‘Reclaiming’ Care Home Fees

A deathly silence has descended upon us!  Call me sceptical but I couldn’t help noticing that it started around the 30th September 2012.  Claims companies that were once assisting the good people of this fair land to ‘claim back’ (almost as if they were referring to a benefit that had not been claimed by the masses) care home fees that they had incurred for themselves or a family member fell silent.

So why has it all gone quiet?

Until recently, individuals and family members have been able to make retrospective claims (backdate their claim) if it was identified that they or a family member were paying for all or some of their care when in fact they should have been receiving full funding to pay for it.   There then was a decision to place a deadline on retrospective claims which is why there has recently been an influx of ‘helpful’ organisations desperate to assist you.  In return for their kind assistance they would take a percentage of your successful claim.  However, one of the deadlines for making retrospective claims that could date back several years has now passed and there remains a less modest time-frame within which claims can be back-dated.

For cases during the period 1st April 2011 – 31st March 2012 the deadline for individuals or their families and representatives to notify the relevant Primary Care Trust will be 31st March 2013.

The truth of the matter is, not everyone who has paid care home fees is entitled to claim a refund.  They were of course referring to Continuing Healthcare funding which is the NHS funding stream that enables some people to have their care home fees refunded or not pay them in the first place if that person meets the eligibility criteria for Continuing Healthcare funding.  Throughout this article I am using the example of a care home but the same information applies to all care such as nursing homes, live-in carers and care agencies visiting someone in their own home.

Why do some have to pay for care home fees and others not?

Care homes charge a weekly fee to cover the cost of such expenses as accommodation and care.  This can range from a few hundred pounds to several thousands of pounds depending upon the care provider and the necessary skills required by the home and carers.  Anyone who is in need of such care is entitled to a community care assessment from the local adult social service department.  If, following this assessment the individual is eligible for help from social services they will then receive a financial assessment.  This has been common practice for a number of years and beyond the scope of this article to discuss in any depth. If an individual has assets (such as savings or a property not being lived in) just over £23000 then they will be required to pay 100% of their care (in this case the care home fees).  If they have less than this amount, they pay variable contributions towards the care home fees and the local authority pay the remainder.  Local authorities usually have funding thresholds which are a maximum they will pay for a care home so won’t automatically pay thousands of pounds each week if the same care is available within their funding limits.

Can I avoid paying care home fees?

This is where Continuing Healthcare funding comes into the equation: Continuing Healthcare or CHC as it is usually referred to is the NHS funding stream used to pay for care fees is someone’s needs are predominantly health related.  Because it is the NHS, unlike social service funding (see section above) CHC funding isn’t means tested and you don’t pay a contribution towards your care home fees.  In practical terms, receiving CHC funding rather than social services funding could be the difference between having to sell your home to pay for care home fees and keeping it!  It is worth reiterating though that not everyone in a care home is entitled for CHC funding.

How do I see if I’m eligible for CHC funding?

The CHC assessment process is detailed within 2 documents; they are national documents so it shouldn’t matter where in the country you live.  I say that with slight apprehension because in reality any assessment that involves human intervention is not always 100% objective all of the time.  If you would like more information, the documents are:

Eligibility for CHC funding starts with the completion of a checklist.  This will be considered when an individual is discharged from hospital for instance or can be requested at any time.  Professional including G.P.’s, social workers, district nurses & occupational therapists might also complete a checklist.  Individuals or family members can also ask for a checklist to be completed.  The threshold for the checklist is set lower than the eligibility threshold to ensure that everyone who may be eligible for CHC funding is considered.

If the checklist has a positive outcome (high enough scores) the full consideration for CHC funding is undertaken in the form of a decision support tool (DST).  A DST isn’t an assessment itself but a tool to help professionals collect all the relevant information such as assessments in order to reach a conclusion as to whether someone is eligible for CHC funding.

How is a decision about CHC funding made?

If someone has a rapidly deteriorating health condition, a G.P. or health professional can ‘fast-track’ a CHC application and avoid an unnecessary assessment; the funding should be agreed by the local Primary Care Trust without question and immediately. Your local Primary Care Trust or PCT is the agency responsible for administering NHS services such as CHC funding at a local level.

If a DST has been completed, the professionals involved will look at the tool and make a decision based on the following characteristics:

Nature –   This describes the particular characteristics of an individual’s needs (which can include physical, mental health or psychological needs) and the type of those needs. It also describes the quality of care required to meet those needs.

Intensity – This relates both to the quality and severity of the need and the support required to meet them, including the need for ongoing care.

Complexity – This is concerned with how the needs present and interact to increase the skills required of the carers.

Unpredictability – This describes the degree to which needs fluctuate and thereby create challenges in managing them.

As you can see, the process isn’t an exact science and can’t be determined by a series of tick boxes.  The determining factor is whether the care required is predominantly health related than social care.  A local authority is not permitted to provide or pay for health care which is why health funding such as CHC exists.

Why I’ve joined the National Health Action Party

Several years ago I quit party politics, quietly resigning from the Labour Party in a fit of disillusionment that I’ve documented here. The superficiality, the blatant careerism and the detachment from the real concerns of real communities had just become too much. Today I did something I thought I’d never do again, and joined a political party.

Since I heard about the National Health Action Party I reflected for some time about whether to support it. I’ve never been particularly one for single-issue politics. My interests are broad and eclectic. I have political views not just on the NHS but also on social inequality, the environment and foreign policy. Then again, parties that started out as single-issue have evolved into broader-based platforms. The Greens are a good example of this.

What is unarguable is that people in the NHS (and people who work elsewhere in health and social care) need to stand up and shout. I’m on the Celtic fringes, so I’m not affected by the wranglings over Clinical Commissioning Groups. Even so, I’ve seen services shrinking: not just in my CAMHS team, but in the social services departments and the schools with which we liaise regularly.

During the recent party conferences, it was depressed how little rhetoric there was about the most vulnerable in society – people with low incomes, or with disabilities and illnesses, the unemployed. If they were spoken about at all, it was to castigate them as scroungers, feeding off the “strivers”. The Tories were the worst for this, unsurprisingly, but Labour were notable for their deafening silence.

There’s a simple reason for this: the poorer and more vulnerable you are, the less likely you are to vote, effectively making you an unperson in political terms, to be ignored while the “squeezed middle” are assiduously courted. Theirs is a silent voice that needs to be heard.

Perhaps a party formed by healthcare professionals can go some way towards raising the unasked questions in politics. Lord knows we could do with a party that doesn’t contain the career politicians who have blighted the Tories and Labour. The recent documentary Young, Bright and On the Right showed just how divorced some of these strutting self-promoters are from the real world, and illustrate the ghastly process that spawned the likes of George Osborne and Jeremy Hunt.

Even if they don’t break out into the mainstream, single-issue parties can sometimes have an impact in terms of pushing the existing parties to deal with issues they’d previously ignored. Again, the Greens are a good example, forcing the Thatcher government to embrace environmental policies after being hurt at the ballot box.

From today, the NHA Party are getting my cautious support. It’s clearly a fledgling party, but it’s one that deserves to be given the opportunity to see what it can do. I’m in.

World Mental Health Day 2012

10 October marks World Mental Health Day. This year’s theme focuses particularly on depression.

Having worked with and known people who have suffered with depression, I think awareness raising in this context is crucial. The word ‘depression’ has moved into common parlance. I might talk about feeling depressed on a daily basis when something comes up that affects my mood negatively.

Actually suffering from the symptoms of depression is vastly different and in some ways, language isn’t a friend to those who do suffer from depression.

As we allow ‘depression’ to become almost synonymous with ‘sadness’ we misjudge a swathe of people for whom the illness is an immense source of difficulty. pain and distress. Depression isn’t sadness. Depression isn’t about the ebb and flow of mood. Depression can be debilitating and hopeless. Depression needs to be far better understood in that context and in the context that it can affect anyone and everyone – regardless of background, class or social status.

We can’t make judgements externally by looking at someone else’s life and decide if they ‘should be happy or not’ because depression doesn’t work like that. Life doesn’t work like that.

What we can do is look and see if someone is suffering and if they are, why should we do anything other than empathise with that experience of suffering and try to alleviate that in any way possible.

Having walked alongside, as far as possible, those who have and do experience depression, I have an admiration for the immense struggle that comes with each day and I learn from it.

My hope for this World Mental Health Day which seeks to increase understanding and reduce stigma is that depression isn’t seen as something is a decision people make about their lives. It can’t be ‘shaken off’ at will.

That needs understanding and that needs focus.

Strivers and Strugglers

As the Conservative Party Conference begins in Birmingham, Cameron has set out his agenda of further benefit cuts and a focus on the ‘strivers’ in society.

Who are these ‘strivers’? They are people who ‘work hard and want to get on in life’.

The issue is that I believe Cameron’s definition both of ‘working hard’ and ‘getting on in life’ is probably vastly different to my reality and the realities I’ve seen at work.

The ‘benefit claimants’ v ‘hard worker’ dynamic is a very toxic one. The government has become very used to divide and rule and this is a further demonstration – and is particularly nefarious in a time of high unemployment and particularly high youth unemployment.

Cameron seems to work on the assumption that all people who have jobs ‘worked hard’ to get them and ‘work hard’ at them. I would challenge that. I wonder  how ‘hard’ the Duchess of Cambridge works at her job.

And looking for work can be an exhausting, demoralising and exceptionally difficult piece of ‘work’. As can caring full time for a family member (with a paltry ‘carers allowance’). Are these people counted as ‘strivers’ in Cameron’s books? What about people who contribute to a community? What about people who overcome challenges and difficulties, including health-related ones for whom actually just getting through the day is an enormous challenge – are they ‘strivers’?  Do they really not work as hard as some people who drive buses, work in social services offices, work in banks etc?  There are hard jobs, of course, but there are also hard lives that exist outside jobs.

The best thing we can do is bat back this ‘striver’ agenda. I don’t want to live in a society that grinds down on those at the bottom without making further expectations of those who have been able to make a success of their lives – and I include myself in that.

Punishing people who don’t, can’t or aren’t able to work seems to be a populist agenda but one of the key things as a social worker I feel a need to challenge are the assumptions made from the safety of the Westminster village about the day to day effects that their policies and their discriminatory rhetoric has on the lives of those who DO strive. Strive desperately – but strive without economic recompense and strive for different goals.

Compassionate Conservatism? It was never anything but empty words.

Jeremy Hunt – The worst Health Secretary since the last one.

Jeremy Hunt is the Health Secre….Jeremy Hunt is the H….

Nope, sorry. Can’t say it without gagging.

It’s not as if the guy had some sort of high benchmark to live up to. His predecessor was some complete and utter Lansley who forced through a massive, untested reform programme that the electorate didn’t vote for and the professional bodies didn’t want, on an NHS that’s in no financial state to undergo restructuring. Surely the next guy had to be an improvement.

Enter Jeremy Hunt, stage right.

Everything about him embodies the worst of Cameron’s posh-boy cabal of unearned privilege and blatant careerism. A Charterhouse-educated son of an admiral; an alumnus of the Oxford University Conservative Association (a body whose nastiness was exposed in all its vainglory in Young, Bright and on the Right); with a background in PR and management consultancy before landing in a safe Tory seat; an expenses sponger; a tax dodger; a shameless promoter of nepotism.

Oh, and his background and qualifications in health? Zero.

Still, I’m sure he did a good job as Culture Secretary.


Yesterday, he kicked off a storm by declaring his view that the time limits on abortion should be cut to 12 weeks. I can find little to say on this that hasn’t already been said by Dan Hodges in the Telegraph.

A reduction in the abortion limit to 12 weeks would create a social – and public health – catastrophe. A significant number of women, especially teenagers, are not even aware they are pregnant after 12 weeks. None would have even had their initial scan conducted. How is a woman supposed to make a mature, rational – and morally balanced – decision on whether to continue with their pregnancy within such a timeframe? A potentially life-changing choice would be reduced by statute to a race against the clock.

Then there are the politics. However much Hunt deserves praise for his candour, he deserves to be hauled over the coals for his stupidity and self-indulgence. He must know that David Cameron took a political risk in transferring him to such a high profile brief in the wake of his Leveson travails. And he’s chosen to repay him by derailing the Tory conference locomotive before it has even left the sidings.

It’s been made clear that this is not a policy decision and we’re not about to see a cut in the abortion limit. So why did he suddenly come out and say this to kick off a firestorm?

One possibility is that he’s trying to hijack the Conservative Party conference in order to import US-style culture wars into Britain. Yes, because we really need those.

Another possibility, much-discussed on Twitter, it that he’s generating a fury in order to bury this story beneath the shouting.

One in 10 accident and emergency departments has either closed recently or could shut in the near future, while a similar proportion of labour wards is at risk.

Significant numbers of children’s units, surgical departments and wards for the elderly are also being considered for closure or downgrading, the analysis of England’s 300 acute hospitals found.

Almost all those at risk are part of major plans to reorganise services and prune back departments to concentrate staff and resources at bigger hospitals.

Jeremy Hunt has achieved the near-impossible. Not only has he made himself as atrocious a health secretary as Andrew Lansley, but he’s done it in just over a month after taking office.





Time to Stand up and Deliver

With all the political wrangling going on over the last few weeks it can be hard to filter out the message that is being delivered. Are we really a nation so shallow that judges our politicians on their ability to perform in front of an audience  In the USA too this seems to be the main priority – how well did they come across in their stand off debates, who was the most confident and who was the most cautious and hesitant? Wow! they delivered their speech without notes! Surely in the current economic times it would be wise to be cautious, to refer to carefully prepared notes in order to demonstrate a genuine concern for the people?

If we compared out politicians to our bankers not a very good comparison I know, but our bankers are people who have been under great scrutiny recently,  would we really be judging them on the same criteria?  I think I would prefer a cautious banker to a cocky one.

As a customer and tax payer I would want to know what are you going to do for me and my family and the local community in which I live?

This week it is the turn of the Conservatives to sell their wares. Please please please don’t waste this valuable opportunity to slag off other parties or crow about your wonderful hindsight. Anyone of us can do that, we want to know what are you going to do for us in order to make our world a better place to live in?

Will Fast-Track Training Improve Social Work?


Yesterday, the Institute for Public Policy Research (IPPR) published a paper called ‘Frontline’ subtitled ‘Improving the children’s social work profession’.

The programme they call ‘Frontline’ is based on the ‘Teach First’ programme.  It’s interesting that the paper was written by Josh McAlister who was one of the drivers behind the Teach First programme.

In the proposed ‘Frontline’ programme, there would be a ‘fast track’ qualification route into social work (or ‘children’s social work’ which the paper seems to consider as a separate profession in itself!).

As the paper says in the introduction

‘This new programme – Frontline – would help attract the best people into one of Britain’s toughest professions, and in the long term create a movement of leaders to challenge social disadvantage’.

The methodology of the study seems ‘unusual’ to say the least. The focus group for a start was of participants in the Teach First programme where I’d have thought it would have been more useful to speak more broadly to practising social workers rather than only to social work academics. I think, as well there are significant differences between Teaching and Social Work and while ‘representatives of BASW and the College of Social Work’ were involved and ‘case studies’ were submitted by five local authorities, there is absolutely nothing written about discussions with those in practice or those who use social work services. Looking at the ‘focus group’ it seems the few who might once have been social workers, would have left frontline practice behind many many decades ago.

How can eight teachers really provide an idea of what might work for social work? I’m truly baffled this is presented as an acceptable ‘study’ of the profession when no practising professional is actually mentioned as having been spoken to in the methodology stated?

The study works on the basis of high vacancy rates and a need for ‘quality recruits’ which personally I find quite insulting as a proposition. The report states

‘Of the 2,765 people starting social work masters-level courses last year, only five completed their undergraduate degree at Oxford or Cambridge , among only 150 from any Russell Group university’

Excuse me while I rage for a moment. So the criteria for a ‘quality entrant’ is THAT? Seriously?? There are many reasons including those of familial expectations, type of school attended and social background which affect choice of university.  I got a good degree from a Russell Group university myself so I feel able to comment but having a degree from one of those specific universities is absolutely NO indication of quality. Honestly. If we start differentiating between an Oxford degree and a London Met degree we start moving into very difficult ground. Are we really saying ‘middle class’? Because that’s a little of what it feels like.

The other aspect that the report criticises is ‘quality of training’ – to which their response is to propose a ‘fast track’ scheme? Again, it doesn’t make sense to me. Surely the answer would be to extend rather than reduce the qualifying course? (I’m not in favour of extending the course beyond what it is currently, by the way, I’m just not sure I see the logic in reducing it if that’s an issue!).

So ‘Teach First’ uses an initial six week residential programme and then places ‘teachers’ in a ‘challenging school’ for two years while they do their PGCE in the first year.

Hm. So the PGCE is one year course anyway. I don’t see how that corresponds to a ‘summer school’ for social workers and then putting them into a ‘challenging’ situation for a couple of years. There’s a lot more study that will be missed along the way with this ‘fast track’ scheme in social work.

Not least, the issue that is completely overlooked in this paper that a social work training course and qualification is generic not specific to ‘children’s social work’ and that ‘children’s social work’ is not a profession apart.

This proposal seems to have completely ignored the idea that social work training is generic. Teacher training would be specific both to age group (secondary) and to subject so narrow in focus.

Someone who qualifies as a social worker needs to have broader experience outside children and families field because people don’t exist in silos attributed to age, because sound Mental Health and Community Care knowledge actually makes all social workers more effective and more skilled in their jobs.  This ‘Frontline’ programme proposes similarly to ‘Teach First’ that it is a two year commitment but that the ‘social worker’ qualifies after one year. I find it mind-boggling that anyone thinks this is a workable model – with the Teach First at least you have a PGCE which is one year but with this ‘Frontline’ the MA programme is two years anyway so that’s much more to ‘pack in’. Too much, I’d say.

What is obvious to me is that the person writing this report has no idea about social work – what it is, how it works and how it should work. He seems preoccupied with his ‘Teach First’ baby and is convinced that Teach First raised the profile and status of Teaching.

Personally, I can’t imagine ‘Frontline’ would have an equivalent role within social work. I think it is dangerous to separate off the profession and focus on the ‘children’s social work profession’ separately because I think learning and experience (through placements) across the life course is something that marks social work training out. I also think that there is a very facile definition of ‘good social work entrants’ that doesn’t seem to have had regard to any complexity I’d expect from a report.

I hope this programme goes nowhere because the experiences of Teaching and Social Work are very different but it’s ridiculous and elitist enough for this government to want to run with it.

I hope they don’t. I hope someone talks to social workers before anything close to this is implemented. Do I think that will happen? On previous record, unlikely and mores the shame for the social work profession as a whole.

photo by Quick, like a Mule @ Flickr

AMHPs and Stress

Dolly Stressed Out!

Back in January, Zarathustra posted a link to a survey for AMHPs on stress and burnout. This was for a piece of research being conducted by Janine Hudson, an  AMHP studying for an MSc in Mental Health Social Work at King’s College, London.

AMHPs are Approved Mental Health Professionals who, according to Wikipedia are ‘trained to implement coercive elements of the Mental Health Act (1983) as amended 2007’ so we (because I am one myself) make decisions with requisite recommendations from medical professionals, about whether someone needs to be admitted to hospital and treated without their consent. There are other roles for example in relation to Guardianship and Community Treatment Orders and certain tasks that are reserved for AMHPs legally but we have specific training around Mental Health Legislation and the implementation of it.  It is a role which does demand particular expertise, sensitivity, compassion and intellectual rigour to conduct well.

Janine and Dr Martin Webber who co-authored the study were  generous enough to share with us here (AMHP Survey 2012)  and while I am not entirely surprised by her results, I was saddened that my own gut impressions seemed to be more than just gut impressions.

Over 500 AMHPs responded to the survey and as many as 43% met the threshold for ‘common mental disorder such as stress and anxiety’. The threshold for burnout was much lower but it does raise the question about the amount of support and consideration given to practising within this particular role in local authorities in particular – whose responsibility warranting them (us) remains – but also within employing NHS Trusts. One of the aims of the study was to determine any differential in stress levels experienced by social work AMHPs and non-social work AMHPs but the findings were that there were still very few non-social work AMHPs and there was little differential. Locally, I know that there have been some issues around funding of non-social work AMHPs as it is a duty of the local authorities to provide sufficient AMHPs and as money is stretched, NHS Trusts have seemingly been less keen on sending people to train for a significant period.  It will be interesting to see how that picks up over the years but as the purpose of extending the role to non-social workers in the first place (we used to be Approved Social Workers and it was a reserved role which only social workers could take) was that there were too few AMHPs, it seems that issue hasn’t really resolved itself fully yet, four years after the switch.

71 AMHPs responded that the work as an AMHP had not had an impact on their non-AMHP role, however most of those worked in dedicated AMHP services because for the rest, the issue of managing AMHP and non-AMHP tasks with no workload concession, an increase in unpaid hours and pressure of work were contributing factors to increased stress.

I have certainly found personally that the AMHP work I carry out encroaches substantially on my ‘regular’ work as the amount increases. I am sometimes called out at very short notice to carry out assessments and these assessments take priority over all the other work I do due to the urgency and statutory nature of the tasks.  I have missed and moved visits at short notice and I can’t use any excuses to service users I work with (because obviously I can’t discuss my other work with them) so I apologise profusely and humbly but my stats aren’t as good as my colleagues in the same team and this is challenged. It is an additional pressure but any mention of removing some of my caseload responsibilities are met with a sad and sympathetic sigh. It’s just not happening!

Sadly familiar too, were some of the difficulties raised in terms of working and organising assessments across different services particularly as resources are stretched. Availability of ambulances, doctors and police are all  factors  in trying to manage and organise an assessment and certainly a factor that I recognise however the overriding issue was one of a lack of available beds.

Personally, I have found this to be much more acute as a issue over the last year and is getting increasingly worse. It isn’t wholly unrelated to the local Trust closing down wards to ‘save money’ however it has led to a massive increase in the provision of private beds at higher cost and further distance. This is the kind of ‘strategic decision’ that makes you wonder about the way snap decisions were made.

The impact on the patient is significant but it is also increasing stress levels in members of staff.

Generally, the research study indicates that AMHPs broadly feel unsupported in the role – except (perhaps unsurprisingly) by other AMHPs but in terms of management support/supervision/debriefing, it can vary significantly.

The report concludes that employers should do more to recognise the important and often difficult role that AMHPs take and reward with workload relief and a pay differential that acknowledges how much other professionals are paid for the work too.

My thoughts on reading this survey are that I’m unsurprised. I think it’s hard to explain to someone who is not involved in the role what exactly it entails but there is an enormous amount of responsibility taken  by the AMHP and it does feel to me, personally, that this is not appreciated or understood by my employing organisation. I wonder if there is a general awareness of some of the stresses that can be placed on an AMHP (and I’m absolutely sure every AMHP has been in this situation) when there is a great deal of distress after a decision to admit has been taken and the doctors have gone and we are waiting for the ambulance – maybe with the police, maybe not – but there’s a great deal of responsibility being handed to the AMHP at that point. It’s important that we are given substantial support.

My best support has definitely come from other AMHPs.

Saying that, while I won’t ever say I enjoy the role because depriving someone of their liberty is a very difficult, challenging and distressing process – the learning that I have done as a part of being an AMHP  has been significant – in terms of my understanding of mental illness and in terms of my practical application of the Mental Health Act, Human Rights Act and Mental Capacity Act.

Being an AMHP has made me a better social worker without any doubt and being an AMHP has and does make me reflect constantly on what the ‘system’ does and doesn’t do to those who come through it – and my role within that system.

However benefiting from the knowledge doesn’t mean that we shouldn’t get greater support for the role. That’s clear from this report and thanks to Janine for sharing her research with us. I hope that it will be disseminated widely to all local authorities who engage AMHPs and if you are an AMHP or know one, take it to your next forum meeting and discuss it.

In order to care and plan best for others, we really do need to look after ourselves and our own mental wellbeing.

photo by kelvin255 @ flickr