Archive for September, 2009

Closing a care home

Tuesday, September 29th, 2009

At the moment I am in the midst of writing part of a unit for the new course ‘Adult Health, Social Care and Wellbeing’ (K217) on ethical dilemmas , and have been struck by the reporting of a battle over the closure of a care home in Wolverhampton. On the one hand, it is being argued by the relatives of the residents, there is a risk to the health and wellbeing of residents if they are moved, or split from other residents with whom they have forged close relationships. On the other hand, the local council insist that the home does not meet modern standards for care provision.

So which argument will win? If the care home is difficult to navigate and cannot be fitted with modern equipment,  then is it not in the best interests of the residents to move them into a more appropriate and modern care environment? But what happens if in moving the residents to newer facilities, there is a risk of harm?

This situation demonstrates some of the ethical issues in providing care in the twenty first century, in the context of resourcing and planning for an ageing population, meeting care standards, and the ever shifting sands of local and central government policy. I for one will be watching with interest to see what the outcome from the Court of Appeal is in this case; I wonder if it will instigate similar types of battles elsewhere?

The Body Beautiful: Mii, myself and the watchful eye

Friday, September 11th, 2009

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Videogames and sedentary lifestyles have long been blamed for rising obesity rates. But a new generation of interactive gaming promises real benefits can be delivered directly through our television screens, and the arrival of Wii Fit seemed a perfect way to combine a consumer society’s insatiable appetite for ‘the latest craze’ with wider social and political concerns to improve the nation’s health. 

When a Wii arrived in our house it quickly established itself as a hit and even ingratiated itself with my sceptical husband, keeping him amused as he worked to improve his tennis backhand. Wii Fit arrived too and we all dutifully stepped on the board to be measured, assessed and awarded our ‘Wii age’. And it was here I started hearing alarm bells. 

It becomes fairly addictive after a while, and I’m sure it might help some people be more healthy (those who can afford it or have extremely generous grandmothers like we did!). The Wii rewards my ‘Mii’ with the systematic application of encouragement and incentives to improve my performance and hence my health. It gives me new yoga poses if I train with it, it gave me streamers on my 40th birthday and currently considers my Wii age to be just 28. With flattery like that I’ll be back for more. But I’m also aware of being slightly controlled by this little white box, fearful that the next time I step on, it will inform me that I am unbalanced, I haven’t been training enough or my Mii age is overtaking my real age. Any Mii who fails to check in for regular body tests appears to be sleeping when you enter the programme – designed no doubt to induce guilt in the real Me.  

The other day it questioned my ‘weight gain’, and asked if I could think of the reason I had gained this weight. Was it down to snacking, drinking too much or indulging in late night binges? There was no box to tick for the real reason – I had wet hair, a bulky water-logged towel on my head and a belt studded with heavy metal. I’m not the only one to have suffered at the hands of the over-zealous all seeing Wii Fit – professional fitness trainer James Mitchell was told he was ‘obese’ by this personable living room health advisor, due to the weight of his perfectly healthy muscle mass.  

I have posted before on this Blog regarding my concerns about the way in which particular messages about what it means to be healthy are omnipresent – from our television screens to the school curriculum – and potentially damaging. As social marketing establishes itself as a firm political favourite for health service development – are even apparently innocent home entertainment systems, such as Wii Fit, just another tool for inspiring Foucauldian style self discipline in a society obsessed with the body beautiful?  

“Social marketing takes lessons from commercial marketing…and applies them to the social and health sectors. It puts a detailed knowledge of consumer behavior at the very heart of the development of behaviour change interventions, campaigns or programmes”. It relies on “the systematic application of marketing concepts and approaches to achieve behavioural goals relevant to improving health.” 

(Department of Health, England).  

To me that sounds very much like what Wii Fit does! But it fails to locate the particular ‘behavioural goals’ of performing these exercises within a sensible ‘behavioural context’. There is no advice on preparation for exercise or how to end your session – except to remind you to clear the area of breakable objects incase you should hit a Ming vase with an imaginary tennis racket. Wii injuries are on the rise according to GPs, many of which are probably the result of failure to warm up, cool down or balance muscle groups. 

The development of games such as Wii Fit certainly promotes awareness of exercise and makes indoor physical activity fun for even the most hardened coach potatoes. But it is half baked health policing. Although the Wii can certainly help to foster healthy competition between family members, each trying to beat each other to pole position on the ski jump, how far it can genuinely improve health in context is questionable.  

It is also possible to cheat. My daughter has discovered you can cheat the Wii into thinking you are running by sitting on the sofa and gently shaking the Wii remote. That’s no solution to the nation’s obesity crisis! And it locks us into the private worlds of our homes instead of encouraging us to get out and meet other people. One of the biggest positive influences on health is the maintenance of strong social networks – the Wii is no substitute for face-to-face interaction. Besides, the Wii tells tales: ‘Did you know Dad hasn’t trained for a while?’ it told me the other evening. 

But my husband is not fooled by the living room health police – he is happy to allow his Mii to fall asleep rather than face the cheeky retorts of the Wii fit trainer. Confident that he has snubbed the all seeing eye he puts on Wii Games instead and starts practising his backhand. But as his skill improves and he progressively unlocks higher levels of challenge, is he any more removed from this subtle social marketing – designed to achieve ‘particular behaviour goals’ – than those of us diligently performing sit ups and sun salutations to curry favour with a little white box..? 

User groups, self-advocacy and the role of support workers

Tuesday, September 8th, 2009

Over the past few weeks I have been writing course material on the subject of advocacy. Following discussion with colleagues, I began to think more carefully about terminology, and specifically whether self-advocacy groups are in any way distinct from other ‘user groups’ in health and social care. Self-advocacy was a term coined in the learning disability field, and describes the process of ‘speaking up for oneself’. Self-advocacy organisations are, in the main, independent voluntary groups, although many are reliant on state funding for survival. Self-advocacy groups provide a space where people come together to develop their skills in advocating for themselves. But they also provide a mechanism for social networks, the development of a collective identity, and a channel for participation in local (and sometimes national) decision-making processes about services. Some self-advocacy organisations (notably People First groups in learning disability) also claim to help people secure their rights, and affect social change.

In this, self-advocacy groups are not much different from the myriad of other user groups in health and social care. In all these groups, peer support is extremely important.  In a blog entry on service users helping each other to produce personalised support, Clare Evans stated that hard to reach service users frequently benefit from direct contact with their ‘experienced peers’ (http://www.communitycare.co.uk/blogs/social-care-experts-blog/2009/07/service-users-help-each-other.html). However, self-advocacy groups for people with learning disabilities employ non-disabled staff to support this process.  Rohhss Chapman wrote about the role of such non-disabled support workers in her PhD thesis, but the wider literature on self-advocacy groups (who often refer to themselves as ‘user-led’ organisations) is notably silent on the issue.

If a distinguishing feature of self-advocacy for people with learning disabilities within the wider context of user groups is the role of support workers who do not have the label of learning disability, is it not time that we looked more carefully at the nature of this support role in practice? I suspect there is reluctance in the advocacy community to do so, because the implication is that such a discussion shifts the focus away from self-advocates. Some may view this as a threat to people’s empowerment. However, with more local authorities drawing on self-advocacy organisations to provide a representative voice for the local population of people with learning difficulties, whilst the threat to self-advocacy funding becomes ever more acute, surely the question of how self-advocacy groups are run and indeed where power lies within these groups, becomes ever more pressing?