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.

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.

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.

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.