Tuesday, 15 November 2011

Why the purchaser/provider split is failing

Well, It's been quite a while since I've posted anything.. my excuses...life has been quite busy starting a new job and am finishing a dissertation among other things.

I've just spotted an excellent article on the Guardian which seems to hit the spot over just what is wrong in social care - in fact it echos a lot of what I said today to a new colleague who as it turns out his wife used to do some of my training when I was still in Social Services. It has led to me to post a response which I'd like to share here...

This is the real scandal in social care

The purchaser/provider split which came in in the 1990 act (but which has really come to maturity in the past 5-8 years as LAs ditched functions like in-house care providers and res. care homes) allows LAs to focus on driving down fees without having to worry themselves about the details of how this is achieved, or what corners are being cut to do this.The problem as pointed out is that lack of money in the system turns the purchaser/provider split into a destructive force which eats itself; it's not about getting quality care for a competitive price, but just about securing the lowest possible price to protect the diminished budget.

What we have is a failing market which is seeing a race to the bottom in terms of care standards.

A massive, massive issue to me, as I was only talking about someone to today is that the purchaser/provider split allows LAs to delegate responsibility and accountability. For instance if there is a scandal in a care home operated by a LA then the head of service and cabinet member are directly accountable... if it's with a private provider then they can simply blame a greedy owner, or bad management and point to the role of CQC.

Being able to escape this direct acvcountability means LAs can turn a blind-eye to just how margins are being cut and the impact of real cuts in the cost of care.

And being cut they are. I can't speak for now, but I began in Social Care in 2004 when providers were being paid £15 per hour for care...... when I left in 2009 the avearage was more like £10-12 per hour.

Tuesday, 4 October 2011

The real scandal in social care

I've always thought that an essential in any good system of social care provision is content staff.

Too often we ignore their needs and treat them as if they are invisible even if we're in the same room and I'll admit here that I've been as guilty as anyone else on a social services training course when the room divides into carers on one side and 'professionals' on the other. A few ex-colleagues of mine had worked, or even continued to work as carers, but this aside there was always to my view an element of snobbishness and power imbalance present in the many interactions between ourselves and carers.

Though a few of us did speak out about the conditions faced by carers it was a topic well down the list for us, far below issues like personalisation, or even the personality politics of the department.

But the treatment of carers is so integral to the system it should be the only issue we're talking about. Why? Well we really need to look at this holistically. If we want a system based on dignity and respect then that standard needs to apply to everyone. If care staff are treated with dignity and respect then we can in turn expect service users to be treated the same. Turning an indifferent eye to care staff being paid below the minimum wage endangers our ideals as much as mistreatment in a care home.

Friday, 23 September 2011

Can the welfare state withstand the global storm?

Blimey! What is going on in the global economy? All this talk of double dips and lost decades (or is that just Shaun Ryder)is actually starting to make me worried now. No better make that terrified.

I'm also beginning to look for a job and have been astonished at the sheer number of people competing for positions. One recent post I applied for, nothing glam at all, had 180 applicants eagerly snapping away like some tabloid feeding frenzy.

What makes me worried is how will the welfare state, weakened by three decades of neo-liberal attacks hold out? Will it be shown to be woefully inadiquate and as easily overrun as the Maginot line?

Is the big society rhetoric like some eerie harbinger of a return to when Victorian liberal capitalism smashed its way unrestrained through lives as nonchelantly as the wind whipping autumn leaves into a swirling menace.

I suspect we'll be finding out soon.

Thursday, 22 September 2011

PFI - Who didn't see this one coming?

I've just read a piece on the BBC website about the strain repaying PFI projects is putting on the budget of NHS Trusts.

There is of course some political point-scoring going on, but honestly who can say that they didn't see this coming? PFI was obviously an ill-conceived idea from the beginning with controversy engulfing one of the first PFI's the Skye Bridge project which George Monbiot pointed to in his widely read 2001 Book 'Captive State; The Corporate Take Over of Britain'

Now the doubters have been proved right, but governments and local authorities still shock in their ability not to take heed of the facts when it comes to policy.

Tuesday, 13 September 2011

RIP Local Government

I've just read in my local rag today that my local authority will be joining forces with another local council to provide services. Is this an issue? The reason is to save money, presumably through economies of scale so win-win?

What about local democracy though? The Authority I worked for only a couple of years back is barely recognisable today. Yes there's still a grand old building slap bang in the middle of the City, but it's emptying out fast. In Social Care the in-house provider has been scaled down and care homes sold off to BUPA, Housing benefit claims are now administered in Bromley, legal services and licencing are shared with a neighbouring authority and now there's plans on the table to merge services with yet another authority.

All this means people just don't know who runs what or who is responsible for what. In these new organisations opaqueness replaces transparency whilst democratically elected councillors seem increasingly irrelevant, just how much influence can they have over services in these public-private-voluntary sector hybrid super-councils? How much say do we have as voters? Or are we no longer voters, but simply customers?

Wednesday, 31 August 2011

Another care agency bites the dust

My local rag reported this week that a care provider went out of business leaving clients in the lurch. Admittedly it was a small one with only about 20 clients in my area who were the story indicated fairly easily accomodated by one of the big providers (though no doubt a few people made a lot of phone calls, sent a lot of faxes and stayed in the office very late) so no real crisis, but could it be a canary? I'm not on the inside anymore, but I can take a guess that the trend of squeezing providers is still going on - probably even more so. Due to the strategy of our commissioning team the money we were paying for care fell about £5 an hour from £15 to around £10 in my time which was 2004-2009, but how sustainable is this system and who is paying the price? Being a labour intensive inustry the bulk of the £5 an hour will probably be wages so where does this leave care staff and what effect does it have on recruitment and retention?

Thursday, 18 August 2011

The London Riots

I was glued to the coverage in the way I used to be only on election nights, following the Guardian’s Live blog, flipping over to the BBC, waiting on every new development. The next day I was equally transfixed by the aftermath, the politicians posturing and discourses emerging; on the right it was about parenting, fecklessness and ‘criminality pure and simple’ and on the left it was about the cuts and alienated youth.

Facebook was also aglow with debate raging through the night and into the next morning. One ex-coursemate from my Sociology degree years posted a theory that the panoptican effect of CCTV has been shown for the sham it is. I personally weighed in with the view that it was all connected to Saskia Sassen’s global cities theory which states that key global cities have been shaped by global capital flows and money markets into highly unequal and polarised places. I reasoned that this created underlying tensions which have possibly been exasperated by the financial crisis. The question I pondered was; is it a coincidence that as the money markets meltdown, so a key point in the global financial system burns?

One thing which struck me especially as a particularly opportunistic bit of behaviour (not unlike that shown by many of the looters I must add) was the attempts by some associated with the police to take back what they see as lost ground with some talking heads complaining about how the ‘force’ is now regarded as being hamstrung by human rights considerations and is now more a ‘service’ now neutered and ineffective. What was needed they insinuated was a force unafraid to get out there and crack some skulls as this extract from the August 11th edition of the New York Times shows:

A former senior riot police officer with knowledge of current operations, who spoke on the condition of anonymity, said that the most recent riots were allowed to rage, in part, because police officers felt constrained. They operated, the former officer said, in the shadow of the case of a newspaper vendor, Ian Tomlinson, who died after being shoved by a riot officer guarding against protesters at a Group of 20 economic conference in 2009. The police officer, Simon Harwood, will go on trial for manslaughter in October.

I find this whole argument particularly difficult to swallow for a number of reasons. Chiefly the whole notion that police officers cannot tell the difference between reasonable force and what constitutes an illegal action is laughable. If they cannot tell the difference then what hope is there for the rest of us?

More specifically with regard to the Tomlinson case. My reading of the case was that the Officer PC Simon Harwood who was assigned to be in effect ‘in the rear with the gear’ by his own admission became 'bored' and then went walkabout with disastorous effect. This was not disciplined policing and in fact questions had been raised about Harwood's 'aggressive behaviour' long before the G20 protests.

The police are not the only ones using the smoke of the riots as cover for a political agenda as Cameron's attempts at turning the welfare state into a more punative part of the criminal justice system testfies, but the arguement that cases like the Tomlinson case have stopped them doing their job does the police a disservice. I hope that PC Harwood is not representative of the majority of officers who can tell the difference between doing their job and breaking the law.

Sunday, 7 August 2011

Losing touch

It's surprising how quickly we can lose touch with things. It's coming up for two years since I left social services to enable me to study for a masters in social policy and whilst for the first year I kept in touch with the department and the wider world of social care this year has been different. I've lost touch with all but one former colleague and also feel out of touch with developments in the field as I no longer have a view from the ground. Incidentally I'm sure this is also something which is experienced by many senior managers.

So amongst all this it was nice to catch-up with an old colleague last week. They themselves left last year to pursue a social work degree after a number of years as an unqualified care-manager. I was curious about what they made of their experiences so far as in the past I've questioned just how well a social work degree prepares someone for what is a hugely demanding and complex role.

Their view was suitably mixed. They felt that there was indeed a gap between the ideal of the theory they were taught in the classroom and what actually happened in practice, but they also felt that what they had learnt had been valuble in enabling them to improve upon their practice.

Overall this left me feeling much better about the relavance of the social work degree, but it does illustrate what a strange area social care is more than any other as it is caught between idealism and pragmitism. As a worker the course of action which you feel best meets the text-book ideal must always be balanced against the limitations imposed by the availability of funds, the amount of time available to work on any one case, or the state of the local care market.

I was surprised to hear though that many newly qualified social workers have found it difficult to secure a job. Being out of touch I just don't know how the cuts are affecting my old department, but always thought that we had been running with unfilled vacancies for so long that it wouldn't be possible to cut anymore. As I said to my old colleague, as we well knew from experience, the job doesn't go away no matter how few people there are to deal with it the work never ever dries up. It's not as if it is a factory which can just slow-down it's production line. Just how are people coping I thought, is staying behind until 10pm becoming more routine than extraordinary I asked? I just can't imagine how it would work with less people.

My friend was also unsure, but one thing they did know was that the uncertain job market meant that the competition for the best placements was intensifying. They told me that you really need a placement with a local authority unless you want an uphill struggle to find work once you qualify.

Tuesday, 12 July 2011

The end of the council care home

My big break in care management came as a result of care home closures. Having been in a junior role doing phone assessments I was seconded to cover a colleague who was in turn seconded to assess and arrange new placements for residents at two council run homes which were earmarked for closure. Initially it was for a six month period, but legal wrangling led to me providing cover for another three months before I finally left to study social policy.

The closures were fought against by the local rag and residents relatives, at one point a hot-shot lawyer who had fought another authority on the issue of care home closures appeared on the scene seeking to halt the process. I remember the colleague I replaced telling me that she felt all this was counter-intuiative as the authority was so keen to close the homes had been exceedingly generous in allocating funds for the residents who were to be moved.

The homes in question were typical of council residential homes built as part of a post-war council estate its homes and care homes founded same impulses of idealism and universality. One was well regarded, the other not so. In my dealings it seemed the issues were typical ones down to not having enough staff and there had been a spat the year before when the authority decided to bring in agency staff to avoid paying overtime breaking a tacit agreement that low pay would be compensated by opportunities to work long hours.

In any case the authority got its way and shut the homes. To the cynic it seemed the authority just didn't want the hassle of trying to run homes on a progressively tightening budget, far better to outsource this problem and any ramifications to the private sector. To my ultra cynical eye I felt that senior management were concerned about the escalating potential for a safeguarding case to crop up at a council run care home, something that would be much worse for them professionally than an equivalent one in a private-sector home.

Maybe this wasnt the case, the official line was that demand was declining (in the short term at least) and that the private sector had ample capacity, there was now simply no need for the homes they said. That they set up a new safeguarding team specifically to deal with institutional safeguarding cases suggested that their faith in the private sector was however, not absolute.

I wonder what their thoughts are this week?

Tuesday, 7 June 2011

Winterbourne View: Deja-vu

In social care it seems to feel as if we were in a world of never ending change, departments and organisational structures come and go, shifting around, merging and splitting like amoebas. People come and go and new ways of doing things come in vogue before being replaced by the next big idea which older colleagues usually observe is the very idea which the last big idea was meant to replace.

Despite this continual flux some things seem to remain the same even when we don't want them to. This week I've been reminded of a course I attended, maybe as long as 6 or 7 years ago. The course was titled 'Adult Abuse Awareness' which perhaps dates it as the professional terminology has long since evolved so the course is now named 'Safeguarding Adults Awareness'. The course ran for three days and was attended by staff from across the authority; carers, social workers, care managers and people like me who at the time just answered the phone.

As part of the couse we watched part of a documentary which had been recently aired and where adults with a learning disability in a care home in a neighbouring authorities area had experienced abuse which had centered around the totally unjustified use of physical restraint. The footage also included a scene where one resident had had water thrown over them. I'm reminded of this by the reports of the abuse at Winterbourne View, where according to the Guardian article

The BBC's Panorama programme used an undercover reporter to film patients being pinned down, slapped, doused in cold water and repeatedly taunted.

Unfortunately dspite a google search I cannot find any details of the programme we saw on the course. Any Google search is foxed by the sheer weight of similar cases (just type in 'care home closed down' for a litany of cases), but the thing which troubles me is that despite the publicity and furore over that now forgotten case we are once again hearing the same story years later despite the best efforts of numerous professionals.

For the person running my awareness course, a former front-line Social Worker, the problem was the type of people attracted to jobs in care homes were those who 'enjoyed having power over other people'. Problems like the ones we've seen at Winterbourne were according to this view the result of something deeply embedded. I acually heard a similar kind of arguement made in a Radio 4 interview by the authour of a book 'scapegoat' who suggested that 'institutional violence' was a longstanding problem going back hundreds of years and for adults with a learning disability the stark choice is between abuse either in institutions or in the community.

The problem therefore is one which the whole of society needs to face. Our attitudes to disability, in particular to learning disability need to be transformed. My trainer all those years ago was optimistic about the prospects for the future beleiving that the greater incidences of adult abuse were the result not of increased prevelance, but of a greater willingness of staff and various others to report abuse which would previously have gone undetected. In other words attitudes had begun to change.

Hopefully this optimism wasn't misplaced.

Monday, 30 May 2011

Social Care is Failing..

... this is according to some Age UK research which has just been published and reported in the Guardian today.

This isn't news to me and probably isn't news to any of you either. It's painfully obvious to anyone who has been involved with the sector in recent years that things need to change.

In fact my, and I'm sure other peoples main opposition to Individual budgets, was that for all the positives around the policy it never dealt with the core issue which was lack of funds - which as the article points too is really the key issue.

It seems that on this issue (and not dissimilar to university funding) there have so far only been sticking plaster soloutions; Politicians ducking out of the big debates. These debates are chiefly who pays and how? It seems that paying for anything from general taxation is out of vogue so we have what I call the 'making a contribution' society - that is responsibility for social risks (i.e poor health; unemployment etc) being increasingly placed on inividuals.

Some time ago a kind of insurance model was mooted for social care this it seems has dissapeared from the agenda, but as the Age UK research shows things need to be addressed sooner rather than later.

Thursday, 19 May 2011

The Military Covenant

The relationship between the military and the welfare state has always been close. In fact its closer than close - the Welfare state owes it's existence to what we are now beginning to term 'the military covenant'. Historians of social policy will tell you that out of the first world war emerged one of the first real attempts made by the state to provide mass housing fit for the troops returning from the trenches; the 'Homes fit For Heroes' scheme - the snappy giving away the political currency it was hoped the project would bestow on its sponsors. Ultimately 'Homes fit for Heroes' was criticised along with other attempts at post-war social reform for not going far enough and It was not until the destruction reaped by a second global conflict, world war two, that Western governments instituted much more ambitious plans, the full-blown welfare-state a conscious and determined effort to build a 'new Jerusalem' a society worthy of the sacrifices made in its name.

Gradually the post-war settlement of 1945 has been eroded, weathered by the harsh winds of time. The idea of the state guaranteeing social rights to its citizens has been overturned to the point where more and more individuals are asked to make a more of a contribution whether this is an 18 year old student being asked to pay £9k a year to cover fees or an 88 year old grandmother being forced to sell her home to pay for the cost of residential care. It is in these terms which the current debates around instituting the military covenant into law are couched; Priority in housing, priority in NHS treatment. Gone is the commitment to universal citizenship and universal social rights, gone is the commitment to honour sacrifice by building a worthy society. No one would deny troops who have made so many sacrifices the best medical treatment, decent housing, or any other social right but we must not forget these are rights which extend to all and to which others can justly make claims to; the firefighter, the nurse, the teacher, the mother. Does a soldier returning from conflict wish to receive the very best whilst watching their parents receive an appalling level of care from an underfunded system? Only by recognising this need to create a fairer and more just society for all as we did in 1945 do we properly honour their sacrifice.

Friday, 29 April 2011

Delivering care

Immediately before working in social care I spent a long summer working for Royal Mail. Most of my routes were in a semi-rural area and despite my anxiety that I was wasting my newly achieved 2:2 it was looking back probably the most relaxing enjoyable job I have ever had; even the occasional rainy days weren't so bad.

Hearing stories about Royal Mail these days I wonder how much the job has changed, in particular I wonder about one of my former colleagues who was always cheerful and always smiling as he simply loved the job. I hope that's still the case, or else he's somewhere else where he's enjoying work, but reading this article in the Guardian about the poor conditions and low-pay within the privatised and liberalised postal service in Holland I do worry what the future holds for employees such as my old colleague.

I mention this all, not by means of reminiscence as I currently grind out a day-time living in the call-centre and nocturnal existence writing essays on research methodologies, but because the conclusion of the article struck a chord:

In this competition the power lies with the few, whose priority is cheapness, rather than the many, whose priority is regularity and universality; cheapness wins, and it is the postal workers who suffer.

Such a passage could easily be applied to care workers. Since the NHS and Community Care act created the purchaser/provider split local government commissioners have prioritised cheapness driving down the cost of both residential and non-residential care. In a labour-intensive industry it has been workers who have paid the biggest price.

Should we worry? Yes. Well-paid and well-respected staff members contribute to a better service. Another reason is that social care is up there at the vanguard having for a combination of reasons moved furthest, fastest when it comes to liberalising welfare markets. The question we really need to ask is do we want to see the social care model replicated in the NHS?

Wednesday, 20 April 2011

Mutuals: A blueprint for the future?

According to a recent article in the Guardian the Government are very much in favour of 'mutuals' this is the process where public servants can club together and effectively opt-out of the public sector.

As a former public servant I must say I always felt that myself and my colleagues could do a better job than our senior managers who seemed to be handpicked for their ability to lurch from crisis to crisis whilst maintaining a veneer of optimism.

The idea of mutuals trouble me though. Much of my interest at university (in fact I'm currently in negotiations about a potential Phd on this very topic) is around how organisational characteristics impact on the public service ethos; in other words is the profit motive found in the private sector inconsistent with public service ethos of the voluntary and public sectors? The answer you may be surprised to hear is that it is not necessarily the case, in fact the opposite may be true; that is in some circumstances for-profit organisations may contribute the public good more effectively that the private or public sectors.

This view is against conventional wisdom, but a great example is provided by the Body Shop. Seen as left-field and pioneering when they were first set up the virtues they champion have been absorbed into the mainstream. All that within a for-profit model which would have been inconceivable in the voluntary or public sector. I am aware that I have defended the public service ethos of the public sector in the past and my views have not necessarily changes, I still beleive that the public sector possesses a particular strength in this aspect, but rather I am more pragmatic about which sectors should deliver services. the way I see it is very much a case of 'horses for courses'; in some instance the public sector is best, in others the qualities of the private or voluntary sectors can be better.

The problems however, centre around the pressures such 'mutuals' may find themselves under. It appears they will be a hybrid of all three sectors and will need to balance public service with profit making. The example given in the article of Cleveland Fire Brigade presents one example; on one hand the organisation has a public service committment committed to providing services to the public, but this will need to be balanced against profit making activities. This means decisions will need to be made in the future as to how best to allocate resources, should a fireman be on standby in case of a fire, or would it be better if he/she was off conducting a paid consultancy to bring in extra cash. This is not far fetched speculation, but a real issue as in the voluntary sector the issue of 'mission drift'; that is abandoning an organisations core mission to chase the funding on offer has become a real and recognised issue in the voluntary sector, first through a glut of funding opportunities and latterly through a scarcity of funding.

The answer to these dilemmas is that there should be a level of accountability, but accountability to who? Local councillors perhaps, but what if an organisations area of operation overlaps several authorities boundaries then who takes the lead and is local government really an effective tool for this? In addition the more mutuals there are, the harder it is to trace accountability. In the NHS and public services as they stand there is a clear chain of command. Numerous mutuals operating in different areas may well be hard to keep track of and their opaqueness could prevent accountability from the public and local media.

I do beleive that there is a case for challenging the monopoly of the public sector, but any moves need to be done with extreme caution and lessons learnt from the experience of transferring services from the public to voluntary sector.

Friday, 15 April 2011

The rotten state of residential care

Well it seems a Social Care story has finally appeared...

Southern Cross Healthcare who own and operate 31 000 residential homes are in serious financial difficulty. The chairman has quit and the firm is threatened with possible insolvency.

According to the Guardian article Southern Cross came unstuck due to greed:

The company's problems stem from heady expansion when it was owned by the US private equity group Blackstone, which undertook the sale and leaseback of homes to bankroll a number of expensive acquisitions. Many leaseback agreements included upward-only rent reviews of up to 2.6% annually.

As the article also explains whilst this may have seemed like a good idea at the time it doesn't seem so good in the face of local government cutbacks. I know my old authourity a couple of years back went with a 1% increase in the maximum funding levels two years in a row, and for all I know this situation probably continued after I left. What this means is that as far as local authority clients went a company like Southern Cross could only expect the price they received per resident to rise by 1% Makes those 2.6% rent reviews seem like a very bad idea indeed.

But, isn't that the way markets work? Risk and Reward. Southern Cross won't be the first firm to have collapsed after overstretching itself to meet ambitious targets. Maybe we could shrug it off if it wasn't for the following passage of the article:

Paul Saper, chief executive of LCS International, the healthcare consultants, said that the cash-strapped group had not "invested properly in some of its homes, with doors falling off the hinges at some properties". He added that, a year ago, about 40 of the company's homes faced embargos from the regulator and that several had been the target of enforcement orders linked to issues such as hygiene and standards of safety.

This is the crucial difference. The state of the residential care sector affects lives; the lives of residents, of staff and of families. This episode serves as a reminder of just how rotten things are in the sector and just how thoroughly rotten the whole system is.

I don't think many people in social care would rush to defend the status quo. In the one corner we have the capitalists seeking to make a profit, in the other we have local authorities keen to cut costs.

Between these two implulses the standard of care in the sector, particularly for those least able to top-up with their own resources, is being driven down. Residents are put at risk and staff are expected to do a tough and demanding job for a pittance and without the right support and training.

There is an irony here that in the event of Southern Cross folding Local Authorities, most of whom have spent the past few years closing down their own homes to a great deal of local resistance, may well end up taking on responsibility for the homes.

Monday, 11 April 2011

A quiet time

A hectic schedule and a problem with internet access have conspired to prevent me from posting anything really meaningful over recent weeks, but is it just me or is the world of social care a rather quiet one right now?

The media is a fickle beast; like a channel-surfing teenager it has a short attention span rapidly flicking between channels to create some sort of post-modern collage. One second we're getting all worked up debating the big society, individual budgets and disability benifits and suddenly the channel is changed. A complete break. We're now talking about NHS reforms. The rest will have to wait patiently until events; a speech, confrence, report or scandal lead the media to return with our collective attention once again.

Sunday, 3 April 2011

Just how well thought through is Government policy?

Just how well is policy thought out. If the current Tuition fee debacle is anything to go by then the answer has to be very badly if at all.

Just take one paragraph from the guardian today which tellingly says:

The number of universities declaring that they wish to charge students the highest amount from next year has caught ministers by surprise, with the majority of institutions planning to charge more than £7,500 a year.

Now, I clearly remember government representatives on television stating that there would be a wide range in terms of fees charged by institutions and that students would be able to then make a choice from this range. Let me just say that the commodification of education is not something I condone at all, in fact it is something I vigourously oppose, but also worryingly it seems that if ministers have got it this wrong on what is comparitively a rather simple market to analyse then what does this say about the basis of policy in other areas such as around social care a much more complex entity.

And the reason why universities are charging high fees... It's because they know demand will still be there even if they charge students extortionate rates. Why? Because university still represents chasing the dream to most young people. It is still seen as virtually the only the route to a career, home-ownership and the middle class. Universities know, even if ministers don't that with few alternatives, people will be prepared to pay for this dream.

Saturday, 19 March 2011

Communication strategies.

I've been planing to write about technology and social care for a few weeks now. I'm still formulating that one, but once again something written on the topic (in the Guardian as ever) has caught my attention and forced my hand. It was a call to harness the power of the Internet to aid communication between organisations and service users more of whom the article assumes will be using individual budgets.

The crux of the article is summarised neatly in one paragraph:

Complimenting this is the interaction between organisations and their clients, cementing online communication as superior to other mediums. The modern Internet holds the potential for service providers to reassure people by offering easy, quick and cheap methods of communication. Being able to receive and respond to feedback, offer online advice and allow vulnerable people to apply for help from their homes are now basic communication requirements in an inter-connected world.

As the commenter's (myself included) point out there are many issues around using the Internet, not least the fact that certain groups have greater access to it than others; Though the article suggests that more people, particularly in the older persons bracket are getting online, the phrase 'digital divide' still seems apt. Another issue is that in my experience for social care email is quite possibly the worst form of communication. Mainly because the conversation is one sided making it very hard to make a quick assessment of a situation. Much more preferable is a telephone call allowing you to get much more info in a shorter time as well as judging a persons state from their tone of voice; scared, upset, confused? Not so easy to tell by email. Top of the tree is a face-to-face visit where you can read a whole set of non-verbal cues and see a person in their surroundings.

The one thing the article does get right is that email is a cheap method of communication. I know a few years ago some authorities still visited almost everyone who asked for assistance to carry out a face-to-face assessment, but it became increasingly common to find 'contact centres' being set up where initial assessment was done by telephone, with some being 'screened-out' so never receiving a visit. Undoubtedly this trend was driven by a need to stretch resources so its quite possible that email or self-assessment via a website will prove hard to resist for cash strapped authority's and rather than helping "people feel closer to those who provide key services" it erects yet another barrier between them.

It's not that I'm some kind of Luddite. I believe that the Internet and email does have a valuable role to play in social care however, as usual I have a number of concerns. Just a couple of years ago for instance my authority announced it was phasing out information leaflets; those ones you see in racks on the wall of a GP's surgery waiting area, or just inside the door of a community centre. It reasoned that they were a costly and inefficient way of communicating with people, so save for a couple they were to be only available on the website in PDF format. In part the authority had a case, keeping the leaflets up to date was a costly exercise (also arguably environmentally unfriendly) and there was no control over the numbers of out-of-date leaflets in various locations all with the wrong information and old phone numbers belonging to teams which have since been re-organised at least 5 times. They also decided to pahse-out the leaflets in various languages, again they could well have had a point as in the office we did have a filing cabinet bursting with leaflets in Polish which never saw the light of day due to there being no demand for them. The councils proposal was that instead translations of all the leaflets would be carried out on request.

Clearly, apart from the cash saving, none of this been thought through. What if people don't have Internet access, and will people at possibly the most vulnerable time in their lives manage to navigate the complexities of a councils web site to find the right leaflet, or is it more likely that they'll spot it in a GP's surgery? Yet again an assumption has been made that the service user is an informed consumer just like someone shopping around for the best car insurance deal when often this is not the case. As for the language issue the situation is even worse. The piles of unused leaflets were not the problem, rather they were the symptom of a wholesale failure to engage with minority communities, particularly the most vulnerable among them; making leaflets only available on request (along with pulling funding from the jointly funded post of a sensory services minority outreach worker and cutting funding for neighbourhood advice centres - where face-to face advice and information leaflets both in a range of languages were easily available) would make matters much worse than they already were.

Fortunately I did notice a leaflet recently in a GP's surgery so unless its an out of date one there may well have been a u-turn on the leaflet policy. I hope so as for all it's promised advantages we need to be careful that new technology does not mean people are left behind.

Thursday, 10 March 2011

When is a social worker not a social worker...

When is a social worker not a social worker? Apparently the answer is when they're impersonating one as Tracey Smith, an 'unqualified assistant social worker' found to her cost resulting in a conviction and fine of £230. I won't dwell on the particulars as it's all in the original Guardian article, but just to say the deception seems to have been mainly based around job references and CV 'creativity'in which she had claimed to have been a social worker.

Ethically this is rather dubious and of course not defensible in any way, but I wonder if the question over what is a social worker is quite so clear-cut. I always remember my first day working for social services; being shown around my biggest shock was that most people were not social workers, in fact apart from the team manager there was only one qualified social worker in a front-line team of 12-15 people. The rest held job titles ranging from admin to information officer, contact assessor and unqualified care manager.

One thing which struck me about my time in public service was the importance attached to job titles. For every visiting professional, dignitary or student social worker we introduced ourselves in turn by name and job title. Each title had a carefully worked out job role courtesy of HR and fitted into a well defined pay structure, not to mention office hierarchy as hilariously demonstrated by this Clare in the Community cartoon (Scroll down to October the 10th).

Despite their importance within the organisation, to the general public such distinctions didn't matter, most would differentiate between admin and a social worker, but almost all, like I had before I joined, just assumed that everyone else was a social worker. Sometimes though this assumption would break down. My first role was answering the telephone, the system broadly operated in the following way: I would take down a persons details and an outline of their particular problem then pass this onto the social-worker who would then call them back or put the form in a tray for one of the other unqualified workers to deal with. Occasionally I would be asked if I was a social worker...

Caller: are you a social worker?

Me: No, I'm a receptionist

Caller: So you can't help me then?

Me: I can see if I can help you, would I be able to take some details from you, then I'll pass them onto the social worker?

Caller: No, I need to speak to the social worker. Now.

Me (to social worker) Umm, I've got someone who says they want to speak to you.

Social Worker: I'm busy I'm afraid, tell them I'll call them back. Take some details.

Pretty much whenever the assumption that I was a social worker broke down the whole system went out the window.

So this poses an interesting question, I was not impersonating a social worker, but to do my job I was relying on peoples assumptions that I was a social worker. My bosses I hasten to add were fully aware of this fact as I told them this many times. Eventually my old job role of answering the phone was shipped out to Capita, would people then stop assuming they were speaking to a social worker when they called in? every so often we'd be told by someone, sometimes even from a professional, that they had spoken to a 'social worker' the day before when in fact the person they had spoken to was based in the call-centre.

Aside from all this within the organisation, job roles though strictly defined on paper also have a habit, especially in times of staff shortages, of developing grey areas round the edges. I've seen safeguarding adults work being done by what we called 'unqualifieds' and it's also not unusual for a newly qualified social worker in a small team to be under the wing of a more experienced but unqualified worker for up to a year.

It was all brought home to me when I was having a conversation with a French Canadian chap and his girlfriend in a hostel on the continent. We were talking about our jobs over dinner. I had described my day-to-day job role to them, but the girlfriend had struggled with some of the language and terms I was using. She asked her boyfriend to help interpret. I picked out two words among what he told her....... 'social worker'

Tuesday, 8 March 2011

Gadaffi and the LSE

This may of course just be an isolated case, but am I alone in wondering whether the much vaunted and terminally embarrasing link between Gaddafi regime and the LSE rings alarm bells when it comes to the plans of exposing much more of the public sector to market imperitives and the influence of filthy lucre?

Wednesday, 23 February 2011

The Cameron Plan

If you want to know what Cameron's vision of the future for public services looks like you could do a lot worse than to read this BBC news piece

The plan isn't a particularly revolutionary one; it's more of a continuation down the path we started out on with the 1990 NHS and Community Care Act. The legislation which instituted the purchaser provider split.

The state, under Cameron's plan becomes like a referee. Its role setting out and enforcing the rules which govern interactions between all the players. If you want to know how this will work the model is taken from the utility privitisations where the states continued interests are represented by industry regulators such as Ofgem

Putting such a system in place is no real practical challenge, but it is a philosophical one. The chief issue is what happens to the public service ethos, can it survive a run in with the profit motive?

Wednesday, 16 February 2011

What if..... the 'Big Society' worked

Just for a second, if I shut my eyes tightly enough, I can imagine a world where the 'Big Society' works (This is despite coming to the end of the excellent 'The Spirit Level: Why Equality is Better for Everyone' which convincingly argues that the level of inequality in the UK and U.S is a major impediment for a sharing and cooperative society). Yes, I can force myself into a state of optimism. I can see innovations like the Ministry of Stories and other stories of individuals and groups being creatively empowered to improved services.

It seems to me that we are all too focused on the many reasons why the 'Big Society' will not work that we are failing to considering what will happen if it does work.
When I say 'work' this is of course somewhat subjective as if the plan does take off I am far from optimistic.

The reason for this is that there are two visions of what may happen if the 'Big Society' idea really gets off the ground. The first is the vision of 'bungling amateurs' which Francis Maude may be relaxed about, but as someone with five years experience in social care I can say I am definately terrified about. Even providing basic services is a complex matter and if something either goes wrong, or more likely something is omitted then the consequences can be dire indeed.

It is however, not just failiure that is the problem. Success is perhaps an even bigger issue for the 'Big Society'. According to the market logic of the likes of Maude, good services will flourish whilst poor ones will disappear through lack of demand. That this can be a problem may seem counter-intuitive; after all if services improve that can only be a good thing, right? The problem though is that when it comes to applying the supply and demand economics of the market to the voluntary and community sector there is a key difference. As Harvard Business School academics James Austin, Howard Stevenson and Jane Wei-Skillern point out both sectors have very different opportunity structures:

In comparing the nature of opportunities in the commercial and social sectors, clearly, there are abundant opportunities in the latter relative to the former. The demand for social entrepreneurial programmes and services usually far exceed the capacity of the social enterprises to serve these needs. Initial successes often lead to increased demand for the social enterprise's programmes, products or services, or even requests to scale or replicate the organization in some form. For many employees and for the outside funders, the growth imperitive often becomes paramount.

So unlike the commercial sector the demmand for services provided by the voluntary and community sector is virtually unlimited. On the face of it this would seem to suggest the need for an initiative like the 'Big Society', but the academics warn the pressures to meet the sheer scale of demand can be detrimental to voluntary and community organisations:

In some cases, growth may not be the best approach to achieve the organization's goals or to have the greatest social impact. Growth for the sake of growth has the potential to squander organizational resources and can actually detract from the organization's overall impact.

This leaves succesful organisations in a bind. Although Austin, Stevenson and Wei-Skillern are not saying that growth is intrinsically a bad thing, they provide a reminder that growth is not necessarily a logical outcome for a succesful organisation. This suggestion ties in with the view expressed by former Shelter Chief Executive Adam Sampson that some charities had grown too large, buracratic, commercial and in the process distant from their beneficiaries in a way which was threatening to undermine the sectors claims to distinctiveness.

This issue boils down to this. If voluntary organisations grow they may in the process of restructuring lose what it was which made them succesful in the first place, but if they choose to remain the same size they must cope with huge levels of demand which they could not possibly hope to meet. How do voluntary organizations cope with excess demand? The market mechanism of increasing price is out of reach to them, so they must choose between having a huge waiting list or develop criteria. The role of the criteria is simply to discriminate between who receives a service and who does not. This could be based on an assessment of need, on geographic residence criteria, financial circumstances, or any other combination of measurable characteristics. In some circumstances criteria my be formal, but in some cases it has been shown that informal arbitary rationing criteria have been used by voluntary ortganisations keen to safeguard limited resources.

What this all leaves is an opaque system where a person in need must approach multiple organisations and satisfy various sets of criteria, becoming as one academic, Caroline Knowles, referred to as "welfare Nomads"; persons spending the day wandering from location to location to piece together a patchwork quilt of support.

Set this against a backdrop of a welfare-state in retreat and you have a potentially toxic combination should the 'Big Society' actually work.

Sunday, 13 February 2011

Big Society Fortnight

I've decided that this is now going to be big society fortnight(backdated to last week). It's been a such a long time since I've had so much to say on one topic and I know I'm not the only one as apparently at the Uni some big-name academics also came together to hold a debate. When I heard this I reflected that it was curious why we're all now devoting so much time to what most of us seem to beleive was just an election gimmick, but here we are and the discussion goes on....

It seems that all of us, even Dave himself, reached a consensus last week; namely that the cuts dished out to the voluntary and community sector by town halls across the country seemed to be anomolous to the aims of the 'big society' programme.

Sensing that the policy was on the verge of turning on its heels and running, to be ruthlesley pursued by the oppositions cavalry it seems the Government will this week be attempting to set a rallying point. Some of the details which have been announced featured in the Guardian over the weekend. Though I am tempted to pick it apart in minute detail I will restrict myself to commenting briefly on the main features.

Firstly there is the announcement that a £100m fund will be available to enable "charities" and "social enterprises" to "compete" for government contracts. Also available will be £200 million in loans from high street banks.

My first impression is, what's new? This is something which was being done under the last Government through programmes such as Change Up and Futurebuilders. I also wonder how the £100 million figure measures up to the cutbacks. As I have previously mentioned in my area alone £400k is expected to be shaved off the main Day Care services contract(currently provided by a nonprofit) alongside 700k or so in funding for voluntary sector organisations in the area. These figures are also per year, it is not clear in the article how many years the £100 million will be spread over. The Guardian piece does rather well in dealing with the issue of the £200 million from the banks, which it states will be on a commercial basis, and again, what's particularly new about this? There has been nothing stopping a non-profit organisation seeking finance in this way before.

A key feature of Cameron's defence of the big society has been how it embodies a philosophy of bottom-up as opposed to top-down action. Leaving aside the fact that this is quite a paradox for a policy being pushed by central government I wonder how the above funding arrangements fit with this philosophy. The reason I ask this is that the current round of local government cuts are likely to bring into question the viability of small locally based voluntary organisations as opposed to large regional or national organisations which will have more diverse funding streams. It is these small organisations which are often credited with being closer to their beneficiaries wheras larger organisations have been critiqued for becoming too buracratic and distant from their beneficiaries I also wonder how shifting the decisions over which charities to fund from democratically elected local authourities to high street banks and central government quangos is in keeping with the bottom-up philosophy?

Something which also seems to run counter to this is the whole process surrounding the 5000 'big society' workers and the establishing of what looks like a central college with what seems to be remit for deciding on a curriculum for a set of community work qualifications. All this at a time when Community Development Workers across the country are in fear of their jobs and department budgets. If this does not smack of top-down centralisation I really don't know what does!

Monday, 7 February 2011

BBC on the Big Society

It amused me to come across this article on the BBC website as it makes some very similar points on the big society to those appearing on the pages of this very blog and comments I have made elsewhere!

The general theme of the piece is that whilst Government is encouraging the idea that the voluntary sector should play an increasingly prominent role in delivering services Local Government budget cuts are actually undermining the capacity of the sector to be able to deliver.

Especially interesting is the following passage dealing with the Governments response to these points:

Asked about the criticism that there was no strategic plan, Cabinet Office mnister Francis Maude told the BBC: "We're not going to dictate from the centre what every local authority should do. They must be accountable to their local communities."

He said three quarters of voluntary organisations got no state funding so would not be affected by council cuts.

Firstly this seems like a clear case of buck passing. Having worked for a local authourity in the past it was clear to me that Local Authorities have very little room for maneuvre. Most of what they do is prescribed by statute or dictated by central-governemt. With barely enough funding to do what is required of them Local Councils main concern is simply one of survival; a case of figuring how to put food on the plate, not making an informed choice between steak and chips or cod and chips. In other words local authourities whatever their persuasion or outlook will seek to cut soft targets; libraries and funding for local voluntary organisations.

The second point I really must take issue with is the figure quoted that 3/4 of voluntary organisations receive no state funding. This may be true, but it does not account for the size of voluntary organisations which vary enourmously from a one room operation consisting of a handful of people, to a national organisation such as Shelter, or a multinational like Greenpeace. Organisations also do differnt activities in different policy areas; not all directly provide services, some provide office support to other organisations, some engage in advocacy and others may act as umbrella groups. So it is not really possible to compare organisations on an individual basis. It may well be more likely that it is the organisations most involved with service provision that are in receipt of state funding.

Thursday, 3 February 2011

The 'big society': Returning to the 1970s

It's been a tough week for the 'big society' first Lord Wei the man dubbed the 'big society Tszar' finds that volunteering is incompatable with the pressures of work and family life, but perhaps more importantly it seems charities will be hit hard by cuts made by local authourities.

The importance of central and local government funding of the voluntary sector cannot be understated. It has been this which has been the key driver behind the sectors growth for over a decade not other factors such as the scale of volunteering which has in some instances actually been in decline according to the academic Ingo Bode.

As I mentioned in my previous post in my area the outlook for the voluntary sector couldn't appear any more grim with the authourity itself recognising the devestating impact their cuts are likely to have on the sector.

"All voluntary sector contracts which are identified as providing non
statutory preventative services are included and will be ended. The
loss of these services will impact on later costs where early
intervention would have reduced service need. Such cuts may
result in some organisations becoming unviable which will impact
on their use by other areas of the Council and partner

Day Care in my area is a great example of this, currently the bulk of the Day Care service is provided by a nonprofit organisation who are contracted by the authourity. This funding is likely to be cut to the tune of £400k. Another organisation which runs and Asian elders day centre also faces the total withdrawl of their funding.

How likely is it that voluntary organisations will make up the shortfall and be able to survive on the resources of the community and volunteers alone? Even if their survival were ensured could current standards and levels of provision be maintained, or would voluntary organisations need to strictly ration access to their services.

The ideal of the big society with its strong appeal to nostalgia may point to a time when communities, individuals and groups did come together to provide services, but such nostalgia is misplaced. As ACEVO chief Stephen Bubb pointed out government funding and an increasingly professional voluntary sector have been responsible for raising standards. It is, as Bubb mentions, quite right that we would not wish to return to the kind of services provided in the 1970s.

With cuts in government funding to the voluntary sector this though is exactly what the 'big society' will mean.

Sunday, 30 January 2011

Day Care part 2

It seems the writing is on the wall for Day Care in my area. A council document published on the website of a local paper projects a budget saving of £400 000 from 'reviewing' the service which reading between the lines involves reducing demand through a two pronged strategy of individual budgets and tightening up eligibility criteria.

This can probably be achieved as there are probably a fair few people going to Day Centre who strictly speaking wouldn't meet the eligibility criteria as it stands today. I remeber in my time assessing people for this service I had the unenviable task of explaining to a lady why she couldn't have a second day at the Day Centre despite the fact that other people had three days there. Quite simply the bar for the service has been raised year-on-year and Care Managers doing reviews don't like taking services away as this involves potential for conflict with the service user and the risk of getting things wrong not to mention more paperwork. This created a two-tier system where existing service users assessed in more lenient times had their privelages maintained whilst potential new ones had to meet much tougher criteria which often saw people with possibly greater levels of need being turned down for services.

This two-tier nature of the system is bad in itself, but also problematic is what happens to people who now don't now meet the eligibility criteria. Will they be able to obtain the service elsewhere? The answer is probably not, if a person isn't eligible for Day Care under FACS (Fair Access to Care Services)they won't be eligible for an Individual Budget either. Can they obtain the services from the voluntary sector? Possibly however, this depends where a person lives and whether they have the resources to access transport. Groups which do exist tend to meet on a fortnightly basis so will also be unlikely to meet demand. As the service in the area is also currently provided by the Voluntary Sector, but funded on a contract basis by the authourity it is much more likely that the Voluntary Sectors ability to provide good quality Day Care services will collapse.

A reason for the bar being set low for access to Day Care was that, as our senior managers were fond of saying, was what was termed a 'preventative service'. It was seen as a form of early-intervention which would prevent someone needing more services at a later stage. This was clearly logical whether it was giving a carer a break, extending a persons support network, improving someones mood, or just being able to tell when something is wrong Day Care did work in this respect.

Our Head of Service used to bemoan how we had so little to invest in such preventative services and how this undoubtedly increased the costs we had to pay now and in the future. A cycle occoured where less money on prevention meant higher costs and even less for prevention.

Reducing Day Care provision seems to be a leap along this cycle, but even more troubling later in the document is the following passage detailing a planned budget saving of £776 000 across the council. The passage reads:

All voluntary sector contracts which are identified as providing non
statutory preventative services are included and will be ended. The
loss of these services will impact on later costs where early
intervention would have reduced service need. Such cuts may
result in some organisations becoming unviable which will impact
on their use by other areas of the Council and partner

Which all leaves me wondering what happens in the future?

Monday, 17 January 2011

The end of day care?

The local rag in my area today carried a story about how the day centres in the district are under threat due to budget cuts. It's made the front page, but to anyone anywhere near the world of social care it's not news at all.

Day care has long been considered to be the weakest gazelle among local authourities portfolio of services. Caught in a pincer movement between cost-conscious authourities who regard day care as an unecessary luxury on one hand and by modernisers who see it as hopelessley out of date the real surprise is how long it's managed to survive.

It could well be that attacking services out in the open is difficult at the best of times as the local rags dedication of their front page testifies, but I distinctly remember talk years ago of a more subtle approach using individual budgets as a way of phasing out day care. The arguement was that people would prefer to buy a football season ticket or do something, anything, other than a jigsaw with missing pieces and a sing-a-long in a church hall. The logic dictated that in the face of greater choice day centres just wouldn't cut it.

Another important argument is that day care is just not inclusive. Social care has a progressive element to it and day care has just got too much of a segregationalist whiff about it. Why should a person not enjoy the kind of leisure activities the rest of us enjoy, football, nights out with friends, watching a gig, just because they have a disability, and hasn't the DDA made all these things more accesable anyway?

There are however, problems with this view. The first being that a lot of people actually like day care. Most centres had a waiting list for spaces and a fair number of people once they had started enjoyed it so much they then asked for a second or third day. This was perfectly understandable as for a lot of people, particularly older people, day centre represented a vital link to the world outside their living rooms. As care managers our day centres also proved invaluable. Their staff could build good relationships with service users meaning they could detect a change in someone which might indicate something was wrong.

Second there is the issue of costs. A football season ticket can cost a lot. Day care on the other hand is cheap. In my area we had a block contract with a voluntary organisation. Most of the premises were also purpose built common rooms at council owned warden assisted accomodation so overheads were low. There may well be better alternatives, but there aren't cheaper ones.

It almost seems like another age, but around four years ago we even offered the service for free and had given days away without any kind of real assessment. Those days are long gone and unlikely to ever return, but I wonder will it be the same for day care?

Monday, 10 January 2011

People matter

I continue to live a double life. Half my time is spent studying social policy, the other half in the call-centre.

I tend to view the call centre as a necessary evil; a mind numbing experience I put myself through to pay the bills. Its certainly not often the call centre teaches me much about social policy, but recently it has.

What I have learnt in the call centre is that whilst there is a lot of rhetoric about the importance of the customer and customer service it is the bottom line which matters above all else. The firms I provide customer service for have no interest in the customer beyond how to squeeze more money out of them.

This was brought home to me when I had to deal with a customer who was quite rightly unhappy with some aspects of the service they received from the company. They told me they would no longer be doing business with the company unless it changed the way it went about certain things. They had simply had enough and would vote with their feet.

I reflected that this would make no difference at all to the company. So long as the majority of customers continued to put up with things and enough new customers replaced the ones walking away it really didn't matter to the firm.

I contrasted this with my time at the council. If someone was unhappy with an aspect of the service their issue would at least be examined and a response provided, but in any case we just weren't happy with failiure, our business was to serve people so people counted.

All this has implications for social care. We are undoubtably edging towards a system with a bigger space for large scale private-providers. We need to protect the notion that above all else people matter.