Choice, Control and Obfuscation – How the Personalisation Dream is Dying

In the bold move towards a transformation in adult social care, it feels from where I sit, that control has completely overtaken any pretence of ‘choice’ in the so-called move towards more idealised ‘person-centred’ care and support planning.

I hope I’ve been clear over the years in which I’ve expressed a remarkably consistent view that I love the idea of people being able to choose the support plan they like from a wide menu of options with ‘professionals’ taking less of a role.  I am a massive fan of direct payments. I want people to have more personalised care and more creative care. Desperately. The options just aren’t there yet for people who lack capacity and that is a terrible disservice and inequity that is being served throughout the care system.

Removing care planning from my role doesn’t concern me – unlike those people on the training courses who bang the drums blindly about how wonderful and bright it looks when we allow people to choice whatever they like to put together packages of care, I don’t want ‘retain control’, I truly don’t believe that I, as a professional ‘know better’,  but likewise I know that with the user group I work with, it is rare that I can just hand someone a support planning tool and a list of potential providers and tell them to ‘get on with it’.

That is as far from reality now as it was 20 years ago in my work. While I can say that everyone I care co-ordinate who has a ‘package of care’ is now officially on a ‘personal budget’ and some even have direct payments, it hasn’t really increased choice or control for any but a couple of those people.

If anyone for a moment wants to ponder the duplicitious nature of those in policy making ivory towers who dribble down policies which they want to couch in ‘soft’ language so they are difficult to challenge, one only has to read a fantastic piece of research conducted and published on The Small Places site.

It is worth reading through the piece in detail. Lucy, the author, made a number of requests to local authorities to ask about how their Resource Allocation Systems (the link between the ‘assessment’ and the ‘cash’ – basically) was calculated.  She seemed to come up against a wall of obfuscation but it’s worth looking at her research in detail.

This reluctance for me, seems to relate to the lack and reduction in spending on care and support – the key ‘missing piece’ as to why a council can ‘reassess’ someone as needing less ‘cash’ than they did last year with a more traditional care package.

My personal experience is that the council I work in (and this is similar to things I’ve heard from people in other councils) probably doesn’t want to share it’s RAS because it’s ashamed of the utter dog’s dinner that it’s made of it. It doesn’t ‘work’. It doesn’t make sense. It is frequently changed. There is more emphasis on physical health needs as opposed to mental health needs and while there can be manual adjustments, some of the figures that are ‘spat out’ just seem nigh on ridiculous (and that works for sometimes calculating care ‘too high’ as much as a figure which is ‘too low’).  It comes down to everything needing to be qualified and fitted onto a spreadsheet when actually the needs of two people who might fill out a self-assessment with the same ‘tick boxes’ might have very different needs in reality – no RAS can account for that. One person might under-score because they are embarrassed by the process and don’t want to admit to being incontinent on an initial visit from a social worker because they haven’t been able to tell anyone other than their GP – another person might be anxious and think they can manage less well than they can. Sometimes and this is what local authorities and health services seem to find hard to account for, you just have to treat people and their needs as individuals rather than the subject of outcome measures, tick box performance indicators or resource allocation systems.

Shouldn’t personalisation be about putting the user at the heart of the system? Every user should have a copy of the RAS and how the figure was determined. Which questions are weighted and which aren’t. Without that, there flow of money and the control rests solely with the local authority.

I’m fully against ‘traditional’ care packages. Having someone anonymous and constantly changing pop in for a 30 min welfare check once a day isn’t about improving the quality, control and choice in someone’s life, it’s about a local authority doing the absolute bare minimum that they can get away with to fulfil their statutory duties of care.

The lack of openness about the ways that the RAS shows the true colours of the reasons for these pushes towards the Eden of ‘Personalisation’.

While I have no doubt that for some people, as I keep saying, those with advocates, family or who are able to voice their own needs clearly, have and will continue to benefit enormously from having direct payments – it’s worth remembering that direct payments have been available and accessible for many years now.

Forcing everyone onto personal budgets has only discriminated against those with carers by reducing the amounts of money they are entitled to through the RAS (that’s my own experience of how our local RAS works) and has discriminated against those who lack capacity by promising all sorts of ‘creative’ ways of exploring third party management of support plans but without providing any real ways of accessing it (this is my current bugbear as I have been requesting assistance with this for months for service users I work with but have been told it is not possible for older adults yet as only those with learning disabilities have budgets large enough to make it cost effective – thereby clearing discriminating on the basis of age and type of disability).

I have changed from a fervent advocate of a system which was supposed to be so much better for everyone to a bitter opponent of a system which favours some kinds of disabilities over others, some kinds of service users over others, some kinds of carers (those who are willing to put a lot more time in to manage and support plan where necessary) than others and all to provide fewer services under the guise of choice.

No wonder Burstow is pushing everyone towards direct payments. He is pushing everyone towards a system which masks the way that payments are determined and discriminates openly against people who lack capacity or who have the ‘wrong’ kind of disability or family support.

Now we know that the local authorities can hide the way they make financial calculations, it becomes much more obvious to see behind the facade of the ‘Wonderful Wizard of Oz’ who promotes choice as the final goal to achieve at all costs.

I feel tricked and betrayed by the implementation of the personalisation agenda and the lack of any of the services around it to tackle directly with the problems at it’s heart.

I was deeply disappointed, for example, that the Mental Health Foundation’s ‘research’ and work with people specifically with dementia only focussed on people who either had capacity or had family.  Their advice talks lovingly of setting up trust funds, appointing brokers – well, that is a fantasy rather than a reality and exists only on paper as a choice. They merely replicated a lot of work which was done when direct payments were rolled out around lack of take up for people with dementia and they hadn’t said anything new (I happened to write my dissertation about the lack of take up of direct payments for older adults so did actually do literature researches at the time..).

Anyway, I’m getting ahead of myself.

For now, I think it’s important that we who see through the cosy policy makers congratulating about a ‘job well done’ speak up and speak up loudly for those for whom the system is a further barrier for true individualised care because these self-same policy-makers see them as ‘too difficult’.

My title explains that the personalisation dream is dying but it isn’t dead yet. To be brought back to life, all those involved need to embrace the principles of honesty and openness and not blind themselves to their successes if they can’t see the continuing barriers.

Age Discrimination and Language – or why I don’t like ‘The Elderly’.

What is age besides a classification? When do we become old? What language is used in relation to people who reach certain points in their life cycle. Does a child become an adult at 18?  Legally perhaps but in a sense these are rough brush strokes which relate in very different ways to different people.  When do we stop being ‘young’ and start being ‘middle aged’? When do you move towards being ‘old’?

Wise Ones

maureenshaugnessy@flickr
I’ve had growing feeling over the past years really, that our society does not value older people. Just yesterday, I received a wonderful application form from a potential student social worker. It was a positive picture of a hardworking and ethically sound potential practitioner. It warmed my heart.

But the student, although careful to detail their work with people with disabilities and children with special needs, felt that it was entirely appropriate to comment alongside this that they had worked with ‘the elderly’.

I presume this wasn’t discussed or mentioned by tutors at the university but it made me wonder how ‘the elderly’ has become more acceptable than ‘the disabled’.

I will put my hand up at any accusation of oversensitivity. I am acutely aware of the importance of language vis a vis power.  I am also aware that language shapes thoughts and reflects thought processes. If that makes me politically correct, I am proud to reclaim that label as a badge of honour.

Maybe in a society that needs to compartmentalise obsessively, it becomes more important to define someone by their age rather than their humanity but it also made me question what we mean by ‘elderly’ or ‘older people’.

Are we merely describing someone who has reached a certain age? I have worked in older adults services for a long time and some have called themselves ‘older adults’ and others ‘over 65s’ teams as a way of providing a context of age.

I read so many stories in the papers about the ‘problem’ of an ageing society and the costs of managing more dementia in society and it saddens me that age becomes another negative label and a problem for the wage-earning society to ‘deal with’. Perhaps that is the key to the perceptions that we have.

It’s natural that our perceptions of age and what ‘old’ is change with time as we and our parents, colleagues and friends move into ‘older age’ and it becomes less of an us and them type discourse and it becomes more personal.

I wonder why we, why society demands we differentiate between disabilities which are ‘age related’ and conclude that it is predominantly a cost issue. Social Security is determined by how economically productive someone is or could potentially be and when someone is past ‘working age’ their needs for social interaction and stimulation must automatically decrease?

Where is the ‘personalisation’ in the determination of Disability Living Allowance as opposed to Attendance Allowance. Look at the differences in those names.

Disability LIVING Allowance is paid to adults of working age (and children). Attendance Allowance is paid to those who are over 65. To be ‘attended to’ or ‘dealt with’. Not to live. Independent Living Fund monies were always restricted to those up to 65 (ok, now they are being wound down but the idea behind them was age-biased).

I wonder how much the Equality legislation will help? Perhaps it will but mostly I will only notice a difference when I stop seeing the ‘problem’ of an ageing population referred to and blame being assigned to people on the basis of their age.

As for me, I’m still deciding whether to raise the language issue with the potential student in their first interview with me or whether it might be something that needs some time to work on..

‘The Elderly’ No, I don’t like that. Not at all.

Personal Budgets, Personalisation, Thoughts and Hopes

Yesterday Think Local Act Personal (TLAP) published the results of a National Personal Budget Survey.

The headline ‘results’ are of course overwhelmingly positive. Personal Budgets work. Direct Payments Are Good. Everyone is happy.
Questionnaire

jrambow@flickr

Is any of this a surprise though? We know that people who can and are able to manage (or have family members to help them to manage) personal budgets delivered through direct payments (where money is paid directly to users) prefer them to less flexible local authority provided care packages – particularly when the scope of local authority care packages is limited to agencies with block contract arrangements.

In Control – which publishes the survey – highlights the following ‘implications’ from the findings. The bold is a direct quote and the italics are mine.

Other implications that can be drawn from the survey results include:

  • Personal budgets work better for older people than you might expect and direct payments work just as well for older people as everyone else.

Who said we were not expecting personal budgets to work for older people? Does this make an ageist assumption and lump together all ‘older people’. Of COURSE they work as well for people who are 65 as they do for people who are 64 but what about people without capacity or who don’t have family or friends involved? What about a more subtle distinction between 65 year olds and 85 year olds rather than a blanket ‘old people’ response.

  • The processes used for delivering personal budgets are more difficult than they need to be and that impacts badly on carers and on personal budget recipients.

Did this seriously need a survey over three months to discover? You could have asked me three years ago and I wouldn’t have charged consultancy fees.

  • More work needs to be done to make direct payments more accessible generally but especially to older people.

This could have been written 6 years ago. We KNEW this from the roll-out of direct payments initially so why was NO WORK WHATSOEVER done around trying to work with more difficult to reach groups when personal budgets were being ‘piloted’. I really can say ‘I told you so’ as I begged our Personal Budgets roll-out team to allow us to pilot or be involved in the initial processes and they said our user group was ‘too complicated’. Heh.

  • There is a need to simplify and clarify the rules and regulations surrounding personal budgets.

So those are the ‘implications’ and forgive me my cynicism. I love the idea of personalisation. I want it to work. I want to work in more creative ways or outsource my work if necessary to other third sector organisations but this is not ‘different’. This is not ‘new’. I fail to see the value of reports and surveys that tell us exactly what we already know again, and again and again instead of actively trying to work with people who actually understand and know what is happening ‘at the sharp end’ to try and work out ways to improve outcomes for those who are not receiving direct payments currently.

So back to the report – which used a Personal Budget Outcomes Evaluation Tool (POET)

in total, 1,114 personal budget holders  completed the POET survey, including 832 returns from the 10 local authority demonstrator sites and returns from at least 76 other local authorities. 417 of these personal budget holders also wrote in a comment about their experience of personal budgets.
In total, 950 carers completed the POET survey,including 782 returns from carers in the 10 local authority demonstrator sites and returns from at least 66 other local authorities. 434 of these carers also wrote in a comment about the impact of personal budgets on their own lives

And

Almost half of people responding to the survey were aged 65 years or more (43%); the social care needs of working age adults (aged 16-64 years) were largely split between learning disabilities (17%), mental health needs (8%) and physical disabilities (25%).

I don’t want to play too many games with statistics but it would be interesting to know what proportion of people who meet the FACS criteria in total are over 65 and whether 43% is a proportionate figure in relation to total recipients of social care services. I think as well, to class ‘older adults’ as ‘over 65s’ is a little disingenuous although I know it is done because that is the basis on which statistics are given but it shows some of the ways that systems restrict and inhibit knowledge. It would be far more interesting to know the differences of take up of personal budgets between 65 year olds as opposed to 85 year olds for example.

And to some of the headline figures, that can catch the press attention – most people who receive personal budgets find there is a ‘positive effect’.

Looking through some of the figures, it seems that older people were much more likely to be receiving council managed budgets – you know, that ‘easy’ way of just switching around a bit of paperwork and making it look like there is now more ‘choice’ when in fact, the services and delivery is almost exactly as it was before the ‘change’.

As for the outcomes the report says

In terms of social care need groups, older adults tend to report less positive outcomes than other social care need groups in six out
of the 14 outcome domains

I find the report to be honest, a bit of a whitewash in itself. It is only accentuating the positives and like all discourse related to personalisation and personal budgets, seems to be going over all the same ground again and again.

People like choice, people like flexibility. Yes, and rabbits like to eat carrots. It doesn’t need a survey to tell me that. What action and money and research needs to be concentrated on is the HOW.

HOW is there going to be an improvement in service delivery to those who are marginalised in this process.

HOW are we going to wriggle out of the sham that is council-managed budgets while allowing those who need to have others to manage their budget and support their care to have the same access to quality care and personal assistants that those who are able to choose and decide have.

I’m rapidly coming round to the view that personal budget support planning needs to be moved out of the hands of local authorities who currently have no interest in the process except for meeting the government targets. Where is the innovation within local government for change? Sure there are people, and I hope to be able to count myself among them, who want to do a better job and provide a better service but the constraints of the type of job I am doing means that I can’t devote the time necessary to truly inclusive and supportive care planning so Mr G whose support plan I am writing up (he doesn’t want to be involved in the process as he ‘doesn’t like forms’ and can generally only tolerate conversations with people for between 5-10 mins maximum and that’s only if he’s known you for at least a year) does get a rushed service because I have to carry out Best Interests Assessments, do Mental Health Act Assessments,  complete reviews and CPAs, liaise with other professionals, arrange discharges from hospital for other people. Yes, it’s a little bit of wallowing in self-pity and I wholly accept that. We are all busy but local authorities have no idea if they want a quality support plan without changing the ways of working in any other respect. Where is the time to devote to Mr G’s creative support plan? Oh, well, we’ll just do a regular care plan and a managed budget. Should it be that way? How has the march towards personalisation helped people like Mr G? Mr G wouldn’t complete a survey about a personal budget even if he did get a letter. Letters worry him and he doesn’t have a phone. I don’t want the Mr G’s that I work with to be forgotten in the rush towards direct payments.

When I first attended training we were told that any additional time we might be spending in our day to day work on these awful process-driven systems would be made up by the amount of time we would save by people completing their own support plans and assessments without any assistance. That may work for some people and I hope it does but for most of the people in the team in which I work it is unfeasible due to the amount of people I work with who have high support needs and who don’t have the capacity to make decisions about their own care needs.

The survey angered me, in a way that is probably irrational. Partly because it seemed to have taught us nothing at all. And partly because again, I see no new thoughts and ideas about developing systems that will be truly inclusive.

HOW can social care improve for everyone. That’s everyone. Even those who don’t want direct payments. Even those who don’t have advocates. Even those who are self-funding their own care packages as the criteria for receiving government support rise higher.

Those are the questions I want Think Local Act Personal to answer.

I have my own ideas. I think there will be a movement to roles for professional ‘support plan advisors’ who aren’t necessarily based in the local authority – perhaps individual social work consultancies but there has to be a separation between planning and delivery and the cost of these services shouldn’t need to be met out of the personal budget itself.

First and above all, there has to be a consistency and a transparency in the way resources are allocated and if necessary a weighting towards people who need assistance to access the same kinds of services who have been excluded from the process and the benefits in the past.

A survey of the skills-base of professionals who do implement support plans needs to be undertaken to establish what is needed and what is important to have.

Maybe it is a professional type qualification or maybe not. There is not much discussion about what the role of the social worker should be in the process. Should we be the ones support planning? I think there’s a argument that a social worker is well-placed to look at building plans together in conjunction with a user and family member if necessary and setting up things like trust funds or managed local authority budgets but only if the social worker is removed from the local authority talons.  Maybe some kind of team of people with different kinds of experience and expertise working together with some background and training in non-directive advocacy for people who do lack the capacity to organise their own support plans. Perhaps the social worker or support worker in these new roles could have longer term relationships with the users and carers and wouldn’t feel so pressured by management if freed from the local authority reins.

But who is going to suggest and discuss the new ideas? Where do they go? Who will collate them?

While I see lots of discussions around me about personalisation, I see little that says anything other than it HAS to work because it is best for ‘people’.

I genuinely believe that is has potential to deliver a much better system but and this is a big but, there has to be more creativity and different kind of research that looks at new models and methods of delivery and consults people – yes, like me – who while being critical really really do want things to work better.

My criticism isn’t because I want to bury my head in the sand and ‘retain the reins of control’. I really don’t. I want to relinquish control but I want more than anything an equitable system that doesn’t fob off ‘more difficult’ service users with a second class service.

Learning Disability Week – Hate Crime and Hate Language

I know I’m a bit late to Learning Disability Week – which runs from the 20th June for.. well, a week but it remains a campaign and a group I have a great attachment to coming from years working with adults with learning disabilities before I qualified as a social worker.

The ‘theme’ if it can be called that, is a new campaign, called Stand by Me,  which is being run by Mencap to challenge and hopefully phase out hate crime which is targeted towards people with learning disabilities.
Lady justice - close up

 

raphaelmarquez@flickr

Apart from, I hope, creating more of a stigma towards those who might seek out and target people with learning disabilities there is a focus on the ways in which crimes which are committed are dealt with by the police and the criminal justice system.

Mencap share some chilling but sadly unsurprising real life stories from people who have suffered from hate crime.

While accepting this is slightly different, I have had difficulties trying to pursue prosecutions for people who have dementia and who are the victims of crime and abusive situations due to the way that the systems are currently set up. I hope there is more attention paid to ways that these processes can be improved for everyone.

Hate crime is an offence which is committed against someone on the basis of their membership of a certain ‘group’ in society be that on by their race, class, disability, gender, age, sexual orientation, gender identity and good old Wikipedia, gives an alternate definition of ‘bias-motivated crime’.

To call something a crime indicates that (obviously) there is a criminal act that has been committed for example, a physical assault but I think the discrimination and the effect of actions of hate towards those who have learning disabilities have significant effects on the way our society perceives some members of our society.

For example, name-calling. Verbal and emotional bullying. Laughing and pointing. This might not count as a ‘crime’ but as long as it is acceptable, it may lead to criminal acts. Those who talk about criticism of the use of certain words being ‘PC correctness gone mad’ would do well to remember that with disrespectful thoughts come disrespectful words and disrespectful and flippant words lead to disrespectful thoughts.

The more we create divides between ‘us’ and ‘them’ the more vulnerable we are to dehumanising ‘them’ and it turns to just a step away from the acceptable or non-intervention in a ‘hate crime’.

So for me, it is a very important campaign but must not just be restricted to those who commit criminal offences against people with learning disabilities. It must also be targeted at those of us who use flippant and insulting language to describe people with learning disabilities.

Someone who describes their phone as being ‘retarded’ because it doesn’t work (yes, that’s a real life example from someone who should know a lot better), that’s the first step towards dehumanisation and degradation of people with learning disabilities and yes, I was accused of ‘political correctness gone mad’ when I challenged this but I maintain and always will that the connection between language and respect are inherent.

So targeting hate crime isn’t just about systems and criminal offences although that is absolutely essential to target. It is about the people around us, the words we use and the respect we afford to other human beings. When we treat people with disabilities as ‘different’ or ‘others’ and dismiss them and their needs, we allow hate crime to flourish.

The Hardest Hit Campaign

The ‘Hardest Hit’ Campaign is has been organised by a number of disability charities which form the heart of the UK Disabled People’s Council which is an umbrella group for many organisations across the country and Disability Benefits Consortium which is another umbrella type body which includes a lot of well known major UK charities and organisations.

Between them, these two bodies substantial weight and experience of disability in the UK and the campaign which has organised a march tomorrow, is intended to highlight the cuts which are being focused on people with disabilities by the government.

Tomorrow, 11th May, there will be a march in London. The details of the march can be found here and will culminate in a lobby of Parliament between 1.30pm and 5.30pm. Unfortunately, I won’t be able to attend myself due to work, however, in  the spirit of inclusiveness there is a joint online campaign for those who are not able to attend. There is both an option to write to your own MP (if you are in the UK!) and/or to send a testament to the campaign so that experiences, worries and issues can be collated.  It is worth reading through some of the testimonies already sent in.

So what changes are being proposed? Why is disability targeted?

Well,  as the Hardest Hit website states, the government (and let’s not forget that the Labour Party are also backing these changes) proposes

–  Cutting 20% from the budget for Disability Living Allowance (DLA)

Putting a percentage figure of cuts necessary only means one thing. It means raising the bar to access DLA. It is not an ‘easy’ benefit to apply for. I know because I’ve filled in many many DLA and Attendance Allowance (the equivalent benefit for over 65s) forms in my time. There are many faults with the system of DLA at the moment but being too lenient isn’t one of them. My own criticism would be about the way that applications are made and the emphasis on physical ‘ability’ and ‘disability’. I genuinely think that more trust should be placed in GPs and teams that are working with the claimants rather than form filling.  It’s important to remember that DLA helps disabled people to WORK.

Disability Living Allowance is also a ‘gateway’ allowance for Carers Allowance. Carers’ can only claim Carers’ Allowance when the person that they care for receives either DLA or Attendance Allowance so a cut would have a substantial effect on carers as well – even though carers’ allowance is pitifully low, it is better than nothing.

– Taking mobility payments away from disabled people living in residential care and children going to residential schools

I think the government may well be backing away from this one already. Campaigns and demonstrations can work.

– Cutting off payments of contributory Employment and Support Allowance after a year to people struggling to get back into work due to disability or serious illness.

This, I think, will have a massive effect as well as ESA (Employment and Support Allowance) is the benefit that is paid when someone cannot work due to ill health or disability. There are so many issues regarding ESA but this one is likely to cause substantial hardship and limiting contributory payments for a year when the effects of the illness or disability are not time-limited will merely serve to reduce payments to those who do not meet the criteria for the income related ESA.

Remember, contributions based means that the person has worked and paid their National Insurance – this is not a ‘layabout charter’ that the government (and opposition) seem to think that ‘hardworking people’ imagine is in place for ‘scroungers’.

Our system should support people who are not able to work due to sickness and disability. I don’t doubt there are problems in the system but I don’t see how employing a private company (ATOS) to make perfunctory tests based on predominantly physical health needs rather than asking GPs and consultants to validate (or not) the claims of their own patients makes sense.

On the one hand the government is saying how trustworthy and fine our GPs are and how they can carry the ‘commissioning’ task as they know their community best but on the other hand they are not trusting GPs to make honest assessments of their patients’ ability to work or not as regards assessments for ESA.

So as for the campaign, I want it to succeed or at least to change some of the distasteful discourse that exists at the moment around benefits and people who rely on them more broadly.

In order for it to succeed, it needs widespread support and the people marching need to know that they are supported.

If you aren’t able to attend tomorrow, go to the website and see what you can do to lend support.  Anyone who has a belief in social justice needs to be involved in building a fairer society for everyone. That’s what social work is about as I see it.

Disability, Language and Respect – Blogging Against Disablism Day

Blogging against Disablism Day is 1 May and it is an initiative that has been running for five years. Diary of a Goldfish is collating all the posts that reference this and I’d recommend reading through them.

I don’t identify myself as disabled. Yet. It is something that is always there in the background for all of us who might not be feel disabled at presence whether due to an illness or injury yet to come or through the experiences of a family member – a parent or a child.

My father identified himself as disabled and the disability movement was very important to him. He found a voice and he found unbelievable amounts of support from peer groups that he was involved with. He also battled with the institutional discrimination in ‘systems’ which were designed almost to make things as complicated as possible.

There is no ‘hierarchy of discrimination’ in my eyes or at least, let me qualify that by saying that there shouldn’t be but there is a sense that some of ‘more acceptable’ than others.

Look at the bullying of people who have learning disabilities for example. The differential in funding arrangements between those who are under and over 65 where being an older adult with a disability that may be ‘age related’ leads to a much more narrowly dispensed service – perhaps because voices are not heard as loudly and the differences in the protection from abuse that exist in the law (and in public attitudes) to abuse of adults who might need support of institutions to protect them and children. Would we allow some of the stories about abusive care environments to be brushed out of the media if children were involved rather than adults? I suspect not.

Anyone who says that discrimination doesn’t exist in services has never had experience of working in services and anyone who says discrimination doesn’t exist from professionals who should know a whole lot better probably hasn’t been able to sit in an office or a meeting and listened to some of the conversations that travel around and the language that is used.

So my minimal contribution to this day is going to be about the importance of language and respect to discrimination.

‘Political Correctness’ has a bad ‘reputation’ because we allow it to be hijacked by the right wing press and commentators and to allow others to determine what is offensive for us.

For discrimination to be challenged, language has to be challenged and not only by those who are affected by the conditions that are being ridiculed or minimised. By everyone.

Politically Correct? Let’s lose the ‘political’ and make changed language normal language. It happens with some words over time and words create perceptions. It might not seem like much to change from talking about someone being handicapped or disabled, having a mental disability to a learning disability – but it is about the people about whom terms are coined to take control of the ways in which they are referred to.

Recently I attended training about the move from using the words ‘vulnerable adult’ in terms of safeguarding to ‘adult at risk’. It emphasises the importance of not using adjectives to determine a persons worth or value. We don’t talk of ‘a schizophrenic man’ or ‘a demented woman’ so why would we refer to a ‘vulnerable’ adult?

Does that make me ‘too PC’? I’m sure I’ll be accused of such but think about the way in which adding the adjective to the description of the person qualifies the importance of the ‘disability’ as a part of that person’s identity. If we talk about a man with schizophrenia – the person comes first.  A woman with dementia – her personhood is highlighted before a condition which may affect her and equally ‘being vulnerable’ shouldn’t label a person before any other facts are known.

So my contribution to the day – think before you speak and challenge discrimination in language. In your office, in your home, in the street and in the press.

I am proud to be politically correct. I honestly think language makes a difference. It is about respect.

Eligibility, Birmingham and Cuts

Birmingham was the first English town without ...

Image via Wikipedia

While awaiting the details of the court judgement, there was an important ruling yesterday that Birmingham Council’s attempt to limit eligibility to social care services to those who have ‘critical’ care needs is unlawful.

Drawing out some of the definitions to what this actually means and could mean requires a look at the details of those who brought the case to court.

There were four defendents which the BBC explains include

a 65-year-old woman with severe learning difficulties who receives 24-hour care in a home paid for by the council

25-year-old man with a rare genetic disorder and severe learning disabilities who receives overnight respite care, also funded by the council

30-year-old deaf, autistic man with severe learning disabilities who is prone to self-harm. His specialist day care would also have gone under the plans

and

a 36-year-old woman with severe learning difficulties whose day care centre will close and who is also set to lose respite care

It’s useful to go back to the definitions of what ‘critical’ and ‘substantial’ needs are to understand fully the implications of councils moving the eligibility criteria from one stage to the next.

Critical needs exist where –

• life is, or will be, threatened; and/or
• significant health problems have developed or will develop; and/or
• there is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or
• serious abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out vital personal care or domestic routines; and/or
• vital involvement in work, education or learning cannot or will not be sustained; and/or
• vital social support systems and relationships cannot or will not be sustained; and/or
• vital family and other social roles and responsibilities cannot or will not be undertaken

Whereas Substantial needs (those that Birmingham are stating they are no longer able to meet) exist where –

• there is, or will be, only partial choice and control over the immediate environment; and/or
• abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out the majority of personal care or domestic routines;
and/or
• involvement in many aspects of work, education or learning cannot or will not be sustained;
and/or
• the majority of social support systems and relationships cannot or will not be sustained; and/or
• the majority of family and other social roles and responsibilities cannot or will not be undertaken

A couple of things to be noted here. A differentiation is made between ‘abuse’ and ‘serious abuse’ so that one will be covered and the other won’t. What kind of ‘legal’ test would there be to determine when abuse counts as ‘serious’ or not? Can we see children in similar cirumstances being subject to a differentiation of level of care available depending on whether abuse is ‘serious’ or ‘not serious’? And who is doing the judging? Well, I can answer that last question. It is the social worker involved as I am asked as a matter of course to ‘band’ people according to these criteria.

The obvious glaring point is the lack of thought of any kind of preventative work that sticking so closely to the criteria will create. Where is the hope of creating those very creative personal budgets when only the very bare minimum of essential needs are being met.

I can’t claim anything other than relief that Birmingham case was challenged in court. These criteria and these levels of need look at people as lists of what they cannot do. That goes against everything that we know and the ways in which we practice by looking at strengths and looking at people as individuals. However, the reason the criteria were brought in in the first place was to end some of the ‘postcode lottery’ of care provisions and to bring consistency to who was offered what nationally. Of course, the problem remained that interpretations of these criteria vary so the consistency which is objected by ticking boxes (the only way the officials seem to know to apply it) depends, as mentioned previously on the social worker who is doing the ‘judging’.

Back to this case though, it was brought under the Disability Discrimination Act and hopefully the judgement will be available soon. Hopefully too, local authorities around the country will be leafing through it and realising that the wholesale and slapdash cuts that they are imposing are not legal.

As for the government of millionaires, none of them will be reliant on social care support from the council. They can buy in any support that they might potentially need and cannot understand the distress of those who are totally reliant on the availability of services.  They cannot understand the implication of their gung-ho ideological cuts and the thought of Cameron, Clegg and Osborne claiming ‘We’re all in this together’ sticks painfully in the throat.

Although I fully expect Birmingham to challenge this ruling, I hope that the case is held and that some of the trigger happy cutting is stopped and the very real effect of the cuts agenda is shouted out more loudly and more clearly – not just for those of us who are personally losing services but to raise our voices with those who cannot always shout so loudly.

That is what social justice is about and that is what social working is about.