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.

Tories’ Insurance Plan

I like to follow the news and so, yesterday, when I heard about the plan proposed by the Shadow Chancellor, George Osborne to allow those approaching 65 to purchase a type of insurance policy for roughly £8000 to cover future cost of nursing or residential home fees, the idea actually baffled me.

image banalities at Flickr

Sure, it served it’s purpose and made lots of headlines about the stretched middle classes who resent that they have pay for services that they receive in later life, even if it means selling their own home to do so.  But the proposal made me wonder how much Osborne and the Conservative Party actually know about the current system and the changes that the ‘Putting People First’ agenda is pushing or whether (which I suspect is the answer) they are chasing cheap headlines.

I will be clear and say that as a home-owner, there is no way on earth I would recommend anyone taking out this insurance at 65. The likelihood of going into ‘care’ is minute. Some newspapers quoted the figure but the current policy is to (quite rightly) keep care in the home as much as is possible. Those who have underlying health conditions that might indicate a propensity to need this  type of care would be excluded from the ‘insurance scheme’.

I suppose I come from a position of seeing how much care costs to the local authorities who fund it and thinking that if someone can pay for their own care, there is no reason that they shouldn’t, however I know that is not the opinion of the majority of the Great British Public and it is politically expedient to provide a ‘solution’ to this issue for the voters.

As pointed out in the Independent, the option of taking insurance against long-term care already exists in the private sector insurance market so presenting this as a public policy also makes little sense.

As with all policies though, the devil is often in the detail rather than the grand posturing designed to capture the attention of the media – just as Labour’s ‘free care for those with highest needs’ did last week.

I am sceptical of both plans to be honest, especially as the consultation period is still open for the Green Paper on the funding of Adult Care. I will await the results of that consultation although it’s looking increasingly likely there will be a change of government next year so we might be back to the beginning again..

A future for adult social work?

Community Care carried out an investigation a couple of weeks ago which found that vacancy rates in adult and children and families’ teams were roughly equal therefore the news that the Migration Advisory Council have dropped specifically adult social work jobs from their list of ‘shortage professions’ while children and families jobs have remained may seem curious.

Further investigation though makes the move seem a little more nefarious.  The Guardian reports that

The decision to remove social workers involved in adult services from the official shortage list follows the introduction of new initiatives to increase the number of students on social work courses and to improve the retention of more experienced workers.

The decision to ban recruitment of international qualified social workers, however, will not apply to those involved in child and family services, where it is considered that a national shortage remains. The MAC’s report says recruitment difficulties in this area have been exacerbated by the negative media image of social workers responsible for children.

Understandable but it does beg a lot of questions. Are all the proposed new graduates expected to go into adult social work jobs? Or are there just going to be less qualified jobs to go round..

Hilton Dawson the new Chief Executive of BASW (British Association of Social Workers) writes in Community Care that

BASW regularly receives complaints from members in adult services who speak of major reductions in social work jobs and, significantly, of a devaluing and lack of understanding of the social work role. Social workers are beginning to feel excluded from personalisation. The unique and vital contribution that social workers can bring to this crucial agenda is being dismissed and ignored.

The Personalisation Agenda remains largely mysterious. There are a few pilots usually with capable adults who benefit massively from being able to design and determine their own packages of care and where the money should be spent but little of the literature (that I have come across – and I have looked) seems to approach those user groups that were and are poorly served by Direct Payments – namely older adults, adults who lack capacity and those with mental illnesses who have not benefited to the same extent as other groups. It makes the right noises though – user choice is, of course, an incredibly positive goal – more holistic, devolved power and services.

Although the aim of the NHS and Community Care Act was to create a role of ‘care managers’ who could help to pick and choose services from different providers and put together user-centred care packages in a holistic manner – and look where that ended? With councils bidding each other down to provide ever cheaper services from private companies who pay a minimum wage salary to inexperienced care staff to rush in and rush out of many homes and houses on tightly implemented limiting packages where there is no scope for any ‘leisure’ activities apart from local day centres – is that was what envisaged when it was laid before Parliament? I don’t want to be over-cynical but it’s hard not to be.

So where does that leave adult social work?

There is likely to be a continuing need in adult protection but the sizes of teams will not be equivalent. In mental health teams which move more progressively towards generic roles, Approved Social Workers have transmuted into Approved Mental Health Professionals – and although the place of a voice for the social model of mental health care remains more than necessary, there is a move towards job adverts more generically calling for ‘mental health professionals’ rather than Social Workers, or CPNs or Occupational Therapists.

There is no doubt in my mind that a signposting role has significant importance for older adults and some people, even those who might not fit into the criteria for a mental health team, do need more outreach work  but is that a place for statutory services?

Perhaps the future of adult social work is actually in the voluntary sector?

It isn’t surprising that protecting children is seen as more ‘urgent’ but really the levels of abuse of older adults is often overlooked – and although it shouldn’t be a case of ‘compare and contrast’ it is difficult to ignore the push to marginalise further vulnerable adults when honestly, abuse of a person is abuse of a person – cruelty is not dependent on age.

As care services become more tailored to the ‘30 min’ rush-in rush-out visits that rarely last 30 minutes there is a greater scope and need for a more cohesive protective and preventative service in a sector that has almost no lee-way to work on any preventative measures apart from for a very small group of people who might fit into specific criteria in a specific service.

All the focus and interest remains very much in the domain of those who work with children and understandably so – it is more emotive and of more immediate concern to the general public.

I wonder why it is so few people are actually concerned about the services or lack of them, provided for older adults. Personally, I think it’s because we don’t want to think about getting old – young people, children – they are ‘other people’ – older adults, they are our parents, and us – eventually. Sometimes we just don’t want to be reminded but one day we are going to have to be.

Depression Awareness Week

Just a quick post today as I need to get myself to work earlier than usual but I noticed that the Depression Alliance are kicking off  ‘Depression Awareness Week’ today.

The Depression Alliance have published some related research (pdf) in time to mark the start of the week which

reveals the majority (79%) of people diagnosed with depression in the UK feel disclosing their condition to colleagues would have a detrimental impact on them, and nearly a third (32%) believe they have been turned down for a job

I can’t say that any of those figures strike me as particularly surprising but it goes to show how important it is to combat the stigma that is associated with mental illness.

Meanwhile the Depression Alliance’s website, which I’ve been browsing through extensively this morning, has an impressive list of links and useful sites that I know I intend to explore more fully in time!

More Sunday Ramblings

Not a ‘proper’ post this time but a few random thoughts that have occurred to me.

Firstly search terms on my blog. This is one of the more interesting aspects of having a blog and it is one that I’m sure others can attest to. Yes, I get a list of all the search terms that people type into google to come up with this blog.

So, I can see that over the past few weeks, I’ve had LOTS of searches for ‘deprivation of liberty’ ‘mental capacity act’ ‘best interests assessor/assessment’ and variations such as ‘case studies for best interests assessment course’ and ‘jobs for best interests assessor’. A sign of the times, without doubt.

I’ve seen a surge of searches for ‘gifts for social workers’ – much though I hope some of those people know me and are planning something special, I’m sure it’s related to the upcoming World Social Work Day – forget the suggestions I touted on the post – chocolate is ALWAYS good.

I still get quite a few hits on hypochondria and more than a few searching for information about memory clinics and recently, a number have been searching for information about making affirmations instead of taking oaths.

I don’t get as many ‘strange’ searches as I used to and while that’s good in the sense that people are finding what they’re looking for – it used to keep me marginally entertained!

In any case, it is a good way of judging a zeitgeist moment!

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I work on a floor of my office where there is a rough ration of 25 women to 2 men. Why do I still feel awkward going into the men’s toilet then when there is absolutely no difference except the little sign on the door? That is good social conditioning!

Sometimes the sheer negativity of colleagues can really be incredibly draining. I have to bite my tongue sometimes but it’s worth it in the long run. I think there is nothing sadder than working alongside someone who is clearly burnt out and resentful but can’t leave for financial reasons.

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I am SO glad I jumped from a generic adult community care team to a specialist mental health team. Care management was turning me into a word processor where any attempt at creativity was being sucked out of me by targets and systems. I still do some care management now but have more flexibility with it. I still work to the same targets and with the same systems. The difference is that I do other things as well – that’s the key. I haven’t had the will to exist managed out of me – which I fear was close to happening in my previous job.

Madmutt asked me on Twitter why I thought generic training was important in social work. It was hard to respond in 140 character messages! He did an admirable job of getting the argument across that teachers and nurses specialise early so why would it be different for social workers.

My (a little more extended) answer is that it is not strictly comparable. Of course specialisation needs to happen  but not necessarily so early as after the first year of a social work degree course. Families do not exist in isolation and I, personally, feel it is important that a wider understanding is held by ALL social workers of the knowledge in common and factors which affect life course work as well as a knowledge of the theoretical bases of social work which are common regardless of client group. The fundamentals of risk management and care planning are transferable.

Rather than narrowing down the studies between children and adults. I’ve always felt, since my course, that, for example,  a however brief, for example, a knowledge of mental health is necessary for all areas of social work.

A background of social policy, equally is essential. As is a knowledge of how the different systems work and operate.

While general nursing and psychiatric nursing are substantially different and teaching secondary or primary requires arguably different skill sets – social workers do have a commonality of skills and my gut feeling is that in the UK, children’s and adult’s services have already been split into different directorates in local authorities – splitting the training would destroy the links between the services which need to engage and work with each other, perhaps more so than Children’s social services does with Educational services.

I have a half-post that has been sitting in my ‘draft’ folder for a month or so all about this. I might dust it off and polish it up shortly as it begins to seem relevant again!

More than I expected to write but there you go! Back to normal service tomorrow.. oh and as a final thought, when should I start worrying about my blogging becoming too prolific? A few months ago I promised I would write less but I wasn’t very good at sticking to that!

Anyone have any general ideas as to whether I’m posting too much or about right (I won’t give ‘too little’ as an option as I wouldn’t comfortably manage any more!).

Any other suggestions, ideas or general feedback would be welcomed.