Looking ahead to 2011

I’m almost reluctant to write up my thoughts for the coming year and it is a battle to contain my more pessimistic urges.  I wrote this post and sat on it for a while because it came across as too depressing.

I try to be as optimistic as I can in my day to day life. As even if optimism/pessimism make no difference on actual outcomes, at least I’ll go down happier if I think positive!

I’m finding it really hard to find much positive to say about my thoughts for 2011 though.


That’s an easy theme. No doubt that it will be the main background through which 2011 is played politically both nationally and locally. In my personal and professional life.

As we turn increasingly into a fire-fighting, crisis management service there will be less, if any, space for preventative work. The government and the local authority won’t headline this because it goes against every piece of evidence about long-term savings but the savagery of the cuts will affect those who just come in below the ‘life or death’ bandings.


Again, this is barely a prediction. Protests and rallies have already been called. They will be increasingly well-attended. I fully intend to participate myself. As people realise their actual tax credits decrease their real income, there will be a wider anger directed towards the government and the poor political process that has served us so badly.

Care Funding

Yes, the next commission will report. It will benefit most those who have the most to lose. Poor people who might have to sell the houses that they own to pay for the care that costs a significant amount of money. Inheritances will be preserved. What that does to the quality and support for those that don’t have, well, we’ll see. I’ve tried being positive, now I’m just cynical. The government have an agenda to protect their own political classes. They have no desire whatsoever to produce a more equitable scheme of funding. No political party does – which is why these consultations have dragged on for so long.

‘Big Society’

Big Society will be discussed and debated. And will be shown up for the sham that it is in the face of funding being withdrawn from voluntary organisations. It will be an opportunity for private enterprise to ‘invest’ in communities. Youth centres  sponsored by McDonalds. Libraries sponsored by BP.

Social Work

The College of Social Work comes into formal existence this year. It has already made some kind of deal with Unison for union membership. I expect it will merge with BASW (British Association of Social Workers) too. I hope so anyway. It will continue to be run by academics, managers and retired social workers because no-one on the ‘front line’ will have any time to be involved in the processes and committee upon committee will be attended by professional ‘consultants’ who may once have been social workers but remain so far removed from actual client contact that they will have no idea about whom they allege to speak for.

I remain hopeful that there will be some kind of positive outcome.


They’ll be more scandals, more appalling practice and more horrified ‘Daily Mail’ stories. No interest whatsoever will be shown in any of the good work that is done every day. Again and again.


Social Media

This is a new one for me. Twitter become much more of a key network for me. I love it for so many reasons but mostly because it gives me more of a character than just a blog does. I love some of the conversations that I’ve been able to have with people whom I would never have had the opportunity with engaging with on any other forum.  Local authorities are increasingly involving themselves in micro-blogging. I’m surprised that there is less in terms of standard blogging as far as government is concerned. It remains the domain generally of individuals and local politicians rather than local officials on behalf of the organisation for whom they work rather than as individuals.

If I really knew what what happen in this sphere, I’d make a fortune but in the meantime I’ll say that there will be more online consultations and more discussion and debate. And more blogs,  podcasts and debates which involve users and carers. It’s a great opportunity and could potentially increase voices sometimes lost in the political process.


Efficiency savings. Ha. Real growth in spending. Ha. We are losing services hand over fist and the government is able to get away with this kind of whitewash. It will continue and services will struggle.  I’ll have to move on from this subject because it really does fill me with fear just thinking about it too much.

And some more local predictions for me and my team


Yes, it’s coming. Another one. I think the third now in just over 2 years but this one is a big one and it’s going to affect not only our team but the entire Trust. Changes have already started and it’ll be the main theme for the year as jobs are lost and downgraded. More staff leave through the so-called ‘natural wastage’ and aren’t replaced.  It seems there may be a change in the way the AMHP service is arranged locally as well. I try to ignore rumours and whisperings and let all the possible plans go over my head somewhat until anything is confirmed.

I’m lucky in the sense that I genuinely love my job. I was talking about it to a colleague yesterday who asked me if I was looking for other jobs and I honestly don’t think I could work for a better team with better managers/consultants/colleagues etc. That’s a pretty special place to be and while I couldn’t, hand on heart, say I love the work I do every day, I wouldn’t want to be doing anything else. In my dreams when I win the lottery, I still work, just part-time!


I hope to take another student social worker on this year. I might look into possibilities of being an off-site practice teacher though as it was a real struggle with workloads to manage having a student in the team. Of course, it didn’t particularly help that I needed to go into hospital the last time I had a student.  I also worry a little that the lack of staff in the team might lead to managers seeking to push additional work towards a student.  The local authority training budgets have been slashed so I don’t think I’ll be able to continue with the Higher Specialist Award in Practice Education (which is my longer term goal.. ) this year or probably for the next few years as quite rightly any funding should be focussed on those who have not accessed training and if there’s one thing I have been doing of late, it is accessing any training available.


One time in particular I was very close to closing this blog down. I even set up a parallel non-related one as a kind of outlet to keep me going and give me something to write about in the expectation that I would stop writing about work-related things. Anonymity can be a burden at times.  It was just a little too hard to completely let go. I would say it’s about 50/50 as to whether I’m around next year to reflect on these predictions at all. I do enjoy writing though and sharing my thoughts about issues as they arise. I hope to continue that whether published or not. It really does help me with my self-reflection and maintaining my interest and connection with current affairs.

I don’t really stick to resolutions but I do want to read and participate more widely in the blogging communities. I was better at it last year and this year have become more insular due to time and health mostly but I want to re-engage more over the next year.

And I have a suspicion that when I do write, it will be a lot more political in tone which leads to..


Social Action

One of my resolutions last year was to be more involved in Unison and BASW, seeing as I pay the subs. This year, I’m particularly going to focus on Unison – the issues and general themes of cuts, cuts and more cuts go far beyond social work specifically. This year I also attended an event put on by SWAN (Social Work Action Network) and it really got me fired up. I hope to go to more of their events. I really want this government to know how much their cuts are hurting and whom they are hurting. I find the injustice in the focus of the cuts and the ‘blame’ narrative sickening. I feel I have to push against it at every angle. I can see myself getting far more involved politically on  many levels.

There is a lot to fight for.


And I hope there is not even one single day of sickness that I take to make up for last year (yes, I feel unnecessarily guilty.. ).

Finally, I hope that everyone has a hopeful and positive year ahead. It won’t be easy but that’s why it needs more effort than ever before.
Fireworks #1

Happy New Year.

2010 – A look back

It’s been one hell of a year and I can’t say I’m terribly sad to see the end of it but my gut feeling is that, however hard I try to be positive, I can’t cover myself in pure optimism regarding 2011.

On 2 January 2010, I wrote a ‘Looking forward to 2010’ post.  I thought it would be interesting to see how right (or wrong) I was.

I wrote:

I expect a lot of changes around in the implementation of the projects and planning laid out in the New Horizons document to come into fruition. It’s about ‘changing focus’ and we have already had ‘consultation documents’ distributed which seem to be proposing some quite dramatic changes in the CMHTs (Community Mental Health Teams).

I know I should some more enthusiastic, after all, the document certainly ‘talks the talk’ about prevention and improvement of access to services but having been barely a year out of the last reorganisation which involved me changing teams and caseloads and having two changes of manager in the last year, it has somewhat quelled my appetite for more imminent (over the next year anyway) change.

But such is the nature of the job, constant changes. All of which at zero cost. There were some noises about ‘Staff Affected by Change consultations’ which doesn’t automatically instil confidence. Oh well, it’ll be interesting to follow where it might lead us over the next year.

My first point related to the ‘New Horizons’ document which I thought would be taking a more prominent role in planning for 2010. I was wrong. New Horizons with its’ focus on prevention and public mental health may well sketch out some new ideas or rather formulate ideas which had been knocking around in ‘the system’ for the last few years but it seems to have been a ‘baby’ of the previous government.

I sure was right about changes in CMHT and my worried noises about circulating ‘Staff Affected by Changes’ documents – but, as it seems, I wasn’t worried enough!  I was already suffering from ‘reconfiguration fatigue’ but didn’t know the half of it as our directors were beavering away with some of the biggest changes for decades and the new government looks for ‘efficiency savings’. Oh dear.

My next point:

Individual budgets, personalisation and the rolling out of such. We have begun to implement the last of the ‘pilots’ and things are beginning to fall into place. I foresee more of the same really although obviously a move out of ‘pilot’ and into ‘implementation’. I expect much confusion and complaining until we all settle into the new ‘way of doing things’ which in the end, will use all the right language and be terribly effective for some people but for others, and possibly those with the least ability to advocate for themselves, will make little difference.

Yep, that was a fairly certain bet and by April 2011 we should have migrated everyone onto the new system. Much confusion and complaining – tick. But that’s as safe a prediction as I could have made due to government targets and attached funding.

The social work Taskforce reports will rumble around over the next year, with much hand wringing by the universities who have been roundly criticised for failing to provide effective placements or levels of education of a new generation of social workers. I expect the GSCC to take a tighter rein in its role as regulator of academic standards.

Nope, no hand wringing by the Universities at all. That criticism seems to have flown under the radar. There have been some of the usual grumblings and gripings but nothing substantial actually done in this area.

And the GSCC has been thought the mire this year itself. It will likely just increase charges so it can retain its ‘independence’ from government but I can’t see it changing very much. It will continue to be detached from practitioners and run by those with little knowledge and insight into front line practice.

And goodbye GSCC. I really didn’t see that coming.  Social Workers will, in the future, be registered by the HPC (Health Professionals Council). I remain fairly neutral in my regard of the HPC to be honest.  I do think that the loss of any desire to regulate social care professionals (as opposed to JUST registered and qualified social workers) is a massive missed opportunity but in the end, it comes down to cost and status, I believe.

The hash that is currently being made of the confusion of the College of Social Work, BASW and Unison grieves me more than a little. I am a member of BASW and a member of Unison. I don’t really understand what a new College will offer me apart from the professional organisation for social workers (BASW) and trade union membership (Unison). I already have both of those. I’m confused. I hope something comes out telling us what the College actually is and will do that is different from BASW.

I’ll write more about the College/BASW/Unison mess in my ‘looking forward’ post as I imagine that play a part over the next year.

I expect the DoLs guidelines and codes of practice to be adjusted and improved through case law primarily but hopefully also by consultation.

Wrong on this one – my attempt to be positive! If anything I am far more critical of the DoLs (Deprivation of Liberty)  guidelines now than I was a year ago. The reason being that I am sorely disappointed by the lack of proper knowledge of them and am seeing that my optimism of case law filling some of the gaps was a triumph of hope over expectation.

DoLs (Deprivation of Liberty Safeguards) were poorly drafted and largely unknown corner of the generally very good ‘Mental Capacity Act 2005’. My cynicism is currently driven by the lack of understanding of the safeguards in a lot of the care homes I visit.

I know the government has a lot on its place at the moment but I would love a wider consultation on DoLs from a lot of people who now have a couple of years experience of using the procedures because it really does need redrafting and rethinking massively. I’m not putting that in my ‘predictions’ post as I don’t think there’s a proverbial ‘cat’s chance in hell’ of that happening. Not in the next year, not in the next decade. Too few people actually know about it.

There will be changes announced in the funding of care. I wish I could forsee what they are! It partly depends on the outcome of the general election. Whatever is chosen, will have a lot of discussion.

More discussion. That was a fairly safe prediction. There was no resolution of this probably due to the election and the new government wishing to commission their own, new.. commission. This is probably a safe prediction (without the bit about the general election) for the  next few years. No-one wants to make the change because while the current system is wholly inadequate, the thought of people paying for care services isn’t going to be popular.

The theme of the year will be ‘zero-cost changes’ I expect as the public purse strings  continue to be tightened.

Well, I was both wrong and right about that. We aren’t talking about ‘zero-cost changes’ anymore. That illusion has been broken. We are now talking about ‘efficiency savings’  but no pretence that the costs will be ‘zero. They will be reducing as will the front-line services. They already have reduced the amount of man hours we spend with people who need our services.

‘Public purse strings being tightened’ was a wholly inappropriate euphemism in the face of such wide-spread public service cuts and cuts in our own services. This isn’t trimming the fat, this isn’t tightening the purse strings – this is a wholesale massacre.

I also expect a year influenced by ‘Payment by Results’ in Mental Health services and outcome scales such as HoNOS and HoNOS 65+ which will be used to measure our ‘effectiveness’

Again, that’s half-true. It is still all in progress but I expect the change to be continued into the new year. Outcome measures seem to be a favoured ‘baby’ of our new government. I remain somewhat sceptical for one reason. I hate having to classify people according to diagnosis. It moves against every person-centred theory in my body. We are asked to reduce everything down to diagnosis and improvement. What works for broken limbs in terms of measuring recovery doesn’t have the same ‘results’ in mental health services. I promised  a post about outcome measures in mental health last year. I didn’t deliver on that – maybe I’ll get down to it next year!

Of course, I didn’t predict how deep the cuts would hurt. What changes there have been in local and national government agendas but to be fair, none of the parties were clear about what they were planning after the election.

On the positive side, I took my first social work student as a practice assessor and undertook and completed the Practice Education branch of my Higher Specialist Award although to be honest, I have no idea how post-qualification training will look in the future.

I had a great student and really enjoyed the experience. I’m considering taking another student but this time as a off site Practice Assessor  but the difficulty is that the office is so busy at the moment with the understaffing/shifting everyone to personal budgets/outcome scales and AMHP/BIA work it is hard to know where to fit in a student.

Our training budgets have also been cut catastrophically. I certainly won’t be able to progress with my Higher Specialist Award this year or in the immediate future. I chose a very good time to pick up the training though as had I delayed, I doubt there would have been funding for it this year.

Other than that, on a personal basis my year has been marked by illness. I went into hospital earlier this year and had a long period of sickness. I have never had that in my life and it was a shock. I was impatient in my recovery and probably went back to work sooner than I should have and suffered as a result! But now I feel much much better than I did prior to the surgery. I am not experiencing any pain at all and am no longer frightened about general anaesthetic. Result all round. Massive credit to the wonderful staff and hospital I was treated at. I honestly couldn’t have bought better care than that I was provided with free even if I had all the money in the world.

My partner’s parents have both been very sick.  They live overseas. I see the difference in the systems here and there with a striking clarity. I am still very glad that we have the social support here that we do  but am so terrified about what is being stripped away. I won’t give it up without a fight. That has been an overriding theme of the second half of the year.

This was the first year without a parent around. That feels more lonely although in a way, I’m glad my dad never knew about my own health problems. He would just have worried and it all turned out well enough.

As for the politics – I’ve mentioned this many times but I am angry. I am angry that this government is ripping apart this country’s social fabric and creating a blame culture.  The election obviously was a key point of the last year but however nasty I always thought the Conservative Party was, I didn’t expect them to be quite as obviously callous with their cuts that they have been. And the Liberal Democrats – didn’t see that coming. They seem to have picked up the pace of cuts with an undisguised fervour. Major learning point politically for 2010 – never ever vote Liberal Democrat again (I’m sorry everyone, I really am doing my utter best to atone for that failing Sad smile ).

One of the saddest conversations I had over this ‘holiday’ period was with an old friend I hadn’t spoken to for about three years. She lives in another part of the country and we don’t catch up much. She has two children and told me how ashamed she was about being a ‘benefit scrounger’. I chastised her for describing herself as such and explained with fervour how she was entirely entitled to what she was claiming but she sighed and shock her head sadly, with a degree of self-loathing.

That makes me angry. It makes me angry that those who need are being reduced to shame for claiming entirely what they are entitled to. That’s not a society I want to subscribe to however ‘big’ it is. I want to live in a society that gives pride rather than heaps shame on people.

But I’ll look at predictions for the next year over the rest of this week.

I will try to be as optimistic as it is humanly possible to be…

Christmas and Depression

A Danish Christmas tree illuminated with burni...

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It’s distinctly emptier in our office this week. I don’t think it’s necessarily the snow – although that hasn’t helped with some of the time-keeping – it’s just a very popular time for annual leave. Next week will be similarly if not more sparse. I quite like working around the Christmas period. I haven’t ever taken the days between Christmas and the New Year off work. I suppose in a warped kind of way, I enjoy the atmosphere and the pace at this time.  I like that other offices often close between Christmas and the New Year and sometimes they assume that our service is closed as well so the bureaucracy winds down a tiny bit and it can be a good time to catch up with paperwork.

A part of the skeleton service that covers these weeks, involves obviously picking up work that is allocated to those absent colleagues. And so it happened that I ended up visiting someone that is usually seen by one of the CPNs who is currently the other side of the country.

Although I wasn’t officially covering the ‘duty system’ of types that we have in place, everyone else was bogged under and I knew the man in question – having previously been allocated to him.

The circumstances of my de-allocation were, at the time, purely due to some geographic reconfiguring rather than a request either on his or my part so it seemed obvious that I should go as I knew him well.

They were difficult times for him.  We spoke about lots of things but one of main themes was the imminent arrival of Christmas and the pleasures and joy of Christmas past.

This is one of the themes of this time of year for me. Christmas is drummed into us as a ‘family’ time – a together time and a joyful time. I’m far from a grouch (well, ok, I can be at times) but the cultural expectations around Christmas can be exceedingly painful for those whose lives, families and circumstances don’t conform to these social norms.

The advertising and the programming that sloshes through the television networks, posters in the streets, supermarket layouts and just about every kind of media that we consume tells us that this is the time to celebrate family and friends. This is the time to spread joy (and consume to the infinite degree).

It is generally the time that not-conforming feels so difficult. And for this man, like many others I have seen over the years, Christmas, like birthdays and anniversaries, compounds more pleasant memories of Christmas’ past urging our collective and individual consciousness’s to compare and contrast those happier times with current, more difficult situations.

It doesn’t take a genius or a great deal of research evidence to have an understanding that this might trigger greater depression as those who don’t comply with this cultural norm can feel excluded from society in a way that may go unnoticed at other times of the year.

I didn’t have any particular words of wisdom for him except to acknowledge his concern, anxiety and stress. We talked through the day itself and what he would do – looked through the Christmas television schedule and even managed to find a few interesting films and programmes to highlight. It is a lonely time though. Sure, going out for a walk is good and healthy and would no doubt, help ones mental state but when there is black ice outside and you have a dodgy hip at the best of times, it isn’t necessarily a panacea.

It’s rare that I have the answers but I felt satisfied that I was a little less worried about him when I left than when I had arrived. Sometimes that’s the most I can ask for.

I said I’d go back again later in the week. I’m trying to fill this week and next up with the people who will be alone over the so-called festive period.

I’ve often said that one of the most precious things I take from my job is an understanding and gratitude for those things that I have in my own life. I never remember that more than this time of year.

Alternate Christmas Carol

I picked a really good weekend to nip away for a few days! I’m back now though but brain still creaking into gear.

I was sent a link to this alternate Twelve Days of Christmas

As explained in ‘Broken of Britain’

‘The 12 Days Of Cripmas is a topical take of a classic carol listing the benefits and services currently being removed from disabled people in Britain. The lyrics were written by a user of the Ouch messageboards, sent to Where’s The Benefit and the track produced and directed by BendyGirl of The Broken Of Britain. We’re all incredibly proud of Imana our 11 yr old singing star who’s mum has Multiple Sclerosis’.

Just as I was about to post a sign-off for the Christmas period, it reminds me of why the fight needs to continued.

Where the cuts fall..


The copy of The Guardian sitting on my desk at work yesterday didn’t exactly bring a vast amount of cheer to the increasingly chilly office with the headline reading that 100,000 jobs are to be lost in the public sector by the Spring.

It had a particular resonance, as I expect it does in everyone employed by a local authority.

Particularly pertinent because we actually found out more of the details of what our local authority was planning to cut yesterday.

A few things struck my mind as I read through the  list in detail. Firstly that no-one in local government can afford to be complacent. Certainly the idea that front-line services are protected is as laughable as it ever was.  Secondly that service delivery is going to be a whole lot more difficult.

Of course these revelations didn’t hit out of the blue.

But there is no doubt that these are frightening times ahead. It is horrible hearing about job losses and hard not to feel compassion. It is particularly hard when you see departments that have been absolutely vital in providing support services completely disappearing.

Day services are being cut, that is a fairly obvious and unidentifiable comment that is happening pretty much across the country. But these aren’t just ‘day services’ – these are people I’ve worked with for many years who love their jobs and put a great deal of care into it.

I was looking over the list with my colleague who sits next to me. She was telling me similar stories about her husband’s borough – he’s a social worker in an outer London borough. She said that she worried because they all seemed so complacent. They were social workers, they were needed, they were safe.

We acknowledged that no-one can really claim to be safe. Not anyone. Child protection social workers are probably ‘safest’. It looks like our borough might be moving social workers from other areas of childrens’ services into child protection teams to bolster them as the more preventative work gets shelved.

I suppose the statutory work that can only be carried out by people with particular roles are safer than others but even then the actual manpower can be reduced wholesale and there’s no guarantee that a particular individual will be chosen over the person sitting next to them.

Eligibility criteria for accessing services in adult care, unsurprisingly, will be raised higher and higher.  Again, that’s a pretty inevitable cut.

The union is gearing up and ready to go. Demonstrations planned. Marches planned. Will I go? Probably. Will it make any difference? Who knows.

I am just so angry at the moment. Angry about so much and politically motivated in a way I  haven’t felt for over a decade. The local authorities have been hung out to dry by the central government and services that are relied upon will be lost. There will be attempts by the central government to shift blame for the loss of these services on local politicians. Choice about which services to cut is not much of a choice where everything that isn’t protected by statute will likely be cut.

Localism rings very hollow from here.

As for the NHS, there was never, not for one millisecond that I actually believed Osborne. Not about real increases in spending nor about front line services not being cut. Promised ‘efficiency savings’ is more than a little hollow and yet another ‘reconfiguration’ and ‘entirely new way of working’ will no doubt suck up all the additional money that it will supposedly save.

The separation of front office from back room is very arbitrary. All very well keeping the same number of social workers but without the people providing support who are being cut, we will be taken away from the face to face tasks that are lauded as being ‘real social work’.  Training budgets – they’ve all been cut too – is training and professional development really ‘back office’?

The upsetting thing is that while, for now, my own job does not seem to be under threat, I see people that I’ve worked with for many years having the Sword of Damocles over their respective heads. On a personal level there is an air of desperate sadness but on a wider level, I fear for the kind of service we will be delivering over the next cold, hard years of famine.

Why the ILF went..

There’s a post on Community Care’s ‘The Big Picture’ blog which explains some of the reasons behind the decision to scrap the ILF (Independent Living Fund). It is written by Melanie Henwood and Professor Bob Hudson who were commissioned (they say) by the DWP to undertake an independent review of the ILF over four years ago.

This decision, they state proudly, is a result of their analysis and ‘review’.

‘More than four years ago we were commissioned by the Department for Work and Pensions to undertake an independent review of the ILF. Our core conclusion was that it is highly anomalous for significant amounts of public money to be placed in the hands of a cash-limited, discretionary fund administered by a board of trustees, resulting in inequity, lack of accountability, overlap and duplication of functions, arbitrary decisions and major confusion for disabled people seeking support for independent living.
This is an anachronistic and paternalistic model that should have no place in a 21st century system of care and support. We recommended therefore that the ILF should be fully integrated with personal budgets rather than existing as a parallel system of social care funding.
Despite welcoming our report, the previous administration failed to act on it, and the coalition government should be congratulated for these first steps towards a principled and strategic decision about the future of the fund.’

Far be it for me to comment. I’m not an ‘independent consultant’ and I’m not a professor of anything. I just worked on the basis of using monies from the ILF and accessing support for service users I worked with.

I am confused by the lack of accountability charge in that the money was accounted for as far as I had always been aware and didn’t seem to be necessarily arbitrary in its allocation but that’s just my limited experience. I’ll concur to the obvious experts on that.

Yes, integrating the system with personal budgets of course makes perfect sense. The problem is that it is highly unlikely that any additional funding will be made available. As we see from the settlements the local authorities received this week, money is going to be beyond stretched.

I, by no means, think the ILF needs to be retained in its current form but it has been a representative acknowledgement of the needs for additional funding over and above what local authorities can provide for. By letting the funding stream slip entirely into the hands of local authorities it risks and will be subsumed by the many different calls for financing by more ‘life and death’ needs.

For me, the purpose of the ILF was to remove some of the budget from the local authorities – it provided a nationally imposed system of allocation which was the same in Belfast and Birmingham – in Hackney and Chelsea – the arbitrary nature was about when the money ran out rather than a so-called ‘postcode lottery’. Neither is fair but one is, perhaps, easier to comprehend.

It’s an interesting piece for Community Care that sure, raises some of the need for change in the way the ILF works. The problem is that for all the earnest explanations of Henwood and Hudson, there has been nothing from the government about any kind of replacement which hardly builds any kind of confidence that that money will be protected.

I don’t want to be blind to the failings of the ILF. I didn’t do any in-depth analysis of its workings to be honest  – I just saw the way it works and the way it has helped people directly.

I can only look back at an article that appeared in Comment is Free on the Guardian website back in October. A panellist, SheenaMacInnes states that

My fear, should the ILF cease to exist, is that these funds will slowly disappear in the future, and that the choice afforded me by my self-directed budget will mean less and less support, let alone choice as the total budget reduces over time. This is not how I want to live my life. Having two funding sources means I have greater security regarding assistance in the long term, and greater flexibility. Less personal assistance will make it harder to contribute to society as well as to access community services such as health. The end of the ILF has the potential to be a disaster for me.

The problem with Henwood and Hudson’s post is that it is all very well calling for the need to change and criticising clear failures in the ILF which has, after all, been their job as consultants – but it’s hard to understand their glorious proclamation of a ‘new chapter’ for the fund-previously-known-as-the-ILF when nothing at all has been announced as its replacement. I have to wonder how much service-user consultation took place before this decision was made.  Unfortunately the post sounds like an apologists’ dream for the new government.

Hollow promises and empty purses make for poorer service delivery. Services need to be fair and transparent, of course they do, but they need to exist and have the money to back them up as well. If the fund needs to change, so be it. I’m no expert in its mechanics, but this feels too much like just another cut than a considered statement on better supporting disabled adults at home and providing the funding necessary to provide good quality care.

The Death of the Independent Living Fund

Yesterday was quite a day for adult social services. As well as the more obvious announcements of the cuts to local authorities and the unveiling of a so-called ‘Localism Bill’, Maria Miller, the minister for disabled people announced that the ILF (Independent Living Fund) would be ‘financially unsustainable’ after 2015.

Financially unsustainable.  It didn’t need a whole lot of foresight to see this coming. Back in June, the ILF was closed to new applicants after running out of money – so the budget for this year lasted between April (when applications opened) until June (when they closed).

Community Care writes that

Miller said that the ILF would stay in place to fund existing users until the end of this parliament in 2015.

Its payments would most likely be transferred to councils to administer as part of personal budgets, though Miller’s statement does not specify whether funding would be protected at existing levels after 2015.

And so it starts, the shaking off of responsibility of central government to provide additional support for disabled adults and the move of the responsibility for the additional funding to local authorities.

There are a few things that it is important to bear in mind at this point. The ILF is only or has been only accessed by people who are most disabled and have the absolute highest care needs. It was set up in 1988 although the rules regarding eligibility were reviewed in 1993. The purpose of the ILF was, as it’s name suggests, to maintain and allow for people with high care needs to remain living independently in the community rather than the alternative which was and is residential care.

The current rules state that someone is eligible for ILF funding when input from a local authority reaches a current level of £340 per week, the ILF funding will match that amount that the local authority on a pound for pound basis.

In my current incarnation, I don’t come across people who have ILF payments frequently – it has, like DLA only been available for people between 18-65 and over 65s can only claim if they had an existing award prior to their 65th birthday.

In the past though, particularly when I was in a generic adult social services team, I had a number of dealings with the ILF. On a personal level as well, my father received money via ILF.

It’s worth remembering that the model for ILF payments in 1988 was revolutionary and one that has and continues to have a major impact on the progression of adult social care. The ILF gave the money for the first time, directly to the disabled adult to choose their own service providers and/or employ their own PA (personal assistant). The Independent Living Fund was very much the forerunner of the direct payment/personal budget progression and the model for both monitoring and extending budgets directly to adults with social care needs themselves was trailblazed by the ILF.

The money provided by the ILF had, of course, guidelines attached regarding what it could be used for but it was money given in addition to the very bare needs met by local authorities. It was and is money that contributes to providing a better quality of life for people with high level needs because, believe me, you don’t get to £340 per week level of needs if you don’t have very high level of support needs.

The difference that the ILF money made was for a carer to accompany a service user to the local shops rather than go out and do the shopping for them. It was the difference that allowed a carer to take a service user to the local swimming pool rather than relying solely on day centre services. There is no doubt in my mind that ILF money contributes precisely to quality of life differences rather than the life or death care that local authorities provided.  These are the examples that are often given for ‘care planning’ with personal budgets provided by the local authority – the difference is the amount of money that you have in the ‘pot’ and the potential doubling that happened when the ILF contributed – acknowledging that those with very high care needs had.. well.. the need for care over and above the bare minimum to retain a positive quality of life living at home rather than in a residential setting.

This is my main sadness is seeing its demise. It’s hard to stomach for the government but quality support and quality of life costs more money. Yes, the money has to come from somewhere but it shouldn’t  be a ‘burden’ . We, as a society,  should be prepared to pay the cost of it.

I know exactly what will happen when Maria Miller shifts the burden of cost of care back to the local authorities – the levels of care provided will fall through the floor and although  for some people (those currently in receipt) that money may well be protected for a period of time,  for those coming up through the ‘system’ who don’t have access to this additional support, it will create a group of people who may be living at home but on whose family the burden of care may well fall more heavily – removing the independent from the idea of independent living and replacing ‘living’ with ‘existing’.

As Lord Morris is quoted as saying by the BBC

“This will not save money. If you make it harder for disabled people to live at home, it will cost more because more of them will have to be in hospitals and other places of full-time care.

“It will mean far more of them having to be in institutional care at far greater cost to the taxpayer.”

It’s so horrifically ironic that as policies shoot away into the distance taking the goal of ‘personalisation’ as a mantra, that the very first forerunner  of that policy  which was revolutionary at the time – is being put down with no evidence that there will be any central government funding to replace it.

That’s not to say that the idea of the ILF needed to stay the same. I have no doubt it needed to develop – not least because I felt the age limits were at best arbitrary and at worse discriminatory –  but by pushing the burden back to increasingly pressed local authorities the government has alerted us to its real intentions about the cost-saving implications of the move towards personal budgets.

The Complainant

A desk in an office.

Image via Wikipedia

It was never going to be a visit I was looking forward to. While our manager no longer sidles up to us and drops a physical paper file on our desks by way of allocation, she now sends emails with links.  This one though, she came to ‘virtually deliver’ personally.

The fact that she apologised on allocation set off all my little internal alert antennae. She then explained that she would de-allocate one of the others she had intended to allocate to me as this one needed more ‘social work’ skills. Hmm. Intriguing.

Then she told me she almost felt like she was setting me up to fail. Aha, I thought, a challenge. That should be interesting – or would be if I had a little more time available.

It was to be a priority.  Mr F had made a complaint about the input of social services. He had made complaints about the input of his GP. He had made complaints about just about everyone he had come into contact with.  He knew the team consultant from clinic visits  (and about whom he had not complained)  and had called him directly with his litany of complaints and had been assured that ‘something would be done’.

And so it was it virtually landed on my desk. The complaints were understandable – to an extent – Mr F felt he and his wife needed more than the eligibility criteria would allow him to access. He did not felt the assessment had taken into account all the relative information and anyway, he said, he found the preponderance of endless forms, assessments, reviews to be overwhelming and positively unhelpful.

I promised to visit and he asked me why. ‘You will just take out a form and ask me more questions that have already been asked’. And I made an assurance to him.

‘How about I visit, just to meet you and the family – and I promise I will not take a piece of paper or a pen out of my bag?’.

He seemed dubious but he concurred. That without doubt is something that the AMHP work has made me confident enough to do. I never conduct Mental Health Act Assessments with pen and paper as it draws a barrier. I often jot things down when I am speaking to someone in my general course but I felt that this visit needed some basic relationship-building before we ran off into the distance to ‘fix all that was not right’.  It is also a luxury I could not have afforded in my previous incarnation when I worked in the social services office. I had a form to fill and an hour for a visit. I needed to ensure I at least made notes even if I didn’t go through the form (which I tried not to do) in the house.

My main aim was to just build up enough trust to visit again.  I was asked what I would do that was different and answered honestly that while I didn’t think I could necessarily provide different services, I might be able to look at the issues through different eyes.

As it was, I did pick up a few things that had not been offered previously, mostly relating to carers’ services. From arriving with trepidation I entered a warm and welcoming environment of a man struggling to get to grips with his wifes’ encroaching and all-encompassing dementia. He wasn’t angry, he was just desperately sad.

He wanted help but he didn’t know what help he wanted yet. He had been offered and cajoled but I think it wasn’t a matter of wanting to complain, just a matter of wanting more time.

I felt hopeful after the first visit. Yes, it had gone on for a couple of hours but I felt we had both made some progress at looking at some other services that might be available but mostly I think the complaint wasn’t substantially about eligibility criteria. It was about coming up against services that shroud themselves in guidelines and paperwork (virtual or not). I suspect before long the honeymoon period will be over and a complaint will find it’s way to the council about me as well. But I hope in the meantime I can at least provide some kind of support.

My concern though, as I look at my diary for the next months ahead, is how much these two hour conversations eat into my limited time to do other things. Talking probably helps more than is accounted for. Feeling that someone is listening is enormously important just as a validation of humanity rather than a process of a bureaucratic function.

It’s not hard to understand what effect the cuts will have in situations like this.

St Michael’s Manor/Mount – Woolton

I wonder how bad a care home has to be to have definitive action taken against it. I came across this story in the Liverpool Echo referring to St Michael’s Manor Nursing Home in Woolton, near Liverpool.

The home received ‘zero stars’ for food hygiene. The article explains that milk had been left out of the fridge for over a day and that dairy products were not kept in appropriately temperate-controlled environments. One doesn’t have to be a genius to appreciate that this could actually be very dangerous in a nursing home environment.

The inspectors found

A fridge-freezer was faulty, staff were not fully trained or supervised and stock rotation was inadequate.

Inspectors said they had “no confidence” in management, saying there was: “Poor track record of compliance; little or no technical knowledge; little or no appreciation of hazards or quality control; no food safety management system.”

The listing on the Liverpool City Council website can be found here.

The article goes on to relate an unconnected story about the same care home where a resident, Mary Potter (89) died in 2008 ‘after being hit by chunks of plaster when the lounge ceiling collapsed.’ Not only that but  – ‘It emerged there was a flood in the room above the ceiling a few days before it collapsed.’

Now, a jury gave a verdict of accidental death in this case and that’s fine and well but it does leave an uneasy feeling about whether the death could possibly have been prevented.

Back to the food hygiene issues though, for me, one of the most telling aspects of this is that it was the not the CQC (Care Quality Commission) that picked up these serious and major failings but the local authority food hygiene inspectors.

I decided to look up St Michael’s Manor on the CQC website.  The only care home in Woolton that it may be seems to be listed as ‘St Michael’s Mount’ – but on the basis that it is the same location, same postcode and has the same owner, I can only assume there may be some discrepancy in the name listed between the Liverpool City Council website and the CQC website.

The concerning thing is that this home managed to be ‘excellent’ and receive three stars which remain evident on the CQC website despite the fact that these ‘star’ ratings are now defunct.

So did things change so much that the CQC inspectors weren’t able to identify issues that the food hygiene inspectors slated so categorically?

If I were living in Woolton and looked up the CQC website I’d be delighted that a home such as this exists so locally.

What  kind of consistent service of inspection and regulation can be CQC provide and what lessons does this teach us? Rhetorical questions for the moment but it leaves a taste of very sour milk in my mouth.