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?

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.

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.

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.

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.

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.

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'