Yesterday, I went to the ‘Community Care Live’ event which runs for a couple of days (it’s on today as well). As usual, I had to pick which day had the more useful sessions and ended up with a fairly busy programme yesterday and a few difficult decisions about which sessions to attend,
I don’t want to go into a detailed review of the sessions here. Not least because I’m sure Community Care will cover the particulars far better than I but there was a theme that came up in a few of the sessions I attended.
It seemed that there is much talk about personalisation. Much distress at the ‘old fashioned’ way and social workers’ opposition to the move towards a far more equitable relationship of power between service users and local authorities. It made me sad to hear it.
It made me sad because I did go into social work to work actively towards empowerment and to embrace user choice and freedoms. I love that personal budgets and direct payments have changed the outlook of social care field. I love that there is a move away from care management and the processes that bog you down in the public sector. Particularly I love the creative way that budgets can and are being used – yes, using a personal budget for bingo trips is the way we should be going.
There is an elephant in the room though. The personal budgets and support plans that I see being approved for older adults are not the creative ones because the margins are so tight that the only money there is for people who need personal care. Sure, if you want to sacrifice one ‘wash’ a week for a bingo trip, you’d be able to but there isn’t as much money in the pot for older adults as there is for younger adults with disabilities. Please let’s have bingo trips and trips to be pub instead of day services but there has to be an understanding that older people do not get as much money as younger adults for ‘leisure interests’ so a trip to be pub may be at the expense of personal care – it’s a choice and it’s good that there is a choice but to pretend the system is equitable between younger adults or older adults or to use younger adults as an example for creative approaches is a fallacy because the budgets don’t stretch as far in older adults’ services.
We can look at day services to provide the ‘creativity’ and yes, it’s feasible that they may stretch to some of the more ‘flexible’ services. I hope they do. At the moment though, in looking at day care for someone with very high needs relating to advanced dementia, there’s a limit to the amount of ‘creativity’ you can establish. Not because we don’t want to, but because there is still a need for carer respite and the budgets are so much lower than adults of working age.
Day centres should be more proactive and certainly have to be more than ‘respite for carers’ centres but that is also about quality control. They aren’t for everyone either but they are for some people.
Of course, there is more paperwork but I can deal with that (ok, I gripe) if I can see the outcomes for the service users that I work with changing fundamentally (as they so obviously do in some situations with younger adults and older adults who are able to and wish to manage their own budgets). The problems I see is that the words are all a smoke-screen. We are being told to implement individual budgets at massively increased bureaucratic levels but then action them through ‘virtual budgets’, buying care in from the same agencies so the effects on the service users are minimal if not negligent but it still ‘counts’ as an Individual Budget for the borough’s PIs (performance indicators).
It feels like a fraud because it isn’t about making the system more flexible but more about allowing the borough to achieve better PIs.
I’m not saying that Individual Budgets are not a wonderful thing. Personalisation is a great step to be taking ideologically and it is absolutely the right way to go. But fitting people into inflexible systems is the problem and not allowing the hours to be taken into account and the training to be widespread and far-reaching – that is the problem.
Again, at Community Care Live yesterday, I cowered as I felt I was being labelled with all those ‘fuddy duddy’ social workers from another era who want to ‘crush’ client choice in their own care services.
I want the opposite. I would love a well-resourced system that allowed us to plan according to needs rather than services. That is what was promised by the NHS and Community Care Act (1990).
I am absolutely and wholeheartedly behind the progress being made in user choice. I just see so many problems with the current implementation as it is led by Performance Indicators rather than a true desire to change the ways that services are delivered to everyone, rather than a smaller range of articulate and able service users. Again, it is those who have the quieter voices who suffer the most from this approach as the money is siphoned to those who are able to shout loudest.
Other thoughts from the Conference yesterday – there is a lot of general uncertainty about where the new government might be taking us. Which policies and frameworks will stay and which might be sidelined in the cause of cost-cutting.
There will always be a disconnect between front line practitioners and policy makers/senior managers who think they might know what it is like ‘in the field’ but work in private consultancies or have managed to ‘go into training’. I wonder sometimes who much contact there is with the front line. Of course, that is tarring a lot of people with the same brush and it isn’t always entirely fair – but sometimes it is. It’s very easy to feel ‘preached to’ by people who haven’t actually been in a front line local authority team for a long long time.
I know everyone has their hearts in the right place but I wonder how much more could be achieved if more front line practitioners were involved in steering and policy groups.
The usual stands with the jobs (mostly children’s services), pens, mugs (didn’t get one this year), mousemats and booklets were all there.
This year I also bumped into quite a lot of people I knew. That’s a sign of my longer service in the field as much as anything. It’s always a good thing to bump into familiar faces – until next year..