Free Personal Care?!

Gordon Brown

Image by lukemontague via Flickr

One of the surprises in Gordon Brown’s speech to the Labour Party Conference yesterday (to me, anyway!) was his proposal that from the middle of 2010 (election result nonewithstanding.. ) he would oversee a change to the provision of free care for people over 65 (and only those over 65 ) who live in their own homes (as this would not affect those in residential care) and who need to receive domiciliary care packages.

This would, in effect, mirror the situation currently in place in Scotland where personal care is provided free. However, this care would only be provided to those who meet the ‘highest needs’.

So we return to the dreaded, ‘Fair Access to Care Services’ – criteria brought in to determine a uniformity to determining who is eligible for care from local authorities and at what level of support– although to be fair, these  criteria are under review.

So, what to make of this announcement. I don’t want to be over-cynical but it’s quite hard not to be.

Firstly, I’m surprised. Currently ways of funding care at home is under review with the Green Paper ‘The Case for Change’ which, among many other things, makes it clear that the money does not exist to pay for current ways of funding social care services. So what does that mean for this policy which seems to offer more money? My worry is that the cuts which have taken place and are taking place to those who are on the lower scale of the eligibility criteria. It is those people with moderate and low needs who have not been offered any services and those with substantial needs who think ‘oh, this service is too expensive, I don’t think I’ll bother with the meals on wheels – even though I don’t have any other way to cook’ that I worry about.

For people with critical needs, there is rarely a choice involved based on finance – the service is essential so they take it. For people lower down the scale of need, they are more likely to refuse solely on the basis of financial burden.

There have, as long as charging policies have been in place by councils, been people who appear to desperately need and even want services who will turn them down purely on the basis of the amount that they cost. This, of course, means that these same people are likely to need to access higher levels of care sooner as no preventative work or support was able to be given.

That isn’t to say that ‘getting stuff for free’ is better than not getting stuff for free. Of course it is – but then, you see, I’ve personally never been opposed to the idea that those who can afford to pay for services, should. Those who lie below the savings threshold haven’t ever needed to pay for services.

If we look at the ‘critical’ banding of need which is the one that is likely to be switching to the ‘free’ part – it is generally very high needs that will be accommodated at very high cost.

The Department of Health issues the following guidelines for the highest band of need which is:

Critical – when
- life is, or will be, threatened; and/or
- significant health problems have developed or will develop; and/or
- there is, or will be, little or no choice and control over vital aspects of the
immediate environment; and/or
- serious abuse or neglect has occurred or will occur; and/or
- there is, or will be, an inability to carry out vital personal care or domestic
routines; and/or
- vital involvement in work, education or learning cannot or will not be
sustained; and/or
- vital social support systems and relationships cannot or will not be
sustained; and/or
- vital family and other social roles and responsibilities cannot or will not be
undertaken.

This obviously narrows down the amount of people that would be affected, although councils do interpret the guidelines a little differently in my experience.

I can’t help wondering if it would have been better to use that money to spread across the tiers of need to encourage those with lower needs to have some services which would and could be more preventative. For me, the pushing aside of those with ‘low’ and ‘moderate’ needs has had a massive effect of building up critical  needs for the future and paying slight attention to preventative work.

Whatever my misgivings though, it is bound to be a popular initiative. Just unusual in a time when the local authorities and central government are so pushed for money.

Anti-Social Behaviour

The tragic faces of Fiona Pilkington and Francecca  (Frankie) Harding look out from a number of newspapers this morning. Fiona and her 18 year old daughter, Frankie died when Fiona set lit to a car they were both travelling in.

It is well-documented that one of the sparks that set fire to the flames of the car was the torment and abuse that Fiona and Frankie had been subject to over a number of years.

The inquest into their deaths closed yesterday. The deaths were deemed to be unlawful death and suicide but it is the circumstances leading to a mother taking such a desperate action with her disabled daughter,  which has become the focus of media attention.

33 complaints had been received by the local police force about the abuse that the family had been suffering at the hands of youths in the area.  These complaints which included kids hurling objects at the house, unfurling torrents of verbal abuse and urinating on the walls of the house, we seen to be of ‘low-grade’ crime that the police wouldn’t necessarily prioritise.

A senior police officer stated at the inquest that it would be the local council’s responsibility to deal with low-level anti-social behaviour.

image

Obviously, among the agencies blamed, the local social services are also brought into the equation.

But in the end, what will make people feel more safe? Perhaps it is the neighbourhood police teams – but that is always a question of resources. Perhaps it is the housing offices being sterner with families where children are partaking in anti-social behaviour, but it’s not always local families involved and if people are moved on, then the problem is just moving with them. Perhaps it is social services support and intervention to those who are being victimised so that they can be heard and helped as necessary.

The police in Leicestershire are being subject to their own investigations about how they dealt with the case of Fiona and Frankie. Gordon Brown is apparently making a speech today which will address some of these issues of anti-social behaviour.

We can look at wider societal moves away, perhaps, from a parental responsibility and discipline and kids with ‘nothing to do’ who clearly find the most vulnerable to victimise and the most visibly vulnerable at that.

In the end, though, I think the lesson is about empowerment of those, like Fiona, who had no voice and even when they shouted and shouted louder to the police, they met with little response. Ultimately, whose responsibility is it to ‘do something’?  In situations where different agencies don’t always speak to each other and certainly don’t speak with clarity to the complainant, it’s easy for the blame to be pushed around on the table with every agency saying that they were not responsible.

Available channels to use to tackle behaviours that may not rate very highly on the a stretched police services’ level of ‘crime to tackle’ but often it is these smaller petty criminals that are able to make a society and a community much more miserable.

Changing IT Systems

We migrated to a new IT system a short time ago. Much angst – gnashing of teeth. The move to electronic records makes sense though. For one, I’m glad to be rid of piles of paper that linger around my general desk area – occasionally creeping onto my ‘neighbour’s’ desk much to her annoyance.

The frustration though is not at the system itself – which seems a lot better than our previous version, but the lack of synchronicity between the different systems that we use. The new system is an NHS one but we have to allay this with our Social Services system. As Social Services try to move away from paper records, we, who are seconded out to mental health teams, haven’t got full access to the same network that our colleagues working in social services offices use.

It leads to some gnashing of teeth as we try to explain, again, to the direct payments team or the specialist rehabilitation team that we can’t use their lovely ‘one-click’ referral system as we are locked into the NHS networks.

I know it is a matter of network security that keeps the two systems from talking to each other so there isn’t really any logical way around it. For very obvious reasons, the security has to be exceptional as there is a lot of very sensitive personal data swilling around in these systems.

I know this is a pie-in-the-sky idea, but wouldn’t systems that could actually talk to each other be fantastic…

On the positive note though, I think I made our IT person’s day when I told her that I really thought the new system was rather good. And it is. There’s no point in being negative just for the sake of it. Sure, it takes a bit of time to get used to it and I might begin to hate it after a few months but for now, it’s wonderful to be able to see notes being updated from a variety of sources immediately. I much prefer typing notes of visits up rather than.. handwriting in files which I was doing up to a few days ago.

Possibly because my handwriting veers dangerously into the ‘illegible’ category.

My hope is that any time spent on trying to work out new systems can off lay the time spent actually writing (I type faster than I can write!) and wandering around the office in search of paper files while stopping off for a chat with a couple of people on the way! It might be a much more effective use of time..

image gsdi10 at Flickr

Petition

Before I forget, a petition has been started by a user, Roberts,  on Community Care’s CareSpace forum for social workers who are opposed to Deirdre Saunders’ invitation to the GSCC annual conference to sign.

I was happy to sign as I think it shows both the out of touch nature of the GSCC and my own strong feelings about an agony aunt having been invited to the Task Force and thus making a mockery of the serious goal of changing social work. If input from a journalist had been required there are many who have more relevant knowledge and experience, there are user representatives quite rightly on the Task Force, but The Sun’s Agony Aunt? Well, my own opinion has been frequently voiced here and the petition’s popularity is rising..

Revisiting Best Interests Assessments

Last week, I carried out a Best Interests Assessment for a man whom I had first assessed six months ago.   In fact, he was the first person I had assessed under the new Deprivation of Liberty Safeguards. I had, at that point, recommended that the Deprivation of Liberty that he was experiencing in the care home in which he was placed be authorised – and I recommended that the authorisation be for six months.

So I was asked back. It makes a lot of sense. Although it was one visit six months ago, I had, at that point, made contact with and discussed the situation with his family members, his care team and his CPN, as well as having a meeting with him directly.

I had made some recommendations the last time I visited but they were not binding conditions, just some aspects of his life that I thought might make a difference to the quality of his life and was pleased to see that these had been actioned almost immediately that I had left the previous time.

It is obvious to say, but it is much easier, reassessing than assessing the first time. Immediately on seeing him, it was obvious to me that he looked physically better, less troubled and agitated. Although I only see a snapshot, by conversation and discussion, that was the picture that was painted for me all around.

My initial choice of six months was because it just felt wrong to me to go for a full year authorisation – especially as I felt that there were a number of adjustments that could be made in the short-term.

In retrospect, I’m glad I did it. I’m glad I was able to go back and see things having improved.

Some aspects of the Deprivation of Liberties Safeguards are flawed, I think. We have not  had a lot of referrals coming in, certainly far less than were envisaged.

Partly I think this is due to the policy guidelines and thresholds being adjusted upwards to more narrowly define what a Deprivation of Liberty is.

I think it is also partly due to a reluctance of managing authorities to make referrals, perhaps seeing it as a criticism or a failing, instead of a positive.

I placed someone in a care home a couple of months ago and I felt immediately on placing her that the placement would be an unfortunate but necessary deprivation of liberty. I informed the home manager that I felt this was the case and recommended that she refer to the Supervisory Body. She was horrified and assured me that the resident was happy at the care home. It took a bit of nagging and the involvement of her IMCA (Independent Mental Capacity Advocate) to facilitate the Deprivation of Liberty Safeguards process but I wondered if her reaction was typical of home managers.

We have also had a number of requests for authorisations come from our psychiatric in-patient wards – particularly those for over 65s. A number of people who have been referred have failed the ‘eligibility’ part of the assessment process meaning that they meet the criteria for a Mental Health Act Assessment rather than the DoLs process.

If anything, it has led to more people being detained formally in hospital. I’m of the mind that this is no bad thing as the Mental Health Act has more robust appeals processes in place than the Mental Capacity Act and the DoLs process which has very weak appeals processes.

Then there is the sticky issue of the right to (free) care under Section 117 of the Mental Health Act – so if a person has been subject to Section 3 of the Mental Health Act, the authorities are responsible for paying for after care services. I should probably devote a whole post to this at some point. It has become a major issue in our Trust and most, I assume, as older people who might not have been formally admitted previously, are now entitled to free aftercare – often through placements – which is some of the most expensive aftercare possible.

I often ponder if people, in general, are aware of their rights to free aftercare but as I said, that’s probably another story for another day..

A knock-on effect of the new safeguards, locally, at least, seems to be that there are more formal admissions.

I’m not sure this was the way that things were ‘meant’ to work but lots of interesting issues being thrown up..