Adult Care Blog

It may have passed you by but we are just coming to the end of Apprenticeships. Workforce development body Skills for Care has reported that 40,000 new apprenticeships were started in social care last year. It has produced a useful guide to apprenticeships, with information for employers and potential apprentices.
But if you don't want to read through all of that here are a couple of videos of apprenticeships in action in social care, courtesy of learning disability provider New Boundaries and the Field House care home in Shropshire. More videos are available from Skills for Care.

The above comes courtesy of the Social Care Institute for Excellence and captures its Mental Capacity Act expert Rachel Griffiths talking about one of the main issues that comes up in her work helping providers implement the Act: whether staff can sign medical treatment consent forms on behalf of service users.
I presume you all know the answer but have a listen if not. Here's the advice in written form.

Three Winterbourne View care workers today pleaded guilty to the ill-treatment of residents at the now closed learning disability hospital in Bristol, reports the BBC.
Wayne Rogers, 31, Alison Dove, 24 and Holly Draper, 22, pleaded guilty to nine, seven and two counts of ill-treatment under (I think) the Mental Capacity Act at Bristol Crown Court today.

This is not the end of the road. The three are due to be sentenced on 16 March and eight further defendants are due to be dealt with next month as well.

This video may cheer you up if you have a spare few minutes - it collects some short clips of carers, parents of disabled children and service users talking about things they have achieved in their communities off the back of In Control Partners in Policymaking courses. These provide training in support planning, influencing policy and organising support groups for users and carers locally, among other things.

A report this week revealed that people in more deprived areas are more likely to die in hospital than those from more affluent places.

In this guest blog, National End of Life Care Programme social care lead Tes Smith argues that social workers have a key role to play in narrowing these inequalities in death.

Fairness is much in the news at present, not least in the shape of the stubborn gap between rich and poor. As in life, so in death it seems. This week, the National End of Life Care Intelligence Network identified that people living in deprived areas are 7% more likely to die in hospital than those residing in the most affluent areas.

Surveys consistently show that most of us would prefer to die at home or in another community setting, such as a hospice, rather than hospital.  Reducing the percentage of deaths that take place in hospital is a key objective of the Department of Health's national end-of-life care strategy.

A small fraction of the gap identified in this week's report - one seventh - can be accounted for by differences in factors such as the cause of death and life expectancy. Individuals affected by some conditions that affect more people in deprived areas, for example chronic obstructive pulmonary disorder, sometimes prefer to be cared for in their final days and hours in hospital.

However the report does raise issues around equity of access to housing and care services that allow people to exercise choice over where they are cared for and, ultimately, where they die. Social care professionals can do something about that.

Social worker role

Yes, death might come after months or even years of high tech medical interventions - whether pharmacological, surgical or technological. However, social care services often have regular contact over a long period with an individual as they become more frail - and with their family or informal carers.

We can liaise with services such as housing and occupational therapy to ensure the individual's home is both decent and equipped with any aides and adaptations needed to support them in their final days, weeks or months.

More powerfully however, we can support individuals nearing the end of life and their carers so they can access the services that will allow them to die at home or in a hospice if that is their wish. This can involve putting in place a package ranging from transport services to specialist pain relief services and community nursing.

With our assessment, communication, co-ordination and care planning skills we should be working with health colleagues in hospitals and the community. We can advocate on behalf of clients who might lack either the verbal skills or self-confidence to effectively pursue such care packages themselves and co-ordinate the delivery of services. With ethnic minorities over-represented amongst the most deprived in our community, there might be language barriers that we can help overcome.

Sharp elbows

The broader social care profession should be working with specialist palliative care social workers in hospices and hospitals to champion the interests of those whose voice might otherwise be lost.

When asked why he thought his new National Health Service would survive, Nye Bevan is said to have replied that the 'sharp elbows of the middle classes' would make quite sure they and their families had access to high quality free healthcare.

Perhaps it is part of the social care professional's role to play the sharp elbows of those less able to voice their wishes and preferences for care in this age of choice. Care provision at the end of life might be a good place to start.

There's an interesting report out today from the King's Fund about the costs (to patients and the NHS) of treating physical and mental health problems separately given the large number of people with long-term conditions who also have mental illnesses.

It finds 46% of people with mental health problems have a long-term condition and 30% of people with a long-term condition have a mental health problem, amounting to 4.6m people.

However, the report says: "A separation of mental and physical health is hard-wired into institutional arrangements, payment systems and professional training curricula. As a result, co-morbid mental health problems commonly go undetected among people with long-term conditions, and where problems are detected the support provided is often not effectively linked or co-ordinated with care provided for physical problems."

The result is poorer patient outcomes and significant cost to the NHS and the wider economy. What's worse is that people with these co-morbidities are disproportionately found in deprived areas, where they lack access to services and resources.

The report has some interesting ideas for bridging the gap:

• Greater involvement of mental health specialists in primary care.
• Much greater investment in liaison psychiatry services in acute hospitals to identify people with mental health problems.
• Training for physical healthcare staff in basic mental healthcare.

There is less about the role of social care professionals in this report, beyond stating that they have a role to play, particularly in relation to people with dementia and long-term conditions.

It would be good for this to be fleshed out as social workers and other care professionals have a crucial role in identifying people with co-morbidities, taking a holistic view of their condition and co-ordinating their support. Hopefully, this is something that can be addressed.

On Friday, The College of Social Work held a summit on the future of adult social work attended by senior managers, civil servants, academics, social work representatives, users and frontline practitioners.

There was a remarkable degree of consensus about what needed to happen: practitioners needed to be liberated from bureaucracy, rationing and risk aversion to exercise professional judgement to better support service users.

But there was less clarity about how we should get to this point.

No Munro review for adult social work

Children's social work has had its own inquiry - the Munro review - to address the self-same issues of bureaucracy and the erosion of professional judgement. But no such review is in the pipeline for adult social work.

The College is keen to influence the forthcoming White Paper on adult social care in a more social work-friendly direction. And the signs on this front are good.

Care services minister Paul Burstow said last week that social work would be at the heart of the paper, with an emphasis on community development, not care management. His message was echoed at Friday's summit by DH official Glen Mason but there was no more detail on what the White Paper would say.

No reserved tasks for social workers

Indeed, Mason was clearer on what the White Paper would not say: that there would be no legislation to establish specific roles and tasks that only social workers can do. This was in response to one summit attendee who felt that such provisions would help carve out a status for adult social work, drawing on the experience of statutory child protection work in raising status.

This means that, whatever the White Paper says about social work, it will be up to individual organisations - particularly local authorities - to put this into practice.
Mason said he felt that most directors of adult social services understood the importance of social work.

However, some in the audience did not share his optimism, particularly in relation to directors who did not have a social work background.

(Image from Rex Features)

Since care services minister Paul Burstow scrapped annual assessments of council adult social services in November 2010, performance management of councils in this area has rather disappeared without trace at a national level.

It's not that it isn't happening: we have a Promoting Excellence in Councils' Adult Social Care Board, whose role is to keep track of performance in all councils and work with authorities to drive improvement. It embodies "sector-led improvement" (i.e. local authorities taking responsibility collectively for improved performance) and includes representatives from the Local Government Association, Association of Directors of Adult Social Services, the Care Quality Commission and the Social Care Institute for Excellence.

But while there is a short paragraph on the board on the LGA website, you'd be hard-pressed to find out much about its work online.

This is in stark contrast to the previous system in which the Care Quality Commission produced an annual report on local government performance in adult social care, with separate reports and performance scores for each council.

The sad thing is that sector-led improvement work is happening. The LGA is conducting peer reviews of councils, where people from within local government go and assess performance in an authority, and there is more targeted support for councils that have been previously deemed to be falling short.

But finding information on progress and the outcomes of peer reviews is next to impossible (well, I've found it next to impossible). Again, this would not have been the case in respect of inspection reports when we had a national system of annual assessment.

At a local level, councils are supposed to be producing local accounts of their performance to provide citizens with a means of scrutinising what is going on. Here are a few that have been published for 2010-11 - Stockport, Hackney, Rotherham - to give you a flavour.
In all cases of published local accounts, I have no doubt, there has been a transparent process locally, where the report has been published prominently, scrutinised by backbench councillors and had input or a critique from the user-led local involvement network.

However, what we don't know is whether all councils have published such a report, or whether any independent judgement has been reached on their quality i.e. the extent to which they involve a genuine self-assessment, rather than a public relations exercise.

I'm not calling for a return to national assessment of council adult social services by the independent regulator. Well, not necessarily. I just think that the system of sector-led assessment needs to prove itself to be something other than a way of making performance assessment cheaper. And for that, we need much more transparency, nationally.

Charities are warning that disabled people are facing abuse on the streets and accused of faking their conditions due to the government's cuts to benefits for the group, reports The Guardian.
Some are declining to use disabled parking bays lest they accused of not being worthwhile recipients of support for their impairment, with people with less visible disabilities at particular risk of abuse.

Here's a reminder of those cuts to benefits and services for disabled people (though one of the 10 listed here - the cut to mobility benefits for people in residential care - has been dropped), illustrating just how stark they are. The government has an opportunity to make concessions after a number of its benefit cuts, in the Welfare Reform Bill, were overturned by the House of Lords; however, ministers just reimposed the cuts in the House of Commons.

And there seems to be no let-up to the twin narratives that there are many thousands of people claiming or applying for sickness benefits who should be looking for work, and that disability living allowance is just too expensive and going to people who aren't really that disabled.

However, the disability movement has been fighting back with a vigorous campaign, illustrating the difference these benefits make to people's lives and the genuine need of claimants. For those of you with a bit of time on your hands, here's a recent dispatch from that campaign: an e-book written by leading campaigners against both the Coalition's reforms to welfare and those of its Labour predecessor.

(Image on Flickr from Byzantine_K and taken from Disabled People Against Cuts poster)