COVID-19 hit England’s social care sector like an ‘earthquake’, according to Oxford Professor of Sociology and Social Policy, Mary Daly, and revealed a sector in crisis and a worrying attitude towards older and vulnerable people.
In a recent article, COVID‐19 and care homes in England: What happened and why?, Professor Daly maintains the treatment of care homes during the first months of the pandemic is ‘fast generating the sense of a scandal’. While the NHS was ‘front and centre of the national response’, Professor Daly says, ‘Care homes were poorly targeted and in many senses neglected until late in the pandemic when a response was unavoidable.’
In the report, Professor Daly exposes ‘erroneous policy choices’ and ‘many mistakes’. But, she says, the reasons for the crisis are ‘more complex’ and fundamental – a mixture of structural and politico/socio cultural factors.
In the report, Professor Daly exposes ‘erroneous policy choices’ and ‘many mistakes’. But, she says, the reasons for the crisis are ‘more complex’ and fundamental
Social care struggles to be seen as a priority, she says, exacerbated by the separation of social care and the health system which makes governance and supply routes difficult, especially in a pandemic. There have also been ‘years of austerity and resource cutting’ which have depleted the ability of local authorities to bolster social care.
In her report, Professor Daly directly criticises the long-term lack of political support for the sector and, in terms of COVID-19, the government’s calculation that care homes might be seen as less important than the NHS and, as a result, policy errors less likely to ‘hurt’ them than an NHS blunder. But, Professor Daly maintains, ‘The weak regulatory tradition of the sector also contributes to explaining the inadequacy of the response. Care homes and social care in general are far down the chain of public policy and the majority are market providers which see relatively little regulation.’
Care homes and social care in general are far down the chain of public policy and the majority are market providers which see relatively little regulation
There have been positives, she says, ‘Initiatives are coming forward to integrate health and social care.’
And, Professor Daly says, the Government did allocate some £600 million to the sector in mid-May and families, prevented from seeing their relatives, have mobilised and made themselves heard
But, talking to Arts blog about the crisis, Professor Daly says, ‘It has revealed fundamental flaws in the sector. There are the problems of funding but there is also the governance system [regulation] and inadequacies in homes.’
Professor Daly maintains, ‘Too few care homes are in the top tier. Very few are ‘Outstanding’ homes.’
Under the care regulation system, governed by the Care Quality Commission, homes are ranked as ‘Outstanding’, ‘Good’, ‘Requires Improvement’ and ‘Inadequate’. Currently, on this scale 4% of homes for older people in England are ‘Outstanding’, while more than 2,000 care homes, one in five, fall into the substandard categories. The system was intended to mirror the Ofsted system of school inspections, but some 20% of state secondary schools are currently ‘Outstanding’ with 14% substandard.
‘Social care is a very difficult area for any government. It is a political hot potato [and no government has wanted to deal with it],’ Professor Daly adds. ‘Care homes needed to be protected before Covid, it was a signal mistake.’
It worries me what all this says about our valuing of older and vulnerable people. I fear they are seen as acceptable casualties
But, she emphasises, ‘It worries me what all this says about our valuing of older and vulnerable people. I fear they are seen as acceptable casualties.’
Professor Daly warns that there is a problematic fault line within the sector, ‘Privatisation in care means that there is a very great reliance on market provision in social care...local authorities got out of provision and now care home owners are responsible for caring for our older and vulnerable people....when care is about profit we need to wake up.’
In concluding her report, Professor Daly calls for, ‘A new model of care for older adults. The large and diverse network of independent providers does not look like a resilient form of provision and is likely to have become even less resilient following the pandemic.
‘Ultimately, the country has to answer the question of what is an acceptable way of caring for its older people and view the pandemic outcome as associated not just with short‐term failures of policy and political leadership but a much deeper undervaluing of the came home sector, the activity of caring and those who require care.’
There is a very great reliance on market provision...care home owners are responsible for caring for our older and vulnerable people....when care is about profit we need to wake up
She insists, ‘Long‐term care policy has to become a meaningful part of the British welfare state in which the rights and entitlements of those involved are given a central place, unseating the far more dominant risk, exigency and need perspectives.’
Mobile games have never been more popular. Some now count their number of players not in the thousands or millions but in the billions, given them a reach that few other channels can compete with. But most of these games have as the main goal to generate revenue. What if we could harness the power of games for something more meaningful?
That is why I have been working with On The EDGE Conservation (OTEC), with game developer Quantum Shift Studios and publisher Playstack to launch ‘Kakapo Run’. This is the first in a series of games to gather support for Evolutionarily Distinct and Globally Endangered (EDGE) species, creatures that have no close relatives and thus represent a big slice of our natural heritage, which are in real risk of disappearing forever. The game is available for download on App Store and Google Play Store, and has no adverts or in-app purchases.
Only around 200 kakapos remain in New Zealand today – invasive mammalian predators, such as the stoat, brought to the islands by European settlers, have wiped out this Critically Endangered species on the mainland. These flightless, nocturnal parrots exist only on heavily controlled island conservation areas.
Only around 200 kakapos remain in New Zealand today
In the game, players must get the kakapo to safety to Sanctuary Island. Each level starts with the cry of the Haast’s Eagle, a huge raptor that used to be the main natural predator for kakapo, but is now extinct. The kakapo freezes in place, a behavioural response to avoid being seen by predators. Soon however, a cloud of dust rises in the horizon, and the kakapo must run for its life. To stay alive, players have not only to dodge the different obstacles on their path but also to knock out, or evade, predators like rats and stoats, brought to New Zealand by European settlers and which now alongside dogs and cats are key predators for the kakapo and its chicks.
We wanted to use this “infinite runner” style gameplay to showcase how species like the kakapo have to continuously dodge a myriad of threats to stay alive. That is why conservation actions to help this and other EDGE species are so crucial.
We wanted to use this “infinite runner” style gameplay to showcase how species like the kakapo have to continuously dodge a myriad of threats to stay alive
The game is, of course, heavily inspired in the unique and varied natural landscapes of New Zealand, the kakapo’s only home: from dense forests to idyllic coastlines; players can even run through the city dodging trams and traffic. It also features the rumi fruit, a red berry-like fruit that is one of the kakapo’s favourite foods.
But does the game make a difference? Initial research revealed that playing the game has important impacts on the players support for environmental conservation. In an experiment, we compared 100 people who played Kakapo Run with 100 people who played Subway Surfers, one of the world most popular mobile game. Our results showed not only that players knowledge increased while playing the game but also that they increasingly perceived their actions as having an impact on the environment and were more likely to volunteer for a conservation organization.
These are very encouraging results and a first for a game focused on wildlife conservation. Our goal is now to get this game in as many mobile phones as possible, not only in New Zealand, but across the globe. Could we make Kakapo Run the next Candy Crush or Subway Surfers?
We are already working on our next game, which will feature another weird and wonderful EDGE species… But for now, we want to hear what the world thinks of our latest release. Go on, have a play!
Diogo Veríssimo, PhD, is a Research Fellow, University of Oxford and Director of Conservation Marketing, On the Edge Conservation
Around the world, people are living longer lives. Figures show that global life expectancy increased by five years between 2000 and 2015. In the UK, lifespans were extended by 4.2 years for men and 1.9 years for women between 1990 and 2010.
Crucially, though, our ‘healthspans’ – the healthy proportion of our lives – have not kept up. For men in the UK, only 2.7 of those extra 4.2 years have been spent in good health; for women, the figure is 1.1 out of 1.9.
As a result, an average of 16-20% of later life is spent in ill health, with many older people managing multiple chronic age-related diseases: arthritis, cancer, diabetes, cardiovascular or neurodegenerative conditions, to name a few.
How do we ensure that people can enjoy their increased lifespans in the 21st century, and ease the burden on health and care systems?
This coexistence of conditions – known as multimorbidity – has become the norm: in the US, 80% of Medicare users have at least two chronic conditions, while multimorbidity affects at least 50 million people in the EU. There are implications for quality of life, and for healthcare systems around the world. Evidence also suggests that multimorbidities develop substantially earlier in people from socially disadvantaged communities, and that polypharmacy – the taking of multiple medications concurrently – can leave patients at risk of adverse effects.
So how do we tackle this growing problem? How do we ensure that people can enjoy their increased lifespans in the 21st century, and ease the burden on health and care systems?
An Oxford University-based programme called UK SPINE was set up with government funding to accelerate innovations in healthy ageing by facilitating the free flow of knowledge between academia, industry, clinicians and investors.
There is growing evidence that targeting ageing mechanisms could reduce or delay age-related diseases
Underlying UK SPINE’s mission is the idea that targeting the ageing process itself – rather than individual conditions – may be a fruitful new approach to pharmaceutical discovery for multimorbidity. In a new paper published in the journal Drug Discovery Today, UK SPINE researchers say there is growing evidence that targeting ageing mechanisms could reduce or delay age-related diseases. Work is under way to identify drugs with the potential to be repurposed in healthy ageing, and to find new targets and biomarkers for the ageing process.
UK SPINE’s annual conference – reimagined as a series of online events taking place between 11 and 20 November – will explore this emerging area of research. Conference organiser Dr Bryan Adriaanse, UK SPINE’s knowledge exchange officer, said: ‘The UK government has set the challenge of ensuring people can enjoy an extra five years of healthy, independent life by 2035. Our conference addresses the question of how that can be achieved, covering topics including animal models of ageing, biomarkers for predicting multimorbidity, and how ageing science can improve outcomes for older people in the context of COVID-19.’
By learning more about the ageing process we can delay the onset of the conditions that do affect us as we age
Professor Chas Bountra, Oxford University’s Pro-Vice-Chancellor for Innovation, is Director of UK SPINE and will be speaking at the conference on the subject of ‘five extra healthy years’. He said: ‘The government has set a clear challenge to the research and innovation community of helping older people in the UK to live healthier lives as well as longer lives. Too many people now spend their later years taking a host of medications for a variety of co-occurring conditions – whether that’s heart disease, respiratory problems, musculoskeletal conditions like osteoarthritis, or dementia. We don’t go to our GPs because we’re getting older, but by learning more about the ageing process we can delay the onset of the conditions that do affect us as we age.
‘To achieve all this, we need to bring together the scientific, industry and clinical expertise that will enable the faster development of treatments that target not just the individual conditions associated with ageing, but the ageing process itself. UK SPINE was set up to do just that, fostering a culture of collaboration and determination to improve quality of life and reduce reliance on medication for our older citizens.’
Find out more about UK SPINE’s conference series, and sign up for individual events: https://www.kespine.org.uk/events/conference-2020-free-flow-knowledge-accelerate-innovation-healthy-ageing
UK SPINE is a national knowledge exchange network funded via Research England’s Connecting Capability Fund. It is led by the University of Oxford, in partnership with the University of Birmingham, the University of Dundee, the Medicines Discovery Catapult, and the Francis Crick Institute.
By Heloise Ardley
As we celebrate Black History Month and reflect upon the hopefully long-lasting impact of Black Lives Matter, the team behind Oxford University Business Economics Programme (OUBEP) wanted to address the issues of discrimination, race, economic opportunities and inequalities by hosting impactful conversations, enriched with data from our research.
We are very excited by the agenda for The Economics of Discrimination series as it will bring together economists, researchers, policy makers, business leaders, students and journalists together to tackle the issues of the economic impact of discrimination.
To introduce the first session, Race and Economic opportunities, I brought together David Williams from Opportunity & Insights at Harvard University and Amgad Sahli, Economics and Management Student at Exeter College, and co-founder of The Black Excellence Network in a short conversation.
Some of the other questions in the series we will discuss include:
- How parental income or the lack of affects a person’s chances of future success?
- Do banks discriminate when lending?
- How is Technology impacting changes in the labour market and could contribute to reducing gender gaps or inequalities in access to employment?
We will explore the findings from our latest research - including how policies translate to strategies and actions - and share real-world accounts of organisations and individuals effecting positive change.
Join the conversation and take part in the event by registering here: https://oubep.econ.ox.ac.uk/the-economics-of-discrimination
In 2018, 2019 and 2020, the World Happiness Report ranked Finland the world's happiest country, both for its total population and for the immigrants there. The United States and the UK were placed eighteenth (fifteenth for immigrants) and nineteenth (twentieth for immigrants), respectively.
The Nordic model has long been touted as the aspiration for social and public policy in Europe and North America, but what is it about Finland which makes the country so successful and, seemingly, such a great place to live?
In the quest for the best of all societies, the School of Geography and the Environment’s Professor Danny Dorling, and co-author Annika Koljonen, explore what can be learnt from Europe’s most equitable country, why it has been so successful, with what consequence, and what does not work well when equality is so high in a newly published book, ‘Finntopia’.
Professor Danny Dorling explains more:
How did 'Finntopia' come about and what main themes does it explores?
I gave a talk in the city of Cambridge for a local group, which had formed a few years ago to campaign for greater equality locally. Like Oxford, Cambridge is very socially divided, by some measures it can lay claim to being the most economically divided in the country. Oxford comes a close second place – for instance, just look at how much the exam results awarded to children living in the city of Oxford vary by where they were born and how rich or poor their parents are. These exam results are almost all about postcodes and privilege but, in very unequal societies, many people can have little idea about that. At Cambridge, I explained this situation would be funny, were it not so sad.
Annika Koljonen was volunteering with the campaigning group. She was then a student in England, but she had been brought up mostly in Finland. What I was saying was extremely clear to her, because she had seen what happens in a more equitable country, Finland - how much less deluded people are there, and what a more equitable education system can achieve, both in reducing delusion and increasing genuine ability. ‘Finntopia’ looks at many aspects of life in Finland, but there is a great deal as well on childhood, education and on later social outcomes.
So, what is Finland’s secret to happiness?
The population of Finland, more than any other on Earth...realises that what it has...is very good
In a nutshell, the population of Finland, more than any other on Earth at the moment, realises that what it has, what it is living with – each individually and collectively – is very good. By very good, I do not mean perfect, but – all things considered – very good.
Finns then, in aggregate, translate this perception to the highest proportion of positive answers recorded per person in world happiness surveys, and have done for each of the last three years. The phrase ‘all things considered’ is important here. The expectations of Finnish people are realistic. They are also aware of what they have achieved in so many spheres of life. It is not just educational achievement but, more importantly, in health, where, a few years ago, Finland recorded the lowest infant mortality the world has ever known. There are fewer grieving parents in Finland than anywhere else, per capita. Finland scores in the top three, usually being the top one, in more than 100 similar social statistics. But the Finns are not smug or complacent. An average Finn would be a little annoyed to read what I have just written and for me to have not mentioned some downsides of life in Finland, or risks in the future to the Finnish achievement.
Can Finland be caught up or overtaken?
It is inevitable that Finland will not keep the top spot for ever. In fact, holding that position for three years is remarkable and may well have a little to do with luck and sample variance in the survey and measures used.
There are several other countries where people are almost as happy as they are in Finland, at any point one of those countries might, very likely, take the top spot. It will be interesting to watch, and the pandemic may play a role in next year’s ranking. Neighbouring Sweden, currently ranks seventh on happiness, but its people might express a little more happiness than Finland’s because their movements and activity were not quite as restricted during lockdown. Alternatively, the country that ranked eighth in 2020, New Zealand, might suddenly jump to pole position , if its citizens decide they really have enjoyed global isolation and a much stricter set of government policies on travel during the pandemic. We will just have to wait and see.
In the long-term, success for Finland would be to see its measures adopted elsewhere and other countries record similar or even higher rankings. That can also happen if the Finns decide that what they have, given the head start they now have gained, is just not good enough in future if they don’t keep improving.
How do you think the country’s ethos might have helped its approach or response to a global pandemic?
Being cautious certainly helped...personal protective equipment has been stockpiled in Finland since at least the 1957 influenza pandemic
Being cautious certainly helped. This helped directly in that personal protective equipment has been stockpiled in Finland since at least the 1957 influenza pandemic.
Finland was ready in ways countries, such as the four which make up the UK, were not. The health service in Finland was also in a far more robust state than the health service in the UK (public spending in Finland has been so much higher for many years). However, the UK has a national health service, which was still mostly public, the US does not.
Finland has much more that would have helped, had the pandemic become well-established in Finland (which it did not): a better social security and employment system is a good example. Finland would not have worried about people who were homeless catching and spreading the disease because almost no one is homeless in Finland.
Finally, politicians in Finland resign at the slightest whiff of corruption or incompetence; and the population of Finland elect competent politicians . Doing the opposite leads to bad pandemic outcomes.
If this book could help bring about one change what would you want it to be and why?
I would hope that the book can give people more hope, especially younger adults and school children. Many think that people are doomed, as the climate emergency is not addressed and as biodiversity continues to be decimated. I visit schools and children tell me that the billionaires have taken almost everything everywhere and there is no hope. I meet university students and young people in employment who think they will spend the rest of their lives struggling to pay rent to landlords, who will have more holidays and grow even richer at their expense.
I meet many people who think that everything is getting worse everywhere and who do not realise that all the states in the EU28 were more equitable than the UK, or that states such as Finland are already committed to being carbon neutral - decades before the UK. I would like people to know what is possible and also to realise how long it took and how much effort it took. What Finland has achieved did not occur overnight; but most of the world has more in common with Finland than with former world dominant states such as the USA and UK.
What Finland has achieved did not occur overnight; but most of the world has more in common with Finland than with...former world dominant states such as the US and UK
What brought you to academia and what drives your research interests
I never left university. I was very lucky in my choice of where I went; and I was incredibly lucky be born into a family where it was seen as ok to go to university. I was born at a time when only one child in 50 from an average school (not a grammar school) went to university. I had almost no idea what I wanted to do at age 18, but I knew I wanted to go to university, that I wanted to travel a long way from where I had grown-up, to see a different place and that I wanted to study social sciences and use maths and statistics.
I was not very impressed by the kinds of things that were taught in economics in the 1980s, which appeared to make no sense. So, I chose geography, maths and some computing, to avoid having to recite economic theory. I am driven by curiosity and a desire to do things that would otherwise not be done. If someone else might do it – why bother? Of course, someone might well, but it is easier if you do not imagine that!
So, if it appears no one has written a book about Europe’s most equitable country, about its strengths and weaknesses, its history and economy in the context of equality, then after a few years' thinking, if the opportunity comes up – why not? Especially if someone else who knows more about the subject than I, is willing to collaborate with me.
For any aspiring researchers out there, why would you encourage them to pursue a career in Geography?
In terms of the Human Geography that most interests me at the moment, things just became a great deal more interesting. States can be seen as natural (or unnatural) experiments where you can ask – what happens, if you did something in the 1980s, to outcomes much later?
This is not scientific. We do not have enough countries in the world to do scientific studies, but Geography is also part of the humanities, along with history, and part of the social sciences alongside politics. A more practical reason to pursue a career in Geography is that it can be relatively easy to change career later, as long as you do the kind of Geography that means you have valued skills. Most of the researchers I have worked with in Geography and the postgraduate students have since moved departments to work in areas such as epidemiology, public health or social policy. As long as you are careful to ensure that what you are doing is of value, a background in Geography can lead to research opportunities outside of Geography, and outside of academia too. You are free to be curious among a much broader range of subjects than had you had any other disciplinary background.
Danny Dorling is Professor of Geography at the University’s School of Geography and the Environment. His work concerns issues of housing, health, employment, education, wealth and poverty. In recent years his research has focussed on economic inequality, and in particular why the UK has been the first and only EU state to try and leave the union. More globally, he has been looking at trends which have indicated that growth rates such as demography and innovation have been slowing.
Find out more about ‘Finntopia’ here: https://www.agendapub.com/books/105/finntopia
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