Letter to Community Care, 28 January 2010
Specialist aids and a 20-year blight
Your investigation into the funding of specialist equipment (“Failure to adapt”,14 January,) made me wonder whether I had fallen into a hole in the space-time continuum.
Twenty years ago I acted as advocate for a man with a spinal injury. We attended a joint health and social care case conference to finalise plans for his move from hospital to an adapted flat in the community.
Being a rural county, managers from both agencies travelled some distance. The meeting stalled without agreement on whether the essential turning bed my client needed would replace “nursing care” or “personal care”.
It was agreed a month later at the reconvened meeting to split the cost of the bed between the two agencies.
I was horrified that such an obvious solution took so long to be reached (let alone the cost in terms of staff time, travel and “bed-blocking” that resulted from the stalemate).
The convoluted buck-passing that still takes place between local authorities and the Social Fund over specialist beds and other vital equipment for disabled people sounds horribly familiar.
Can this still be happening? What must it feel like for a disabled person, whose independence and well-being rely on essential equipment, to have to wait and watch while agencies argue over responsibility for funding?
I agree with Scope’s head of policy, Marc Bush, that social workers have a key role to play in focusing on a person’s lifestyle and aspirations rather than sterile, functional outcomes.
Surely, identifying need and meeting it isn’t rocket science – but your investigation suggests we are still not there yet.
Carl Freeman, Worcester
Legal protection for care home residents
I was appalled by the cruel evictions in the snow of 106-year-old Louisa Watts and other vulnerable pensioners against their wishes from Underhill House care home, which was closing as part of Wolverhampton Council’s £40m budget cuts.
Is it too much to hope that any of our three main political parties will include in their general election manifestos legislation to prevent these continuing evictions of vulnerable elderly people from care homes in which they are happy and settled?
Assessments that would feed stigma
As a former child in care and a child psychologist, I view as folly the recommendation that all children entering care should be assessed by a child psychologist ; not least in helping to stigmatise looked-after children more.
The weight of negative labelling for this group by mental health services has already been a disaster.
A disproportionate number of looked-after children do need mental health and Camhs services, but not all. This is like batting for the wrong side in terms of supporting looked-after children.
It is right that mental health services should have a specialist in the team. Most now have that.
Dr Peter McParlin, Child psychologist
Less choice under personalisation
It is naïve to say the only providers that will leave the care market with the advent of personalisation are those that cannot provide what a user needs.
Many providers may have accommodation as well as support or care and they are funded on that basis. Hence, if the service user wants an external provider of support or care, then the financial model on which it is based collapses.
Take any client group who live at, say, a 10-bed facility. If one client chooses another provider, the financial model of the provider suddenly has a 10% shortfall – if two clients do this it is 20%.
That facility quickly becomes non-viable. Hence providers will flee the market despite “satisfying” 80% or 90% of their customers. That is very different from not providing what a service user wants.
Given that there has been a massive move from residential care to the supported living model (mainly because it can be part-funded by housing benefit rents), what personalisation will do is reduce choice because providers cannot make accommodation-based services sustainable if one or two users decide they want an alternative provider of support or care.
This reduced choice of suppliers or providers will lead to increases in costs of care and support as well as reduced choice – the opposite of what personalisation aims to do.
New entrants to the market will be discouraged because the risks of personalisation explained here will make new provision or new entry into the market too risky and less sustainable.
Without an adequate supply of provision and an adequate alternate provision, personalisation cannot work in practice.
The rabid promotion and selling of personalisation as increased service user choice is delusional and the “sexy” theory is so incredibly superficial that in practice it will lead to the opposite and deny real choice for vulnerable service users.
Joe Halewood, supported Housing consultant