Readers’ views: Individual budgets, Philip Hill, elderly people’s treatment in NHS, workplace attitudes

Letter of the week 9 October 2008

From: John Drury, director, Supported Lives

Individual budgets do not provide all the answers

Individualised budgets for people with disabilities are being welcomed as a significant move forward in bringing about independence (“Going for broke,” 11 September). But unless they are accompanied by serious thought and investment into meaningful activities, then for a large number of people, particularly those with high support needs, they will mean trudging round the streets with their support worker or trying to keep warm in some local café.

Part of the government’s and councils’ enthusiasm for IBs stems from their hope that they could lead to major savings. However, in some areas where IBs are being offered, no account has been taken of the cost of brokerage in awarding these budgets.

This process, which sets up and maintains the person to lead and maintain a fulfilling life within the community may not be necessary for all people with disabilities, but for people with high support needs it is essential.

Just as important as this is the need for physical resources places where people can go, somewhere to act as a base, or just a space where a person can be with their support worker without feeling they are in the way, or have to spend large amounts of money which they don’t have just to keep warm. Allowing people with disabilities to access their own communities is all well and good but for many people (for example, people with challenging behaviour) this is all too often not a reality.

Even when resources are found, there are still large chunks of the day where people are bored, wandering around aimlessly.

Care in the community has all too often meant that people lost the friends and roles they had in the old learning disability hospitals (although I would not want for a moment to romanticise this!). With the de-commissioning of day services and the advent of IBs it is vital that the same mistake is not made.

It is good and right that national and local government should hand back the power to individuals and those who care for them. But it is also essential that meaningful opportunities and physical spaces are created through partnerships with the private and third sector which will make the move a positive one. Without this happening, a fundamental part of the jigsaw is missing.


An inspiring account of a troubled life

I read with delight and pride the story of Philip Hill (“A traumatic life brought to book”, 25 September). We are told constantly by health professionals that we are what we eat, but we are also what we have experienced/inherited. Phil is a real, powerful role model to all of us of what can be achieved and overcome. I commend him.

Gerry Molumby, Nottinghamshire


Immobility and boredom on wards

There are gaps in hospital ­services that must be filled. During two short hospital stays last year I saw that physically able elderly patients can unnecessarily spend all but half an hour out of every 24 in their beds or sitting on the chair beside it, because there is no one to assist them in taking a walk.

This has been confirmed by talking to the elderly people I work with. Visitors are often elderly themselves and glad of a rest after negotiating long corridors and stairs. So they are in no position themselves to offer help to elderly patients.

Enforced immobility leads to depression, dependency and weak muscles, which will cause difficulties with independence and mobility after discharge.

Some of these people would be active at home, where they have access to support and know where things are. It seems like a good opportunity for volunteers to offer some company and help.

Secondly, I observed that ­visually impaired patients were not automatically asked or assessed whether they needed help with meals. One lady, in her nineties, kept leaving her meals, saying she wasn’t impressed by them but saying she was hungry.

It turned out that she couldn’t see the food, couldn’t open ­cellophane wraps or plastic containers, but hadn’t thought to tell the catering staff.

I informed them myself, using the meal response slip. She was immediately offered help to solve her problems and she was able to enjoy her meals.

This lady was also one of those who was unable to walk about to relieve the boredom, as she couldn’t see well enough. Visits to the loo were her only exercise for some weeks.

Gil Evans, activity organiser, Skipton


Qualified in bigotry and snobbery?

Qualified or unqualified? A question posed to me by a learning disability nurse 15 years ago when I was a social care worker. “Qualified”, I said, because I have a degree in applied social science. “That means you are unqualified”, she said, because I did not possess a diploma.

She made her apologies, because she had the morning set aside to write three care plans.

I have since undertaken three degrees and hold the Registered Managers Award. I am now a senior manager of a community serving people with a learning disability.

I was recently reminded of my status when another learning disability nurse asked me once again if I was qualified or unqualified.

Again I asked if she wanted to know whether I was qualified at degree level in several subjects or did I hold the lower qualification of a nursing diploma? “I take it then that you are unqualified,” she said.

This time discretion was the best part of valour. There seemed little sense in debating such an attitude. But my mind went back 15 years – why was the nurse writing the care plan?

She never offered personal care so how could she write a plan, say, on toileting a person?

I empower my staff to work with residents to agree care plans. I check these to ensure they meet the standards set out by the Commission for Social Care Inspection.

Empowerment, enablement, choice, inclusion and respect somehow do not fit with qualified or unqualified. Please let the bigotry end.

Paul Sear, Walcott, Norfolk

More from Community Care

Comments are closed.