Rethinking Personal Budgets in Social Care

Reading Community Care, I saw that NLGN (New Local Government Network) have published a report stating that the ‘rush towards personal budgets’ must be slowed down.

I’ve tried unsuccessfully to find this report on the NLGN website but haven’t been able to do so am reliant on the third party reports from Community Care but I thought it raised a number of issues that are worth pondering.

The author of the report, Daria Kutsnetsova says in the article

.. in a lot of cases, personal budgets do not mean choice and control for service users because people are not given the choice of direct payments. Their budgets are handled by a care manager, which can be a choice in the personal budgets system, but in many cases it is not a choice and people are receiving the same care they were always receiving, she said.

It’s just called a ‘personal budget’ to push this government target,” she added.  (my emphasis)

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Enjoy earthy body smells! Meet a homosexual! Make “far out” friends!

While browsing through various assessment scales I came across the Sensation Seeking Scale (Word document), a psychological tool published in 1971 for identifying personality traits that make people prone to risk-taking, experience-seeking or disinhibited behaviour. It asks the individual to choose between two different statements and decide which applies more to them. For example,

1.A I like “wild” uninhibited parties.
B I prefer quiet parties with good conversation.

Oh yes, and there’s lots of quotation marks in the questions, to the point that you feel like putting down the pen at intervals to do air quotes with your fingers.

I’m finding it an absolutely fascinating artefact – not so much for what it’s telling me about psychology, but what it says about how times have changed in what’s considered risky (or risque!) behaviour. Bizarrely, I’m told some professionals still recommend this as an assessment tool. Anyway, let’s delve in and find out whether we’re sensation seekers or not.
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On Trolling for a Living

Can there be any more pointless occupation than being a “professional contrarian”? I just don’t get it. Surely the purpose of a writer is to say something interesting or informative, rather than just coming up with the most facile disagree-with-everything bile purely for the sake of getting a reader reaction? Okay, I can understand there might be a certain thrill one can get from it, but personally it’s not for me. Maybe it’s because my parents gave me attention when I was a child.

Yes, I’ve been reading articles by Brendan O’Neill, the Telegraph columnist and editor of Spiked Online, the website for upper-middle class media types to massage their victim complexes.
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Is the CQC fit for purpose?

There was an interesting article in the Guardian yesterday about the Care Quality Commission which was set up as a new regulatory body for health and social care in 2009.

The CQC is headed by Cynthia Bower at a salary of £195,000 pa who was previously the Chief Executive of the West Midlands Strategic Health Authority – responsible for Stafford Hospital at the time it was found to have been providing substandard care.

How she was able to take post at the CQC is quite staggering to me, as an outsider but there she is, responsible for the regulation of health and adult social care services. You’d think it was the opening of a black comedy. Maybe it is.

There are some chilling facts that the Guardian have uncovered and they deserve repeating – over and over again – because the CQC is responsible for the regulation – not only of hospitals but of every care home and domiciliary care agency in England.
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Supervision and Social Work

In advance of an the SWSCmedia chat on supervision (15/11/2011 – 8pm GMT), I thought I’d share some thoughts of my own experiences of supervising and of being supervised.

I’m not a manager but I am a Practice Educator so my experience of supervising is around supervising students rather than other practitioners and I have different needs and requirements both of the supervision I give and the supervision I receive but I’m also acutely aware of the reality of supervision structures in busy statutory services.

According to, to supervise is to oversee (a process, work, workers, etc.) during execution or performance; superintend; have the oversight and direction of.

We sometimes can become beholden to the ‘fluffier’ sides of supervision as professional growth and nurturing but ultimately, it is a management function and that is crucial to remember at all times. It is important that there is a two-way flow of information but forgetting that ultimately it is a way that we are held professionally accountable for our actions is the underlying motive and purpose of being supervised.

Fpr me, the key is that supervision determines accountability.
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What Kind of Therapy?

A lot of my working day is spent doing psychological therapies. Despite the image of child psychiatry as Ritalin-obsessed drug pushers, CAMHS probably makes more use of talking treatments than any other branch of NHS mental health services. Hence I take a keen interest in news about psychotherapy.

Just recently I was browsing a petition from the Alliance for Counselling and Psychotherapy (ACP) which calls for reform of the NICE guidelines with regard to psychotherapy.

We, the undersigned providers and/or users of counselling and psychotherapy, call upon the Department of Health to instigate an urgent independent investigation into the National Institute for Health and Clinical Excellence (NICE) guidelines for the use of psychological therapies in the NHS. These guidelines currently display unwarranted and well documented bias in favour of cognitive behaviour therapy (CBT). Their formulation involved inadequate representation of and consultation with the counselling and psychotherapy field, and relied upon a very narrow range of research methodologies which fail to do justice to clients’ subjective experience and the complexity of human interaction.

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What is a Deprivation of Liberty? – Thoughts on Cheshire West and Chester Council v P

I accept that this post is about something of a niche in the corner of health and social care but it’s an area I have some interest in as I’m a Best Interests Assessor. This is going to be a long haul of a post so I’ll start this time with a glossary.

Deprivation of Liberty Safeguards – particular additions to the Mental Capacity Act which were supposed to fix a ‘gap’ (known as the Bournewood Gap – see below) in UK legislation where people without capacity could be ‘deprived of their liberty’ in a hospital or care home without leave to appeal.

Bournewood Gap – while it sounds like the name of a service station, it resulted from the HL v Bournewood case which was taken to the European Court of Human Rights and determined at a man (HL) with learning disabilities had been detained unlawfully in Bournewood Hospital. This case meant the UK needed to change its law to be compatible with the Human Rights Act.

Mental Capacity Act – broad legislation introduced in 2005 which included (on amendment of the 2007 Mental Health Act) these Deprivation of Liberty Safeguards

Best Interest Assessor – one of the minimum of two people involved in assessing whether a deprivation of liberty should be authorised or not. Usually a social worker, nurse or  occupational therapist – could also be a clinical psychologist (unusual). They will assess both whether there is a deprivation of liberty and whether it is in the person’s best interest.

Mental Health Assessor – the other person who would be involved in assessing whether a deprivation of liberty should be authorised. They will be a specially trained doctor. They assess, well, the Mental Health.

So back to the start again and ‘What is a deprivation of liberty?’ in this context? Considering I’m a Best Interests Assessor and one of my roles is to actually assess whether a deprivation of liberty is taking place or not, you’d think that I would have a great answer to add to my ‘summing up’ glossary above.

You’d be wrong. The definition of ‘deprivation of liberty’ is fuzzy and continues to get fuzzier.
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Falling through the Gap

Like others, I read with a deep sense of sadness about the deaths by suicide of Mark and Helen Mullins, a couple in Coventry who were struggling against the insurmountable barriers set up by a social services and social security system that seemed to be weighted against them – existing between them only on £57.50 per week due to a set of circumstances that laid to waste the idea of a welfare state that supports those who need support to the extent that they were driven to despair.

However, the overwhelming sadness I felt was not accompanied by surprise that I’ve seen others express. I am shocked that this situation can come to pass in the UK today. Shocked but not surprised. I can see how it happened.
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Little Hope In The Big Society

Although I’ve been to the centre once before, I’m lost in the maze of this industrial estate. Every unit looks the same, sharp angles and harsh functionality, and my satnav has given up. I think it’s shrugging in helplessness so I turn it off, park up and walk.


After a couple of aimless minutes, a low building down an alley catches my eye and I head towards it, the 60s brick, rusting metal rectangular windows and a couple of portacabins the clues I need. This must be an ex-council building. Inside, the faded paint, slightly stained carpet and chaotic noticeboards are welcoming and familiar. I’ve spent the majority of my working life in places like this and amongst the shabbiness I feel right at home.

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Opening Secret Courts

As it happens, I work a lot around issues of Mental Capacity in my day to day work so I have more than a passing interest in the dealings of the Court of Protection. The Court of Protection, you see, has a hand in many of the issues that might relate to decisions that are made in relation to people who lack capacity.

The Court of Protection is generally closed. The reasons being (and I make no judgement of the rightness or wrongness of this) is to protect those whose personal business arises in the court. As it relates to people who lack capacity in general, they are not able to make a decision about the reporting, or not, of their personal lives as they unfurl in the court and usually have not personally taken the active decision to go to court so should not (the argument goes, I suppose) deal with the publicity that surrounds it.

This is what is mean by ‘closed’ justice and ‘hidden’ courts that some newspapers, the Independent notably, campaign against.
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