Declaring Independence

What is Independence?

Unfortunately it is one of those words that means different things to different people, it is not easily definable. If you quickly ask a dozen or so people what the word independence means I am sure you will get a series of similar, but never quite the same.

A quick Google search of the term independent and we get;

1.    Free from outside control; not subject to another’s authority

2.    Not depending on another for livelihood or subsistence

Yet neither of these terms can really be applied to social care, can they?

Naturally effective social care depends on those who need care services providing the right level of support to help them to live life as fully as possible but, as a result those who need social care depend on others (i.e. carers, care workers etc.) to provide that livelihood and subsistence and, at the same time, that support is subject to local social services authority about the level of support provided.

So how do we define independence in relation to social care provision?

As the term itself is dependent on each persons’ interpretation of it, it becomes ever more important to understand the individuals needs and how they view what independence means to them.  One person may view support at home as a means to help them live independently while another may consider it interference and a threat to independence yet both may be in equal need of support and at risk from the same sort of issues (e.g. falls). Obviously we declare that individuals have the right to take risks, as long as they have the capacity to judge those risks, yet such individualism presents problems for local authorities and health services that have a duty to safeguard the vulnerable.

This can, inevitably, lead to a situation where local authorities and health services then decide what independence means in their world. So, in other words, we become dependent on another’s authority about what independence means for us!

Real independence is entirely individualistic. For example independence may mean being able to do whatever you wish at any time yet giving a person minimum social care support at home may actually inhibit that freedom, they may become house bound and isolated rather than having the support they need to get out and live the life they wish conversely, for some, too much support may seem restrictive and intrusive to them again inhibiting their own sense of independence and freedom.

So if we are to succeed in truly providing independence to those who need social care services the first question always must be “What does independence mean to you?” followed by “How can we help you to live the independent life you want?”

Obviously there are restrictions on what public services can actually do yet those restrictions should not halt those first two questions. After those two questions co-production (I still do not like that terminology!) can begin as you work toward a support package that brings the best possible independence to the individual, an independence that helps them live the life they want.

Social Care Culture Wars

One of the changes promised by the Care Quality Commission in their “Fresh Start” document published yesterday (http://www.cqc.org.uk/public/news/new-approach-inspecting-social-care-services) was that they will be “checking providers who apply to be registered have the right values and motives, as well as ability and experience.”

This could be challenging!

Whether we like it or not the bulk of social care provision, at present, is delivered by companies, large and small (and every size in between!) who are out to make a profit, because without profitability the business will fail. Therefore private company that applies to register a care service has, naturally, to have the right business values and motives to be profitable in order to be able to deliver the care service.

This fact highlights one of the issues with social care in England and why integration seems such a difficult thing to achieve.

The word ‘silos’ is often used to describe the way in which different parts of the care system are isolated but, in reality, we should see them as different cultures and, as often happens with cultures, the existence of that particular culture is built on difference rather than commonality and those within a culture will defend the values and motives that underpin that culture.

So at the front line of social care provision we have providers who have to make money, even charities and not for profit companies have to ensure their income in order to carry on their business, so they have to exist in a ‘market’ culture where income must exceed (or at least match) expenditure, their actual provision of care is limited by the monies they receive, however good their values and motives are in terms of wanting to care they are constrained by economics. There are over 12,000 registered care providers and each one will have a different organisational culture based on the values and motives of the company owners.

Another culture within the system are the Local Authorities, 152 with social services responsibilities. Each on will have their own ‘corporate’ identity, influenced by working practices, senior leadership and, importantly, politics. All local authorities are over seen by elected councillors and this, obviously, impacts on the organisational culture. Somewhat like the EU, the heads of social services departments gather together to discuss overarching policy but, again like the EU, these can be implemented slightly differently in each council because of the values and motives of those who lead the council.

Within the local authority system are other elements that those who need care services also need to access, e.g. housing. In many areas these are located within a different authority than the one responsible for social care which, again, has its own particular organisational culture.

Then there is the NHS, another completely different organisational culture, founded on a basis totally different from care providers and local authorities. Health services (either NHS or private) have grown from medical science with a fairly rigid hierarchy of who is allowed to do what and developed a clinical culture that is different from other fields of work. The NHS itself is more fragmented now, which is why individual hospitals or trusts have failed because of inadequate leadership, but the overall structure is the same. In this realm we have the Royal Colleges which underpin the professional expertise of those who work in health, and which elevate the roles they undertake, all of this creates the values and motives of the NHS and other health services.

The problem for those who need care services is that all of these different cultures have different languages and practices, all have different values and motives that underpin their roles.

Because different cultures defend their identity through maintaining difference with other cultures, the integration needed by those who need care services is hampered and will continuously be so unless we develop a culture which recognises that the individual is more important than any of the organisational cultures involved.

To achieve connected services for people who need care services all involved need to recognise the commonalities in their services and who they benefit the individual.

Before care providers can be judged on their values and motives we need to establish what those values and motives are and how they benefit the individual rather than imposing values and motives that cannot be achieved at the ‘market’ end of the system and which, ultimately, impact negatively on the care service provided.

Let's Have CONNECTED UNDERSTANDING

We often hear the terms, integration, connected thinking, joined- up thinking etc. when talking about providing the best possible care services yet perhaps the most important thing we need to develop is “CONNECTED UNDERSTANDING”.

Because different aspects of the care system work in different ways it means barriers are created through a lack of understanding how other elements of the system work and because social care is such a fragmented wide-spread system it means opportunities for not understanding are immense as points of view differ drastically.

An example, some see social care as a public service. In one sense this is right, social care is organised by central Government, commissioned and paid for through local Government, Social Workers, employed by local authorities are public servants etc. Yet the bulk of social care is actually delivered by private sector organisations, where the motivation of those who own the companies is, ultimately, profit and compliance with regulation about achieving it at the lowest possible cost in order to protect profit. Those, usually low paid workers, who are actually responsible for delivering intimate care services would hardly class themselves as public servants, a term which is generally associated with better working conditions (e.g. pensions) than those in the care work sector.

Another aspect to this gap is that those who receive care services funded by local authorities may well be receiving a public service, albeit provided by the private sector, but there are many more people receiving care services from the same providers who are having to pay for it themselves, and often paying more to make up the LA shortfall in funding. How does their care equate to public service provision?

Yet even between ‘public service’ elements of care provision similar barriers of understanding exist. Not simply because of different ways of working between sectors, e.g. between Social Service departments and the NHS, but also current economic conditions which create misunderstanding. Local authorities are having to cut their spending yet NHS funding is not under the same pressure and it is important that both sides understand what the other are doing and, more important, are able to do over the coming few years.

Beyond this is the fact that public service integration needs to go beyond just health and social services, it needs to include housing, welfare etc, again a lack of understanding which can create barriers that impact on the lives of those who actually need to access services.

Obviously this nit-picking difference between those various elements who deliver social care services pales into relative insignificance compared to the lack of understanding faced by the general public about social care, a situation generated by the fragmented system which sends out mixed and confusing messages. Who is eligible for care? What is the difference between Local Authority funded care and NHS Continuing Care? How much do I actually have to pay?

If we are to really deliver quality care services we really need to begin to start working on connected understanding, we need those at the top of the chain to have a greater understanding of actual care delivery and we need those who deliver care to understand why Government, Local Authorities and Health Services operate in the way they do. Naturally the most important thing is that those involved in all aspects of care delivery understand the needs of those who need care services and understand how to connect with them.

Take Care Before Wielding the Knife

An interesting piece of news from the National Skills Academy for Social Care (https://www.nsasocialcare.co.uk/news/whitehall-to-consider-protecting-social-care?utm_source=twitterfeed&utm_medium=twitter) which suggests that the treasury are looking at further ways of cutting the social care budget, including curbing care provider fees.

Now the reality is that care providers have, in general, had lower than inflation increases in fees since at least 2008, well before the current financial crisis really kicked and, the bottom line is, the constant reduction in real terms of care fees impacts on the quality of care that providers can deliver.

Costs have spiralled, even if social care workers pay has be held back the costs of heating premises etc has risen sharply as have food prices and other costs.

While we have to accept the implementation of austerity measures handed to us the fact is further cutting back on care provider costs affects the lives of those who need care services.

While providers focus on meeting increasing costs and maintaining the level of care they provide there are inevitably areas that have to be cut back, invariably training of staff is one of those areas and because of this it means less well trained staff are providing direct care services and because they are less well trained it means the level of service will drop.

This is, of course, exacerbated by the fact that much of the funding for care training has almost completely disappeared. Where once NVQs for workers of all ages were funded, now only under 24s generally get free training yet many of those coming into care are older, usually returning to work rather than as a first job, which means the £1000 plus cost of a formal qualification is beyond the realms of realistic costs for many and, unfortunately, because it is no longer a requirement under the current standards it means many employers will not see the point of spending that amount out.

The real issue that needs to be tackled right now is not how we can save money but how we can ensure the safety and dignity of those who need social care services, yes we need to ensure people can stay in their own home as long as possible but this should not solely be based on saving money. Those who provide care in a person’s home still need to be adequately trained and given time to sufficiently care for the individuals rather than be forced into excruciatingly tight time slots which do little for helping the individual.

There are, undoubtedly, savings that can be made yet the Government must proceed with caution to ensure the well-being of those who need care services. Cutting care provider fees could drive some providers out of business, if that happens then the Government will find themselves actually increasing social care costs as they will have to fill the gap. The reason most care is provided by private companies is because it was felt this was a cheaper option than local authority provided care by driving providers out of the market it is probable that local authority provision will have to increase.

Social care in the U.K. is increasingly complicated, with control from Whitehall being disseminated through local authorities while actual provision is delivered by private companies who receive payment for services through many different channels, i.e. local authorities, the NHS, private funding or a combination of those.

If we want to save money let’s start by reducing some of this bureaucracy rather than targeting those who provide front line care in order to minimise the impact of cuts on those who actually need care services.

Front Line Social Care Health & Well-Being

Ergonomics, occupational health, employee well-being. Probably familiar phrases if you are employed in a large organisation, in fact those larger organisations will usually have people employed specifically for occupational health to ensure the well-being of their employees. This is often supplemented, particularly in public sector organisations, by union representatives with specific roles in promoting workplace well-being.

Smaller organisations, generally, do not have any of this and 80% of social care is provided by smaller organisations.

Naturally the principle focus of social care is on those who use services yet in order to deliver those services we have to rely on front line workers and, unfortunately, little attention is paid to ensuring their health and well-being in performing such a vitally important role.

We need a wider focus on those who actually provide care in order to improve the quality of care as well as the quality of life for the workers the nation depends on.

For example, much is made of the 15 minute visit rightly maligned by many as inadequate for those who need care and support services. Yet how often is the effect it has on care workers? Simply imagine the stress of having to complete a visit in such a limited time, or, maybe, think about the pressure of travelling between visits. I am sure everyone has been in a situation where traffic delays get us frustrated as we try to get to an appointment, what impact would that frustration have to a person who then has to rush through a 15 minute visit before heading out onto the road again to get to the next?

What is the impact on the health and well-being on those who daily support those who have challenging behaviours?  What is the impact on the health and well-being on those who daily support those at the end of their lives? What is the impact on the health and well-being of those who daily support those need intense physical support? And, importantly, how does this affect the quality of care delivery?

It is not rocket science to know that how we feel, both physically and mentally, impacts on the way we work, no matter what our job is yet for front line social care it will also impact on those who receive care services.

It is not unusual to hear about the work-place stress on social workers who are becoming increasingly over-loaded in their work. We hear about it because the majority of social workers work for public sector organisations where such things are monitored both by the organisation and unions. What hear little about is the workload and stress of front line care workers because most are employed by small employers with little union representation across the sector.

Whenever those who set policy for social care, national Government or Local Authority, speak there always seems to be an assumption that social care is a public sector service and that it operates in the same way as public sector bodies and that those who work in social care are the same as any other public sector workers. The truth is that the vast majority of social care workers are employed by small, private sector companies who do not have the same ability as larger companies to employ people to manage occupational health.

If we are to ensure the health and well-being of those who need social care services then we have to also ensure the health and well-being of those who deliver those care services. To do so we need Government to recognise that the thousands of small companies that provide care services need support to be able to do this.

Social Care: A Simple Philosophy

Social care exists because people need care and support in their everyday lives. The type of care and support may vary, those with learning disabilities will have differing needs from those with physical disabilities and older peoples care and support will vary depending on the age related conditions affecting them but the bottom line is social care is about supporting those individuals who need some form of help in their everyday lives.

Policy, bureaucracy, regulations etc. have no real meaning in social care unless the directly benefit those individuals who need care services.

So a simple philosophy should begin with a simple question, “how is what I am doing benefitting those I am providing care and support for?”

This simple question can be applied at all levels of social care provision.

At the front line of social care the question is more simplistic and, perhaps, applied more easily.  So, for example, maintaining effective infection control routines benefits the individual from reduced risk of infection or supporting an individual to attend community events benefits their social well-being. There are, of course, examples of where the question is not applied. I am sure we have all heard of tales were care staff take those they are supporting out to places that are of more interest to the staff than the people they are supporting and, at the extreme end of the scale, the behaviours of staff at Winterbourne View were abhorrent and bear no reality to providing care.

Yet at the point of care delivery the philosophy has to be “how is what I am doing benefitting those I am providing care and support for?” the question should also be the basis of care inspections by the Care Quality Commission, or other inspectorates. Not every care provider works in the same way and they should be able to show that their care and support works in a way that benefits those they are delivering a service too.

As we move up through the levels things become a little more complex but the same simple question should apply. The Care Quality Commission should base their work on the same principle. How does their inspection system benefit the individuals who receive care services. After all social care inspectors exist only because social care exists and social care is about those individuals.

At local authority level there is a multitude of bureaucratic levels but each must apply the question to their work. The most obvious level of local authority work is done by social workers and social work assistants (or whatever the preferred term is in a particular authority!). Social workers/assistants have direct contact with social care users but they are subject to systems and procedure and it is those that need to be looked to see if they are designed to benefit those who need care services or if they are designed to benefit the local authority. There is a need for a certain amount of red tape, reporting and recording are essential but each part of that red tape needs to be challenged to find out who it benefits and whether or not it enhances the life of the individual who needs support.

The back office functions, commissioner’s, funding panels, payments etc. must all exist only to improve the lives of those who need care services and their functions must be a benefit to the rather than the local authority itself. Elected councillors should learn to challenge the social care departments and asking how working practices, policies, procedures etc. actually benefit those who need care services.

Even at the highest level of Westminster ministers and civil servants who deal with social care should ask themselves how their work benefits the needs of social care users. As with local authorities the multiple levels of bureaucracy must have the question in mind as they prepare policies and reports, in the edicts they send out to local authorities.

Naturally there are many thousands of people and organisations involved in social care but each should ask themselves how what they do benefits the lives of the individuals who need care services and apply this question to every aspect of their work.  How does this process benefit, how does this terminology benefit, how does this job role benefit etc.

People do, unfortunately, often justify themselves in ways that satisfies their own actions therefore it is important that, at all levels of social care that we challenge people by asking “how is what you are doing benefitting those who need social care service.” David Cameron should be asking Jeremy Hunt who should be challenging the Permanent Secretary right the way through the Department of Health. The Department of Health should be challenging local authorities and national social care organisations who receive Government funding. It should a question that commissioners ask providers, and vice versa, it should be a standard question in every supervision of a person employed, in whatever capacity, in social care. It is a question that should be asked in every meeting and every time procedures are reviewed. It is a question that should be at the heart of everything to do with social care.

Social care does not exist to create jobs, those jobs exist because people need care and support. Social care does not exist to satisfy bureaucracy those systems are in place because people need care and support. Social care exists because people need care and support in their everyday lives and everything we do must be centred around those people.

Ask yourself now – “how is what I am doing benefitting those I am providing care and support for?” 

Compassionate Government - Bah Humbug

This week’s Autumn Statement from the Chancellor seems to finally put paid to any pretence of ‘compassionate conservatism’ as, subtly he put social care under increasing economic pressure and impacted on the lives of the millions who need social care services to help them in their everyday lives.

There were multiple blows to social care, none of which actually identified it but the implications are there and the vulnerable in society will suffer from the impact.

Firstly there was central Government spending. George Osborne announced that all Westminster departments will need to cut spending further. There were only a few exceptions, his own department HMRC, education and the NHS. There is an important distinction here, as the NHS is not the whole of the Department of Health and the social care side of the DH looks like it will have to reduce spending in line with the cuts made across other departments meaning less money to essential front line services.

On top of this local authority spending will have to be cut further. Back in October the President of the Association of Directors of Adult Services warned the care services were on the edge (see here) and the prospect of extra cuts can only mean those vital services may tip over the edge as less and less people either fall out of eligibility criteria or services become so time orientated that any form of personalised care goes out the window.

Yet the cuts to local authority spending will have a secondary impact. Under the health reforms the responsibility for public health functions was transferred to local authorities including things such as health protection, public health initiatives to tackle social inclusion, initiatives to reduce seasonal mortality rates, public mental health services and many more which have a direct impact on the lives of those who need social care services.

The real irony is that investment in social care and public health could actually be more beneficial to the NHS budget than simply ring-fencing that alone. It is well documented that prevention services mean less need for hospital admissions etc, people prefer to remain at home during illness and home care with preventative public health services can increase the likelihood of that.

So the Autumn Statement proposals are not just punitive punishment on those who need social care services but they are also false economics.

The other aspect of social care overlooked by the Government is the fact that not all people who need social care services are over the age of 65. Many people with learning disabilities receive ordinary benefits which have now been capped meaning an increasing number will fall further into poverty. The Foundation for People with Learning Disabilities stated that only 7% of people with learning disabilities are in employment yet 65% want a job. It is unfair to label these people as shirkers when it is the Government’s failure to create an economic climate that creates full-time jobs.

In addition to all of this we have the lack of action on social care funding in general, it has been nearly 18 months since the Dilnot Commission submitted its final report yet still nothing has happened, the urgency with which the Government launched the commission has totally and utterly turned into a lethargy of inaction.

There are millions of people with social care striving to make life as bearable as possible yet the shirkers in Westminster seem to determined to make that as hard as possible.

Cabinet Minister for Social Care: Business Focus

Yesterday the Daily Telegraph revealed that the big care companies have a total debt of £5 billion (http://www.telegraph.co.uk/health/elderhealth/9655229/Britains-biggest-care-home-owners-have-5-billion-debts.html), also yesterday Ed Miliband declared support for the ‘Living Wage’ saying “there are almost five million people in Britain who aren’t earning the living wage” (http://www.labour.org.uk/ed-miliband-speech-on-the-living-wage).

It is probably fair to say that at least one in five of these people are frontline social care workers who are on, or just above, the national minimum wage.

The current minimum wage is £6.19 per hour and the touted living wage is £7.20 per hour, the average pay for a care worker sits neatly in between at £6.65 an hour. So to reach the living wage employers need to find 55p per hour per employee working, on average 40 hours a week for 52 weeks (inc holiday pay) a year. With this applying to over a million people the cost will be around £1.1 billion a year, add into this employers NI contribution etc. and the cost gets higher.

I totally and whole-heartedly agree with the living wage and the benefits of it to social care will be enormous, particularly in terms of recruitment and retention but the real issue is where will the money come from. Most agree that social care funding is in crisis and without promises of extra money to fund the living wage the only place it can come from is existing care services and as noted earlier the debt situation of the bigger care providers hardly suggests that they can afford the living wage whilst maintaining care standards.

Many people easily and comfortably slip in to the idea that social care is a Government run and funded thing yet the reality is, of course quite different. There is no homogenous entity such as the NHS as social care is provided by, according to Skills for Care, approximately 22,100 organisations over 49,700 establishments. Just to put this number in some sort of perspective, the total number of high street bank branches across the UK is just 11,000. This vast, complex myriad of care providers range from the smallest micro-providers to the huge debt-ridden big companies, from not-for-profit voluntary organisations to those owned by offshore parent.

Social care is big business, around 20% of local authority spending in England goes on social care equating to around £21billion per year, so it is no wonder some offshore companies feel there is money to be made, and, of course, this does not include the money paid by those not entitled to local authority support or those who have to pay ‘top-up’ fees to providers.

Yet, despite this seemingly high amount, the payments by local authorities have declined in real terms over the past few years, with eligibility criteria also tightening, and many professionals agreeing that social care needs an urgent injection of real cash to prevent and halt the constant cut back in services.

The business of social care can be as complex as meeting the needs of many individuals who need care services yet everything is the responsibility of a junior minister within the Department of Health.

I truly and honestly believe this needs to change and I would ask you to support my epetition calling for a Cabinet Minister for Social Care - http://epetitions.direct.gov.uk/petitions/39701

Personalisation: Structure and Agency

A basic common debate within social sciences is the question of structure versus agency, how the social structures of society impact on us as individuals and how our individual choices and freedoms are constrained by those social structures.

These arguments need to be considered in relation to social care, particularly personalisation.

The Social Care Institute for Excellence give us the following definition for personalisation;

"Personalisation means thinking about care and support services in an entirely different way. It means starting with the person as an individual with strengths, preferences and aspirations, and putting them at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives. It requires a significant transformation of adult social care so that all systems, processes, staff and services are geared up to put people first"

This shows the intrinsic link between structure and agency within delivering personalisation. It could also be argued that it demonstrates why personalisation has been difficult to achieve and why personalisation will never be truly personal unless there is a major change in the way social care is structured.

The SCIE definition describes the individual as being at the centre of the process of identifying their needs and making choices about how and when they are supported to live their lives.

In other words, the person is at the centre of the structure! But, how much is their individual agency constrained by that structure.

Unfortunately that structure is one that limits those choices available for personalised care and support and it is a multi-layered structure, each layer filled with bureaucracy and each layer with, at times, competing agendas.

The big, over-arching layer of structure in social care is, of course, Westminster. Parliament set out the laws and regulations under which social care is practiced in England, it sets out how social care is funded and it sets the structure under which personalisation can operate. This is all administered by the Department of Health who, as is its name suggests, has a primary focus on health and while many aspects of social care may overlap with health there are many other areas, such as housing and welfare, that do not.

The next layer in the structure is the most diverse and, perhaps, Weberian in its nature and that is the delegated bureaucracy. The role of implementing and enforcing the dictates of Westminster is handed down to a myriad of Quango’s (e.g. CQC, NICE etc) who have their own structures for implementing the written law handed down to them and of course, 152 local authorities with responsibility for commissioning state funded care and again with their own structures and political leadership which may vary from that sitting in Westminster.

The next layer surrounding the individual is the providers of care services. This is not just care homes or home carers, it also includes Social Workers who provide a service on behalf of the local authorities, providers of advocacy services, services which provide employment opportunities etc.

Eventually we reach the person needing care and support services.

Whichever way you look at it, as a top down structure or a circle with the individual at the centre, the layers of structure hamper the ideals of personalisation.

Those who provide services can only do so in controlled circumstances, they must be appropriately registered or have an appropriate contract and the services must be provided within the budget available. For those who need to choose services the choice becomes limited by these structural constraints, even those who have personal budgets or direct payments have the budgetary implications to consider. Whatever an individual’s strengths, preferences and aspiration, services can only operate within the structure dictated by the layers that surround care provision and the rules and regulations imposed on them.

This is not to argue that such constraints should be removed but that the structure should be revisited if we are to improve social care services and increase the opportunities for greater personalisation.

We are trying to move from a top down structure to one that has the individual at the centre yet the actual structure remains the same and has the same constraints on agency. If we want to change the outcomes for individuals we need to take a real look at the structure within which social care operates.

Cut Out the Middle Man: Do we need Local Councils in Social Care?

So there isn’t a pot of gold for social care (http://www.bbc.co.uk/news/health-17740832)

So we need to find new ways of making certain that the money that is available goes directly to those who need care services.

I am not an economist and I do not have the figures to hand but it seems to me that  the best way forward  is to take a radical look at the social care system and make wholesale changes that increase the funds at the front line.

We all know the way the current system works, money from central government filtered through Local Authorities to front line care provision.

So how about cutting out the middle man?

There are 152 Councils with Social Services Responsibilities (CSSRs) and, therefore, 152 directors of Adult Social Services (or whichever name they currently go by!), similarly there are 152 different administration systems that have to be paid for and 152 systems of line management.

It is said that this system creates a postcode lottery it which where you live can be important in the level of care you receive.

What if we eliminate that?

Have just one Director of Adult Social Services (there is one already in situ at the Department of Health), have one administration and assessment system that provides the same level of care across England and a system that allows more money to be directed at front line services.

Such a system will, of course, still have localism at its heart. Obviously social work remains in local offices and local services will meet the needs of local people but does such a thing really need director level involvement local level and does localism need variation when it comes to who is entitled to what service?

This would not necessarily mean that Local Authorities have no impact on local social care services. The Health & Well-Being boards could exist as a monitor to services and are still important in providing an oversight to ensure integration between services.

I have admitted I don’t have the figures for what the savings actually would be but I think it is an exercise that needs to be undertaken. Money is tight and we need what money is available to provide support and care for the people who need it and if that means 152 Directors of Adult Social Services losing their jobs isn’t that worth it in the long run?

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.

Public Service & Private Profit: The BIGGEST Elephant in the Social Care Room

“There were a number of respondents who raised concerns over the business ethic of the care homes they worked for. These respondents felt the organisation and/or general management were driven by profit, rather than providing high-quality care” RCN – Persistent Challenges to Providing Quality Care 2012

If there is to be any resolution of the current care crisis and to ensure the provision of quality care for the most vulnerable adults in our society then the BIGGEST elephant in the room has to be tackled or, at the very least, talked about openly.

The majority of social care provision is delivered by private sector companies who do so in order to make a profit. Direct public sector provision has dwindled and continues to do so as more local authorities look to close or sell care homes.

The reason for this is relatively simply – it’s cheaper. By outsourcing care services local authorities save on administration costs yet more specifically the save on wage costs. Private companies are less bound by conditions that local authority employers have to abide by, particularly in terms of pensions and the myriad of different companies delivering social care means the workforce is fragmented, largely un-unionised which has allowed care worker wages to remain low at a national average of £6.71 per hour (Skills for Care NDMS Data). 

Undoubtedly the poor pay and conditions associated with working in social care contribute to the continual recruitment and retention problems which, in themselves, have an impact on the quality of care provision.

Now there is no doubt that what local authorities have paid in fees for social care provision has dropped, in real terms, over the last few years firstly by lower than inflation increases and more recently by totally freezing fee increases and there is equally no doubt that social care needs greater investment.

There is also the additional fact that many of those who have to pay for their own care provision are forced to pay a higher amount in order to ‘make up’ for the low fees paid by local authorities despite receiving exactly the same quality of care by the provider.

Yet the issue that has to be addressed is what guarantees are there that increasing fees will drive improvement in the quality of care or workers’ pay rather than line the pockets of those who run their companies for profit?

One solution by a respondent to the RCN survey was to suggest a cap on the amount of profit that could be made ensuring the rest was reinvested into the care of residents.

But to flip the argument a little, most people go into business to make money and any threat to the profitability of the care sector would discourage people entering it. With the demographics indicating increasing amounts of social care provision being needed there will be a demand for more suppliers. So what happens if the suppliers are not there? There will then be pressure for local authorities to take responsibility for providing care at the higher costs associated with the public sector.

There is no obvious or easy solution to the dilemma but it is one that has to be recognised as a major part of the debate on social care.