Individual Fudge-its.

I have tried to embrace the personalisation agenda. Really, client-choice is wonderful. I welcomed Direct Payments and saw a few through to the finish although always keen to emphasise the difficulties as they arose. Basically, the idea of giving the users of services the power and control to purchase services directly is a good one. Money and finance is such a crucial key in the dynamic and it is an almost Victorian and very ‘modern’ adage for the providers of social care to be spreading cash and services like charities rather than according to rights and needs. I always emphasise that any service provided is an absolute right – nothing to be grateful or thankful for. We have a duty to provide for those who need.

That is where the  mindset needs to be changed however, I think the move towards spreading out individual budgets has been wholly focussed on a model that works extremely well with younger physically and learning disabled adults who are able to advocate well for themselves or have active families and networks around them to provide the support and guidance – either formally or informally.

Where the system seems to struggle is firstly that (wrongly in my very humble opinion) choices and more importantly, money is less forthcoming with over 65s. The budgets are tighter and there just isn’t so much money around. There are also less ‘support’ hours available from social workers – in the sense that allocations in over 65s services are MUCH higher than in the other more specialist teams. Whereas someone who has a learning disability may have been known to a particular social worker for many years and have had time to build up relationships with a team and a family, an older adult will likely have much less time to have any form of ‘relationship building’ going on.

Self-assessment questionnaires are all well and good  but from my own experience, I’ve had a couple of people completely freeze up when presented with them (even in the context of me explaining that I would be happy to help) or laughed at (What?? Another Form?? All the questions ask about physical disabilities?? It’s just like a DLA/AA form (accompanied by a disheartened sigh ).

Any time I have raised concerns at meetings or training, I have been shouted down by the trainer as being opposed to client choice and just being an old stick-in-the-mud ‘care manager’ style of social worker who wants to retain all the control myself. I find that offensive for a start as these trainers have no idea what challenges exist and in their minds we have hours to spend constructing care plans for every person that we come across.

The truth is that it is a fudge of the highest degree. There is no more choice than there was for the people who don’t have networks of support. They are still constricted to the same care agencies that charge the lowest amount and pay their staff the minimum wages. Sure, they can employ people directly but there is no safety net or extensive support to recruit that was once promised. Being an employer is not for everyone – especially if it is someone who might be suffering from a cognitive impairment without a family member to actively choose and advocate. There is more flexibility, for sure, but it is found through such a convoluted method to have been painful to reach. The ideas are good but unless the commissioners and project managers listen to those who have experience, there will be no different outcomes for the most vulnerable service users.

That is my concern and has always been my concern. It has been emphasised that no more money will be made available. It is hard to provide a better service without more money coming in and noone seems to be prepared to accept that. Between one party saying they will ‘try and keep people out of residential homes’ and the other talking about insurance plans to ensure that more people go into homes there is a hotch-potch and neither of the main parties seem to have engaged with the personalisation agenda very much through their arguments about funding, fear of the middle classes who feel resentful about having to pay for services for their parents with their own inheritances and the thought of an actual cost being attached to the provision of quality care.

Self-directed support sounds wonderful and it honestly is wonderful for some people. What seems to have been lost is not that I particularly want to choose the services that other people get – I like the idea of choice and flexibility – but really the idea that some people need a lot of support to plan and develop personalised care and support plans and there has been no account whatsoever taken of the time factors in a team that this means.

We are running pilots at present in our borough and I feel almost resentful at the lack of listening that has been done. There is an assumption that is actually ironic when you think about it that the roll-out of individual budgets is about empowering people and not assuming ‘we know best’ however the manner of the implementation is the same through mental health, learning disabilities, physical disabilities and older adult services.

Some people are actively ignoring the growing pace of the agenda – I’ve tried to embrace it so as to be in a better position to add my voice to those who are shaping the policies. I am trying to be positive and think that some elements are really good – it has just increased my paperwork a thousand-fold.  I know complaining about paperwork is old hat  but the extra man hours haven’t been factored in.

We have an option to ask some local advocacy services to help with self-assessment questionnaires and support planning however, in our service where we do have the opportunity to build up relationships with users and carers over a period, I should see it as some kind of triumph that everyone I work with has preferred me, a face that they know and (hopefully!) trust to assist as opposed to someone else new coming in to do these pieces of work. At least they know I’ll be accountable over the longer period.

And so while trying to be positive, I have a certain amount of annoyance with the implementation. Yes, it’s a good idea. Yes, it sounds wonderful on paper. No, noone has actually listened much to ALL the practitioners who work with different user groups and noone seems to have taken note of the barriers that existed to direct payments as a starting point.

I think it is another means to privatise and decentralise services and to give ‘responsibility’ to the service user as a way of diluting responsibilities of the provider. I hope I am wrong and just a little too cynical for my own good.

I still try to be hopeful for the future though. I still intend to make my voice heard by making positive suggestions as opposed to merely grumbling and griping in the corner.

That’s the ‘right’ thing I do, I’m sure of it. I have no doubt whatsoever that this will be something of a theme for me over the coming months.

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Moving on Individual Budgets

And so it starts. Currently we are still in ‘pilot’ phase of the Individual Budget roll-out – the forefront of the personalisation and self-directed support agenda and if that sentence made little sense to you – you can probably count yourself lucky!

Very basically there is an ideologically  welcome move towards more control by users of services around the services they receive which is a very noble and worthy cause. We are trying to work through some of the details and our local authority is trying to put systems together through the pilots that have been running. While I’d like to hide my head in the sand and pretend nothing is changing, not because I don’t think it is a worthy ideal, but rather because of the intense increase in bureaucracy and the time needed to work through the new and somewhat shaky systems being put into place.

I decided that I really needed to be positive and try to actually understand what was to be happening because it isn’t going away  and so, in conjunction with a service user and her daughter (main carer) who want to engage with the process and ‘see how it works’, I am doing what I can to work through the systems as they exist.

The main pilots so far have focussed on younger adults with disabilities, people with learning disabilities and older adults with fairly straightforward care packages.

Although at the time, I explained I felt they needed to tackle some of the more complex examples at the time, mental health services were very much left out of the ‘loop’ of information.

Currently, I have assisted in the completion of the self-assessment questionnaires and have validated them. As the service user in question as fairly advanced Alzheimer’s type dementia, there was a significant input from her family and carers and I assisted considerably myself – so the ‘self-assessment’ idea was somewhat lost through that process but I felt it was important to work through the ‘processes’ with a person who has little capacity to engage actively with the assessments and realistically, it will involve many of the users of our service.

I tackled the RAS (Resource Allocation System) although I’m not entirely confident it is ‘correct’ and so my next task is to take the documents to a meeting to discover what the ‘indicative budget’ is and then, assuming all goes well, to return to patient and carer (I am running two different applications side-by-side – one for service user and a different one for carer in her own right).

I might have messed the entire thing up of course, but as I expected to user and carer themselves, the worst thing that could happen at this point is remaining with the status quo while I spend time working things out. The positive outcome would be more flexibility to choose carers and tasks that are more appropriate to their individual circumstances and to have more input into the support packages that provide the best outcomes.

But.. and this is the big but.. so far, getting as far as we have, namely writing up all the documentation and putting the forms, assessments, resource allocations etc has taken me the good part of a couple of days. That’s not including the three specific visits each of at least an hour to work through the actual assessment forms. Which would be fine and dandy if that linked in with the time taken on other work, emergency assessments, people being discharged from hospital,  rushing to court to get warrants etc.

Suffice to say the team isn’t overly heartened by the lack of support in implementing these new systems – the local authority has put a lot of support into the Community Care teams with additional workers and weekly support groups  but in the bleak and distant mental health teams, we are left increasingly on the periphery and detached further from the general information streams and planning but my thought is that at least by attempting it, we won’t be completely left out and if I make a mess of my attempts, at least I am identifying a genuine training need!

Hopefully, I’ll be able to update the process as I go through it.. .

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