Initial thoughts on the Dilnot Report on Funding of Care and Support

Scheduling and exhaustion meant I didn’t have time to look at the Dilnot proposals in detail yesterday so this morning I have fired up my browser and am going to make a few initial comments on the baseline main recommendations and hopefully over the next few days can look at some of the details.

The Dilnot Report on Funding of Care and Support runs at 82 pages.  It attempts to forge a solution for the currently antiquated and inequitable system of care funding that is currently in place. Much talk has been made of the current threshold of £23,250 of assets, at which people currently become responsible for paying for their own care services but little made of the current discounting of homes in certain circumstances and the ability to raise a charge on a property to postpone payment of costs for care services. Nevertheless, this threshold was deemed as being too low. People who own houses like to keep houses for children. People don’t like those who ‘haven’t worked as hard’ or ‘saved as much’ getting something for free.

The system is broken though, don’t get me wrong, I just think the focus of the discussion has been too much around middle class fears of actually paying for something they believe should be free. Now, I’ve got that off my chest, back to the report.

The main recommendations are

– to cap lifetime costs of care between £25,000 and £100,000 – with a suggested threshold (which is used throughout the report for ease) of £35,000

– means-tested assistance will be extended to those who have between £23,250 and £100,000 of assets.

– Those who ‘enter adulthood’ with support needs will not be means-tested and care will be provided free.

-Universal disability benefits will continue but may be some differences in names regarding Attendance Allowance. (erm.. DLA?).

– There will be a cap on so-called ‘hotel costs’ in residential care between £7,000-£10,000

-There should be a national, portable eligibility framework which is more transparent.

– A government awareness campaign about planning ahead and preparing for potential age-related disabilities. And their costs.

– There should be a new information and advice strategy to help people through the confusing forest of knowledge.

– Better carers support and information.

– More health and social care integration

Of course, these recommendation run alongside the Law Commission’s report for changes in adult social care law. Together they could create a much better and clearer system than we currently have.

The ‘lifetime cap’ allows for insurance policies to be generated and probably very profitable ones too for the insurance companies. Most people do not need high level social care provision but the fear generated by the media is enough to drive right minded people into the arms (those who can afford it and who have substantial assets) into the arms of the insurance companies. I’m not sure how comfortable I am with the lifetime cap on care costs. It means the more wealth someone has, the more they are protected. I understand the logic behind it in that noone chooses ill-health and disability but the more than government spends on those who do have substantial assets, the less there is for those who cannot afford it and the higher the criteria to access support rises.

I just have a few queries which may be answered in the details. If Mrs Smith has a house worth £300,000 and she lives alone with no other substantial assets – say, for example, she has savings of £10,000 – is her house sold to release the asset worth up to the cap of £35,000 – assuming she doesn’t have an insurance policy? If she chooses to live in a care home which is private, but then the money runs out, will the local authority still move her? Will she ‘top up’ the local authority fees, paying above the ‘cap’ to do so? What is she lacks capacity and has no family?  I suspect all these answers are in the report but they will be questions I will be looking for.  The system of deferred payment is mentioned and I’ll hunt around for clarification.

The cap though, seems to be there to protect middle class votes.

I do, however wholly support the increase in the level of means-testing. I think it is entirely right to continue to means test up to £100,000 and I’d even go further than that. I don’t have a problem with mixed funding, I am just not entirely comfortable with the capping.

Again, the clarity of the coverage of those who ‘enter adulthood’ with care needs is entirely right. There is a necessary distinction between working age adults with care needs and older adults with care needs but quite rightly it is wrong to have a distinction fixed at a specific age. Indeed, Dilnot proposes that those who develop long term care needs before the age of 40 should continue to have a zero cap and costs should be met fully by the state. Above the age of 40 there will be some kind of tapering of the cap up to retirement age where the full proposed £35,000 cap would be reached.

Regarding the accessibility of universal disability benefits, Dilnot clarifies that he does not propose any reform that would lead to anyone losing their disability benefits and that attendance allowance will continue. I do wonder though how this ties in with the government plans to remove 20% of DLA claimants.

There are some recommendations though to change Attendance Allowance (AA). Firstly to change the name to something more understandable and an appreciation that many who are eligible for it do not claim it. That absolutely reflects my experience.  People who reach the cap when the government takes over payment will not continue to receive Attendance Allowance (or whatever it will be called) because the government is fully paying for their care needs – which makes sense to me.  The Personal Expenses Allowance (PEA) is proposed to continue – this is the payment that is made to people whose costs are met by the government in residential care and is currently about £23 pw – there is a suggestion that it should increase but not a recommendation.

The cap on hotel costs is excellent news in my view because I saw this as a potential ‘get out’ clause for residential homes. I do want to know how some of the private homes will adapt to these new systems though and what the cap will mean for overall quality of care provision.

The idea of clearer, portable assessments is a good one and long overdue. Eligibility criteria interpretation can differ wildly and there needs to be more transparency.   The minimum threshold would be applied at the ‘substantial’ level of care so I wonder how this portability will work for those who live in areas that meet lower levels at present.  It seems that there is some kind of recommendation to do away with FACS over the longer term.

Can’t be soon enough – a new assessment framework will be developed ‘with experts’. Please please please can front-line practitioners be involved in these developments – not just people who professionally develop policies and have never needed to use assessments in their lives. This is why we end up with unusable systems. There is also a way of building self-assessments into these new models. That’s the idea anyway.

The last recommendations about building awareness and improving quality of information seem to be sound all round. Nothing to argue about there.

I am interested in the recommendations as they relate to carers. As far as I am concerned, I want more than just an assessment for carers, I want the provision of more services. Supporting carers very well both financially and with practical and flexible support is probably the one aspect which can potentially save the government more money in the longer term than anything else – but more than that, it is an issue of ethics and morality. I know that doesn’t often come into government services but it’s something I feel very strongly about.

There is more commentary about the details of Dilnot in Community Care, the Guardian has extensive coverage (including an article I wrote before the details were known).

I also recommend Arbitrary Constant for links and discussion about Dilnot.

My First Social Work Job

Czytelnia Humanistyczna BUR

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I can’t quite remember my first day in my first job as a qualified social worker. I’m trying to think back. I remember a few things though and as university courses come to their ends and thoughts turn to employment, I considered thinking back to that time when I was pushed forward from my training into the world of ‘real’ social work.

Finding employment hadn’t been an issue. At that time, we had kind of mini-careers fairs and events in the university where employers mainly neighbouring local authorities and agencies would try to tempt us to join them. Some offered golden handshakes in cash terms and others endless support.

Later, in a different job at a different time, one of our managers remarked how at that point, all you had to do was sit on a street corner with your DipSW (or MA or BA) in Social Work and you would have people come up to you and offer you a job. Perhaps it wasn’t as much of an overstatement as we thought.

I went with a social work agency. My closest friends from the course – in fact, the only ones I’m still in touch with now – both took local authority jobs in neighbouring (different) boroughs – one in a Child Protection team and the other in a Leaving Care team. I knew I wanted to work in adults’ services. I’d known from before the course started. I wasn’t so anchored as to which part of adult services I worked in. I was open to anything.

I met with the agency consultant and we spoke about what I wanted in a job and how far I’d be willing to travel. About a week later, he came back with two posts available and both were in older adults services. As that had been where my ‘statutory’ placement was, I was more than happy as I felt I had a little understanding and experience in that area. I interviewed at both places and chose the borough which was nearer to me with the added bonus that I knew a few people in the team already as they had been seconded onto the same social work course as me as ‘workplace based students’. Even one or two familiar faces in a large office was enough of a draw.

It was a large office and I had no experience apart from my placement, in a social services department. In some ways, I felt more than a little out of my depth but the team was kind and friendly. It also seemed to be staffed by about 50% of agency workers. I had heard rumours of prejudices against agency staff due to the differentials in the salaries  but honestly, I never really experienced that. I didn’t pretend to be anything I wasn’t.

If anything, I noticed more of a tension between ‘qualified’ and ‘unqualified’ staff than ‘agency’ and ‘permanent’ because a lot of the care management work we did was generic and especially when I was starting out, I was taking cases with less complexity than the more experienced ‘unqualified’ staff who would be getting stuck in.

In general though the unity of experience was greater than the division of types and salaries. The team as a whole could not have been friendlier or more welcoming. I was able to attend all the training courses provided, despite being ‘agency’. There was no differentiation in the type of supervision I received nor the inclusiveness I felt. Looking back, I realise that perhaps I was lucky but I worked with and among many people that I had and have the utmost respect for.

I would be afraid, at times, to ask the stupid questions. Where do I find this form? How do I find this file? How do I contact about this? What do I do when subjected to a hearty rant? Can I help this person get this service?

It seems like a different world now. Before FACS. Before any kind of charging policies. When we still met needs that would later be classified as ‘low’.

We didn’t type much. I shared a PC with the person next to me and we had to take it in turns to write reports or arrange visits with each other so we weren’t in at the same time – both wanting to use a computer. Along with our carefully designed care schedules, we had to provide costings for every service provided ourselves on spreadsheets either completed by hand or for the more techno-friendly, on PC.  Later it all got fed into central databases and spreadsheets so the figures would automatically be adjusted but there wasn’t a desk at that time, without a big desk calculator on it.

I think my memories have been shaded with a little rose tinge at times. I remember a lot of anxieties about covering duty and wondering what would turn up. This was before the single access points and call centre type offices existed to ‘screen’ calls or distribute them appropriately so we had calls from everything about loose dogs on the streets to people who hadn’t seen their elderly neighbours for a few days and were worried. Some entirely appropriate and some.. more creative.

I don’t miss those days though. It was a different way of working and a good base. There were some very good people I worked with. It was an ‘older’ team. I was immediately the youngest qualified worker in the team when I joined. I think that made it easier for me to ask questions. I learnt that the most important thing is to ask and not assume and that old chestnut about there being no such thing as a stupid question never felt more true.

Did the university prepare me for the work I was doing? A little but it was the start and  not the end. I have never stopped learning since then and I have a long, long way to go.

I realised that the lecturers at the time were teaching us about a social work system that had existed when they had been practitioners, about 10 years previously. I realised that the time pressures between being a student on placement and a qualified member of staff employed and paid were exponentially different.

There were problems and difficulties. I still remember some of the distress I felt when the first service user that I had worked with extensively, died. I remember the fear of my first manager and some of the bullying tactics she employed on the staff under her.

I had dreams at that point (I still do now, but very different ones). I wanted to travel the world. I felt I had a lot still to do. I vowed to myself I didn’t want to turn into the older staff that I’d seen there, plugging away after 10, 20, 30 years in the same post and becoming insular and self-absorbed.

Those thoughts pushed me to save up and leave after a year. I did go off and see the world and do many different things. I realised I missed the work, mostly I missed working in social care and I missed, well, I missed home.

I came back to the UK, a couple of years later, I was lucky enough to still be able to walk into a social work job and I knew it was exactly where I wanted to be and what I wanted to do for the rest of my career.

Things have changed a whole lot and some things are a lot better.

I’ll continue with my story at another point when I got back to the UK to find new legislation, systems, agencies and.. everyone not only had their own PC but they were expected to use it!

To be continued..

Personalisation and Professional Disillusionment

Yesterday, Community Care published the result of a survey they had undertaken about ‘personalisation’ among social care professionals.

The headline figures while wholly unsurprising, make for interesting reading where only 41% of respondents felt that service users would benefit from the implementation of personal budgets and 83% felt that cuts would impede the progress of the personalisation agenda.

To which my first thought was ‘only 83%’?

Anyone who has read some of my previous writing/ranting about personalisation will be pretty clear where I stand.

While the idea and the concept of introducing more person-centred support planning and opening up direct payments to a wider range of people is absolutely fantastic as a concept, the implementation has been dire.

There has been a complete side-lining of service user groups that don’t fit into the ‘easy’ mode – namely those with mental health problems, older adults and those who might not have capacity to involve themselves fully in the support planning process, the same figures and quotes that the government and her agencies roll out again and again about the man who pays for a PA to go with him to a football match instead of a day centre are so completely off the radar when the smaller pool of money available for care services exist that they are almost insulting to those for whom a) the thought of having enough money allocated to pay for two tickets to a football match would equal 7 showers a week – so it’s football or cleanliness and b) that group of people (because, yes, much as the government don’t want to accept it, they do exist) that actually WANT to go to day centres.

And so we plough on.

But even though I have had many criticisms of the way that personalisation and particularly personal budgets either managed centrally by the local authority (where the end effect is exactly the same for the service users in most situations) or delivered by direct payments (where someone has to have capacity and desire to take on the direct payment and employ assistants or have someone who is willing and able to do that for them) – there is more to the personalisation agenda and process which is in danger of being lost in the process.

Personalisation as a value base and an approach to work and social work in particular with people who need or who are eligible to receive services for care ties in perfectly with aims of re-addressing the power differential between provider and ‘receiver’ and the imbedded dichotomy between ‘giver’ and ‘taker’ in society.

That model of giver/taker which is bound within the welfare state system can create an imbalance and the potential to give back some of the ‘control’ and some of the decisions to the person who receives services may, in some way, redress elements of this balance. There is no way that my training and experience has taught me better than anyone else, what YOU as a recipient need. Yes, I learnt my theories and my models and understand that building social networks is important but if you prefer to do that at a coffee morning at the local museum instead of at a day centre that’s perfect. If you want your neighbour’s granddaughter to help with your personal care rather than an anonymous and frequently changing ‘carer’ from a local agency who is paid at mimimum wage and has a day full of appointments and who isn’t paid for travel time by her agency so she needs to cut short on some of the time – perfect.

But we already had that system with Direct Payments. Where is the difference?

Ideologically, the difference was that everyone would know how much money they were ‘getting’ – whether directly or managed and they would be able to be consumers. Our society tells us that money is power. Money creates consumers and the market will right itself.

Even, theoretically, when a personal budget is managed by a third party (and I include the local authority as a potential ‘manager’) you will know how much is ‘allocated’ to you so that you can ‘spend’ it in the way you want.

This doesn’t happen in practice though because local authorities need to save money and are still tied up into procurement contracts that make agencies unequal when ‘bidding’ for the funds that have been allotted via personal budgets.

I know this is getting a bit technical and complicated but it’s important to understand. I don’t think anyone can oppose ‘personalisation’ as an approach regarding empowerment and ideology.

The implementation, however, reeks of money-saving and penny pinching. It also has pushed the responsibility for services away from the local authorities and onto individuals and their carers.

You have £100 per week, find the care yourself – then we (the LA) aren’t responsible anymore.

I’m wholly in favour of contracting out assistance and advice on self-assessments and support planning to local voluntary sector organisations. My own LA tried that. We referred lots of people to them.  They withdrew because we were referring too  many people to them and the local organisations didn’t have the resources (or the contract) to undertake as many support plans as were being referred – but the idea is not one I have any problem with and in fact, I rather like it.

But this wasn’t offered to people who do not have the capacity to lead in their own self-assessment and support planning. The organisations couldn’t do that because they were not experienced in non-directed advocacy work – it takes longer.

It is hard to see through the budget cuts as well towards a future where, as Burstow as said he wants direct payments to be the ‘preferred method’ of delivery of personal budgets.  I don’t want to detract from the fact that this is and will be fantastic for some, perhaps most people, we move to a model where there is – again – a ‘one size fits all’ approach.

The true tragedy of the personalisation agenda is that is has and is coming to fruition during a period of cuts – the government (and the previous Labour government too) want to pull back the responsibilities of local authorities and with the criteria for accessing any support is rising rapidly it may well be that more and more personal budgets are delivered directly from peoples’ own savings or disability benefits (while they still exist).

I am fearful of the future for adult social care but I’m not necessarily unhopeful.

I think there is potential for change and development but unfortunately the ways I see of improving systems come at higher cost.  There has to be some major research and debate about the delivery of personal budgets and the way that personalisation encompasses people who lack capacity and lack advocates (family and friends) and how they can best benefit from this process – perhaps access to additional funds to pay for the trust fund type system of management we were assured would happen but in practice is not feasible for a relatively small sum of money as it costs more than it might deliver.

We need to see more about how support planning can work in the voluntary sector as, speaking personally, I genuinely don’t have time to do the process of support planning any justice as a part of my day to day job. It ends up being rushed because I can’t devote a couple of visits of a couple of hours to talk through and develop a truly person centred support plan.

The process of self-assessment needs to be reconsidered because while the idea is fantastic for some people – our self-assessment forms are biased towards physical disabilities and look scarily similar to a DLA form where people are asked to explain how they are on ‘their worst day’. That doesn’t really help with confident-building when you are working with someone who has very low self-esteem and depression/anxiety. The process of self-assessment in itself can and has been traumatic – let alone the person who is not able to engage with the assessment process due to a lack of mental capacity where questions about ‘dreams, hopes and wishes for the future’ while well-intentioned, can be hurtful and hard for families to listen to when they are asked to their parent who has advanced dementia.

I fear we have allowed a great conceit to be steamrollered into simply another ‘one size fits all’ approach to developing social care. It doesn’t have to be like this but that seems to be the government perception about what ‘personalisation and personal budgets’ are.

Choice is fantastic of course, but sometimes people want quality as well. It shouldn’t ever need to be an either/or. It does feel like it at the moment with the promotion of choice above all things.

So where are we going? Personalisation isn’t going away and nor should it. Personal budgets aren’t going away and nor should they.  Local authorities, however, might be going away – further and further away from social care and the responsibilities that they hold towards it.

We keep up with the advocacy and with the systems that are failing because we owe it to those who are reliant on these systems to make them work as best they can but we keep trying to pinpoint and pin down the flaws in the implementation with the hope that sometime, some day, someone will listen.

As professionals we don’t oppose personalisation. We have always been trying to use person-centred approaches. We just dislike injustice and inequity and that seems to be painted all over the current implementation and the frustration is that so few people (if any) in government seem to be aware.  Am I disillusioned? Yes, definitely. We were promised new ways of working in a more person centred way.

Desperate, no, not yet though as long as there’s some fight left in the belly to keep banging on and on and on about what personalisation SHOULD be and why it isn’t working yet. Not for everyone.

Guilt, Work and Switching Off

Over the weekend, I was reading Dorlee, from the ‘Social Work Career Development’’s guest post ‘The ABCs of Self-Care for Psychotherapists’ on ‘Private Practice From the  Inside Out’.

It is a useful and interesting list that can be extrapolated for many in the social work and social care sector – and probably many other sectors and areas where we work in stressful environments to be honest.
Libby's Guide to Total Relaxation

hewgriff @ flickr

It made me reflect on some of the ways in which our organisations work and are structured here in the UK and how unhealthy some of the ways we are forced to work are.

It is easy to blame poor management in the public sector (and that’s what I’m concentrating on, because honestly, that’s what I know) and in many cases it would be a fair place to apportion blame.

I have seen so many friends and colleagues ‘burn out’ by being almost criminally unsupported in the work place – ‘learning by doing’ through the false assumption that employers make that somehow social work graduates are immediately ‘ready for practice’ due to having one statutory placement.

Placements during the course are good arenas for training but they aren’t any more than a stepping stone to practice which is one of the reasons I am so strongly in favour of an assessed year of practice prior to registration as a social worker in the UK.

The real area for exploration though is the assumptions that are made at higher management levels about what work can and is safely carried out ‘on the front line’. I wonder sometimes what happens in the higher echelons of the Adult Services (and Childrens Services) directorates in the local authorities when they set some of the strangest and oddest targets and keep feeding the pressure on to the front line managers. It seems so very very distant.

So back to ‘self-care’ and ‘switching off’ from work.  It is something that, I think, for me anyway, takes practice.

I sometimes draw on my A level economics recollections of ‘Cost Benefit Analysis’ but instead of ‘costs’ and ‘benefits’ – I have the two ‘mental columns’ of ‘Things I can change’ and ‘Things I can’t change’ (without the financial implications!)

I can’t change whether Mrs M is going to have a fall this weekend. I felt that although she lacks capacity to make a decision as to her care and placement needs, it was in her best interests to stay at home in potentially risky environment as she had, prior to her dementia taking hold, indicated she never wanted to ‘go into a home’. She knows her way around her own home and while some ‘trip hazards’ may have been removed through an Occupational Therapy assessment and actions resulting from that, she remains a bit wobbly on her feet. Do I think about her when I go home on a Friday – sure, maybe a little – but I know I’ve done everything I could and I can’t stop her falling on a Friday evening or even on a Monday morning.

Am I worried about Mr Y who I assessed last week and made a decision not to admit to hospital under the Mental Health Act? Well, a little – after all, he wasn’t well and was disturbed – but I have to follow the criteria of the Act and I genuinely didn’t feel that he met them. Yet. I can’t ‘save the world’ or prevent all the accidents and incidents that might have adverse effects happening – so I try not to over-worry about them.

I am bound by the law of course and if someone doesn’t meet the criteria for compulsory admission to hospital under the Mental Health Act and they retain capacity – there’s nothing I can do. Quite rightly. Although sometimes, that instinct that drove me into this job – the ‘wanting to help’, the ‘wanting to make things ‘right’’ – it tries to pull me in another direction and those seeds of worry can be planted to blossom through the evenings and early mornings or over the weekend.

Sometimes I have to do this consciously and logically tell myself to evaluate situations.

Sometimes the worry comes because there are things that I haven’t done at work – telephone calls I haven’t made – reports I haven’t sent – visits I haven’t made.

Time is limited. As long as I can justify the time I do spend at work, I try to detach myself from these thoughts. I could always do more but the job is one of constant re-prioritising. Sometimes I forget to do things I’ve said I’d do or follow up on things I said I would. It happens. While it is my ‘fault’, I don’t necessarily see it as my ‘failing’. I know I can account for every single minute that I’m paid to be at work – even those minutes that I’m sitting chatting to colleagues about the weekends’ television or having a cup of coffee – because if we don’t have those minutes, we run the risk of further rushed, unreflected, unthoughtful pieces of work.

Colleagues have told me since my first social work job how important it is to look after ourselves in this profession.  The spur that often drives people into social care is a wish to make a difference and perhaps a desire for self-validation – the odd pat on the head of feeling that you made a positive difference to someone’s life. Unfortunately that same trait which is usually a force for good can be used and manipulated by managers to force people to work overlong hours, not take breaks throughout the day, push people to take work home because, you know, Mr K will suffer if you aren’t able to finish the paperwork this week. They know well how to pull on our ‘conscience’ because the same happened to them when they were mere practitioners.

It’s hard to say ‘no’ when you know the people involved. I’m drawn into some of the guilt because I promised to visit Mrs P last week. Well, I won’t say promise, because I don’t put things in those terms, but I said I would – then things happen and other things seem to take over and the telephone call about this or that suddenly has to take priority – and before I know it the week is over and I haven’t seen Mrs P or written up the report that I should have or telephoned a family member to confirm dates for respite.  It’s hard not to feel that I haven’t done my job.

But by weighing up what I did and how I prioritised, I can, at least switch off and learn to ease some of the personal responsibility by redrafting and reframing it as organisational guilt and responsibility.  That isn’t to say that I slack off or try and push the blame on others – to be clear, I never do that with a service user – and always take personal responsibility there as the last thing anyone ever wants to here if they are upset, disappointed or distressed is a social worker trying to fob them off on someone else – but mentally I try and differentiate between ‘things I can change’ and ‘things I can’t’.

For me, it works. But sometimes it’s something that has to be learnt each for themselves.

Eligibility, Birmingham and Cuts

Birmingham was the first English town without ...

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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.

Between the NHS and the Local Authority – On Being Seconded

I’ve been a local government employee for a good number of years but however much I try to ensure that I am fully linked into the policies that trickle down to us via my own employing council, I can’t help but feel an increasingly sense of separation on the basis of my ‘secondment’. Don’t get me wrong, I think the advantages of the secondment outweigh the negatives but it’s something I tend to just take for granted.

It isn’t uncommon for mental health social workers to be seconded to mental health trusts. It is the case in most of the mental health teams I know. While my colleagues whom I sit alongside are employed on NHS contracts, only the social workers in the team are local authority employees.

The background to this is mostly historical. Before community mental health teams were interdisciplinary in the way they are now, social workers within the local authority worked generically and so when these new teams emerged, some of those generic social workers were moved out and seconded into the new teams in the NHS. Legally, there was also a provision in the 1983 Mental Health Act that specified that Approved Social Workers should be employed by the responsible local authority.  A change in the legislation with the passage of the 2007 amendments to the 1983 Mental Health Act mean that the employment is no longer specified and there are some noises about some of the social workers being employed directly by the NHS but I feel relatively confident in saying that my position of being seconded to work in the NHS by the local authority is likely to be the majority position for Mental Health Social Workers in England at the moment.

I moved into this team  from a local authority social work team and without doubt there is an increased feeling of isolation and detachment from our local authority employers when I compare the experience to that when I worked in the local LA office.

On a very basic level, we are frozen out of the intranet and the local authority IT system. It wasn’t always like this and isn’t supposed to be like this but increased security both on the Local Authority IT systems and the NHS systems mean it is impossible to run both networks on the same physical PCs.  Whisper it quietly but I haven’t checked my local authority email address for about three months and only get around to it when I visit other offices and can borrow someone else’s PC that is ‘on the network’.

The difficulty in this is that some people in our communication department, despise being told again and again and again, refuse to believe us and persist in sending all relevant information to our local authority email addresses.

Some people in other departments repeatedly try to contact me via the LA email address and although I have an ‘out of office’ response on it, I always find things that I should have seen much earlier when I check it. I know, it’s my own fault but they don’t make things easy for us!

It also means the ‘wonderfully efficient’ e-tools that the local authority has in place on its intranet to do all your appraisals online and to book annual leave and training online remain barren and unused and we are using scraps of paper to log our annual leave because HR wants to charge us for paper versions of the old ‘cardboard ‘real’ Annual Leave cards’.

It also explains why, apart from safeguarding training, I receive almost all my annual quota of training from the NHS Trust rather than accessing the local authority training schedules.

Recently, I did find myself in a meeting over in the local authority offices and  I was actually staggered by the amount of policies I hadn’t been aware of, training I haven’t heard of and ways of working that had completely passed me by.  Of course, none of it makes a massive difference to practice (which makes you wonder about the people who sit in offices and write reams of policies)  but sometimes you feel almost as if you have a duel identity working in an NHS team as a local authority employee with neither ‘employer’ wanting to take overall responsibility. Mind, I’m still a bit bitter about the lack of our involvement in the development of personal budgets. I genuinely believe we could have created a far better system if we had been consulted about the way that process had been rolled out and piloted.

But the positives outweigh the negatives. Apart from the annoyances that emerge when trying to claim any kind of expenses back for travelling which involve begging a ‘friendly’ local authority team to let us please use their budget for our ‘permit to travel’. Fortunately having previously worked in the social services office, I have some contacts to lean on at the requisite moments but it is not something that is made particularly easy for us.

The main positive is the sense of independence for a start. We are slightly detached from the rest of the CMHT having different employers and can sometimes take a step back. Personally, I think it allows a greater freedom to challenge ‘from the outside’ as one thing that can definitely be said about the NHS is that it is a hierarchical organisation. By remaining slightly outside as seconded employees and being ‘representatives’ of the local authority within CMHTs gives it a slightly different hue and sphere of influence.  The role of the Mental Health Social Worker in a team has to be about advocacy and promoting involvement and bringing the importance of social issues into the scene when looking at helping someone holistically.

Terms and conditions are generally (although this is arguable) better in the local authorities. None of the social workers want to switch over to NHS contracts (because yes, it has been discussed many times and is something that seems to be perpetually ‘in the pipeline’ since the change in the 1983 Mental Health Act).

I think the feeling of difference is remarkably important and it gives the local authority a physical presence in the team which is particularly important as care management and support planning is a massive part of our role in older adults services. The introduction of personal budgets to all our service users has meant that more information and documentation is channelled between the teams but I can’t help the nagging feeling that we are sometimes the  ‘forgotten’ employees. This is not always a bad thing.

As well as the intranet and the lovely sparkly new HR systems that we can’t use, on a far more fundamental and basic level, we can’t use any of the local authority databases. Their attempts to move everyone to paperless working mean many battles trying to explain to whichever service it is that we can’t get onto the intranet to make referrals online seems to be a constant.

In my dream world, the local authority would issue some kind of communal email to everyone in the council telling them that not everyone who works for the council can actually access the intranet. I think that would come as news to them on account of the amount of times I’ve tried explaining this to baffled looks of astonishment.

But generally, I’m happy where I am.  Taking a step back and looking at the situation in the broader context, I think I have and am continuing to learn incredibly useful lessons about the ways that organisations develop and grow and work or don’t work.

Sometimes there are frustrations but if everything worked perfectly, it would just be more boring and standing between both the Local Authority and the NHS allows for a more critical reflection of the ways that both operate and are managed in a way that I couldn’t have if I were entirely placed in either one or the other.

The Past is Another Locality..

The RedBalloon office - an example of an open ...

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I’ve mentioned this before, but I have worked in a couple of different teams within the same borough. Through fair means or foul, yesterday, I ended up in the office where I used to work before I moved to my current team, roughly five years ago.

I was there for a meeting in one of the side rooms but decided to wander into the open plan area (after making my way through much better security than there had been when I worked there!). Fortunately, someone ‘official’ recognised me and ushered me in.

The room had changed. They have  moved to ‘smart working’ with laptops and hot desking. They have little lockers with their names on, reminiscent of school – as the lack of personal desk space means that things can’t be, as they were, left on desks.

Some of the faces have changed as new people have arrived and older ones have left. Retired or ‘reconfigured’ to different teams.

But there were enough familiar faces for me to find a warm welcome. It had been a good team to work in.

I commented on the desks and the laptops and I was met with some level of surprise that ‘hot desking’ hasn’t yet made it to our offices.

‘No’, I said ‘we still have our own desks’.

I was met with wistful sighs of memories long past.

As I said it, I could feel the preciousness of those words – and acknowledged, internally at least, how rare they  must sound to this team.

We passed some general conversation about respective families before inevitably asking about work.

‘How are things going here?’ I asked tentatively.

A few nervous laughs and rolling of eyes.

‘Busy – but that’s pretty much a default decision’.

I decided to grasp the proverbial nettle.

‘How about.. the cuts?.. are they affecting you guys.. are there any jobs going?’.

I still work for the local authority but feel a sense of detachment as I am seconded into the NHS – so I don’t always get the same information as those directly working in the local authority might get. I was really eager to find out some more information.

‘Think so’. ‘Yeah’. There were despondent nods and acknowledgments all around. ‘There’s no money left in next year’s budget, let alone this years’.

I nodded

‘People are leaving and not being replaced – that’s mostly how we see it – but we are being asked to do more. There are rumours about people being asked to leave but we haven’t heard anything concrete yet’

They told me about services that were closing – day centres, sheltered housing losing the on-site wardens, posts being amalgamated.

The  morale was notably low. It had been a happy team, full of chatter and jokes. I like where I work now. I like the work I do now. But that old team had been and is the friendliest I had ever worked in, as a member of staff.

It was flat and clinical now. People didn’t have the same opportunity to build relationships with colleagues. There were no students (a couple of the social workers there, at least, are practice teachers and a few more on top would be workplace supervisors). Usually, when I have been there there were always at least a couple of students around, this time of year.

I asked.

‘Nah, we haven’t taken any students in this team this year. We just don’t know what’s happening in the service. There are more meetings planned but it isn’t fair for a student to be learning in this environment at the moment’.

I was given the names of a couple of people who had left or were about to.

It was the team I remembered but it was a shell of what it had been. The spirit had more or less been sucked out of it as we are increasingly turned into mechanised automatons drowning under paperwork in what had been heralded as a system of paperless offices.

I think I might have seen the future.

It wasn’t working.

It was inputting.