again there was little professionalism once the child became an adult. What was worse professional social workers who ought to have known better then not only merged themselves into one professional organisation, but then destroyed the initial structure of specialist sections in favour of national specialist committees which provide a good career making opportunity for a handful of people who then were accepted by government as the professional advisers. It has taken thirty years for the system to reorganised to meet the realities of today and tomorrow.

However it may be too late to alter the ludicrousness of treating medical doctors as being on a different planet from other health service professional service providers and manager, just as treating nurses who work in hospital as living on a different planet from those who provide personal care to people in residential and day care establishments or in their homes, but most damaging has been separating the specialist child care services, especially those for children under five from education and separating social services and social work provision for adult services from the health services and how this happened and with what consequences is a subject for another day. Back to institutions

It took several generations before it was accepted that putting and keeping cast numbers of children and adults in huge long stay hospital institutions was not only wrong but also dangerous because of the way the power was misused, My favourite frightening statement from the medical boss of a large institutional complex was when he said, you know Colin my problem is that whereas the majority my patients know they have a problem and need my services, the majority of the staff who work here do not. On the other hand he also explained that the community had become so well organised that if you told someone you needed something at the entrance gate by the time you reached his office in the middle of vast complex of buildings and grounds someone had provided it, but this only added to the difficulty of the long stay residents then fitting into the outside world.

My mother who is 100 and I am nearly 70 and we tend to look on the world through our childhood and pre adult experiences, from family, to music, to cinema, to events. Last night on Big Brother a young man giving a mini lecture on music said that old people are fixated on the Beatles and then quickly moved on to a few fashionable contemporary performers that have and will govern the perspective of his generation. It requires a major effort for people like me to keep up with change although sometimes our experience remains the one which should govern today's viewpoints. My most influential and attitude changing experience about institutions was not prison but a visit as a student social worker to a long stay hospital to visit a patient, a boy in his early teens who was immobile and without speech, bringing back memories of the aunt who my mother and other sisters had cared for at home, until she died in her forties, disabled from the meningitis as a teenager. The boy had been abandoned by his family and had no other visitors. I was only there for half a day, telling him whatever came into my head, but I got a smile or two. I never saw him again, although I debated doing so but I was working day and night to keep up with the course and knew I would be moving elsewhere when the course ended.

In the same period of my life I was the first male child care student to spend time )a month over Christmas) working in a large fifty place residential nursery in Birmingham, a building which I visited again forty years later when it had long since been used for other purposes. There were then over twenty female staff mostly accommodated in a hostel in the grounds so I was given the sleeping in room of the deputy in the nursery who was on extended leave having married. The nursery was divided into four rooms on two floors and the children were loved by the staff, especially as few had regular visitors, but despite their best efforts some of the children were becoming institutionalised. I got into deep water with my course because I said so in the required report on the placement. Fortunately when I became a Director of Social Services over a decade later my employers closed the residential nursery that was open, and did so over time as children were found more appropriate care keeping the establishment staffed for several months for one child with support from financial officers once situation was explained to them. Today's professionals would be horrified if anyone suggested placing and leaving a baby in a an establishment for other babies and TV programme criticise when this is still the position in other countries.

Time and time and time again I have come across those who run establishments, those who inspect establishments and those who make policies about establishments whose starting point is value for money (the curse of the accountant), or what is the statutory requirement (the curse of the lawyers), or what is popular (the curse if the politician) rather than the person who needs help, (whether they believe they need or want it), I have mentioned before the brilliance of my supervisor at the a Family Services Unit in 1962 (guess what the politicians are thinking of reinventing such units once more) who for my first ever visit sent me out to see someone who had been on their books from the beginning, as had several of her children who had become parents with children, and who had been featured in a TV documentary (which was unusual at that time) and I had to sit before her as she sat one end of large lounge created from two council houses while she spent two hours telling me about all the social workers and social work students who had visited, what they were like, their strengths and their weaknesses (Look into abyss and the abyss looks into you). It was evident from her perspective that they were being measured according to how she was able to manipulate them into helping her and her family the way she wished, but she had grudging admiration for those who had not been seduced emotionally, psychologically, and I suspected, physically, in her younger day. This is an even greater problem for those who work in any form of institution because it is more difficult to maintain a professional relationship and if one is not careful the animals can take over the zoo, which if you are an animal is often a good thing, especially as zoos can attract those who wish to exploit the vulnerabilities of animals.

This has ended very differently from how I started and there are chunks of drafts which will now form the main subjects of further writing when there is time and inclination.