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
organisations.

Which all leaves me wondering what happens in the future?

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?

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.

I told you so

Well, it's been an interesting year in politics and social policy. There would have been few prizes on offer for the prediction that Cameron would be PM, but as head of a Con-Dem coalition??

Before writing this I re-visited the predictions I offered last year to see if I could produce a scorecard. Unfortunately I seem to have been far too vauge and long-term - more personalisation was one of my conclusions this time a year ago. Well, yes probably and being a long-term trend it will probably continue. So I award myself null points for that one.

I'm hoping to do better with my 2011 predictions, or rather one prediction. In a sense I'm cheating because it has already happened. The stories are finally beginning to appear linking cuts with their less than desierable outcomes.

So far we have had the ideological sell. Cuts need to have been made we have been told and we seem for the most part to have bought it. For the Government this was the easy part as time is needed reveal the consequences of these decisions. This is now beginning with the Guardian reporting that a £609 000 saving from scrapping a flu awareness campaign has now been reversed as it has been decided in the midst of a flu ourtbreak that it was probably not the best idea.

Another piece in the paper carries a warning from a campaigner, Lucy Cope of Mothers Against Guns, that public spending cuts may result in an "era of terror". Rather a chilling prediction, but one which firmly holds the Government to account. Like the Health Secretary is finding out to his cost now; if individual ministerial decisions to cut funding can be linked to a negative event or set of outcomes the result is highly politically damaging.

The government is sure to be seeing many more 'I told you so' moments in 2011

Ragged trousers

Back in my council employee days days we received a monthly e-mailed newsletter. A cynic like me generally regarded this as mere propaganda, back-slapping by senior managers on hitting a target which meant nothing to anyone remotely near the frontline, but one feature I loved was where another member of staff would pick their top ten books. Most interesting was the senior managers picks. The Executive Director tellingly plumping for Machiavelli's The Prince among his ten, recommending it as an excellent manual for any manager.

The Prince did not appear on anyone elses list, but one title seemed to be almost de riguer: The Ragged Trousered Philanthropists.

Spotting it for £3 in a branch of HMV it has lain on my bookshelf for several months just waiting patientley for the right mood to take me. That mood would come folowing this particularly vacuous read (even by the standard of football books) by Colin Murray which left me gasping for something a bit more heavyweight.

My initial reluctance to read the book was inspired in part by the fact that I felt that it would, at over 100 years old, have little relevance to today.

How wrong could I be. The book shows how little has changed in 100 years. I am only a third of the way through and it has already dealt with how people in poverty are blamed for their own predicament rather than any blame being placed on the system. Perhaps if anything the book is more relavant today than ever as it shows how (despite the protestations of current and previous governments) work alone is not necessarily a route out of poverty. It also shows how the system leads to a grossly uneven distribution of wealth, again a lesson becoming more and more relavant as workers earn minimum wages whilst company directors protect their already huge profits by tax avoidance.

The book also reminds us us why we need a welfare state. Its all very well to knock it and to say that 'hand-outs' result in dependency and reduce the incentive to work, but do we really want the alternative?

Christmas shopping

Whilst we are all busy with our Christmas shopping; please spare a thought for the workers who produce the goods we are buying.

I will not write much on the subject; it is all explained much better in this article

Grim statistics

It's been impossible to get away from the news content generated from the fees demonstration. It left me wondering today why as my younger self would have headed to central London, or at least marched round campus, my older self is happy just to watch it all on TV. I tell myself that it's because I haven't the time, work, family and university meaning free time is now a rare luxury.

Besides, the forces I am currently doing battle with are statistics; more specifically assignment number two and all its logistic regression analysis.

Statistics has never been my strong point and having just finished a book about the Tour de France I can't help but draw comparisons between myself and the riders as they approach the Pyranees.

It feels as if my degree is the race. I've had some good results on the flat stages of Northern France, but as I look at Mt Logistical Regression towering above me I know I'll be spending the next few stages in the autobus; the group of riders at the back straining just to stay inside the race cut off time whilst dreaming of the finish on the Champs-Elysees