Ageing and India

Valerie LipmanValerie Lipman is an honorary Postdoc Research Fellow at the Social Care Workforce Research Unit, the Policy Institute at King’s. (926 words)

Just as the British TV-watching public was being captivated by the start of a three-part reality-style programme, ‘The Real Marigold Hotel’, showing eight familiar-faced senior citizens set up home in Jaipur north India, I was on my way to West Bengal in east India to take part in a gerontology conference. While the show raised some big questions about realistic retirement choices, including enjoying India’s many splendours, India is coming to terms with its own vast and growing population of older citizens. Continue reading

Assessing practice: the OSCE adapted for social work

photo of Imogen Taylor

Professor Imogen Taylor, University of Sussex, reports on the first seminar in a new series hosted by the Social Care Workforce Research Unit at which she was discussant. (332 words)

Professor Marion Bogo from the University of Toronto Faculty of Social Work gave the first of the new Social Work Seminar Series at King’s College London on Tuesday 5 May on the topic of the use of the OSCE, an Objective Structured Clinical Exam, in social work.

The invited audience for this virtual seminar [these are Prof Bogo’s presentation slides] came from social work policy, education, research and practice, including key members of stakeholder groups, to hear about the use of the OSCE in North America and debate its application to social work in England.  We learned that the OSCE was initially developed in medical education in the 1970s in Scotland and has been adopted by other health related professions. In North America, it is now being piloted and researched in social work. The essence of the social work OSCE is two-fold: first, practice competence is directly observed and assessed in 15-minute simulated interviews with standardised clients/users played by actors trained to enact the role of a client scenario; second, immediately post-interview, ‘meta-competences’ are assessed  in a rating of the students’ critical reflection on their practice, how they linked theory to practice and what they planned to take forward from the experience. Continue reading

Piloting the Sababu Intervention in the wake of Ebola

Meredith NewlinMeredith Newlin, Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s, reports from Sierra Leone. Her post incorporates photographs of the Sababu Training Programme in action last month. (1,386 words)

The Ebola outbreak, which reached Sierra Leone in May 2014, quickly became a global health crisis and caused significant psychosocial distress and a disintegration of communities across West Africa. The case numbers are now dropping and Sierra Leoneans talk about the ‘aftermath’ and a shift towards a recovery phase. However, amid a resource-limited system there is still an urgent call to address the psychosocial needs of individuals and families by enhancing the skills and capacity of the existing workforce. Continue reading

New directions in child welfare: good news from the Canadian province of New Brunswick

Geraldine Poirier BaianiDr Joan RapaportGeraldine Poirier Baiani (left) and Joan Rapaport report from New Brunswick. (931 words)

These days, high profile reports of child care tragedies, rising numbers of children being taken into care and social workers struggling with high caseloads are commonplace. Stories of positive developments in children and family services are rare. However, a chance meeting whilst on holiday led to a remarkable discovery: the caseloads of child welfare social workers in the Canadian province of New Brunswick now stand at an incredible seven. Continue reading

Push and pull: doctors deciding to leave the UK for New Zealand

Stephen MartineauStephen Martineau is a researcher at the Social Care Workforce Research Unit in the Policy Institute at King’s. (670 words)

The Social Care Workforce Research Unit (SCWRU) last week hosted a lecture by Robin Gauld of the University of Otago, New Zealand. Professor Gauld, who is 2014 NZ-UK Link Foundation Visiting Professor, presented new research (done with Dr Simon Horsburgh) on the migration of medical professionals from the UK to New Zealand. Audience members, who included the High Commissioner of New Zealand and the Executive Dean of the Faculty of Social Science and Public Policy at King’s, also heard formal responses from Stephen Bach (Dept of Management at King’s) and Jill Manthorpe, Director of SCWRU. Continue reading

The challenges of medical workforce migration between the UK and New Zealand

Prof Robin GauldOn 29 October 2014 the Social Care Workforce Research Unit at King’s hosts a seminar examining workforce migration in health and social care (places still available). Prof Jill Manthorpe, Director of the Unit, is joined by Prof Stephen Bach, Department of Management at King’s: they will be the formal respondents to a presentation given by Professor Robin Gauld who is the 2014 NZ-UK Link Foundation Visiting Professor. Here, Robin Gauld introduces his work, which focuses on health workforce migration between New Zealand and the UK. (531 words)

The week of 6 October saw significant media coverage in the UK of the 2014 State of Medical Education and Practice report by the General Medical Council. This indicated that around half of all migrating doctors are departing for the shores of Australia and New Zealand. One newspaper summed it up as: ‘…They cost us £610,000 to train – but 3,000 a year are leaving us for a life in the sun…‘. Continue reading

The opportunities and challenges in managing non-UK-qualified social workers in London social work practice

Dr Allen Bartley

Dr Allen Bartley

Are you a registered social worker who has supervised or managed a social work team and who has worked closely for at least 3 months with a non-UK-qualified social worker? If so, Dr Allen Bartley of the University of Auckland would like to hear from you. Dr Bartley, Visiting Research Fellow at the Social Care Workforce Research Unit, is conducting a new study, Crossing Borders: Social work employers’ and managers’ perspectives of migrant social workers. In this call for participants he explains the rationale for the study and how you may be able to help. Interviews are in July.

Background to the study

Social work is a global profession practised in over 140 countries. Its spread and development have been accompanied by a drive to attain professional status and a coherent international identity through the work of a number of international organisations concerned with social work practice and education, such as the International Federation of Social Workers (IFSW) and the International Association of Schools of Social Work (IASSW). The global nature of the profession is reflected in the large number of international professional and academic social work publications and, in Europe, the imperatives of various EU directives and initiatives such as the Bologna Declaration have motivated social work educators and registering authorities to move towards a closer alignment of practice standards to a European norm (Walsh, Wilson & O’Connor, 2009).

That social work as a profession aspires to such a globalized outlook is premised on an assertion that the profession adheres to a central set of values and ethics that transcends national boundaries (Welbourne et al., 2007). Similarly, higher educational programmes in social work across a number of countries now stress ‘universal social work professional values’ such as self-determination, confidentiality, being non-judgemental, acceptance and the respect for diversity (Welbourne et al., 2007; Calderwood, Harper, Ball & Liang, 2009).

As a result, social workers in many countries may feel that they belong to a transnational profession. This perception is reinforced by both government immigration policies and by the global recruitment activities of social work employers. Social work agencies have been actively recruiting and marketing to migrants the benefits of living and practising in the UK, in an effort to fill gaps in its social care system (Hussein, 2014; Christie & Campbell, 2009; Simpson, 2009;). In the UK, between 2003 and 2004 there was an 82 percent increase in the number of overseas qualified social workers entering the country, with the greatest numbers coming from Australia, South Africa and the US (Welbourne et al., 2007), though changes to UK immigration policies more recently have seen a shift towards recruitment from across the European Economic Area (Hussein, 2014). This internationalization of practice has led us to conceptualise social work as inhabiting a transnational professional space (Bartley et al., 2012).

That transnational professional space is not without its challenges. However universal they may be, social work values and ethical codes are always interpreted through the lens of national or regionally-specific historical, social, political and cultural norms (Welbourne et al., 2007; Simpson, 2009). These norms are manifest in a range of challenges that confront transnational social workers: in employment practices and workplace cultures; in negotiating new sets of legislative imperatives and political tensions; and in gaining recognition and acceptance of the validity and transportability of their educational qualifications, skills and practice expertise gained overseas; and in navigating the particular forms of ethnic and cultural diversity and the attendant politics that manifest in local sites and impact on social work practice.

Taking part in the study

As part of the Research On Workforce Mobility network (ROWM) at King’s College London, the Crossing Borders team has partnered with Dr Shereen Hussein, Principal Research Fellow at the Social Care Workforce Research Unit, to replicate in London a study currently underway in Auckland. We plan to interview social work employers and managers in London about their experiences of supervising non-UK-qualified social workers practising in the local context. We will conduct the interviews in London throughout July 2014, or if you are not in London during this time we can arrange for a video or telephone interview.

We would like to hear from you if you are:

  • a registered social worker who has supervised or managed a social work team; and
  • have worked closely for at least 3 months with a non-UK-qualified social worker; and
  • willing to talk about your experiences and reflections.

Please contact: Dr Shereen Hussein to arrange an interview on 020 7848 1669 or shereen.hussein@kcl.ac.uk.

We invite participation from professionals in both statutory, for-profit and voluntary (not for profit) organisations of varying sizes (from very small to very large), and across a range of fields of practice. This study is part of a larger comparative study involving professionals in New Zealand and Australia.

More information: on the Crossing Borders project web page and in the Information Sheet for Study Participants (pdf, 2pp).

Dr Allen Bartley is a New Zealand-trained sociologist who migrated to New Zealand from the United States in 1992. Based in the social work programme in the School of Counselling, Human Services & Social Work at the University of Auckland, he is part of a research team investigating the transnational dynamics of the social work workforce in New Zealand. Additionally Allen is involved in a project exploring the use of social media by migrants in Auckland, and its impact on their sense of identity and belonging. He is Visiting Research Fellow at the Social Care Workforce Research Unit, King’s College London (from July 2014).

Letter from Sarasota: support services for older people

Valerie Lipman

Valerie Lipman

Dr Valerie Lipman is a social gerontologist and independent researcher. She reports here on support services for older people in Sarasota, Florida and particularly on the growing trend there toward ‘board-and-care’ arrangements in private homes. Could we see more of this in the UK?

I’m in the old age capital of the world. Sarasota on the Gulf Coast of Florida, USA boasts a total population of 386,147 of whom 32.5% are over the age of 65 years. And a third of that grouping is over 85 years. In the UK, the equivalent would be a town such as Christchurch in Dorset where 30% of residents are aged 65 and over. The national figure for the 65+ population in the USA is about 13%, and just under 18% for the State of Florida as a whole. This makes Florida fairly similar to the UK where the equivalent figure is just under 17%.

Older people come to Florida from across North America, and some from Europe to live here*. The sun shines most days, though it’s been a bit like England lately—teeming, non-stop rain and colourless skies. But freak days aside, it’s mostly a pleasure to wake up to.

With such a large older population the scope for delivering and trying out new support services feels almost endless. The general aim is to encourage ‘ageing in place’ and there are scores of home agencies, as well as ‘homemaker companion’ services, providing friendship and support. The former are registered services, the latter are not.

But just the same, many want or need the certainty and security of residential care. From continuing care retirement communities (CCRCs) to nursing homes there are innumerable private registered bodies in the Sarasota area offering services to older people. CCRCs offer a full range of housing choices and services on one campus—from independent living to assisted living to skilled nursing in an attached facility. The skilled nursing option costs $4,000-$8,000 per month in addition to entrant fees ranging from $150,000-$600,000. Assisted living facilities (support centres are called ‘facilities’ here) and memory (dementia) facilities/homes average around $3,000-$4,000 per month. There are also State-run services. Classically these are nursing homes, for which you have to demonstrate income below a certain level to qualify for what’s known as the Medicaid waiver.

But what do you do if you find yourself caught in the old eligibility trap of being too rich for Medicaid and too poor for the private homes? You could take a risk at one of a growing number of ‘private care homes’—also known as board-and-care homes. They are not the private homes of the UK that can serve any number of older people. Homeowners offer long-term personal and less regimented residence in a family friendly environment for one or two elders as a home business. These homes are not, however, regulated by the state.  They don’t have to meet any of the rigorous requirements that apply to group homes and assisted-living facilities (see Barbara Peters Smith, ‘Private-home care could become more common for elders’, Sarasota Herald Tribune, 23 January 2014).

They do, however, fill a huge need when it comes to cost. People will tend to hand over their pension to the homeowner to take care of them. No one knows how many of these homes exist. Most operate by word-of-mouth referrals and are private-pay only, but they are on the increase in an area where there is pressure on affordable places for the growing 80+ population. And like any other home the residents are dependent on the good will, attitude and behaviours of the owner/manager. Without family or friends to check out what’s going on, the scope for abuse is endless—at every possible level.

Yet, with some regulation and light-touch inspection, could this be added to the options of support for older people in the UK? It may be that Shared Lives is our take on this—an adaptation of what used to be called adult placement or adult fostering, but with the critical difference that Shared Lives arrangements are registered and regulated.

Sarasota is dealing with the complexities of an ageing population that we will have to meet in the UK in time. How to provide sufficient and varied enough facilities capable of offering security, safety and care in a homely environment that are not strangled at birth by hide-bound bureaucracy or slip into becoming exploitative ‘senior farms’?  Watch this space!

Dr Valerie Lipman is undertaking an investigation of how recent government changes in public services in the UK are impacting on BME elders. You can contact Valerie on valerielipman2003@yahoo.co.uk


*Projections from the University of Florida’s Bureau of Economic and Business Research (BEBR) show the percentage of the 65 and over population increasing to over 35% by 2020, and almost 40% in Sarasota County by 2030 BEBR, Florida Population Studies, Volume 44, Bulletin 159, June 2011.

 

A new approach to social work recruitment in the United States

Dr Mary Baginsky

Dr Mary Baginsky

Mary Baginsky, Visiting Senior Research Fellow at the Social Care Workforce Research Unit at King’s and an expert on the UK Step Up to Social Work programme, reports on a New York initiative, the Children’s Corps.

I have also come to learn the difference between ‘feeling unsafe and just feeling out of place’. There have been many times when I feel out of place but I am getting over that.—A Children’s Corps Programme member

There is an increasing interest in the United States (US) in trying to ensure that those who are employed in children’s welfare services know what is ahead of them. What have been called ‘realistic job interviews’ attempt to give applicants a deeper insight into what the job entails. They are proving to be reasonably effective where the job is complex or difficult and where there are high turnover rates early on in careers, as well as where aspects of the work may not be fully understood by applicants. By giving them a real idea of the challenges the chances of retaining good staff increase. In the UK many of those recruiting onto social work programmes already do this explicitly or implicitly. We are also seeing some targeting of resources (such as the bursary) at people with prior experience with the idea that this will pay dividends in quality and retention.

The UK Step Up to Social Work programme has now recruited its third cohort. It is targeted at those with a good degree (defined as a first or upper second) as well as significant experience with children and young people. Time will tell what the retention rate is like but the feedback from trainees indicated that their prior experience was invaluable, even if they felt it was not always recognised by the universities or agencies where they were based. On the other side of the Atlantic another similar initiative has also just recruited its third cohort. Once again experience is at the heart of the thinking about how to attract and retain good social workers of the future.

Based in New York, Fostering Change for Children recruits college graduates as well as existing professionals on to the Children’s Corps programme. They all have to be prepared to commit to work in foster care and preventive services in New York City (NYC) for two years. The hope is that many of those who are accepted onto the programme will go on to qualify and practise as social workers. In fact some of those in all three cohorts already have a Bachelors degree in Social Work and see the programme as a way of gaining experience before embarking on a Master’s course. Since 2011, 88 Children’s Corps members have been placed in jobs in foster care agencies and preventive programmes across NYC. The receiving agencies are not expected to provide any additional support and the Corps members are no different from any other employee.

The Children’s Corps programme was inspired by Teach for America and shares its hallmark traits of emphasizing selection, training and support. Its message is that child welfare work is rewarding, but is also complex and demanding; it takes a strong and motivated individual to succeed in the field. The application and recruitment process is rigorous and involves realistic interviewing techniques and resilience testing to try to ensure they get people prepared for tough work in difficult environments. The programme starts with a five-week intensive summer school, but there is no funding to support the participants so they must have or need to find the resources to survive in New York without a stipend. The staff of Fostering Change for Children realise that there is a danger that it will therefore tend to attract those who have enough funds or supportive parents to see them through.

In May I was fortunate enough to be able to spend time with four Corps members while I was in the US as part of my Churchill Fellowship. Two of the four did not fit this profile. One had come to the US from the Caribbean when she was eight and said she had always been encouraged by her mother to give back to the society where they had made their home. She had recently married and the couple was able to live on one salary until she started earning. Another member had borrowed money from her family that she paid back when she started to receive a salary.

While the summer school was said to be excellent they all admitted that they had faced a steep learning curve when they joined their agencies. The average turnover in fostering agencies in NYC is 40 per cent, which meant that those coming towards the end of their second year had seen almost all their original colleagues leave. To say they were dealing with very difficult cases is an understatement and, at times, they had all wondered if they could go on. The quality of the supervision they received in the agencies had varied as this person told me:

For the first nine months of my job when all these workers were leaving it was a very negative work environment – it was not supportive and you were very much on your own. You had seven families assigned to you – I had 19 children assigned as a result. Sometimes I wouldn’t even know what I was supposed to be doing. I had some really old cases that were very hard. I thought about quitting every other day – may be at one point every day. I used to come home late at night after working a 12-hour day and I would cry – I was so exhausted. I did not know how I’d be able to go back the next day. It was very hard.

This person did not quit and is now studying for a MSW. But, as with her colleagues, she attributed her survival to the support she received from Children’s Corps. Not only does each member have a mentor whom they can use as much or as little as they want, the organisation provides monthly training sessions that also offer the opportunity for peer support as well as additional training. The retention level has been good across the early cohorts. Of the four Corps members I met three intended to qualify and practise as social workers and the fourth is deciding between that and going on to become a clinical psychologist, where she admitted she would earn more and probably attract more professional respect. The experience they have gained means that those going into the profession do so with a very realistic expectation of what the work is like. They have also learnt that if they are to stay in the profession they will have to seek out support if it is not immediately available.

Mary Baginsky is Visiting Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. She is author, with Claire Teague, of Speaking from Experience: the views of the first cohort of trainees of Step Up to Social Work (Department for Education, June 2013). Follow Mary on Twitter: @abbotsky

Go to the Fostering Change for Children websiteChildren’s Corps blog

Invisible communities: Working with older people from Europe and beyond

Joan Rapaport

by Joan Rapaport

Our fifth annual older people conference hosted jointly with Making Research Count and Age UK London was held on 30 January at the Guy’s campus of King’s College London.
Joan Rapaport, one of over a hundred attendees and a Visiting Research Fellow at the Social Care Workforce Research Unit, reflects on the findings reported during the day.
Presentations from the day are on our website.

 

Professor Jill Manthorpe: Addressing ‘invisible’ inequalities in social careWhy now?

In her opening comments, Professor Manthorpe described an ‘elastic’ Eurovision definition of ‘White Other’ which included non-EU and EU nationals who were also often defined as White Other as well as the more frequently cited migrants from Canada, USA and Australia. As usual, she noted, London is a hotbed of change. The backgrounds of ‘White Other’ people are extremely diverse, with huge implications for appropriate social care provision. However, although the Equality Act 2010 is now in force, the needs of this population group as they age have not been explored.  Professor Manthorpe acknowledged the challenges faced by busy social workers and the constraints of assessment forms but asked:

  • How can appropriate services be provided if vital biographies and life stories have not been recorded?
  • What happens to people with memory problems or whose speech is impaired after a stroke – who provides the life experience to inform the care plan?
  • How can we help people to recall their memories and help care staff to see the person behind the care plan, so that social care truly reflects their needs?

Professor Karen Christensen: Older Scandinavians in London – how do they fare?

Professor Christensen identified the longstanding historical connections between Norway and Britain. Norway’s population is small (5 million) and scattered amongst 429 municipalities. It is difficult to find out the exact numbers of Norwegians living in the UK today, as the government figures are workforce related.

Her recent and unique life course interviews of seven Norwegians living in London, ages ranging from 59 – 75, revealed that these women came to London for love and marriage, au pair work, freedom from close knit communities and disappointment about Norwegian welfare services. Their passage was made easier because their fathers had encouraged them to learn English, as a ‘useful’ language. Those who had trodden the au pair and marriage route had stayed for family reasons and had chosen part-time work to suit. Others, who had come for career reasons and later married here, had made their decision to stay right from the start. These women juggled their careers with family responsibilities and worked until retirement. None had come ‘to get a better life’ in the traditional migrant sense.

Only one, married to a black man, had faced discrimination. Although settled in Britain, none wanted to become British citizens. They had all their rights, bar the right to vote. Professor Christensen considered that if there had been the option of dual nationality, their decisions might have been different. However, they could keep in touch with their Norwegian culture through their community networks and work and telling their grandchildren about Norway. There was also the Norwegian ‘injection’ of the holiday cottage – but then straight back to Britain! These women had no fear of getting old in Britain, as long as they could avoid residential care. They hoped for help from their families in return for caring for grandchildren. Those who had worked for Norwegian agencies received higher pensions than their British counterparts. They could thus afford private care.

Dr Shereen Hussein: Older Turkish migrants’ care needs in the UK: cultural encounters and unmet needshow do these compare?

Dr Hussein identified three distinct Turkish population groups: Turks, Alevi/Kurds and Turkish Cypriots living in the UK, sometimes referred to as ‘invisible minorities’. Although separate in their homeland, ethnic divisions are less apparent over here. However, each group has different ethnic histories. Old age is taking some by surprise.

With a Turkish colleague, Dr Hussein has been interviewing older Turkish men and women (ages ranging from 55 – 102) as well as Turkish care and community care workers. These interviews were conducted in Turkish (crucial to the study). Typically, and in stark contrast to the Norwegian experience, people came to London for a ‘better life’, to find work and possibly to flee persecution. The jobs they found, often through friends, were low-skilled, with poor working conditions and without ‘formalities’ (regulated). They did not have to speak English because the whole workforce spoke Turkish. Many had been over here for 50 years and never learnt English. Once they left the labour market, they found a ‘sudden’ need to speak English and know the system. Language posed a huge barrier, although those with adult offspring who had grown up in the UK were more aware of services and activities. However, for others retirement has meant ‘when I became old’, nostalgia for their homeland, loss of identity and feelings of disempowerment. Whilst inter-changeable care responsibilities from and for older people were assumed within the culture and elsewhere, these expectations could not always be met and older people were sometimes obliged to use social care services with trepidation. The gap between actual and perceived social care needs was large and culturally sensitive services were viewed by the research participants to be limited. Overall, the Norwegian participants painted a far rosier picture of growing old in London than their Turkish counterparts.

What needs to change?

  • Awareness that family is an important care provider but is not always available;
  • A focus on working with younger and older Turkish communities to bridge language and care barriers;
  • Assessment of the cost implications of not providing culturally sensitive early intervention and preventative measures, on crisis and intensive care services.

Jo Moriarty: The Equality Act 2010: Protected or ignored characteristics?

Jo Moriarty explained that most of the provisions of the Equality Act had come into force in October 2010, and those relating to Age Discrimination later in October 2012. Direct and indirect discrimination, harassment and victimisation are now outlawed. There are nine protected ‘characteristics’ of which seven apply in her review on the needs of older people: age – disability – gender reassignment – race – religion or belief – sex and sexual orientation. The study considered the impact of the Equality Act for Age UK across five different services. However, the task was very difficult because of the invisibility of the population in question and the dearth of research focusing specifically on equality and diversity. Routine monitoring for different protected characteristics is uneven, there are differing reporting standards and detail relating to the characteristics is not picked out. For example, in respect of Falls Prevention and the known benefits of exercise classes, areas such as accessible publicity, opportunities to socialise, religious preferences and single sex facilities have not been researched and the impact of discrimination on take-up is unknown. Day service provision is similarly neglected. Faith-based services may provide communal social activities, but these too are very under-researched. Furthermore, as more older lesbian, gay and bisexual people live alone than other groups – does this mean they have an increased need for home and hospital services?

Jo Moriarty warned of the risks of making assumptions and cited the example of the famous film star, Merle Oberon who was elusive about her Anglo-Indian background, to the extent she hid the fact that her Indian mother was actually her dresser. Jo highlighted the similar trap of erroneous assumptions of heterosexual relationships and the impact on people’s feelings.

What are the key messages?

  • Carry out more research on the needs of people with protected characteristics;
  • Provide inclusive publicity to reassure people;
  • Show staff have been trained in equality and diversity issues;
  • Avoid stereotyping;
  • Seek service users’ views even on sensitive matters; people like to be asked, especially if they are consulted on how to ask the question.

Dr Nan Greenwood: Does ethnicity matter? Working with older people from minority ethnic groups

Dr Greenwood said that her literature review had confirmed that health and social care issues for older people from minority ethnic groups were truly invisible. There was some information, but no one collates it. Statistics are unreliable and research is limited. Older refugees in particular may be isolated because of health and social problems and cultural differences and face multiple layers of disadvantage. If they have no permanent address they may have difficulties registering with a GP and thus accessing health services. Cultural perceptions about illness and the process of ageing may also act as barriers to accessing services more generally. The experiences of carers from minority ethnic groups are additionally compounded by disadvantage and marginalisation and culturally insensitive services. The effort to obtain help (phone calls and forms) is a major barrier to seeking help. Carers value information, accessible, culturally sensitive services and, most importantly, face-to-face contact and first language support.

People from lower socio-economic status groups from all minority ethnic groups describe their health as poorer. This information is complex as ethnicity is multi-faceted and changing and given the opportunity people may define themselves as belonging to more than one race. Homogeneity within groups may be overemphasised and mask heterogeneity. Ethnicity needs to be considered against other aspects of identity such as gender, age, religion, disability and health. Dr Greenwood stressed that the general principles of good care need to be embedded throughout and cited recent research that showed people from minority ethnic groups also wanted to be treated with dignity and respect.

Dr Greenwood acknowledged pros and cons in respect of separate or mainstream services. Separate services may be more culturally sensitive and innovative and mediate with general services. However, they may also bleach culture and set people apart. Evidence is as yet lacking to help tease out these and other issues.

What are the key messages?

  • Be aware that the concept of ethnicity may sometimes obscure other facets of identity and difference;
  • Health and social care evidence about the needs of people from ethnic minorities exist despite the limitations of the research;
  • Stop problematising ethnicity and blaming the characteristics of ethnic minorities e.g. for low take-up of services;
  • Keep abreast of changing patterns of health and disease to improve take up of screening and early intervention;
  • Keep the common factors of care in sight.

Jean Lambert MEP: Does London work for older Europeans?

Jean Lambert explained that it is assumed there about 100,000 EU nationals living in London who are over 60 years of age. They have come at different times and for different purposes, some as a result of WWII, refugees fleeing persecution, Jews from various parts of Europe, to join families, for work and so on. Under EU directives, discrimination is forbidden. Information is available in twenty-three languages on the EU website to help people attain their rights. Whilst discrepancies exist between different health and welfare systems across all member states, problems for non-EU nationals living within the EU are even greater.

In respect of workforce mobility issues and the UK, Jean Lambert expressed concern about attitudes in the UK in respect of transitional arrangements relating to people coming into the country from Bulgaria and other parts of Eastern Europe. Previously, even when apparently welcoming people from Poland, a whole host of problems had arisen: lack of support, language problems and people not understanding their rights and entitlements and often those on the administering side likewise. People when they arrive know they have rights but not what these are. Nothing has since changed.

This is the Year of European Citizenship and to mark the occasion one million Euro has been set aside to put on a number of events. As part of the Year, the European Parliament has commissioned and will report on discrepancies between the different systems, including those between Europe and the UK. In addition, funding from the Citizen Rights to Equality Programme (under the former European Year of Active Ageing) is expected to report on the needs of people needing dementia care.

What are the key lessons?

  • More research on the needs of older people from these minority groups could be helpful;
  • People need to be able to access information about their rights in their own language;
  • People need a single point of expert help and someone to assist them through the process.

Conclusions and closing comments

Professor Manthorpe highlighted the importance of ensuring that the histories of people from ‘White Other’ population groups were not forgotten, given their relevance to appropriate health and social care provision. The day had demonstrated that people have very different trajectories and these need to be acknowledged. In particular, the question remains how can social workers respond under their current work pressures at a time of dwindling resources? Attention to a person’s story may help at least to get things right first time by making sure that services are both accessible and acceptable.

Joan Rapaport is Visiting Research Fellow at the Social Care Workforce Research Unit, King’s College London. The Invisible Communities conference was organised by Jess Harris. Twitter hashtag for the conference is #olderpeople5