Going grey behind bars: meeting the care needs of older people in prisons

The population is ageing. People are living longer, and are in need of greater levels of care than ever before. But how is this increase in life expectancy and demand for care being met in prisons? Our prison population is also ageing, at a time when the sector is under increasing pressure, low staff numbers, higher levels of prison violence and disorder, and poor, crowded living conditions. In an environment which is largely designed to support young, able bodied men, how are prison staff and care teams liaising to help meet the needs of older prisoners?

A care plan for ageing prisoners

A report published in 2017 by the Scottish Prison Service called for a specific care plan for ageing prisoners to react to and provide planning to reflect the change in demographic of the prison population. The report found that between 2010 and 2016, the number of men aged over 50 in Scotland’s prison population rose by more than 60%, from 603 to 988. According to a Ministry of Justice report on prison population, the number of inmates aged over 50 is projected to grow from 12,700 to 13,900 by the end of June 2020, a rise of 9.5%, while the number of over-60s behind bars will grow by 20% from 4,500 to 5,400 over the same period.

In July 2017 Prisons and Probation Ombudsman produced the Thematic Review: Older Prisoners, which stated that HM Prison and Probation Service needs a national strategy to address the needs of the increasing numbers of elderly prisoners. It highlighted six areas where lessons still needed to be learned: healthcare and diagnosis, restraints, end-of-life care, family involvement, early release and dementia, and complex needs.

The difficulties older prisoners face on prison estates are far reaching. Not only are there physical barriers to moving around and living within a prison environment, but the increased mental health and social care burden is significant, as well as the potential need to begin end-of-life care. Many prison inmates suffer from multiple, longstanding and complex conditions, including addiction, and these conditions are exacerbated by a phenomenon known as “accelerated ageing”, which suggests that prisoners age on average 10 years faster than people of the same age in the wider community.

While some prisons have effective care plans which allow older prisoners to live with dignity, often older prisoners rely on the goodwill of officers and fellow inmates to meet the gaps in their care needs. And while in England and Wales the Care Act means that, a statutory requirement to provide care lies with the local authority within which the prison is located, this is not a guarantee. Calls have been made for care planning in prisons to become more robust, with minimum standards of care and a clear pathway of delivery, with accountability and responsibility of specific bodies being made explicit.

 

Prison staff, care teams and the NHS in partnership

Any care planning for older people needs input from a number of different sources, and care planning for older people in prison is no different. It will require input from professionals across health, social care, and housing and the criminal justice system as well as wider coordination support and legislative and financial backing from central and local government.

Prisoners with physical disabilities or diseases such as dementia need specialist care at a level that standard prison officers cannot give. Research has suggested that prison staff are being expected to shoulder this extra burden, often having to perform beyond their duty to care for and look for signs of degeneration in prisoners, particularly those who show signs of Alzheimer’s and dementia.

A number of research studies have looked at the provision of training and the use of additional, multi-agency staff to try to bridge the gap in care for elderly prisoners. In 2013 a review was conducted of multiple prisons, including some in England, the USA and Japan, which examined the training available on each estate for prisoners with dementia and similar conditions.

A number of schemes have been trialled, including extra training for staff, the allocation of specific wings or cells adapted to cater to the specific needs of older and vulnerable prisoners, and the use of peer to peer buddying or befriending services to help with care and support. Some prisons have also trialled the introduction of “dementia champions” to identify and support those with early signs of dementia or Alzheimer’s.

Extra challenges on release

As well as social care needs inside prison, specific rehabilitative needs of older prisoners being released from prison is also something that prison charities and reform bodies are keen to raise onto the agenda. A report from the Prison Reform Trust in 2016 highlighted the challenges of rehabilitative and parole needs of older prisoners, commenting that older people released from prison are being “set up to fail” by a lack of adequate provision to meet their health and social care needs on release. It highlights the limited and inconsistent housing, employment, debt and substance abuse advice available specifically for older offenders and suggest that their particularly vulnerable position puts them at risk of serious harm or reoffending.

Final thoughts

The population of older prisoners in our prisons is growing, and it is clear that a comprehensive strategy is needed to ensure that the specific, and at times unique care needs of these prisoners are met. This will mean greater cooperation from social care, health and criminal justice agencies, but will also mean reassessing how we think about social care, how it should be delivered and funded. The needs of older prisoners go beyond physical adaptations, to mental health, dealing with social isolation, the onset of chronic illnesses and at times the provision and planning of end of life care.

Follow us on Twitter to see what developments are interesting our research team.

If you enjoyed this blog, you may also be interested in our other articles:

Helping people with dementia to live well through good urban design

Planning for an ageing population: some key considerations

Co-production in the criminal justice system

Highlighting policy and practice: research briefings from The Knowledge Exchange

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So far this year, our team of Research Officers in The Knowledge Exchange have researched and written more than 30 policy and research briefings on a diverse range of subjects, from housing and planning to technology and training. Written in a clear and concise style, each briefing brings together examples of recently published evidence, alerts readers to new and continuing developments and signposts sources of further information. New briefings are available exclusively to members of our Information Service, and the choice of topics is driven by what our members are asking us about.

Today’s blog post offers a flavour of just some of the topics we’ve been covering during the year.

Housing

In many parts of the UK, people are struggling to buy or rent affordable housing. One consequence is a rise in homelessness. Our briefing – Delivering solutions to tackle homelessness – describes the complexities involved in defining homelessness, and the subsequent difficulties in measuring the scale of the problem. The causes of homelessness are no less complex, and the briefing lists some of the factors that lead to people finding themselves on the street, such as eviction, unemployment, health problems and relationship breakdowns. It also highlights approaches to tackling homelessness, such as social impact bonds and homeless health peer advocacy.

Planning

Closely related to housing is the role of planning in ensuring that individuals and families not only have adequate homes, but the infrastructure and services needed to support communities. One of the significant developments in this area has been the UK government’s policy on devolving more powers (including planning) to England’s cities and regions. Our briefing – Devolution of planning powers to city-regions – explains that each devolution deal agreed between the UK government and local authorities is tailored to the local area. In the West Midlands, for example, a directly-elected mayor will be given planning powers to drive housing delivery and improvements.

The briefing notes that, while there is widespread agreement that devolution of planning powers to local areas is a positive step, there is also concern that local areas won’t be able to deliver what they need to in terms of planning without control of expenditure, much of which is still retained by central government.

Technology

Our “Ideas in Practice” series of briefings presents case studies of projects and initiatives that have tackled a range of social issues, often resulting in reduced costs or improved efficiency. Our smart cities briefing on MK: Smart outlines a technology-led urban innovation project in Milton Keynes that aims to improve the town’s key infrastructure in areas such as transport, energy, and water. One of MK:Smart’s success stories is its Smart Parking initiative, which has encouraged drivers to use limited parking spaces more effectively, as well as providing the council with a better understanding of parking behaviour.

Another technology-focused briefing looks at the increasing development of “serious games” in the domains of planning, education, health and cultural heritage. Serious games in the policy field have borrowed elements from the video games sector, such as virtual reality, simulations and digital game-based learning. As well as improving skills and engagement among individuals, serious games have been used as a powerful way of introducing new concepts to the public, and providing people with an understanding of different points of view. The briefing showcases some examples of the application of serious games, including ‘B3— Design your Marketplace!’ which created an immersive and playful environment to encourage citizens to give their views on the design of a marketplace in Billstedt, a district of Hamburg.

Education, training and skills

A number of our briefings this year have focused on the all-important areas of education, training and skills. The Ideas in Practice briefing on science, technology, engineering and maths (STEM) education considers key trends and practical applications. Among the initiatives highlighted in the briefing is Third Space Learning, which connects primary schools in England and Wales with maths specialists via one-to-one online sessions.

In August, we published a briefing focusing on the impact of outdoor learning on educational attainment. It includes information on the implementation of the Forest School initiative in the UK, which places emphasis on children having contact with nature from an early age. The briefing highlights evidence that pupils with the highest connection to nature have been found to perform better in exams, and notes the positive impact on the attainment of those from deprived backgrounds.

Crime

Our briefing on urban gang crime highlights some of the ways that local authorities and organisations have sought to tackle the problem. One of the case studies focused on the exploitation of young women by gangs in Manchester. Delivered by women who have survived gang exploitation, it provides one-to-one support, allowing both mentors and victims to create lasting relationships and networks of support which help them as they transition from life within a gang. In 2013, the project won the Women in Housing award for best community/ training project for its work in rebuilding women’s lives.

Further information

This is just a taster of the variety of subjects addressed in The Knowledge Exchange’s policy and research briefings. A fuller list of briefings is provided here, and members of the Idox Information Service can keep up-to-date with newly-published briefings via our weekly Bulletin.

Reducing re-offending: rehabilitation and integration through employment

By Rebecca Jackson

Prisons in Britain have a poor record for reducing re-offending – 46% of adults are re-convicted within one year of release. And it’s estimated that each year, the financial cost to society of re-offending in Britain is £11bn.

In 2014, 68% of prisoners thought that ‘having a job’ was important in stopping re-offending.

However almost 50% of prisoners in the UK said that they had no qualifications, 40% needed help with education while in prison, and of these, 21% needed help with basic literacy and numeracy.

Government and academic research has supported the idea of employment post-sentence as being a key way to reduce re-offending and help integrate ex-offenders back into society. But opportunities within prison are often limited and once released, former offenders often find employers reluctant to hire them because their criminal record.

Roof Womens Prison Lincoln Castle, Creative Commons, rodtuk, July 2015.

Roof Womens Prison Lincoln Castle, rodtuk via Creative Commons, July 2015.

Building skills within prison

While in prison, inmates are given the opportunity to learn skills, trades and improve their basic literacy and numeracy ability. Some are allowed to do kitchen work within their prison; others work in offices alongside prison staff carrying out menial tasks in order to help strengthen their CV on their return to ‘normal life’.

However for many, there is little or no support, and the skills they learn are not sufficient to get them a job ‘on the outside’.

The prison service has introduced a number of schemes to attempt to improve this preparedness for work in the real world, but as the re-offending statistics show, success has been somewhat limited, with many struggling to stay in work or find work altogether.

Barriers to employment

While in some instances it is a lack of willingness or a lack of preparedness on the part of the former offender, another huge barrier to ex offender employment is the stigma associated with a criminal record and the reluctance of employers to consider people for roles who have served time in prison.

Efforts have been made by both government and independent employment and criminal justice organisations to reduce concern from employers.

Some firms have made a conscious effort, to deliver a series of very public and very successful ex offender training programmes, including companies such as National Grid, Timpsons, First Direct, Co-Op,Marks and Spencer, Virgin, Greggs and DHL.

And the Ban the box campaign, whcih aims to remove the tick box from application forms that asks about criminal convictions, hopes to reduce the impact of stigma even further by allowing ex offending applicants to reach the latter stages of an interview process, after it was found that many employers would automatically exclude someone who had checked this box on an application form.

Innovative offender employment projects

Creative Commons, Robert Fairchild, Cupcakes n sprinkles, 2011

Robert Fairchild via Creative Commons, 2011

The Freedom Bakery, based in Glasgow, is a social enterprise that employs ex-offenders, in the hope that employment will break the cycle of re-offending. The founder of the bakery said the aim of the scheme was to help encourage personal development as well as skills and integrate former offenders back into society. However he stressed that it is not about ‘pity employment‘ – people are given the chance to reform and develop, and the company hopes to make money.

Similarly Bad Boy’s Bakery, the brain child of TV chef Gordon Ramsay is now a well-established CIC (Community Interest Company) run by Working Links. Based at HMP Brixton in London, they sell goods to local Caffe Nero stores, as well as local sellers and within the prison canteen. Recruits are trained to industry standards in food quality and safety, including NVQ Levels 1 and 2 in Food Production, giving them skills in food preparation, baking, stock and time management, as well as knowledge of health and safety.

But it’s not just independent businesses who are engaging with ex- offenders. Well known high street chain Timpson’s also has one of the most successful and well established ex-offender employment schemes in the country. 16 of their shops in the UK are now managed by individuals who have spent time in prison and have come through their rehabilitation scheme.

The National Grid also offers offender training and employment programmes with people coming to the end of their sentences and provides training and a job on release for those selected. Over 2,000 prisoners have completed the scheme which has a re-offending rate of just 6%.

Our infographic breaks down some of the key facts.

Prisoners inforgraphic


Follow us on Twitter to see what developments in public and social policy are interesting our research team.

What technology brings to health and social care: a case study of Calderdale and Idox

 

By Steven McGinty

In the second of our articles on health and social care and technology, we‘re going to look at the advantages of using technology, as well as a case study of an innovative partnership between Calderdale Council and Idox.

The ‘Digital working, learning and information sharing’ strategy, developed in partnership with the adult social care sector, identifies three areas where technology would bring a number of benefits:

  • working directly with those who need care and their carers;
  • supporting the learning and professional development of staff;
  • organisational business support and information management systems.

The use of electronic notes, for instance, would be a simple step that would have a significant impact on homecare workers (highlighted in section 5 of the Burstow Commission report on the future of the home care workforce).  At the moment, care workers usually make handwritten notes and leave them in a book in someone’s home.  However, if care workers moved from handwritten notes to electronic notes, information could be shared more easily. This would mean that care managers and families would be able to monitor an individual’s care and conditions remotely.

Organisations have also seen the advantage of incorporating e-learning into staff development.  The Skills for Care ‘Digital capabilities in social care’ report found that 95% of organisations used e-learning courses to support staff development, particularly in administration-related areas, such as health and safety and fire training. For instance, instead of sending staff on full day training sessions, e-learning courses can be completed by staff in an hour, offering greater efficiency and flexibility.

However, the report also highlighted that social care related e-learning courses, which looked at issues such as dignity and respect, were of ‘variable quality’ and not able to compete with the experience of face-to-face and group learning. Therefore, it’s possible that an opportunity is being missed by education and training providers, as technology should be able to provide better solutions than the simple tick box exercises described in the report.

Interestingly, the report also suggests this might not be too far off, as one of the organisations revealed that they were looking at more interactive options and were currently working on a research project with a university in Greece, which focused on the idea of ‘gamification’.

One local authority that’s certainly tried to capitalise on the benefits of technology is Calderdale Council. The council has developed an innovative case management tool to support their day-to-day work, in areas such as child protection, looked after children, and fostering and adopting. Parveen Akhtar, Early Intervention Service Manager, at Calderdale Council explains that:

“The Child Social Care solution was created in partnership with schools, health and police. Providing an intuitive system to meet the requirements of front line social care practitioners, it enhances our ability to provide better services to families within our community.”

The Child Social Care solution creates a single view of a child through combining information from several sources into one record. This means that practitioners are able to create, access and share information easily and securely, supporting informed decisions and putting in place appropriate support for children and their families.

The system has a number of benefits and features, including:

  • improving multi-agency communication and response;
  • reducing the amount of time taken by practitioners to locate another agency involved in a child’s case;
  • enabling practitioners to access information remotely;
  • offering comprehensive performance and reporting tools for providing vital statistics;
  • providing the ability to monitor and track the progress that children and families are making.

Calderdale have teamed up with Idox, a specialist in providing technology, content and funding solutions to government, and are now offering their system to other local authorities. The partnership has already proven to be successful, with Calderdale and Idox providing their solution to councils in the Isles of Scilly and Leeds.

Over the coming years, health and social care will be facing ever greater demands with tighter budgets. For this reason, technology is going to be essential to support better outcomes and more efficient services.  It is therefore important that a strategic approach is taken concerning information technology, and that organisations look at its long term benefits, rather than the short term savings from cuts to investment.

The first article on health and social care and technology, “What’s preventing health and social care from going digital?”, can be found here.

Further reading:

 

Taming the information jungle

TonyphotoIn the latest of our series of posts looking at the work of housing associations, Tony McLaughlin explains how managing information supports activities across the Wheatley Group.

By Tony McLaughlin, Research and Policy Officer, the Wheatley Group

Comparing the volume of information we come across as a ‘jungle’ may seem a little hyperbolic, but for my colleagues and I in the Research and Development Team at the Wheatley Group, Scotland’s leading housing, care and community regeneration organisation, it can certainly seem that way.

Managing information on behalf of our colleagues in other parts of the business to ensure that they have the data and information they need at their fingertips is a core part of what we do. However, keeping on top of the information we are bombarded with can be a task in itself.

In keeping with the jungle analogy, the sources where we get information from can be quite different beasts. A quick survey of our team found that collectively we are on the mailing lists of over eighty organisations, including many specialists beyond our core business of housing, care and regeneration. These mailing lists are just the tip of the information iceberg. If you take into account social media, the number of information sources would be likely to multiply several times.

We are responsible for supporting activities across a large organisation which provides services to over 100,000 people, and employs more than 2,100 people across Central Scotland. With a team of seven people, and many competing demands on our time, we have to be smart about what we focus on. We appreciate services that cut down the amount of time we have to spend identifying useful resources. It’s important for us to provide information that is specific to the needs of our business and which supports excellence in everything that we do. We do this in a number of ways, two of which are given as examples below.

We produce an ‘Insight’ bulletin, which is aimed at leaders and is a short themed think-piece which informs strategy and service development. Recent editions have focused on diverse topics such as customer segmentation, value for money, working with communities and employment trends. We are planning editions on digital inclusion, care and support, challenging poverty, and innovative funding.

We also organise a series of seminars for staff at all levels of our organisation and for relevant people from our partner agencies. These are typically hosted at our purpose-built learning and conference centre, The Academy, which is located at our Glasgow headquarters. Our most recent seminars were arranged as part of the corporate partnership which the Wheatley Group has with the professional body for housing, the Chartered Institute of Housing (CIH).

The first of these was a visit by CIH Chief Executive, Grainia Long, to address our leadership team on the challenges faced by the housing sector in the coming years. The second was a presentation on our innovative ‘Frontline Futures’ research aimed at frontline staff, which examines the role of the frontline housing professional in light of new challenges facing social housing providers and customers.

These seminars are part of a coordinated approach to supporting staff CPD. Our membership of IDOX Information Service contributes to this, as it allows our colleagues who undertake academic study as part of their professional development to access a range of resources to help them achieve their qualifications.

To sum up, our team should not simply navigate through the information jungle for material that we find interesting – everything we do should have a purpose in promoting excellence within our organisation; the information that we disseminate should always help drive innovation and improvement.

I would be happy to discuss any ideas with other like-minded organisations. Please drop me an email at tony.mclaughlin@wheatley-group.com

For more information about what we do visit www.wheatley-group.com


 

The Wheatley Group are members of the Idox Information Service. For the past 40 years, the Information Service has been the first port of call for information and knowledge on public and social policy and practice.

Our previous blogs on housing associations include:

 

Can the Care Act really provide the transformation in adult social care needed for modern society?

pregnant carer giving pills and medication to her patientBy Heather Cameron

The legislative framework for adult social care in England has been described as out-dated by the Department of Health (DH) as it is focused on crisis intervention rather than prevention and early intervention, and on the provision of services, rather than enabling the system to be centred around the health and wellbeing of people and carers. The DH has therefore highlighted the need for government intervention to reform the legal framework so it better fits the purpose of modern care and support.

The government’s objectives for adult social care are to improve people’s quality of life, delay and reduce the need for care, ensure positive care experiences and safeguard adults from harm. The Care Act 2014 was passed into law on 14th May 2014 with the aim of transforming adult social care in England to meet these objectives.  Although the Act is generally concerned with care and support matters in England, some provisions extend to the devolved nations.  The main focus of the Act is on promoting individual wellbeing and preventing the need for care and support. In particular, it makes provision:

  • to reform the law relating to care and support for adults and the law relating to support for carers;
  • about safeguarding adults from abuse or neglect;
  • about care standards;
  • about Health Education England;
  • about the Health Research Authority;
  • about integrating care and support with health services; and
  • for connected purposes.

According to Care and Support Minister, Norman Lamb: “the Care Act represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support. For the first time, the Act will put a limit on the amount anyone will have to pay towards the costs of their care.”

Due to come into force in April 2015, with its provisions related to funding reform to be implemented a year later, the success, or otherwise, of the Care Act’s implementation is as yet unknown.

Nevertheless, there has been much discussion over the potential issues and challenges with regard to implementation. The College of Social Work (TCSW) argues that the implementation of the legislative reforms “will be challenging and demand significant cultural and attitudinal changes, both strategically and in professional practice”.

The Act presents significant changes for local authorities which will be challenging to implement in the proposed timescale. Concerns have been raised by both local authorities and charities over the funding of the Act’s provisions and the sustainability of adult social care services. A recent article published in Community Care highlights such concerns among councils, noting that nine out of 10 councils believe key parts of the Act will be jeopardised if the government fails to provide local authorities with adequate funding for implementing the reforms.

According to London Councils, London is facing double the shortfall in funding to prepare for the Care Act than previously thought with proposed new funding arrangements unveiled by the government to leave the capital with a £36 million gap.

Moreover, a subsequent article in Community Care suggests that local authorities need to consider the training challenge now in order to negotiate the issues raised by the new funding reforms.

The main costs of the Act relate to improved legal rights for carers (rising to £175 million per annum). However, there may be additional costs, for example where local authorities face increased demand for services due to improved information. Greater clarification on the support available to carers could potentially increase the workload for social care professionals as the number of carers’ assessments could also increase.

The additional requirements of providing support to self-funders as well as carers could also take its toll on councils. Caroline May, business partner in finance at Havering LBC noted at a recent roundtable that:

“There are a lot of unknowns out there that will present us with financial challenges. I think culture shift is going to be huge across the board.”

The Association of Directors of Adult Social Care (ADASS), which represents local authorities, is unconvinced that local authorities can implement the changes required in the proposed timescale. In a joint report with the Local Government Association, they highlight the financial challenges local authorities face, particularly at a time of budget cuts and increasing demand for services. A recent inquiry into adult social care in England has highlighted that there was an 8% real terms cut in spending between 2010/11 and 2012/13; and demand for care provided by adults is projected to rise by over 50% between 2007 and 2032, while the supply of this care is projected to rise by only 20%, according to Carers UK.

Despite these funding issues, however, cost savings have also been identified in relation to public expenditure savings of improved support for carers, according to the DH’s recent impact assessment, which also states that these cost savings outweigh other new costs overall. The potential benefits of the Act for people with care and support needs which could also lead to savings were identified as: “improved wellbeing, better prevention of care and support need, greater clarity, consistency and equality of access to care and support and reduction of unmet need.”

It will undoubtedly be challenging to implement the provisions of the Care Act and it remains to be seen whether the funding provided will be adequate.

Only time will tell whether the proposed reforms will truly transform the currently outdated adult social care system.


 

Further reading

The Idox Information Service has a wealth of research reports, articles and case studies on a range of adult social care issues. Items we’ve recently summarised for our database include:

The Care Act and the care market: conference summary

Adult social care in England: sixth report of session 2014-15 (HC 518)

Using technology to deliver social care, IN Local Government Chronicle, No 7598 17 Jul 2014

Carers’ quality of life and experiences of adult social care support in England, IN Health and Social Care in the Community, Vol 22 No 4 Jul 2014

Transforming adult social care (improving efficiency in council social care services), IN Local Government Chronicle, 5 Jun 2014

Care Act 2014

Understanding personalisation: implications for social work, IN Journal of Social Work, Vol 14 No 3 May 2014

State of caring 2014

Care home top-up fees: research with local authorities

Making our health and care systems fit for an ageing population

N.B. Abstracts and full text access to subscription journal articles are only available to members of the Idox Information Service.

A story with a happy ending? The UK labour market and the future of skills

Skills, Knowledge, Abilities

by Laura Dobie

Last week the UK Commission for Employment and Skills published The Labour Market Story, a series of reports exploring how the UK labour market is working following recession. In this article, we take a closer look at the results and key findings.

The reports reviewed research from the UKCES, other UK organisations and international sources to investigate:

The research revealed that while the UK economy is returning to sustained recovery, this has taken longer than before. There has been sustained growth in self-employment, and a rise in precarious forms of work, such as casual and short term work, and zero hours contracts. Youth unemployment is four times the rate for those aged 24 to 64.

There has been a long term reduction in administrative and secretarial work in many industries, typical middle level jobs, which has led to increasing polarisation in the labour market. Those with higher skills and qualifications are more likely to remain in employment and have considerably greater earnings prospects, highlighting the importance of skills in individuals’ labour market outcomes.

Continue reading

Housing associations – great places to work?

protect houseIn our second blog on housing associations we look at why they are consistently cited as great places to work and what the future might hold for them.

by Brelda Baum

Housing associations (HAs) are perceived to be great places to work according to The Sunday Times Best Companies to Work For 2014 survey (not for profit results) which is dominated by HAs and social housing employers. This seems to demonstrate that, despite the availability of other more lucrative options, people still want to work in the housing sector, perhaps because HAs and social housing organisations are at the forefront of a very rapidly changing environment, often at the cutting edge of a lot of social issues, so that by working for them, people see themselves in a position to do some good and see evidence of it. Continue reading