Caring with Confidence

I was pointed in the direction of  the link of Caring with Confidence directly by some of those responsible for its implementation – not having been aware of its existence – but having checked it out briefly (to ensure authenticity – because often I am pointed in the direction of people paid stuff or other dodgy businesses!) I’m more than happy to share the link!

It is a free programme sponsored by the government as part of the Carer’s Strategy  to provide support, information and particularly access to training to informal carers over 18  across England. Having looked at the site, I think it seems to be a positive step and definitely a resource that I would add to my ‘toolkit’ and follows on in the footsteps of the Expert Carers Programme. I haven’t had any experience of people I personally know following the Expert Carers Programme but from those that I personally know who have followed the Expert Patient’s Programme, the feedback has been enormously positive so on that basis I’d think it can be no bad thing.

It seems to be a very flexible approach to providing the information that is all too often ‘out there’ but has, sometimes, needed to be sifted through and they are offering online courses as well as face-to-face group sessions and workbooks to help carers access a full and substantial training programme to ensure that their needs are met or at least, an awareness of where the needs haven’t been met or that entitlements have not been offered.

I’m almost ashamed to say I had never come across this before – especially as in our team, we do a massive amount of work with carers and anything that will be able to add support to the structures that all too often don’t do enough.

I have been a little rushed over the past couple of weeks but I hope that over the next few weeks, I might have more opportunity to investigate the material but as it’s freely accessible, I’d also welcome any feedback from anyone who does so..

As far as I’m concerned, the more free and accessible resources available, the better!

Men Needed

Perhaps it is unsurprising to learn that the majority of people who work in ‘social care’ are women. The Joseph Rowntree Foundation published a report last week explaining why it was necessary for the sector to reach out and attract more men to the workforce.

stepheye Stepheye at Flickr

Some of the points made will come as no surprise. Care is traditionally  the province of women. For as much as we shout about inequalities and assumptions it cannot be disputed that while there are more male electronic engineers, there are more female home carers.

The report stated how informal care has been provided by women in society over a long period of time. An increase in women moving into the workforce from the latter part of the 20th century has created jobs and a sector in a way that might not have existed previously.

Basic sociological history so far.

One of the reasons given for the massive bias in the gender balance in the care sector is the low pay in the sector. It is less likely to attract men to the sector if the pay rates veer around the minimum wage level. While I think this is a factor, perhaps it isn’t a factor that affects only men and low pay rates probably deter a significant amount of quality applicants and potential carers.

Another reason given was that

Privatisation of residential and domiciliary care has produced a labour market with insufficient opportunities for training and career development. This is unlikely to attract men, and women will increasingly leave as their employment opportunities improve.

This isn’t a point that I see as particularly gender specific but it does raise a lot of questions about the way that social care is delivered and more importantly by whom. I work in a profession that values development and training and willingness to see work on a continuum with learning.

So why should the social care sector, meaning those that deliver hands-on care, should have the training dead end and the lack of opportunities? Why do wages at the residential homes where I place people hover around the minimum wage? (A pay cut was enforced following the privatisation of those homes).

It is seen as a ‘throwaway’ or stop-gap job – something you do when you are looking for a more permanent job. It shouldn’t be.

I always maintain that if a good training programme is in place with ways to advance and develop as well as a sturdy pension plan then the wages can be lower. People will look to benefits if necessary but when there is no added value on top of base salary and organisations rely on the ‘feel good’ factor in members of staff to take lower paying jobs, they are creating a false economy by paying poor wages.

I have to mention that there are many good private companies out there. The ones I, personally, have come across tend to be smaller but there’s no reason a large company cannot be an excellent employer. I am just slightly more sceptical.

Coming back to the Joseph Rowntree Report, they suggest a few ways of moving forward

  • This situation will be unsustainable for meeting society’s care needs unless:
    – pay and conditions improve to retain more women and encourage men to enter the care sector;
    – unpaid carers receive financial and other support, and working hours are reduced for all, so that more people can combine family care with employment;
    – cash payments to individuals are not allowed to drive out funding for vital community services; and
    – policies are judged by the quality of care they support and how much they encourage a stable, less gender-divided workforce, as well as value for money
  • Any other solution would be unworkable, unfair and inconsistent with government commitments to reduce gender inequalities.
  • Sounds fair enough to me!

    Now, just to find some more men..

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    Direct Payments – Chapter One

    Direct Payments is the system of, basically, rather than giving a direct service, providing money to the user of the service to ‘buy’ the care that they need directly.

    ‘Direct Payments were introduced in the UK

    – for adults with a disability in 1997

    – for older people in 2000

    – for carers, parents of disabled children and for 16 and 17 year olds in 2001

    Since 2003, councils have been required to make Direct Payments available to those who are able to choose to have them and who wish to have them’

    (Source : Direct Payments for people with mental health problems: A guide to action)

    I have worked with Direct Payments a few times although it isn’t something that comes up with any great regularity in the field that I am currently working in – mostly because, I imagine, my work is focused on a combination for the two groups of service users who have found the system of direct payments least accessible – older people and people with mental illnesses.

    So working in a team for older people with mental health problems seems to be possibly the least likely place for direct payments to be accessed.

    I have instigated a few direct payments packages but not a many. One of the things that I have found the most frustrating is the time-lag between going in to someone and identifying a support need – offering and explaining direct payments alongside an explanation of the direct provision of services.

    On meeting potential interest, the boxes get ticked but in the meantime the service is needed immediately – it can and  has taken months to get a direct payment service up and running but in the meantime a direct service is needed to meet the need that still exists – sometimes a carer is employed in the meantime with whom the patient gets on very well – seeing no need to change to direct payments after a few months of building up a relationship.

    Sometimes the  delay between setting up a ‘new’ system leads to a complacency to fall back to the ‘default’ system.

    But sometimes, occasionally, it has followed through.

    I have two reasons for bringing this up at the moment

    Firstly, I am starting the process of referring someone for direct payments and her daughter for carers direct payments.

    I thought it would be a useful illustration of the time it between someone deciding they need a service to its eventual ‘fruition’ if I can follow it here by indicating the different points in the process as they arise.

    I hope I will be proved wrong and that we can get things up and running quickly. I really do.

    Bit of brief background, service user and potential user of direct payments has an Alzheimer’s type dementia. She has had this diagnosis for a couple of years and can function fairly well. On meeting her, you probably wouldn’t realise she has dementia until you’ve been talking to her for at least about half an hour when some of the conversation begins to repeat itself. She would certainly have the capacity at present to make decisions about her own care and support packages.

    She has been receiving a directly provided care package for a while but some of the elements have proved to be less than satisfactory. She doesn’t enjoy the day services on offer and would probably get more from community activities such as tai chi classes at the local leisure centre. One of the ideas of the direct payments is to look at someone to take her to these kinds of activities rather than her going to the local community day centre.

    Image via Wikipedia

    Outdoor practice in Beijing's Temple of Heaven.

    Her daughter is her main carer and lives locally but not walking distance. Her daughter has a young family and provides a substantial amount of emotional support to her mother, visiting most days and taking her mother to stay with her family many weekends.

    I’m hoping that Carers Direct Payments will be able to address some of her needs regarding travel costs between the two houses and possibly some of the domestic care.

    It’s been a while since I referred a Direct Payment care package so I called the Direct Payment lead (who I get on well with anyway and always find it easy to talk to) to confirm the procedure to refer.

    I sent her an initial care schedule with costings and times attached.

    Meanwhile, on the ‘Carer’s’ front, I need still (and hope to today) update the most recent Carers Assessment and Carers Care Plan to include the conversation I had with daughter to include Direct Payments for Carers as an outcome.

    Anyway, lets see together how long it takes to get these things up and running..

    Caring for Carers

    This week is Carers Week. There has been quite widespread coverage in the press – certainly from where I’m sitting anyway. Yesterday the government printed its 10 year Strategy for Carers.


    It has been widely reported that the main tenet of the strategy published – as far as I could tell from the reporting of it  as I haven’t actually had time to read it yet, was a Government pledge to increase spending on

    Respite care (£150m)

    Support for return to work and training and general work/life balancing health checks(£38m)

    Training for GPs to raise awareness of Carers’ Health and Input from Voluntary Organisations (£61m)

    Focus of young carers (£6m)

    Which adds up to the total £255m injection into carers’ services in total.

    More money is better than no money. A recent survey, carried out to coincide with Carers’ Week suggests that

    ‘ a large majority of carers admit to feeling ill, anxious or exhausted, with a staggering 95% of those questioned said they regularly cover up or disguise the fact that their health was suffering in order to continue with their caring responsibilities. Worryingly, one-fifth (19%) of these carers said they ignored feeling ill “all the time”.

    Almost 1 in 4 (24%) of carers say they frequently felt unable to cope with their day-to-day duties due to the physical and emotional stresses of their caring role, and a further 64% said they were occasionally unable to cope.’

    So pushing finance into a focus on Carers’ own health is a positive step.

    Flexible working patterns are, as well, important. I know that some employers are more sympathetic than others to time being taken for caring duties and some kind of statutory guidance that would provide more protection to Carers would be helpful.

    Alison Benjamin on The Guardian website sums up some of the responses from the main voluntary organisations which work in the field.

    She writes about a scheme of ‘Caring Vouchers’ which has been advocated by leading charities and some larger employers to work in a similar way to childcare vouchers – allowing for services relating to care, podiatry is given as an example, to be purchased with these vouchers.

    But these are some of the elements missing from the strategy.

    Rethink approaches some of the proposals from a different angle asking

    ‘What does £15 pounds buy you?’

    Noting that dividing the £150m set aside for ‘Respite’ breaks by the amount of carers in the UK doesn’t exactly make for extensive holiday breaks.

    But it won’t be £15 each because some people will never claim holidays or respite they are entitled. My difficulty at work has been more trying to desperately convince people to take those breaks that they are entitled to and that they can access money for.

    Where I work, there is a fairly substantial pot of money which has been put aside specifically for carers breaks. It is consistently used by the same groups of people which isn’t a problem because there is always some money in the pot as others are so reluctant to consider using it.

    Strangely, the existence of money to go away isn’t the issue – it is persuading people to access it.

    I work primarily with older people and older carers so I can’t speak more generally, but often, regardless of the amount of stress, time and health concerns, they do not want to leave their partner in a residential home for a week while they go away.

    I hope there is more access to creative options for respite such as allowing (paying) for someone to come and allow respite in the home. But the costs of that would, I fear, skyrocket far past £150m.

    Bert 2332 Bert 2332 @ flickr

    The other major criticism of the strategy drawn out by Alison Benjamin is the lack of any revised approach to Carers Allowance.

    ‘The most glaring omission from the government’s strategy is any proposal to increase the carers’ allowance or provide additional financial assistance to carers who are struggling to make ends meet. Although their role is estimated to save the state £87bn a year, many are living on just over £50 a week, plus other meagre benefits.’

    And it is an embarrassing and humiliating attempt at piecing together a so-called ‘benefit’. Perhaps some more money for carers directly, rather than vouchers or health checks or training of GPs would have a more immediate effect quickly.

    Of course, throwing money at problems is hardly the most creative approach but the Carers Allowance, is one of the worst examples of a poorly thought out benefits system that is insulting to those who jump through enough hoops to be able to claim it.

    My own fear, and granted this is a result of reading the press rather than the actual strategy itself, is that the focus will be on those, again, who can ask for help and who shout for it when necessary. Those who are the ‘silent carers’, who need more time, money and outreach may be missed in the floods of additional funding trickling through the system. But I’m hoping to be proved wrong!

    Help to care

    I first saw on the news over the weekend about the report produced by the Institute for Public Policy Research related to  Personalised Budgets for Carers and it baffled me a little bit.

    Don’t get me wrong, I completely think that carers need, deserve and are entitled to a lot more support than is available presently.

    The Carers Allowance is, quite frankly, an insult to those who put in so many hours and whose lives are changed by the amount of care that is put in (as well as, on a less emotive level, the amount of money that is saved by both the NHS and Social Services). Also (for what its worth) it’s linked to Disability Living Allowance/Attendance Allowance and is means-tested. All of which contribute to its inefficiency.

    But the call for personalised budgets seems to be, as far as I can garner, more or less the same as Direct Payments for Carers – which is explained much better on the Worcestershire County Council site (thank you, Worcestershire – and no, I don’t work there – actually, I don’t think I’ve ever been there!) as follows

    ‘Support for Carers

    A Direct Payment can be provided to enable family and informal carers to purchase the services they are assessed as needing as carers to support them and to maintain their own health and well-being.

    A Carers Assessment and Support Plan should be completed to identify the impact of caring on the person’s life along with the support they require to continue caring or to take a break from their caring role.

    Carers are able to use Direct Payments to purchase support in any variety of ways including:

    • Short breaks for themselves and/or the people they care for;
    • Personal assistance within the home;
    • Sitting services;
    • Social, education and leisure activities;
    • Transport costs;
    • Equipment
    • Relaxation, stress management and holistic therapies.

    Some of the intended outcomes of using Direct Payments for carers are:

    • Promoting social inclusion through greater opportunities for carers to actively participate in family and community life;
    • Greater opportunities for the personal development of carers;
    • Promotion of the carer’s health, well-being and coping skills;
    • More responsive, timely and consistent methods of providing support, with greater opportunities for creativity;
    • Values the essential contribution carers make to family life and the wider community.

    Under the service, young people, aged 16-to17-years, are also eligible to receive Direct Payments to support them in their role as young carers and to minimise any difficulties or isolation they may experience in undertaking their caring responsibilities’.

    image psd @ flickr

    I have to say I like the direct payment scheme as it works for carers because it is incredibly flexible. Indeed, I’d say it is the easiest way to provide direct support to carers and in the most visible way – so I’ve got a fair amount of experience using it.

    In a lot of ways, it is a lot more flexible than the direct payments provided for service users because it can be used for ‘anything that would support the carer’ – so gym membership, travel costs, parking costs, washing machines – there is the ability to be much more creative. ‘

    And it exists now – today and has been used with frequency.

    So that’s why I didn’t really understand the call by the IPPR for personalised budgets with no comment about what is actually happening in social services departments to support carers today. Maybe they are calling for more money to be a part of the personalised budgets (a good thing) or more control (although the control can be basically in the hands of the carer themselves), more exposure to issues that matter to carers or less scrutiny from local authorities who provide the funding.

    I suppose I’ll have to actually read the whole report rather than just the reporting of it!

    I noticed that Sophie Moullin from the IPPR wrote about this in the Guardian and from what she says, I can’t see any difference in the new system she proposes to what is actually, legislatively in place at the moment.

    I am absolutely in favour of anything that will help though and if the proposed system will ringfence more money or provide more exposure or utilisation of services then I’m the first person to applaud it.

    But to promote the new system which has a lot of links with Carers’ Direct Payments without discussing the failings of that particular system and to look at the issue as if this system didn’t exist, seems not to be giving a true picture of the situation as it is today. Perhaps more needs to actually be done to increase awareness of the system as it exists today and promote use and access to it.

    Ageism – the ‘acceptable’ face of prejudice

    Social workers are supposed to be a liberal group. We are trained extensively in anti-discriminatory practice. I can’t imagine there are any social work courses in the country that don’t, at least explore, the implications of discrimination, power and oppression even at the interview level.

    So it is particularly upsetting and distressing to see colleagues behave, speak or act in a way that seems contrary to those values that not only were emphasised throughout training and practice but that also carry through to every facet of life.

    We know that one of the fundamental foundations on which social work is based is that of combating oppressive practice and prejudices – so what to do when it is people and organisations you live and work in that are so prejudicial?

    I was confronted with this towards the end of last week. I still  have some anger – but the anger has changed from writing letters and shooting ’emails of indignation’ off in my head, to a more rational, ‘what can I do about this’ process. Time, although not as good a healer as it is given credit for, can produce some more rationality!

    Basically, the prejudice in question was ageism. It seems that our society is a lot more tolerant of ageism than other prejudices that are slowly, at least on an organisational level, easing out of the picture. But ageism is alive and kicking – and in some cases kicking very hard.

    The particular incident that annoyed me was the result of some casual comments which I followed up and found out that there were some changes ‘in the works’ which I seemed to regard older people as a separate entity to ‘adult’ services – and the people who work with some of the other departments are very anxious to divest themselves of all responsibility to older people because they are being presented as ‘different’ – but this was just one incident among many that I have encountered. From other teams who don’t work within Older People’s Services, from hospital wards, from GPs, from Commissioners within Social Services and most disappointingly from other Social Workers.

    A lot of the work of CMHTs (Community Mental Health Teams) seem to relate to risk and somehow the impression that I was getting was that risk to self is somehow less ‘cutting edge’ than risk to others. I can see how that can be much more obvious but the role is of looking at best interests and risk to self can be as damaging. The implication that older people do not have the same levels of risk to self or that the self in question has less value due to the age is something that has been making me increasingly angry and indignant.

    I know that the majority of the work that I undertake is with people who have dementia but people over 65 do not and should not suddenly lose the right to an equality of service and opportunities, just because they are over 65.

    The Independent writes about the growing implications for dementia for with an ageing population.

    Help the Aged conducted some research which presented (what a surprise) that the NHS claiming

    “The Department of Health has acknowledged that there are deep-rooted negative attitudes and behaviours towards older people and these are at the heart of failure to provide decent services for them.”

    The poverty, poor care, paucity of resources and lack of public funding experienced by older people in the UK would not be tolerated by any other section of society without people generally raising arms in a sea of disgust and outrage.

    Even today The Guardian has a leader about ageism within the National Health Service and working within the system, I see it very clearly and try to rage against it as far as I can  but I have my work cut out and it’s frustrating and upsetting.

    So why has it been possible to maintain an oppressive attitude to older people?

    Why isn’t there as much emotion and outrage when an older, vulnerable adult is abused?

    Are stories about older people dying (through neglect) in institutional settings or in their own homes not even reaching the front page of their local papers – let alone instigating national outrage and soul-searching which might lead to more changes in policy and quickly?

    I think when the stories are presented, people are disgusted and outraged but not to be same levels – adults can look after themselves, perhaps, people assume. Or they have families, friends, people to advocate for them where often they don’t.

    For me, I am asked (as I am occasionally and was frequently when I was on Post Qualifying Training) why I work with Older Adults or whether I find it ‘depressing’

    No, I don’t and partly it’s because I believe there is so much to be done in this area.

    It has the opportunity to be the most dynamic area of social work because there is so much to catch up on and I don’t know if I can speak in concrete terms but at the moment, there is no other area that interests me as much.

    I have strong beliefs that older people and carers don’t get the services, the respect and the focus that they deserve and that can be quite a forceful drive when some working days make you wonder why you went into this profession to begin with!