Shifts in Support Planning

Community Care alerted me to a new report developed about a great model of support planning  called ‘Empower and Enable’  that is being proposed as a way to invigorate the ‘personalisation’ agenda and move it back to the roots of putting the user at the heart of support planning and removing this from the scope of professionals.

In the process of developing and implementing care currently, after the assessment has been fed through the ‘resource allocation system’ and an indicative budget has been established – the ‘support planning’ comes in to build, yes, you guessed it, a ‘support plan’ which would be what might have been called a ‘care plan’ in the past and details how that support will be delivered for the individual to whom it relates.

Groundswell  Partnership , the ‘personalisation consultancy’  who wrote it, explain that councils should change their models of support planning and move the focus back towards the users of the services provided.

I couldn’t possibly agree more. This is what we were told when the whole personalisation agenda was moved out and I can’t honestly see what’s different apart from the lack of roll out to wider groups than those that  benefited from direct payments. This was the ethos behind rolling  ‘personalisation’ out beyond those who were receiving direct payments previously to everyone in general.

The model presented is one of ensuring that information is more freely available and that ‘professionals’ don’t need to take hold of support planning. It  talks about shedding the ‘belief’ that professional support is necessary to enable support planning. Absolutely right.   I would counter that councils have been trying to move away from professional support for support planning as it is more expensive but are too slow to change and stuck in systems of commissioning and getting services ‘approved’ to have moved quickly enough on this.

Currently, I am deeply concerned that the level of access to support and different kinds of support can be based on the particular social worker or care coordinator allocated in terms of our own knowledge of available services – particularly as regards managed personal budgets. I agree that the way around this is to make as  much information about resources and services open access – including costs and deductions and details of block contracts and how they are delivered,  so that anyone and everyone can have equal knowledge.

I love the idea that support planning should take time but there needs to be some thought to the more immediate support planning that might take place in a crisis situation and looking at how that can feed into these models and look at ways that people can – as far as possible – build in contingencies and forward planning into the current support plans.

The report also talks about building on community capacity to provide support and support planning. Wonderful. Truly wonderful but it fails to tackle those who are excluded by the communities in which they live. Working with a number of people who may lack capacity to manage their own support planning, lack informal support and are isolated or excluded by their community, I often wonder when a realistic report is going to tackle this issue properly – rather than a sentence saying ‘some people may need professional support’.  Maybe it needs it’s own report. I’d love to see that. Honestly. I want to cheer these reports as they flow out of the ‘personalisation consultancies’ and I often do but I need to see some innovative thinking that looks at the realities I face daily.

I would counter that ‘these people’ who lack capacity require independent advocacy on top of professional support. Relying on a social worker for support planning, particularly in work with older adults where the case loads and expectations regarding quantity of work undertaken is particularly high, is absolutely going to  produce a poorer quality support plan. I don’t think anyone is denying that – including the local authority employers – I suspect they would love to tender out this role however the clunky nature of contracting and commissioning makes this slow moving.

I know I put together some poor support plans myself. It doesn’t make me proud. I don’t go to work thinking to myself ‘today I’m doing to produce a poor support plan and I’m not going to ask Mrs Brown or her family about what she actually wants’. I try to consult but the time needed is squeezed. I try to engage family and friends, but you know, believe it or not, some families or friends actually don’t want to be actively involved and some people don’t have family and friends.

These reports are fantastic. We need more. We need more reports to explain why we are doing a poor job about providing support planning.

But what we also need are properly assessed and arranged targets set to local authorities that demand involvement by users in more than a peripheral box ticking way.

We need resources to provide effective and independent advocacy which will allow for equality of access to innovative support planning tools for those who are not able to independently access them for themselves.

My own dream was to break free from the LA yoke and establish some kind of local social enterprise type organisation that would be able to offer dual support planning and non-directed advocacy for those who lack capacity to produce really good support plans and support networks to fill in the gaps for those who don’t have the informal networks or whose family want to support and help but might not be able to to the extent expected sometimes.

If anyone wants to fund me or pay my salary while I do that, please do let me know.

There are better ways. I’m sure of it. While I enjoyed reading the report as it is,  my brain was buzzing about how this model could work with the people I see every day – I’m still waiting for a report to deal with that. And if noone will fund my little social enterprise project, perhaps they could commission me to write report – for myself – about ways it could work better.

But I don’t think I can promise what these reports promise – which is zero cost.

And possibly that’s the key.

Will Adult Social Care Reform Stall?

The Health and Social Care Bill currently limping through Parliament is a mess. Even though I try to take an active interest in its progress, even as someone who is desperately concerned and involved (working, as I do, in an NHS team), I lose heart at trudging my way through some of the details which have been changed, adjusted and repackaged beyond the level of human (oh, ok, maybe it’s just me!) comprehension.

I was baffled though by this piece which turned up on the Guardian website yesterday.

Announcing that Lansley, having been stung and having lost credibility as his health reforms (hopefully) hit the buffers, is going to be delaying his announcement of reform in social care.

Resource Allocation Systems on Trial

How are direct payments, personal budgets and resources allocated in adult social care? I’ve been working in this field for many years at the front line and couldn’t tell you. Fortunately, the courts are shedding some light, albeit foggy, on the matter.

This morning I came across this blogpost on the Guardian website. It mentions the case of R(KM) v Cambridgeshire County Council which will be heard by the Supreme Court on appeal next week.

I read through the previous judgement which is being appealed and would recommend it to anyone involved in adult social care in England.

While the previous judgement found that according to the Kensington and Gloucestershire rulings, local authorities could take resources into account when extending services to those in need without their bounds and remain within the National Assistance Act (1948), the Chronically Sick and Disabled Persons Act (1970) and the NHS and Community Care Act (1990) to assess and provide services, the method of developing non-transparent ‘resource allocation systems’ (AKA RAS) was criticised heavily.

Direct Payments, Fraud and Safeguarding

Yesterday, I was engaged in a (very brief) discussion on Twitter about this article in the Guardian on Wednesday which highlights a case where direct payments were used fraudulently with tragic consequences.

The thrust of the discussion was that while there will always be isolated incidences of potential abuse and criminal actions, highlighting the method of delivery of the service (through direct payments) was unhelpful at best when there is so much abuse in the delivery of ‘standard’ care packages especially with the follow up article here about ‘how to prevent fraud in direct payments’ which itself states that

There is as yet no evidence that having more people on personal budgets in Enfield has increased the amount of fraud. In fact, of all the fraud cases identified in the area in the past year, only one was related to personal budgets.

Having been involved in the provision and delivery of direct payments since they were first established (Community Care (Direct Payments) Act 1996)   I’ve never personally  come across an instance of them being misused intentionally.

My gut feeling is that the man in the first article who was killed by his son – after receiving a direct payment for a couple of years – may not have experienced a different outcome if the means of delivery of the care had been different.

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)

Social Care in a Time of Cuts

When I went into social work, and still from time to time, I come across more experienced colleagues who have been working in the field for far longer than I and they tell me about the ‘golden era’ of social work.

They tell me about the joys of real generic social work where they might start the day liaising with foster carers and end the day supporting an adult with a mental health need. Where they might have been involved in ‘real community work’ rather than the staid and procedural role that seems to have forced its way into the profession in recent decades.

It seemed to me, as an extension of the human propensity to reminiscence about times and experiences ‘in the past’ with a certain sugar coating. Just as ‘schooldays are your happiest days’ type memories.

As I move through the stages of my career, such as it is, I feel some mild thoughts of ‘how it used to be type nostalgia’ creeping into my own narratives.

I never thought we had particularly ‘good’ times but when I compare the types of care planning and support that was available and look at the bare bones of support provision now, I can’t help but thinking that perhaps we are moving backwards as opposed to forwards.

Social Work in a time of cuts presents a whole new world of ethical dilemmas that previously we might not have faced.

There are some improvements. The roll out of  ‘Direct Payments’ whereby people who  need services were ‘given’ the pot of funding available and were and are able to choose ways to spend it on different and more creative services has been a big step forward.

However this has led to the ‘personalisation’ agenda or the ‘transformation’ agenda or ‘any-kind-of-large-mostly-meaningless-word-you-want-to-add’ agenda which wants to use this model and extrapolate it out. While this certainly provides better systems for some groups of people, the agenda has left others behind, but I’ll come back to that another day.

Regardless of the detail the fact that choice is extended (however poorly in practice it is done – and it is done poorly) and that users are put at the heart of service provision is generally a good thing.

It’s a shame that the push towards ‘choice’ has come in an era of cuts or perhaps it is and always was wholly inevitable. We are seeing an attempt to push the responsibilities present in the NHS and Community Care Act (1990) and the National Assistance Act (1948) away from local authorities and towards individuals. For some individuals this is wholly appropriate and welcome but as we march towards another type of ‘one size fits all’ provision I do worry where it might lead.

We have fewer provisions to ‘hand out’ and eligibility criteria are rising so that fewer people fall into the ‘service user’ category. As a result, fewer carers will be entitled to what sparse support is available for them and the local authority responsibilities shrink accordingly.

My hope as a part of this blog and as a social worker who has and does work with adults is to monitor and process the ‘dying of the light’ or perhaps, on a very negative day what might be perceived as the ‘dying of the support’.

While less state involvement is exactly the right thing for a lot of people, we have to remember those for whom it remains necessary. The old tired ‘throwing the baby out with the bathwater’ phrase can be overused but I’m going to take the liberty of referring to it here because it explains to me what I see as happening to our social care and health services at the moment.

We, who see it from the ‘inside’ have a duty to report and share with those who might not be aware as it’s happening.

We need to fight.