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.

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?

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?

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.

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.

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?

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.