I was talking to a friend of mine who does exactly the same job as me in a neighbouring local authority. Actually, we first met on our ASW (Approved Social Worker – as was) training…perhaps that’s another story for another day.
She was telling me about cuts in the services and the nervousness that is being expressed throughout the offices in the NHS and Social Services. She explained that there were a lot of jittery middle managers but that the following a ‘meeting’ a lot of additional work was being requested by the front line staff with no ‘give’ in the amount of allocations or expected emergencies to manage.
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We had a brief, fanciful jaunt through some of the fantasy ideas of ‘getting out of frontline work’ that comes up from time to time before chuckling those thoughts out of our systems.
The truth is that the culture of cuts did not begin with the new government and the general election. Our services were being cut away and savings being made for the last couple of years at least.
I am returning to work soon and there are more reconfigurations and changes to roles in progress. There are also job cuts coming. We like to think in terms of non-front line staff, of agency, bank staff but honestly, all those posts have already gone. We’ve already not been recruiting to vacant positions. No, I have a feeling there will be job cuts from those already in situ.
I’ve been fairly phlegmatic about it personally. I know there is a shortage of AMHPs (Approved Mental Health Professionals) and I have a hefty amount of experience at this point. I am also a bit complacent because I work in London and there are many many local authorities competing for the same supply of staff. There is no doubt though that quality of services will suffer and this is where my fears for personalisation agenda come in. Yes, it is a wonderful programme to increase choice but if the supply of funding narrows, the ILF (Independent Living Fund) closes down – there will be more calls on the budgets of local authorities and there may be more heading the way of Warwickshire, who, as reported in Community Care, are planning to ‘reduce or remove subsidies for services including home, day and respite care, direct payments and transport’.
Yes, this is a means-tested service but all so often, I’ve seen the possibility of high payments being a reason to refuse desperately needed services.
There are two problems with providing services at cost.
Firstly having grown up with a National Health Service, there is an ingrained sense of entitlement to state provision of services that relate to ‘health’. Of course, the wrangles between health and social services have a massive implication but to the lay user of services, if someone has a dementia, they have a health need, if someone has poor mobility following a hip replacement, that’s related to health – to the funding managers of the NHS and the Social Services the responsibility for finances falls differently but logically and emotionally it comes as a shock to pay and there is an inherent sense of right to receive free care.
Secondly, there are a lot of people who refuse services that would be preventative on the basis of cost thereby leading to excessively costly future costs – usually to the health service. It’s hard to ‘sell’ direct payments when the payment received is barely more than the money paid. It makes little sense but still involves the same extreme levels of bureaucracy.
The new government talk a lot about consultation but I have to wonder how much consultation has taken place to those who actually rely on public services as opposed to the Daily Mail narrative of those who are interfering or ‘lazy’ public servants who have no interest in anything save their own ‘fat cat’ pension pots.
Take, for example, the axing of the Caring with Confidence scheme to provide support and training for informal carers. I wrote about it briefly last year It is a good resource and useful training materials and the reasons for the cutting short of the programme seem blurry to say the least. I hope at the very least that the website and the information remain operational however without anyone actually knowing about the project, it will be of little use.
I know there is discussion of the government taking suggestions from front-line workers about ways in which cuts can be made but it’s a well-travelled joke to make about turkeys voting for Christmas. The shame is that there are a lot of vital and important contributions that front line workers could provide in discussions about commissioning and the needs of people in the boroughs and areas in which they work but there isn’t the time or the space to make these contributions and to provide these insights at length because while the belts tighten so the workloads increase and the desires to take more ‘global’ views of the wider issues facing the services shrinks and so it remains with the professional policy writers to move things in directions and establish new think tanks and ignore the grass-roots services that exist.
But I don’t want to end on a negative theme, hard though it may be. There are many ‘flabby’ services and cuts that can be made – not least at the management levels. I wonder if a wider use of the voluntary sector may be a way forward. As far as adult social care goes though, until the latest (yawn) consultation on funding reaches a conclusion there is little to be done about the more global long-term shape that will be taken by services.
Cuts are not new in our services though. They have happened in the past and will again. Those whose services are cut are not the ones with the political will and strength to challenge them. Perhaps that is the real role of the social worker as advocate in the lean years ahead – to ensure that those for whom we work do not have the silent voices they have had in the past and to ensure that our own moral compasses over-ride those of the management agenda where necessary.