The Ageing Process Does Not Stop to Wait for Politicians

Just 55 days after the publication of the Social Care White Paper, “Caring for our future: reforming care and support”, social care is once again in a situation of not really knowing what the future is.

The White paper was short on details on funding, after its publication Richard Humphries of the Kings Fund said “Despite its commitment in the “programme for government” to the urgency of reform, the government has failed to produce a clear plan for how care should be funded or a timetable for how these decisions will be considered.” (click here for full press statement).

Then in mid-august we start getting press reports that Prime Minister, David Cameron “has pledged to end the heartache of tens of thousands of elderly people who are forced to sell their homes to fund long-term care” (Daily Mail 16th Aug 2012) by introducing the Dilnot proposals and introducing a £35,000 cap on care costs.

What is unclear is the extent to which the Dilnot proposals will be implemented. The report by Andrew Dilnot applied the cap to care costs not stating that those in care homes should contribute to accommodation and food costs to the tune of £7,000 to £10,000 a year. Given that the current annual state pension is £5,587.40 pensioners in need of care home services would still need to find money from somewhere.

Because of this, as well as the increase in those who will be publicly funded and the greater overhaul of the system that will be needed if the full Dilnot proposals are introduced, the White Paper largely becomes redundant before its consultation period has even ended.

To top this all off the Ministerial architects of the White Paper and draft legislation, Andrew Lansley & Paul Burstow have been shipped out of the Department of Health, and the principle civil servant in creating the paper, David Behan, has now moved to the Care Quality Commission.

Where does this leave the thousands that need social care services, those who care for them, the thousands of workers providing care etc.

Whatever the political reasons for the change of heart about Dilnot and the reshuffling of Ministers we need, NOW, a statement from Number 10 on exactly what is happening, how things stand with the White Paper and draft legislation in order to reassure social care users and the social care sector that there will be no delay in implementing reform. Social care has become all too familiar with the prevarication of politicians and these changes in policy and the personnel delivering it must not be used as an excuse.

We have an ageing population with increasing need for social care services, the ageing process does not stop to wait for politicians so those politicians need to act now for the benefit of people who need care services now.

Are we too focused on service user involvement?

Are we too focused on service user involvement in care services?

I know that is a controversial question but make no apologies for it because I think it is a debate worth having because while we  focus  on that we may be missing some of the essential ingredients to  truly personalised  care and support provision.

The idea of service user involvement is a natural extension of the theory of Social Role Valorization (or normalisation or an ‘ordinary life’ which ever term you choose to use). The idea behind this is that all people with disabilities should have the same conditions in life as are offered to the general public and that they should have the same should have the same opportunities in housing, education, health and freedom of choice. It does not mean that we should try to make everyone ‘normal’ but it does mean the same conditions of life should allowed to occur.

So why could we be too focused on service user involvement? Let’s take two areas where it is touted as a good thing for users to be involved in, recruitment and supervision.

The aim is to create an ordinary life, the same as the general population but at what point do the general public get involved in the recruitment and supervision of people in the services that they use? When was the last time you were given the opportunity to sit in on the recruitment process of your bank, your G.P. or your local NHS Trust or, indeed, have the opportunity to sit in a supervision session at your local council, supermarket or energy supplier?

The fact of the matter is we are all service users in one way or another, the principle difference being the majority do not use care services but if people are to be given the opportunity of an ordinary life then, surely, care services (in this sense) should be treated the same as any other service.

This is where the true difference occurs and where social care fails in providing the opportunity for an ordinary life. What do the general population do if they are really unhappy with a service they receive? Simple, they change the suppliers if they are able to or, if not (as in NHS services), they will challenge the quality of the service.

What many service users lack is the opportunity of freedom of choice in the service they receive and it is the denial of freedom of choice that needs to be addressed.

How much choice to service users get in the social worker ‘allocated’ to them to assist them in sorting out their care package? An unfair question because we would not expect any other service to give us the choice yet if we were unhappy we would be able to move to a different provider, something not available to care service users or we would be able to make a specific request about the type of person we wanted to help us – how many service users are given that choice?

And what about the choice of actual care services? Is there a real choice or are service users again ‘allocated’ the approved local authority contractor? Given that we are talking about vulnerable adults, is there really an adequate mechanism for challenging the quality of the service and a choice of care provider available?

Service users should be involved in their care but rather than the somewhat tokenistic concept of involvement in recruitment, supervisions etc. the real involvement should be in the choice of services they receive in order that they can have the ordinary life opportunities available to the rest of us.

62% of Care Users Extremely or Very Satisfied

           The recently published final report from the Health & Social Care Information Centre, entitled “Personal Social Services Adult Social Care Survey, England 2010-2011” actually paints a fairly good picture of social care and is perhaps worth highlighting to counter the general negative reporting we usually see.

            The survey, which had 61,115 respondents, found that 62% of those who responded were extremely or very satisfied with the care and support services they received, 28% were fairly satisfied, 7% neither satisfied or dissatisfied and just 3% said they were dissatisfied.

            Given that we are trying to achieve a person centred culture it seems odd that the constant criticism of the care system does not seem to be wholly reflected in the views of those who use care services.

            The survey also asked about individual’s quality of life. In this just over a quarter of the people who responded (26%) stated that their quality of life was so good it could not be bettered, 31% responded as it being good and 33% as alright with only 7% responding their quality of life was bad and 3% so bad that it could not be worse.

            We should also be singing the praises of social care workers. The survey asked “How happy are you with the way the staff help you?” A staggering 69.2% responded “I am very happy with the way the staff help me, it’s really good”.

            The overall picture of social care service delivery in England is a positive one.

            Yet more work needs to be done. The survey does not, unfortunately, fully identify where any differences in care delivery may occur. The responses are broadly uniform across the country and in terms of demographics the level of dissatisfaction with care services appears age related with younger people more likely to be dissatisfied and, I suspect, more detailed research would be needed to discover if this is because services are that much poorer for younger adults or whether it is purely because of age.

            We also need to be able to pick out what is the best practice that can be disseminated. What is being provided to the 62% who are extremely or very satisfied with their care package that can be translated into the care packages of the remaining 38% of care service users.

            We need to be able to identify what it is that makes care users happy with the way care workers help and support them, so we can disseminate this good practice throughout the social care workforce.

            Perhaps more importantly we need to raise the profile of this survey to show that the social care delivered in England is good, that the people who count – i.e. those who use the care and support services – are broadly happy with the service being received.

            Yes we do need a fundamental review of social care in the UK but we must be careful not to throw the baby out with the bath water and we should take the time to recognise that the bulk of care and support provision is good.