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Reflections on Rotherham: part 1

September 1, 2014 1 comment

I’ve read and re-read the Alexis Jay report into child sexual exploitation in Rotherham, and now feel able to comment.  Actually reading a report properly before commenting on it is, I well understand, something of a minority sport nowadays, but one I grew used to in the days before the absolute need to offer comment within minutes of publication.

Anyway, There are a number of things that stand out for me, and which I’ll cover in two longish commentaries:

1) The reports’s good, but not that good, and shouldn’t be taken as gospel

The Francis report into the poor care at Mid-Staffordshire NHS Trust was immediately hailed as everything that needed to be known and done about both mid-Staffs and the NHS in general.  In parliament, Labour called for the implementation of all the report’s recommendations even before it was physically possible to have read it.  In fact, it turned out that some of the recommendations were misguided, and reflected a good deal of ignorance on the part of Francis and his team.

The Jay report, while more limited in scope (it makes no national level recommendations, as it was commissioned by the local authority) falls into the same bracket, because it can be bent – knowing that most people won’t actually read it) to most pre-established agendas: it’s all about race; it’s not all about race; it’s all about leadership; it’s all about reporting.  Whatever your agenda is, you’ll find something in there to back your claim.

In fact, the report’s a good report, especially given the tight time constraints against it which it was battered out (the grammatical errors are testament to that), and offers very important insights and details, but it’s far from a great report, carrying great authority (to be fair to Jay, such authority is never claimed).

While it’s very good on both the institutional attempts and failures to get to grips with the situation, and on the the harrowing details of the exploitation of young people, the analysis in several places in inconsistent or non-existent.  This is crucial when it comes to the ethnicity issue (see below), to which a specific chapter is devoted, precisely because it now allows those with pre-set agendas to cherry-pick, but it several other areas too the report provides more questions than answers.

Perhaps the best that can be said of the report is that while it doesn’t format those questions well itself, a reasonable critical analysis of the findings should contribute to the formulation of a good set of questions for the fuller public inquiry into nationwide child sexual exploitation, which Labour is now (rightly) proposing and which should be allowed to build on rather than replace the work being done by the Office of the Children’s Commissioner (which is properly referenced in the Jay report).

2) The question of ethnicity

The question of whether being an Asian man makes you more likely to sexually exploit children because of your “culture” is the one that has dominated the media.  The Jay report itself appears conflicted.  The chapter on ethnicity starts with a categorical enough statement:

As has been stated many times before, there is no simple link between race and child sexual exploitation, and across the UK the greatest numbers of perpetrators of CSE are white men (para 11.2).

This suggests that those arguing for ‘race-blind’ protection and prosecution. Sunny Hundal, for example, argues, using the same assertion in the Jay report that:

There is certainly a problem here but its not about race or religion – it is about misogyny and a desire to subjugate women……The men preyed on these girls because they were weak or because they were physically or mentally intimidated, not because of the colour of their skin.

Yet just a few paragraphs later, the Jay report appears to backslide on its evidence-based position:

The issue of race, regardless of ethnic group, should be tackled as an absolute priority if it is known to be a significant factor in the criminal activity of organised abuse in any local community. There was little evidence of such action being taken in Rotherham in the earlier years.(11.11)

This backsliding (which actually dominates the executive summary to chapter 11) opens the door to those, such as Ben Cobley and now (in practice rather than Ben’s theory) the BNP/EDL are keen to peddle their nonsense about embedded “ethnic favouritism” (the argument presumably being that if this allleged favouritism were removed from public policy, child sexual exploitation would magically cease).

This is unfortunate, since there is a perfectly coherent explanation as to why perpetators in one area may tend to be one ethnic group rather than another, and indeed why perpetators identified may come from certain ethnic groups in numbers which are disproportionate to their numbers within the overall population.  It is an explanation which allows for prosecution and protection to remain as ‘race-blind’ as it should be, while still ensuring that the local contexts for perpetration, which mean that perpetrators come disproportionately are of a single ethnicity, are still appropriately taken into account.

It’s not rocket science. When I discussed the ‘issue of ethnicity’ with a senior social worker colleague the other day, she was quite clear:  Asian men in some Northern towns may be the main perpetrators of child sexual exploitation not because of their ‘culture’, but because of the particular “infrastructure” that their working lives provides.  In simple terms – they drive taxis, or have friends who do; they work in/own kebab joints, where young people (especially those unsafe and/or unhappy at home) congregate; they work irregular hours in family businesses, in which the don’t clock on or off, and in which absences of two or three hours go unremarked.

Now of course, taxi driving and kebab shop owning can be seen as a part of an Asian ‘culture’, but it is more historically accurate to see it as a structural feature of changes in the economy, and the racial discrimination that accompanied those changes, which just happens to provide, in conjunction with the growth of mobile technology and social media over the last 15 years, the opportunity for people who happen to be of Asian ethnicity to become involved in exploitation.   As Arun Kundnani sets out (see references here) in relation to Northern mill towns [1]:

As the mills declined, entire towns were left on the scrap-heap. White and black workers were united in their unemployment. The only future now for the Asian communities lay in the local service economy. A few brothers would pool their savings and set up shop, a restaurant or a takeway. Otherwise there was minicabbing, with long hours and the risk of violence, often racially motivated. With the end of the textile industry, the largest employers were now the public services but discrimination keptmost of these jobs for Whites (2001:106)

If this analysis is taken on board [2], it becomes perfectly reasonable to construct child protection and perpetrator prosecution processes which are both ‘race blind’ and context aware.   If more Asians are prosecuted, so be it – being forced into the taxi business by employment discrimination a generation ago does not legitimise heinous actions – but it can still be accepted that there is no direct relationship between ethnicity and a desire to have sex or sell sex with underage girls (and of course this analysis leaves aside that taxi drivers may be prosecuted because they are easier to identify than people who do not go out onto the streets late at night but have the same intent).

3) Rotherham may turn out to be better than the rest

Rotherham: “the nation’s exploitation capital of England”, screamed the Guardian headline to one of the many fact and thought-free commentaries which appeared in the first days after publication of the report.

This is what the report actually says:

At the time of the Inquiry there was no standardised reporting of child sexual exploitation that would allow reliable judgements about whether child sexual exploitation was more or less prevalent in Rotherham than in other parts of the country and the very nature of the problem means that accurate reporting will continue to be a challenge. It seems likely that the existence of the Risky Business project, its ability to attract referrals directly from children and parents affected by sexual exploitation, and the attention given to child sexual exploitation at a multi-agency level over the years meant that the problem would have been more visible in Rotherham than in some other parts of the country (para 4.11)

In short, Rotherham is almost certainly no worse in terms of numbers of sexually exploited children, and probably a good deal better (although the massive under-resourcing of the council reported by Alexis Jay certainly had an impact on Rotherham.   Whether or not that will in time be evidenced is open to doubt, but there is simply no evidence – and this follows from the analysis above – that Rotherham has a unique toxic mix of people and circumstance which makes it more prone to a sex exploitation epidemic than anywhere else in the country.

The issue of “standardised reporting” is an important one. When I discussed this point in the report with social workers who had not read the report last week, they immediately stressed a point made elsewhere in the report (para 13.13) – the tendency for actual child sexual exploitation to be hidden by figures and reports relating to guns and gangs; that is, just as in Rotherham until fairly recently, there are still lots of areas in the country – including London – where children being raped is seen as either incidental to ‘more serious’ crime patterns, or remains simply not known.

In general, right across the country, there are senior council officers and police commanders in a state somewhere between panic at being found out and continuing denial.  It waits to be seen what happens next in relation to a possible public inquiry, but I think it’s better to prepare for more and bigger shocks.

4) The perfect storm

But shock at new revelations will not be enough.  As other horrors are exposed, we need to understand better why there has been this apparent nationwide explosion in abuse and exploitation.

The Jay report gets halfway there.  It acknowledges, as best it can in the context of limited data, that the actual incidence of child sexual exploitation is likely to be higher in the 200os and 2010s than it was in the 1990s, when it was largely still wrongly referred to as child prostitution, but it makes no effort to establish why, because the focus of the report is instead on why the authorities failed to respond to the information they were getting from Risky Business and others.

The reason for the upsurge, though, is not that hard to find.  Across the country new online pornography and mobile technologies, and arguably also imported rap discourses, have created a toxic mix of deeply misogynist attitudes, whereby girls (of any ethnicity) are regarded without due humanity, and new opportunities and tools to engage in sordid sexual (and increasingly financial) gratification.  A vital aspect of this toxic mix is the stripping away from young girls of their self-esteem, such that they become compliant in their own abuse – witness the details in the report of how abused girls cling to the notion that they are in a loving relationship.

This isn’t just happening in adult-child exploitation situations; perhaps even more alarming is the normalisation of sexual violence and exploitation between children, where sexual degradation of 13 and 14 year olds through repeated sex acts has become a normalised part of growing up.

If we are to move on from Rotherham, we need to accept that, while the council and police institutions may have failed, they (and lots of others around the country) have partly failed because they were hit by this perfect storm of ‘modernity’, of the type Giddens (1991) describes so presciently, in which whole tranches of the population find themselves, through the collapse of  time and space, utterly ‘disembedded’, prey to ‘ontological insecurities’ of the type my and previous generations never were, and then ‘re-embedded’ in weirdly perverted social norms.  Of course, it is those who are materially powerless – poor families in Rotherham spring to mind – who suffer most from in these reformed social relations.

5) Moving on from Rotherham

That’s enough for today.  Tomorrow, I’ll start to explore how we, a society as a whole but led (I suggest) by a re-energised,  re-focused, even re-professionalised social work profession, might start to tackle some of the social ‘disembedding’ that has led (in part at least) to what we now see in Rotherham.  That involves putting the social back in social work (via Amartya Sen).

In setting out this agenda, Ill keep coming back to the Jay report, looking in particular at the sections on management failure and loss of professional autonomy (not least Barnardo’s part in that), and at the mistakes assumptions Jay makes about what she sees as two ends of the spectrum – the “community development model” she wrongly ascribes to Risky Business, and the “child protection model” which she acribes, without due critique, to Rotherham’s social workers.

There’ll also be a section on Jay’s wrong-headed dismissal as irrelevant the fact that CSE cases made up just 2-3% of all children’s social care cases.

 

Notes

[1]Rotherham is not of course a mill town (though it has had some textile industry), but some of the same processes have taken place, and this is an analysis of the wider position in the North of England.

[2] And for those who refuse/are unable to grasp the concept, it may be worth asking why it always seems to be bankers, and almost never postmen, who commit bank fraud.

 

 

 

 

 

 

 

Why the throat?

June 20, 2014 1 comment

I try not to join in twitterstorms, but the one about Michael Fabricant MP’s threat to punch a woman in the throat does bring with it an interesting question.

Why the throat?  Why not the more common concept of a punch to the face or the nose?

Domestic violence-focused literature more than hints at a possible reason: this study finds that 68% in the  ( fairly small) sample of women who suffered domestic violence have suffered from strangulation, and here’s one showing that violent death by strangulation is 6 times more likely for women than men.

The Fabricant tweet may reflect less sudden rage, and more a desire to subjugate, control and make defenceless, and be specific to women.  That’s what makes the tweet more disturbing.

Now, I’m not suggesting that Fabricant is someone prone to violence against women, and of course punching is not strangling..   But I am suggesting that, as part of his making amends as best as he can, he might want to explore why he wanted to go for the throat, and make that exploration public.  That might be a useful service.

 

 

 

Categories: Gender Politics, Law

Improving child protection and family support

enhanced-31052-1402589737-2 (2)While it’s utterly scandalous that the tabloid media has apparently gone and done a cheap photoshop on the picture of Ed Miliband getting ready to get to grips with our submission to the Labour policy review, the important thing is that it has been lodged and that he is clearly taking a keen interest.

The submission is online at the party’s policy review website ‘Your Britain’ (see below if you’re not registered).   If you do read it and support the nine recommendations made, please do take a moment to leave a comment, as evidence of online support is important in getting it up the league table of submissions to be taken seriously.

And it is a very serious submission.

 

Pdf:  SUBMISSION TO LABOUR POLICY REVIEW

Fisking the fisker

January 31, 2013 Leave a comment

I’m not blogging much at the moment, but I still abide by my golden rule of blogging:  if I happen to come across some twat misusing PISA results in defence of Gove, then I will always make a point of calling her/him out, if I can be arsed.

So there’s a total twat, Toby Young by name, misusing PISA results in defence of Gove, and I can be arsed.

Young says, in a piece ‘fisking’ the apparently “hysterical” Suzanne Moore*:

Ah. Here we go. Her [Moore's] views are “evidence-based”, Gove’s are “ideological”. Odd line of argument for a former employee of Marxism Today to pursue, but there it is. In fact, there’s plenty of evidence to support Gove’s policies. Here’s evidence that standards fell during Labour’s 13 years in office. Here’s evidence that free schools have raised standards in Sweden. Here’s evidence that increasing school choice has raised standards in England. Here’s evidence that the academies programme is raising standards in England.

The first link is to the wikipedia entry on the Programme for International Student Assessment (PISA).

And this is what the Chair of the UK Statistics Authority had to say about the blatant misuse of PISA data by Ofsted and the DfE:

While I understand that some users of these data would like to make comparisons between the first PISA study in 2000 and the most recent in 2009, the weaknesses relating to the response-rate standard in earlier studies should not be ignored. The validity of comparisons of national rankings as a result of an increase in the number of countries covered by the PISA study, and the degrees of uncertainty in country scores attributed to sampling and measurement error are also important in this regard.

That is, Young is totally and utterly wrong**.  More on why he’s wrong here***, here, here and, just for completeness sake, the National Foundation for Educational Research review of the PISA 2009 study:

England’s performance in 2009 does not differ greatly from that in the last Pisa survey in 2006.

*  Readers may wish to note James Delingpole’s delightful metaphor on twitter for Young’s attempted fisking of the “hysterical” Moore.   I can’t remember where I put it though.  Anyway, it’s bound to cause a twitterstorm so you may see it before I see it again.

**  Of course, it’s not just that he’s deliberately misusing the PISA data.  His logic is also utterly at sea.  Even valid evidence that England may have fallen down the international ranking wouldn’t be proof that standards have fallen.  It might be as easily explained by other countries getting better (oh, and the huge increase in the number of countries in the rankings).

***  , I note that I asked, in this post about the Chair of the UK Statistics Authority’s October ’12 letter:

Will they continue to peddle the same untruths, secure in the knowledge that the “plummeting down the international league tables” is now well entrenched as a result of lies to date, and much more likely to gain press coverage than a letter from the UK Statistics Authority?

I think we now know the answer.

Jackie Ashley on Labour and migration: grammatically, factually and politically incorrect

December 17, 2012 4 comments

Jackie Ashley is by no means the worst Guardian columnist – Simon Jenkins is, by a country mile – but this is horribly disappointing:

We do need to think about the numbers. In a decade, almost 4 million migrants settled in England and Wales, according to last week’s census figures. The population rose by 3.7 million between 2001 and last year; 70% of the rise was caused by immigration.

Though the effects are spread across most of urban Britain, they are most dramatic in London. There, just under 45% of people are white British. Across the country less than 90% are white. Some 7.5 million people are foreign-born; there are apparently around a million households that speak no English……….

There are some fundamentals on which Labour should be more forthright, less mealy-mouthed. One is language. What we want is a strong sense of common citizenship, obligation and rights going together. That’s always been the progressive position. But it’s impossible to fully participate if you don’t speak and understand English. Miliband is talking about this at last, but can afford to push harder.

Alongside this go basic, longstanding progressive positions on women’s rights, free speech, equal educational opportunities for all and individual freedom of choice. In a time when one religion – Christianity – is on the wane, but others are on the rise, the liberal advances won over decades can never be taken for granted.

First of all, Ashley looks to be factually wrong on  the number of “households that speak no English”.  (That’s slipped past the Guardian grammar police, and I assume it means “households in which no-one speaks English”).  She appears to have got the 1 million figure from the ONS findings (pdf via here), which says that in 4% of the 23.4 million households in the country (so roughly 1 million) no-one “speaks English as a main language” (p.18)  Not having English as a main language is quite different from speaking no English, and the ONS makes this perfectly clear in the very next sentence:

People who did not report English as a main language may br fluent English speakers and were able to report their English language proficiency as ‘good’ or ‘very good’.

So the Guardian’s fact-check police appear to have been on holiday too.

The key issue, though, is how this fairly glaring error  fits with the overall narrative that having funny-language foreigners, especially non-white ones, is necessarily a problem that Labour needs to work on.

As I set out the other day, the evidence suggests that, for the country’ s long-term future, the opposite may be true.  Research from the US, for example, suggests that children who grow up ‘language brokering’ for the non-English speaking parents actually benefit cognitively, to the extent that they achieve more academically than peers who don’t have this life-role.  Further, NALDIC reports that children growing up to become bilingual make faster progress in the English GCSE curriculum than their monolingual peers, as well as outperforming them overall in GCSE Biology; Chemistry; Physics; Mathematics; Statistics; Religious Studies; French; German; and Spanish (h/t @barsacq).*

But it’s the last paragraph quoted above which is particularly worrying.  Does Ashley really mean what she says?  Does she really believe that the decline of Christianity and the the rise of other religions provides a threat to “equal educational opportunities”?  Does she really think there are a large number of Muslim/Sikh/Hindu parents intent on denying girls education?

If so, she’s not just ignorant of the research** showing the opposite, she’s also been reading too much the Daily Mail.  As, arguably, have the Guardian sub-editors.

* I was talking about this stuff with people in the pub at the weekend.  It occurred to us that in fact migrant parents not learning English as quickly as they might (or at least not admitting to having done so) may in fact be – at least partially – some kind of learned response (i.e not consciously articulated) around the developmental needs and subsequent life-chances of their children.

Compare, for example, the way in which parents (myself included) feign ignorance about subject areas so as to encourage their children to “teach” them about their new findings about the world, and how this creates not just confidence in the subject area itself but also helps to develop oracy around it.  Could it be that parents do the same as their foreign-born children learn English more quickly than them?

Further, having learned a couple of languages myself by ‘throwing myself in the deep end’ (notably Bangla from scratch but also French-to-working-fluency in a Swiss hospital), I can vouch for how absolutely knackering and even stressful it is in the early stages, when you don’t trust yourself to understand what’s said back to you.  Is it not an appropriate response for parents to provide the safety and reassurance of the first language in the home, to the extent that this becomes a familial norm even when children have got the fluency point?

** Just as two examples of Asian family commitment to female education in Britain:

1) Basit TN (1997) ‘I Want More Freedom, but Not Too Much': British Muslim girls and the dynamism of family values, Gender and Education, V ol. 9 , No. 4 , pp. 425 – 439:

Research shows that young Asian women who have been to school in Britain are increasingly been allowed to work, if only until their marriage (Sharpe, 1976). However, the assumption that British Asian girls will have an arranged marriage and will not need career advice is not borne out by research (Thornley & Siann, 1991), as the wish for marriage, children and family life does not necessarily preclude the desire for labour market participation amongst girls (Mirza, 1992). British Asian Muslim parents are amenable to their daughters’ desire to work if they are able to attain a good education and go into a career perceived as safe and respectable: one which does not jeopardise the safety and reputation of these young women (Basit, 1996a).

2) Afsha H (1989): hopes, expectations and achievements of Muslim women in West Yorkshire, Gender and Education, Vol. 1, No. 3  pp 261 – 262:

Muslim women in West Yorkshire, like their male counterparts, place an inordinate trust in the ability of the educational system to act as a means of delivering their children from the drudgery of poverty. Although in practice there is not enough evidence to support their optimism, women of all backgrounds, regardless of their own levels of educational achievement, seek to promote their children within the school and further educational systems and are increasingly doing so for their daughters as well as their sons.

For a wider review, try Stevens, Peter A. J (2007). Researching Race/Ethnicity and Educational Inequality in English Secondary Schools: A Critical Review of the Research Literature Between 1980 and 2005.  Review of Educational Research  Vol. 77, No. 2, pp. 147 – 185.

The advantage of migrants not learning English

December 14, 2012 5 comments

There’s been plenty of coverage of Ed Milband’s speech on ‘cultural integration’ in Tooting today, and I don’t intend to repeat stuff.  For the record, I agree that it was an attempt at celebrating cultural diversity, along with some decent enough policy points about protecting migrants from some of the worst excesses of capitalism.  I still don’t see how the labour movement can really claim the high ground on how we all live together until it confronts once and for all its shameful institutionally racist past, which helped create the divisions of today, but that’s another post (here’s one I wrote earlier).  As it stood, it was on ok speech.

But this bit was strangely strawman-like:

Where there are Home School Agreements, English language learning should be included.  Which too often doesn’t happen at the moment.  That would ensure that both schools and parents share the responsibility for helping foreign-born children learn how to speak English.

Is Ed Miliband really suggesting that there’s a substantial number of parents out there who are keen to stop their children learning English at school – children who can only be saved from a lifetime of  English-free non-integration by making their parents sign a piece of paper which presumably they won’t be able to read anyway?  If so, who and where are these people? Because the research I’ve seen about migrant parents’ attitude to their children’s education suggests quite the opposite of what Miliband appears to be suggesting is going on.

For example, Haleh Afshar’s research back in the 1980s found that:

Muslim women in West Yorkshire, like their male counterparts, place an inordinate trust in the ability of the educational system to act as a means of delivering their children from the drudgery of poverty. Although in practice there is not enough evidence to support their optimism, women of all backgrounds, regardless of their own levels of educational achievement, seek to promote their children within the school and further educational systems and are increasingly doing so for their daughters as well as their sons.

And later (2002), Tahir Abbas found in his study of Asian families in Birmingham that, while social class may play a part in attitudes to the importance of education:

In general, both parents and their children are convinced in their enthusiasm for educational achievement, with research continuing to show the importance of parenting to secondary schooling.

If Asian and Muslim communities – arguably the broad group in Britain most demonized as separating themselves off from the ‘mainstream’ – are so keen for their children to participate and succeed in school (for which presumably a grasp of English is necessary), what other groups are out there actively denying their children access to the lingua franca?  Is Miliband suggesting that ‘foreign-born’ children are affected by a a whole new set of attitudes from parents which don’t seem to be held by earlier migrants? I just don’t get it.

But perhaps I’m being too pernickety.  Perhaps Miliband was merely seeking to point out the importance of newly arrived parents learning English as quickly as possible so that they can help their kids out at school, so that those kids get over the barrier of a late start and catch up as best they can. That would sound much more reasonable.

Oddly, though, the research doesn’t seem to support such a thesis. On the contrary, the research that has been done (in the US) on children of migrant families who learn English while their parents don’t suggests that their role as ‘language brokers’ is a significant factor driving their educational achievement.  Dorner et al (2007), for example*, studied “the regularity with which the children of mostly Mexican immigrants in Chicago interpret languages and cultural practices for their families”, and found that:

[S]uch “language brokering” is related to academic outcomes. Using data collected from a subset of children (n=87) longitudinal regression models, which controlled for early school performance, showed that higher levels of language brokering were significantly linked to better scores on fifth- and sixth-grade standardized reading tests………The practice of language brokering that we have identified has not received much attention from educational researchers seeking to boost students’ achievement. And yet it is a literacy and numeracy practice that takes place every day in the homes of immigrant families, and it is one that may have measurable payoffs for children’s school successes across a range of subject areas. While not all language brokering situations may have uniformly positive benefits—and earlier research has demonstrated the trade-offs between cognitive and psychosocial costs and benefits—standardized test score gains may indeed occur for the children of immigrants who accomplish deep and varied brokering tasks.

This, I suggest, is more than an esoteric research point.   It suggests that significant numbers of children coming into schools and not just learning English for themselves but using their new language to help their families navigate through their new lives in Britain might, if the proper teaching resources are in place to help, actually be beneficial for educational standards overall, with native-born children carried along in the wake of these growing competencies and life skills.  It even provides one partial explanation, dare I say, for the impressive surge in the achievement across London’s very diverse schools (p.18 of report), which, as Chris Cook at the FT has pointed out, is difficult to attribute entirely to improvements within the schools themselves (though this is undoubtedly important).

In short, maybe immigration is making for a cleverer country.  Even the Daily Mail might have trouble arguing that that’s a bad thing.

That is not to argue, of course, that we should be actively seeking to deny parents access to English tuition so that their children can grow into even more rounded, talented people than they will be anyway.  That would be pretty stupid, given the other advantages that having parents who can communicate freely in their new country will bring.

But it is to point out that, sometimes, this stuff about ‘cultural integration’, and the creation of a problem just so that Ed Miliband can offer the papers a thoroughly New Labour, managerial solution (Home School Agreements for Gawd’s sake), might not actually be a very good idea, and that a wholesale defence and celebration of immigration, in the interests of the (One) Nation,  might actually end up being a winner, if Labour has the balls for it.

* For more, see also Halgunseth, L. (2003). Language brokering: Positive developmental outcomes. In M. Coleman & L. Ganong (Eds.), Points and Counterpoints: Controversial relationship and family issues in the 21st century: An anthology (pp. 154-157). Los Angles, CA: Roxbury.

Nursing’s existential crisis (part 1)

December 9, 2012 2 comments

At PMQs on Wednesday, Cameron was confronted with Ann Clywd’s personal testimony on standards within the NHS.  He concluded his reply with:

I set up a nursing care quality forum that I have attended myself to discuss these issues with nurses and nurse leaders. There is no silver bullet and no magic wand, but some simple steps, such as asking every hospital to carry out a friends and family test, asking the patients and the staff whether they would be happy for their family or friends to be treated in that hospital, can make a real difference. So can hourly rounding, which is not something to do with statistics but the idea that the nurse should be there by the bedside of elderly patients once an hour checking that they have had water and something to eat, that they do not have bedsores and that they are properly looked after.

This is utter shit.

I have written before about Cameron’s arrogant, ignorant and patronising insistence that hourly “intentional” rounding promises to embed within nursing a managerialism which will, in, short order, actually reduced standards of care, not improve them. It is difficult to see how a process which requires up to 150 boxes per patient per day to be initialed by nurses will do anything else.

When I wrote to Cameron’s Nursing & Care Quality Forum about this, setting out the kind of implementation research they should study before going down such a path, my letter was at first ignored and then, when I demanded a reply, was dismissed with the assurance that they had seen “some research” from the US with promising results.

It is with a certain grim satisfaction, therefore, that I note that the Hospital Trust where Ann Clwyd’s husband suffered such a sad and lonely death introduced “intentional rounding” some three years ago.  A Cardiff & Value University Health Board document reads:

Many improvements are thanks to a new process called ‘intentional rounding’ which guides nurses to deliver more structured care.  It includes hourly checks on patients to look at any potential risks such as the position they are lying in and the condition of their skin.  In the wards, nurses have made a real difference to patients’ mealtimes.  By implementing simple measures such as colour coding food trays and patient food charts, patients’ dietary needs are being more easily recognised and met.  The colour coding systems enables nurses to understand what a patient needs, in terms of assistance at meal times, which is important if a patient has difficulty communicating.  There is ample evidence, from research and from hospital visitors and family members, that nutrition has direct implications for patient recovery and length of stay.  Importantly, it also ensures mealtimes are as enjoyable and comfortable as possible.
Of course, one of Ann Clwyd’s area of complaints is that, as her husband died, a cheery shout about mealtimes resounded in the ward.
There is an existential crisis in nursing.  The crisis is exacerbated by tbe cuts. but it wasn’t started by them.  To suggest otherwise, as this piece does is denial of the type we saw from some on the left in the Winterbourne abuse case.  Nor is it because the “wrong people” go into nursing (as Ann Clwyd has suggested on the Marr show this morning).
The crisis has complex roots, including the changing class relations between doctors and nurses and the physical architecture of hospitals which have not taken nursing into account, as well as the long decline is staffing levels, but perhaps the biggest issue has been the abject failure of the profession’s main union, the Royal College of Nursing, to take responsibility for what really goes on on wards.  Rather, just as Cameron has done, it has sought to put the problem in the management in-tray, and blame “poor leadership” when it goes wrong.
More in part 2.
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