Category Archives: local authority

Choice, Control and Obfuscation – How the Personalisation Dream is Dying

In the bold move towards a transformation in adult social care, it feels from where I sit, that control has completely overtaken any pretence of ‘choice’ in the so-called move towards more idealised ‘person-centred’ care and support planning.

I hope I’ve been clear over the years in which I’ve expressed a remarkably consistent view that I love the idea of people being able to choose the support plan they like from a wide menu of options with ‘professionals’ taking less of a role.  I am a massive fan of direct payments. I want people to have more personalised care and more creative care. Desperately. The options just aren’t there yet for people who lack capacity and that is a terrible disservice and inequity that is being served throughout the care system.

Removing care planning from my role doesn’t concern me – unlike those people on the training courses who bang the drums blindly about how wonderful and bright it looks when we allow people to choice whatever they like to put together packages of care, I don’t want ‘retain control’, I truly don’t believe that I, as a professional ‘know better’,  but likewise I know that with the user group I work with, it is rare that I can just hand someone a support planning tool and a list of potential providers and tell them to ‘get on with it’.

That is as far from reality now as it was 20 years ago in my work. While I can say that everyone I care co-ordinate who has a ‘package of care’ is now officially on a ‘personal budget’ and some even have direct payments, it hasn’t really increased choice or control for any but a couple of those people.

If anyone for a moment wants to ponder the duplicitious nature of those in policy making ivory towers who dribble down policies which they want to couch in ‘soft’ language so they are difficult to challenge, one only has to read a fantastic piece of research conducted and published on The Small Places site.

It is worth reading through the piece in detail. Lucy, the author, made a number of requests to local authorities to ask about how their Resource Allocation Systems (the link between the ‘assessment’ and the ‘cash’ – basically) was calculated.  She seemed to come up against a wall of obfuscation but it’s worth looking at her research in detail.

This reluctance for me, seems to relate to the lack and reduction in spending on care and support – the key ‘missing piece’ as to why a council can ‘reassess’ someone as needing less ‘cash’ than they did last year with a more traditional care package.

My personal experience is that the council I work in (and this is similar to things I’ve heard from people in other councils) probably doesn’t want to share it’s RAS because it’s ashamed of the utter dog’s dinner that it’s made of it. It doesn’t ‘work’. It doesn’t make sense. It is frequently changed. There is more emphasis on physical health needs as opposed to mental health needs and while there can be manual adjustments, some of the figures that are ‘spat out’ just seem nigh on ridiculous (and that works for sometimes calculating care ‘too high’ as much as a figure which is ‘too low’).  It comes down to everything needing to be qualified and fitted onto a spreadsheet when actually the needs of two people who might fill out a self-assessment with the same ‘tick boxes’ might have very different needs in reality – no RAS can account for that. One person might under-score because they are embarrassed by the process and don’t want to admit to being incontinent on an initial visit from a social worker because they haven’t been able to tell anyone other than their GP – another person might be anxious and think they can manage less well than they can. Sometimes and this is what local authorities and health services seem to find hard to account for, you just have to treat people and their needs as individuals rather than the subject of outcome measures, tick box performance indicators or resource allocation systems.

Shouldn’t personalisation be about putting the user at the heart of the system? Every user should have a copy of the RAS and how the figure was determined. Which questions are weighted and which aren’t. Without that, there flow of money and the control rests solely with the local authority.

I’m fully against ‘traditional’ care packages. Having someone anonymous and constantly changing pop in for a 30 min welfare check once a day isn’t about improving the quality, control and choice in someone’s life, it’s about a local authority doing the absolute bare minimum that they can get away with to fulfil their statutory duties of care.

The lack of openness about the ways that the RAS shows the true colours of the reasons for these pushes towards the Eden of ‘Personalisation’.

While I have no doubt that for some people, as I keep saying, those with advocates, family or who are able to voice their own needs clearly, have and will continue to benefit enormously from having direct payments – it’s worth remembering that direct payments have been available and accessible for many years now.

Forcing everyone onto personal budgets has only discriminated against those with carers by reducing the amounts of money they are entitled to through the RAS (that’s my own experience of how our local RAS works) and has discriminated against those who lack capacity by promising all sorts of ‘creative’ ways of exploring third party management of support plans but without providing any real ways of accessing it (this is my current bugbear as I have been requesting assistance with this for months for service users I work with but have been told it is not possible for older adults yet as only those with learning disabilities have budgets large enough to make it cost effective – thereby clearing discriminating on the basis of age and type of disability).

I have changed from a fervent advocate of a system which was supposed to be so much better for everyone to a bitter opponent of a system which favours some kinds of disabilities over others, some kinds of service users over others, some kinds of carers (those who are willing to put a lot more time in to manage and support plan where necessary) than others and all to provide fewer services under the guise of choice.

No wonder Burstow is pushing everyone towards direct payments. He is pushing everyone towards a system which masks the way that payments are determined and discriminates openly against people who lack capacity or who have the ‘wrong’ kind of disability or family support.

Now we know that the local authorities can hide the way they make financial calculations, it becomes much more obvious to see behind the facade of the ‘Wonderful Wizard of Oz’ who promotes choice as the final goal to achieve at all costs.

I feel tricked and betrayed by the implementation of the personalisation agenda and the lack of any of the services around it to tackle directly with the problems at it’s heart.

I was deeply disappointed, for example, that the Mental Health Foundation’s ‘research’ and work with people specifically with dementia only focussed on people who either had capacity or had family.  Their advice talks lovingly of setting up trust funds, appointing brokers – well, that is a fantasy rather than a reality and exists only on paper as a choice. They merely replicated a lot of work which was done when direct payments were rolled out around lack of take up for people with dementia and they hadn’t said anything new (I happened to write my dissertation about the lack of take up of direct payments for older adults so did actually do literature researches at the time..).

Anyway, I’m getting ahead of myself.

For now, I think it’s important that we who see through the cosy policy makers congratulating about a ‘job well done’ speak up and speak up loudly for those for whom the system is a further barrier for true individualised care because these self-same policy-makers see them as ‘too difficult’.

My title explains that the personalisation dream is dying but it isn’t dead yet. To be brought back to life, all those involved need to embrace the principles of honesty and openness and not blind themselves to their successes if they can’t see the continuing barriers.

Consultations

I was interested in this article on Community Care website yesterday that more than half local authorities did not comply with the twelve week period for consultation when setting their adult social care budgets for 2011-12.

I had to stop and think whether the authority I work for did this. I think they did. I have vague recollections of something like a consultation being circulated but we’ve been subject to a number of different consultations for a whole variety of things and I’ve lost track of which were for what.

Facilitator works with participants for final strategies

CWGL @ Flickr

I’ve probably been directly party to more consultations over the past 18 months than I have at any other point in my career and to say I’m disillusioned is an understatement.

Consultations, in my experience, are never about actually consulting. They are about presenting decisions that have been made in smoky rooms, behind closed doors as a fait accompli.

These ‘management consultants’ who are engaged at high cost to produce these consultations only do so to meet statutory guidelines about what ‘consultations’ should be but I’ve been party to consultations which seem to arrive during the Christmas period, at Easter, over the summer holidays – whatever time seems to be the least convenient to actually gain the opinions of those directly affected and in whatever way seems to stymy any kind of criticism the most.

Do I sound cynical? Well, maybe just a teeny bit. It’s because we’ve been blasted by some massive changes presented through consultations-that-are-not-real-consultations and I’m bitter. I’m very bitter.

One of the major issues I’ve noted is the short periods of time between the ends of the consultations and the publishing of proposals as if, by magic, all the submissions could be judged within a week.. oh, not many responses? Well, that’s awfully convenient.

I’ve seen documents accompanying the consultations which don’t even try to disguise what the final outcome to the so-called consultation will be.

I have no doubt whatsoever in  my mind that consultation is about the most misused term in local government and the NHS that I have ever come across and that’s saying a lot.

Large organisations don’t want to consult. Or rather, they want to consult with their own consultants. They want to consult with the same group of people whom they can explain and describe to at detail. Thinking about creativity, if there was a real desire to consult about changes rather than impose them, the organisations should be forced to use more creative means to garner responses. Questionnaires don’t always work. Public meetings attract the same time-rich people who will always attend. What is done in a consultation to seek out those who are least likely to respond? Is three months really sufficient time for this?

As I said, I’m a cynic. I can’t see the work ‘consultation’ without laughing cynically and reading the end of the document to see what is proposed and what will, no doubt happen.

I’d love more openness in the process of putting together proposals and garnering ideas rather than being given consultation documents which appear to be vastly resourced ‘fait accompli’ type documents justifying why ‘we’ are changing what ‘we’ are changing.

Does anyone have any positive experiences of consultations? I’d really be interested in hearing.

Technology, Social Media and Social Services – Finding new ways to ‘help’

iPad con dock y teclado inalámbrico

Image via Wikipedia

I have some across lots of discussions and debates about ways of using social media and new technologies and interactions to ‘help’ social services become more effective. Most of it seems to revolve around building online directories and databases of micro providers and services that are available which build on so-called community capacity to improve the way that personal budgets can or might work.

At the risk of sounding overly cynical there is nothing ‘innovative’ in my mind about building a directory of services.  To me, this is not a particularly innovative way to use ‘technology’ in social services.  It taking a very obvious and well-trodden route to using new technologies. Providing directories while being useful to a certain group of people again exacerbates the isolation of those who are not party to or able to use them.  Being innovative isn’t always necessary to be helpful but it is very important that new ideas are focussed so we don’t just end up with increasingly specialised, localised directories that might have more ‘interactive’ features and feedback, look more ‘user led’ and compatible with the buzz words of social media but in the end they are brushing the surface of possibilities.

It feels more and more as if that there is a growing division between the ‘haves’ and ‘have nots’ as far as personal budgets have been extended and does absolutely nothing to address or use technologies to address those who reside continually in the ‘have not’ section.

While at work, we labour with database systems that have clearly been developed through conversations between commissioners and software companies without any recourse to frontline practitioners, nice new provider directories are being tinkered around with while the fundamental foundations of the systems we work with remain resolutely inaccessible.

I’ve had a few ideas myself and whilst I lack the technological expertise to see any of these ideas to fruition, this is a kind of ‘wish list’ of the sorts of things I’d like to see.  I’m under no illusion that these are ‘new’ ideas. I am sure similar things already exist in some form but they are things I’d like to see pan out in the longer run. Things I’d like to use at work.

I’d like to see more creativity in the use of technologies to assist with decision making for adults who have some kind of cognitive deficit. I’m a great fan of the ‘tablet’ and ‘touch screen’ model as I think it is intuitively an easier interface to understand.  When I see people instinctively reach out to touch the screen of my Kindle (which isn’t touchscreen!) I realise that we are becoming conditioned to seek the easiest input methods which are about touching a screen and speaking into a microphone and perhaps writing on a tablet. Now, voice recognition has improved, I’m yet to come across very successful handwriting recognition (possibly because I have scrawly almost illegible handwriting) but there is potential there. In the meantime, pictures and touchscreens seem like a good way to go.

Using pictures/sounds/music it can draw on multi-media ‘shows’ and explanations of different options – moving beyond the ‘written word’. Providing documentation in aural form or in pictorial/moving form rather than reams of leaflets. Having recordings of familiar voices or pictures of familiar faces might help to reassure. I’m a great fan of telecare in general with the proviso of always being mindful that the human contact is not replaced but in days where human contact is sparsely provisioned anyway, it may be something that can be experimented with.

Why not a YouTube type video to explain how services can be chosen instead of reams of ‘easy read’ leaflets which really aren’t remotely ‘easy read’. Instead of flooding people with lists of providers (which, while good for some ignores those who are restricted in terms of capacity and carers to choose ‘freely’ the types of services they garner) why not explain and expound in different ways the ways that services can work?

Why not explain providers in terms of what they can actually provide and what purpose they serve rather than creating directories that are meant for people with a good understanding of what they want and need?

I was in a day centre last week and there was a seemingly unused Wii. I wonder if he Kinect might be a better project to develop some type of interactive play, exercise and work as it doesn’t need a controller at all and uses the more innovative way of body movement.  Using participatory games with larger screens in company can provide different stimuli. I know why games developers  haven’t tackled directly the ‘older’ market with games that might otherwise reside in memories but why not repackage old school yard games and board games with Kinects and iPads? It may be a good way to introduce the use of these new technologies in a ‘friendly’ manner which may then see them used in other wider ways – such as directories or personalised information sources. Using YouTube video channels for personally designed ‘reminiscence’ therapies could personalise the delivery of memories and digitise memory boxes where items are not there to build up the frames of someone’s life and people aren’t there to fill in the gaps.

There are many ‘dating site’ type services that match people and organisations. Volunteers to voluntary groups etc. How about a type of match between schools and residential homes? I know it’s something that’s sometimes done locally where I work and having spoken to both providers and some of the kids who go in, they seem to enjoy it and it can change and break expectations – each of the other.  I

We talk of social media a lot and often it is used to provide ‘recommendations’ to particular services through these databases. Perhaps more user and carer led general recommendations can be collated. Crowd source an ‘introduction’ to social services provisions by those currently using the service.

Ask ‘what do you wish you’d known?’ ‘what do you wish someone had told you?’ and while taking out all the obviously libellous stuff, a local authority must be brave enough to leave in the criticisms. We learn through complains and criticisms and it can take a lot of guts (or anger) to make a complaint or to criticism and that MUST be respected by the service and the individuals at fault and used as a means of improvement.

I don’t want to see local authorities ‘whitewash’ problems in order to gain sparkling OFSTED or CQC inspections. It sullies the whole process and makes the inspections worthless. Regulation should be less authoritarian and more about actually making improvements and making things better for the end user – not about allowing local authorities to produce the ‘right’ results while poor practice is brushed away from the sight of the inspectors.

But back to my point about using social media to crowdsource – it is important that social media ALONE is not used as an ‘answer’. Crowd sourcing must be honest but it must also be broader than putting out an ‘internet consultation’ and having a Twitter account or blog. There must be pounding of the streets too to engage those who are not able to use digital means to put their points across. There should be knocking at doors and face to face discussions – not leaflets, not inaccessible (for some) groups.

Talking about crowdsourcing though, there’s a much better and perhaps more obvious way it can be used and certainly isn’t being used at the moment and that’s to engage other social workers and professionals into putting together more information and useful methods of practice for ourselves. Sure, it needs time but we remain reliant on organisations to provide ‘guidance’ such as SCIE (who do provide fantastic resources) and BASW and the College of Social Work but why none of these organisations who purport to exist to help social work and social care practice actually engage more directly and use social media and open access blogs/discussion groups/forums/micro blogging etc to engage with currently practicing social workers is completely beyond me.

I’ve become very interested in open access education and resources and feel there is great scope for professional engagement and information to build its own resources and information together with users and carers, together with other professionals but there has to be a push for social workers to see the benefit of sharing and finding appropriate ways to share the information that we learn every day.

I have other ideas which will come in different posts  but I’d be interested in hearing other peoples’ ideas for uses of ‘technology’ in the very broadest sense and how they can develop to help the broadest range of people we see in social services – particularly those who are less able to look information up in various fancy online directories.

Blame the Poor – A Riot Rhetoric

I apologise for keeping on one track in my posts this week but I am preoccupied by events of the last week. I’m not the same person I was a week ago. Some of the pillars that I held on both tangible and intangible have gone now, never to be replaced.

There is so much I’m angry about. I’m angry that our ‘so-called’ leaders were all absent and seemed happy to let Tottenham burn, only coming home when the violence spread.

Tottenham, the patter and media seem to imply is a ‘place like that’. It’s not like Ealing or Clapham or Croydon.

There is a lot of ugly rhetoric that has been stoked by the government too. The blame is afforded to poor parenting, poverty, gangs – all, of course, present in places like Tottenham and making easy armchair sociologists of us all – myself included.

The truth is far more complex though as the cases coming through the Magistrates’ Courts testify. It was obvious from Saturday that the situation was exacerbated by opportunism.

Police ‘engaged’ in one area left other areas open to be looted pretty much at will. This ‘model’ spread around London and around the country.

Is it a coincidence that the increase in policing came when the ‘leaders’ returned? I doubt it.

As for those following the story, the Guardian are updating lists of those cases brought up to the Magistrates’ Court. It will make for interesting reading but for me, for the moment, it’s all a bit raw.

The push towards taking away council housing and ‘benefits’ from people found guilty of looting or rioting is ignorant beyond belief in my very humble opinion.

Housing isn’t a treat to be dangled in front of ‘poor people’.

It is actually a basic right so is the ability to live in a dignified manner.

And what about those ‘rioters’ who live in private housing? Or is there an assumption that it must have been ‘poor people’ in ‘council estates’ who caused the trouble.

It is easy to paint broad brushes and make easy judgements – so long as they are judgements made by ‘other people’.

Our minds need to simplify often complicated issues but there’s a danger in jumping to conclusions that can be wholly damaging. My concern is that that’s exactly what the government have and are doing.

Communities

One word that has come up a lot in the last few days are discussions about communities.

Whether is it ‘affected communities’, or ‘community leaders’ or ‘rebuilding communities’ and it has made me wonder about what the meaning of the word is.

build community

whizchickonabun@flickr

Also in terms of the work I do, I think about the word and the way it is used in the personalisation agenda about ‘building community capacity’. The government uses community in terms of the ‘big society’, volunteering, giving power to communities, but they don’t really explain exactly what this means excepting the idea that ‘community’ is somehow a Good Thing. Strong communities are good.

So what is a ‘community’?

This is the definition given on Dictionary.com.

1.a social group of any size whose members reside in a specific locality, share government, and often have a common cultural and historical heritage.

2.a locality inhabited by such a group.

3. a social, religious, occupational, or other group sharing common characteristics or interests and perceived or perceiving itself as distinct in some respect from the larger society within which it exists (usually preceded by the )

The first two definitions base the term on a geographical location. Your community is the people who inhabit the world around you. The community might be all the people who live within this local area or it might be people of a specific cultural/historical heritage who live within this local area.

I wonder if the idea of splitting apart ‘community’ on the basis of cultural heritage is helpful sometimes.

What is clear is that the meaning of community is very different in Tottenham from  how it is in Chipping Norton.

The word is used in the context of building communities ‘online’. Obviously that comes under the third part of the definition. A community exists within a forum or even within readers of a blog. A community can be a Facebook group or a Twitter stream. We can belong to a range of communities. Some communities though, take more effort to join and be a part of than others.

Some communities we are born into by virtue of location and/or culture and history.

Some communities we move into through geographic location.

Some communities we actively choose to join.

The government talk about community as if it is the answer to every solution but I wonder how they feel the answers will come in areas where communities are not as cohesive as they know and are used to or not as homogenous in nature.

This is a part of the detachment I feel of the government from the people who are governed.  Cameron’s ‘community’ doesn’t feel and look like my ‘community’.

My community has different needs and concerns. My community doesn’t have the resources, either in time or money that his community does.

What gives some communities more ‘value’ than others? That’s the question that I ask myself frequently. When government leaders seek out ‘community leaders’ do they prescribe value to the communities on the basis of the loudest voices or the largest numbers?

Are those who are isolated or who don’t have families or voices detached from any kind of community? I suspect they are and sometimes people don’t want to be a part of a community.

Community is always seen in terms of being a good thing, but the people involved in the riots and mass destruction across London as well as other cities, they were part of a community too. Why is community always positive? Perhaps because the experiences of those who ‘rule’ is that they come from communities, yes, that word again, where there is hope and aspiration. Communities can drag people down as well as pull people up and when we talk about ‘community building, we can’t ignore the uglier aspects of some communities.

As Cameron talks of ‘pockets of sick society’, I think we know where he is pointing the finger.  He is pointing the finger at ‘other communities’. He is pointing the finger away from himself and people like him. This is not his problem because this is not his community. Are those ‘pockets’ communities within themselves? It seems to me that they are and there needs to be a recognition that community is far broader in scope than the ‘let’s all help each other’ model.

The sooner we broaden communities and build communities across economic and cultural lines the more we improve society. If we, like the Prime Minister states, see this as a problem with ‘pockets of a sick society’ we isolate and abandon those elements and detach them from our own more mainstream society.

That is dangerous.

The sickness of society is that there are ‘pockets’ within it.  This is not simply about poverty. This is about the difference between building exclusive and inclusive societies and yes, communities.

Communities have to reach out and build bridges across them. We have to build more inclusion. We have to take responsibility and those that wish to push us into communities have to understand better the way the networks are interdependent.

My community is hurting. The only way I can see to rebuild it is to involve myself in it.

If anything indicates that there is a role for more macro social work. A role for community work  but an inclusive type of community that doesn’t self-select and is able to reach out to those who might not naturally seek to be a part.

I have felt fear this week, in a way I haven’t felt fear before. I’ve also felt anger and sadness. Now, I’m trying to find hope and I have and I will.

But I still despair of the politicians who purport to ‘lead’ us and the desperate isolation and detachment I feel between my world and the world I see and the worlds in which they move.

Community has a better hope of existing when some of the barriers between ‘us’ and ‘them’ are challenged and broken down.

That’s the real challenge for communities in these days ahead of us and we can no longer leave it in the hands of detached politicians who live in their own privileged communities.

We need to build. As the world moves on to the next News story, those of us left need to hold our attention on those around us and see what we might not have seen if we didn’t choose to look.

So what does community mean for you? Is it a useful word or has its lost it’s use through overused dullness?

I’d be interested in the responses because it’s been vexing my mind for a while.

London – Some thoughts and hopes

I didn’t sleep  much last night. Or the night before. Or the night before that. My city is burning. There is a tangible fear in the air. I’m not above it because I feel it and I see it.

I don’t want to listen to politicians being parachuted in (when they finally arrive back in the country) to talk about mindless violence and talking to ‘community leaders’.  ‘Community leaders’ who are self-appointed and seem to want to polarise and divide rather than come together and heal.

Don’t speak to community leaders, come and speak to me. Come and speak to people like me who just want to find ways for sense and our voice to be heard. I’m just as much a part of this community as ‘church leaders’. Why are they credited with greater access to the ‘influential’.

I want people who live here and love this city to find ways to heal her and pull her together. I don’t want the same ‘community leaders’ speaking to the same ‘politicians’ trying to build up their own special interests and agendas.

I want to shout and scream and rage at all those who seem hell-bent on destruction but this is a symptom not a cause.

This is and never was about race. This is about age and belonging. How can you care for a society when society cares nothing for you?

This is a disaffected youth who are devoid of a moral compass because our society values goods and monetary worth over basic humanity. This is what has been learnt. The ‘establishment’ doesn’t work for you but against you. You take what you can.

Perhaps though, these awful scenes and desperate situations will provide an opportunity to build a better society for everyone and to reach out to disaffected youth and marginalised people.

Maybe, this will be the way to build a real, true community and to build a better London.

I love this city. I was born here. It’s my home. It has its rough and smooth.  But it is a good place and it is filled with good people. There are enough of us here to force a triumph for the good.

Riots, Poverty and Assumptions

It would be remiss of me not to mention the rioting that took place in London over the weekend. I work and live in some of the poorer areas of the city and felt, indeed, still feel desperately saddened by some of the pictures and reportage coming from Tottenham, Enfield and Brixton among other places.

I can’t begin to make sense of it. I know the initial trouble grew from anger against the police after the shooting of a local resident last Thursday.

Regardless of the details of the initial spark that lit the tinderbox of malcontent across London, my sense is that it was, for many an excuse to cause trouble.

That isn’t to say there may not be real reasons for anger against the police and against the ‘establishment’ but the way the anger was expressed through mindless violence and looting seemed to indicate that there was also a wish to express anger and rage against lots of other things as well.

The places the riot went, so went the Twitter messages, Facebook posts and groups and the less ‘keyed in’ SMS messages letting others know where to come for random violence. Where to come for looting ‘opportunities’. Where to express ‘anger’ even if sometimes it was unclear what the anger was about or to whom it should be directed. It seems harsh that the ordinary citizens of Tottenham will be the ones to bear the deepest repercussions of the violence and aggression – for whatever reasons.

This morning I was listening to the radio. I heard the host say, ironically I suspect that the people of Tottenham deserved this for not ‘parenting their children’ correctly. For allowing their children to run wild. He said, again, I think it was intended to be ironically – ‘Where were their parents? Or rather, where were their mothers as I’m sure most of them don’t know their fathers’.

Wow.

Let’s just think about the way that we perceive people who live in poverty and poor areas for a moment.

I’m no sociologist. I have though been living and working cheek by jowl with poverty. It doesn’t make me an expert and I am fortunate enough to say I don’t have a lived experience of poverty. I’ve had periods of debt problems.  I’ve had periods of difficulties.  I lived in a single parent family but I haven’t experienced poverty.

Even so, I think that poverty is not necessarily one of the flames that fuelled the protest.  I think there’s an element of wanting excitement, wanting danger, perhaps even – wanting to change the way things are in society that lead to so many and so much injustice, discrimination and pain.

The ‘order’ of things that makes some people own and other people beg. A governing class that can take fancy foreign holidays while the streets of Tottenham burn.

Then there is the looting. Wanting something for nothing. The politics or rather the sociology of envy. The kinds of programmes that fill our evenings of reality star mania that make fame and wealth so easily accessible without the commensurate effort. Without seeing something grow. Without working.

Without work. That’s another element. Can it be a sheer coincidence that the levels of joblessness around Tottenham are some of the highest in London?

Probably not.

While Cameron holidays in Tuscany and Osbourne enjoys the delights of Disneyland (or DisneyWorld or wherever he is), I genuinely wonder if they can ever understand the fears and concerns of the people of Tottenham.

We’re all in this together?

Sticks a little in the throat to say it while statements are returned to the country from exotic foreign climates.

There needs to be a real effort and a real desire to make this world and this country better.

As for those who proposed, instigated and enjoyed the riots. Those who looted and ruined local communities already hurt by poverty. I hope they are caught and punished. I’m a social liberal and my views tend to drift leftwards but I have no time whatsoever for mindless destruction.

The pictures I’ve seen have been ones of mindless destruction and people enjoying violence. That needs punishment.

As for now, we need to think about these communities. We need to care about the people of Tottenham and places like that. We need to think about the effects of the cuts programmes in areas like this and why the levels of disengagement and disaffection are so high.

We need to heal this city and this country.

No, violence should never ‘win’. Destruction and crime must be punished.

But creating a better community, society and country need to be the goal.

As for today, I’ll share a thought or two with those caught up in the violence, fear and disorder. The people who live in the communities and particularly the people of Tottenham.

I wish them healing and time to build their community back up stronger and better.

Commissioning

Yesterday, I caught up with a friend of mine whom I hadn’t seen for a few months. She works in commissioning. She didn’t work in commissioning when we first met but her career trajectory has taken a few odd side steps and there she is.

We talked about commissioning for a while. She doesn’t work in a part of commissioning that affects the services that would be delivered by my part of the service so I felt fairly safe moving into rant mode as I spoke to her.

I wondered, to her, why the process of commissioning is so far removed from the frontline service delivery.

But there are service user consultations, she added. Yes, I replied but they are narrow in scope and where are the voices of those who do not ‘self-select’ themselves on ‘panels’. Where are the voices of those who may not have the capacity to make some of the decisions related to their care needs? Where are the voices of the carers who don’t actually have the ability to leave their homes because of the lack of appropriate respite – particularly older carers? Where are the voices of the voiceless?

She had a good comeback of course and spoke to me about the reams of additional advocacy support she is involved with but it made my heart sink.

You see, all advocacy apart from statutory IMCAs (Independent Mental Capacity Advocates) and IMHAs (Independent Mental Health Advocates) have been withdrawn from the services that I work in. The voluntary sector agencies that might have helped have either been axed or cut back sufficiently that they won’t ‘work with’ people who enter our services.

But back to the commissioners. I wonder why I didn’t know the name of any of the people involved in commissioning services for our local authority in the user group I work with. Why don’t they come to our team and meet with us and talk to us, I suggested to my friend, while, of course, absolving her personally – I know she is both good at her job and dedicated to providing good quality services.

Surely we, who are involved in scoping out support plans, making suggestions about which care agencies might be better than others, we who receive the day to day complaints when services aren’t available or aren’t working, would be useful people for commissioners to engage with? But I don’t even know the names of the people who work in commissioning the services we are asked to use.

They make block contracts on the basis of cost which deliver poorly. Yet when renewal time came around, exactly the same contracts were dished out. Perhaps we should meet and discuss our respective jobs a little more often.

I feel angry towards the unnamed commissioners in our service. I feel angry because they drop services on us which are basically unsuitable but cheap. They say they ‘consult’ but as I have learnt over my time in the job, ‘consult’ does not mean discuss, it means tell.

I wonder how many of these faceless ‘commissioners’ would be happy to stand alongside me in a hospital as I tell a family they will have to travel miles each way to visit their parent in a residential home because we have nothing available locally. Or stand next to me as I apologise, in my role as a corporate ‘entity’ because the provision of respite which was promised is wholly unsuitable because its all we have to offer.  Or listen to the conversations I have to take about carers rushed off their feet because they are limited to these ‘15 minute’ pop-in visits to desperately lonely people or listen to the discussions about why we no longer do a hot meals on wheels service and deliver only microwaveable meals. Occasionally, I’ve been known to tap out a grumbly email to ‘commissioning’ about particular services – and why I think they work or what I think is lacking – simply because I am not sure what other action to take and I want to ‘do something’. I’ve never really had anything other than perfunctory responses. They seem to exist in a parallel universe of contracts and submissions and plans.

Who was consulted before these commissioning decisions were made? I’m sure people were. Or were they? What backgrounds to ‘commissioners’ have in human services – I honestly don’t know. I don’t know if they have ever had any professional expertise in the areas that they commission for or have just moved up through various administrative ranks without any frontline experience.

I know ‘back office’ is important. I know there are some people that need to commission services. I understand that. I just wish sometimes I knew who they were and the ways that they made their decisions. I wish sometimes they would show their collective faces in our offices to understand better the implications of the decisions they make.

I’m very far from an expert in organisational systems but surely it can only help when different parts of a ‘group’ come to know each other face to face through discussion and understanding rather than the continual barriers that are put up between us by people who feel it necessary to stay in their safe silos.

I don’t want to mistrust commissioners. I just want to know who they are. More importantly, I want to know they understand the effect of their decisions on the people I see every day.

Fear and Loathing in the Public Sector – Or Why I despise Oliver Letwin

Oliver Letwin, United Kingdom Conservative Par...

Image via Wikipedia

Yesterday I read this article about Oliver Letwin, who, according to the Guardian article

..warned that it was only through “some real discipline and some fear” of job losses that excellence would be achieved in the public sector.

Letwin added that some of those running schools and hospitals would not survive the process and that it was an “inevitable and intended” consequence of government policy.

A little background about Oliver Letwin. I’m always a little wary of using Wikipedia as a source but a few choice verifiable ‘quotes’  jump out.

He is the ‘architect of modern Conservative party policy’.

He would rather ‘beg than send his children to an inner city school’

Oh and earlier this year he said did not ‘want more families from Sheffield taking cheap foreign holidays’.

So do we have a picture of the man? The Eton-educated man who would not know the real effects of true fear in the workplace? That encompassing, sleep depriving fear of not knowing if you can afford your next mortgage payment or if your job will be there next week, next month or next year.

Does fear drive excellence?

Let me tell Mr Letwin exactly what it means in the working environment that I am based in.

I work in a Community Mental Health Team – our team has been decimated – actually to use that word literally, it is far worse than decimation – over the past two years. No, I don’t restrict the blame to the current government but include changes under the previous government in my criticism.

We have piles of unallocated ‘virtual’ files while we are pushed to the limits by increasing expectations regarding recording and inputting data which is supposed to ‘prove’ our efficiency.

We have had wards closed at the local hospital such that people who need emergency hospital admissions to psychiatric hospitals are placed away from their communities or on ‘inappropriate’ wards. I have police unable to provide assistance because their services have been cut.

Fear drives efficiency, he says? In our service we have been told there will be job cuts including possibilities of compulsory redundancies. Yes, I’m fearful.

The ‘consultation’ about what will actually be proposed for our jobs will probably be announced soon but we’ve known it has been coming for months. We’ve heard rumours. We’ve heard gossip. We’ve heard absolutely zero from our managers though. Nice. Way to generate lots of fear. All boxes ticked.

So what has this fear done for our efficiency? We are beyond demoralised. We have more people leaving and taking jobs elsewhere and  people are  taking longer periods of sick leave.

I know that Letwin wasn’t referring to the ‘front line’ staff in the public sector – oh no, he meant the managers because he is of a class and a mindset that probably finds it hard to hold a conversation on a human level with anyone who earns under £100,000 per year.

The distinction between ‘frontline’ and ‘backroom’ is a false one though as it is impossible that can operate without the other.

Hospital wards are closing. Cuts are being pushed through. We feel your ‘pressure’ Letwin. We feel your fear. But I could not possibly despise  you any more than I do for your ignorance and self-serving words that for me, epitomise what the Conservative Party and their ideology-driven cuts want to do to this country.

I would like to ask Letwin if he is happy to condone a country of Castlebecks. Well, you see, coming from someone who would ‘rather beg than send his child to an inner city school’ – he would never be in a position to actually know or understand the real concerns of people who are dependent on public services because he can always choose the private course for himself and his family.

I know he wants to ‘make a name for himself’. He likes to garner attention and oh, how clever he is to want to drive ‘fear’ into the public sector but that, to me, sounds close to cruelty.

Efficiency? I think we can do with  fewer MPs who feel the need to make claims for repairs to their tennis courts and to have their Agas serviced.

What kind of society have we become when we feel it is appropriate for a Government ‘Policy Minister’ to drive a disdain and almost bullying approach to a public sector that provides services he will never need?

Oh and the speech he made these remarks in?

It took place

at the London headquarters of KPMG, one of the biggest recipients of government cash, which won the first contract for NHS commissioning following the decision to scrap primary care trusts and further open the health service to private companies.

Nice work, Letwin. Roll on, executive consultancy. You are all in each others’ pockets.

Meanwhile I have work tomorrow.

You enjoy your private tennis court today.

Goodbye Southern Cross, Hello Open Public Services

So Southern Cross – the largest private care home provider in the UK will be closed.

What of the 31,000 residents who live in their properties? Well, the government has given us its assurance that they will be ok so that’s alright then.

Or not.

Goodbye, Hello

m kasahara @ flickr

On the day that the Open Public Services White Paper was published  (which can be found here – pdf) – which couched in the comfort of positive words like ‘choice’ , we would do well to heed the warnings of the way in which social care was sold off in chunks, from public to private and reflect on whether it is better to allow care homes to ‘fail’ in order to prove that the strongest will rise to the ‘top’.

The problem is that Southern Cross WAS the strongest. It did rise. It also speculated on property and ownership transferred away from the core business base of providing care and homes for those who needed both.

But on a more pressing issue, what will happen to those who live in Southern Cross homes and work for Southern Cross homes.

As the Independent says

Analysis by the GMB union revealed the names of 80 landlords who own 615 of the homes, many of which are subsidiaries of larger companies registered overseas. This makes it much harder to obtain financial information about the companies as rules governing accountability and transparency, especially in “tax havens” such as Jersey, Cayman Islands and British Virgin Islands are significantly more lax.

In addition, the GMB was unable to trace more than 120 landlords, which mean thousands of people are living in care homes where the identities of the owners and directors are unknown.

In the absence of full company accounts and other relevant information, such as the names of directors, it is “nigh on impossible” to assess whether they are suitable to run care homes funded in large part by public money, according to Andrew Craven, GMB statistician and researcher

At least the ‘Department of Health’ spokesman says

“Whatever the outcome, no one will find themselves homeless or without care. We will not let that happen. Today’s announcement does not change the position of residents. The Care Quality Commission will continue to monitor the services provided… We have been in constant contact over the course of discussions and remain ready to talk to all parties.”

That’s reassuring. Or not. Would that spokesman or anyone in the Department of Health want that level of uncertainty lying over their head or the heads of one of their parents? The residents of the homes will not know who their landlords are or whether they are fit to run care homes at all. Of course no-one will find themselves homeless – it will be the local authorities, the elected local authorities who will have to spend and fret themselves out of this one – nothing to do with the Department of Health’s reassurances – unless the Department of Health is going to compensate those local authorities for the time and cost they spend to ensure the welfare of residents of Southern Cross homes that may close.

As for the CQC, I think we have established that it is unfit for purpose and unable to regulate a care industry that has grown too large and too costly to be regulated efficiently. How about an idea? The Department of Health invests very heavily directly in the CQC so that they can provide at least twice-yearly, unannounced inspections together with a host of lay visitors attached to every single residential and nursing home?

No, the Department of Health is weedling out of this crisis as it will weedle out of the cost of ensuring that the residents of Southern Cross Care Homes are not made homeless.

Now, I want to link some of these issues to the Public Service White Paper that was published yesterday and particularly one or two sentences I picked out.

Firstly

In the context of rolling out more extensive ‘choice’ in other areas of government, the paper says

‘We will ensure that individual service providers are licensed or registered by the relevant regulator for each sector (e.g. the Care Quality Commission) so that those choosing services can known that providers are reliable, without stifling cost”

Does that not lead to a tiny little shiver down ones spine? The CQC is being held up as a reason to trust in this extension of ‘choice’.  Has noone mentioned the cost of good quality regulation, either.  It’s worth reading this post at The Small Places for more consideration of the way the CQC regulates social care services. The CQC has failed to regulate and the care sector is failing to deliver on personalisation so far. The care sector has had time to learn as well. We had direct payments for many years and before that the ILF (Independent Living Fund) which allowed payments to be made directly to adults with disabilities to choose care. The system should be sophisticated enough by now to deliver good quality, equitable services but it has taken many years even to reach this point. There’s a long long way to go.

Secondly

“The wider public sector has much to learn from local authority successes in commissioning, for example, in adult social care”.

See, look at us, government, we’re a success! Success. This is the end-result of success. Adult care commissioning is not a success. It has not extended choice unless of course (and I think I’ve found the key) success is based on the principle of privatisation and provision of contracts to the those who deliver at the lowest cost regardless of quality. That is the adult social care ‘success’ that the government is lauding in the Open Public Services White Paper.

We are dazzled by words such as ‘choice’ and ‘open government’  but they have no meaning outside ‘lowest cost’ and ‘discharge of responsibility’.

Think of Southern Cross. Think of Adult Social Care. It’s coming to our homes, our hospitals, our high schools and our highways.

So much for my week of positivity!

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