Social work on film: Bringing the older people’s care ‘crisis’ to the small screen

[Replay Community Care’s online discussion on the first episode of Protecting Our Parents, today at 9pm.]

Student social worker Gemma is faced with a dilemma on her placement with Solihull council’s hospital social work team at Heartlands Hospital, Birmingham.

An older person experiencing increased frailty – Betty Williams – is determined to return home following a hospital admission triggered by a fall. But her cluttered home is not suitable and would leave her at risk of further admissions; Betty, however, does not want anyone coming in to declutter it without her present

Gemma comes up with the solution of Betty moving into a council-funded respite placement in a nursing home for four weeks from where she can take part in the decluttering of her home, paving the way for her return home.

However, things do not work out as planned. Betty does not visit her home during the four weeks and is reluctant to return permanently after it concludes; so the council extends funding for a further four weeks during which she still does not visit her home and it remains cluttered.

With council funding at an end, Betty decides to return home. However, eight weeks later she is back in hospital, following another fall.

This may be a fairly common scenario for hospital social workers; however, unlike the vast majority of such cases it has been caught on camera and was at the heart of this evening’s first episode of Protecting Our Parents, a three-part BBC documentary series into the care of older people.

Successor to Protecting Our Children

Made by BBC Bristol’s documentaries team, which made 2012 child protection series, Protecting Our Children, it tracks the cases of eight older people through hospital admissions, returns home and admissions to care placements, focusing on how decisions are made about their care.

In doing so it brings a rare human dimension to the debate that dominates health and social care policy today: how best to support the increasing number older people who are frail or have dementia or other chronic conditions to stay independent and reduce admissions to hospital and residential care.

“We don’t have many examples of older people, and particularly of their experiences of health and social care, on British television and we wanted to stimulate a much wider discussion among the public about this,” says series producer Alice Perman.

Alison Coppock, manager of the Solihull hospital social work team, says the programme shines a light on the realities and dilemmas of social work with older people, including the fact the difficulties in finding solutions for people.

Unresolved cases

“[Betty’s case] wasn’t resolved but that’s the reality. There’s not always a magical solution. It’s quite a good case because it does show that you can’t always achieve what people want you to.”

The reasons programmes such as Protecting Our Parents are a rarity are evident from the time and effort it took to make. Perman and her team approached 60 NHS acute trusts to take part in the programme; after initially turning them down, the Heart of England NHS Foundation Trust, which runs Heartlands, agreed.

But then they had to secure the involvement of partner agencies – Solihull and Birmingham councils, mental health and community health care trusts and some local care homes, and negotiate terms for filming people and their families at the most sensitive of times in highly pressured environments.

That process took 18 months, the filming a further year and the editing a further 30 weeks; over three hours, the series tracks the cases of eight older people.

“We were all very aware that we were filming people at crisis point and often going through the most difficult process of their lives. We owed them a huge duty of care.”

Consent challenges

This included setting up a robust best interests decision-making process for cases where the person lacked the capacity to consent to being involved. Professionals and family members made these decisions based on their perception of what the person’s view would have been on taking part in such a programme had they still had capacity to decide. Older people and their families also got to see the programmes before they went out.

Coppock says she was relieved that all of her team’s clients who were filmed had capacity to consent.

“I would have found that a bit tricky to deal with – it saved us that dilemma.”

The professional who encouraged the Heart of England trust to take part was Dr Peter Wallis, who recently retired as lead elderly care consultant at Heartlands Hospital.

“There was quite a lot of nervousness about having a film crew in the hospital,” he says. “But the BBC was quite clear that they were here to raise awareness of the issues around care of older people. They have a lot of experience of making these very sensitive documentaries.”

He says the programme illustrates some of the central themes in the health and social care of older people: the challenges of living alone; responding to crises, including falls and carer breakdown; weighting up the risks against the benefits of hospital admissions; the lack of investment in community services; and decision-making where people with dementia lack the capacity to decide on their care.

‘Easiest option not always the best’

Echoing Coppock, he says: “I think what the programme shows is that some of these scenarios are quite complex in terms of resolving them. The easiest option for people is not always the best option, and the latter can take quite a lot of time and perhaps a period of reablement.”

Wallis hopes the programme will help add weight to arguments for greater investment in community health and social care services to help older people stay independent, and the need for much closer links between hospitals and primary and community services, including care homes.

“The system is under pressure and we know the numbers of frail older people is going to increase steadily over the next two to three decades, so to stand still we’ve got to scale up.”