Monthly Archives: September 2009

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..

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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..

World Alzheimer’s Day 2009

Today is World Alzheimer’s Day. The theme of the day this year is ‘Diagnosing Dementia : Seeing it Sooner’.

Alzheimer’s Disease International explains the theme by saying that the focus is to ensure and emphasise the importance of getting a diagnosis and encouraging medical professionals to recognise the signs of the disease in order for people to receive the treatment they need.

While some promises of  concrete treatment might be a giving a kind of false hope at present -  there is no doubt that those who have a knowledge of their diagnosis and are able to access support groups and information are in a far, far better place than those who do not.

Raising awareness (and money) can only help both in the research developments and in the day to day practicalities involved in caring for those with dementia.

The Alzheimer’s Society put together this video though that explains some of the importance of diagnosis in the words who have received them. It might seem incredibly bleak  but often a confirmed diagnosis can be a relief because it provides an explanation about what is happening some certainty in a world and a situation that becomes increasingly vague and distant.

A variety of Alzheimer’s organisations throughout the world have initiated ‘Memory Walks’ to mark World Alzheimer’s Day as well as to raise money for local organisations which provide support.

I know in the UK these mostly took place over the weekend and the Alzheimer’s Society has a good summary of the events (atlhough written before the event!).

It seems that barely a week passes without new thoughts and hopes for cures or tests for new Alzheimer’s drugs. I am reminded of a woman I saw whose daughter told me how she would travel anywhere in the country that they were conducting trials of new medications (a story had  come out in the media that week about trials in Scotland) in order for her mother to receive any drugs – trial or otherwise – that might help.

While at this point, drugs may not help, apart from possibly in the short term to delay the progression of Alzheimer’s a little.

This desperation  focused my mind to remain committed to providing the support and information as best I can and if possible ease some of the process of dealing with a disease like this however possible.

So today it’s worth spending some time thinking and remembering those who might be suffering from dementia, and those who care for them.

Students

image wonderlane at flickr

Over the past week,   I have submitted an application to a practice teaching programme. It was always a part of my long-term plan – for many years, I’ve mentioned my interest in taking a student within the service that I work, in fact, even in my interview for my current job, I stated it was a ‘career’ goal’.

During that self-same interview, I was told by the service manager that the service need would dictate that first, I train as an ASW (as was..) and when I had completed that qualification, then and only then would I be able to take the practice teaching course.

I pondered on the ‘Enabling Others’ shorter course to take a student on, but settled on the full Practice Teaching award. I enjoy learning and training and can see definite advantages in the longer programme – as long as my local authority are happy for me to take it (which they are).

The training manager who is responsible for social workers’ post-qualification training has been pestered repeatedly by me for the last couple of years, asking her to give me details of the available courses – so much so that she mentioned it to my manager at a time I had more or less forgotten that the deadline was advancing.

And so it was that I submitted an application.

The borough is fairly flexible and being in London, there is access to a number of different universities with which they have links. I had the choice initially of three different programmes run by three different universities.

The ideal one (I felt) involved the longest travelling distances so I caved and as of next year, I return to the university at which I first qualified, myself as a social worker. I had a number of reservations – mostly built on memories of the university 10 years back – but one of the things that nudged me was the recollections of myself as a student at X University and how much I would have loved a placement at the place where I am now currently working…

I have no doubts it’ll be a tough period. I am finding work hard to balance at times, especially as some of the work can come up so suddenly – but that is pretty much how the work is and I think it will be a useful placement to someone out there!

And on the subject of student social workers, which I wasn’t really.. I had one come to shadow me earlier in the year. I was actually asked because she is currently doing some home care work for one of the service users I am allocated to. I offered to have her come in because it can be hard to find a social worker to shadow and I quite like having students around.

And so it was that she asked me to write a report about her time with me. It didn’t help that she had shadowed me in March and requested the report in July but I’d been on holiday so I ended up writing the report the day morning my father died. It was sitting on my desk when I left work at speed. I didn’t send it.

When I returned to work 10 days later, I  had a string of telephone calls and emails asking me when I was going to send the report to her – quite grumpy really – and another call telling me she was going to fail her portfolio because I had never sent the report.

I was sorry but I wasn’t terribly impressed to be honest. I sent her a curt email explaining that I had been off work on compassionate leave and would send the report immediately.

Yesterday, as I was trying to re-arrange some care package for the service user that she visits, he mentioned that he was sorry to hear about my father and that –insert name of social work student- had told him why I’d been off work.

As it was, I wasn’t too bothered about him knowing – but if it had happened before I’d written the glowing report – I’d have had a few things to say to the university about confidentiality, professionalism and appropriateness.

So there’s a lesson I’ll no doubt be able to share with my first student, when he or she arrives, probably in the new year..

Sick

The Independent reports that the average social worker in the UK takes almost 60% more sick leave in any given year than the ‘average employee’.

The figures were put together by MP Annette Brooke and they show that

Social workers’ annual absence rate was 11.8 days a year – 60 per cent higher than the national average of 7.4 days for all employees.

While not necessarily surprised, I would expect that rather than a lot of employees, taking a lot of days off, it is more likely (just through my own very limited experience) that it is more due to the amount of people who are on long-term sick leave that the average is so high.

image ellectric @ flickr

Compared to other public sector workers, the difference isn’t necessary so notable although there is still a differential.

The sickness rate is more than two days higher than the national average in the public sector of 9.7 days, including 11 in the National Health Service, 10.2 in the police and 7.5 in education. The average in the private sector is 6.4 days’ absence.

While links are obviously being drawn between stress and overwork, lack of support and lack of staffing – it is hard to understand how this might be tackled on a short term basis – save that by pushing out the recruitment campaigns. I wonder too, if the stress levels in other professions within the National Health Service and the police are really that much less.

Of course, it might be possible to guess that social workers are just less healthy people but I don’t really consider that – although it leads me to some rather comical mental images!

Personally, I think that there is a question of more people filling vacancies. I went to visit a friend of mine, a social worker in a child protection team in one of the more pleasant home counties. She told me they had barely any full-time employees and most of the team was made up with agency workers travelling from London – of course, posts need to be filled.  Although my own team and the previous team I worked in where all fully staffed by permanent employees, that is more of a rarity.

I also think though that  management needs to be more effective as well. People who are experienced and competent should be trained to be managers, not just appointed to management positions because they’ve been around in the team for so long. Management is a skill and can be taught and mastered.

I have had both good and bad managers. I have had many days where I’ve felt sick just as I’ve turned to the door of my office because I’ve felt that I couldn’t bear another day of the constant levels of stress – but the difference between walking through the door and not, is the support of a manager.

The Guardian reports on a scheme to train new social work/social care managers. The demand for managers in the sector, is, apparently, growing. I am more surprised that this scheme isn’t focussing on those who have a few years experience in the sector rather than new graduates – but it seems to be a scheme the government likes to support – seeing young graduates in management and fast-tracking ‘the right’ people although grumpy old me thinks it’s a bit of a sheep in sheep’s clothing approach.

Perhaps the cynicism will make me sick.

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