By Robin Bush
Stephen Bubb’s report, Winterbourne View – Time for Change, is welcome, but less for its content and more because it allows the sector to reflect on the issues it faces.
As chief executive of a grassroots organisation working hard to give vulnerable people the quality of life they deserve, I find it hard to believe that a mere three years after the appalling events at Winterbourne View were uncovered, we have had to fight tooth and nail to maintain sufficient funding to allow our supported living service to continue.
There’s a mismatch between the market rate the NHS, local authorities and central government think they should be paying – and the commercially viable rate required by specialised service providers to deliver excellent care. Put simply, we are being asked to provide (and are trying to provide) a Harrods service for an Aldi price. The figures just don’t stack up.
Community care services for individuals with complex and challenging behaviour require highly specialised intervention from committed staff, backed by organisations with a real breadth of in-house expertise. In our organisation, our dedicated autism practice department ensures that every new recruit embarks on a six-month induction programme made up of 25 autism-specific training courses, incorporating the very latest learning. Thereafter, staff training is a continuous process, with internal conferences, development days and bespoke sessions used to enhance on-the-job experience.
This level of commitment delivers life-changing outcomes for our service users. For example, before coming to us, no-one knew how to cope with Nigel and he spent 12 years living in a secure hospital. Now he lives in one of our supported living houses and is a changed man. His confidence has grown beyond measure. He’s happy in his home, supported by staff he trusts – he’s even able to venture out on his own and has joined a local snooker team.
Another client, Paul, had been slowly destroying his home. His carpets were soaked with urine, he could barely speak and he ate with his hands. Thanks to our work he now lives in an adapted property with toughened furniture. We’ve helped him expand his vocabulary and we’ve taken him on his first holiday. He’s happy and settled and we’ve never had a serious incident with him.
‘Race to the bottom’ on price
To develop and maintain these excellent outcomes there needs to be a recognition from local authorities that such specialist services require adequate financial resources to support them. Yet, across the country and locally there has been a “race to the bottom” in terms of price for community services with well-respected organisations with a proven track record of supporting complex individuals having their hourly rates cut, because adult social care commissioners are unable to pay a fair rate for this type of service.
The truth is that funding for specialist adult social care is non-existent on the social care landscape. And social care is the poor relation of the NHS. At present, vital services such as ours are being eroded at grassroots level because they are unable to sustain the high level of training required to enable staff to meet service user needs. Even if they could afford to support staff through training, social care providers struggle to attract and retain staff because they can’t afford to pay the wages worthy of such a challenging job.
The Bubb report suggests the development of a social investment fund in order to build capacity for community care. Most social care providers don’t want to be given money to develop services, we just want to know that we will be given a fair price for the care we already provide. I’d far rather see the Libor fines [from banks for rigging interest rates], suggested as seed capital for the social investment fund, going into direct service provision – and a portion of the £2bn earmarked by health secretary Jeremy Hunt for the NHS in 2015-16 coming to social care via the Better Care Fund, with a commitment that it is ringfenced for specialist services for people with complex and challenging behaviours.
We need to fix this funding issue. If we don’t, the dreadful reality is that community-based social care providers will fail to provide the right level of support and vulnerable people will end up in the very institutional care we are trying to avoid. And there they’ll stay, with the discharge pathway blocked, because the funding is not available for the specialist support to help them return to life in the community.
Robin Bush is the chief executive of the Wirral Autistic Society