I don’t have time for a long post today, just a few brief thoughts that came to me as I considered the unsurprisingly critical report on Castlebeck by the CQC.
Of course it’s easy to be wise after the event but it leaves a bitter taste in the mouth when the CQC comes down hard on Castlebeck after it required a TV undercover programme to uncover the widespread abuse at Winterbourne View. Where is our faith in the CQC? Well, personally, I didn’t have any to begin with but this report is not a solution, it smacks of a desperation to gain any kind of public recognition of the CQC itself rather than a real attempt to improve any system of regulation.
Regulation costs. Good regulation costs. In the week that the Ofsted is planning two week, unannounced inspections of childrens’ services, I ask why services for adults have been allowed to be neglected?
Yesterday I heard Paul Burstow on the radio on my way home. Two things struck me, firstly that he didn’t seem to have any understanding of the difference between a hospital such as Winterbourne View and a care home. He seemed to be happy to blame local commissioners for the quality of the placements that they commissioned in hospitals without an understanding of what had led to this situation – namely chasing the lowest prices. He still is banging on about his so-called Excellence scheme which, if anything, will make things worse as I wrote here. The Excellence scheme is opt-in and it is for companies to pay to be a part of. That is not about excellence, that is about money-making.
The CQC should be demanding excellence from every single service it inspects. Every day. It doesn’t. It demands sufficient paperwork every couple of years, at most. That is how it inspects. Actually, the CQC doesn’t inspect any more. It does not have enough people to inspect, control and check.
We have allowed companies like Castlebeck to rake in millions of pounds of profits on the back of providing poor care to vulnerable residents and patients. We have allowed this because noone is calling the CQC and the government to account for destroying adult care services.
The CQC criticising Castlebeck – of course it will but remember this is on the back of one television programme with hidden cameras. What about the thousands of homes without hidden cameras? Where are the checks? Where is the scrutiny? Where is the excellence?
- Winterbourne View company’s failures at 11 more care homes (telegraph.co.uk)
- Castlebeck care ‘concerns’ raised (bbc.co.uk)
Sometimes, some days feel filled with sadness. I had one of those days this week. I don’t like to use the word ‘hardened’ but to put it this way, in over 10 years of frontline social work practice in some of the most deprived areas of the country and in the inner city, I’ve seen a fair bit of what society has to throw in terms of crumbs to those who are some of the most vulnerable members of it.
I look at the high rises that skirt around the cities and I see hundreds of lives being lived, families existing and stories being told. Some with hope and pride. Some with desperation and despair. All different, all a part of this community and society we live in. Poverty is real. Despair is real. The two don’t have to go hand in hand though.
I have a strong stomach and don’t bat an eyelid at all sorts of things when I walk into a house. I’ve probably seen worse.
In some ways, human misery is a part of my trade. Not always, of course, because there are the wonderfully reassuring smatterings of hope but difficult social circumstances and social deprivation run a theme through my career.
Although I often emphasis that mental ill-health is certainly no respecter of social class or financial assets, it is sometimes the level of deprivation and the difficulty and shame of poverty that I see that reminds me of the way that this political class intentionally ignores and isolates some members of the community.
Perhaps the most difficult part of my job is wrapped up in the AMHP (Approved Mental Health Practitioner) role. It is a mirror into my ethical compass and while I enjoy the aspects that were involved in training and the support and development and even community feeling I have with other AMHPs, the process of making a decision about someone’s forced detention in hospital or a forced medication regime is never one that can be taken lightly and I don’t think it is one that should ever be ‘enjoyed’. It is power, writ large. It is control.
Sometimes people thank you retrospectively for ‘making the right decision for me at the time’ but more likely that isn’t going to happen.
This week, I carried out a Mental Health Act Assessment in a hospital. That is very far from unusual. When I read the background and the circumstances, when I conducted the assessment and made the application for detention, which I did, I was overcome with a feeling of sadness for the action that I had taken and for the life that it predominantly affected.
For obvious reasons I won’t go into details – anyway, even if I did they would possibly sound fanciful and unrealistic. To people who think that I have a ‘difficult’ job, I would say I have had a walk-on part among some fine and very strong people who have had to contend with sickness, pain and family circumstances that have rolled all the dice against them in the lottery of life.
And when I sign the papers and write up the report, I don’t forget. I think, I reflect and I try to learn. What could we have done to prevent this situation from having occurred? Sometimes the answer is nothing but sometimes there might have been a different path, a different action or different guidance that might have led to a different outcome.
Sometimes, some days, I just feel overcome with sadness. Sadness at the injustices that are meted out by life, fate and circumstance. Sadness at the way that this society perpetuates and builds on those injustices of circumstance. Sadness at my role my own complacency in accepting that we have created such an unequal and unfair society.
In a community where people who live on state benefits are treated with an intention to humiliate and scorn and where the government not only condones and supports this, it tries to create further barriers between the ‘haves’ (with ‘have’ meaning working tax-payer) and the ‘have-nots’ (meaning those who depend on the state for income) it sickens me as I know that the rhetoric of ‘choice’ and ‘community capacity building’ are empty words which mean nothing without the world of privilege. By privilege I don’t mean money, necessarily, but include the privilege of having family or friends around, the privilege of being well enough to build up networks of support, the privilege of being a part of a community. There is so much more to privilege that cash assets or income.
Sometimes I want to shout against the system that I am a part of. The social care system in this country is not ‘fair’ – it reeks desperately of unfairness and the pushing of ‘choice’ in very narrow terms onto a wide range of people who in reality have no choice whatsoever further marginalises and discriminates against poverty, incapacity and isolation.
But I continue in my job. I go into work and ‘buy into’ the system. In my own defence, I fight as hard as I can from the inside and I don’t forget the names, the faces and the stories of those whose lives touch mine.
I remember, I note and I learn and sometimes, that just fills me with sadness – but when I stop feeling that sadness, I stop learning, growing and trying to create a better world. One person at a time. In spite of the system I work in and with rather than because of it.
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.
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.
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.
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.
“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!
- Thousands face uncertain future as care home chain is broken up (independent.co.uk)
- Elderly care at the mercy of firms in tax havens as Silver Cross shuts (independent.co.uk)
- Public services reform to slow down, white paper suggests (guardian.co.uk)
Tags: care, Care Quality Commission, david cameron, Department of Health, GMB (trade union), government, nursing home, open public services white paper, opswp, Public services, social care, social work, Southern Cross, Southern Cross Healthcare Group, uk, uk government, White paper
Scheduling and exhaustion meant I didn’t have time to look at the Dilnot proposals in detail yesterday so this morning I have fired up my browser and am going to make a few initial comments on the baseline main recommendations and hopefully over the next few days can look at some of the details.
The Dilnot Report on Funding of Care and Support runs at 82 pages. It attempts to forge a solution for the currently antiquated and inequitable system of care funding that is currently in place. Much talk has been made of the current threshold of £23,250 of assets, at which people currently become responsible for paying for their own care services but little made of the current discounting of homes in certain circumstances and the ability to raise a charge on a property to postpone payment of costs for care services. Nevertheless, this threshold was deemed as being too low. People who own houses like to keep houses for children. People don’t like those who ‘haven’t worked as hard’ or ‘saved as much’ getting something for free.
The system is broken though, don’t get me wrong, I just think the focus of the discussion has been too much around middle class fears of actually paying for something they believe should be free. Now, I’ve got that off my chest, back to the report.
The main recommendations are
- to cap lifetime costs of care between £25,000 and £100,000 – with a suggested threshold (which is used throughout the report for ease) of £35,000
- means-tested assistance will be extended to those who have between £23,250 and £100,000 of assets.
- Those who ‘enter adulthood’ with support needs will not be means-tested and care will be provided free.
-Universal disability benefits will continue but may be some differences in names regarding Attendance Allowance. (erm.. DLA?).
- There will be a cap on so-called ‘hotel costs’ in residential care between £7,000-£10,000
-There should be a national, portable eligibility framework which is more transparent.
- A government awareness campaign about planning ahead and preparing for potential age-related disabilities. And their costs.
- There should be a new information and advice strategy to help people through the confusing forest of knowledge.
- Better carers support and information.
- More health and social care integration
Of course, these recommendation run alongside the Law Commission’s report for changes in adult social care law. Together they could create a much better and clearer system than we currently have.
The ‘lifetime cap’ allows for insurance policies to be generated and probably very profitable ones too for the insurance companies. Most people do not need high level social care provision but the fear generated by the media is enough to drive right minded people into the arms (those who can afford it and who have substantial assets) into the arms of the insurance companies. I’m not sure how comfortable I am with the lifetime cap on care costs. It means the more wealth someone has, the more they are protected. I understand the logic behind it in that noone chooses ill-health and disability but the more than government spends on those who do have substantial assets, the less there is for those who cannot afford it and the higher the criteria to access support rises.
I just have a few queries which may be answered in the details. If Mrs Smith has a house worth £300,000 and she lives alone with no other substantial assets – say, for example, she has savings of £10,000 – is her house sold to release the asset worth up to the cap of £35,000 – assuming she doesn’t have an insurance policy? If she chooses to live in a care home which is private, but then the money runs out, will the local authority still move her? Will she ‘top up’ the local authority fees, paying above the ‘cap’ to do so? What is she lacks capacity and has no family? I suspect all these answers are in the report but they will be questions I will be looking for. The system of deferred payment is mentioned and I’ll hunt around for clarification.
The cap though, seems to be there to protect middle class votes.
I do, however wholly support the increase in the level of means-testing. I think it is entirely right to continue to means test up to £100,000 and I’d even go further than that. I don’t have a problem with mixed funding, I am just not entirely comfortable with the capping.
Again, the clarity of the coverage of those who ‘enter adulthood’ with care needs is entirely right. There is a necessary distinction between working age adults with care needs and older adults with care needs but quite rightly it is wrong to have a distinction fixed at a specific age. Indeed, Dilnot proposes that those who develop long term care needs before the age of 40 should continue to have a zero cap and costs should be met fully by the state. Above the age of 40 there will be some kind of tapering of the cap up to retirement age where the full proposed £35,000 cap would be reached.
Regarding the accessibility of universal disability benefits, Dilnot clarifies that he does not propose any reform that would lead to anyone losing their disability benefits and that attendance allowance will continue. I do wonder though how this ties in with the government plans to remove 20% of DLA claimants.
There are some recommendations though to change Attendance Allowance (AA). Firstly to change the name to something more understandable and an appreciation that many who are eligible for it do not claim it. That absolutely reflects my experience. People who reach the cap when the government takes over payment will not continue to receive Attendance Allowance (or whatever it will be called) because the government is fully paying for their care needs – which makes sense to me. The Personal Expenses Allowance (PEA) is proposed to continue – this is the payment that is made to people whose costs are met by the government in residential care and is currently about £23 pw – there is a suggestion that it should increase but not a recommendation.
The cap on hotel costs is excellent news in my view because I saw this as a potential ‘get out’ clause for residential homes. I do want to know how some of the private homes will adapt to these new systems though and what the cap will mean for overall quality of care provision.
The idea of clearer, portable assessments is a good one and long overdue. Eligibility criteria interpretation can differ wildly and there needs to be more transparency. The minimum threshold would be applied at the ‘substantial’ level of care so I wonder how this portability will work for those who live in areas that meet lower levels at present. It seems that there is some kind of recommendation to do away with FACS over the longer term.
Can’t be soon enough – a new assessment framework will be developed ‘with experts’. Please please please can front-line practitioners be involved in these developments – not just people who professionally develop policies and have never needed to use assessments in their lives. This is why we end up with unusable systems. There is also a way of building self-assessments into these new models. That’s the idea anyway.
The last recommendations about building awareness and improving quality of information seem to be sound all round. Nothing to argue about there.
I am interested in the recommendations as they relate to carers. As far as I am concerned, I want more than just an assessment for carers, I want the provision of more services. Supporting carers very well both financially and with practical and flexible support is probably the one aspect which can potentially save the government more money in the longer term than anything else – but more than that, it is an issue of ethics and morality. I know that doesn’t often come into government services but it’s something I feel very strongly about.
I also recommend Arbitrary Constant for links and discussion about Dilnot.
Tags: Andrew Dilnot, british politics, care and funding, dillnot report, dilnot report, dilnot report on funding of care and support, dilnott report, Funding, funding of care, health, local authority, long-term care, Means test, nursing home, old age, social care, social work
Yesterday, Community Care published the result of a survey they had undertaken about ‘personalisation’ among social care professionals.
The headline figures while wholly unsurprising, make for interesting reading where only 41% of respondents felt that service users would benefit from the implementation of personal budgets and 83% felt that cuts would impede the progress of the personalisation agenda.
To which my first thought was ‘only 83%’?
Anyone who has read some of my previous writing/ranting about personalisation will be pretty clear where I stand.
While the idea and the concept of introducing more person-centred support planning and opening up direct payments to a wider range of people is absolutely fantastic as a concept, the implementation has been dire.
There has been a complete side-lining of service user groups that don’t fit into the ‘easy’ mode – namely those with mental health problems, older adults and those who might not have capacity to involve themselves fully in the support planning process, the same figures and quotes that the government and her agencies roll out again and again about the man who pays for a PA to go with him to a football match instead of a day centre are so completely off the radar when the smaller pool of money available for care services exist that they are almost insulting to those for whom a) the thought of having enough money allocated to pay for two tickets to a football match would equal 7 showers a week – so it’s football or cleanliness and b) that group of people (because, yes, much as the government don’t want to accept it, they do exist) that actually WANT to go to day centres.
And so we plough on.
But even though I have had many criticisms of the way that personalisation and particularly personal budgets either managed centrally by the local authority (where the end effect is exactly the same for the service users in most situations) or delivered by direct payments (where someone has to have capacity and desire to take on the direct payment and employ assistants or have someone who is willing and able to do that for them) – there is more to the personalisation agenda and process which is in danger of being lost in the process.
Personalisation as a value base and an approach to work and social work in particular with people who need or who are eligible to receive services for care ties in perfectly with aims of re-addressing the power differential between provider and ‘receiver’ and the imbedded dichotomy between ‘giver’ and ‘taker’ in society.
That model of giver/taker which is bound within the welfare state system can create an imbalance and the potential to give back some of the ‘control’ and some of the decisions to the person who receives services may, in some way, redress elements of this balance. There is no way that my training and experience has taught me better than anyone else, what YOU as a recipient need. Yes, I learnt my theories and my models and understand that building social networks is important but if you prefer to do that at a coffee morning at the local museum instead of at a day centre that’s perfect. If you want your neighbour’s granddaughter to help with your personal care rather than an anonymous and frequently changing ‘carer’ from a local agency who is paid at mimimum wage and has a day full of appointments and who isn’t paid for travel time by her agency so she needs to cut short on some of the time – perfect.
But we already had that system with Direct Payments. Where is the difference?
Ideologically, the difference was that everyone would know how much money they were ‘getting’ – whether directly or managed and they would be able to be consumers. Our society tells us that money is power. Money creates consumers and the market will right itself.
Even, theoretically, when a personal budget is managed by a third party (and I include the local authority as a potential ‘manager’) you will know how much is ‘allocated’ to you so that you can ‘spend’ it in the way you want.
This doesn’t happen in practice though because local authorities need to save money and are still tied up into procurement contracts that make agencies unequal when ‘bidding’ for the funds that have been allotted via personal budgets.
I know this is getting a bit technical and complicated but it’s important to understand. I don’t think anyone can oppose ‘personalisation’ as an approach regarding empowerment and ideology.
The implementation, however, reeks of money-saving and penny pinching. It also has pushed the responsibility for services away from the local authorities and onto individuals and their carers.
You have £100 per week, find the care yourself – then we (the LA) aren’t responsible anymore.
I’m wholly in favour of contracting out assistance and advice on self-assessments and support planning to local voluntary sector organisations. My own LA tried that. We referred lots of people to them. They withdrew because we were referring too many people to them and the local organisations didn’t have the resources (or the contract) to undertake as many support plans as were being referred – but the idea is not one I have any problem with and in fact, I rather like it.
But this wasn’t offered to people who do not have the capacity to lead in their own self-assessment and support planning. The organisations couldn’t do that because they were not experienced in non-directed advocacy work – it takes longer.
It is hard to see through the budget cuts as well towards a future where, as Burstow as said he wants direct payments to be the ‘preferred method’ of delivery of personal budgets. I don’t want to detract from the fact that this is and will be fantastic for some, perhaps most people, we move to a model where there is – again – a ‘one size fits all’ approach.
The true tragedy of the personalisation agenda is that is has and is coming to fruition during a period of cuts – the government (and the previous Labour government too) want to pull back the responsibilities of local authorities and with the criteria for accessing any support is rising rapidly it may well be that more and more personal budgets are delivered directly from peoples’ own savings or disability benefits (while they still exist).
I am fearful of the future for adult social care but I’m not necessarily unhopeful.
I think there is potential for change and development but unfortunately the ways I see of improving systems come at higher cost. There has to be some major research and debate about the delivery of personal budgets and the way that personalisation encompasses people who lack capacity and lack advocates (family and friends) and how they can best benefit from this process – perhaps access to additional funds to pay for the trust fund type system of management we were assured would happen but in practice is not feasible for a relatively small sum of money as it costs more than it might deliver.
We need to see more about how support planning can work in the voluntary sector as, speaking personally, I genuinely don’t have time to do the process of support planning any justice as a part of my day to day job. It ends up being rushed because I can’t devote a couple of visits of a couple of hours to talk through and develop a truly person centred support plan.
The process of self-assessment needs to be reconsidered because while the idea is fantastic for some people – our self-assessment forms are biased towards physical disabilities and look scarily similar to a DLA form where people are asked to explain how they are on ‘their worst day’. That doesn’t really help with confident-building when you are working with someone who has very low self-esteem and depression/anxiety. The process of self-assessment in itself can and has been traumatic – let alone the person who is not able to engage with the assessment process due to a lack of mental capacity where questions about ‘dreams, hopes and wishes for the future’ while well-intentioned, can be hurtful and hard for families to listen to when they are asked to their parent who has advanced dementia.
I fear we have allowed a great conceit to be steamrollered into simply another ‘one size fits all’ approach to developing social care. It doesn’t have to be like this but that seems to be the government perception about what ‘personalisation and personal budgets’ are.
Choice is fantastic of course, but sometimes people want quality as well. It shouldn’t ever need to be an either/or. It does feel like it at the moment with the promotion of choice above all things.
So where are we going? Personalisation isn’t going away and nor should it. Personal budgets aren’t going away and nor should they. Local authorities, however, might be going away – further and further away from social care and the responsibilities that they hold towards it.
We keep up with the advocacy and with the systems that are failing because we owe it to those who are reliant on these systems to make them work as best they can but we keep trying to pinpoint and pin down the flaws in the implementation with the hope that sometime, some day, someone will listen.
As professionals we don’t oppose personalisation. We have always been trying to use person-centred approaches. We just dislike injustice and inequity and that seems to be painted all over the current implementation and the frustration is that so few people (if any) in government seem to be aware. Am I disillusioned? Yes, definitely. We were promised new ways of working in a more person centred way.
Desperate, no, not yet though as long as there’s some fight left in the belly to keep banging on and on and on about what personalisation SHOULD be and why it isn’t working yet. Not for everyone.
- Personalisation in Mental Health and Older Adult Services (fightingmonsters.wordpress.com)
- Personal view of personal budgets (fightingmonsters.wordpress.com)
Tags: budget, burstow, care in the community, direct payments, implementation of personalisation, individual budgets, local authority, local government, paul burstow, personal budget, personal budgets, personalisation, personalisation agenda, Personalization, social care, social work, uk
I’ve been engaged in an interesting conversation on Twitter over the past couple of days about guidance being developed or potentially being developed about use of social media for social workers and more generally people who work in social care.
Our sector seems to be dragging its feet a little in this respect – certainly in comparison to some of the more sophisticated writing and communities that exist in other professional domains.
Can you imagine, for example, a social care blogging event taking place on the same scale that a legal blogging event is taking place today?
Or a weekly twitter chat about social care and social media strategies as happens with the NHS.
I wonder how long many of my colleagues and managers are going to be left ‘out of the loop’ and continue to let the world develop and grow around them.
The reasons that I am so strongly in favour of guidelines is that the bars are being moved regarding contact, discourse and discussion constantly and with many people testing out new ways of communicating and engaging, there are certain difficulties that lie ahead for the front line practitioner.
One is the anonymity vs named issue which I covered a couple of weeks ago. A part of me (the part where pride is based, I guess) would love to write under my own name but I worry about the impact that would have both on the service users I work with on a day to day basis and I am genuinely unsure if I am breaking any kind of contractual rules with my writing and can’t afford to risk my job.
Another is sheer openness of the debate and discussion. Just as I told one of our foster children not to put anything on Facebook that she would not want everyone in her school and family to see, the same applies for me but more so. With Twitter/Blogs/Facebook, privacy settings can be tightened but security is always an issue and even behind an anonymous persona, being a prig or prejudicial or just ‘having a moan about a visit’ might come across very differently to a service user who has just had an unpleasant and forced encounter with a social worker – does a search – and sees social workers complaining about seeing the ‘druggie’ or about people with ‘too many children’. Everyone likes a moan but having a moan about having a busy day is different from having a moan about some of the more particular things you might see on a day to day basis.
Then there is the illusionary barrier that is provided by a screen-name. Anyone can be a ‘social worker’ if they say they are. Anyone can be a ‘judge’ or a ‘professor of social work’ or a ‘psychologist’ if they say they are. While I have a healthy degree of scepticism generally, I tend to take people at face value but I add a hefty pinch of salt as the ‘internet’ and by extension ‘social media’ can be a great way to invent less than useful ‘personalities’ if you are so minded to do.
I remember when I did some research back in the day into the use of social networks for self-help groups – and this is over 10 years ago when I was initially doing my MA – and came across lots of research examples of online confabulation. As I say, a healthy pinch of salt.
I hope that the baton is picked up by the social work profession because more than media guides and focus groups and the odd press release here and there, we, at the grass roots of the profession have an real opportunity to be heard by those who are able to make changes and help them get an understanding of what is happening beyond those focus groups but we can also change the perception of the profession and the sector and while I certainly don’t see ‘social media’ as a cure-all, I do see it as yet another tool to be added to our arsenal regarding communication.
Where previously a bad experience with a particular social worker might have shaped someones’ perception of the profession forever, now we have the chance to join in the discussion on blogs, give advice and thoughts in different forums, add support and information on twitter and show that social workers can do a lot more than just become mouthpieces of their employers.
But our employers and our College (whatever form that takes) need to take up the baton and run with it so that guidance can allow for safer practice and inform and education others in the profession about the opportunities that are now open to them.
I’ve not had much time to look through the Law Commission Report into the proposed changed in Adult Social Care Law but to say it’s been long needed is an understatement. Adult Social Care Law is a hotch-potch and a mess. A couple of weeks ago, I was talking to a student who asked for some help with her law revision and she put it very succintly to me when she said it was much harder to understand community care legislation because it was ‘all over the place’ as compared to legislation related to work with children or in the mental health fields.
Hopefully, there is an upcoming reassessment and improvement in the way that community care legislation and legal duties are delivered through a single Act. That was the purpose of the Law Commission Report.
There are 12 parts to the report and I’ll briefly look at each section and make no apology for summarising the bits that I, personally, will find useful and interesting. The report in full and in summary can be found here. Among all the links, there is also an audio version available.
Part 1 – Introduction
Unsurprisingly, this explains the background to the report namely that adult social care legislation is currently spread across disparate Acts of Parliament and there are some pieces of legislation that remain ‘on the statute book’ but are not currently in use/useable (s47 of the National Assistance Act!)
Usefully, this section does introduce an initial brief definition of ‘Adult Social Care’ as being
the care and support provided by local social services
authorities pursuant to their responsibilities towards adults who need extra support. This includes older people, people with learning disabilities, physically disabled people, people with mental health problems, drug and alcohol misusers and carers.
The introduction continues to explain the timetable for the change process and some of the policy developments (most notably ‘personalisation’ and the move towards personal budgets in social care) that are taking place in the context of this review.
Part 2 – Defining Adult Social Care
While a brief definition was given in the introduction, this second section explains the need for a more robust definition of what or rather, who, comes into the definition of ‘adult social care’ in legislation. This ‘definition’ will go beyond who receives services from social services departments and will include those who are not eligible for services so as well as duties regarding assessment and provision of services, there is likely to be a duty around providing more general information and advice. This comes from splitting into two the principles of provision of social care – the universal (where the advice, information and support would come in) and needs identified following an assessment.
Part 3 – Structure of the Reform
This talks about the need for a consolidation of social care legislation. Currently, the suggestion is that there will be one single ‘Adult Social Care’ Bill which will cover both England and Wales (although this depends on how far Wales may diverge post-election).
As for the details of legislative powers and guidance, there are going to be three ‘levels’
- Primary Legislation
- Statutory Instruments
- Statutory Guidance
This seems to make sense and is particularly uncontroversial but I was particularly pleased that there will be a Code of Practice introduced (the Statutory Guidance). Those of us use to working with the Mental Health Act and the Mental Capacity Act will have a good understanding of how Codes of Practice link to primary legislation and I think they have been enormously helpful in explaining the legal issues to laypeople and practitioners. It is actually specifically mentioned that the role of this Code of Practice will be similar to that in the MHA and MCA.
Part 4 – Statutory Principles
These ‘principles’ are familiar to those of us who work with Mental Health (and Children’s) legislation whereby there will be some underlying guiding principles and ideas to pull through the whole legislative framework.
There is an interesting discussion in this section about the way that the content of these principles had been considered when open to consultation. One of the principles (and the ‘main’ one) will be about a general aim to promote and contribute ‘to the well-being of the individual’ but the Act will also encompass some of the ways that this can be done by ensuring the individual in question is included in the process.
There is also a principle (unsurprisingly) about safeguarding adults from abuse and neglect and using a ‘least restrictive’ principle which will be familiar from the Mental Capacity Act. I am interested in how a ‘least restrictive’ principle will work in the context of people who do not lack capacity but I expect the issues will become clearer in the passage of time.
Part 5 – Assessments
Ah, the Assessment – that ‘core legal right’ at the heart of the Act and what will be the ‘gateway’ to services however they are delivered. Firstly the term ‘community care assessment’ was criticised as being old-fashioned. To be honest, we don’t use the term in any context except a legal one anymore anyway.
It is agreed that the threshold for accessing an assessment should be low and and that the assessment itself could be seen as a ‘service’ in its own right – the comparison is made with having a GP check up.
The local authority would be able to flag up voluntary sector services for people who did not meet the eligibility criteria and would be a source for advice and information as well as services. The paper also talks about clarifying the position of people who refuse assessments so they might be able to access information and advice without having to have an ‘assessment’ of any kind.
The threshold for a fuller assessment will be met when a person may have needs that could be met by service provision so there will be a change of language in the law however there is a (quite right) determination that the threshold will remain low – because you might not know if the need could be met until you have assessed!
There are a number of more specific guidelines mentioned about the way assessments should be conducted and who might conduct the assessments and how they would be undertaken. Generally, there are likely to be statutory instruments covering some of these issues and the details will follow, no doubt. There will be some scope for specialist assessments to be requested in certain circumstances where the user might have specific needs.
There was some mention of this being a reserved task for social workers but that was dismissed quite summarily (because there wouldn’t be enough social workers, I presume) and will be a matter for the statutory instruments!
There will also be further specific guidance about the scope and place for self-assessments in the process.
Part 6 – Eligibility
This is quite a complex one but basically, the recommendations include codifying what is, in effect, current practice – namely that the social care needs identified through an assessment are measured against eligibility criteria and if the individual meets those criteria as determined, the local authority arranges or provides services to meet those needs.
There would be in indication in the Code of Practice regarding the levels of eligible need and how the councils would interpret them.
The law is not going to specify where the line should be drawn by the local authorities regarding setting the ‘thresholds’.
Interesting discussion in the document about duties under s21 of the National Assistance Act. I won’t go into details because I don’t have time but it looks like the duties will be recommended to be retained.
Part 7 – Carers Assessments and Eligibility
Unsurprisingly, there will be a consolidation of duties under various carers’ legislation to provide a carers’ assessment. I’m shocked when I hear of the number of people who are not being offered carers’ assessments when they should always be as a matter of course. Hopefully, this will be an imagining of a long distant past.
The ‘cared-for’ person needs to have at least some social care needs for the carers assessment to be ‘triggered’ and not only ‘medical’ needs. This is a bit of a blind spot in my view but the document recognises this and feels that any changes made in regard to this have to be done as a matter of policy by the government.
The requirement to provide a carers assessment will though apply to any care provided and not be limited to those providing ‘substantial’ care as it is as at the moment.
It is proposed that rather than the carer needing to request an assessment, the local authority will have a duty to provide which is far better as I see it.
Part 8 Provision of Services
There is an discussion in this section about whether or not to define what ‘services’ actually are in the context of that which can be provided. It was felt by the commission that there should be some kind of list involved and that there was also a need to specify preferred outcomes of the provision of services. The list will take the form of categories of support in the context of those which will provide the desired outcomes.
The recommendation which explains it far better than I can annotate, explains
Community care services (however named) should be
defined in the statute as any of the following provided in accordance with the
(1) residential accommodation;
(2) community and home-based services;
(3) advice, social work, counselling and advocacy services; or
(4) financial or any other assistance.
The statute should set out the following list of outcomes to which the wellbeing principle must be directed:
(1) health and emotional well-being;
(2) protection from harm;
(3) education, training and recreation;
(4) the contribution made to society; and
(5) securing rights and entitlements
I actually really like the idea of including the outcomes. I think it adds significant clarity to the position and scope of provision of services overall.
It’s also interesting that social work services are seen as a discreet ‘service’ as opposed to advice, counselling and advocacy. I wonder if that is a shoe-in for a different type of social work with adults in the future. We can but hope.
Carers’ services will follow similar guidance as above.
A care/support plan must also be provided in written form for the user and carer (if necessary) that should include assessed needs, eligible needs and desired outcomes. I see in my future more paperwork but actually, if it is going to be an improvement, I’ll welcome it with open arms!
Direct payments will be retained in their current form and interestingly there is a proposal to introduce them to allow for payment for residential services. I am not necessarily opposed to this however I do think there are some practical issues that are a concern. I’ll have to come back to this though in a post of its own!
None of the existing provisions for services that are being provided free of charge (for example those subject to s117 aftercare) will be affected by this and they will continue to operate in the current form.
Part 9 Adult Protection
There will be a specific role for the local authority to lead on safeguarding processes regarding adults at risk of being abused. In fact, the term ‘vulnerable adult’ will be replaced by the term ‘adult at risk’. The document states:-
We, therefore, proposed that an adult at risk should be defined as a person aged 18 or over and who:
(1) is eligible for or receives any adult social care service (including carers’
services) provided or arranged by a local authority; or
(2) receives direct payments in lieu of adult social care services; or
(3) funds their own care and has social care needs; or
(4) otherwise has social care needs that are low, moderate, substantial or
(5) falls within any other categories prescribed by the Secretary of State or
Welsh Ministers; and
(6) is at risk of significant harm, where harm is defined as ill treatment or the
impairment of health or development or unlawful conduct which
appropriates or adversely affects property, rights or interests (for
example theft and fraud).
Quite a broad definition but contrary to be beliefs of some, does not include everyone over 65!
Harm will be defined as
(1) ill treatment (including sexual abuse, exploitation and forms of ill
treatment which are not physical);
(2) the impairment of health (physical or mental) or development (physical,
intellectual, emotional, social or behavioural);
(3) self-harm and neglect; or
(4) unlawful conduct which adversely affects property, rights or interests
(for example, financial abuse).
but significant harm will be a judgement process.
Section 47 of the National Assistance Act will be repealed which is unsurprisingly and there will be another commission to look specifically at what it should be replaced by. This is, perhaps, where compulsory powers of entry will come in.
Adult Safeguarding Boards will be put on a statutory footing and there is some additional guidance on how they will operate.
The qualification that Guardianship can only be used for people with learning disabilities when there is abnormally aggressive or seriously irresponsible conduct’ will be removed which I think will allow for better protection for people with learning disabilities in the longer run.
The other sections of the report, I’ll cover very briefly
Part 10 Ordinary Residence and Portability
There is some clarification on the rules about residency in a particular authority and the principle of being able to take the assessment between different local authorities is, quite rightly, introduced.
Part 11 Overlap Issues
This part clarifies some of the areas where there are different pieces of legislation and particularly where there would be a crossover between health and social care issues but also with housing issues, forensic services and with childrens’ services. There is some guidance about clarity regarding continuing care guidelines and how direct payments might work if they are extended into healthcare (which is likely).
It also recommends that adult social care teams can assess 16 and 17 year olds .
Part 12 Other issues
This includes a look at the right to advocacy which the report says should be retained as far as it already exists but not extended.
The local authorities will retain their registers of people who are blind and partially sighted and have discretionary powers to maintain other ‘registers’.
There will be a continued review about a proposed definition of ‘a disabled person’.
So that’s all! Well, it’s been interesting to read through. Generally it seems like a substantially positive review and I think it will improve the way that services are delivered and at least make it clearer. There are parts of the review I’d like to explore in more detail – particularly the safeguarding arrangements and some of the items in the overlap issues like continuing care but I’ll have to come back to them.
I’d be interested to hear other thoughts about the process!
- Social care law revamp proposed (bbc.co.uk)
- A new legal framework for social care; the Law Commission reports (ageukblog.org.uk)
Tags: adult social care, british social work, direct payments for residential care, health, Law Commission, law commission report on adult social care, local government, mental health, national assistance act, national assistance act 1948, social care, social care law, social work, Statute, uk