Respite, Disability and Personal Budgets.

Rivan Vincent has been prominent in the news over the last day or so.  She has a six year old daughter, Celyn, who has quadriplegic cerebral palsy and epilepsy. In the face of additional respite services being denied to her, she expressed her frustration on a Mumsnet forum stating she had asked social services to take her daughter into care because she could not cope anymore.

From this forum post, a campaign was generated which has led to coverage in many national papers.  The Mail, The Guardian, The Telegraph, the Mirror, The Independent,  – they all cover the story.

All, quite rightly broadening the debate to concentrate on the wider issue of access to respite for those who care for people (particularly children) with disabilities has had welcome ‘column space’ in the news agenda.

I really hope that Ms Vincent does receive the additional support she needs and it is possible she will due to the intervention of the Prime Minister in her case.

What I hope, far more, is that the debate is continued and that it is not only Ms Vincent, and not only the carers of children with disabilities that benefit from this flash of publicity.

I am concerned that the government have batted back criticism of their promises to promote respite by claiming that they are pushing extra money into these services.

An extra £800m apparently. Not ring-fenced. Going to local authorities. So in effect, it is money that is going to be swallowed up with other care costs and the government can claim the moral high ground – but pushing an additional £800 million into respite care while taking hundreds of millions of pounds from local authorities in other areas doesn’t really cut mustard, so to speak.

I wonder how long it will take for the government to blame local authorities for not providing care services. Not too long.

The Telegraph leader which urges us not to blame Downing Street for these matters

South Gloucestershire council, not Downing Street, has declined Mrs Vincent’s request. No doubt its social services budget has been cut – but is there no money to be saved elsewhere? The council’s website is heavy with the jargon of environmentalism and diversity. Perhaps its “equalities team” could be slimmed down to free up money for Celyn. And perhaps other local authorities should start dismantling similar initiatives before cutting front-line services and putting the blame on the Government.

So we see the rub. It is the council that is spending things on anything that isn’t ‘front-line’ that is ‘to blame’ for the current situation.

For me, it’s important this opportunity isn’t lost to create more interest and focus on the role that carers play not just carers of children with disabilities but all carers. If the government really wanted to help more broadly, they could look at the insult which is Carers Allowance. That would put more money in the hands of carers.

The problem is that for every Celyn who has public focus, there are hundreds of thousands who don’t have the same media access and spotlight. Saying that it is important that this becomes and remains an issue in the public consciousness.

The fact is, it comes down to money. Better care costs.

It also seems almost woefully ironic that in the face of cuts to Disability Living Allowance and Employment and Support Allowance, the government seems to have found a conscience for disabled children.

Cameron would be as good to remember that children grow up and continue to need support and continue to face higher costs of living than people who do not have disabilities.

There’s an article on the  Guardian’s website from the mother of a disabled child, who writes, in the context of her frustration about the process of assessment by social workers

Instead of strangers with clipboards, the first stage in an assessment could be made by the disabled person themselves. My daughter could have been asked to keep a detailed diary of what she did and what she needed help with. It needn’t be written down; it could be recorded or dictated. This would allow her to paint a rich portrait of her teenage life, which includes going out to see The King’s Speech with friends, as well as someone helping her on and off the toilet.

This baffled me because that is exactly what is and has been happening through the roll out of personal budgets and self-assessment questionnaires. People DO write their own assessments now. They shouldn’t need to be written. They can be recorded, drawn, dictated – that is what we were promised in theory.  This is exactly what the Putting People First agenda should be doing and encouraging – instead of generating a whole new pile of forms.

This week I had to have a couple of support plans for users of  Personal Budgets approved. They were both for older adults with dementia who unfortunately were not able to take as full a role in the decision process as would be ideal due to a lack of understanding, however, I spoke extensively to family members and gained a good feel for the situations at hand and provided advice as to what I felt might be useful.

Family members while involved felt confused by some of the details so I tried to simplify as much as I could.

Infuriated by the paperwork, I pushed my ‘forms’ to one side and wrote out the support plan that we had discussed extensively on just a plain piece of paper. I was frustrated by the level of repetition that was expected of me.

After all, I remember training I had been on about wonderfully creative support plans and all the nodding and smiling about that’s what we should be using. Let’s work in new ways and break out of local authority mentality.

I took my ‘new style’ paperwork which involved just free form writing. No questions answered.  No exposition about what could or could not be done.  My manager thought I was having a joke with her and I responded, no, I hadn’t filled out ‘x’ form or ‘y’ form. This was the support plan that I was presenting.  They nodded and agreed.  Then told me to copy out all the information into one of the local authority forms.

I did because if I hadn’t the services might not have been provided in the same way and to be honest, it didn’t take me too long but it is indicative of the type of way that people have been working for so long.  This happened to me two days ago.

Local authorities have had lots of ring-fenced money to promote the shift to personal budgets. I think some of the focus and project management has been aimed at wasting as much of that money as possible.

We are left with systems that are barely shadows of what they could have been. Sure, they work fantastically for some people but the rest have to pick up the dregs that are left behind.

Hopeful thoughts  for the day.

a) It’s Friday

b) Ms Vincent’s desperation and plight will lead to greater insight and better services for all disabled adults and children and their carers.

Care Credits

Paul Burstow MP, Minister of State for Care Se...

Image by Department of Health via Flickr

Over the weekend, the Paul Burstow announced that he was looking at the system of ‘credits’ where people who volunteer to help older adults and adults with disabilities in exchange for ‘credits’ towards their own care when they are older that can also be ‘cashed’ in favour of family members.

Where to start on this? It sounds wonderful in theory and ties in to the happy, smiley so-called ‘big society’ theme. Let’s all help each other and do pleasant voluntary work. The issues come on a few different strands.

Firstly, it is not entirely voluntary if there is an active reward in place. It is payment by another less obvious (or perhaps clunkily over-obvious) way. Perhaps I have a romanticised view of voluntary work – I have spent a considerable amount of time carrying out voluntary work for the record, and the motivations that might push someone into caring for potentially vulnerable adults is something that has often raised red flags to me.

Secondly, it is absolutely a system that could potentially favour the time (and cash) rich who would have more leisure time to expend on voluntary work.

Thirdly, it could take work away from skilled social care workers and intimates a potentially dangerous ‘anyone can do it’ attitude towards care work as picked up on the Going Public blog over the weekend.

One of the more concerning aspects that I heard about was a report that the Care Minister, Mr Burstow was suggesting that you get more ‘credits’ for carrying out personal care than you would for domestic care.

Now that, was the really frightening part for me.

He suggests that these volunteers would not only be engaged to carry out the tasks that a voluntary organisation might cover today – some befriending, popping out to get some shopping, this is all covered in the current system (on a purely voluntary basis of course), a bit of company and a chat over a cup of tea.

Very different to introduce a ‘personal care’ angle. This is care that should be provided by professionals who are trained and have to adhere to a professional contract. Personal care is not something that anyone who fancies a few extra ‘credits’ can turn up and do. It sounds great on paper but firstly it is a way of shifting the expectations of what the state will provide for older adults and adults with disabilities, it denigrates the experience and training of those who currently carry out this work well – (I know there are A LOT of problems with some care workers but honestly, if you think it is bad now, wait until the volunteers arrive.. and there are a lot of very good care workers as well!), it potentially discriminates against those who, for whatever reason, have not been able to ‘build up’ their credits, either because they have some disabilities themselves, or just have to devote all the possible time they have to raising a family, caring for a family member informally or just, well, working hard to pay the rent/mortgage.

Would this scheme be developed into other areas or professions? Will I get credits against my tax bill if I run a through sums up on a calculator? Will I be able to get my copies of the daily newspaper free because I ramble on a bit on a blog? If I pop into a school and talk about something or other that I know about, will I get credits against a night class?  If I put a plaster on the knee of a kid who falls over in the street, will I get credits towards my prescription costs? I shouldn’t give them any ideas, I guess – but for me, it is a devaluation of the adult social care sector to suggest that ‘anyone can do it’.

This is another erosion of our expectations of what the state will provide for us. Who would honestly believe that any credits achieved now would seriously be honoured by a different government in 20-30-40 years time?

In some ways it is the idea that has been planted in our head that we should assume nothing is sacred as the government chips and chistles away the support for the least able at every level.

Sure, it is the older adults, adults with disabilities, people who are unemployed who will be first,  but the ideology behind the cuts is becoming more and more apparent.

I thought I was a fairly passive, fluffy, pragmatic, ‘let’s all get on and be friends’ type of person and I am, for the most part but I’m really angry with the government now. Really, really angry. I haven’t felt that since I was at school and railing against Thatcher in my highly ideological Marxist phase…

The government is set to destroying the foundations that have taken decades to lay down and it is not something that we should be willing to give up without a fight.

Of Pride and Social Work

I have attended a number of meetings and training events recently that have been either borough-wide across social workers in many different teams or across different boroughs. These events have put me into contact with a lot of other social workers I wouldn’t otherwise have met  – in my office there are three others, one of whom is my manager.

At one of the events, I was the least experienced by about a decade (and I’ve been qualified for 10 years myself). All the other participants had been working in the field or in management for 20/30 years, some were recently retired or about to. They bemoaned the state of social work in general and how difficult things had become, how paperwork was overwhelming and face to face contact was not given the priority that the job deserves. When it was my chance to ‘introduce’ myself, I expressed surprise at some of the negativity because I’m fortunate to be in a position where I enjoy my job and perhaps despite some of the endless reorganisations and reconfigurations, the positives far outweigh the negatives. It is very easy to revert to the ‘wasn’t like that in MY day’ type rhetoric.

Another training course and a different group of people. Again, we were talking about social work and being a social worker in quite general terms by means of an introduction. The facilitator said that she felt it was so sad that no-one was proud of being a social worker anymore and that people didn’t tell others their job for fear of a poor response.

Participants nodded sagely and sadly.

I was confused. I have never not told someone I’m a social worker and am immensely proud of my job and my profession. Is that really so unusual? I didn’t think it was, especially. Maybe it’s the friends I mix with..

Processing these thoughts, I figured if we are so negative ourselves and show no sense of pride, is it any wonder the contempt that we are able to be held in more widely?

Yes, there is a media agenda and the government won’t get much political capital from pushing money or praise into social work but surely self-pride, respect and strength is what emanates outwards?

Personally, I think there is an overemphasis on ‘status’ and being ‘considered professional’ which reeks of self-indulgence and lack of confidence. It is almost like the profession is trying to look for reassurances from the ‘general public’, the ‘press’, other ‘professions’, in order to put ourselves on a par.

But often respect is as respect does. Yes, we have had to deal with some rather bizarre chopping and changing to regulation/training/function over the last decade or so – but sometimes we, as a profession, don’t always help ourselves.

We can look jealously at the esteem that other professions may be held in but that doesn’t mean we must expect automatically that the professional title we hold will be enough to garner that respect.

Professional independence doesn’t always have to be granted, sometimes it needs to be claimed.

We are in a precarious position at the moment. Local government is shrinking. Anyone who thinks social care or social work is exempt from the forthcoming cuts is living in an illusionary world.

The Guardian is reporting that Suffolk County Council are about to outsource virtually all their jobs and services

A few neighbouring boroughs in London have been looking at sourcing joint services between them which is an obvious way to reduce staffing costs.

A good social worker is and needs to be an advocate in a broad sense – for the people that the service is intended to serve.

A good social worker is a confident social worker.

Is being proud such a rarity in the UK that the matter was brought up again and again to me in various ways and means? Maybe.

I sometimes have waves of negativity. I have no doubt it is evident in my writing. I get angry at some politician or journalist who might show an extreme lack of knowledge in the sector or the environment. When I get into one of those fixes, I find the best thing is for me to recall why I wanted to be a social worker and what I love, not just about being a social worker but about my job in particular.

I wanted to fight societal injustice and still do. Social services are entrenched in social policy and social policy adapts quickly. We have to be able to think on our feet and think independently. Perhaps some of that independent thought has been ‘managed’ out of some of us by an encroachment of Performance Indicators and constant outcomes measurements.

Of course these need to be done because there has to be some measure of efficiency. Most people can probably think of a few in any office who might be less inclined to hard work than others. The ends cannot however, justify the means.

A good social worker is compassionate, competent and confident. Compassion without competence or confidence will not be enough. Competence without compassion is not enough. There is a need to actually care about individuals and the results of interventions. That doesn’t mean we have to like the people we work with but we have to offer an equitable service regardless of personal feelings and opinions.

Compassion and competence without confidence may result in being led by potentially poor management.

How are these skills developed? Not just through university courses but by good examples and good supervision in practice. A confident and competent manager will, as often as not,  have confident and competent staff.

So to anyone thinking about the profession who might be put up by the malaise of negativity that sometimes engulfs us, don’t be.

There is a lot of work to be done still. There are a lot of inequitable systems that need to be fought and they can be fought from within, indeed, they need to be.

Vacancy Rates

Community Care have published a special report into social work vacancy rates in the UK. The report finds that 1 in 10 social work posts in the UK are currently vacant according to information that they have put together following a Freedom of Information request.

There has been a big push towards social work recruitment over the last year, indeed, the article states that

In England, where the government has invested £11m in recruitment campaigns and at least £28m into the reform programme, vacancy rates have risen from 10.9% in 2009 to 11.3%.

I would expect it’s too early to see the benefits of these investments as a lot of the push was towards social work training so it may be interesting to see any changes in the amount of people applying to study social work degrees has changed but it’s still a very high rate.

The breakdown of figures shows that the highest vacancy rates are  in the East of England at 15.3%, running slightly ahead of London at 15%. The lowest vacancy rates are in Northern Ireland.

It’s interesting that Northern Ireland, Wales and Scotland have lower vacancy rates than England. England is less cohesive and there are more variable elements. The GSCC seems to have lost its way somewhat and there is less of a shared identity across the whole of England perhaps.

Social Work according to another article in Community Care, has a different status in Northern Ireland where it seems to be (or at least, that’s my inference from the article) more highly respected and sought after – meaning that universities can be more selective and that vacancies are more likely to be filled by competent applicants.

In Scotland, the example is given that the workforce may not be as mobile and that social workers are more likely to live and work in the same areas.

The problem is, well, one of the problems is that the higher the vacancy levels, the worst the strain is on the current workers and the more likely they are to burn out or leave – leading to the problem existing in a cyclical nature.

There doesn’t, from my brief glance, seem to be a definite trend as to whether the vacancies are in adult services or children services.

For example (using London as it is what I am familiar with)

Waltham Forest has vacancy levels at 47.8% in children services and 16% in adult services whereas Richmond Upon Thames has children vacancy rates at 26.1% and adult at 43.1%.

(come on Richmond, you must be able to do better than that !)

Those are just a few of the examples.

These figures don’t surprise me. We knew as much last year and this is not a situation which is going to solve itself within a year. The changes I, personally, have seen in the year – well, we’ve had people leaving our team whose posts are not going to be recruited to. Reconfigurations have meant that those posts have now ‘officially’ disappeared and therefore wouldn’t show up in any statistics on vacancy levels but they are vacancies because there are fewer people to do the same amount of work.

On a real level, that means quality slips, mistakes are made and increased pressure makes a less healthy and potentially more expensive (sick leave) workforce.

But this isn’t news to anyone. This is common sense.

Going back to the initial article and report there are a few things that worry me and I am speaking from my position as a social worker particularly in adult services.

Tim Loughton has written a piece for Community Care pledging to bring down vacancy rates in Childrens Social Work. He is the Parliamentary Under-Secretary of State for Children and Families. But – he has also been tasked with overseeing the social work reforms. Of course his priority will be seeing to the childrens’ services. That is where the political capital is to be gained.

Again, Community Care emphasises this explaining

English councils can now access a share of the £23m local social work improvement fund for children’s services promised in March.

Other programmes aimed at children’s services in England include the development of an advanced social work professional status, due to be launched by the Children’s Workforce Development Council next month. Keith Brumfitt, director of strategy at the CWDC described this as “a retention and reform measure to keep experienced people in frontline jobs so they can share their expertise”.

Where is the input regarding Adult Services – where in there any government minister showing an interest or pledging that social work in the adult sectors will be injected with cash or promoted or that our services are actually vitally important.

It shouldn’t need to be a competition but my worry remains that with the money and the focus on vacancies in childrens’ services, adult services which are suffering equally and more silently, will be slowly sucked dry of any expertise.

Community Care teams will be replaced by Support workers who validate self assessment questionnaires as they come in but the underlying principles, training and theoretical base is lost and Mental Health teams slowly replace social workers with ‘mental health practitioners who can come from a wide range of disciplines of which social work is one’.

Social Work has a lot going for it. It is a lot more than administration.

To me, this is the ultimate legacy of the NHS and Community Care Act and the advance of Care Management to the stage that there is no longer any need for a professional background to carry it out as it increasingly becomes more about ticking boxes.

Hope remains in the form of the Reform Board though and possibly developments attached to the establishment of the College of Social Work.

Things can only get better.

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).