Monthly Archives: June 2011
I’ve written about my background and my somewhat ambivalent relationship with Unison in the past but today, as there is to be a widespread strike in the UK, I almost wish we had also been called out to strike alongside the teachers and the civil servants.
I’m very far from a ‘trigger happy’ union member. My default position has been to vote against any strikes called because I just want to get on with my job. Saying that, my attitude has changed over the last year or so since the election of this government and the dismantlement of the welfare state. The difference is that now, I’m angry.
Yes, I have a ‘public sector’ pension so the issue that today’s strike is about does affect me directly. I think the amount of jealousy and petty spirited hate that has been stirred up by the current government against public sector workers is distasteful in the extreme. We are portrayed as ‘fat cats’ milking the State while we depend on the poor private sector to prop us up. Oh, I might have a ‘get out’ because I could be regarded (although who knows on what definition that go) as a ‘front line worker’ but I don’t want to be patted on the head and distinguished from those who work incredibly hard to make sure that the work I do ‘at the front line’ can be carried out.
The administrative support, the IT support, the care workers (as we still have an in-house service) the emergency alarm cord operators, the library staff, the receptionists, the training department, the HR team and the accountants.
I want to know who these ‘paper pushers’ are supposed to be as most of the paper pushing happens in the executive offices or in the Houses of Parliament.
Over the last year, when we have had endless consultations about the cuts that are coming in our services and the changes that are coming to our jobs, I have seen the real value of union membership. As a member of Unison, I have attended regular meetings in our service and have gleaned a lot more information about the process than I would otherwise have had. We have been involved because the council has needed to involve us and yes, some of the shop stewards can be a bit bolshy, but that has been a very necessary characteristic in their dealing with the council.
I do wonder if BASW’s idea of a Union of Social Workers would have the same fire and resources to fight so strongly on our behalf as local authority employees. At the moment, I am very happy with Unison and the way they have supported and informed us through these difficult times.
As for today, good luck to those on strike. The issue they strike about today is also my issue but my anger is much broader than the pension issue – it is the destruction of support in society and the way that those who have least as being asked to pay.
I have learnt more in the last year about the importance of union membership than I had in the previous ten. I don’t expect to ever follow blindly but I do value my membership much much more in these uncertain times.
- Strikes: Which Workers Will Walk Out And Why (news.sky.com)
- One million public sector workers to strike this autumn over pension changes, union warns (telegraph.co.uk)
At Arbitrary Constant there is some useful background reading about the Green and White Papers which were published by the previous government regarding changes to the funding of adult social care. It will indeed, by interesting to compare and contrast with the proposals set out on Monday.
The scare stories about the Dilnot report started emerging from the press over the weekend with the Observer reporting on a £35,000 cap on payments towards care while the The Times (£) write about a cap of up to 30% of the value of a property.
The very thought about paying for care at these levels seems to strike fear and anger in the heart of the property-owning middle classes and perish the thought that they might actually need to pay towards the cost of their care. Although it’s important to remember that social care costs can be potentially incurred at any point in someone’s life. It isn’t necessarily about ‘saving up’ till old age or insurance schemes at the age of 60. What if you need the services at the age of 55 or 25?
Meanwhile Community Care reports that there is expected to be a hostile public reaction to Dilnot. The article says
That was the warning today from housing and care provider Anchor, who found that 44% of Britons believed the state should fund all their care costs in a survey of over 2,000 people.
Which is the crux. No-one wants to pay for what they think they should be getting free. The payments into the ‘system’ and into ‘national insurance’ should cover care costs. The thing is, they don’t and they can’t.
Cost have escalated. It isn’t just about care home fees, home care packages and support plans delivered through personal budgets are increasing as people with higher care needs can remain at home for longer.
The sometimes seemingly arbitrary divide between health care needs (free) and social care needs (means-tested) can generate understandable anger as systems like the continuing healthcare assessments can be incredibly complicated and seemingly counter to common sense understandings of what ‘health’ care actually is.
There seems to be a proposal to separate out ‘hotel costs’ of the care home from ‘social care’ costs which will, I expect, lead to all sorts of interesting accounting mechanisms to ensure that the highest fees can be garnered beyond whatever system is implemented.
But I want to be hopeful. Dilnot is unlikely to be popular in ‘Daily Mail’ land, there are murmurings in ‘Guardian’ land too. Maybe we just need all parties to actually work together for the good of the whole at this point rather than worry about the cost in votes that any change in a system might incur.
I was ruminating over the post I wrote yesterday about the interplay and interaction between being a social worker and being a foster carer and the one aspect that played on my mind was the differential in ‘status’.
I used to think status and professional status was very important to me as a social worker. Don’t get me wrong. I’m very proud to be a social worker but I think when I was first qualified, I was also proud to be doing ‘something proper’ and recognised.
I had, at this point, in my defence, worked for years in the care sector as a support worker and a care worker. I had had friends and family asking me when I was going to get a ‘proper’ job and tell me that my academic qualifications were ‘underused’ in a minimum wage care job.
And I listened. I began to believe. The process towards my professionalisation was one I was proud of. Sometimes if you do a ‘low status’ job or have no job, society makes assumptions about your general intelligence level so being able to prove that I could make it through a postgraduate course was also an element of pride for me. I liked the idea of ‘having a profession’.
But I wonder if I was too taken by status and if the divides and gaping holes that exist between policy makers and practitioners is because ‘status’ is a bar.
For example, yesterday I had an extensive conversation with the Personal Budgets Implementation Manager about a case I was working on. We made good progress on hopefully working on a more creative option for a service user I’m working with currently.
My colleagues were surprised that a) I had approached this ‘manager’ directly and b) that she had listened.
I thought about this and my role in perpetuating the divides between policy and practice and how status remains such a predominant factor in blocking conversations from the ‘front line’ to ‘management’.
We are institutionalised both by our employers who determine that ‘conversation’ flows in one direction and by our society where we, as a species seem to be keen to label everything, put labels on everything and want to by our nature, know our place in the societal pyramids of power.
So back now to the foster carer and the social worker. Is the foster carer really on a ‘lower’ rung of the ladder of professionalism than the social worker that they can be ‘looked down on’ by so-called professionals? It can honestly feel that way and taking a step back to look at the way I am ‘dealt’ with when I have my ‘social worker’ hat on as opposed to when I introduce and describe myself as a ‘foster care’ is a glimpse into the different statuses that it is accorded.
Status is afforded because power is present and this is something that overrides the social work profession in whatever capacity it is undertaken. Whether it is in adult care management where it can feel as a practitioner that you are pretty reined in in terms of what care can be provided on financial levels, in the eyes of the service user you are the ‘gatekeeper’ to the mythical goal of ‘provision of care services’.
In Mental Health work there are some obvious legal powers under the Mental Health Act but even in day to day care co-ordination, you become the conduit between the multidisciplinary team and the service user. You decide what is important to feed back, what constitutes a concern or a worry and how situations may be resolved or, if necessary escalated.
And we go into people’s homes. We make appointments. We decide on timings to fit into our busy diaries. Sometimes we even cancel appointments. These are all displays of power. Power isn’t about flexing of muscles, it can be as much about sending a letter or making a phone call suggesting a time to visit. Of course, it has to exist but the important thing is never to forget the power differentials and the way that they change the dynamics between user and provider.
With my last social work student, we spoke a lot about power and I alluded that she should reflect on the power relationship between us as well as the power relationship with service users. I smile and I joke with her but there is an enormous power differential between us that cannot go unacknowledged.
And as a foster carer, I accept that social workers will turn up at any point to see the child I have in placement or to just see the home or to check up on us. That’s fine, it’s understandable and I have no problem whatsoever with that, I know it’s a part of the process and I would feel angry if foster carers were not subject to checks but there is a power differential there and it has to be acknowledged – even if it is not openly acknowledged.
We can never have an truly equitable ‘status’ because social workers can come and check on me and are responsible for my approval as a foster carer but I can’t wander into their home or even office at will (trust me, I wouldn’t want to!). I think without acknowledging this power differential or by pretending there is any kind of ‘equal’ status we do both parties a disservice.
Once acknowleged, issues of power can be addressed and considered but if it remains unspoken, they can be levered and used for less positive outcomes and ends.
As for ‘professionalism’ in social work, I think we could go round in circles with this one. Respect is helpful but that is a truism that can pretty much be applied to any sphere of life. Is the respect based on professionalism? Only if the professional is respectful and competent. An incompetent professional can do far more damage than good and the converse is true for a good professional.
Thinking back to the stories of abuse at Winterbourne View, we see much more obvious displays of power. The power was held by the care workers and exercised on the patients at Winterbourne. There is something within the care sector where so much work is done with some who for many reasons may have little power that it can attract people who want to exercise power for the wrong reasons – to augment feelings of self-worth or to bolster failings in other areas of their lives. It is important that the power dynamic is acknowledged and guarded against at all levels and that it never ever becomes something that is taken for granted or played on to make others feel threatened or denigrated.
The status, the qualification, the experience and the practice alone don’t make a ‘good professional’ – it is a mixture of all of them and the way that power is used, acknowledged (internally) and processed that create good practice and good practitioners.
We can often talk about qualities that are important for good social workers and social care workers. I wonder if I’ve mentioned it but for the reasons above, I would put the quality of humility very high. We need to listen and be aware of the inherent power we have. We need to ensure the voices we hear are echoed upwards in our chains of ‘command’. We need to listen to experts of their own situation and the people close to them. Sometimes we have to impose and sometimes we have to say no, but we acting with humility is a rich and exceptional quality and one that makes a good social worker.
I don’t bring the foster care that I do onto the this blog too much. It might be because we don’t have a child in placement at the moment (although that could, of course, change at any moment) but it’s because I know my ‘audience’ is related to social work and I am very wary of any information that might identify a child that is placed with me.
However, there are a few general points that I’ve learnt from being a foster carer, going through the assessment and review process and having my own social worker (a supervising social worker who is allocated to us as foster carers) as well as interactions with the respective childrens’ social worker.
1. The power dynamics in social work while being constantly re-examined in practice, can sometimes be taken for granted by social workers. Having been on the other side of that dynamic is a very very strong feeling. I try to remember these feelings in my own practice. Phoning up social work teams and being passed around/kept on hold/fobbed off can be disempowering. In practice, I try to give people answers as best as I can and be honest with them as much as possible because the feeling that people are ignoring you or are too busy for you is not one that helps an individual or family feel valued.
2. I didn’t grow up in poverty. I see poverty and the effects of it every day at work but having a child come into your house who has never been to the cinema, never owned a book, indeed, lived in a house where there were no books, brings issues of luxury and need v want home in a dramatic way. One child looked aghast at our 32” TV and said she didn’t know people had TVs that size in their homes. One of her best friends described how she lived in a bedsit with her mum and was too ashamed to invite friends round. It put my whining about wanting a 40” TV into context. I knew this on a professional and intellectual level but seeing it made a difference and made me value more what I have and what I had.
3. Prejudice. I have dealt with schools that have policies which seem to be less equitable for children in care or less thoughtful of the issues that they might face – for example, when school trip places are allocated on a first-come/first-served basis and I have to get permission via social services, it means a child in that situation may miss out (I did have a long discussion with the senior staff in the school about that and they just hadn’t considered it and child got her place on the trip.. but that’s possibly because I’m mouthy and pushy). People I meet tend to assume that foster children are ‘difficult’. All the kids I have had the pleasure to share my home with for differing periods have been wonderful, thoughtful and kind but sad. Very sad. Children are individuals. People are individuals. Labels never help.
4. Developing new skill sets. I haven’t worked a great deal with children but I have a strong belief in honesty and openness (while keeping conversations age-appropriate) . It is hard though when a child asks questions that you don’t know the answer to like ‘when can I go home?’ ‘why can’t I go home?’ and the social worker who is clearly pushed for time, endlessly postpones visits so the answers remain distant. I think I expected more support to be honest and more interaction with the social workers and less, just do what you think is best.. Foster care needs a lot of resourceful thinking and quick thinking. It is one of the most responsible ‘jobs’ I have ever undertaken. If ever I feel disillusioned about my idea of going into social work ‘to help people’, I think of the much more dramatic and immediate ‘difference’ I can make with the foster caring. I do despair that foster care has such little regard as far as ‘professional status’ goes and particularly it makes me as angry to hear social workers make flippant and disrespectful comments about foster carers as it does for me to hear some of the foster carers make assumptions and unfair comments about social workers.
5. Assumptions. I think that social workers working with me as a foster carer make assumptions about what knowledge I have and other foster carers who know I’m a social worker are a little bit wary of me. I am absolutely sure I’ve been told information by social workers that I shouldn’t be a party to. I suspect it is because I’m a social worker and they feel a bit ‘safer’ with me but there are still some fairly gaping confidentiality issues that I have been concerned about. Sometimes they chat informally about other kids they are working with. ‘No no no’, I think, internally – don’t tell me that. I don’t need to know! At some of the foster carers’ events, other carers seem a bit diffident and less than friendly and over eager to criticise or maybe I’m just oversensitive. I’ve also mentioned this before but as my partner is the ‘main carer’ and is male, this seems to mess with a lot of the assumptions that people make about us and they still seem to default telephone calls and letters to me, because I’m female.
I think that being a user of social work services is something that is enormously helpful in my practice and hope it will continue to be so. It sometimes feels that the two roles pull me in different directions but I also think that both help the other. I know some of the ‘social work think’ and know the importance of not drawing unnecessary lines of ‘status’ betweeen professionals and users of services.
Respect goes a long way but it has to be given if it is to be expected.
Yesterday Think Local Act Personal (TLAP) published the results of a National Personal Budget Survey.
Is any of this a surprise though? We know that people who can and are able to manage (or have family members to help them to manage) personal budgets delivered through direct payments (where money is paid directly to users) prefer them to less flexible local authority provided care packages – particularly when the scope of local authority care packages is limited to agencies with block contract arrangements.
In Control – which publishes the survey – highlights the following ‘implications’ from the findings. The bold is a direct quote and the italics are mine.
Other implications that can be drawn from the survey results include:
- Personal budgets work better for older people than you might expect and direct payments work just as well for older people as everyone else.
Who said we were not expecting personal budgets to work for older people? Does this make an ageist assumption and lump together all ‘older people’. Of COURSE they work as well for people who are 65 as they do for people who are 64 but what about people without capacity or who don’t have family or friends involved? What about a more subtle distinction between 65 year olds and 85 year olds rather than a blanket ‘old people’ response.
- The processes used for delivering personal budgets are more difficult than they need to be and that impacts badly on carers and on personal budget recipients.
Did this seriously need a survey over three months to discover? You could have asked me three years ago and I wouldn’t have charged consultancy fees.
- More work needs to be done to make direct payments more accessible generally but especially to older people.
This could have been written 6 years ago. We KNEW this from the roll-out of direct payments initially so why was NO WORK WHATSOEVER done around trying to work with more difficult to reach groups when personal budgets were being ‘piloted’. I really can say ‘I told you so’ as I begged our Personal Budgets roll-out team to allow us to pilot or be involved in the initial processes and they said our user group was ‘too complicated’. Heh.
- There is a need to simplify and clarify the rules and regulations surrounding personal budgets.
So those are the ‘implications’ and forgive me my cynicism. I love the idea of personalisation. I want it to work. I want to work in more creative ways or outsource my work if necessary to other third sector organisations but this is not ‘different’. This is not ‘new’. I fail to see the value of reports and surveys that tell us exactly what we already know again, and again and again instead of actively trying to work with people who actually understand and know what is happening ‘at the sharp end’ to try and work out ways to improve outcomes for those who are not receiving direct payments currently.
So back to the report – which used a Personal Budget Outcomes Evaluation Tool (POET)
in total, 1,114 personal budget holders completed the POET survey, including 832 returns from the 10 local authority demonstrator sites and returns from at least 76 other local authorities. 417 of these personal budget holders also wrote in a comment about their experience of personal budgets.
In total, 950 carers completed the POET survey,including 782 returns from carers in the 10 local authority demonstrator sites and returns from at least 66 other local authorities. 434 of these carers also wrote in a comment about the impact of personal budgets on their own lives
Almost half of people responding to the survey were aged 65 years or more (43%); the social care needs of working age adults (aged 16-64 years) were largely split between learning disabilities (17%), mental health needs (8%) and physical disabilities (25%).
I don’t want to play too many games with statistics but it would be interesting to know what proportion of people who meet the FACS criteria in total are over 65 and whether 43% is a proportionate figure in relation to total recipients of social care services. I think as well, to class ‘older adults’ as ‘over 65s’ is a little disingenuous although I know it is done because that is the basis on which statistics are given but it shows some of the ways that systems restrict and inhibit knowledge. It would be far more interesting to know the differences of take up of personal budgets between 65 year olds as opposed to 85 year olds for example.
And to some of the headline figures, that can catch the press attention – most people who receive personal budgets find there is a ‘positive effect’.
Looking through some of the figures, it seems that older people were much more likely to be receiving council managed budgets – you know, that ‘easy’ way of just switching around a bit of paperwork and making it look like there is now more ‘choice’ when in fact, the services and delivery is almost exactly as it was before the ‘change’.
As for the outcomes the report says
In terms of social care need groups, older adults tend to report less positive outcomes than other social care need groups in six out
of the 14 outcome domains
I find the report to be honest, a bit of a whitewash in itself. It is only accentuating the positives and like all discourse related to personalisation and personal budgets, seems to be going over all the same ground again and again.
People like choice, people like flexibility. Yes, and rabbits like to eat carrots. It doesn’t need a survey to tell me that. What action and money and research needs to be concentrated on is the HOW.
HOW is there going to be an improvement in service delivery to those who are marginalised in this process.
HOW are we going to wriggle out of the sham that is council-managed budgets while allowing those who need to have others to manage their budget and support their care to have the same access to quality care and personal assistants that those who are able to choose and decide have.
I’m rapidly coming round to the view that personal budget support planning needs to be moved out of the hands of local authorities who currently have no interest in the process except for meeting the government targets. Where is the innovation within local government for change? Sure there are people, and I hope to be able to count myself among them, who want to do a better job and provide a better service but the constraints of the type of job I am doing means that I can’t devote the time necessary to truly inclusive and supportive care planning so Mr G whose support plan I am writing up (he doesn’t want to be involved in the process as he ‘doesn’t like forms’ and can generally only tolerate conversations with people for between 5-10 mins maximum and that’s only if he’s known you for at least a year) does get a rushed service because I have to carry out Best Interests Assessments, do Mental Health Act Assessments, complete reviews and CPAs, liaise with other professionals, arrange discharges from hospital for other people. Yes, it’s a little bit of wallowing in self-pity and I wholly accept that. We are all busy but local authorities have no idea if they want a quality support plan without changing the ways of working in any other respect. Where is the time to devote to Mr G’s creative support plan? Oh, well, we’ll just do a regular care plan and a managed budget. Should it be that way? How has the march towards personalisation helped people like Mr G? Mr G wouldn’t complete a survey about a personal budget even if he did get a letter. Letters worry him and he doesn’t have a phone. I don’t want the Mr G’s that I work with to be forgotten in the rush towards direct payments.
When I first attended training we were told that any additional time we might be spending in our day to day work on these awful process-driven systems would be made up by the amount of time we would save by people completing their own support plans and assessments without any assistance. That may work for some people and I hope it does but for most of the people in the team in which I work it is unfeasible due to the amount of people I work with who have high support needs and who don’t have the capacity to make decisions about their own care needs.
The survey angered me, in a way that is probably irrational. Partly because it seemed to have taught us nothing at all. And partly because again, I see no new thoughts and ideas about developing systems that will be truly inclusive.
HOW can social care improve for everyone. That’s everyone. Even those who don’t want direct payments. Even those who don’t have advocates. Even those who are self-funding their own care packages as the criteria for receiving government support rise higher.
Those are the questions I want Think Local Act Personal to answer.
I have my own ideas. I think there will be a movement to roles for professional ‘support plan advisors’ who aren’t necessarily based in the local authority – perhaps individual social work consultancies but there has to be a separation between planning and delivery and the cost of these services shouldn’t need to be met out of the personal budget itself.
First and above all, there has to be a consistency and a transparency in the way resources are allocated and if necessary a weighting towards people who need assistance to access the same kinds of services who have been excluded from the process and the benefits in the past.
A survey of the skills-base of professionals who do implement support plans needs to be undertaken to establish what is needed and what is important to have.
Maybe it is a professional type qualification or maybe not. There is not much discussion about what the role of the social worker should be in the process. Should we be the ones support planning? I think there’s a argument that a social worker is well-placed to look at building plans together in conjunction with a user and family member if necessary and setting up things like trust funds or managed local authority budgets but only if the social worker is removed from the local authority talons. Maybe some kind of team of people with different kinds of experience and expertise working together with some background and training in non-directive advocacy for people who do lack the capacity to organise their own support plans. Perhaps the social worker or support worker in these new roles could have longer term relationships with the users and carers and wouldn’t feel so pressured by management if freed from the local authority reins.
But who is going to suggest and discuss the new ideas? Where do they go? Who will collate them?
While I see lots of discussions around me about personalisation, I see little that says anything other than it HAS to work because it is best for ‘people’.
I genuinely believe that is has potential to deliver a much better system but and this is a big but, there has to be more creativity and different kind of research that looks at new models and methods of delivery and consults people – yes, like me – who while being critical really really do want things to work better.
My criticism isn’t because I want to bury my head in the sand and ‘retain the reins of control’. I really don’t. I want to relinquish control but I want more than anything an equitable system that doesn’t fob off ‘more difficult’ service users with a second class service.
- Personal view of personal budgets (fightingmonsters.wordpress.com)
- Should private companies be looking after the elderly? (telegraph.co.uk)
I know I’m a bit late to Learning Disability Week – which runs from the 20th June for.. well, a week but it remains a campaign and a group I have a great attachment to coming from years working with adults with learning disabilities before I qualified as a social worker.
The ‘theme’ if it can be called that, is a new campaign, called Stand by Me, which is being run by Mencap to challenge and hopefully phase out hate crime which is targeted towards people with learning disabilities.
Apart from, I hope, creating more of a stigma towards those who might seek out and target people with learning disabilities there is a focus on the ways in which crimes which are committed are dealt with by the police and the criminal justice system.
Mencap share some chilling but sadly unsurprising real life stories from people who have suffered from hate crime.
While accepting this is slightly different, I have had difficulties trying to pursue prosecutions for people who have dementia and who are the victims of crime and abusive situations due to the way that the systems are currently set up. I hope there is more attention paid to ways that these processes can be improved for everyone.
Hate crime is an offence which is committed against someone on the basis of their membership of a certain ‘group’ in society be that on by their race, class, disability, gender, age, sexual orientation, gender identity and good old Wikipedia, gives an alternate definition of ‘bias-motivated crime’.
To call something a crime indicates that (obviously) there is a criminal act that has been committed for example, a physical assault but I think the discrimination and the effect of actions of hate towards those who have learning disabilities have significant effects on the way our society perceives some members of our society.
For example, name-calling. Verbal and emotional bullying. Laughing and pointing. This might not count as a ‘crime’ but as long as it is acceptable, it may lead to criminal acts. Those who talk about criticism of the use of certain words being ‘PC correctness gone mad’ would do well to remember that with disrespectful thoughts come disrespectful words and disrespectful and flippant words lead to disrespectful thoughts.
The more we create divides between ‘us’ and ‘them’ the more vulnerable we are to dehumanising ‘them’ and it turns to just a step away from the acceptable or non-intervention in a ‘hate crime’.
So for me, it is a very important campaign but must not just be restricted to those who commit criminal offences against people with learning disabilities. It must also be targeted at those of us who use flippant and insulting language to describe people with learning disabilities.
Someone who describes their phone as being ‘retarded’ because it doesn’t work (yes, that’s a real life example from someone who should know a lot better), that’s the first step towards dehumanisation and degradation of people with learning disabilities and yes, I was accused of ‘political correctness gone mad’ when I challenged this but I maintain and always will that the connection between language and respect are inherent.
So targeting hate crime isn’t just about systems and criminal offences although that is absolutely essential to target. It is about the people around us, the words we use and the respect we afford to other human beings. When we treat people with disabilities as ‘different’ or ‘others’ and dismiss them and their needs, we allow hate crime to flourish.
There is a story on the Community Care website this morning about an ombudsman’s report relating a woman, Mrs J, who was placed in a care home in Bristol.
This was a care home which was not only rated ‘poor’ or had no stars under the old rating system that doesn’t exist anymore but from the time she was placed in 2005 until Feb 2009 when she finally did move (only to die later that year) , the responsible council – Bristol City Council – did not monitor or review her placement adequately.
Her son, Mr P, asked for his mother to be moved however as the cost of the identified ‘replacement’ care home was higher than the cost that the local authority would pay, he had to make ‘top up’ payments.
The Care Home which strangely is not named in the report – and I find that rather suspicious to be honest, had had a number of safeguarding alerts over the period of Mrs J’s placement there. It had received a zero star rating and there had been a couple of ‘freezes on admissions’ – probably relating to the safeguarding alerts.
The council investigated and placed the responsibility entirely on the care home however the ombudsman found that the council had failed Mrs J as it was the commissioner of the service
The Ombudsman considers that there was maladministration in the Council’s reviewing and safeguarding strategy and is concerned about the poor communication between the Council and the family. The Ombudsman also finds that the Council had not properly considered the circumstances around Mrs J’s move to an alternative placement, which had led to Mr J contributing to the cost.
For the pain and suffering caused by the lack of appropriate safeguarding and review procedures, Bristol City Council were ordered to pay compensation to Mrs J of £6000 and to Mr J of £500 as well as pay back the contributions Mr J made towards his mother’s care between February 2009 and October 2009 when she died.
That’s the background and now my thoughts about this – deep breath.
It’s horrific. Firstly not everyone has family that are as determined as Mr J to pursue and stand up for residents in care homes. If Mrs J had not had a son, this poor practice and abusive situation may have continued with perhaps, some perfunctory safeguarding alerts but with little action in relation to the management of the care home taking place. The care home working in conjunction with the CSCI (predecessor to the CQC as inspection service) where people living in homes that are rated as poor (of course, they are not rated at all now – easy get out of this situation?) continue to do so without batting an eyelid as long as the fees are low enough to be met by the local authority.
Another thing – what about everyone else living in the same care home? Seriously. Were they moved as well?
Why is the name of the care home not given? Surely this information should be transparent. A government (and this not not just the present one but the previous one too – I am making no party political point here) which is bound to link choice to care decisions is finding it quite handy to mask the names of inadequate and frankly, dangerous, care homes.
I did a search of care homes in Bristol which had poor ratings at the time that the rating system was abolished in 2010 and there were none listed. Perhaps they had managed to haul one more star. These are the homes I found that had one star. It may well be none of these homes but it makes pretty depressing reading looking through inspection reports from ‘adequate’ care homes.
This raises a number of issues – mostly why on earth can’t family members and social workers making placements in residential homes know which home it was that failed so appallingly? Isn’t that how ‘markets’ work? Or is it through hiding behind reports which obfuscate and confuse and seem to dance around the real issues of care – in the long periods between when they appear.
Finally, a thought or two about the way the council were criticised and censured. £6500 will not deter a council from acting in the same way again. The cost of fully staffing/training a competent review team may be much much higher than that. Quality Assurance Teams in the councils are one of those ‘non-jobs’ or ‘back-office’ jobs that Pickles seems to like to mock but in the face of a national regulatory system that is little more than a joke, they could and would provide a great service to citizens who need placement – particularly those without strong advocates and family members to stand up for them.
We need these stories to have more publicity though because there needs to be a greater understanding of the challenges faced and the poor quality that has almost become tacitly acceptable in the ‘free market’ of care.
The imposition of the market economy into the care sector hasn’t allowed the cream to rise to the top for those who are wholly reliant on support for placement from local authorities. It has allowed care homes which charge low fees to thrive despite poor care provision because it suits both parties to allow them to continue and to allow their names to be protected.
This makes me angry. I did not come into social work to deliver what I consider to be poor care or poor care services. I want everyone to be able to access good quality care and support regardless of their income, savings, property values or their family or friends’ willingness and ability to advocate on their behalf.
In a world of rose-tinted spectacles through which the Care Minister seems to envisage that people like Mrs P will have more ‘choice and control’, we have to make sure that basic minimum standards of care are respected for everyone who is reliant on them.
And we aren’t.
UPDATE – BBC have published the name of the care home - it is Amerind Grove Nursing Home owned and run by BUPA. Mrs J is Mrs Iris Shipway. This is the report from 2008 which gave Amerind Grove a 0 star rating. It is a 171 bedded home. Stop and think about that for a while. 171 people in a care home. That’s big business. That’s not a ‘home’ – that’s warehousing. Would we place younger adults in 171-bedded units. Let alone poor 171 bedded units. And what about the other 170 people living there when Mrs Shipway’s treatment was so poor. Can we see how the large companies have local authority commissioners ‘over a barrel’? They would not be able to find alternative placements for that amount of people.
The answer is less institutionalisation – more creative thinking about alternatives to residential and nursing cares – the answer is not 171 bedded homes.
Tags: bristol, care homes in bristol, Care Quality Commission, Commission for Social Care Inspection, csci, Home Care, local government, Local Government Ombudsman, nursing home, old age, Standard of care
I read on the BBC website among others that there is a report suggesting that care provided in the home by local authorities to older adults may be overlooking human rights issues.
An inquiry into this was initiated by the Equality and Human Rights Commission in November 2010 and will report in December 2011 but some interim findings have already been published.
I think the context in which the inquiry is taking place is crucial in times that Cameron trying to pretend that he invented the personalisation agenda and rebrand it as a version of ‘Big Society’.
The scope then of the Inquiry as to determine where the responsibility of the ‘public authority’ under the Human Rights Act actually lies and I’m going to quote directly from the EHRC (Equality and Human Rights Commission) as I think this is a crucially important point in the progress of personal budgets and home care provision (n.b. the underlining is my own).
The nature of social care is changing rapidly with a greater emphasis on personalised services and choice. The majority of social care services are already delivered by private sector agencies, either via contract with local authorities or directly with individuals through a mix of public and private funding.
This complex web of transactions is combined with a narrow judicial interpretation of the meaning of ‘public authority’ under the Human Rights Act. This combination has created a confused picture concerning the duties and obligations of the various groups involved in respecting, protecting and promoting human rights.
Further, an increasing number of care transactions are likely to take place at the margins of, or even outside of, regulated care. There is the possibility that these transactions are beyond the present human rights obligations of the State.
We are also seeing the emergence of new on-line care marketing and brokerage services aimed at people purchasing social care with either ‘individual budgets’ or private funds. These marketing and brokering services are currently completely outside of the regulatory system with no means of monitoring the quality of the advice and services they offer. The Government wants to accelerate the pace of reform even further. While personalised care and support has many potential benefits, this is uncharted territory. There are concerns that human rights protection (and other issues) could fall between the gaps.
I’m going to come back, I’m afraid, to my perennial bugbear of people who lack capacity to make choices regarding care provisions and care delivery and wonder again how this group of people without family members, friends or advocates will be able to secure their own well-being in a world where responsibility of the state and the public authority is being discharged to private individuals. Will it become the responsibility of an advocacy service to determine that the support package and the provider of the support package are of a good quality? Or the carer/family member? Hardly the same as a protection under the Human Rights Act.
Food for thought and while I am extremely happy with the forward march of personal budgets and direct payments to those who are able and happy to manage their own budgets, the way that local authority managed budgets provide ‘more of the same’ regarding cheaply bought, block contracted social care remains floating fairly close to the edge regarding what is acceptable and what isn’t.
My fear is that the roll-out of personal budgets has not led to choice for all. It is a false choice and a false impression of the so-called ‘success’ of the roll-out. It has led to great benefits and more choice for some, yes, but I worry that this is actually at the expense of those without the louder voices to shout who have, again, been pushed to the bottom of the pile when quality services are being distributed.
So back to the reports findings so far.
Back to the BBC report
The Commission describes cases of people being left in bed for 17 hours, or more, between care visits and a failure to wash people regularly.
It received reports of people being left in filthy nightwear and bedding after a homecare visit, or without a wash or hair wash for several weeks.
Visits are sometimes so brief, the report says, that people have to choose between having a cooked meal or a wash.
The short visits also mean that staff have to rush tasks like washing and dressing, which frustrates elderly people and care staff
That doesn’t even bat an eyelid with me. This is what I have dealt with for the years I have been working in adult social care. Complaints and apologies about the time we can allocate for specific tasks due to budgets. Apologies on behalf of private agencies who have block contracts that cannot assure any kind of continuity of care. That’s not even mentioning the missed visits, the non-payment to staff of travel costs so they are cutting short visits in order to make it to the next ones. This is the reality of social care for older adults in the UK. Not the ‘season tickets to football matches’, not the ‘let me choose nice Mrs Walters’ daughter who I know from church to be my home carer’ kind of idyll that we are presented in the personalisation literature.
The reality for the people I work with and for is increasingly rushed visits and yes, choosing between a cooked meal (but only if it is a microwave meal because there is never ever time to cook a meal more complicated than tinned soup or beans on toast from ‘scratch’) and a shower.
The way to solve this problem and promote dignity is to increase and not reduce budgets for social care in the home. But budgets are being cut and cut hard.
Local authorities use block contacts with private care agencies to save money. The private care agencies generally pay staff at minimum wage. There are some fantastic carers and some fantastic agencies but they are penalised if they don’t offer their services at the very very lowest cost.
As for personal budgets? It is a wonderful reality for some but for most of the people I work with and for, it is a pipe-dream for people with a different kind of disability and with different kinds of support needs from the ones which are mostly promoted in our training programmes and in our policy documents.
If the government truly and genuinely means what it says about increasing and drawing out the personalisation agenda and increasing personal budgets delivered by direct payments there have to be ways clear and research undertaken to help us to create protective and interactive systems for people who are not at the forefront of the march because they don’t realise how much they are being penalised for not having a family member who is able to help with choosing and designing a care package and because they are not able to do this for themselves.
There has to be money spent on developing ways to allow those who at the moment are most at risk of vulnerability to be protected and cared for.
There are so many problems with a society that treats older adults or, in fact, anyone in the way that older people who are in need of care are treated currently. No-one wants to address it because no-one wants to pay. And it will cost.
No-one wants to lose their homes. No-one wants to lose their savings. No-one wants to pay higher taxes. No-one wants to lose weekly bin collections. No-one wants to pay insurance premiums.
The people who hold the reins of power will never be subjected to the humiliations which become a part of daily life for older adults who have need of support that is provided because they’ll be able to buy in their own ‘help’ privately.
Older people in need of assistance are less noisy than younger adults and less emotive than children in poverty and need. Ultimately we shouldn’t ration compassion and there’s no need for a choice to need to be made between one group or another
In the roll out of direct payments and then personalisation and personal budgets, it is the more able younger adults who have led the march and those who have been setting the policy and agenda seem to have completely forgotten the group of older people who don’t have involved family members and who might not have the capacity to take decisions about care needs for themselves in the rush towards pushing the responsibility for support planning and choice of care routines. They have forgotten amid the wonderful stories of attending football matches instead of day centres that some peoples’ reality is more about choosing a microwave meal or a shower.
Until those issues are addressed and the protection of the most potentially vulnerable groups of people is managed, the new system will not be equitable and it will not be fair. But perhaps that suits this government that wants shift responsibility from the state to the individual – which is fine to an extent but there are some people who really need that protection.
I look forward to the final report of the EHRC in December.
- Should private companies be looking after the elderly? (telegraph.co.uk)
Posted in carer, carers, dementia, direct payments, Disability, discrimination, elderly, health, local authority, mental health, old age, older people, personal, personal budget, social care, social work, work
Tags: direct payments, ehrc, elderly home care, equality and human rights commission, government, Home Care, home care and human rights, Human Right, Human Rights and Liberties, human rights of older adults, individual budgets, local government, old age, personal budgets, personalisation, report into home care, social work