Personal Budgets in Practice

Recently, I’ve been working with a service user and his carer (daughter) to put together a  support plan or rather two support plans – one for him and one for his daughter . The two live together and without his daughter’s presence, there is no doubt at all that the man, G, would be in residential care so the personal budget is relatively substantial.  G has advanced dementia. His daughter who is a strong advocate for him and a devoted carer has given  up her job in order to care for her father. She receives carers allowance which is a pitiful £55.55. Think about that – for constant care (yes, she gets respite but that is sparse and shrinking).

As for creativity with G’s support plan, it isn’t particularly, because he has quite specific personal care needs and there is no scope for much creativity regarding tasks apart from the ability to potentially employ someone from outside the usual agencies.  Oh, we can choose the time and the ‘blocks of care’ but the type of care needed is specific so we can’t ‘skip a shower one day so there’s more time for a bath the next (seriously, that was suggested in one of the training sessions I attended!)’ as health reasons determine the need for regular visits. G’s support plan is, what we call a ‘managed personal budget’. That means that a virtual budget is assigned to G and I make the arrangements for agencies to cover the specified hours. I don’t get a choice of agencies. The agencies that are employed are those that have won ‘bidding’ contests with the local authority and are party to block contracts.

This ‘counts’ as a ‘personal budget’ for the purposes of the local authorities’ ‘figures’ even though the effect is exactly the same as it was prior to the ‘personalisation agenda’ – no, wait, there is a difference. I have three times the amount of paperwork to complete. Am I working in a more ‘person-centred’ way – well, I hope that I was ALWAYs involving service users and carers in care planning. That’s not to say that direct payments haven’t been enormously liberating and positive for a lot of service users. I absolutely don’t believe that everyone should have ‘managed’ personal budgets but it is a fallacy to believe the ‘hype’ that this personalisation agenda has brought the same benefits for all service users.

So we move to the idea that Burstow promotes that all support plans should be delivered by direct payments. We discussed delivering this package via direct payments, when I promoted even a slither of interest, I invited someone from our direct payments team round to meet the family (because they can ‘sell it’ better than me and can answer all the detailed questions about implementation and finances that sometimes I can’t) and we stalled. Why? Because G’s daughter felt genuinely stressed and frightened at the thought of employing someone directly – the agencies that accept the direct payments amounts are limited and don’t include her preferred agency and if she went with the preferred agency, her father would lose vital necessary hours of care.  She has little enough time to herself as it is and spending more time managing and planning her father’s care processes was something she felt that we should be doing.

Her father has very poor cognitive functioning to the extent that communication is very difficult.  The direct payment option, was, she saw, a way to push more stress onto her as a carer.

This is a reality that some of those who are implementing the wonderful new world of everyone receiving direct payments type personal budgets really have to address.

However I do have a more positive story to follow up on. That is that she, (M’s daughter) has a carer’s personal budget for herself which is delivered via a direct payment. While I won’t go into the details about what has been provided, you’ll have to trust me on this as I say we have been able to be incredibly ‘creative’ with the support planning of the carer’s personal budget and it will have an immediate positive effect on her quality of life. So all’s well that end’s well.

Generally, I have had a lot of success with carer’s personal budgets being implemented and I think that has been because the money provided (although not very much) is money in addition to the core care needs for the cared-for person.  There is a scope for more interesting ideas of things to use the money for.

It’s hard to see how more creativity can be instilled without more money and as long as the figures allow ‘managed’ personal budgets to be ‘counted’ we won’t have a real idea of how ‘ground-breaking’ these programmes are.

I don’t know the answers to these problems – I hope some of those consultants who are paid multiples of my salary and can spend all their days in discussions and consultations are able to come up with some genuinely practical responses rather than the usual ‘try harder/work harder/involve users (as if we don’t do all this already’.

Let’s see.

And on a final unrelated point, I saw a link to this blog yesterday on Twitter. It is written by the 18 year old son of someone with Alzheimer’s and I found it excellent and insightful.

Personalisation in Mental Health and Older Adult Services

Personalisation is a very broad brush term to describe the so-called ‘transformation’ agenda in adult social care. In very general terms it refers to the process of moving from resource-led to needs-led systems of service provision (just as the NHS and Community Care Act 1990 was supposed to do) but this time… with individual budgets.

The idea is one is it difficult to find fault with. Users and carers would have more control in choosing the type of care which was provided through having ‘pots of money’ either virtual or actual payments  and deciding how best they could be used.

The change was led, ironically, by the soon to be extinct ILF (Independent Living Fund) which was the forerunner of the Direct Payment system whereby money was put directly into the hands of service users to choose and buy their own support and hire their own carers (with substantial support regarding admin and regulation if necessary). It was a new way of doing things and it generally worked very well.

Then with the ‘Putting People First’ white paper, the idea was to be rolled out to everyone receiving a package of care from the local authority. Wonderful. We would be living in a world where patronising social workers wouldn’t be dictating that ‘they knew best’ and imposing care packages based on large scale contracts negotiated down to reduce the costs and people would be able to choose the services they wanted and the carers they needed and liked. It would all end happily ever after.

I was a great campaigner for direct payments. I saw a lot of people do extremely well from them. I also think a lot more needed to be done though in increasing the take up and levelling the parity of service provision.

It appeared to me that those best able to advocate for themselves or who had active and involved families got the lions’ share of the services and were able to cherry pick whereas those who weren’t able to access the best systems either though lacking mental capacity, through lacking the desire or just being so knocked out by disability/age or lack of family got the scraps left behind by the system. The contracts that had been negotiated by commissioners who never themselves would actually use the services of minimum wage carers who were overworked by the care agencies determined to slash costs in order to win these prized contracts.

Soon though, the announcement came that everyone would get ‘personal budgets’ for social care. Wonderful. That would level the playing field, surely.

It was quite exciting. For a time. Until we realised that the people the local authority were ‘piloting’ the system with where exactly the people that they knew the system would work with – namely those who had successful direct payments packages.

Now, in my time, and the only time I’ve done properly authorised and supervised research as a practitioner, so happened to be related to direct payments. I spent a few months researching the lack of take up of direct payments by older adults and adults with mental health needs.

Now, my research was primarily literature-based. I did no direct interviews (ethics committees take time!). There was substantial sources of literature available, even at that point.

So what was learnt from the research that had taken place at that time and how was this used to improve the service provision when personal budgets were rolled out?

It wasn’t. So we find ourselves in the same place years later.

That’s a very long background to my point this morning but I think it’s important to emphasise the context through which I read the SCIE report ‘Keeping Personal Budgets Personal : Learning from the experiences of older people, people with mental health problems and their carers’.

I read this report last week and as is the case in all the best research, it backed up, with evidence my own feelings and ‘hunches’. I like research that does that.

The main learning from the report is that the key to the implementation of a successful personal budget is both information and involvement of a professional. People wanted support with completing self-assessment questionnaires in general so while our local authority employers promised us (don’t worry, we never believed them for a second) that time saved in leaving people to complete their own self-assessment questionnaires is time we could use in ‘creative support planning’ actually, the SAQ can be a daunting document.

In my experience, it is extremely poorly drafted (possibly because the focus groups were very narrow) and I am almost embarrassed to give it out. It focussed heavily on physical care needs and asked particularly strangely worded questions about capacity which shows the author of the forms have no understanding of the Mental Capacity Act and the idea of ‘decision-specific capacity’. It reminds me (and service users I’ve taken it to) of a DLA form. Jumping through hoops and ticking boxes to get money is not dignified.

The SCIE research also emphasises the importance of having a consistent person available to take a user through the process. Again, less necessary when there is a someone who is high functioning or who has highly involvement family/carers but the resource distribution of support doesn’t create an equity for those who need more. Professional time is increasingly stretched and the time spent rushing through a SAQ and package of support is not respecting the principle of self-directed support. As professionals with heavy caseloads though and targets which are tracked and time-limited, it is hard to balance this ethically.

Moving onto the Resource Allocation Systems (RAS) which is the way that the self-assessment ‘turns into’ a sum of money – either real or virtual for the user to ‘spend onservices’. I can’t express my anger about the RAS system strongly enough. It is heavily biased against older adults. It is even more heavily biased against people who have carer support.  I don;t know how widely this information is known  but if you have a family member providing support, you suffer massively when the finances are pumped out of the ‘RAS system’. The more help the family member provides, the less money comes out. I feel this is immoral and short-sighted. It places additional stress on unpaid carers and pays no heed to preventative care.    Yes, individual cases can be argued but that takes more time and effort.

The we move to the support planning stage. You have the ‘virtual budget’ in  hand so what amazingly creative package of care can you create. Again, the evidence in the report shows that it is often information that is shared by the professional in the first place that leads to the quality of support planning.  Users wanted continuity of staff throughout the whole process of assessing and support planning so our local authorities great idea of commissioning organisations to help might miss this point – although that idea and those commissions fell through when the organisations they had commissioned were so overwhelmed with referrals they were unable to take on any more users. Oh, and the user groups that were commissioned? Physical and learning disabilities charities. Nothing for mental health or older adults. Surprise. Even though those were the groups least likely to get the support and planning needed.

There is so much in this report and it is worth reading if you are involved in any way in implementing personalisation in adult social care in the UK.

The sadly predictable thing is that I could have told the councils these messages 5 years ago but noone would have listened – come to think of it, I DID tell the implementation team 5 years ago and many times in between. They are so vested in this new system of delivery of services being ‘better’ that they are blinded to the vast swathes of people who are again increasingly sidelined and excluded from the positive thrust of the personalisation agenda.

Sadly, it feels like the lessons will never be learnt because the wrong people are being asked. No-one wants or is able to invest real money in providing better services and more flexible and easier ways of managing the service provision in the less engaging client groups.

It’s unfortunate that the agenda has sprung into life at a time when cuts are at the front of our communal minds. It has become too easy to see personal budgets and cuts in the same sentence when they were never meant to be.

The truth is that the whole system is failing those who need the support, advocacy and choice the most. You know, those elderly people with dementia who have care staff on minimum wage coming for 30 mins in the morning to give them a shower. There are lots and lots of them around.

I want to ask how is the personalisation agenda helping THEM? How is it helping us to help them? We are closing day centres because people can ‘group together and commission day services jointly’  but sometimes the purpose of a day centre is the company that you surround yourself with, the support of peers and not about completing a specific task or learning a specific skill.

More able, more active older adults may well use their ‘day services’ budget to go to the local bridge club or swimming pool – but how about those with advancing dementia whose carers need the respite that day services bring as much as the company and hot meal are welcomed by users. Are the local swimming pools and adult education colleges going to be suitable for all?

The idea of personalisation was the it would be something that would be actively chosen and engaged with and there is no doubt, it works very well for those who are actively interested and engage with their care services.

My concern is that the process has, again, run away with itself and left behind, far behind, those who cannot make decisions for themselves about their own needs and who don’t have family to advocate for them. They are left with the same ‘old style’ service delivery model of the cheapest agencies providing poor quality care by rushed carers on minimum wage. The difference is now the day centres are closing and the government are telling us this system works better.

The sad thing is, if they had read and understood the research that was available at the time regarding the take up of direct payments by adults with mental health problems and older adults, they would have learnt all these lessons and maybe put better systems in place. The cynic in me says they only wanted to see success and the same groups of service users suffer yet again.

One of the things that saddens me the most on a personal level, is that I was always a great advocate of the direct payment system. I plugged away with it and got some incredible results with specific service users.  I was the little pet of the direct payments team, explaining again and again to my colleagues who wonderful it was to be able to reliquish control and allow and promote user choice.

I wanted and was sure the system of personal budgets would be even better. It would be more inclusive. It would fix the faults of the direct payments system because, look, we had research to back up why it  hadn’t worked so well with these particular service groups (older adults and people with mental health problems).

All the research was ignored. Mistakes were replicated and exacerbated. If anything it is even more exclusive and inequitable than the previous system and no-one seems interested in listening to any of the real concerns and criticisms.

A great opportunity has been missed. Hopefully someone somewhere will actually read the SCIE research paper and think about making real changes in the systems of delivery and implementation. It could all have been done in advance though and that’s the true tragedy of the personalisation agenda.

Cuts – a personal tale

A couple of weeks ago, I had one of those deeply depressing moments that will generally punctuate a career in social care.

I had to go and tell a woman, who cares for her mother with enormous patience and dignity, that we could not increase their personal budget although her mother’s care needs had grown.

I suppose I went to my manager in a relaxed almost casual way and explained how the needs of the older woman had changed and to ensure her well-being, she needed additional time.

I was told, with a degree of equal sadness and regret that there would be no increase. If we were to provide what I felt was a necessary increase in care, the time had to be taken from the the hours already allocated.

She did, to her credit, try to have a discussion about this with her own manager but there was no budging on budgets. Despite the change in various situations, there would be no extra money. In fact, she added, the plan really needed to be cut.

It had been my first personal budget implemented. The council, in an attempt to encourage and prod us to implement these personal budgets had promised us and by extension, the service users and carers we work with, that no-one would be disadvantaged by moving to a personal budget so even if the RAS (resource allocation system – the way that figures are attached to needs through the personal budgets  system) did not ‘deliver’ enough money to provide an equivalent package of care that had been delivered under the ‘old’ system – it would not be reduced (and here’s the key) at least, not initially.

Now this particular service user and her daughter had what was a high package of care. It had costed much  more than the ‘RAS’ had spat out.

After making the promises, after the move to personal budgets is no longer an optional roll out of volunteers – the cuts are coming.  There is no longer the carrot to offer of ‘equivalent packages of care’ because we now offer everyone as a matter of course a personal budget and those who were not receiving them are being transferred over to the new system regardless – they don’t have to be self-managed, of course, but they have to exist.

So I visited the family and we looked at ways of shifting around hours.

The hours that were cut were the respite hours.

I suppose it was inevitable.

Family carers are invisible. The work they do is not costed. Of course the daughter was sacrificing her own needs for a few hours respite to her mother’s needs for additional personal care.

This is what the cuts mean to one family.

I had to tell them and negotiate with them about what to cut from their own package of care.

Not the Prime Minister. Not the Millionaires in the cabinet. Not any elected politician or Council Chief Executive. No councillor had to sit in that room with me and look the service user and carer in the face and ask them what they would prefer to give up from their package of care.

I’ve known this family for many years. I have a good understanding what is at stake for them and how much these cuts are hurting. I also know they won’t complain or grumble or shout from the rooftops.

They are not going to be going on any rallies or demonstrations against the cuts – not least because the respite hours have been cut.

We who can, have to demonstrate and shout and scream on their behalf.

And you know, as I know and I say this with a heavy heart – they’ll be much more of this to come.

Personal view of personal budgets

Just a quick link to an Guardian piece by a recipient of a personal budget. Go and read the article and then come back!

It’s always more interesting hearing about services and policy implementation from people for whom the services are created rather than from professionals who put the policies and the procedures together.

A few interesting snippets leapt out at me and I suspect it is partly because the way the implementation is different in different local authorities.

This point in particular

Every social worker is aware of how much political capital has been invested in personalisation by the government, and it cannot be seen to fail. So social workers cherrypick service users who they think will be the best candidates. Yes, prejudice and social bias even extends to disability.

When I asked my social worker what the drawbacks of personalisation were, he was candid. He admitted it was a process of self-selection. Only those who were erudite, well educated and well organised were encouraged to apply for personalisation and those who led chaotic lives – a euphemism meaning that anyone with drink, drug or mental health issues was not put forward.

While no doubt that was the case when some of the pilot schemes were running, now we have no choice whatsoever (quite rightly). Everyone assessed for a service is going to be receiving a personal budget. Everyone whose service is reviewed will be transferred to a personal budget.

This point raises one of my bugbears as well. I begged our implementation team to include people with more complicated needs on the pilot. I personally spoke directly to the project manager and explained that until the scheme had been piloted fully with people who did not have ‘straightforward’ needs, people who may not have the capacity to make full decisions about their own care needs and older people who might have the same high needs for services as a younger disabled adult  but with a LOT less funding available, we could not be able to create a system that worked across the board.

Of course, I was told that no, the pilot needs to be straightforward so we can work out the glitches.. THEN we will introduce some of the more complex aspects. The problem is that we have been left with documentation and assessments that are focussed on physical care needs while the mental health services were left behind as they were not involved in the pilot – being ‘more complex’.

So yes, the self-selection occurred (not in our team as we weren’t a part of the pilot – despite my pleas!) but it does not occur anymore – not in my authority. Now it is a blanket approach.

The part of the article that cut to the core was this, in my opinion

It is suitable for anyone who is organised, methodical and lucid, but it helps immeasurably if someone else is able assist on your behalf and make sure you are not making any accounting mistakes.

Honestly, that made my heart sink. Not because I am not thrilled for people like the writer of the piece who is, without doubt, getting an infinitely better service – but because it further sidelines people who are NOT organised, methodical and lucid and people who do not have someone else to assist on their behalf.

In an ideal world, independent advocacy both directed and non-directed would be a wonderful tie-in for those who need assistance with details and management and for those who might not have the capacity to manage some of the details – however costs are being cut. Our own advocacy services now have a massive waiting list. The expectation again falls on statutory social services and honestly, I don’t say this because I’m proud of it but because it is the reality, in the day to day workload, there will not be the time for a social worker or social work assistant to provide the same level of support putting together an individualised and personally focussed care plan – maybe there would be in a learning disabilities team but in an older persons’ team where a much faster throughput is expected – it’ll likely be the same usual agencies that are used for the same, usual tasks.

I see personalisation as a wonderful thing in theory. In practice is has made a lot of care much better for the ‘organised, methodical and lucid’. The massive challenge is how to ensure that equal and better services are delivered to those who are not ‘organised, methodical and lucid’. Those who do not have networks of support. My fear is that the funding will be siphoned to those who are better able to articulate their own  needs.

I promise I’ll try to stop with the personalisation posts soon. I get the feeling I’m being somewhat repetitive but they are very much on my mind at work at the moment as I’m running through a few and so I keep thinking of more reasons to be frustrated with the implementation (as opposed to the ideology which I support completely).

Community Care Live – reflections

Yesterday, I went to the ‘Community Care Live’ event which runs for a couple of days (it’s on today as well). As usual, I had to pick which day had the more useful sessions and ended up with a fairly busy programme yesterday and a few difficult decisions about which sessions to attend,

I don’t want to go into a detailed review of the sessions here. Not least because I’m sure Community Care will cover the particulars far better than I but there was a theme that came up in a few of the sessions I attended.

It seemed that there is much talk about personalisation. Much distress at the ‘old fashioned’ way and social workers’ opposition to the move towards a far more equitable relationship of power between service users and local authorities. It made me sad to hear it.

It made me sad because I did go into social work to work actively towards empowerment and to embrace user choice and freedoms. I love that personal budgets and direct payments have changed the outlook of social care field. I love that there is a move away from care management and the processes that bog you down in the public sector. Particularly I love the creative way that budgets can and are being used – yes, using a personal budget for bingo trips is the way we should be going.

There is an elephant in the room though. The personal budgets and support plans that I see being approved for older adults are not the creative ones because the margins are so tight that the only money there is for people who need personal care. Sure, if you want to sacrifice one ‘wash’ a week for a bingo trip, you’d be able to but there isn’t as much money in the pot for older adults as there is for younger adults with disabilities. Please let’s have bingo trips and trips to be pub instead of day services but there has to be an understanding that older people do not get as much money as younger adults for ‘leisure interests’ so a trip to be pub may be at the expense of personal care – it’s a choice and it’s good that there is a choice but to pretend the system is equitable between younger adults or older adults or to use younger adults as an example for creative approaches is a fallacy because the budgets don’t stretch as far in older adults’ services.

We can look at day services to provide the ‘creativity’ and yes, it’s feasible that they may stretch to some of the more ‘flexible’ services. I hope they do. At the moment though, in looking at day care for someone with very high needs relating to advanced dementia, there’s a limit to the amount of ‘creativity’ you can establish. Not because we don’t want to,  but because there is still a need for carer respite and the budgets are so much lower than adults of working age.

Day centres should be more proactive and certainly have to be more than ‘respite for carers’ centres but that is also about quality control. They aren’t for everyone either but they are for some people.

Of course, there is more paperwork but I can deal with that (ok, I gripe) if I can see the outcomes for the service users that I work with changing fundamentally (as they so obviously do in some situations with younger adults and older adults who are able to and wish to manage their own budgets). The problems I see is that the words are all a smoke-screen. We are being told to implement individual budgets at massively increased bureaucratic levels but then action them through ‘virtual budgets’, buying care in from the same agencies so the effects on the service users are minimal if not negligent but it still ‘counts’ as an Individual Budget for the borough’s PIs (performance indicators).

It feels like a fraud because it isn’t about making the system more flexible but more about allowing the borough to achieve better PIs.

I’m not saying that Individual Budgets are not a wonderful thing. Personalisation is a great step to be taking ideologically and it is absolutely the right way to go. But fitting people into inflexible systems is the problem and not allowing the hours to be taken into account and the training to be widespread and far-reaching – that is the problem.

Again, at Community Care Live yesterday, I cowered as I felt I was being labelled with all those ‘fuddy duddy’ social workers from another era who want to ‘crush’ client choice in their own care services.

I want the opposite. I would love a well-resourced system that allowed us to plan according to needs rather than services. That is what was promised by the NHS and Community Care Act (1990).

I am absolutely and wholeheartedly behind the progress being made in user choice. I just see so many problems with the current implementation as it is led by Performance Indicators rather than a true desire to change the ways that services are delivered to everyone, rather than a smaller range of articulate and able service users. Again, it is those who have the quieter voices who suffer the most from this approach as the money is siphoned to those who are able to shout loudest.

Other thoughts from the Conference yesterday – there is a lot of general uncertainty about where the new government might be taking us. Which policies and frameworks will stay and which might be sidelined in the cause of cost-cutting.

There will always be a disconnect between front line practitioners and policy makers/senior managers who think they might know what it is like ‘in the field’ but work in private consultancies or have managed to ‘go into training’. I wonder sometimes who much contact there is with the front line. Of course, that is tarring a lot of people with the same brush and it isn’t always entirely fair – but sometimes it is. It’s very easy to feel ‘preached to’ by people who haven’t actually been in a front line local authority team for a long long time.

I know everyone has their hearts in the right place but I wonder how much more could be achieved if more front line practitioners were involved in steering and policy groups.

The usual stands with the jobs (mostly children’s services), pens, mugs (didn’t get one this year), mousemats and booklets were all there.

This year I also bumped into quite a lot of people I knew. That’s a sign of my longer service in the field as much as anything. It’s always a good thing to bump into familiar faces – until next year..

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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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