The Guardian reports that there has been a dip in public sector productivity in 2008. The worst offenders are those in Adult Social Care. Oops. It makes interesting reading though when you consider what is classed as ‘productivity’.

The productivity measure used by the ONS sets outputs of public services, such as NHS operations and GCSE grades, against inputs of labour, materials and capital assets.

[picapp align=”none” wrap=”false” link=”term=lazy&iid=308999″ src=”http://view2.picapp.com/pictures.photo/image/308999/businessman-relaxing-grass/businessman-relaxing-grass.jpg?size=500&imageId=308999″ width=”234″ height=”175″ /]

I expect these are those wonderful performance indicator types that we are measured on. With operations and exam grades positive results might be better determinable but if you think about social care, let’s think what kinds of things might count as productivity?

It can’t be hours of care provided as we are consistently encouraged to cut down care and tighten criteria.

Anyway, hours provided is not a factor in itself of success or failure. Even hours provided against hours provided to the same person last year as if there has been an increase it could be wholly unrelated to the effective of any service provided (through there being a deterioration in health, for example) and if there has been an increase – well, increased cost is hardly likely to be seen as an indicator of good performance.

We are marked on the  number of carers’ assessments but to be honest, carers’ assessments are mandatory anyway, so we should be doing them for everyone who has an informal carer, so working on the basis that everyone is availed of their mandatory right to receive an assessment, there is no way to ‘increase’ these. You have one, if you are a carer, or, if you don’t have a carer, no-one has one. I can’t see how these can be increased apart from by stretching the definition of ‘informal’ carer or as a previous manager once told us, to carry out carers assessments ‘on paper’ even if the carers’ themselves had refused them in order to meet the numbers (we didn’t do this and I’m not sure if she was being entirely serious when she suggested it!).

Another criteria we are measured on is Safeguarding Alerts and Investigations. Again, this is a mandatory social work function. If there is a concern, an alert/investigation is completed. You can’t really massage the figures in any way because you HAVE to do the work – the only way productivity could increase is for there to be more abuse recognised and alerted…  Maybe the lack of safeguarding alerts could be a seen as a good thing and a sign of high levels of care rather than a bad thing and an unproductive office – this is bearing in mind that a lot of safeguarding issues arise from care given in a formal capacity – residential care homes and paid carers.

We factor in timeliness in completing assessments and responding to referrals. This is all well and good and better than people waiting for months. But if the quality of service better as a direct result or is moving a limited staff team from otherwise important work to take a low level referral an effective use of time.

I would question how many of the people in the ONS (Office of National Statistics) have ever had a hands-on role working in adult social care to be able to understand the way that quality and quantity of work can be judged.

It’s a great headline though – look at those inefficient workers in adult social care – they aren’t as good as other sectors in maintaining ‘productivity’. I would say that outcome measures are currently not making any allowance for quality of care and the shame is that it is on the basis of reports such as this that jobs will be lost and services cut – and more staff time will be spent on administrative tasks which ensure that ‘outcome measures’ are favourably determined as opposed to devoting time (and money) to fighting for a high quality of care and service delivery.

The role of a social worker

Often it takes an ‘outsider’ to see it clearly but this post from Stuart Sorensen says it far better than I could .

I would only add that professional courage is developed from confident practitioners. Confident practitioners – namely those who are able to advocate for the service users they work with, are able challenge their management and procedures and not just ‘tow the party line’.

This is something that is developed through  good supervision and support from more experienced social workers and a healthy dose of challenging some of the more commonly held paradigms in the sector, even if it doesn’t make a friend of the ‘management’ who prefer things to be clearly defined and cost effective.

Social Work cannot always be clearly defined and cost effective for as long as it claims to be a value-based profession. A social worker who is a ‘yes-man’ is the most dangerous and ineffective type.

I hope that is something that the Social Work Reform Board/College or whoever will be responsible for social work training and professional standards in the future pay heed to.

The Generation Game

Yesterday, I watched ‘The Generation Game’ on BBC1. It irritated me. The programme seemed geared very much to a comfortable middle class scared of losing their right to their parent’s properties. There was no ‘cutting edge’ in the debate. It was geared towards a particular audience that doesn’t link in with a large swathe of people that I might come across on a day to day basis. Remember, the poor woman who had to sell her mother’s house that she knows she and her brothers and sisters would have inherited, chose a care home which was not on the list approved by the local authority and cost £900 per week. Who exactly does she think should pay the £900 per week? Also, if all care home places were funded that would leave a massive gap in funding and at least the way of ensuring that people who can pay, do, means that more of those who cannot pay can receive services and no, this are not people who have ‘frittered their lives away’ and not paid attention to saving – but people who might have have different circumstances and situations that might have arisen or who have had lower paid jobs. It is not as simple as drawing a line and saying ‘everyone should save’. Not everyone can.

I’m not saying the current system is fair. It needs to change. But the picture painted in the first part of the programme was unrealistic and actually false in some parts.

Where the programme failed was to actually look at support for those who don’t have resources to fall back on.

Yes, the extra-care sheltered scheme was fine but if they were like the schemes in our local authority, they don’t like to take people who have anything verging on what might be considered a ‘mental health’ diagnosis (and yes, that does include dementia – ironically). I have a lot to say about extra-care sheltered schemes in general and should probably leave that for a post in itself…

I wonder if I’m the only person that thinks paying for care needed in life from ones’ estate is actually quite a good idea and has no ethical issues with a ‘death tax’.

Last night’s TV

There were a couple of TV programmes of interest on last night. One was on ITV, called ‘Behind Closed Doors’ and was about childrens’ social services in Birmingham. I didn’t watch it because.. er.. we were watching Beethoven… you never grow too old for cute animal films!   Living the Social Work Dream writes up a brief account of her impressions and it seems like a sympathetic view.

[picapp align=”none” wrap=”false” link=”term=television&iid=275670″ src=”http://view.picapp.com/pictures.photo/image/275670/channel-surfing-changing/channel-surfing-changing.jpg?size=500&imageId=275670″ width=”319″ height=”480″ /]

The other programme, which I did watch was ‘Undercover Boss’ on Channel 4 about Kevan Collins, the Chief Executive of Tower Hamlets. I  was curious to see what the perceptions of services on the ground would be from a local authority Chief Executive. I thought it was an interesting programme and quite enjoyed it. Of course, I’d have loved to have seen him in a social work office but the scope of the work of the council is so broad that it would take an 8 hour programme to cover all the different departments. The one thing that struck me at the beginning, where the filmed the Council Executive meeting (I assume) was how the ‘suits’ seemed all so worthy and nodded away when they talked about the usefulness of getting ‘front line’ workers to give input as they knew what was going on ‘on the ground’. I wonder it takes a television programme to emphasis this. I think they would all do well to ‘get their hands dirty’ to some extent and to actually listen to some of the ideas that would filter up.

Collins spent some time with the meals on wheels service. As I mentioned to my partner, Tower Hamlets is lucky to an extent as my local authority don’t deliver hot meals anymore and all the services have been contracted out. It was painful to watch how much that simple human contact can deliver to a person living alone at home who might not have the personal care needs to warrant a care package, and yet it is denied due to the costs of meal delivery systems. I hope it means that Tower Hamlets retains and promotes this service.  He certainly came out of the programme positively and I hope it was more than a just-for-the-cameras interest he was showing and will continue to show in the services in that Borough.

I jalso wanted to highlight this post from a US social worker who came to London with her college to learn about social services in the UK. She visited Waltham Forest and gave an interesting view ‘from the outside’. One of the things I have enjoyed most about the blogging experience is learning more about comparative systems of social work, particularly in the US, It makes a fascinating read to see how a British Social Work team is viewed and is something quite different from the usual navel-gazing that we occupy ourselves with!

Personal view of personal budgets

Just a quick link to an Guardian piece by a recipient of a personal budget. Go and read the article and then come back!

It’s always more interesting hearing about services and policy implementation from people for whom the services are created rather than from professionals who put the policies and the procedures together.

A few interesting snippets leapt out at me and I suspect it is partly because the way the implementation is different in different local authorities.

This point in particular

Every social worker is aware of how much political capital has been invested in personalisation by the government, and it cannot be seen to fail. So social workers cherrypick service users who they think will be the best candidates. Yes, prejudice and social bias even extends to disability.

When I asked my social worker what the drawbacks of personalisation were, he was candid. He admitted it was a process of self-selection. Only those who were erudite, well educated and well organised were encouraged to apply for personalisation and those who led chaotic lives – a euphemism meaning that anyone with drink, drug or mental health issues was not put forward.

While no doubt that was the case when some of the pilot schemes were running, now we have no choice whatsoever (quite rightly). Everyone assessed for a service is going to be receiving a personal budget. Everyone whose service is reviewed will be transferred to a personal budget.

This point raises one of my bugbears as well. I begged our implementation team to include people with more complicated needs on the pilot. I personally spoke directly to the project manager and explained that until the scheme had been piloted fully with people who did not have ‘straightforward’ needs, people who may not have the capacity to make full decisions about their own care needs and older people who might have the same high needs for services as a younger disabled adult  but with a LOT less funding available, we could not be able to create a system that worked across the board.

Of course, I was told that no, the pilot needs to be straightforward so we can work out the glitches.. THEN we will introduce some of the more complex aspects. The problem is that we have been left with documentation and assessments that are focussed on physical care needs while the mental health services were left behind as they were not involved in the pilot – being ‘more complex’.

So yes, the self-selection occurred (not in our team as we weren’t a part of the pilot – despite my pleas!) but it does not occur anymore – not in my authority. Now it is a blanket approach.

The part of the article that cut to the core was this, in my opinion

It is suitable for anyone who is organised, methodical and lucid, but it helps immeasurably if someone else is able assist on your behalf and make sure you are not making any accounting mistakes.

Honestly, that made my heart sink. Not because I am not thrilled for people like the writer of the piece who is, without doubt, getting an infinitely better service – but because it further sidelines people who are NOT organised, methodical and lucid and people who do not have someone else to assist on their behalf.

In an ideal world, independent advocacy both directed and non-directed would be a wonderful tie-in for those who need assistance with details and management and for those who might not have the capacity to manage some of the details – however costs are being cut. Our own advocacy services now have a massive waiting list. The expectation again falls on statutory social services and honestly, I don’t say this because I’m proud of it but because it is the reality, in the day to day workload, there will not be the time for a social worker or social work assistant to provide the same level of support putting together an individualised and personally focussed care plan – maybe there would be in a learning disabilities team but in an older persons’ team where a much faster throughput is expected – it’ll likely be the same usual agencies that are used for the same, usual tasks.

I see personalisation as a wonderful thing in theory. In practice is has made a lot of care much better for the ‘organised, methodical and lucid’. The massive challenge is how to ensure that equal and better services are delivered to those who are not ‘organised, methodical and lucid’. Those who do not have networks of support. My fear is that the funding will be siphoned to those who are better able to articulate their own  needs.

I promise I’ll try to stop with the personalisation posts soon. I get the feeling I’m being somewhat repetitive but they are very much on my mind at work at the moment as I’m running through a few and so I keep thinking of more reasons to be frustrated with the implementation (as opposed to the ideology which I support completely).

Big Society

So here we have the phrase that Cameron wanted to become a catchphrase during the election but somehow got lost possibly due to public indifference. However, now it’s back to bite.

Cameron launched his ‘Big Society’ initiative a couple of days ago. He uses all the right language of course. It is about a devolution of power and influence over local matters from central government to smaller communities.

As he said in  his speech in Liverpool

‘The big society … is about liberation – the biggest, most dramatic redistribution of power from elites in Whitehall to the man and woman on the street,”

Sounds great so far. As for the details as well as giving some examples of this ‘Big Society’ in action, for example, people in Cumbria buying their own local pub or Liverpudlians opening up some museum services with volunteers.

The idea seems to be to open up the spirit of philanthropy and volunteerism. Money from ‘dormant bank accounts’ will be used to fund some of these projects and plans.

I was sceptical during the election campaign and I remain sceptical now.

Firstly, I am a great fan of voluntary work and voluntary services. I have been directly involved in many voluntary projects and personally developed my own career extensively based on experience as a volunteer. I love it.

But, and this is a big but, I was able to volunteer as my personal financial circumstances at that period of time allowed it. I was in a fortunate enough position to be able to self-fund the work I did as a volunteer.

Is volunteering a luxury then? Not necessarily – those were my own personal circumstances but I am well aware of many many people who manage to work full-time/run a household and find time to input directly into voluntary services. Maybe it’s just me that wouldn’t have the time and energy to do so but I wonder if there is a whiff of middle class morality about it all. Not in all cases, but the example of the pub being bought out by locals certainly seems to pitch the community at a certain level of income.

My other concern is one that relates both to the area I work in and the area I live in. This is as inner-city as it gets. There are some very strong community groups who could easily gain ground both by being active in particular pockets and having the time to invest in the structures of this new ‘big society’ programme that would perhaps, disadvantage minority groups living in areas where there are large homogenous majority communities.

The other concerns relate to reliance on the third sector – this point has been raised in The Guardian . It’s obvious why the government would like to place hopes in the voluntary sector. Often voluntary groups can be ‘closer to the ground’ but do they have more authority that local government? It might be a cheaper way to run things. Currently – and I’m referring to the sectors I am personally aware of – the local authority might well commission local charities to do pieces of work for them or provide services – the Alzheimer’s Society provide day centre support and carers groups for example and receive funding from the local authority. Local authorities are cutting down on spending and the money may come from these ‘big society’ projects from central government funding – oops, I mean ‘dormant bank accounts’ (by the way, is there REALLY that much money in these dormant bank accounts… ).

To the charitable sector, the funding may be cut from one source to be granted at another. Who is better placed to decide which local services are needed or required and what will be the bid process for these charities? The reason I am concerned is that I’ve seen some rather bogus organisations with charitable status – particularly religious groups to be honest. That concerns me.

I don’t want to be cynical about all these wonderful goals. I am a great fan of community work and working within communities. I am just concerned that some of the minority sectors and opinions might be missed in a bidding process for funding for grand ideas.

I really want to be proved wrong though.

It is a question of whether the conception of ‘Big Society’ will work as well in Tower Hamlets as in Tunbridge Wells?  Hopefully the Liverpool pilot will be the proof of the pudding..

Resource Allocation Systems

Community Care has an article about a case which refers to the RAS (resource allocation system) used to determine the levels of  personal budgets in social care.

Perhaps I should step back a little and explain briefly about the RAS. There is a lot of jargon in the world of personal budgets – little of it is genuinely helpful.

An assessment (usually a self-assessment but sometimes carried out with an advocate or social worker) will be placed through a spreadsheet chart analysis and depending on the data fed in, the RAS (as it is known) will spit out an ‘indicative budget’.

[picapp align=”none” wrap=”false” link=”term=computer+paper&iid=301677″ src=”http://view3.picapp.com/pictures.photo/image/301677/computer-mouse-next/computer-mouse-next.jpg?size=500&imageId=301677″ width=”338″ height=”506″ /]

Now this is where the court case comes in – R (Savva) v Kensington & Chelsea LBC

As is explained in the Community Care article, the case involved a 70 year old woman with a number of long-standing health conditions. She completed a self-assessment and under the ‘RAS’ system was granted an indicative budget of £82 per week. Being indicative meant it didn’t necessarily align with the ‘true costs’ of services so she was given a budget of £170.

Fast-forward to a hospital admission and a deterioration in her physical health which meant an increase in her needs. Self-assessment completed again – this time the RAS indicated higher needs and a higher indicative budget but the actual budget, the £170 allowed, remained the same.

The judge ruled that the RAS was not unlawful as it had been cross-checked by a human however the local authority should have shown greater transparency and explained the reasons better to the woman as to how the decisions were made.

For me, this is something I could see happening where I work. The RAS is known to be a very poor and ineffective tool.

Just last week, I was explaining to a colleague about it and he was becoming increasingly agitated as I explained again and again – the RAS just doesn’t work – don’t rely on it, just discuss what the needs are and his (very good) point being ‘if it doesn’t work, why do we us it at all?’.

Perhaps it is an indication of our need to find ‘systems’ and computers to compute things that actually can’t be computed. My understanding is that the reason for the RAS is to somehow try to equate and quantify different needs on an equitable basis. The RAS was determined by various people working in policy-making ivory towers who are absolutely convinced that there must be automated ways to do everything. Look, it will save time………. hahaha

Someone needs help with making breakfast – assign one figure for that.

Someone needs to have some daytime activities – assign one figure for that.

But reality suggests that the cost of an hour of ‘daytime activity’ will not equate to an hour of ‘meal preparation’.

Of course, this will make no sense to someone coming in from the outside – they see the figure and run with it – truthfully, it makes little sense to someone on the inside either.

So on the basis of the local government looking at ways to save money on administrative tasks – perhaps eliminating a practically useless attempt to automate clients’ needs according to financial figures would be one of them – as the work needs to be replicated manually in any case.

The only fortunate thing is that it takes a couple of minutes to run an assessment through a RAS – the unfortunate thing is that it is a completely soul-destroying couple of minutes where you know what you are doing has no purpose whatsoever as it all needs to be done again with more human input.

Computers don’t solve everything. Sometimes the systems merely serve to obfuscate.

Perhaps the real danger of the RAS is that it will be used to confuse users as to their needs and what they are entitled to.