Tuesday, 3 April 2012

The Voice of the Vulnerable

The Guardian’s Social Care Network has recently asked the question “How do we give service users a voice?” yet the fact that the question needs to be asked does, perhaps, highlight what is wrong with the current social care system and why we need wholesale reform to achieve social care that meets the needs of those who need it.

The most obvious answer to the question is, simply, that we ask those who use the services and, more importantly listen to what they say. But, unfortunately we have such a fragmented and somewhat territorialised system that any messages have to pass, in the manner of Chinese Whispers, upwards towards those who make policy decisions via the agendas of the various parties involved.

If we start with the individual the person who will listen to them the most and who probably has the best rapport with them is the frontline care worker. There may be occasional contact with a social worker but my general experience this will only happen once or twice a year at reviews, obviously families will probably also be involved in listening to what the individual thinks about their care package.

The route for the care worker is obviously their own line management but that would require the care worker be given the time (and be paid for it!) to sit down with the manager to outline their discussions with the care user, how things could be done differently to meet their needs and how the care service an improve their overall care delivery.

From there the route upwards means the care provider talking to the local authority funding the care to pass on the individual’s views and what they want from their care package. Yet there are probably very few opportunities to do this except where reviews take place and there is almost certainly not enough time to discuss everything the user may have said over the intervening period and be more focused on the care plan in place. It is also at this point the Chinese Whispers can begin with the agenda of the provider being set.

For example a care user might have said they would prefer to have their care at a particular time and the care worker would have passed this on, but if the care provider was unable to facilitate this because of staffing levels etc then would they necessarily pass this on to the local authority, especially if they feared the contract could be passed to another company who could accommodate that.

Once the care provider has passed on the views of the care user to the social worker then it will get passed along the upward line of the local authority where, to be brutally frank, it is likely to get lost or transform from the voice of an individual into a statistic aimed at proving why the authority should get more money from central Government. Of course the message may have to go through the NHS route and that is equally convoluted.

So by the time that the voice of the care service user gets to the Department of Health it has changed beyond recognition ceasing to be a voice and just one of many numbers that are processed by the bureaucracy of Westminster.

How do we stop this? Well the simply way is to ensure that all user comments about their care service are written down. This may seem a little old fashioned but it achieves one thing – the original message retains its value, unadulterated, on the way to the top. Yes it would generate a lot of paperwork (or e-paperwork!) but at least in Westminster they would have access to the qualitative data in addition to just the quantitative stuff!

In reality the problem is a fundamental one, the distance between the person using a service and the policy makers deciding what is best for individuals is an immense chasm with a rickety bridge connecting the two. The change in social care needs to address this, it needs to ensure there is a smoother, undistorted route for the users of care service to move up the line towards those who make the policy and hold the cash.

Not easy by any means but worthwhile it we are to achieve the best social care for those who need it.