Fighting Monsters

Earlier in the week,  as a result of the Care Ambassador scheme that I am a party to,  I  had a meeting with a someone from  Skills for Care who is involved in setting up some of the meetings and training sessions with schools.

The Care Ambassador scheme is something I had been involved with for a few years, although somewhere along the line it has changed from the Health and Social Care Ambassador - but the Health part seems to have fallen along the wayside  - my guess would be something to do with the funding being provided now from Skills for Care.. with the changes to the way that its being run it has been relaunched now - hence the meeting.

The idea of the scheme is to promote careers in Social Work and Social Care to younger people who might not have even considered it as a career path.  It is part of a longer term strategy to bolster up an ageing (thanks!) workforce and promote positive images of social care and particularly career opportunities that are available in social care to people who might not  have even considered it as an option.

One of the things we were discussing was things about the career that I found to be positive - and I almost surprised myself by the ease in which I was able to reel off the things I like about my job.

I also had to write a short piece that will potentially distributed to the kids that I work with about myself, my own career path. I was asked where I wanted to be in five years time.

I gulped. I know I was probably expected, in the context of this being about promoting career paths and wanting kids to ‘aim high’  to say that I wanted to be some kind of manager. I really don’t though and couldn’t bring myself, in all honesty to put that down. In the end I said I’d like to see myself doing the same thing that I’m doing now - because its true - possibly in a different setting or a different area - but not fundamentally different. Or some kind of academic work - research or teaching.

I also needed to come up with some ‘interesting’ facts about me that might spark interest.

The woman I was speaking to was giving me examples about all the strange and exciting things other people had written, one, she said, had worked for the Queen at Buckingham Palace. Another had been skydiving.

I tried to wrack my brains for ‘interesting-things-I-have-done’ and offered up a rather pathetic story about an old and rather uninteresting summer job I’d had one summer at school.

And then, as we moved onto other topics, I realised I’d completely forgotten to mention my I’m-quitting-my-job-and-grabbing-a-random-flight-to-the-sun moment a few years  back which resulted in a two year ’sabbatical’.  But that’s a story for another day - sometimes it takes effort to remember I’m perhaps not as dull as I think I am!

It’s an interesting programme and I like the idea of it. As I said to my manager yesterday, I think it’s a good thing for me to do because I have to remind myself frequently about the genuinely positive reasons I do the job and why I chose it. Also, on the basis that I’m going into exclusively inner city schools (we ‘operate’ in the area in which we work)   I think there really are opportunities in the sector that people might not know about.

As I was told, some of these kids (and not just kids!) might have very poor ideas of what social workers are and what they do.. so its a chance to at least change some of those perceptions.

Variety is the spice of life, so to speak and it keeps things interesting for me too, as, I noted in the piece I wrote - one of the things I like about the job is that every day is different..

So, a week from the start of my journey into a Direct Payments referral and I have sent the appropriate forms, documents and paperwork to the appropriate people.  The figures are being checked and the amount that has been requested matched up against  the Fair Access to Care criteria along with a brief (at this stage) breakdown of what each minute paid will be used for.

As is ironic the person to whom I sent them is  on holiday - but this is not ‘urgent’ so it will wait. I doubt that a week or two will make much difference in the long run. So possibly no update next week!

I have asked the daughter to open a separate bank account for her mother - I like to get this done as quickly as possible. We have some pro-forma letters to send to banks to request that the facilitate the opening of a bank account and don’t perhaps, use the usual criteria that used to make opening a bank account quite difficult for some users. The letter is a result of some consultations between the council and the banks.

The Consumerist at Flickr

We also had a very very brief chat about the process of employing a carer.

As for the Carers DP, that has a different path for authorisation. I updated the Carers Care Plan and Assessment sent it to someone else who coordinates carers services to request payments.

Meanwhile, in a somewhat timely manner, The Social Work Blog writes about a GSCC consultation regarding the regulation of personal assistants who are employed by users of Direct Payments.

Up till now, employees of Direct Payments users have not been required to have the Criminal Records Bureau checks required of all over professionals in the social care sector.

This was partly to allow for a more flexible approach to be taken to employments by users and to cut through some of the ‘red tape’ that might prevent users from employing whoever they want.

Personally, I think that’s all very well for some users who are able to  manage and organise the direct payments but for me, it adds another layer to the barrier to being able to wholeheartedly run with direct payments when working with a more vulnerable user group - particularly, I’m thinking of older people.

I have to claim having a slight vested interest in the debate.

My father is uses direct payments and employs carers directly - he has had directly provided services (without too many details, he has been a user of social services care for many years) and he now has, and has had a direct payments care package for a number of years.

He has currently and has been lucky to have almost consistently, a number of exceptional carers - some of whom I’d like to poach for service users that I work with, but I don’t think he’d forgive me!

But I want to know that he has safe carers. That it isn’t a case that anyone can look at an advert in a newsagent and reply and be working in the home of a vulnerable elderly (sorry dad!) person within days.

Sometimes when I’m at work, people might see me as a detached professional without possibly knowing that I have had quite a lot of experience as an indirect recipient the other end.

And that’s what  I mean when I judge the services I provide against ‘Would I want my dad to go here/get this/have this service?’ It isn’t quite as theoretical a question as it might sound..

Both The Times and The Guardian reported that Southern Cross Healthcare Group have been launched into some kind of financial crisis following the failure to repay a loan of some £46 million.

Times are getting harder and a lot of firms are failing - but Southern Cross are the largest provider and operator of Residential and Nursing Care  Homes in the UK.

I actually have to say I have had no dealings at all with Southern Cross in the years I’ve been working. So can say neither good nor bad things about them from personal experience.

But just putting a few pieces of very rudimentary information together

The Guardian quotes the company spokesman as saying that the reasons for their financial difficulties are

.. tighter local authority spending for a period of disappointing occupancy rates. High fixed costs and disappointing occupancy rates meant Active Care in particular was performing “significantly below forecasts”. The company also said occupancy levels had been hit by several unexpected deaths of residents in its homes for the elderly.

I was going to say that I’m no cynic, but that’s probably not true - I was reminded of a story I wrote about at the beginning of May where CSCI (Commission for Social Care Inspection) criticised a Southern Cross Care Home for having poor basic dementia training among other things.

You’d think though, that a large company like this would have contingencies for ’several unexpected deaths of residents’

I know the previous time I wrote about Southern Cross it was in the context of a freeze on placements to a particular home following a poor CSCI report and the death of one of the residents. Disappointing occupancy rates? Quite possibly.

It’s strange that The Financial Times reported back in May that

‘The group has increased the cost of staying in its homes over the past six months, agreeing fee rises of 5 per cent on average with 85 per cent of its local authority customers.’

which is, more or less, in line with inflation and certainly higher than my proposed salary increase this year (!) so, less than six weeks later to blame failings on

‘tighter local authority spending’

seems more than a little churlish.

It seems one of the business practices of Southern Cross was based around building property to lease it back and making its profit partly on property portfolios and management.

The Times quotes the Chief Executive saying

“The care homes sector is cyclical and the cycle has turned down. The margins of two or three years ago will likely be squeezed and fall at least 5 per cent in the next two years.”

I am no accountant but surely cyclical also means, to some extent predicable.. basic kind of saving-for-a-rainy-day type stuff.

Anyway, I am the last person who should really be commenting on Southern Cross’ business model. My idea of wise investment is an instant access savings account.

But I can’t help but wonder what the implications will be for people who are in the residential homes that are failing.

A large proportion of care services,  both residential and domiciliary, has been out-sourced to private companies who have many different interests at heart not least, shareholders.

If they see a death as ‘a disappointing occupancy level’  and lurch towards crisis when there is a cyclical downturn it doesn’t really augur well for planning long term care.

Anyway, at least two of the execs who were in charge of running the company managed to sell their own stock when they were at a high of 550p in December before leaving the company..

The stock fell to 130p yesterday.

And other factors that don’t endear the company, which again, I have had no personal contact include one which was highlighted by Mental Nurse back in April indicating that they were involved in the landmark decision in the High Court which ruled that Care homes can evict residents by being the owners of the Care Home that was trying to do the evicting..

This is also the same Southern Cross that opposed the payment of £7.02 per hour for Senior Care Workers - many of whom were from the Philippines and were refused visas to stay on the basis of the wages that they were receiving - thus being deported.

It doesn’t get much better for Southern Cross (isn’t Google a wonderful thing) as, The Times says again, in another article that

‘In November, The Sunday Times conducted an undercover investigation, with a reporter posing as a carer, and documented a series of alleged abuses and said the home was under-resourced and understaffed.’

At, yes, a Southern Cross Home.

Between deaths, attempted evictions, seemingly poor payment and treatment of staff and undercover reporting that proves, if more evidence were needed, that there is a poor quality delivery of care due to understaffing and under-resourcing.. it is a little clearer why there might have been underoccupancy.

I’m sure in such a large company there are some good quality care homes among there somewhere but reputations do stick when placements are being made - I certainly know there are some companies that I am less likely to make placements with than others, on the basis of how some of the different homes that they own are run - rightly or wrongly you can’t take chances when you are choosing the place that someone is likely to be living for the rest of their life.

But at least some of the executives got out at the top..

I just wonder how this leaves and will leave those who are receiving the services at the moment.

I work in the inner city and have since I did my first practice placement in the first year of my social work course almost 10 years ago now.  For as long as I have been working as a social worker , I have only ever worked in the inner city - different parts of it granted but its what I’m used to and what I know.

While most of the work is in the overcrowded tower blocks that circle the main business districts and higher class shopping areas of the city - neither mental  illness nor old age spare any income bracket or social class.

So yesterday, I found myself in a house that I had to seriously brace myself before entering - and not in the way I’m accustomed to. I am no estate agent, but the size and location would put a fair multi-million estimate on the property.

Inside though, the issues, pain and confusion were the same as those I see in the high rises that are less than a mile away.

Mr A has dementia and goes for his walk in the local area. Mrs A lives with the fear that every time he goes out he won’t be able to find his way home or he gets on buses and ends up the other side of the city.

She surruptiously (as he won’t tolerate identity bracelets or pendants) sticks a label with his name and address on the inside of his jacket when he leaves - just in case. Every day.

They are and have been a very close couple. Now, Mr A won’t see anyone else. I got in because I said I work with the doctor (who had been to assess him previously and asked me to follow up)

Mr A with his confusion is still of an age that equates ‘what the doctor says’ as being irrefutable.

But Mr A won’t let his family visit anymore. He doesn’t like Mrs A going out without him and she doesn’t like leaving him alone.

She told me about the loneliness she felt. Not being able to have her family visit. She told me of a completely different Mr A before the dementia  had taken hold who used to love chatting with his daughters and having the grandchildren and great-grandchildren come to play in the garden.

She wanted him back but over the years had become resigned to the reality of the current situation.

Now, she just wanted to a break.

When I explained to her about the provisions of regular residential respite care she almost snatched my hand off. I ran through a list of the local carers groups and user-led groups that I felt would be helpful. Possibilities of practical things that could be done and help that could be offered.

We ran through the possibilities of domiciliary respite care (where someone comes into the home and provides a sitting service)  and various telecare devices which can provide some reassurance.

This is a situation that is far from uncommon for me and often, when I visit following a medical assessment or diagnosis of dementia, I will be the first ‘face’ of social care than a family have ever been presented with.

And as I was talking, I was aware of my own assumptions - going into a truly palatial home isn’t what I am used to. Perhaps I used to make more assumptions about the way people live and what needs are there.

But really, the work is exactly the same. The needs are still there and the pain and confusion is still there.

I know I wasn’t really expecting it any other way, but sometimes when you walk through those kinds of houses in those kinds of areas and you glance into the windows and wonder what it would be like to live  that way, usually with some wistfulness  - the people inside the houses do live, breathe, worry and feel in the same way - they get old and grow ill in the same ways.

They just probably don’t have to make the judgements about the loaf of bread or the extra winter heating so often…

I read in on the Times website that a letter has been written to the British Journal of Psychiatry,  in which 36 signatories complain that

‘patients with serious problems are often referred to psychologists and social workers rather than clinicians and do not receive the medical therapies they need.’

Now, I don’t have access to the British Journal of Psychiatry so have to rely on the Times reporting.

Apparently, this is a great disservice to the patients who are in need of medical treatment (a position that I can understand as far as it is the case) I’m a little baffled though, as all the referrals we take into our service are referrals to our team which includes a consultant psychiatrist, a  Specialist Registrar (I know, they’ve changed the names - but I can’t remember what grade they equate to now!), a clinical psychologist, some CPNs, Social Workers and an Occupational Therapist. None of us accept direct referrals to individual professionals without the team being involved first.

- and, according to the Times article

The changes came about under a scheme, New Ways of Working, established in 2005. GPs now refer patients with symptoms of mental illness to a team of up to eight people, which will include psychologists, nurses, social workers and a psychiatrist

Now, I reserve the write to be completely wrong here - it wouldn’t be an unusual position for me to take, but my understanding of New Ways of Working initiative is that although a report was published back in 2005, it is still in the consultative phase and was being discussed in 2005 then rather than being ‘established’. Some tentative steps might be being taken in that direction in some trusts but it by no means ‘up and running’

Multi-disciplinary Teams - these ‘teams of up to eight people which  include psychologists, nurses, social workers and a psychiatrist’ have been in play for many years - certainly prior to 2005.

So I’m a little confused by the issues and the facts - although not being able to read the original letter of course, means that I’m relying on the second-hand reporting of the Times.

It seems that the main area of concern is that people with severe and enduring mental illnesses will see one of the team that provides ‘psycho-social’ support rather than ‘medical’ support.

So

‘“If a GP suspected a patient had cancer, he wouldn’t dream of referring him to anybody other than a cancer specialist. A cancer patient might need jollying along, but what he really needs is the correct diagnosis and treatment. That’s what he gets from a specialist. But patients with mental illness are not automatically referred to psychiatrists. If they only see a social worker, there’s every chance that mental illness, or underlying physical illness, will be missed. Patients are getting a bum deal.”

winnie the pooh mbbp at flickr

Of course, I am not a doctor and nor do I want to take the role of a doctor. I don’t want to diagnose or prescribe - but I’d also take issue that people that I work with ‘get a bum deal’ when I am involved in their care - not least because there is not a single person that I see that I don’t discuss in a team setting with our consultant psychiatrist on a regular basis. As I said earlier, all allocations come through a team discussion which includes the presence of doctors initially.

And as I work with someone, when there is any change or concern, he is the first person I would contact to discuss these concerns with.

I can’t say I speak for all multi-disciplinary teams in the country but although I’m not a medic or medically trained, I’d like to think I can recognise areas of concern and bring a psychiatrist in very quickly when required (and sometimes when not required - I tend to play safe) . I don’t need to diagnose in order to recognise.

A part of the multi-disciplinary team structure is to work towards strengths. I would also hope that I provide a little more input than ‘jollying along’ but sometimes you just take what you can get and what you can work with.

The New Ways of Working, is, as far as I understand it, is a way of delivering a wider range of services by a broad group of professionals - but not about training others to do the job of doctors or about deskilling specialists. It is, as far as I could understand, about providing a higher skilled professional with more training , into the picture.

Noone wants to see a poor service being delivered or any kind of practice that would detract from medical treatment being provided when necessary. I would never consider myself a replacement for a medical professional but as a different branch of the same tree - because that’s where my expertise lies. I don’t want to be a ‘poor man’s doctor’. I want to be a social worker and not a doctor and to do the job that I am trained and expected to do and I want to do it well.

If that includes ‘jollying along’ so be it but not at the expense of clinical need. Social circumstances and considerations do have a very important role to play within Mental Health services though and to ignore those needs too can be an issue for concern for the patient.

This week I completed two Mental Health Act Assessments (not on my own, of course, I’m still not warranted!). So I probably don’t need to elaborate on the fact that it’s been quite busy.

Just a few aspects as I saw them.

I spoke to one patient’s mother before first assessment as is required by the Mental Health Act. She was his nearest relative. I needed to ensure that she knew was what going to happen and although we were looking for an admission to assess and therefore consent wasn’t required, I needed to consult and obviously wanted to make a very hard and difficult situation as smooth as was possible.

She was sobbing audibly as I spoke to her. I explained with as much gentleness as I could muster that we would be visiting and who would be there, how long I expected that we would be there and some of the things that we would be doing and saying.

I explained that we may bring her son into hospital - and she agreed that she felt he needed it. She was worried and concerned but repeated to me that ‘I never thought it would come to this’.

She was present during the assessment - still sobbing. I’m glad we didn’t need to use the police. She helped her son pack his bag. Fortunately she lives near the hospital. Her son actually thanked us, as we left him in the hands of the wonderfully sensitive nursing staff who were able to address his concerns and worries - one by one without rushing him through the admission process. That took me aback a little bit. Of all the reactions I have seen, I never really expected to be thanked.

The other assessment, we couldn’t locate the patient’s mother. But she was very clear she wanted no contact with any members of her family to be made so apart from checking with GP, hospital, back through all the records we had - social services as well as health, we couldn’t really do anything more. We didn’t even have a name to go on.

But as it happened we didn’t admit her anyway. It was an interesting assessment as both medical recommendations had been signed. It wasn’t the first time that I haven’t admitted someone following an assessment but it was the first time that I hadn’t in the face of two medical recommendations.

I think in some ways the assessments that don’t result in an admission need a lot more consideration as the risk assessments need to be very clear. Especially if the medical recommendations are in place.

The new Mental Health Act Code of Practice is going to be (so I’m told) far more explicit about not using the threat of an admission under the Mental Health Act as a way of trying to affect behaviours, so, for example, it will not be acceptable to say

‘We have two medical recommendations and while we won’t admit you now, we can come back and take you to hospital if you don’t take your medication’ (i.e. sign the admission papers).

This is something I was very mindful of during the second assessment as we spoke, specifically about coming back the next week to see how things had developed but we (myself and the ASW there) spoke about how we could present this without it being a threat. I’m quite confident in my mind and regarding the reaction that it was not presented and perceived that way.

But I am going back next week..

I wasn’t intending to follow up the post I wrote on Saturday but then, yesterday, I read that Social Workers are buckling under the stress burden according to The Guardian, and the coincidence seemed to be too ripe to pass up.

Anushka Astana writes

‘Research carried out by the Conservative party, using figures obtained under the Freedom of Information Act from local authorities across England, show that as many as 15,550 social workers took long-term sick leave. The rate is one of the highest for any profession and double that of teachers. Meanwhile, stress-related claims by social workers cost the taxpayer £13m last year.’

kelvin255 @ flickr

I can’t think of anyone in statutory social work (and I’d say I know a fair few!) who could be remotely surprised by these figures. Although not currently, I have worked in more than a few teams that have been decimated by stress-related sickness.

It’s all very well for this to be acknowledged by The Conservative Party but by noting that this is information has been made available under the Freedom of Information Act, this does, by its nature imply that this is nothing new to the Social Work departments in local government.

Our employers (and I’m speaking from the view of someone who has worked, since qualification anyway, in the statutory sector) know exactly how many of us they are driving into stress-related sickness.

We don’t need national politicians to tell us.

But they have consistently allowed this situation to continue.

Occasionally, in my experience, when the situation is too hard to avoid due to sheer numbers - it might be addressed but never in a very proactive way. Of course, I’m speaking from personal experience so there might be, and I’d expect it, some great teams out there somewhere that have excellent evidence-based practice in relation to stress management at work - but judging by the figures above, not enough of them!

There are, in my view, a couple of things that would help the situation. Personally, the one factor that causes me stress is management, expectations and target-driven work. Not that actual contact work, that is.

I am used to working with people in difficult situations, I am used to being verbally abused either directly by service users or by family/carers on a regular basis, I’m used, now, to having my physical appearance, dress-sense (or lack of it!) , race, class, weight, accent, religion and gender picked up on by people, my competence questioned, my intelligence (or rather, lack of it!) mocked. That is something I am well able to manage. I know it isn’t me, personally, that the attack is aimed at, but my role, my job, my organisation, the government policies, local and national and the completely uneven power dynamic in the relationship. Honestly, I can deal with that and manage it. It isn’t always easy but it definitely gets easier to detach from verbal abuse at work.

What really stresses me is the lack of support from management - lack of opportunities to ‘let go’ of some of the feelings that I have when I finish work at the end of the day. The loss of sight of the individual in the mass of figures and targets.

I don’t see people as targets. I would love not to meet the ‘adult abuse investigation’ targets because those targets are black and white on a balance sheet but they mean that someone, somewhere has been undergoing pain - and collating figures doesn’t always match up.

Some of them I can understand more, like the targets for carers services - which have really been pushed and have been the source for more services to be put in but some of the exercises are just paper exercises and looking at how work you already do can be interpreted to meet the targets that have been put in place.

I’d like to see more humanity in the structure of social services management that accepts that workers have needs as well and that dealing with the situations that people find themselves in on a daily basis, can be draining on the workers as well - maybe not every day - but it isn’t a fair expectation that we should all take this home to our families.

The targets aren’t going to disappear - I’m under no illusion. It’s the means by which local authorities and Trusts are funded and judged. I am not entirely sure about the realistic nature of the figures expected and whether some more quality-based ‘figures’ can be added to the frame to make the work less pressured.

Some positive focuses and praise when things do work out as a result of work we put in. That would help too.

Caseload management and support - some kind of structure in the way that work is distributed more evenly. I can’t remember what our guidance is on caseloads at the moment - something like 25 I think. But having a system that just sees people has figures is ridiculous. I can spend an entire week working with just one or two people - and on the other hand see (or speak to) someone else once a month. It is not a comparison of like with like when you just have a figure. The tasks aren’t considered just the ‘caseload’.

Personally, I think more teamwork and joint working would improve the situation enormously or at least having a more formalised ‘buddy’ or ‘mentoring’ system where you can discuss issues with colleagues if you are not primarily office-based with the support and discussion around you.

The article goes on to say

‘The Conservatives are calling for a Chief Social Worker to represent the profession. They also want a high-profile advertising campaign stressing the importance of social work as a career.’

Well, I’m not sure what a Chief Social Worker would do to be honest but I would have thought that would be the purpose of British Association of Social Workers (BASW) in this. Surely they should have this purpose of representing the profession. I would imagine this so-called ‘Chief Social Worker’ would be someone who has moved through the management structures (probably by meeting targets!) that they would be so far removed from the front-line practitioner that it would serve no purpose anyway.

I’d rather see the change at a much lower level - as ultimately, I’ve become basically indifferent to the public perception of social workers. Sure, it would be nice if people actually knew what we did on a day to day level - if people actually did see the positive work that goes on, but few people go into social work with any illusions that at the end of the day, society will thank them for it!

I’d like to see the government, local and national, looking at the figures they are asking social workers to move towards and how realistic these figures and targets are.

I would like to see time built into these ’standards’ to allow for quality rather than quantity of work to be achieved. It is easy for the policy-makers and commissioners who have no idea of the actual work on the ground to huff and puff in their seminars (that are too expensive to be offered to ‘ordinary’ front line social workers) about meeting targets and raising quality - but until they engage the people who are going out and doing the work - and putting their own health at risk because they have been pushed to the point that the quantity of work being asked for is not able to be provided in a 39 hour week - the situation won’t be getting better.

It sometimes feels that at the end of the day, we are more or less expendable and a newly qualified social worker will be along to replace us one by one until they, in turn burn out.

I hope I’m wrong - but I have seen little evidence of action being taken to work on the causes of the stress for social workers. It can’t be a coincidence that so many of our number need to be actually signed off on long term sick leave.

‘One in five of the country’s 76,000 social workers has signed off work for 20 consecutive days or more in the past five years because of conditions such as stress or anxiety.’

One in five. Imagine one in five of the nation’s teachers, doctors, nurses being signed off, and you’d see some action.

This week is Carers Week. There has been quite widespread coverage in the press - certainly from where I’m sitting anyway. Yesterday the government printed its 10 year Strategy for Carers.

It has been widely reported that the main tenet of the strategy published - as far as I could tell from the reporting of it  as I haven’t actually had time to read it yet, was a Government pledge to increase spending on

Respite care (£150m)

Support for return to work and training and general work/life balancing health checks(£38m)

Training for GPs to raise awareness of Carers’ Health and Input from Voluntary Organisations (£61m)

Focus of young carers (£6m)

Which adds up to the total £255m injection into carers’ services in total.

More money is better than no money. A recent survey, carried out to coincide with Carers’ Week suggests that

‘ a large majority of carers admit to feeling ill, anxious or exhausted, with a staggering 95% of those questioned said they regularly cover up or disguise the fact that their health was suffering in order to continue with their caring responsibilities. Worryingly, one-fifth (19%) of these carers said they ignored feeling ill “all the time”.

Almost 1 in 4 (24%) of carers say they frequently felt unable to cope with their day-to-day duties due to the physical and emotional stresses of their caring role, and a further 64% said they were occasionally unable to cope.’

So pushing finance into a focus on Carers’ own health is a positive step.

Flexible working patterns are, as well, important. I know that some employers are more sympathetic than others to time being taken for caring duties and some kind of statutory guidance that would provide more protection to Carers would be helpful.

Alison Benjamin on The Guardian website sums up some of the responses from the main voluntary organisations which work in the field.

She writes about a scheme of ‘Caring Vouchers’ which has been advocated by leading charities and some larger employers to work in a similar way to childcare vouchers - allowing for services relating to care, podiatry is given as an example, to be purchased with these vouchers.

But these are some of the elements missing from the strategy.

Rethink approaches some of the proposals from a different angle asking

‘What does £15 pounds buy you?’

Noting that dividing the £150m set aside for ‘Respite’ breaks by the amount of carers in the UK doesn’t exactly make for extensive holiday breaks.

But it won’t be £15 each because some people will never claim holidays or respite they are entitled. My difficulty at work has been more trying to desperately convince people to take those breaks that they are entitled to and that they can access money for.

Where I work, there is a fairly substantial pot of money which has been put aside specifically for carers breaks. It is consistently used by the same groups of people which isn’t a problem because there is always some money in the pot as others are so reluctant to consider using it.

Strangely, the existence of money to go away isn’t the issue - it is persuading people to access it.

I work primarily with older people and older carers so I can’t speak more generally, but often, regardless of the amount of stress, time and health concerns, they do not want to leave their partner in a residential home for a week while they go away.

I hope there is more access to creative options for respite such as allowing (paying) for someone to come and allow respite in the home. But the costs of that would, I fear, skyrocket far past £150m.

Bert 2332 @ flickr

The other major criticism of the strategy drawn out by Alison Benjamin is the lack of any revised approach to Carers Allowance.

‘The most glaring omission from the government’s strategy is any proposal to increase the carers’ allowance or provide additional financial assistance to carers who are struggling to make ends meet. Although their role is estimated to save the state £87bn a year, many are living on just over £50 a week, plus other meagre benefits.’

And it is an embarrassing and humiliating attempt at piecing together a so-called ‘benefit’. Perhaps some more money for carers directly, rather than vouchers or health checks or training of GPs would have a more immediate effect quickly.

Of course, throwing money at problems is hardly the most creative approach but the Carers Allowance, is one of the worst examples of a poorly thought out benefits system that is insulting to those who jump through enough hoops to be able to claim it.

My own fear, and granted this is a result of reading the press rather than the actual strategy itself, is that the focus will be on those, again, who can ask for help and who shout for it when necessary. Those who are the ’silent carers’, who need more time, money and outreach may be missed in the floods of additional funding trickling through the system. But I’m hoping to be proved wrong!

I don’t drive. Not only do I not drive, I don’t actually have a driving license. My last driving lesson (14 years ago) ended in my driving instructor actually telling me she did not want to teach me anymore (2nd crash - in my defence it wasn’t serious - I only drove into the back of a stationary police car - noone was hurt!).

So  it’s probably no surprise that I have no interest in cars. Yesterday, I visited a woman who has an anxiety disorder. I go as regularly as I can and just keep an eye on how she is managing and in general it is one of those fairly low-key visits.

She has a car, and her car was broken. I offered to phone the RAC for her as she has a distrust and dislike of the telephone. I feel faintly embarrassed by the conversation I had - but I think the RAC man had a good old laugh.

Image via Wikipedia

OK, perhaps when I was asked what type of car it was, answering ‘Green’ might not have been the wisest answer - but I don’t know what car is what! I also tried ‘Green and smallish, I think it’s quite old’. At that point, I could hear him sniggering. Of course, when he asked what was wrong with it,  we entered an almost surreal level of conversation - as I wasn’t actually sure.

‘It won’t start’ I said.

‘Yes’ said the still-giggling RAC man ‘I understand that, but why?’

‘Because it doesn’t go - I don’t know’

I’m sure he was calling his mates over or had me on speaker phone in his call centre place!

‘Can you be a bit more specific, miss’ Grrrr. I wish I knew about cars. I  really hate conforming to gender stereotypes and I find ‘miss’ faintly patronising but I felt I wasn’t in a position to complain for want of causing more hilarity.

‘Not really, because I don’t know’.

Anyway, in the end, he agreed to come. I’ll pop in today to check the car was actually fixed.

If he’d asked me about ancient Greek philosophy or discourse theory, I’d have had a really good response to him - but cars.. not my forte.

Mel @ flickr

Another visit yesterday with an almost comical slant. I was visiting a man with fairly advanced dementia and substantial physical health problems and his wife. There were three generations living in the same two bedroom flat, so there were a couple of children running in the corridor.

As I walked to the lounge, one of the kids shouted at me to ‘Watch out’. I looked down - and I had almost stood on  a tiny  kitten.

Luckily I managed to sidestep out of the way,  but this kitten was minute. I was told by the wife that it had been given to one of the children by someone in a park but it was much too small to have been away from its mother - still it was quite a sprightly thing. It was fascinated by my feet, which it constantly tried to nibble and was trying to climb into my bag (which I did close) throughout.

I had to be really careful when I left the house with a small kitten that would have fit easily into the palm of my hand scurrying around my feet. I had the constant ‘Must not tread on cat’ mantra running through my head. And that’s a thought I don’t often consider.

I first saw on the news over the weekend about the report produced by the Institute for Public Policy Research related to  Personalised Budgets for Carers and it baffled me a little bit.

Don’t get me wrong, I completely think that carers need, deserve and are entitled to a lot more support than is available presently.

The Carers Allowance is, quite frankly, an insult to those who put in so many hours and whose lives are changed by the amount of care that is put in (as well as, on a less emotive level, the amount of money that is saved by both the NHS and Social Services). Also (for what its worth) it’s linked to Disability Living Allowance/Attendance Allowance and is means-tested. All of which contribute to its inefficiency.

But the call for personalised budgets seems to be, as far as I can garner, more or less the same as Direct Payments for Carers - which is explained much better on the Worcestershire County Council site (thank you, Worcestershire - and no, I don’t work there - actually, I don’t think I’ve ever been there!) as follows

‘Support for Carers

A Direct Payment can be provided to enable family and informal carers to purchase the services they are assessed as needing as carers to support them and to maintain their own health and well-being.

A Carers Assessment and Support Plan should be completed to identify the impact of caring on the person’s life along with the support they require to continue caring or to take a break from their caring role.

Carers are able to use Direct Payments to purchase support in any variety of ways including:

• Short breaks for themselves and/or the people they care for;
• Personal assistance within the home;
• Sitting services;
• Social, education and leisure activities;
• Transport costs;
• Equipment
• Relaxation, stress management and holistic therapies.

Some of the intended outcomes of using Direct Payments for carers are:

• Promoting social inclusion through greater opportunities for carers to actively participate in family and community life;
• Greater opportunities for the personal development of carers;
• Promotion of the carer’s health, well-being and coping skills;
• More responsive, timely and consistent methods of providing support, with greater opportunities for creativity;
• Values the essential contribution carers make to family life and the wider community.

Under the service, young people, aged 16-to17-years, are also eligible to receive Direct Payments to support them in their role as young carers and to minimise any difficulties or isolation they may experience in undertaking their caring responsibilities’.

psd @ flickr

I have to say I like the direct payment scheme as it works for carers because it is incredibly flexible. Indeed, I’d say it is the easiest way to provide direct support to carers and in the most visible way - so I’ve got a fair amount of experience using it.

In a lot of ways, it is a lot more flexible than the direct payments provided for service users because it can be used for ‘anything that would support the carer’ - so gym membership, travel costs, parking costs, washing machines - there is the ability to be much more creative. ‘

And it exists now - today and has been used with frequency.

So that’s why I didn’t really understand the call by the IPPR for personalised budgets with no comment about what is actually happening in social services departments to support carers today. Maybe they are calling for more money to be a part of the personalised budgets (a good thing) or more control (although the control can be basically in the hands of the carer themselves), more exposure to issues that matter to carers or less scrutiny from local authorities who provide the funding.

I suppose I’ll have to actually read the whole report rather than just the reporting of it!

I noticed that Sophie Moullin from the IPPR wrote about this in the Guardian and from what she says, I can’t see any difference in the new system she proposes to what is actually, legislatively in place at the moment.

I am absolutely in favour of anything that will help though and if the proposed system will ringfence more money or provide more exposure or utilisation of services then I’m the first person to applaud it.

But to promote the new system which has a lot of links with Carers’ Direct Payments without discussing the failings of that particular system and to look at the issue as if this system didn’t exist, seems not to be giving a true picture of the situation as it is today. Perhaps more needs to actually be done to increase awareness of the system as it exists today and promote use and access to it.