Paying for long term care

Just a quick post which I hope will be of use to some. I listen to the Moneybox and Moneybox Live podcasts and yesterday, I heard the edition from Wednesday of Moneybox Live which was about funding long term care.

There were a few discussions (it has the format of a phone-in) about differing issues and certainly clarified some points for me and can be downloaded here.

Incidentally, although it is often not in the slightest bit related to my work, it is a well-constructed and more-interesting-that-it-sounds podcast that I’d recommend more generally.

Speaking Up

Community Care reports this week on a comment made by Julie Jones, the Chief Executive of SCIE (Social Care Institute of Excellence) compelling social workers to ‘speak up and speak out’ in order to put across their positive messages to counter some of the negativity that the mainstream media and general public seem to hold in regard to the profession.

My general argument (and not just mine) has been that our employers would not welcome direct contact with the press – indeed – we have been instructed to push any media contact request via our press office. This was instilled in us during our initial inductions in the authority and it is hard to shake free from that mindset.

SCIE is positioning itself to be the ‘first point of call for the media’ seeking news stories and sources relating to social work and social care and as such, they are establishing an online TV station particularly devoted to Social Work and Social Care stories. It’s an interesting and potentially useful initiative to use different sources of media to promote positive news as well as training initiatives for the sector.

Conversely though, I can’t help but be marginally concerned by the ‘outing’ of Night Jack – an esteemed anonymous police blogger – whose anonymity was blasted by The Times after a court ruling that the injunction the blogger had taken against the Times revealing his identity could not stand as the judge said

“I do not accept that it is part of the court’s function to protect police officers who are, or think they may be, acting in breach of police disciplinary regulations from coming to the attention of their superiors,” Eady added.

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The implications for anonymous bloggers is obvious – there is no protection in the law. It has served as a short, sharp shock for me anyway.

Nightjack closed his blog, deleted it and has, indeed, been disciplined by his employers.

I try to vary my content between the general and the specific but have no doubt that were someone who works directly with me to come across this site, they would, quite quickly be able to ascertain my identity. I am not as careful as I could be.

For me though, it has provided a wonderful way to bypass the ‘press office’ of the local authority and to speak about the work I do and how I do it in a more direct manner. I hope to provide some insight into social workers who do not necessarily meet the media stereotype. I would argue that writing has improved my practice, knowledge base and effectiveness as certainly, the scope for reflection, thought and comment has increased.

I am torn between being more careful, being less careful and just packing in altogether.  I doubt the ‘packing in altogether’ option would be viable. I am now accustomed to writing, indeed, I missed it when I was on holiday – but to use a tired old cliche, it is food for thought.

I think there is a place for anonymous blogging – and although I have to say, I never expected there to be much protection as anonymity is and can be very fragile, the Nightjack lesson shown to prove how much more careful it is necessary to be.

Depression and Disclosure

My brain is slowly chugging back into something akin to functioning mode – after just a few days away it is always surprising how quickly it is possible to switch off.

Fortunately (or not, as the case may be) I don’t have much of an opportunity to stand still as my working week starts with a 9am Mental Health Act Assessment which was set up for my return.

So I’m charging my work phone in order to check the messages so that I’ll know if I’m still needed.

In the meantime there seem to be a gaggle of stories worthy of comment of which I can only touch on a couple which link in a way to depression, work and stigma.

A report in The Independent yesterday notes that

The blight of depression affecting hundreds of thousands of people across Britain is costing the nation’s ailing economy £8.6bn a year, £3bn more than a decade ago

Of course, there is no doubt about the debilitating nature of depression but I was curious as to why the costs relating to depression should have increased so sharply.

The research quoted by the Independent, allays this  figure  not to increased costs for treatment of depression through the price of medication or treatment on in-patient wards but rather the cost of lost labour due to the difficulty of managing return to work although all those factors would contribute to an increased national cost.

The ‘New Horizons’ strategy which is due to be published later in the year is said to have a stronger focus on ‘public mental health’ and broader preventative measures and until anything is published it is hard to comment or critique any potential plans.

Oil on canvas

Image via Wikipedia

 

 

Interestingly though, Margaret Wallace, the Chief Executive of SANE is quoted as saying

There has been continued loss of psychiatric beds for inpatient care, the closure of day centres and impoverishment of occupational therapies. While the Government is planning to increase the availability of cognitive behavioural therapy for those with mild to moderate depression, we are aware from the many thousands of people who contact Sane that there will continue to be many with complex diagnoses who may not be included in such programmes, and who continue to struggle without the necessary psychological support

It’s an interesting and useful insight into the measures that have been promoted by the government towards shifting money to more CBT (Cognitive Behavioural Therapy) and preventative work at the milder end of the ‘depression’ scale – but the gap remains with those who are suffering more acutely.

The trouble is that working in the secondary health care services, it’s always difficult to know about the people who you don’t see or know about – although there is no doubt that between mild and severe, is a large group of people who may be unable to work but not able to access sufficient support.

It leads me on to another story that had been rumbling in the background relating to Christine Laird – the Chief Executive of Cheltenham Borough Council – who, in the words of The Guardian,  was taken to court by the council that

claimed Christine Laird fraudulently or negligently withheld details of a history of depressive illness when she became its managing director.

To sum up, Laird was employed in 2002, underwent significant stress at work including allegations of poor treatment at the hands of some in the  and left in 2005 requiring a period of treatment at a psychiatric hospital.

The key to the case revolved around a medical questionnaire that Laird had completed when she applied for the job in the first place.

To the question: "Do you normally enjoy good health?" she replied "Yes". To: "Do you have a mental impairment?" she replied "No".

The court was told Laird suffered "three episodes of depression with associated anxiety" between 1997 and 2001. But she saw it as "stress-related illness and not depression" linked to "non-specific, non-recurrent events".

I wonder how much work-related stress and depression are linked to be honest. I know a few people personally who  have what I would consider to have suffered from bouts of depression but have insisted that it is recorded as work-related stress on any documentation for work purposes. I suppose the hope that the stigma related to ‘depression’ is still too high but this case doesn’t really help matters. 

The Court highlighted the ridiculous nature of those specific questions – ‘normally enjoying good health’ can be interpreted so broadly as to be largely insignificant. It is also a completely value-based judgement. As for asking about a mental impairment – again, is it asking for a legal definition in accordance with Section One of the Mental Health Act (1983 as amended 2007) or is it asking for an ‘average man on the street’ definition which would probably stigmatise ‘mental impairment’ to a much higher degree.

Laird won her case but was instructed to pay partial costs amounting to £190, 000 but leaving the council with a bill for £1.6 million.

Of course, it is always important to be truthful on medical questionnaires but it is possible to see where the discrimination can fall.

It is hard enough for work to be found at times without giving employers more reasons to refuse to employ someone with a history of mental ill-health. The questions were poorly structured and perhaps a more straightforward way of asking where no doubt could have incurred should be and probably is now, written into the application forms but I wonder how much influence they would have on the appointment of a perfect potential employee who has, in the past, suffered from a depressive episode.

Quite rightly, campaigning groups have welcomed the court ruling against Cheltenham Borough Council but I wonder how many councils will be more wary to employ someone with a similar background in the future – maybe reports from medical professionals will be relied on more strongly in these circumstances and a type of ‘well note’ will emerge where it is possible to explain what can be done rather than where problems lie although to be honest, that is a little fanciful.

Would an employer make this effort for a potential employee when there is another potential employee without a similar medical history? Realistically it is unlikely and that is a cause for sadness.

The ease at glossing over any past problems can be all too tempting in a culture that judges health and competence so narrowly.

Entitlements

I was interested to read about this case in Reading last week, where the local authority was challenged regarding a decision not to support a disabled woman who is HIV+ according to the Fair Access to Care Criteria which would indicate that although she had irrefutable ‘needs’ – they were not at a substantial level which qualified for assistance under the National Assistance Act (1947).  As the article goes on to say, she lost her bid because, according to the judge

She is not so badly off that she is entitled to be “looked after” at public expense.

In some ways, I’m surprised there are not more of these types of cases. I was involved in a situation with threatened litigation a few years ago myself. The question in that case as with this lay on the levels of needs and what the council was obliged to provide.

There is a story that has done the round in both the local authorities I worked in about a poor Care Manager who wrote up a care plan saying a person needed to live in better accommodation and then this was challenged in court and the council were obliged to provide new accommodation for the person in question. I have no idea if this story is true but it was used as a word of caution by older, more experienced social workers to younger colleagues to be careful about wording and writing what you are recommending as opposed to what you being is absolutely essential!

Although there is no doubt in my mind that we (and by that I am referring to those working in Adult Social Care) would love to provide all the necessary services to all the people who might benefit even in the slightest, the resources just do not exist.

This is where you see the social worker as gatekeeper role which was envisaged in the NHS and Community Care Act. It is an adjustment of the mind to move from the promotion and advocacy role that is presented in training to the gatekeeper role and keeper of resources that has morphed into care management in some senses.  Of course decisions about funding rarely lie with social workers and are taken way up the management line, it is still a mindset that is encouraged when assessing – what is this person entitled to? What criteria do they meet? Rather than what could possibly be provided to add quality to their lives.

I remain a bit of a fanciful dreamer, even after almost 10 years of practice and I know money and resources are limited so we cannot possibly give everyone what they want but there has to be a balance somewhere.

My only hope is that the personalisation agenda will move things on somewhat and that individualised budgets will prove to be as wonderful as the literature makes them sound.