Docking Benefits and Blaming the Poor

I know I covered this more generally on Monday in my rant about ‘benefits’ but it’s worth coming back to with the proposals explained in the Guardian

Magistrates and crown court judges could be asked to dock benefits from convicted criminals under preliminary proposals being drawn up by the government in response to the riots, the Guardian can reveal.

Ministers are looking hard at how benefits, or tax credits, could be taken away to show criminals that privileges provided by the state can be temporarily withdrawn.

Under the proposals anyone convicted of a crime could be punished once rather than potentially facing separate fines – first by a magistrates court and then a benefit office. By giving powers to the courts to strip benefits, the Department of Work and Pensions would not be required to intervene in the criminal justice system.

Yesterday, a little tardy, I know, I listened to the podcast of Pienaar’s Politics which I tend to really enjoy and I did except for the presence of Kelvin McKenzie and an odious interview with Iain Duncan-Smith in which he discussed this.

(Iain Duncan-Smith who, incidently, laughingly claimed at his constituency of Chingford and Woodford Green was ‘inner city’. Really? Waltham Forest is inner city? Really? Have I missed something? Anyway, back to the programme).

Let me explain why it is so odious if I need to.

Firstly there are the assumptions that all those who rioted are claiming benefits. Yes, I know there are links to poverty but will how will there be an equivalent punishment for someone who commits a crime and does not claim any money from the State. This is an intentional scapegoating and targeting of poverty.

The riots were awful but the causes run much much deeper and broader than ‘gangs’ and ‘benefit fraud’.

Duncan-Smith in a truly odious and preaching manner seemed to make links between ‘generations of joblessness’ and the feckless claimants. He emphasised his joy in ripping away support for those who received Invalidity Benefit and while me gave a cursory nod to those who might have caring roles – he mentioned them solely in terms of the money that they save the government.

How about truly visionary leaders that display integrity and leadership rather than those who pander solely to  the lowest common denominator of cheap ‘kicks’ at those who need to claim money for support and those who are not able to afford the lives they see the privileged lead.

This week we have seen our millionaire cabinet members talk about the ‘feral underclass’ (Kenneth Clarke who was one of the few Tories I had a smidgeon of respect for previously).  Really?

Yes, the people involved in the riots may well have been some of the poorest and most disengaged but that doesn’t mean the cause of the riots needs to look solely at those who were out on the streets looting. If it does, it allows the cosy middle classes to look on from the suburbs (or in IDS language ‘inner cities’) to preach from their own comfortable positions of superiority.

These riots, this inequity, it is the problem of ‘other people’.

Surely the riots, the way that culture has become so consumerist in its nature, the dishonesty and the lack of censorship of anything other than ‘getting away with it’ the lack of inherent understanding of right from wrong in any other terms – that is not a problem of the poor and it is not a problem which is solved by taking away ‘benefits’. That merely pushes all the problems of a society onto one particular class that will match with the photofit of ‘problems’ that rest most easily in the middle-class heads. By looking at analysis of ‘who rioted’ or rather ‘who was caught‘ and looking at lists from magistrate’s courts we provide a very narrow view of what was responsible in our society for creating a moment when people thought they could ‘get away with it’.  The riots were not about who was rioting. They were about what is and has been happening within our society from top to tail and by concentrating reasons and solutions on the lower end, we allow those more privileged  to get away with all kinds of poor behaviours and excuse the problems that their behaviours have caused which have led to such strong feelings of disillusionment.

Personally and I base this on no research base other than my gut feeling, I think the problem  and the problems in society must be examined in a much deeper and more fundamental way. In England, at least, we have seen successive scandals and betrayals from the finance services through the collapse and deceit in the banking system, the MPs fiddling expenses compulsively, the Press through the phone hacking scandals and the police for bribery.

While politicians lament of a world where people loot ‘because they can get away with it’ and only refrain from crime not because of an inherent ethical desire but because they will not be caught, it is impossible to separate those who loot shops from those who loot the public purse. Those who sit in their comfortable suburban (sorry, inner city) homes.

How can we, as a nation, allow our poorest people to be scapegoated by an establishment (financial/political and media) that has been equally deceitful but who will never feel ‘benefits’ being taken away because they are all wrapped up in each others’ collective pockets. They will never be evicted from their council houses because of the behaviour of their children because they are fortunate enough to own their own homes and they will never suffer from having child benefit withdrawn when their kids truant because they aren’t reliant on child benefit and their children have trust funds.

How can we allow this to be the voice of ‘reason’ in the country?

I truly can’t understand it but I know it makes me angry.

Related articles

• Response: It’s wrong to blame fatherless families for Britain’s ‘moral collapse’ (guardian.co.uk)
• We must become ‘nation of the second chance’, says Iain Duncan Smith (guardian.co.uk)
• Kenneth Clarke says broken prison system which failed to stop ‘feral underclass’ to blame for riots (telegraph.co.uk)

RIP NHS?

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A truly national health service as conceived in the post-war years has been tottering on the brink for a number of years.  As the previous Labour government sowed, so the Liberal Democrats and the Conservatives will reap today as the NHS and Social Care Bill reaches its last stages in the House of Commons  and the Conservative Party  institute their idealised version on a market-led health service which will deliver profits into the hands of investment companies and will place efficiency above effectiveness in treatment delivery methods.

Yes, I feel bitter, very bitter. I don’t see the Labour Party hauling us out of the mess that the both the Liberal Democrats and the Conservative Parties have conspired to leave us with because the Labour Party in their previous guise very much laid the groundwork for this to be done.

I find it hard to believe the audacity and the incompetence of our political elite as they push through a hugely unpopular bill tonight but then, as I pause, I wonder if it is truly incompetence as they are ‘getting away with it’.

We have been confused by details and have been tricked into believing a ‘consultation’ process has taken place. It has taken place very much on the government’s own terms and the listening that has been done has been very selective.

I try not to have a blanket opposition to the ‘private sector’ and ‘profit-making’ in the health and social care sectors but I’ve been burnt by experience. There are some companies that may well be able to improve some aspects of service delivery and I completely accept we all need to move away from the blind public/private being good/bad depending on where you stand on the political spectrum. That’s quite hard for me to ‘get my head around’ as I feel instinctively that profit should not be made from ill-health but equally the government’s obsession with public being bad is equally short-sighted and damaging.

What really sticks is the way that Cameron has blatantly misled the country in the quest for votes. ‘No top down reorganisation of the NHS’ he said, lying openly to the nation and yet we have to accept the mishmash garbage that he is now leading through Parliament as the Health and Social Care Bill and it moves towards it’s Third Reading in the House of Commons today.

I feel angry at the way that language has been turned and stolen from us.

‘Choice’  has become a catch-word but as I have discovered through the ill-spirited and contemptuous way that ‘individual budgets’ have been delivered in social care – choice mostly a luxury of the ‘worried well’ or the more affluent middle classes – in whose ranks sit all those MPs who vote on these changes today.

Choice means very little if you are not in a group that can cost a company money rather than increase their profits.

We have been hoodwinked into believing that ‘choice’ will genuinely exist when these private companies rip up our public services to deliver profit to their shareholders? I think we should ask whose ‘choices’ is it that the government and the health companies that support then, they will be?

Let me turn to the social care sector again because that’s an area I am familiar with. I am very familiar in the ways that privatisation has worked or rather, not worked and the way that ‘choice’ has been promoted – falsely – as the achievable outcome for all end users.

The pushing of the public sector from social care delivery has decreased ‘choice’ in many instances. In the areas I’m familiar with, local authorities have been pushed out as providers of residential and home care services to be replaced by companies such as Southern Cross (RIP), Bupa, Care UK (always worth repeating that they donated to fund Andrew Lansley’s private office)  and homes have closed, block contracts have been signed to provide care at the cheapest costs which increases profits for the private companies of course and limits choice for individuals who need these services.

Anyone who claims that the roll out of personal budgets has or will change this and has increased ‘choice’ I will point to those who have capacity issues – those without family or friends to support them – those who are more marginalised have far fewer choice than the ‘mainstream’ who are able to engage in the process and that suits the government and the propaganda machine just fine.

That is what I fear for with the Health Bill (I am not sure why it’s even called the Health and Social Care Bill as Social Care is so obviously a troublesome ‘aside’ for the government).

Choice may well be nice for making decisions about which hospital is most convenient for a scan but what is being done to assist, support and advocate for those who are not able to make choices?

We are all in this together? Really? I doubt it.

As for me, I’m off to the vigil outside the Houses of Parliament tonight with my local Unison branch.

The TUC have also organised an ‘online vigil’ to oppose the passage of this Act.

And then.. to the Lords. But I will take careful note of the voting as it happens tonight. And I won’t forget.

Cuts – a personal tale

A couple of weeks ago, I had one of those deeply depressing moments that will generally punctuate a career in social care.

I had to go and tell a woman, who cares for her mother with enormous patience and dignity, that we could not increase their personal budget although her mother’s care needs had grown.

I suppose I went to my manager in a relaxed almost casual way and explained how the needs of the older woman had changed and to ensure her well-being, she needed additional time.

I was told, with a degree of equal sadness and regret that there would be no increase. If we were to provide what I felt was a necessary increase in care, the time had to be taken from the the hours already allocated.

She did, to her credit, try to have a discussion about this with her own manager but there was no budging on budgets. Despite the change in various situations, there would be no extra money. In fact, she added, the plan really needed to be cut.

It had been my first personal budget implemented. The council, in an attempt to encourage and prod us to implement these personal budgets had promised us and by extension, the service users and carers we work with, that no-one would be disadvantaged by moving to a personal budget so even if the RAS (resource allocation system – the way that figures are attached to needs through the personal budgets  system) did not ‘deliver’ enough money to provide an equivalent package of care that had been delivered under the ‘old’ system – it would not be reduced (and here’s the key) at least, not initially.

Now this particular service user and her daughter had what was a high package of care. It had costed much  more than the ‘RAS’ had spat out.

After making the promises, after the move to personal budgets is no longer an optional roll out of volunteers – the cuts are coming.  There is no longer the carrot to offer of ‘equivalent packages of care’ because we now offer everyone as a matter of course a personal budget and those who were not receiving them are being transferred over to the new system regardless – they don’t have to be self-managed, of course, but they have to exist.

So I visited the family and we looked at ways of shifting around hours.

The hours that were cut were the respite hours.

I suppose it was inevitable.

Family carers are invisible. The work they do is not costed. Of course the daughter was sacrificing her own needs for a few hours respite to her mother’s needs for additional personal care.

This is what the cuts mean to one family.

I had to tell them and negotiate with them about what to cut from their own package of care.

Not the Prime Minister. Not the Millionaires in the cabinet. Not any elected politician or Council Chief Executive. No councillor had to sit in that room with me and look the service user and carer in the face and ask them what they would prefer to give up from their package of care.

I’ve known this family for many years. I have a good understanding what is at stake for them and how much these cuts are hurting. I also know they won’t complain or grumble or shout from the rooftops.

They are not going to be going on any rallies or demonstrations against the cuts – not least because the respite hours have been cut.

We who can, have to demonstrate and shout and scream on their behalf.

And you know, as I know and I say this with a heavy heart – they’ll be much more of this to come.

Related Articles

• Greater ‘choice’ for social care (bbc.co.uk)
• Paul Burstow writes… Our vision for social care (libdemvoice.org)
• David Cameron accused of second betrayal over care for disabled children (telegraph.co.uk)

Health and Social Care Bill 2010/1 – some comments and not much hope

I haven’t read the Health and Social Care Bill. I have glanced at it. I tried to look at anything connected with Mental Health and Social Care and there are a few bits and pieces nestled in there towards the end but the problem with reading primary legislation is that, well, it has a language all of it’s own and it isn’t a particularly easy read compared to White or Green Papers.

That’s my excuse out of the way.

I have, instead, read through some of the commentary about the Bill. I retain all my reservations. In fact, I have some increased ones about the role that the private sector is set to have in the healthcare ‘business’. I find it hard to comprehend how much of a dissonance from Cameron’s mealy-mouthed words about protecting the NHS through the election campaign and the Coalition Document’s promise of ‘No top-down reorganisation’ of the NHS.

Ah, say those whispering Tories, this is not ‘top-down’, this is ‘bottom-up’ reorganisation. So what, exactly, is the government imposing new systems and yet another reorganisation – if not ‘top down’.

I’m no great fan of much that the last government did so I can’t say Labour would be any better. It just feels so hopeless to cry into the night sometimes.

On a local level, we are losing beds and losing wards. That isn’t a far off fiction. That’s happening today. They probably haven’t been noticed because they are psychiatric wards and hospitals rather than cancer or paediatric beds but remember we were there to warn you.. sigh.. I wish it didn’t have to be that way.

Back to the Bill then

The Guardian has a good summary of the main points. Apart from the abolition of the PCT and the move to GP-led consortia bidding for services, there are to be a few regulatory quangos. One, Monitor, which currently.. um.. monitors Foundation Trusts will be beefed up as all Hospital Trusts will have to become independent Foundation Trusts.

Strange then that Monitor is one of the few health bodies that comes out in favour of the Bill.  Their almost smug press release saying

Monitor strongly supports the Government’s proposals to move to a more devolved system for the NHS, with increased competition in healthcare, as set out in the Health and Social Care Bill…

In Monitor’s view, introducing more competition into healthcare is an important step in raising the productivity of the sector and delivering ever higher quality care for patients…

It has delivered significant benefits in other sectors and has been shown to improve quality within healthcare and other sectors under the right circumstances.

In particular we welcome the Government’s intention that we will become the economic regulator for health and adult social care.

I’m sure they do welcome the fact that they will be one of the few quangos to be beefed up. It does seem more than a little self-serving as a statement though. I worry that social care regulation has been bundled in to an extent. It’s always going to be clear where the priority lies (clue – it won’t be with social care when it competes to time, money and resources against health).

There is mention of the setting up of a body called HealthWatch which is supposedly some kind of ‘patient voice’. It’s reported to be some kind of ‘consumer champion’ service within the CQC. Well, that discredits it for a start as the CQC seems to be barely fit for purpose and working on less than acceptable staff ratios to keep the public safe.

My concerns remain about the process of commissioning, the welcoming of competition into a market that is not neutral and cost should not be the base denominator of best.

The process of change is tiring. I am no great fan of over-management but I can’t see how a public castigation of the higher echelons of an organisation makes it easier to stomach the change. Change does need to be managed, after all.

We, right at the very bottom of the tier, way below the GP commissioners, will be expected to carry out a better job with less time. I do wonder what will happen to us in secondary health care services. Will we be ‘value for money’?

How will our value be determined? On how much money we save the Trust by ‘keeping people out of now, non-existent hospital beds’?

A few points that I did pick up were that some of the tasks delegated to PCTs currently will be shifted to already pushed local authorities. There are some increased responsibilities for public health and more specifically to my interests, the provision of the IMHA (Independent Mental Health Advocates). I see that local authorities will take responsibility for s117 aftercare services.  A tiny line in the Act but potentially a MASSIVE increase in cost. Wow. That’s going to have some implications for the budgets of some care services. Particularly where I work in older adults services.

(N.B s117 of the Mental Health Act 1983 (as amended 2007) compels PCTs (soon to be local authorities) to pay for care for the patient in the community following an detention in hospital under Section 3 of the Mental Health Act. In Older adults services, that can (not always) mean nursing and residential care. Where someone has dementia, they don’t ‘get better’ so the s117 funding remains in place indeterminately. So basically, it means that there will be a lot of funding consideration for the local authorities to pick up and it could mean a lot of care home fees for which no payment can be taken from the families).

The Bill also confirms the demise of the GSCC (General Social Care Council – which registers and regulates social workers in England) and authorises the HPC (Health Professions Council) to be renamed Health and Care Professions Council and to carry out the similar role. I remain basically ambivalent about this until I have reason to believe it may be better or worse than what we have at the moment.

Here’s what I think about the future. And it’s pretty bleak so you might want to look away now.

Private companies like Care UK – you know, the company that made a donation to Andrew Lansley’s private office – will run some of these GP consortia. It won’t be my GP making any choices. It certainly won’t be me making any choices. Cameron’s talk about choice is a red herring in my view.

The talk about choice in the Putting People First and personalisation agenda has been more or less a complete whitewash. Some people get A LOT more choice – those with capacity, those who are able, those with carers able to article what they want, but for the majority of people I work with, that vestige of choice is an illusion.  They are getting the same carers, for the same cost carrying out the same tasks with more paperwork and higher criteria for accessing services.

So will be choice in the health service. Articulate and active participants, the ‘worried well’ and those who are able to shout loudest, will have the most choice.

The choice for those who have acute illness will always be limited. Do I trust my GP to make the best decisions for me? Not particularly. I live in an area where there are likely to be lots of involved interest groups with far louder voices.

Will my team be ‘competing’ with private companies able to specialise in managing some of the ‘more straightforward’ situations that we might deal with? Probably. I can certainly see adult care management services devolving now – indeed, that is already happening.

Will it make for better services? Possibly – and I say that with a heavy heart – for some people. The problem will lie with those that the private companies don’t want to ‘hive off’. They will have little choice and with the resources being pushed into reducing cost, possibly fewer resources.

I see this as a blueprint to increase health inequality and social inequality in England.

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I’m not joking when I write this but I am considering moving to Scotland where at least I have family links. I wonder how easy it would be to pick up the Scottish legislation and switch my English registration for a Scottish one.. seriously, if anyone does know the answer to that, let me know!

Related Articles

• Health and social care bill: the main points (guardian.co.uk)
• NHS reform proposals under fire (mirror.co.uk)
• Changes in the NHS – initial thoughts (fightingmonsters.wordpress.com)
• Bill to detail major NHS overhaul (bbc.co.uk)