Who killed free personal care?

Forget who killed Archie in Eastenders. If you want twists, turns, skulduggery and intrigue look no further than the free personal care at home bill.

It seems that what began as a pledge for free care has turned into a fairly large flat fee paid on either retirement or death

I freely admit to having lost track of what is going on. The thought of a flat-fee on retirement worries me; what about people who are not yet at retirement age, how does this affect IB's, what will the thresholds be? One thing I am certain of is that this is not the way to make policy. Service users, workers and carers all deserve more than this.

New Semester and Old Friends

I'm currently reading an excellent book called The Rider by Tim Krabbe. It's about cycle racing a sport which I have been intrigued about since heading to London a few years back to watch the Tour Prologue. I was led there by my love of simply just being on my bike, but my knowledge serbved only by faded memories of the Tour on Channel 4. This meant I didn't really know what was going on but the full-frontal assault of the publicity caravan with its shower of gallic gifts from Hotel Etap pens to Laughing Cow fridge magnets engulfed me in the atmosphere like a peloton mercilessly swallows a lone rider. The smudges of garish colour burnt onto the pixels of my too-slow camera and indelibly in my mind led me to read about the tragedy of Tom Simpson on the moonlike Mont Ventoux, the struggles of the unsung domestique and the pantomine that has always been the Tour de France. These however, are only background to The Rider. Krabbe, a cycle racer himself, invites you deep inside his mind during a fictitious race. This however, serves as a vehicle for an exploration of the real emotions of the racer. The garish colours are stripped away allowing the obsession, pain and determination to glow with flourescent force.

I know I can never be a cycle racer, I do not possess the masochism or ability to ignore pain that is the stock-in-trade of the rider. But, the emotions feel familiar - they should to all of us. We are all involved in our own cycle race. Sometimes we collaborate, sometimes sitting in anothers draft and sometimes we break out alone. We struggle up mountains and try to hold our nerve as we hurtle down the other side. We stretch our mental and physical abilities with an eye on the finish line. University certainly feels this way to me - essay deadlines being like the crest of mountains.

At the moment I am enjoying a section of the race on the flat where the rhythm is more relaxed. I've just been to an introductory seminar for my second unit this semester. The subject of this, and my other unit, is on changes in the delivery of welfare - particularly the involvement of the private sector and voluntary sector in welfare delivery. A subject I'm particularly interested in and intend to enjoy before I reach the next mountain.

I will also be seeing a lot of my old social-services colleagues tonight. It should be a nice get together as even though promises were made to keep in contact these were, despite good intentions, buried under layers of work and other commitments. I will however, have to try to refrain from getting too carried away in discussing social policy!

The Beeb reports

I'm currently paying my way through my uni course by working in a call centre three days a week. For some reason my employers provide internet access but this is limited to the BBC web domain. Exploring this is like exploring Wookey Hole caves with its hidden chambers slowly revealed by deeper and deeper dives into the dark waters. One of my best discoveries to date is a wonderful text based adventure game based on the Hitchikers Guide to ther Galaxy. My main stomping grounds are the news and sport pages. I'm not a huge fan of BBC news, but 9-5 it's all I've got. Today I also noticed an article directly related to the post I made yesterday about the Governments plans for free social care.

According the BBC report the schemes financial projections have been called into question by the Association of Directors of Adult Social Services (ADASS). It turns out the Government assumed that the average cost for a care package for someone meeting the criical criteria is around £100 a week. ADASS on the other hand estimeate it at £200. A figure which from my care management experience appears more realistic. The effect of this underestimate is, the article suggests a £500m funding shortfall which falls squarely on the shoulders of local authorities.

Interestingly elsewhere on the site is an article about a report by former civil-service insiders which in criticising poor legislation fingers the Personal Care at Home Bill as a possible example of legislation which is not sufficiently thought through.

Perhaps yesterday I overstated what I felt was the agenda behind the legislation. To be sure I beleive there is a long term trend for increasing white-collar privitisation in local government but, maybe and this is equally worrying policymakers in government are simply making it up as they go along informed by nothing more than their hunches. To me this is a proposition more worrying than the hypothesis I put forward yesterday.

There are certainly a whole load of logistical issues. One which springs instantly to mind is that care managers will find themselves pressured on one hand by service users and families keen to receive free services and the authourity on the other hand which wants to protect its budget. Has anyone thought of this?

#welovetheNHS

We all love the NHS. So much so that when it was slurred in the context of an American political debate thousands of people inventively hollered their support from cyberspaces newest technological rooftop.

We love the NHS for one simple reason. It is universal - Simply put it means the same to all of us; healthcare when we need it without regard to our material or social position. The NHS is the most true monument to the thinking which underpinned the development of the welfare state; All citizens, not just those who succeed via the free market, possessing rights; rights to education, rights to health, rights to live a fulfilled life.

Well, there are two reasons we love the NHS. The second is that despite Thatchers attempts at destabilisation in the late 1980s it delivers a high standard of care. Though to be fair to myself this is linked much more closely with universalism than is first thought. Universal services tend to be of higher quality and like the NHS are far more resilient to Politicians cutting funding. Cut Jobseekers allowance - the unemployed suffer. Cut a local hospitals budget we all suffer.

So what are we to make of the Government's suggestion for a "National Care Service". The name choice seems like a supermarket own-brand cola brands attempt at aping coca-colas distinctive packaging - in effect branding piggybacking; in this case suggestive of the national standard and universal entitlements of our beloved NHS. But will we be getting the real thing or a cup of water with a spoonful of sugar and a drop of food dye?

Social Care on the other hand combines universalism with it's opposite number selectivism. We are all entitled to an assessment and to services but when it comes to funding services this is by way of means-testing which varies across local authorities and can be in some cases quite punitive, by the Government's own admission penalising those on middle-incomes or with savings. The Government's plans keep this structure in place for the vast majority of service users but add an outhouse of universalism for the much lower number of people with the highest level of need. Local authorities will also still be in charge of delivering services which will mean that National standards will be logistically hard to implement and postcode lottery most likely to be the result.

As this article points out the National Care Service idea seems to have materialised from nowhere. There was certainly no talk of it when I was still in an authourity at the tail end of last year. Which all begs the question... just what is going on?

I beleive there is a divorce taking place between care management and social work. If the kind of initiatives I have seen piloted in the last couple of years such as individual budgets, self-assessment and care management being carried out by voluntary sector 'Brokers' works out as planned then Government can scale back their involvement in this area, concentrating instead on service users with high-level and complex cases which are primarily the realm of qualified social workers. A National Care Service encompasing only this latter area and which overlaps with the NHS and its universal ethos would certainly be a way of creating a framework in which this could be achieved.

This would be entirely consistent with what has been happening at a local level. Since the 1980s local authourities have increasingly outsourced. Beginning with workers in peripheral activities and/or at the bottom of local government pay scales, cleaners, cooks, carers, the tide has been rising higher up the pay grades, council tax officers, finance officers, IT technicians, HR, payroll are now likely to be found with ID badges bearing the tell-tell words of privitisation: 'working with.' The future is I beleive one where authourities will consist of a rump of qualified professionals involved in complex cases or enforcement functions; town planners, highway engineers, and social workers who will direct and supervise work carried out by outsourced non-qualified staff.

Closing the gap

The depressing news that inequality is today worse than the 1970s comes as little surprise. One of the points made in the BBC report is how this is embarrasing for a government which has set out with the aim of tackling inequality.

I am reminded that a couple of years ago my directorate listed 'closing the gap' among its core aims. Its fate was to be eventually dropped by an incoming Conservative administration but for the couple of years of its tenure it seemed a noble objective.

In my experience however, the authority did little to reach out across barrriers. Changes were introduced so leaflets in surgeries and other locations disappeared in favour of 'factsheets' online and translated leaflets became only available on request. The service became in effect only visable to those who had the resources to search for it. Service users on low to middle incomes also faced the biggest squeeze when the financal assesment procedures were overhauled.

The trouble is that the policy aims were like a piece of soviet-era rhetoric, a doctrine of equality preached by a comfortably-off political class with no real commitment to them apart from as a smokescreen. I once quizzed our Executive Director about how a policy which could be detrimental to this aim could be amended to take equality into consideration only to be told, reveallingly, that 'social levelling' was not the aim of the policy in question. This left me to wonder what the point of aims, charters and in my authourity's best jargon 'golden-threads' (the process by which the core aims filtered down to ground level actions) are apart from to impose a layer of hyper-reality where we supposedly work towards an aim but by our actions move ever further from it.

Social-care has a crucial role to play in pushing for greater equality. In my city it was no accident that the busiest team covered the worst-off area of the city. There are undisputed links between poverty and poor health. Conditions such as COPD and diabetes are more likely to affect the poorest. We need a more pro-active social care agenda which is not afraid to question policies, to empower individuals and communities, and to find new ways of working with education, health and other services to prevent needs arising. But, we can only do this if we mean it, if we really care about closing the gap.

Predictions

In the last week I've reached a milestone. I now automatically write the date as 2010, no longer is my official correspondance besmirched by a scruffily scrubbed out 09.

Social care is also at something of a milestone. Twenty years since the last major piece of legislation the 1990 NHS and Community Care Act.

Interestingly major legislation appears to come neatly in two decade cycles. The 1948 NA act and 1970 CSDP act both preceding the 1990 act. In terms of adult services this previous legislation has remained on the statute book - there has never been a clean sweep of the legislative broom with the result that the legislative framework takes on a the architectural characteristics of Hampton Court Palace with wings added, rooms refurbished, new facades and repaired fire damage. Can we expect another addition to this mix in the next few years and if so what shape will it take?

There has been an attitude shift at the heart of the welfare state. Beneficiaries are no longer the passive recipients of the Beveridge era but are in policy terms becoming 'active' This is very much a rights and responsibilities issue and has been seen so far in unemployment benefit where recipients are expected to enter into a contract to actively look for work and update their skills. For social care it will mean a shift in emphasis from a care manager planning a care package and providing services contracted through the local authourity; instead it will mean an individual deciding on their own sources of support and managing this. In other words a person will have a right to care but the responsibility to plan and arrange it.

I also expect the way in which care is funded to change. My initial reading had been that there was an expectation that the cash locked in glacial-like block contracts would as they melted in the new climate mingle with funding streams from the voluntary and private sectors to create a fertile valley of healthy diverse services resulting in savings. This expectation was wildly optimistic. The cheapest way of providing services is by uniform en-masse block contracts with in-built economies of scale. I wouldn't be surprised to see a modified AA and DLA given more of a centre-stage role when it comes to funding care packages and longer term beleive there may well be a move toward a social-insurance type scheme with a degree of state and private sector involvement. I also expect the directly paid workforce in local authorities to be reduced to social workers focused on safeguarding work and a rump of care managers focused on auditing and approving care packages with activities such as setting up care, dealing with minor issues and completing assessment forms to be carried out by the voluntary sector.

It is impossible to predict however, whether these changes will be good or bad. There are certainly concerns. My biggest concern would be middle-class opt-out. Under personalisation the middle class who can top-up may opt out leaving those less well off or with complex needs in receipt of residual services - possibly offered by a local authourity as a 'safety-net'. In social policy there is a wealth of literature to suggest middle class opt-out has huge negative affects on services which become more succeptible to funding cuts. Just think about the arguements that schools fail when the middle class pull their children out.

This and other issues remain a question of government. Both parties favour personalisation. It is a curious issue where the critique of the right has informed the actions of the left. The parties will I beleive differ in their emphasis on elements of the policy with the Tories true to type favouring a more private sector based funding resolution wheras Labour will favour the road of voluntary sector partnerships.

Happy New Year

A slightly belated happy New Year to everyone and welcome to a new decade. In the spirit of the time of year I will offer a review of the year as it has affected me personally and professionally before I look into my social care crystal ball to offer some predictions for the year or decade to come.

Firstly the personal and professional. 2009 saw me finally get my break as an unqualified care manager via a secondment opportunity from mid-January to mid-October. I then ended my almost five year association with the authority at the end of October. The end came as I had two years previously, fresh out of a relationship and into career doldrums, decided to apply for an MSc in Social Policy which I deferred for a year. Just after taking up my place at the beginning of October, using reserves of annual leave to attend lectures, I was interviewed for and offered a permanent care management post, the catch was that they couldn’t accommodate my request for part-time hours. This resulted in an agonising overnight decision with much tossing and turning in bed. I had been attempting since 2006 to obtain a care management post but I had started the MSc and was enjoying it as policy had been a particular interest of mine. I decided that my long-term goal of a job in a policy capacity would best be achieved by remaining on the course. I also felt the need of a change of scenery to rejuvenate me so I handed in my notice.

As of now I am still on the course, I am also achieving pass marks but, as it has been seven years since my last determined academic effort I have found the going tough. The Christmas break ended today and I have a deadline approaching in a couple of weeks for an essay on New Social Risks. I am working harder than ever before, working in a call centre four days a week and spending late nights in the library. I have now cut work down to three days and have had a chance to relax a bit over Christmas – though it has awakened memories of being able to put my feet up in the evenings.

Part of my course has involved learning about comparative social policy, the practice of comparing welfare regimes across the continent. The logic of this is that there is only so much you can learn about a welfare state by studying it in isolation. So it is with work. Leaving the field has been a learning experience in itself. In my call centre role, the one change I notice is the lack of pressure. This struck me just before Christmas. Local weather conditions conspired to leave the city resembling an ice rink in the morning. As I slid to work amidst surreal scenes of abandoned cars and pedestrians trudging in the road, car and bicycle travel an impossibility, I passed a warden assisted block. I suddenly thought of my former colleagues. Some of them would have arrived in the office, found half their colleagues hadn’t been able to get in. Then the calls would begin. Carers would be unable to get into work so clients would not get their visits. Med prompts, meals and personal care would be seriously delayed or missed. Someone would need to establish which calls were really, really essential and try to get a stretched Rapid Response team to visit. The day care bus wouldn’t have been able to get round, people would need to have something to eat as they wouldn’t eat at day centre, Meals on Wheels would also be affected so that wouldn’t be an option……… I sent one of my friends in my old team a text to say I was thinking of her. I knew what sort of day she would be having. Heroic.