Adult Care Blog: June 2011 Archives

Adult social care spending goes up - or does it?

By Mithran Samuel, adults' editor, on June 30, 2011 5:03 PM | No Comments

Some government figures out yesterday on council spending caught my eye - they show that expenditure on adult social care is due to go up this year in England.
This can't be right can it? Well the figures show a rise from £14.4bn to £14.9bn, a rise of 3.2%.
However, a closer inspection reveals that this is not all it seems. The Department for Communities and Local Government admits that this rise is explained (in part at least) by the transfer of £1.3bn in funding from PCTs to councils to meet the social care needs of people with learning disabilities.
If you subtract this sum you're left with £13.6bn, a reduction of 5.6%, but I don't think this will be quite right. In previous years, money has been transferred from PCTs to councils locally (as opposed to nationally) for this purpose. So it depends how far this was accounted for in the £14.4bn figure for 2010-11.

Killing by mental health patient may have been 'preventable' but for care failings

By Mithran Samuel, adults' editor, on June 30, 2011 2:38 PM | No Comments

Damning report out just now from the Healthcare Inspectorate Wales about failings in the care given to Martin Davies, a mental health patient who stabbed to death a 66-year-old woman, Gwen Poole, in in Llanbradach, near Caerphilly, in March 2009.

The review concluded that:

There was a great deal of evidence which indicated that in a crisis, Davies was likely to harm himself or others.
There were many shortcomings in his care and treatment of over a number of years, and failings by various health and social care organisations and care providers.
Opportunities were missed during January and February 2009 to admit him to hospital either as an informal patient or under the Mental Health Act.

Davies pleaded guilty to manslaughter on ground of diminished responsibility in May 2009 and was detained indefinitely in a high secure unit under the Mental Health Act.

Dilnot commission: The case for social care funding reform

By Jeremy Dunning, senior adult beat journalist on June 30, 2011 2:11 PM | No Comments

The commission on reforming care funding, chaired by Andrew Dilnot , will report on Monday. But why was it set up in the first place? As part of our coverage of the commission's report, this piece examines the case for reform.

Few people have anything good to say about the current state of England's system of care and support.

It is damned as unfit for purpose due to the growing levels of unmet need. It is also perceived as unfair both because of the postcode lottery of council-set eligibility thresholds and due to means-testing.

The system, while offering a safety net to those on low incomes with high needs, potentially leaves many older people at risk of losing all their assets and income.

This is because those with high care costs are required to support themselves in residential care until they run down their assets to £23,250, leaving little to pass on to their family.

In the current state of austerity things are only getting worse. Age UK has concluded that councils have cut care spending on older people by 8.4% this year - well above the government's estimate of a 4.7% reduction overall in council budgets for 2011-12 in England.

Age UK has previously predicted that council cuts from 2011-15 will leave more than one million older people in need not receiving formal care - up from 800,000 - and slash support for those in receipt of services.

Unmet need has already been calculated as 111 million hours of care as of 2010, research by the Personal Social Services Research Unit has found, and it is expected to rise to 157 million hours by 2025.

The population of older people is projected to grow by 50% over the next 20 years as a result of longer life expectancy, while the proportion of the working age adult population is falling.

There are also growing numbers of working age adults with a learning disability, primarily as a result of falling death rates.

This suggests England will be spending a greater share of its national income on care and support, which will hit working-age adults hardest without system reform.

Assuming unchanged policies, the Office for Budgetary Responsibility has suggested that by 2029-30 government will be spending 1.7% of national income on long-term care, compared with 1.2% in 2009-10.

This explains why many people say the system is ripe for change.

(Image on Flickr from hweiling)

What can we expect from Andrew Dilnot?

By Jeremy Dunning, senior adult beat journalist on June 30, 2011 1:05 PM | No Comments

Andrew Dilnot, the man charged with reforming the funding of adult care in England, has been popular with the social care sector.

Affable and approachable, with a keen understanding of the problems the sector is facing, Dilnot is generally thought to have developed options that are politically acceptable and yet also able to actually do some good.

So what will his report on Monday (4 July) say?

Limited liability for individuals, more state funding, an end to the postcode lottery and a larger role for care insurance: the broad outline of the Dilnot commission's solution is already largely known.

Key recommendations are likely to include that individuals should pay no more than £50,000 in care costs, with the state paying anything over that amount. It is also expected to call for a large increase in the level of assets people can hold - currently £23,250 for residential care - before they receive any state help at all with costs. Dilnot may recommend a figure closer to £100,000, it is reported.

As now, the poorest will continue to receive free or subsidised care.

The commission is also likely to recommend a national assessment system to end the postcode lottery of Fair Access to Care Services.

Alongside this, enough hints have been dropped suggesting that it will oppose a compulsory system of care insurance to fund individual contributions to their care. Instead, Dilnot will propose measures to help develop a market in private insurance for care, foremost among them a cap on individual costs.

Dilnot will say his reforms will protect people with high needs from catastrophic costs while also ensuring the poorest are still able to receive care and support and ending many sources of unfairness in the current system.

The question is, will the government - or more particularly the Treasury - agree?

Continue reading What can we expect from Andrew Dilnot?.

Scottish MPs to scrutinise care regulation

By Vern Pitt, journalist, on June 30, 2011 10:51 AM | No Comments

The health and sport committee of the Scottish Parliament has launched an inquiry into care regulation.

Its sole aim is to establish if the regulatory system is fit to ensure the care of older people is both safe and good quality.

It's seeking responses to the following questions:

Can we be confident that the regulatory system is picking up on care services where the quality of care is poor?
Are there any particular weaknesses in the current system?
Does the system adequately take into account the views of service users?
Does the registration and regulatory system provide an appropriate basis for the regulation, inspection and enforcement of integrated social and NHS care in the community?

It will be interesting to compare the results of this inquiry to the report of the health select committee in Westminster into the functioning of the Care Quality Commission, which regulates care in England, due for publication later this year.

The committee is calling for written evidence before 24 August.

Further oral evidence sessions will be held in September.

Is your CRB check revealing your mental health record?

By Vern Pitt, journalist, on June 30, 2011 9:45 AM | No Comments

Is my CRB check revealing my mental health record? That's the question which, I imagine, will spring to mind for a lot of people working in the social care sector after reading a post on Alastair Campbell's blog this morning.

Campbell has posted a letter from Eileen O'Hara, in which she recounts a tale of having her mental health record included on at CRB check despite having no criminal conviction.

It's a pretty disturbing find and according to O'Hara, who has done a bit of reading on the subject, entirely without any process of appeal.

Campbell, a committed mental health campaigner himself, seems pretty shocked by it all.

I'd be interested to know if this has happened to anyone else.

Thanks to Lucy Series @thesmallplaces for the link.

Good round-up/analysis of Dilnot commission stuff

By Mithran Samuel, adults' editor, on June 30, 2011 8:43 AM | 1 Comment

Here's a useful round-up of coverage around the Dilnot commission on care funding, which reports on Monday. It comes courtesy of the ever reliable Rich Watts (@rich_w on Twitter), director of policy at Essex Coalition of Disabled People.

Hope you caught our latest story on the subject yesterday. Looking at the press today, the main new line appears to be that the White Paper on social care - that should enact the Dilnot reforms, along with those proposed by the Law Commission around adult care law - may be delayed until 2012 (see this from the FT)

The myth of free social care and the Dilnot commission

By Mithran Samuel, adults' editor, on June 29, 2011 5:01 PM | 1 Comment

Economist Andrew Dilnot (the chap on our left) delivers his much-anticipated report on the future funding of care next Monday (4 July).

In the occassionally mundane world of social care, this is as close to a hot ticket as you're likely to find these days.

Here's what we expect it to say:-

No to free personal care.
Yes to a cap on social care costs for individuals of about £50,000, meaning the state would pick up the rest of the tab for people with the highest needs.
Yes to a national assessment system to end the postcode lottery of Fair Access to Care Services.
No to a compulsory tax/social insurance scheme to fund care.
Yes to ways of encouraging the private sector to develop insurance products to help people meet their care contribution.

But there are already concerns (check this out from care services minister Paul Burstow) that reform may be thrown off course because of public ignorance and media misinformation about the costs of care.

The key issue is the ongoing myth of free social care. This survey by care provider Anchor found that 44% of people believe the state should pay for care.
And some press reports (see this from the Daily Express) on the cap on individual care costs that is likely to be proposed by Dilnot have characterised it as a "tax on the middle-classes" when it is actually a way of saving middle-class people from catastrophic care costs. (Even this Observer headline slightly falls into this trap).

The other concern is that the Treasury will balk at the implications of Dilnot for the public purse - with more people being brought within the purview of state-funded care then more public funds will have to be found to pay for it.

So whatever happens next week it will seem that the success of the reform will depend on how far Dilnot (and his allies in government) are able to rise above the media noise and successfully inform the public about what needs to happen and how it will need to be paid for. We wish them luck.

We'll be providing some more preview coverage later in the week and full coverage of the findings on Monday (and subsequently).

Personal budgets and good outcomes - is it all about money?

By Mithran Samuel, adults' editor, on June 29, 2011 4:43 PM | No Comments

We've had an interesting contribution from a reader about the research on personal budgets from Think Local Act Personal and In Control - his view is that its findings point to the impact of personal budgets being tied to the level of funding that people receive. That was one of the findings of the research (the bigger the budget the better the outcomes, broadly speaking) but this was among a range of factors that determined positive or negative outcomes; however, this reader reckons that this is the big story - in which case, with cuts already being applied to personal budgets we're in trouble.

Big Society heat map published

By Jeremy Dunning, senior adult beat journalist on June 29, 2011 3:25 PM | No Comments

Independent thinktank the New Local Government Network has published a report today showing the communities ready to benefit from Big Society and those at risk.

The report shows that:

There is no strong link between a community's wealth and its 'Big Society' resources, with some deprived areas comparatively rich in community wealth. A poll of local authorities suggested that even in areas facing the steepest budget reductions, ingredients of the Big Society are often strong.
In new heat maps illustrating Big Society resources, Barking & Dagenham and Harlow councils are least well placed to benefit from the Big Society, with the South West and North of England regions faring strongest.
Communities faced with 'double deprivation' - those lacking both financial wealth and community resources such as volunteering - should be targeted for extra help to cope with the withdrawal of traditional state services.

The report recommends a much clearer role for local government in helping the Big Society grow from within localities and also to target those communities lacking both financial wealth and community resources such as volunteering for extra help to cope with the withdrawal of traditional state services.

Nick Clegg rolls out pooled budgets for socially excluded families

By Mithran Samuel, adults' editor, on June 29, 2011 12:46 PM | No Comments

That most game of political punching bags, Nick Clegg, has been in action again. He has announced the national roll-out of community budgets, something I reckon is likely to cause him less trouble than tuition fees or the NHS reforms.
So what are community budgets again? They involve local government, health, police, probation and others pooling funds to support families with multiple problems (i.e. drugs, domestic violence, alcohol, mental health, homelessness, antisocial behaviour etc).
These are the families who account for a lot of public funding and a good chunk of professionals' time for whom more co-ordinated support would (you would think) be beneficial for all concerned.

For an example of the sort of support this may result in, check out this feature on social exclusion work in Merton in south London.

This approach also feeds into the government's localism agenda and, in this regard, ministers are going further by allowing two local areas to pool all local public service funding (the council's, the PCT's, the police's etc) together in a single pot. The Local Government Association is very excited about this - Clegg announced it at the LGA's annual conference this week - though predictably fears that it won't be as radical as the government thinks it will (check out this rhetoric from Clegg: "Every government preaches localism. This government will practice it.").

Anyway, once you get beneath the high politics and policy wonkery, there is a good idea waiting to get out here.

(Image on Flickr from Liberal Democrats)

CQC hit by vote of confidence from care home providers

By Mithran Samuel, adults' editor, on June 29, 2011 9:53 AM | No Comments

My colleague Vern had some fun blogging about the Care Quality Commission's travails yesterday but there's some more challenging (to put it mildly) news for the regulator. Last week's National Care Homes Congress ( agreed a vote of no confidence in the CQC - this is perhaps unsurprising given recent criticisms of the regulator from providers over the registration process and regulatory fees; but perhaps more seriously, the Today programme thought this was worth running a story on this morning and had Amanda Sherlock, the regulator's operations chief, on for a grilling.
Pressure appears to be mounting for a concerted look at either the remit of the regulator or its resourcing - we understand that this is being discussed within the Department of Health though with so much else going on, action may not be imminent.

(Image on Flickr from gcoldironjr2003)

Independent advocacy is vital for vulnerable clients - but it is being cut

By Mithran Samuel, adults' editor, on June 28, 2011 8:51 PM | No Comments

This is part response to our recent feature on how to avoid another Winterbourne View case and part clarion call about the need to invest in independent advocacy for vulnerable service users - and the current danger to such services. It comes from Elaine Boyden, chief executive officer at Advocacy Matters.

I read with interest the special report on Winterbourne View and, in particular, Jim Mansell's eight-point plan for preventing abuse in learning disability services. Whilst the points raised by Jim are absolutely essential I was very disappointed that there was no clear mention of the vital and crucial role of independent advocacy. As someone who has been involved in independent advocacy for almost twenty one years I have seen the profile of independent advocacy rise considerably following the onset of Valuing People in 2001 and, later, Valuing People Now.

Sadly, however, demand for independent advocacy continues to exceed supply. This appalling case exposes once again that had independent advocates been on the scene supporting even a few of the vulnerable individuals living there, opportunities for staff to behave in the way they did would have been reduced. In addition, poor practice could have been questioned, challenged and formal complaints and legal challenges could have been offered.

You may argue that independent advocates are not inspectors. However, if we are looking at more focus on prevention (rather than crisis intervention) and person-centred ways of working, then independent advocacy has to be an important part of the jigsaw.

Independent advocates at all times keep the focus firmly on the advocacy partner or "service user". Over a period of time an advocate can build up trust and really get to know the service user well. Power imbalances can be addressed. Advocates also focus on building up confidence and self-esteem, self-advocacy skills and an awareness of human and civil rights that many learning disabled individuals are not aware of. Skilled and experienced advocates also pick up on the wider culture of the organisation, either by observations, using easy to understand communication methods or by talking to their advocacy partners.

Non-instructed advocacy is also very useful in situations where there are complex communication needs. Furthermore under the Mental Capacity Act 2005, independent mental capacity advocates (IMCAs) are able to get involved in safeguarding situations when safeguarding is open and there is a decision that needs to be made. This is the case even where the family is appropriate to consult.

It is very worrying that, during the last year, some advocacy organisations across the UK are closing their doors due to funding shortages and cutbacks. What we need is for commissioners and practitioners in both social care and health to fully acknowledge that independent advocacy is not an "extra" but, in many situations, an essential ingredient in keeping the most vulnerable people in our society safe to enjoy a good quality of life that most of us simply take for granted.

In addition, an understanding of independent advocacy needs to be included in the training of care staff in any care setting so staff can be more pro-active and identify when to refer their clients to advocacy organisations.

Call for evidence for disability harassment inquiry

By Mithran Samuel, adults' editor, on June 28, 2011 8:24 PM | No Comments

Just letting you know about a call for evidence for the Equality and Human Rights Commission's inquiry into disability harassment from Anne Novis, a disability campaigner who has herself been a victim of hate crime.

Novis, who is advising the commission on the inquiry, wants people to put their thoughts on the Broken of Britain website.

The circular logic of the CQC

By Vern Pitt, journalist, on June 28, 2011 4:41 PM | No Comments

Earlier today, I blogged about Stephen Dorrell's lack of faith in the Care Quality Commission following this morning's health select committee meeting, in which Dorrell and fellow MPs grilled the CQC chair Jo Williams, but if you watched it this morning via the internet that won't come as much of a surprise.

In an exchange, which has not been widely reported, MPs grew increasingly irate as Williams appeared to simultaneously acknowledge the validity of their criticism while also appearing reluctant or powerless to fix it.

The topic was staff to patient ratios. You don't have to follow health management matters very closely to know that these are often an important indicator of quality. After all, if you don't have enough staff to do the job it will inevitably effect quality.

"So why weren't the CQC collecting this information?" asked Lib Dem MP Andrew George.

"The regulations themselves are focused on the outcomes for people, rather than the inputs," said Williams.

"If we discovered that there's a breach of regulations, which related to the numbers of staff on duty and the ability to give a quality service, we would say to those providers that they need to look a their staff levels," she continued.

Well, that seems pretty reasonable, right? Until you realise, as George did, that staff-to-patient ratios are only monitored in the NHS not adult social care.

"If you are not monitoring that then there may be a pattern emerging in the residential sector where staff levels are not appropriate," he said.

Amanda Sherlock, director of operations at the CQC, tried to come to Williams' rescue. She pointed out that the CQC were minded to go beyond the exact boundaries of the regulations when they thought it was useful. She said it had applied conditions to registration of some services where there was no registered manager, which was also outside of the letter of the regulations.

The frustration in the room was palpable.

George then raised the issue of older people being put to bed at 3pm because of short staffing in care homes, a common enough complaint. It raised the question of why are these providers not being dealt with, if CQC can step outside the regulations?

Williams said where CQC heard of these cases they would talk to providers.

But you won't even know its happening because you're not monitoring it, countered the MPs.

We would find out from whistleblowers or inspections (two methods whose efficiency have been called into question lately), argued the CQC.

"The public have to tell us," blurted out Sherlock. At that point this bizarre circle of logic was complete. If the CQC doesn't know there's nothing it can do, but it's not really mandated, or minded, to find out. That, it would seem, is your job.

"We'll take this away," said Williams.

Image by Skuds on Flickr

Stephen Dorrell slams CQC management decisions

By Vern Pitt, journalist, on June 28, 2011 3:02 PM | No Comments

Stephen Dorrell, chair of the Health Select Committee, has slammed the quality of management decisions at the Care Quality Commission.

Today, the CQC told the committee that it had asked for an extra 10% in its annual budget from the Department of Health to help it increase staff and inspection rates.

CQC chair Jo Williams answered questions on a range of topics, frequently acknowledging that there was need for improvement, but arguing much headway had been made since she appeared before the committeee nine months earlier.

Following the grilling, I asked Dorrell if he was convinced of CQC's ability to improve, given the evidence of the day - "no" was the flat answer which came back.

He said the priorities the CQC accorded its respective tasks were quite wrong. "It seems to me extraordinary that the registration of dentists is regarded as a priority at a time when it's acknowledged that the regulation of care homes, domiciliary care and hospitals have major issues," he said.

When asked about the large number of vacant posts he expressed the same disbelief. He asked: "What was the set of priorities that led them not to recruit inspectors but to focus on registration?"

"I think they have an aspiration and a set of short-term management goals but whether they have a plan to get them to fruition in a suitable timescale is doubtful," he added.

Dorrell refused to be drawn on whether he felt the problems in the CQC's management stemmed from the individual people involved or the system in which they were operating.

Personalisation: Are volunteers the answer?

By Mithran Samuel, adults' editor, on June 28, 2011 12:05 PM | No Comments

Interesting contribution to the personalisation and cost debate today from volunteering charity CSV.
The charity provides volunteers to support adults with support needs in their own homes for up to a year, offering help with personal care, preparing meals, going to work and meeting friends and family.
CSV is now calling on social workers to consider alerting service users to its volunteer service, which involves matching clients with volunteers.
Obviously this provides a financial benefit but the charity is stressing the positive outcomes it brings too.

'Make telecare free to cut care bills'

By Mithran Samuel, adults' editor, on June 28, 2011 11:44 AM | No Comments

Telecare should be free or low-cost for service users in need to support preventive work that keeps people out of more expensive services such as residential care.
So says a report out today from the Strategic Society Centre, a think-tank that does a lot on social care funding.
"Telecare can reduce demand for care, reduce the burden on informal carers, and save money for the state and families. But it makes no sense at all to means-test its availability," says director James Lloyd. "The state funds 60% of older people living in residential care, but restricts the availability of telecare support, despite it being a fraction of the cost of residential care, and proven to enable individuals to live in their own homes for longer."
Crucially, the report says telecare should be available to people outside the social care system, such as many of those receiving attendance allowance.

Police investigate abuse at London care home

By Vern Pitt, journalist, on June 27, 2011 2:54 PM | No Comments

Scotland Yard is investigating claims of violent abuse at a London care home, after footage of a resident being slapped was caught on camera, the Evening Standard reports.

Big Society needs financial muscle if homeless people are not to be further excluded

By Jeremy Dunning, senior adult beat journalist on June 27, 2011 12:19 PM | No Comments

"Cuts to services will prevent people moving on with their lives and becoming members of the Big Society."

These are the words of a homeless client of frontline charity St Mungo's, interviewed for its new report 'Enough Room: Is society big enough for homeless people?', marking the start of its 2011 Action Week (27 June to 3 July).

The report highlights that homeless people see volunteering as an important way in which they can move from feeling 'shunned', 'excluded' and 'out in the cold' to being active community members again.

But survey findings from homeless people, sector leaders and the public reveal concerns that the picture could become yet bleaker, with homelessness rising and cuts starting to impact on the services people need, including the closure of St Mungo's hostels.

The report highlights that:

Only 14% of St Mungo's clients and staff surveyed thought homeless people are included in society. One person said: "the majority of society are ignorant and fearful about homeless people and don't really want to include them', another said: "Excluded: Watching from the sidelines sceptically.'
A total of 39% of the public surveyed in a YouGov poll agreed the Coalition Government should specifically pledge to protect homeless people. Less than 1 in 10 people (9%) thought the Government is currently doing enough to protect homeless people. However, 30% of people didn't personally want to donate time, money or support homeless charities through taxes.
Of St Mungo's homeless clients surveyed, 70% wanted to volunteer to "give something back to their local community" or to "help other people.

Continue reading Big Society needs financial muscle if homeless people are not to be further excluded.

Isolated social worker says experience was life-changing.

By Jeremy Dunning, senior adult beat journalist on June 27, 2011 10:36 AM | No Comments

"I can't quite put in to words yet the depth of emotions I have experienced this week, but one thing is for sure - this experience will stay with me forever."

Liverpool-based social worker Pam Stopforth's period of isolation is finally over and in her last blog it's clear how much this means to her.

She experienced increasing depression and physical pain from the exercises during her week pretending to be an isolated elderly person and as she admits she has a better insight into this sort of life.

In her last video she spoke about not having got out of bed until 3pm on Saturday because of the pain.

It will be interesting to see how this informs her practice and whether she will make any differences into her work. We'll catch up with Pam later today.

Brighton MP Caroline Lucas bids to decriminalise drugs across city

By Mithran Samuel, adults' editor, on June 27, 2011 10:04 AM | No Comments

Brighton MP Caroline Lucas is bidding to decriminalise drugs use across the city in a bid to tackle its serious substance misuse problem, reports The Observer.
She believes that the government's localism agenda can enable the city to experiment with a policy that would not be in place elsewhere for a trial period, and she seems to have the support (up to a point) of a senior police officer.
Brighton has the highest death rate per capita of any place in the country so there would seem to be an argument for trying a new approach there. But it seems beyond the realms of the possible for this government to allow it.

Austerity hits care training budgets

By Mike McNabb on June 24, 2011 4:50 PM | 1 Comment

By Mark Drinkwater, a London-based community worker

In these austere times, local authorities' social care training budgets are an easy target for savings. And while there are a range of views among co-workers about the importance of learning and development, most would agree that, until now, social care training has been relatively generous.

But with less money from central government, local authorities need to make savings where they can. Already the impact is being felt. First for the chop were the free sandwich lunches. Then, there seemed to be a dip in the number of courses being offered. More recently, sessions have been held at lesser venues as the council seeks to sell its more desirable properties.

But now our council looks set to provide training in partnership with several neighbouring authorities. Elsewhere, such alliances have been seen to be more cost-effective.

In future, instead of several borough-based administrators, the consortium will have a solitary administration team. This will be provided by an external private company, mainly taking online bookings.

There are advantages with such arrangements. These have larger catchment areas creating economies of scale that should enable more courses to be run, with a wider variety of topics. So, in theory, if you've just missed a course you'll have less of a wait for it to be repeated.

However, there are worries. Online booking systems seldom run smoothly at first. And those who choose venues and make decisions about courses will be so much more distant from course attendees.

A further consideration is that, until now, participants come from the borough in which I work. This has created numerous opportunities for developing contacts who work locally. With consortium training, participants will come from further-flung parts - boroughs with which I have no work-related connections. It won't be the same in future.

How personalisation is like Gwyneth Paltrow film Sliding Doors

By Mithran Samuel, adults' editor, on June 24, 2011 12:46 PM | No Comments

That's the intriguing premise of a blog post today from Martin Routledge, former DH personalisation lead and now head of operations at In Control, the charity that pioneered the concept of personal budgets.

It's essentially a response to all the stuff we've had lately - including research from In Control - about the state of personalisation (see this post from the other day).

Just as Paltrow's character's life follows two different trajectories in Sliding Doors, based on whether she catches a particular train or not, Routledge sees personalisation taking one of two paths: on one, service users are given genuine freedom to spend their personal budgets, processes are kept to a minimum and outcomes are consequently good, in general; on the other, the opposite happens and personal budgets get tied up in red tape and genuine choice is denied.

He fears we are currently on this second train but argues that it isn't too late to change. Let's hope so.

(Image from dno1967b on Flickr)

Isolated social worker can't wait for the "desolate" week to end

By Jeremy Dunning, senior adult beat journalist on June 24, 2011 9:36 AM | No Comments

Pretending to be an isolated elderly person is getting to isolated social worker Pam Stopforth.

Her latest tweet @pam_iweek says: "I'm ashamed to say I'm feeling sorry for myself today," while last night she tweeted: "My word for this evening is desolate."

In yesterday's video she talked about not having had "the best night's sleep" because her back and neck are both sore from the various tasks and was also finding it hard to motivate herself.

She spoke of the impact popcorn kernels in her socks had on her feet and posture and said she might have to spend the day on her sofa. One of her tweets referred to having to shuffle downstairs on her bottom in search of painkillers because her back was sore.

She is clearly longing for the social experiment to end. Come on Pam. You can do it.

Disabled will lose out in planned reform of social fund, warn charities

By Jeremy Dunning, senior adult beat journalist on June 23, 2011 3:18 PM | No Comments

Charities are understandably nervous with government plans for local delivery of crisis loans and community care grants.

The government's intention is to pool both into the general fund without incorporating a duty for a minimum level of service and to improve the speed of delivery.

For crisis loans the intention is to restrict the number of awards in any one year and reducing the maximum payable amount from 75% of the daily personal allowance to 60%, while community care grant applications will have to be more directed to need.

It is true that delivery may not have been timely but not to ring-fence it or require a minimum duty will surely lead to inequalities as charities pointed out in the call for evidence, which the government has just responded to.

The disability sector, in particular, points out that many of its client group live in poverty and these loans and grants are a way of making ends meet.

The government acknowledges this concern but still argues that giving local areas the freedom to develop their own systems will lead to better outcomes and more efficient use of resource.

We're already seen what happened with Supporting People. Is this the next Supporting People?

Emotions start to overwhelm isolated social worker

By Jeremy Dunning, senior adult beat journalist on June 23, 2011 9:51 AM | No Comments

"My head aches with thinking. Surreal not speaking for hours on end. Bottom lip wobbly tonight."

This is one of the latest tweets from isolated social worker Pam Stopforth @pam_iweek, who is clearly struggling, as my colleague Mithran remarked yesterday.

She also remarks how much she misses her family, who I know she speaks with every single day, and refers to the start of another "long day" looming.

In her blog yesterday Pam said she struggled to get out of bed and that her back and neck were stiff following the tasks she had to carry out as if she were an isolated older person.

"I simply cannot be bothered," she said, which is how an isolated older person with depression must feel.

The task she had to undertake sounded awful. She had to get up off the floor with the bean and popcorn mixture in her socks, which was clearly painful and was "not a pretty sight - very undignified."

Isolated social worker: "I'm frustrated and emotional"

By Mithran Samuel, adults' editor, on June 22, 2011 5:11 PM | No Comments

Isolated social worker Pam Stopforth has just uploaded her latest video, on day three of her week away from her family and the normal comforts of life. It sounds like she's really starting to struggle but is determined to persevere.

Law to allow disabled people to keep services when they move

By Vern Pitt, journalist, on June 22, 2011 3:01 PM | No Comments

Local authorities could be given an obligation to continue to meet the needs of disabled people moving to their area if a private members bill introduced today into Parliament is passed.

The Bill aims to ensure continuity of support when disabled people move between authorities. It would also make it difficult for a receiving local authority to cut a package of support, if they cannot show there has been a substantial drop in the level of need.

The receiving authority would also be liable to reimburse the originating authority for support provided while it organised a package in the new locality.

The Portability Bill has been introduced by Baroness Campbell. She said: "We all have a human right to move home around the country to be close to family and friends or a job, university etc; or so I thought, until I tried to move 22 years ago. It was then I found out that thousands of disabled and older people who receive social care support do not enjoy this same right."

"22 years later things have not changed," she added.

She said the changes would be cost neutral to the public purse as a whole and probably result in savings through decreased benefit bills because work opportunities for disabled people would broaden.

The Bill follows recommendations by the Law Commission that local authorities should be given an enhanced duty to cooperate when disabled people move home.

RADAR said that any law introduced by the government, stemming from the Commission's recommendations, was unlikely to take effect until 2015 and portability of services was needed sooner than that.

Depression and loneliness grips Isolation Week social worker

By Jeremy Dunning, senior adult beat journalist on June 22, 2011 10:19 AM | No Comments

"I can't believe how flat I feel today."

The words of Liverpool-based social worker Pam Stopforth as she reaches her third day experiencing isolation as if she were an isolated elderly person and clearly the experiment is beginning to tell.

Today she has put popcorn kernels into her socks to simulate arthritis and complains on Twitter @pam_iweek that her "poor feet" feel like they've aged 20 years.

In yesterday's blog she wrote : "I didn't really feel like getting out of bed today as there was nothing to get up for - I had a temporary moment of panic when I woke thinking that David was late for school, then realised he wasn't here, which made me feel quite sad and worried that he is doing ok."

In her latest video diary for Isolation Week, Pam speaks of the problems she has in carrying out day-to-day tasks while wearing vision-impaired glasses and headphones connected to an MP3 player that plays white noise.

Pam, who is one of 11 people taking part in the social experiment, says she found it almost impossible to read instructions from a medicine bottle while she could remember little from the evening news because she was concentrating so hard in trying to make out words.

What is certain from this week already is that Pam has gained a greater understanding of the difficulties elderly people experience.

Click here for the latest on Pam's experience during Isolation Week.

Personalisation: is your glass half-empty or half-full?

By Mithran Samuel, adults' editor, on June 21, 2011 9:28 PM | No Comments

Today's National Personal Budget Survey completes a trinity of research publications analysing the current state of personalisation from the perspectives of users and carers (this survey), councils (last week's survey of progress on personal budgets from Adass) and practitioners (Community Care and Unison's annual survey, issued last month).
Here's our coverage of the findings:-
So what can we conclude:-

That personalisation in general, and personal budgets in particular, are working well, when implemented properly, in terms of improving outcomes for users and carers.
This applies to all client groups, including older people.
Direct payments generally improve outcomes more significantly than council-managed personal budgets, including for older people, though people should not be denied the choice of council-managed budgets.
Councils have a big role to play in ensuring personalisation is properly implemented, but their performance in this area is very variable.
Proper implementation means trusting service users and professionals, not restricting use of personal budgets or tying practitioners up in bureaucracy over assessments, resource allocation or support planning.
It also means not being driven by targets, such as the previous government's goal of getting 30% of users and carers on personal budgets by April 2011. While this target was met by most councils it seems at least some service users may have just been given nominal personal budgets, without choice or control.

We've also learned that personalisation continues to cause controversy - with much debate on Twitter about the impact it is having; however, few appear to argue with its principles (with the exception of offerings such as this from ex-council director Blair McPherson); rather, critics are concerned that implementation has gone wrong in several ways, a point borne out by the research.

As we march onwards through 2011 and amid massive public spending cuts, ensuring the worst performing and middling councils can learn the lessons of the best will be key. This will be the key test for sector coalition the Think Local Act Personal Partnership, one that it will hopefully pass.

(Image on Flickr from Pimlico Badger)

Learning the lessons of Winterbourne View

By Mithran Samuel, adults' editor, on June 21, 2011 9:06 PM | No Comments

As we report, learning disability experts have urged prime minister David Cameron to use the Winterbourne View case to transform services away from institutional care, including by ending placements in hospitals such as the Castlebeck service (which is itself due for closure this week).
Their message is that the response to the case should not just be to put the commissioners, provider, regulator and safeguarding agencies involved in the dock, but to re-examine learning disability care from top to bottom.

As it happens we have looked at how services can be changed after Winterbourne in some pieces this week.

We have examined why people with learning disabilities and complex needs or challenging behaviour are still being placed in institutions such as Winterbourne. The answer appears to be poor commissioning and a lack of appropriate support in the community for this client group. As part of this, learning disability and challenging behaviour expert Jim Mansell has set out an eight-point plan for avoiding another Winterbourne, which is well-worth reading.

Good practice in residential services for this client group is available, however, as our piece on Voyage shows, with investment in training, including of management being key, alongside tight monitoring of services and a culture that provides staff with opportunities and challenge.

The importance of training is also highlighted by a piece from the British Institute of Learning Disabilities on training requirements for providers of services for people with learning disabilities and challenging behaviour.

I'm not sure whether the government will order widespread change in learning disability services. For one, they don't tend to order widespread change; for two, what experts are calling for will likely require up-front investment in community support and advocacy that will be a turnoff for government. However, ensuring that the good practice that does exist is disseminated widely and learned from seems a task that should be achievable.

Is the implementation of personalisation killing off personalised services?

By Mithran Samuel, adults' editor, on June 21, 2011 8:40 PM | No Comments

Just spotted this blog post on personalisation - it's in part a response to our survey on personalisation with Unison.
It essentially asks the questions of how far personalised services can survive under personalisation in its current form. The writer is Suzanne Mildinhall, personalisation and development officer at Workwise, a charitable employment support provider for people with mental health services in Suffolk.
She says that Workwise has been losing customers under the impact of personalisation (or rather, a certain form of personalisation that restricts people's use of personal budgets or gives people insufficient funding to pay for good services), despite the service proving itself in effectively supporting people back into work.
She ends with the question: "My question is simple: is the personalisation agenda actually what it says on the tin, or a Trojan horse of clever funding cuts?"
Interesting stuff and a worry too.

Avoiding another Winterbourne: Getting training right

By Mithran Samuel, adults' editor, on June 21, 2011 8:00 PM | No Comments

In the latest article responding to the Winterbourne View case, Lesley Barcham (right) and Jackie Pountney of the British Institute of Learning Disabilities discuss how care providers should train staff to work with people with learning disabilities and challenging behaviour.

Finding, developing and keeping the right staff to provide good support for people whose behaviour is seen as challenging is a complex activity to manage and get right. What learning and development opportunities should a service provider be providing for staff?
A comprehensive induction programme is key to ensuring workers understand what is required of them to support people with respect and dignity and in a person-centred way and to understand and respect people's diversity. The common induction standards provide a framework for induction, which should be contextualised to the organisation and the people it supports.

Mandatory training: to cover health and safety requirements such as fire safety, moving and handling, and food hygiene, in accordance with guidance from the relevant professional body.
A commitment to qualifications: the new health and social care qualifications enable services to tailor the qualifications of support workers to the needs of the individuals they support. A range of specialist units are available, including autistic spectrum conditions, person-centred thinking and planning, and positive behaviour support. These units can be used as part of the learning disability pathway through the diploma in health and social care.

Continuous professional development: a programme of training and qualifications has to meet the needs of the worker and the organisation should build in good supervision and appraisal and a personal development plan for each worker. Professionals should undertake CPD in line with the requirements of their registration. Units from the level 2 and 3 diploma in health and social care are also available in smaller qualifications, such as the level 2 and 3 certificate in supporting individuals with learning disabilities.

The development of managers is critical, their leadership must reinforce the values of the organisation and they should be role models to their staff in promoting dignity and respect. Their professional development will benefit from opportunities on practice with other external managers and leaders and to have opportunities to visit and observe best practice. The new level 5 diploma in leadership for health and social care and children's and young people's services contains specialist leadership and management units.

Workforce planning: Although the Mansell report on learning disabilities and challenging behaviour (2007) and the Valuing People Now strategy (2009) provide guidance to providers to direct their workforce planning and development, the Care Quality Commission doesn't currently offer detailed guidance on workforce planning and development for specialist private health providers. Skills for Care and the CQC provide workforce guidance for social care providers. This is a grey area and private heath providers might benefit from further direction from CQC in workforce issues.

Providers should support and develop people with learning disabilities so they can lead and contribute to the training of staff, in line with Valuing People Now recommendations. Hearing the experiences of people who use the service and family carers can have a significant impact on workers.

It is the responsibility of the senior staff of a provider and the registered manager of a service to continually seek to improve the quality of the support they provide though a well trained and managed workforce.

Lesley Barcham is workforce development manager and Jackie Pountney is qualifications manager at the British Institute of Learning Disabilities.

As Cameron U-turns on sentencing, sector gears up to fight legal aid cuts

By Mithran Samuel, adults' editor, on June 21, 2011 12:48 PM | No Comments

David Cameron may be making waves with his latest U-turn, on reforming sentencing policy in a somewhat more lenient direction, but the government shows no signs of retreating on the other part of its Sentencing and Legal Aid Bill, due out today: namely cuts to the £2bn a year legal aid budget.
As we have reported, these plans have sparked significant concerns about access to civil justice for the most vulnerable, however the representatives of benefit claimants, migrants and other affected groups do not quite possess the tabloid press's ability to sway politicians.
Nevertheless, campaigners for the vulnerable and lawyers' groups are gearing up to fight the cuts through their Justice for All campaign.

The Law Society's president, Linda Lee, said today: "The reforms will be a disaster for the public and will prevent many ordinary people from enforcing legitimately held rights."

Somehow I don't see the government budging on this one given the nature of their opponents but I am sure it will be a hard-fought battle.

(Image on Flickr from World Economic Forum)

Burstow updates House of Commons on Winterbourne View case

By Mithran Samuel, adults' editor, on June 21, 2011 12:33 PM | No Comments

Care services minister Paul Burstow has updated Parliament on the Winterbourne View case in a ministerial statement today. It includes yesterday's news of the impending closure of the learning disabilities hospital as well as a rundown of the many inquiries that are going on into the case (see our special report on the case).

There's not a lot that's new in the statement, but here are a few snippets worth sharing:-

The Care Quality Commission's review of all registered services (in England) run by Castlebeck Care is due to conclude on 1 July. Not sure when the regulator will report on this (publicly at least).
There will be inquiries into the role of the NHS in relation to the case (as the commissioner of care for those placed at Winterbourne View). The South West Strategic Health Authority is co-ordinating serious incident reviews into the care of all the patients and just finalising terms of reference with the Department of Health.

There is going to be a lot coming out on Winterbourne in the coming months and it will then be the Department of Health's role to piece it all together. Sector experts will be hoping that the result will be significant changes to the care of learning disabled people, including an end to institutional arrangements.

Mental health services in crisis

By Mithran Samuel, adults' editor, on June 21, 2011 9:45 AM | No Comments

Big story in The Guardian today on the state of mental health and it's not good.
Royal College of Psychiatrists president Dinesh Bhugra warned that there are serious problems on mental health wards with patient safety, overcrowding and care standards. This is being made worse by an impending staffing crisis as the number of UK medical graduates going into psychiatry falls and the supply of doctors from abroad dwindles.
I've just been sent the report by the college on these issues and we'll have a story up on it shortly.

Stop falls by getting older people to the opticians

By Vern Pitt, journalist, on June 21, 2011 1:50 AM | No Comments

Poor vision was a cause of 270,000 falls of people age over 60 last year, a study by Age UK revealed today.

To make matters worse, the research showed 2m older people have not taken advantage of free sight tests in the last two years.

In other research, published today by The College of Optometrists, it was shown that over a third of carers were completely unaware of common eye conditions in older people such as age-related macular degeneration.

The study was conducted as part of Falls Awareness Week, which this year focuses on the relationship of falls and vision.

Winterbourne View to close this Thursday, apparently

By Vern Pitt, journalist, on June 20, 2011 2:20 PM | No Comments

Winterbourne View, the learning disability hospital, which has been at the centre of an abuse case exposed by BBC Panorama, is set to close this Thursday, according to a whistleblower.

Terry Bryan, who worked at the home and reported the abuse to the management and the Care Quality Commission, before a lack of action led him to turn to Panorama, has just claimed the hospital is set to close this Thursday.

About and hour ago, on Twitter Bryan wrote (his caps, not mine): "WINTERBOURNE VIEW IS CLOSING DOWN THIS THURSDAY!!!"

When the scandal broke it was known the home would only remain open for a matter of weeks, but this still seems pretty swift. Certainly no one I've spoke to at the CQC, NHS South West or Castlebeck was aware of this, so it's yet to be confirmed.

More information as it comes through.

Rough sleeping on the rise in London

By Jeremy Dunning, senior adult beat journalist on June 20, 2011 6:55 AM | No Comments

Rough sleeping is on the rise in London, according to homelessness charity Broadway.

The figures, contained in its annual report on rough sleeping "Street to Home Bulletin 2010/2011" and released today, show that the total number of people seen sleeping on the streets of London rose by eight per cent from the previous year.

This should come as little surprise considering Government figures out earlier this month showed a 10% rise in the number of households accepted as homeless by councils in England from 2009-10 to 2010-11.

The headline findings from the Street to Home Report 2010/11 include:

3,975 people were seen rough sleeping in 2010/11
1,934 (49%) of these people were seen rough sleeping just once
2,846 (72%) were only seen in one quarter of the year
457 (11%) were seen in three or four different quarters of the year
2,363 (60%) of these people were new to the streets
28% of those seen sleeping rough were from Central and Eastern European countries that joined the EU in 2004 and 2007
Just four people under 18 were contacted and only 8% of those seen sleeping rough throughout the year were under 25
Amongst UK nationals, 3% (36 people) were known to have served in the armed forces at some point.
Outreach teams moved 1,372 people into accommodation in 2010/11. This was primarily hostels for single homeless people
326 people were assisted to return to a home area or an area where they could access appropriate services
159 people were moved into long term accommodation with the help of outreach workers in this year
366 people started tenancies in social rented Clearing House properties, which are allocated to people who have a history of rough sleeping in London.

Interestingly though Broadway and the Mayor's office both believe their target of having rough sleeping at near zero by the end of next year is still achievable as long as resources are used in the right way.

Vacancies down but turnover up in social care workforce

By Mithran Samuel, adults' editor, on June 17, 2011 5:11 PM | No Comments

Vacancies in adult social care services have gone down but staff turnover is on the up, figures produced by the National Care Forum have shown.
The NCF, which represents not-for-profit providers, has surveyed members and found that average vacancy rate has fallen from 7% to 5% this year but turnover has gone up across all sectors - with a rise from 21.2% to 23.9% in the domiciliary sector for older people.
NCF says more work needs to be done to look into the reasons behind these figures.

Tory MP: Let disabled work below minimum wage to gain jobs

By Mithran Samuel, adults' editor, on June 17, 2011 4:13 PM | No Comments

Tory MP Philip Davies has made himself a rather unpopular chap by suggesting in parliament that the national minimum wage (something he opposes in principle) is preventing disabled people from getting work.
Here's the logic:-

Employers faced with two candidates, one with mental health problems or learning disabilities, one without, will choose the latter, given that they would have to be paid the same.
Getting people with mental health problems or learning disabilities into work in much higher numbers requires allowing them to work for less than others (including less than the minimum wage in some cases).

Here's a choice quote:

"Given that some of those people with a learning disability cannot, by definition, be as productive in their work as someone who does not have a disability of that nature, and given that the employer would have to pay the two people the same, it was inevitable that the employer would take on the person who was going to be more productive and less of a risk."

Here's the reaction:-

Paul Jenkins, chief executive, Rethink
"To suggest that the answer to employment discrimination is to cut the wages of those already facing disadvantage is seriously misguided. Would he use the same logic to argue that women or people from a minority ethnic background should be paid less?"

Deborah Jack, chief executive, National Aids Trust
"The suggestion by Tory MP Philip Davies that disabled job seekers might offer themselves for less than minimum wage just to get on the employment ladder is essentially advocating the discrimination people with disabilities so often experience when looking for a job."

Molly Mattingly, assistant director of the Foundation for People with Learning Disabilities
"Mr Davies' suggestion that the discrimination and lack of understanding faced by people with learning disabilities in the workplace means that they should work for less than is deemed acceptable for everyone else displays a breathtaking ignorance and is deeply offensive."

There's plenty more on Twitter.

On Twitter, Davies (@PhilipDaviesMP) has defended himself by saying that he was just repeating what people with learning disabilities told him.
However, for Mattingly this is no excuse: "He is an elected member of parliament and has a responsibility to think about what he is saying before making such idiotic comments."

And going back to his remarks in parliament, it seems he was talking to a group of people with mental health problems at a service run by Mind.

Hence this from Jenkins: "Mr Davies has also revealed a worrying lack of understanding of the difference between a learning disability and mental illness - swapping between the two terms as if they are one and the same thing."

Jenkins and Mattingly has called on David Cameron to distance himself from these remarks - something I assume he will do.

The way forward for personalisation in Scotland

By Mithran Samuel, adults' editor, on June 17, 2011 1:03 PM | No Comments

Amid the continuing focus on how well personalisation is being implemented in England - see our latest piece here - one can sometimes forget that it's an increasingly significant agenda in Scotland.
They are even legislating on making self-directed support the norm north of the border and the Scottish government has just published responses to consultation on its draft Self Directed-Support Bill.
Have a look and let us know if there's anything that strikes you.

#CarersWeek: A DWP vote of confidence

By Vern Pitt, journalist, on June 17, 2011 12:44 PM | No Comments

Yesterday, the Department for Work and Pensions published some statistics on benefit fraud. The overall conclusion was that £1.2bn was being lost to fraud.

However, buried in the statistics was some data on fraudulent claims for carer's allowance. But it was from 1997.

When I asked the DWP why they hadn't looked at fraud in relation to carer's allowance in 14 years, the response was that it prioritised which benefits to look at regularly by risk. Calculating rates of fraud is, apparently, quite lengthily and difficult.

Clearly, the DWP feels carers are a pretty honest bunch.

This is despite the fact that carer's allowance now ranks as the benefit with the second highest rate of fraud at 3.9% (just behind job seekers allowance at 4.1%). That's if you can even compare stats from 1997 and 2001, which I don't think you can because, I understand, fraud rates were significantly higher than in 1997.

As a celebration of this vote of confidence, I think it's appropriate that we all enjoy something else from 1997...

Welfare Reform Bill: Charities' bid to halt poverty fund overhaul fails

By Mithran Samuel, adults' editor, on June 17, 2011 11:07 AM | No Comments

Charities' bid to force a government rethink on plans to scrap much of the discretionary Social Fund, which supports families in crisis, has failed.
A Labour amendment to the Welfare Reform Bill
To recap, the plans are to:-

Scrap community care grants and crisis loans.
Transfer funding to councils and give them the power - though not a duty - to deliver similar services locally.
Scrap the Independent Review Service and the Social Fund Commissioner, which scrutinise decisions taken under the discretionary Social Fund.

Anti-poverty and family support charities such as Family Action have campaigned vigorously against the plans, which they see as leading to deepening poverty and increased risks for vulnerable groups, such as women at risk of domestic violence who have to move between local authority areas.

They devised an amendment - put forward by Labour - to the bill, which would have ensured that councils did provide equivalent schemes locally with clear eligibility criteria specified nationally and the retention of an independent review service.

However, it was defeated by 63 votes.

The government's view is that there is a high level of abuse in the current system and that support should be better targeted, something councils will be able to do better than a nationally run body such as Jobcentre Plus.

However, here's Labour's Bridget Phillipson (MP for Houghton and Sunderland South) on what she sees as the likely impact of the reforms: "It is simply not good enough for the government to hope that local councils will be able to manage this complex change. With a budget that is not ring-fenced and the potential for a reduced level of funding from recovered grants, it is inevitable that some local councils will not want to take people without a clear and established local connection, which I believe will be particularly damaging for women fleeing domestic violence if this is not done properly. That is why it is imperative that the government set out detailed proposals, as amendment 39 makes clear, including eligibility criteria and an independent appeals mechanism. Without further clarity and detail, there is a real likelihood that some of the most vulnerable people in our communities will be unable to access financial support when they need it most."

Is the journalists' union striking for better social care?

By Vern Pitt, journalist, on June 17, 2011 9:51 AM | No Comments

The Care Quality Commission is already focussing on ensuring HealthWatch, the patient body designed to keep health and social care services in check, has a good relationship with local papers, Frances Hasler, HealthWatch development lead at the CQC, said today.

Speaking between sessions at a Westminster Health Forum conference on the future of the patient run watchdog yesterday, she said: "One of the things that we are looking to do with local HealthWatch is to connect with the local media to promote what it does."

"One of the things that we do know is that the older generations read the local the local papers and that's how you involve them. They are the high end users of the service," she added.

However, as Hasler spoke there were protesters in Sutton rallying against job cuts at a series of south London local papers.

They are by no means alone. Local papers have been in decline for years struggling, as they are, to compete with the internet for advertising revenues and bloggers for editorial attention.

Hasler acknowledged this was a problem but, this early on in the process, has no answer to it.

So, if you see journalists protesting to save your local paper remember that in a round-about way they are protesting to get a better social care system in your area too.

Photo from Facebook

#CarersWeek: Small changes, big difference

By Vern Pitt, journalist, on June 17, 2011 1:55 AM | 1 Comment

All this week we have been asking carers what small change would make a big difference to your life?

The Princess Royal Trust for Carers has been asking its members the same thing. Here are its list of the top five changes (in no particular order) carers said they want.

Schools should introduce a school lead and implement a policy for young carers and their families.
Carers should be given information about the support available when the person they are caring for is discharged from hospital. They should also be involved in planning for discharge.
Referral to a carer gateway service such as a local carers centre, would cut down a lot of confusion and offer a single point of access for carers.
All care plans should include details of needs that are being met by carers, which would automatically increase identification of carers.
The NHS in England should use the £400m given to it to support carers for just that.

It doesn't stop there. After the jump there are a whole host of other suggestions from carers sent to the Princess Royal Trust.

Continue reading #CarersWeek: Small changes, big difference.

Raising awareness of social isolation

By Jeremy Dunning, senior adult beat journalist on June 16, 2011 5:08 PM | No Comments

A few weeks ago I wrote about a social experiment called Isolation Week, whereby 11 people will experience social isolation as if they were themselves an isolated older person.

During the week, which takes place from 20 to 26 June, we will be following social worker Pam Stopforth of Liverpool, who will be writing a daily video diary and producing a video blog of what it is like to be isolated.

The idea of the week is to raise awareness and to encourage communities to be more pro-active with the older people around them.

You can also follow Pam via Twitter on @pam_iweek, though it will be a one-way conversation and discuss the issues on CareSpace.

Musing on mayonnaise and social care

By Vern Pitt, journalist, on June 16, 2011 3:10 PM | No Comments

Everywhere I turn I hear talk about how we need better integration of health and social care. Almost every report on the sector contains this as a recommendation somewhere. It forms one of the biggest goals of the Health and Social Care Bill, currently before Parliament. It is the holy grail of health policy.

But making it happen is another matter entirely.

Well, at last there may be a workable solution - and all this time it has been hiding in my lunchbox.

"How do you mix oil and water?" asked Christian Dingwall, partner at law firm Hempsons, before an audience of health and social care professionals at a conference organised by Westminster Health Forum, this morning. "By adding an emulsifier, such as egg yolk," he said. Then, you see, you get mayonnaise, he explained.

This was his metaphor for how to get public and private organisations to work together, and by extension the two sides of the health and social care divide (social care currently being mostly delivered in the private sector, while health remains predominantly public). The yolk in the equation is public involvement.

Dingwall's idea is that if you get the public involved, through HealthWatch, the proposed public interest body in the Health and Social Care Bill, then you align the objectives of the two radically different organisations. It's simple as that.

The only thing I fear is an aspect of reform which Dingwall failed to mention - if you want to make mayonnaise you've got to break some eggs.

Image by afiler on Flickr

Government pledges to learn lessons on Southern Cross

By Jeremy Dunning, senior adult beat journalist on June 16, 2011 2:17 PM | No Comments

The government has admitted that it needs to "learn lessons" from the Southern Cross debacle, though is not so far ordering an enquiry.

Responding to an urgent question on Southern Cross from MP Nick Smith, care services minister Paul Burstow said the government would look at learning lessons "in terms of regulation" and "lessons about how this happened" in the context of a reformed social care system, but stressed now was not the time.

Last night Southern Cross struck a deal with landlords to work towards a long-term solution through a restructuring of the company, which is likely to mean a far smaller group but which will ensure continuity of care.

Burstow added that the government would look further at the duty of the Care Quality Commission to look at the financial viability of companies providing care but also said it was contemplating extending the powers of Monitor - the health economic regulator - to the social care sector in the Health and Social Care Bill.

#Carersweek: 'I'm not a second class citizen'

By Vern Pitt, journalist, on June 16, 2011 1:44 AM | No Comments

Second class by Tom BKK.jpg This week is national Carers Week and we've been asking people what small change would make the biggest difference to their lives as carers? Here's what Phillipa, carer for her husband, said.

I am a 24/7 sole carer for my spouse. I believe, as a carer, that I am treated as a second-class citizen.

In order to qualify for carer's allowance of £55.55 a week I have to prove that I am working as a carer for a minimum of 35 hours a week. Unlike other workers I am not entitled to the minimum wage.

If I am able to take up part-time employment in addition to caring and I earn over £100 a week, by as little as one penny, I lose my entitlement to carer's allowance. What other worker employed in two jobs has their wages taken from them in one of their jobs when they earn more than £100 a week in the other?

The maximum working week of 48 hours does not apply to me; I am on duty 24 hours a day, seven days a week. I am not entitled to annual leave or time off for bank holidays.

The lack of appropriate affordable respite means that I have no choice but to care and that my life is very restricted. The normal freedoms that most people enjoy, that I enjoyed before becoming a carer, such as going for a walk or getting an uninterrupted nights, sleep, are a thing of the past.

If respite and support services are available the government's fairer charging policy, whereby service users are expected to contribute towards the cost of their care, results in many carers and carees, who are already living on a restricted income, being unable to afford to access much needed support.

Despite warm words of praise from many politicians about the 'amazing work' that carers do, politicians from all the major parties are apparently content to see carers treated as second-class citizens.

There is in fact no help in the Welfare Reform bill for carers other than helping them back to work. Caring for an ill, elderly or disabled person is a full time job in itself. If a carer gave up paid employment they did so because they found it impossible to balance caring and working. Offering to help them back to work, in the majority of carers circumstances, is a futile and empty gesture. The government are failing to recognise that caring is work.

Image by Tom BKK on Flickr

Have your say on bonfire of social care performance data

By Mithran Samuel, adults' editor, on June 15, 2011 11:58 AM | No Comments

Consultation has started on plans to radically scale back the collection of data on adult social care from councils in England.

The 8-week NHS Information Centre consultation is all part of government plans to reduce the burden of national performance management on local authorities. However, some performance data will still need to be collected, it says.

Proposed for the chop are data on:-

The number of hearing impaired people locally.
Council spending on grant-funded services.
Timeliness between assessments and the delivery of a service.
Sources of new referrals for clients.

It also asks some wider questions around whether we should have more regular collections of data. Worth having your say (by 8 August).

Heinz Wolff's solution to the care funding problem

By Mithran Samuel, adults' editor, on June 15, 2011 11:33 AM | No Comments

You probably know this man. Yes, it's Heinz Wolff, he of the Great Egg Race, one of Britain's most recognisable scientists. He has in recent years developed an idea to tackle the great care funding problem known as Care4Care: essentially people volunteer to provide care for others in their community and thereby earn time credits which they can cash in when they need care themselves. With the Dilnot commission report on the funding of care just a matter of weeks away, Wolff and colleagues are holding an event to push forward his idea, attended by organisations that have tested it out.

"Unlike existing social care, we think that the government should have little, if anything, to do with the running of the Care4Care scheme. The concept offers people the chance to provide for their own future by offering care to those in need in their own communities, allowing more of them to stay in their own homes for longer."

"However, there are legal obligations and regulations which both central and local government have to meet and apply in terms of social care, and the scheme will have to fit within these, We will have to persuade government that the Care4Care idea has sufficient support and potential scale to make it a viable contributor to care in the country."

(Picture from Care4Care)

Southern Cross crunch meeting takes place today

By Jeremy Dunning, senior adult beat journalist on June 15, 2011 9:54 AM | No Comments

Southern Cross has a crunch meeting today with lenders, landlords and officials from the Department of Health in order to reach an agreement on its financial future.

Most commentators - and I am among those - believe the final shape of Southern Cross will be decided at this meeting.

Quite what the final shape will be is unclear as there are numerous briefings flying around entailing Southern Cross ending up with between 250 to 500 homes.

The BBC has a good story today incorporating the general offer that will be put today by landlords:

"They are looking to the government and lenders to agree to write off some of the money Southern Cross owes them.

"Under their joint proposal, individual landlords would reportedly be given various options, including:

taking back homes and running them themselves
taking back homes and bringing in a new operator
sticking with Southern Cross, who would bring in new management."

#CarersWeek: Welsh government should give right to respite, say Tories

By Vern Pitt, journalist, on June 15, 2011 9:53 AM | No Comments

The Welsh government should institute a right to respite for carers, the Tories have said.

In a statement yesterday assembly member Darren Millar said: "Caring for an unwell or elderly friend or relative can be both mentally and physically exhausting and places a heavy burden on relationships.

"Even a brief period of respite care can be a major source of support and rejuvenation to carers."

Full statement after the jump.

Continue reading #CarersWeek: Welsh government should give right to respite, say Tories.

#Carersweek: Carers need financial planning help

By Andy McNicoll on June 15, 2011 1:23 AM | No Comments

As Carers Week continues Peter Watt, chief executive of Counsel and Care, sets out his case for better financial planning information for carers.

As an independent advice and information service Counsel and Care hears a lot of stories from families who are having serious trouble understanding and navigating through the complicated world of paying for care. While we do the best we can to make sure that they receive the best advice possible we are happy to hear that clear information is high on the list of recommendations from the Law Commission's review of adult social care law and is high on the agenda of the Commission for the Long Term Funding of Care.

Families can often feel stressed and scared about how they will pay for a loved one's care needs. For example, we were recently contacted by Mr F whose parents currently live in a nursing home. Due to reductions in budgets, the local authority is closing down its care homes, so his parents will have to move. A residential care home for his father has been suggested by the local authority, despite the fact that his mother also has nursing care needs.

Mr F wants to take the opportunity to move his parents nearer to him but the local authority will not fund the full cost of their care, as the care homes nearer to him are more expensive. He has found a great care home to meet his parents' needs - it is close to family, with two beds together and able to meet the different needs of both of his parents. He has been told by the local authority that they will only pay an additional £100 towards the care home fees, which require an additional £160 and £120 respectively.

These complicated situations are things we deal with daily at Counsel and Care. What are families, such as Mr F's, supposed to do when faced with unclear guidance, pressure, and a lack of information about their options? Often by the time families are discussing changing care needs, or moving in to a care home, the situation has reached a crisis point. The result for Mr F and his family is fear and confusion.

It is the duty and responsibility of the government, and organisations such as ours, to provide people with advice and support so that they can make the right decisions for themselves and their family.
We are all getting older. If you or a loved one need some social care and support at some point, how will you pay for it? Let's hope that someone is able to give you the advice and information that you need.

Image by Kenteegardin on Flickr
Ken Teegardin runs the Senior Living site.

Winterbourne View: PCTs, not councils, responsible for purchasing places in learning disability hospitals

By Mithran Samuel, adults' editor, on June 14, 2011 8:40 PM | No Comments

Just thought I'd share with you a letter we have received in relation to the Winterbourne View abuse case from Paul Morgan, strategic commissioning manager, adult and community services, at Dorset Council.

The Panorama programme has shocked us all. The Care Quality Commission seems to think that some of the residents are funded by local authorities.

In its press statement on the case, it said: "We are working with the primary care trusts and councils who pay for the care of people at the hospital to secure the best outcomes for those people"

I seem to have been living in a parallel world where local authorities cannot lawfully purchase a private hospital service as it is health care. Local authorities have no legal powers to purchase health care. Certainly, before the Healthcare Commission's demise in March 2009, it was very explicit that if a provider was registered with it, local authorities could not fund the placement. I found that use of the word "hospital" gave me a very handy clue - in fact, it still does. I cannot understand why any local authorities would fund such placements (if indeed they were) as they would be the financial responsibility of the NHS. Clearly, better understanding is required regarding the lawful limits of local authority provision for any local authorities that did purchase care at Winterbourne View.

The fact that the NHS funds individuals in private hospitals should not automatically mean that there is no ongoing role for the local authority in supporting the individual and monitoring the provision of care. We make such an offer to our local PCTs in Dorset. Only by clearly understanding our responsibilities as local authorities and adopting joint approaches to client care and commissioning with the NHS can we minimise the possibility of further such scandals in the future.

Ensure service users have advocacy and avoid care scandals

By Adam McCulloch on June 14, 2011 3:58 PM | No Comments

by Alex Fox

It's a turbulent time for social care. Huge care provider Southern Cross, which became tangled in complex deals to maximise profits, faces insolvency. And we are all reeling from the BBC expose of the abuse within Winterbourne View, a private hospital for adults with learning disabilities. Even when staff, typically low-paid and unqualified, are well-motivated and trying their best, it's hard to imagine how a 24-bed facility with a locked ward could hope to enable people with learning disabilities to experience ordinary living.

But it is only too easy to see how such an environment leads to "challenging behaviour", which in turn justifies its huge costs. I was reminded of "Alan", supported in a place he said he hated, but which could "manage" his challenging behaviour. Alan now lives happily in an ordinary family home with the support of Shared Lives carers, for £50,000 less each year. Now that he is happy, he is rarely "challenging".

Southern Cross and Winterbourne suggest two ways in which large scale care may be the wrong direction. Yet workers surveyed by Community Care are losing faith in personalisation and a new report on "mate" crime identifies living alone in the community as a key factor in some sickening incidents of people with learning disabilities being victimised and even killed by supposed friends.

There are in fact some excellent large providers, whose service users experience a small, personalised environment. And there are small-scale providers and solutions that help people form real friendships and become a valued part of their communities. In both cases, people who use the services have a voice. If there is one change we should make after Winterbourne, it's independent advocacy for everyone, regardless of their care setting. We cannot hope to end abuse, whether it's in an outdated institution or the flat next door, without it.

Alex Fox is chief executive of NAAPS, the UK network for Shared Lives, Homeshare and small community services

Personal budgets figures: good and bad news

By Mithran Samuel, adults' editor, on June 14, 2011 2:47 PM | 6 Comments

Significant figures out today on personal budgets from the Association of Directors of Adult Social Services and the Think Local Act Personal Partnership.

Here's the good news:-

The number of users and carers on personal budgets in England doubled from 2010-11.
Most councils met Labour's target of having 30% of users/carers on PBs by April 2011.

Here's the bad:-

There are still wide variations in take-up.
One in seven councils have less than 20% of users/carers on PBs.

Here's the questionable:-

Most of the increase in PBs in 2010-11 came in the form of council-managed personal budgets. This raises questions about whether councils - in a bid to meet the 30% target - were allocating nominal personal budgets to individuals without giving them genuine choice over their care and support. An alternative explanation is that service users were positively choosing council-managed personal budgets (something that two-thirds of all service users have chosen) because they wanted the choice and control of a personal budget without the responsibilities entailed by a direct payment.

We - and others - will need to do some more digging on that one.

Government accepts NHS bill overhaul

By Mithran Samuel, adults' editor, on June 14, 2011 12:21 PM | No Comments

The government has announced that it is accepting the bulk of the recommendations put forward by experts to revamp its Health and Social Care Bill, as my colleague Jeremy predicted earlier.
More coverage to come

How to avoid another Winterbourne View abuse scandal

By Mithran Samuel, adults' editor, on June 14, 2011 11:13 AM | No Comments

Sharon Paley.jpg Our latest response to the Winterbourne View scandal looks at how such abusive environments can be prevented and good care promoted for people with learning disabilities and complex needs.

It comes from Sharon Paley, development manager for behaviour support at the British Institute of Learning Disabilities (BILD).

BILD has developed a code of practice on the use of physical intervention with people with learning disabilities and autism and accredits training in this area.

Finding, developing and keeping the right staff to provide good support for people whose behaviour is seen as challenging is a complex activity to manage and get right. It involves a range of interrelated workforce areas including recruitment and induction, learning and qualifications, continuous professional development, regular supervision and appraisal, and, crucially, effective leadership and management. Getting some or all of these areas wrong can result in the kind of abuse that we witnessed so shockingly in Panorama's Undercover Care: the Abuse Exposed.

The investigations into institutional abuse at Sutton and Merton and Cornwall showed NHS organisations with considerable systemic weaknesses in the development of their workforce and it seems evident that similar failings might have happened in the Castlebeck service in Bristol.

At Winterbourne View we saw a situation where staff felt intimidated by some colleagues, where there was a lack of purposeful engagement and activity and where both the people with learning disabilities and the staff were bored. Winterbourne View appears to have been an archetypal 'toxic working culture' as described by Dr Michael Nunno of Cornell University. He says this is an environment that shows:

A lack of a clear mission or therapeutic approach.
A lack of leadership and where management and supervision are poor.
A culture of interpersonal aggression - between staff as well as aimed at service users.
An absence of active support or positive engagement with service users.
A lack of appropriate assessment or risk management systems.
A lack of quality assurance processes and internal or external review.

So what do we need to do to get the support right? Not by simply having another review and trying to 'ensure this never happens again'. The issue need instead to be approached from several angles.

First, the implementation of best practice and current policies should be the top priority for the Department of Health, the Care Quality Commission (CQC), commissioners and providers. There is a strong evidence and policy base to support the development of local specialist community-based services for people who have learning disabilities who have challenging behaviour or mental health needs in Professor Jim Mansell's 2007 report for government and the 2009 Valuing People Now strategy.

Second, providers must respond by developing a proactive, whole-service approach in which human rights-based aims and values permeate throughout the organisation and support the delivery of person-centred, individually-tailored, flexible and responsive support. They should ensure that each person is treated as a valued member of their local community with dignity, respect and the same rights as everyone else. Services should understand and respect people's culture, ethnicity and religion.

To make sure this is implemented, providers need strong governance, leadership and management, underpinned by up-to-date policies and procedures, a commitment to government policies and best practice and a striving for continual improvement. Those responsible for governance need to show how they engage with and learn from those being supported and their families.

As well, providers need to establish a learning and development programme for all staff that focuses on the needs of the people who use the service and is in line with the Skills for Care and CQC requirements on the induction of support workers and their ongoing development using the new health and social care qualifications.

Finally, and most importantly, the people who need support and their families must be fully involved in the planning, delivery and review of their support. Their ideas and concerns should be sought and valued and responses should be proactive, not based on crisis management. This means everyone having an up-to-date and regularly reviewed person-centred plan, access to independent advocacy and an accessible complaints process.

We know what makes a good service and we know how to prevent abuse, now as a society we - government, regulators, commissioners, monitoring authorities, providers and those engaged in delivering support - have to take responsibility for taking clear, practical and measurable steps that ensure that all vulnerable people live the best life possible.

Social workers invited to Essex summer school to discuss mental health issues

By Jeremy Dunning, senior adult beat journalist on June 14, 2011 11:01 AM | No Comments

The dilemmas faced every day by frontline mental health professionals in assessing mental capacity are being focused on by philosophers at the University of Essex through its Autonomy Project, headed up by Prof Wayne Martin (pictured).

And as part of this it is launching the Autonomy Summer School, which aims to bring together practitioners from the police, health, social welfare and legal world with researchers in philosophy, law and medicine to discuss the ideal of individual autonomy in human affairs.

I thought this sounded quite interesting in that it is getting practitioners to talk about philosophical and ethical dilemmas when dealing with practical aspects of the Mental Health Act and the Mental Capacity Act.

Continue reading Social workers invited to Essex summer school to discuss mental health issues.

Government set to endorse changes to its health reforms

By Jeremy Dunning, senior adult beat journalist on June 14, 2011 10:37 AM | No Comments

The panel of experts recruited to tinker with the government's health reforms published their findings yesterday.

For social workers the most interesting aspects revolve around the strengthening of the health and well-being boards versus the commissioning consortia; the opening up of commissioning to multi-disciplinary groups of professionals, such as social workers, rather than just GPs and the focus on cooperation, choice and competition rather than just competition.

The positives are that provided the government says yes to the recommendations today we have a workable piece of legislation and that integration is unlikely to be endangered as it could have been under the previous half-baked plans.

Some aspects of this require a bit more thinking through as it's not entirely clear how the commissioning aspect will now work in practice. I assume it will mean the development of sub-committees to report into the main consortia board, on which would also sit - again I assume - a multi-faceted group of professionals.

Nor is it clear how Monitor will be able to reconcile competition and cooperation.

And because there are so many changes I would assume it will have to go back through committee, though this may not be a tolerable situation considering health is currently left in limbo.

What this means for the health secretary is another matter. The prime minister wrote today in the Daily Mail that while the direction of travel was right, "some of the details were wrong".

He added: "So we had a choice. We could have ridden roughshod over people's concerns - but frankly, that is not the action of the sort of government I want to lead."

Hardly ringing endorsement for Andrew Lansley.

Pratchett's assisted suicide documentary branded 'shocking' but 'moving'

By Vern Pitt, journalist, on June 14, 2011 10:18 AM | No Comments

You might want to think twice if, like me, you had set a date in your iPlayer diary to catch-up on Terry Pratchett's Choosing to Die, broadcast last night on BBC2.

If you've got delicate sensibilities it may be a bit much.

"Shocking" is the verdict from the Herald, while "chilling" and "uncomfortable" are chosen words of The Independent.

However, "moving" is the verdict from the Telegraph this morning and the Metro reports tweeters hailing it as powerful.

This is one programme which demands to be seen, if only to establish where on that wide spectrum you sit.

Carers Week: No assessments for most carers

By Mithran Samuel, adults' editor, on June 14, 2011 9:56 AM | No Comments

Concerning figures have been published by Gateshead Carers Association for Carers Week showing that two-thirds of carers in the area have not had an assessment. Perhaps most worryingly half of those surveyed had not heard of carers' assessments.
We have looked at this issue of carers missing out on assessments in a feature this week. This shows that there are many groups of hidden carers who are missing out on support at the moment, in part because of bureaucratic rules around assessments. These would be swept aside if the government adopts proposals from the Law Commission to simplify - and lower the threshold for - carers' assessments, so there is hope for those in Gateshead and elsewhere who are currently missing out.

Other results from the Gateshead survey include:-

49% did not have an emergency plan in place for the person they care for.
57% did not know about personal budgets.
Most cared for more than 100 hours a week!

Community Care is looking for suggestions on how life can be made easier/better for carers for our Carers Wall so do send in your comments and suggestions.

Landlords strike deal in Southern Cross saga

By Jeremy Dunning, senior adult beat journalist on June 14, 2011 9:45 AM | No Comments

As I blogged yesterday the end game is in sight for ailing care home operator Southern Cross.

The BBC reported that Southern Cross has reached a deal with its landlords under which no care homes will be closed in a transition period that will last until at least October.

The landlords also told the BBC that they were prepared to make "significant financial concessions", though the firm would survive under a different name with the number of homes falling from 751 to about 500.

Meanwhile the Daily Mail said the Southern Cross Landlords' Committee said it wanted the Government and the company's lenders to share the financial pain in helping to rescue it.

The interesting impact on this news has been on Southern Cross's share price, which closed 27.8% up at 6.39 pence on Monday and at the time of writing this blog stood at 9.90 pence.

#Carersweek: 'Just make us feel human'

By Vern Pitt, journalist, on June 14, 2011 4:02 AM | No Comments

This week is national carers week and we've been asking people what small change would make the biggest difference to their lives as carers? Here's what Pat Onions, carer for her husband David, said.

The situation David and I find ourselves in is not unique but is pretty rare. I am his full time carer, nothing unusual, but I am registered blind. He broke his back whilst serving in the Royal Navy and suffers chronic pain, reactive depression and severe restrictions with mobility. It's the blind leading the lame.

Over many, many years I have attended an equal amount of government cross party groups, local authority meetings, conferences, interviews and committees about being a carer or disabled person. I always go with hope in my heart that this one will be different and always take the same message, ask us what we want and listen.

Do these experts take any notice? No. I get told of strategies, policies, new funding and lack of funding. I have sat in on implementation boards regarding 'health checks' for carers (I wonder where that little gem disappeared to) and have been involved with research for my particular hereditary eye condition.

The two hats merged into one long ago. I always hoped that one day those of us who cared for loved ones would be listened to and taken notice of.

As David is the one who gets minimal home care, begrudgingly from social workers, I asked him what small thing would make a big difference. Do you know what his first thought was? Help for me. Even in his fuzzy muddled world of pain and drugs he still hoped help for me would mean less work for me. Obviously we would love more, but the answer to that request is an emphatic, "No."

After showering, if the girls could just clear up the wet towels, and tidy the bathroom it would make a difference. Or, when he has been scrubbed, dressed and his broken body put back together, they would say, "you sit down and I will make you a cup of tea," it would help. The simple things that give me a few minutes, the simple things that make him feel human and not a commodity.

That, and that alone, is our one small thing that could make a big difference.

Image by equality on Flick

CQC finds failings in over quarter of Southern Cross homes

By Mithran Samuel, adults' editor, on June 13, 2011 9:43 AM | No Comments

Good scoop from the Observer over the weekend on Southern Cross: Care Quality Commission figures show 28% of the company's homes in England have improvement notices against them due to failures to meet essential standards of quality and safety.
No detail has been put forward on what sorts of regulatory breaches these refer to - presumably they vary quite a lot across homes - though the Observer reports that the sorts of failings that could be causing the notices include not having a registered manager, inadequate staffing or service users not receiving help with eating or dressing.
It has long been known that Southern Cross under-performs against the market average for quality - as judged by the CQC - though since the abolition of star ratings last year there has been no easy way of quantifying this.
What this story needs is some way of telling you what proportion of all services (or all care homes) have improvement notices against them. Have asked the CQC and will let you know what answer I get.
All this comes with a critical meeting taking place today about the future of the troubled company (see my colleague Jeremy's blog for the latest).

Southern Cross chairman insists it will remain responsible for "critical mass" of homes

By Jeremy Dunning, senior adult beat journalist on June 13, 2011 9:23 AM | No Comments

The chairman of ailing care home operator Southern Cross has apologised for the "uncertainty and concern" caused by difficulties in the business, but has said that residents should not fear widespread programme of home closures.

In the interview with BBC Radio 4's John Humphrys, Christopher Fisher said a "relatively small" number of homes gave cause for concern for their medium term future for economic reasons where occupancy levels have fallen too low, but their closure will be a matter ultimately for their landlords.

Fisher insists that Southern Cross will continue to be responsible for the "critical mass" of homes. "All our landlords are committed to achieving a consensual solvent outcome to this process where a restructured Southern Cross emerges," Fisher told Humphrys.

My sources indicate the likely end solution will see landlords, who also run their own homes - such as Bondcare and Four Seasons - taking back their own homes but with some other landlords who are likely to form the core rump agreeing to new leases either under the current Southern Cross management or under new operators.

On Wednesday the stakeholders in the company, together with the NHS, will release a statement on the future of the business.

Carers Week: Carers under pressure as cuts start to bite

By Mithran Samuel, adults' editor, on June 13, 2011 12:00 AM | No Comments

Today marks the start of Carers Week and research published for the campaign makes clear that the tough lives of the nation's six million carers are getting tougher as public spending cuts start to bite.

A survey of over 2,000 carers found:-

81% are worried about the proposed cuts.
44% wonder how they will cope as a result of cuts.

These are people for whom a deterioration in their situation could be critical, given that:-

49% have a disability, condition or illness.
64% provide more than ten hours a week of care.
75% have suffered health issues as a result of caring.

This year's campaign - organised by nine charities including Carers UK, the Princess Royal Trust for Carers and Crossroads Care - is looking to have carers at its heart - it is dubbed The True Face of Caring. They are also highlighting the estimated £119bn that carers save the UK economy each year.

An estimated 8,000 events are happening across the country to celebrate the work of carers.

Meanwhile, research has found that a quarter of adults in Northern Ireland have a caring responsibility. This study, by Queen's University and the University of Ulster, also illustrates the extent of caring responsibilities - 18% of the carers surveyed spent more than 60 hours a week on their caring role while 20% of carers had been in the role for over 20 years.

Families must be at heart of reviews into domestic violence killings

By Mithran Samuel, adults' editor, on June 12, 2011 6:44 PM | 1 Comment

In this guest blog post, Frank Mullane discusses how new domestic homicide reviews can help agencies learn the lessons from killings related to domestic violence. Mullane is the co-ordinator of the charity AAFDA (Advocacy After Fatal Domestic Abuse), which offers help to families and training to agencies conducting domestic homicide reviews. His sister and nephew were killed in a domestic violence homicide.

Since 1999, an average of 126 people have been killed each year in England and Wales by former or current intimate partners, four women for every man. These disturbing numbers are recurring despite significant initiatives to combat them, such as standardised risk tools, multi-agency risk assessment conferences (Maracs) and independent domestic violence advocates (IDVAs).

I don't know why this is. Apparently, around half of those killed did not contact 'official' agencies. Perhaps they contacted friends, family and community leaders. So, within the community, we need to increase awareness of risk factors and safe interventions. But people sometimes get killed after contacting 'official' agencies too, so are we doing enough to protect those at risk?

On 13 April this year, seven years after being presented to parliament as section 9 of the Domestic Violence Crime and Victims Act, domestic homicide reviews became law. Now the real work begins. These reviews need to prevent murders and improve services provided to all domestic violence victims.

In 2008, the Pemberton Homicide Review of the murders of my sister and nephew, a pilot for this legislation, was published. It led to my helping write the guidance for these reviews and Home Office leaflets for families and friends of victims. I set up the charity AAFDA to help families after these tragedies by listening to their stories and offering practical help, particularly with Domestic Homicide Reviews. AAFDA also provides training for many agencies.

I agree with the 'no blame' approach to these reviews, as followed in America, but this does not mean 'no accountability'. Attaching blame may lead to shame, humiliation and scape-goating, perhaps mimicking the relationships being reviewed. Holding public bodies to account is simply about ensuring that our public services do what they should.

We should be focusing on changing systems and processes. Bad systems allow and may even facilitate poor performance. One way to inspire professionals to be thorough and creative in these reviews is to help them experience the depth and profundity of the loss. This may in part be achieved by the review team meeting the family and friends of the victim. As one chair of a review personally communicated to me, "without the input of family it would have been a very thin review indeed".

Official records need to include a view of tragedy as seen through the victims' eyes and those of the victims' families, friends and acquaintances. This eventually happened during my family's review and egregious failures were highlighted, leading to significant impetus for change. The revelation of failures may often be very helpful to families, as the government's victim commissioner, Louise Casey, has noted "What people often say they want is information on why it was that, in their view, the criminal justice system let them down."

Too often, official records hold only the view of the statutory agencies, a point strongly made by Dr. Jane Monckton-Smith of the University of Gloucestershire. We need to speak to perpetrators and their families too.

Perhaps another way to get comprehensive and innovative reviews is to dispense with the organisational hierarchy as professionals meet to participate in the inquiry. After all, we shouldn't mimic the inequality in the relationship that is being considered. This approach may help free up and empower individuals to bring their best efforts to the table.

The reviews need to have what Professor Neil Websdale of the National Domestic Violence Fatality Review Initiative calls a 'wide angle lens' approach. They should not just focus on what intervention opportunities were missed and why, but on what new ones could be introduced.

Professionals have said to me that if the victim did not contact them, there was nothing they could have been expected to do. But in these cases we need to ask ourselves why a victim did not contact the official agencies. Were the agencies' services advertised ? Did the victim not trust an agency? Did the victim approach an agency but no record of that contact was kept? For those local areas tempted to avoid holding a review in these circumstances, please think again. Reviews need to be forward-looking too.

I lobbied hard to include in the guidance that a purpose of these reviews is to prevent homicide. I'm a bit weary of learning lessons being described as an end game. We need to apply as well as learn lessons or nothing changes, so learning and applying are activities we must undertake to achieve the main purpose. I hope local areas will really try to make these reviews count, or what's the point?

Complaints upheld against many Southern Cross care homes in Scotland

By Jeremy Dunning, senior adult beat journalist on June 10, 2011 3:13 PM | No Comments

Readers interested in the state of Southern Cross care homes may like to read this from The Herald, which has found that three-quarters of all Scottish care homes owned by the ailing operator have had complaints upheld in the past five years.

Councils refusing help to more and more homeless people

By Mithran Samuel, adults' editor, on June 10, 2011 9:58 AM | No Comments

Depressingly predictably homelessness is on the rise. Government figures out yesterday show a 10% rise in the number of households accepted as homeless by councils in England from 2009-10 to 2010-11.
But what of those who are not accepted as homeless. Homeless Link points out that the acceptance rate for homelessness applicants was 43% in the first quarter of 2011, the lowest rate since 1999.
Chief executive Jenny Edwards said she was concerned about what happened to people who were refused help:
"When people experience financial problems, they need effective help not a closed door, even if they are not defined as being a 'priority'. We need to prevent people from facing the alternative of illegal lets, staying with friends or squats. We know these are often the last stop before the streets.
"At a time when funding for front-line homelessness services has been cut in many areas and some services are closing, we need a clearer duty for councils to offer effective advice and information to help people who are homeless but not offered accommodation."

What does the Steven Neary case mean for you?

By Vern Pitt, journalist, on June 10, 2011 9:11 AM | No Comments

What does the Steven Neary case mean for social workers doing best interest assessments? That's the question CB at Fighting Monsters appears to be seeking to answer this morning. In short, quite a lot.

Do you know the core principles of dementia care?

By Vern Pitt, journalist, on June 9, 2011 4:14 PM | No Comments

Do you know the core principles of dementia care? If not, then you should probably check-out some guidance published today by the Department of Health.

I don't often go to the trouble of praising these kinds of documents, but this one is genuinely a very good starting point for anyone new to dementia care or wanting to refresh their practice. I have to read a lot of documents in a hurry in this job and I can vouch for the fact this is one of the easiest to navigate that I've seen in a while.

Southern Cross landlords working on "break-up" plan

By Jeremy Dunning, senior adult beat journalist on June 9, 2011 10:43 AM | No Comments

Healthcare commentators are increasingly convinced that ailing care home operator Southern Cross is doomed.

Most give it at best a few weeks, partly as a result of its decision to withhold 30% rent from its landlords, though Southern Cross is still talking confidently of surviving with a core rump.

Analyst Paul Saper said to me he does not think it will make it as far as July 12 when it is meant to meet its shareholders.

"It's accurate to say that there's increasing stories that the landlords are working together," he said. "You can't not pay one creditor in order that you pay off the banks and the taxman."

The Guardian has an interesting take on the unfolding story.

It has reported that landlords have threatened to seize control of the firm rather than accept a cut in rents. This appears to be a variation on a theme as the phrase I've heard commonly bandied about is "orderly break-up" as no landlord is prepared to take control of the whole of Southern Cross because it is felt to be too big.

This comes with Channel 4 News having seen also research, which shows that in 2010 a third of Southern Cross homes - 265 - did not have permanent, registered managers.

CQC warned Southern Cross last year that a third of its homes lacking registered managers would be a significant issue for the company, and one that it must address.

Southern Cross told Channel 4 News it was the regulator delaying proceedings for taking on new managers..

For full coverage on Southern Cross click here.

'Review dementia patient prescriptions of antipsychotics,' care managers told

By Vern Pitt, journalist, on June 9, 2011 12:01 AM | No Comments

Care managers should have all dementia patients' prescriptions of antipsychotics reviewed by April 2012, a consortium of charities has said.

The Dementia Action Alliance, which consists of 50 charities in the sector, is hoping the move will reduce the numbers of people on the drugs, which have been shown to shorten people's lives.

To help managers it is consulting on some best practice guidance which will highlight ways people with dementia can be cared for while avoiding the use of the drugs, which are currently prescribed to 180,000 people in the UK. Up to 144,000 are thought to be on the drugs unnecessarily.

The Alliance has also produced guidance for carers and patients to recognise inappropriate use of the drugs.

If you're of African-Caribbean background you may want to pick-up that guidance - you're more likely to need it.

A separate study, published in the British Journal of Psychiatry, has shown African-Caribbean people over 60 are more likely have dementia than their white British counterparts.

A study of over 400 people in London showed 9.6% of those who had migrated from the Caribbean or Guyana had dementia while only 6.9% of white British people of the same age did.

Personalisation: Bridging the gap between service users and professionals

By Mithran Samuel, adults' editor, on June 8, 2011 10:59 AM | 2 Comments

I don't think the online debate on personalisation has ever been as fervent as it is now, reflecting an apparent consensus that we are reaching a critical point in the implementation of the agenda.

One theme that is coming across loud and clear is a gap - real and perceived - between the views of service users and those of social care professionals. Take the following:-

Research with service users in Essex has identified significant benefits among those receiving personal budgets as cash payments. Service users are experiencing a greater number of positive outcomes after a year on their personal budget compared with before, found the study by the Essex Coalition of Disabled People (ECDP) and the Office for Public Management. These include improved quality of care, increased sense of control and increased opportunities for social interaction, with positive outcomes across all service user groups. I haven't read the full report so don't know the ins and outs of this research but it certainly seems to reflect what we all want out of personalisation. There is a lot of chatter about it on Twitter, led by ECDP policy chief Rich Watts (@rich_w).
However, contrast it with Community Care's survey of social care professionals on personalisation, which found a declining belief in personalisation's ability to deliver for service users and concerns that it would be seriously undermined by cuts and bureaucracy.
Back to service users - in a blog post for us today, disability trainer and activist Simon Stevens argues that personalisation has been "stolen" from service users by professionals, "assuming only they are capable of planning the lives of disabled people".
This follows controversy over a post last week by former Lancashire director of community services Blair McPherson, who was accused of claiming that one of the problems with personalisation was that it was supported by service users and not by professionals (actually, I don't think he said that - see this post).

What are we to make of all of this? Are service users and professionals really at loggerheads over an agenda that was supposed to bring them together in the name of independence and social work values?

No, I think (hope) is the answer. A good explanation of why comes in a comment on my last blog on this topic from learning disability expert Chris Hatton, of Lancaster University.

Essentially there is good personalisation (empowering of people and professionals, low on bureaucracy and creative) and bad personalisation (disempowering, bureaucratic and standardising) and councils and providers across the country sit in a spectrum across the two.

What our survey results (and Stevens) appear to be saying is that bad personalisation may be on the march as the cuts start to bite, while the Essex case appears to be an example of good personalisation.

Hatton, I'm happy to say, is much more optimistic - in a further comment to my last post, he says: "Cash-strapped times are often the times when radical change is possible and most likely. Deinstitutionalisation for people with learning difficulties came about partly because people woke up to the appalling conditions of life in institutions for people, but also in large measure because there was a financial crisis in renewing crumbling institutions which created the opportunity and the will for things to be done differently."

He says the same could happen for personalisation. Let's hope so.

(Image by Walt Stoneburner on Flickr)

Wirral Council to publish review into care charging scandal

By Vern Pitt, journalist, on June 8, 2011 10:48 AM | No Comments

Wirral Council is set to publish a review into a long running care charging scandal, the Liverpool Daily Post reports.

The council overcharged people with learning disabilities for supported living services between 2000 and 2006. It then forced Martin Morton, the social worker who blew the whistle on the abuse, to resign.

However, another independent review into how the council had handled the case of Morton, the whistleblower, which was handed to the council in April, resulted in him being offered his job back. The current council leader said he had been "treated disgracefully".

That review was not published at the time to avoid biasing any disciplinary action against those concerned with the case.

The second review, which is due for publication later this month, is thought to be even more critical of the actions of the council towards Morton.

So, I assume that any disciplinary action has now concluded. What the result of that has been is not clear from the Liverpool Daily Post's report, but rest assured I'm just off to find out.

Homeless may lose safety net, experts warn

By Jeremy Dunning, senior adult beat journalist on June 7, 2011 2:36 PM | No Comments

An open letter from the chief executives of the National Housing Federation, St Mungo's and Homeless Link on their concerns for the homeless through the government's proposed health reforms.

"We are deeply concerned that homeless people will be left without a safety net under the Government's radical reforms to the health service. Homeless people suffer from high rates of poor health, but ensuring that they receive the right care benefits them, and saves tax-payers money.

"The NHS proposals fail to ensure that the needs of homeless people will be considered. People who don't have a home are often transient and they can be invisible to the very GPs who are about to become responsible for commissioning health services.

"At a time when thousands of homeless people already face cutbacks to the lifeline services that help them get a home, regain their health and rebuild their lives, these health reforms threaten to make this situation worse. The reforms offer opportunities to improve the health of the poorest by enabling housing and health services to work in a new way, but these must not be missed.

"We are calling on the Government and NHS Future Forum to establish greater accountability for new health bodies including GP commissioners to address the needs of homeless and vulnerable people so they are not forgotten in the health reforms."

David Orr, chief executive, the National Housing Federation

Charles Fraser, chief executive, St Mungo's

Jenny Edwards, chief executive, Homeless Link.

For more see our story: Homeless face worsening health as cuts bite

Panorama and the deprivation of liberty safeguards, part 2

By Vern Pitt, journalist, on June 7, 2011 1:16 PM | No Comments

Yesterday I posted links to two blogs asking why the deprivation of liberty safeguards were not applied at Winterbourne View, the learning disability hospital currently in the midst of an abuse scandal.

I was then swiftly contacted with an answer to that question by Roger Hargreaves, author of the Mental Health Alliance's report on the implementation of the safeguards published last July, a man who is considered something of an authority on the subject.

Below is what he sent in response:

"My understanding is that Winterbourne View is a hospital providing treatment for mental disorder and registered to take patients detained under the Mental Health Act (and that at least some of its patients were detained under that Act).

"All the patients would therefore be "mental health patients" for the purposes of the deprivation of liberty safeguards (DoLS) and could be detained under it only if they weren't objecting - i.e. if they were completely compliant with the treatment and care regime and not objecting to being there. Even if they weren't objecting, the "primacy principle" established in the GJ case would still apply, giving precedence to the Mental Health Act. So, if they were being deprived of their liberty, which would require the hospital to have legal authority to detain them, the Mental Health Act rather than DoLS would have to be used if that was possible.

"It seems unlikely, given the purpose and nature of the establishment, that there were any patients there who couldn't have been detained, if necessary, under the Mental Health Act.

"The question that needs to be asked, therefore, is whether there were any "informal" patients who were being deprived of their liberty but who could and should have been detained under the Mental Health Act."

Tackling poor quality care is becoming more and more difficult

By Mithran Samuel, adults' editor, on June 6, 2011 10:00 PM | No Comments

In this response to the Winterbourne View learning disability abuse scandal, one council contracts monitoring officer warns that cuts are making the difficult job of identifying and tackling poor quality care even harder.

Everyone who watched the recent Panorama programme on abuse in a private hospital for adults with a learning disability were rightly shocked by what they saw. The question of inspection and monitoring was highlighted as a serious weakness.

In the programme, there was no mention of monitoring undertaken by the host local authority for the area or the primary care trusts who had placed people in the hospital, Winterbourne View.
I know from undertaking years of monitoring visits as well as managing a team of contract officers that monitoring services is very difficult. There is a constant worry that something has been missed, that while you are walking in one door, something untoward is going on behind another door. Monitoring is only ever a snapshot, a moment in time, generally the staff are not hitting people while you are there.

However, there are things that indicate that there is something not right, for example:-

Complaints - too many or none.
Constant turnover of staff.
Poor recruitment practices.
Poor quality of or lack of staff training.
A service admitting service users it is not equipped to support.

You get a feeling for a service as soon as you walk in; the hairs on the back of the neck really do stand up. I know of several services where the quality was poor, but knowing and proving are two different things. Even when you point the failures out to families it is not unknown for them to say that they like the home and do not want their family member moved; it is even known for families to threaten complaints or court action if you try to move someone.

Even when you have pointed areas of failures out to homes, offered advice on how to improve the quality, some services just never seem to have the ability to improve the quality of service outcomes.

The sad fact is that monitoring services is becoming increasingly difficult. The Care Quality Commission is operating on a lower budget than its predecessor regulators and has had to re-register thousands of services alongside its assessment and inspection work; and local authorities are having their funding cut. While councils try to protect frontline services, areas such as contracts and commissioning are easy targets for cuts.

Although the majority of residential services are good, as with children services in the past, it will sadly take more exposures regarding poor practice for real lasting change to be made and quality to be improved for adult service users and their families.

Southern Cross: GMB union calls for private equity ban in social care

By Jeremy Dunning, senior adult beat journalist on June 6, 2011 3:15 PM | 1 Comment

The city's coming in for a battering with the debacle at Southern Cross.

Today the GMB union called on the government to investigate and ban the financial engineering that underpinned ailing care home operator Southern Cross.

In a report published today at its Congress in Brighton, "Southern Cross: the cross we have to bear - the Greedy and the Gullible", the GMB said that politicians of all parties have "an absolute responsibility to outlaw such financial engineering in social care, health care and vital services and to make sure that it does not happen again."

The union, which has many members working in Southern Cross homes, criticised as "greedy" the attitude of major UK and US financial institutions who were involved in buying into the sale and leaseback model for Southern Cross - a model criticised by many for Southern Cross's current difficulties.

is this criticism fair? I'm not going to pretend to be an expert in finance, but I will point out that elderly care remains chronically underfunded and until we - as a society - are prepared to pay more in tax then it will remain underfunded. This is the true scandal. Money has to come from somewhere and private equity is a way of doing this.

Should we be surprised the CQC didn't act on abuse at Winterbourne View?

By Vern Pitt, journalist, on June 6, 2011 12:37 PM | 4 Comments

Feet on desk by pheaber.jpg When BBC Panorama revealed last week that residents at the learning disability hospital Winterbourne View in Bristol had been subjected to a pattern of abuse, scorn was poured on all involved.

The home's owner Castlebeck was very contrite (calling their central office last week was rather like speaking to the staff at a funeral parlour it was so sombre). Commissioners' abilities were swiftly called into question for failing to monitor what taxpayers' money was spent on. The local authority is hardly blameless, having failed to get a safeguarding adults board meeting together for several months.

But the most scorn was reserved for the Care Quality Commission, whose job, one supposes, is to ensure the quality of these people's care.

The only problem is that it's not really. Its job is to monitor essential standards (a subtle difference, which probably holds little sway with the public). The only person I could see saying something akin to this last week was Norman Lamb, Lib Dem MP and former shadow health secretary.

Speaking on the Today programme he pointed to the CQC's policy on individual complaints.

"Even though we cannot investigate your individual complaint for you, we would like to hear about your experience. This is because we believe involving people who use services in everything we do will help improve them for everyone. We therefore encourage people to share information with us," say the CQC website.

Now, that doesn't make it OK that the CQC didn't act when the abuse was reported to them in December, as surely the information should have been enough to call into question the hospital's meeting of those essential standards. But it does make it less surprising.

When I spoke to Lamb later that day he said: "I'm not at all sure that the current framework is effective when it comes to individual complaints. Does the fact that the CQC don't have the power to carry out an investigation into an individual complaint shape their thinking?"

The actual place to take an individual complaint about social care is to the Local Government Ombudsman, though as Castlebeck (the owner of Winterbourne View) is a healthcare provider I'm not sure if it falls within the LGO's remit. The CQC website directs would-be complainers in this area to a number of trade bodies but none appear to have powers to investigate the same way statutory bodies do in other areas.

It's confusing and it should be simpler. That, after all, is why we have an integrated regulator.

For certain, the CQC does not have the resources to investigate individual complaints about all the areas of health and social care it covers, unless you subscribe to the idea that there is a massive failure of management in the organisation. It already struggles to maintain its previous level of inspection under the current statutory framework and it is conducting an investigation into what went wrong in this case.

But it is not the CQC's fault that they have neither resource nor the power to take on this work (not that the CQC is openly complaining about its resources). That is down to the politicians. And they, sadly, were elected by us, the public, the same people that are outraged there was not enough oversight at Winterbourne View.

Image by pheaber on Flickr

Panorama: Where were the deprivation of liberty safeguards?

By Vern Pitt, journalist, on June 6, 2011 9:57 AM | No Comments

Where were the deprivation of liberty safeguards at Winterbourne View, the care home currently in the centre of an abuse scandal? That's the question being asked by Fighting Monsters this morning.

As CB, the author at Fighting Monsters, quotes Lucy Series, who is pretty well versed in the operation of those safeguards, is also asking that question.

I don't have an answer, other than I'm fairly confident no amount of training in this subject would have prompted any of the staff in the documentary to pay attention to them.

What does the sector want out of the Dilnot commission?

By Mithran Samuel, adults' editor, on June 3, 2011 3:20 PM | No Comments

With a month to go before the care funding commission chaired by Andrew Dilnot (pictured) reports, freelance journalist Rachel Salmon talks to leading sector bodies about what they want it to say.

Social care leaders this week urged political party leaders to put aside their differences and forge a consensus on the reform of care funding, on the back of the recommendations of the Dilnot commission.

But what does the sector actually want out of the Dilnot commission.

For some, social care needs to be funded out of general taxation along NHS-lines, a position adopted by Peter Beresford, chair of user group Shaping Our Lives and professor of social policy at Brunel University.

"It's more than money, but without money the problems are going to stay," he said.

However, this option has been ruled out by the commission.

The Joseph Rowntree Foundation believes that people should be entitled to achieve a minimum set of outcomes from the care system, but if people wanted more, they could chose to take out insurance.

The British Geriatric Society also backs a minimum level of provision, which should be widely publicised, to allow people to plan for old age.

And Carers UK is keen that any reformed system caters for the needs of carers and families.

"It is really important that the families are well supported," says director of policy and public affairs Emily Holzhausen. "If you invest in care, more families are able to work, their health is better they are less isolated.

"Many carers say that they would not change their decision to care but the need quality of life. They are saving the government £119bn a year."

However, the charity also wants to see more funding from taxation.

"We need more funding to meet growing demand," she adds. "We know we have a shortfall today we need to meet that shortfall and meet rising demand. "The state has an important role in funding and ensuring that people can plan for what they need."

Mental health: Justice for Joe

By Jeremy Dunning, senior adult beat journalist on June 3, 2011 12:03 PM | No Comments

There's an interesting but difficult article in The Guardian today about how a mentally ill young man called Joe, whose mother has now launched a campaign, Justice for Joe.

Joe's story saw him being sectioned, trying to escape from hospital and then being given a prison sentence that could see him spend the rest of his life behind bars.

Meanwhile Swindon's mental health service provider has been fined more than a quarter of a million pounds for missing targets and breaking rules.

Southern Cross: Calls for regulation pick up.

By Jeremy Dunning, senior adult beat journalist on June 3, 2011 10:50 AM | No Comments

Our observation that experts are calling for a regulator for the care home sector in the light of the failure of operator Southern Cross has now been picked up by other media outlets.

Channel 4 News and Radio 4's Today programme have both now reported on the growing thoughts that there needs to be financial regulation in the social care sector. What will the government do?

We know that Stephen Dorrell, chairman of the health select committee and often referred to as the health secretary in waiting, agrees this needs to be looked at, but even he doesn't know what the answer is in terms of what.

Meanwhile Norman Lamb, political adviser to deputy prime minister Nick Clegg, agrees that this is a opportune time to look at the issues raised by Southern Cross what with the Law Commission and the Dilnot Commission.

CQC has 15% of inspector posts vacant

By Vern Pitt, journalist, on June 3, 2011 9:37 AM | No Comments

The Care Quality Commission (CQC) has 15% of its inspector posts vacant, the Financial Times reports today.

There are currently nearly 300 positions unfilled across the organisation.

Can't say I'm surprised. Last year the CQC's own research showed morale amoungst its workforce was at rock bottom, can you really blame anyone for not wanting to walk into that environment.

Personalisation debate still alive and kicking

By Mithran Samuel, adults' editor, on June 2, 2011 10:20 PM | 6 Comments

You may have thought that personalisation as a topic of debate had taken a back seat as the cases of Southern Cross and the Castlebeck abuse scandal have come to the fore, but think again.

There's been some chatter on Twitter about a blog we posted yesterday from Blair McPherson, the former director of community services at Lancashire Council and a writer on public sector management.

Under the provocative headline, "Personalisation was oversold, let's scale it back", McPherson discusses the results of our personalisation survey that shows declining social worker faith in the agenda. His critique appears to be twofold: that the benefits of personalisation are being undermined by cuts to personal budgets; and that the vision of transforming adult social care through personalisation is suspect. His response is to make personalisation an option for service users, rather than a blueprint for full-scale transformation.

It's not clear what McPherson has against a well-funded version of personalisation and there is perhaps something of a personalisation=personal budgets approach in this piece.

However, what has sparked anger on Twitter is the following sentence: "Personalisation was never championed by social workers but by service user groups, politicians and senior managers."

In response, Rich Watts (@rich_w), policy chief at Essex Coalition of Disabled People, said: "Just read a #socialcare commentator criticise #personalisation because it was (in part) wanted by service user groups. The mind boggles."

Watts is worried about an increasing trend in anti-personalisation commentary in the media. He was in dialogue on Twitter with community care legal researcher @TheSmallPlaces, who voiced concerns about the impact of cuts on personalisation, but added re: McPherson: "That passage is bizarre tho - surely if service user groups champion it, they are the ones to listen to! (for those groups)."

Here's the full passage from McPherson: "The news that a recent survey has found that social workers believe personalisation will fail and that only a minority believe service users will benefit from individual budgets is hardly a big surprise. Personalisation was never championed by social workers but by service user groups, politicians and senior managers. It was always in danger of over promising and under delivering all the more so now it is finance driven rather than practise led."

I take this to mean the following:- that it is not surprising that social workers think personalisation is failing because they [social workers] have never championed personalisation; other groups have, including service users; that personalisation is being undermined by cuts and personalisation as an agenda of transformation is slightly suspect anyway. What I don't think he is saying that personalisation's problems stem in any part from it being supported by service users. Though I could well be wrong about that.

On the broader point made by Watts about an anti-personalisation trend in media coverage, I don't know. I think there remains a broad consensus about the principles of personalisation (though McPherson appears to be departing somewhat from this) but a lot of concern about the impact of cuts, and of restrictions placed on the use of personal budgets and of the bureaucracy surrounding the assessment and support planning processes - the things brought up by our survey.

If the focus (by us and others) on these failures of implementation is undermining understanding of the benefits of personalisation then we are in difficulty - but we have to find a way of ensuring that public debate on this issue can separate problems of principle and problems of implementation.

What exactly is the government saying about Castlebeck and Southern Cross?

By Mithran Samuel, adults' editor, on June 2, 2011 10:15 PM | No Comments

We on Community Care have been asking ourselves that question a lot over the past couple of days.

There has been a lot of tough talk from ministers such as Paul Burstow (left) - much of which has been amplified through the national media - but beneath the rhetoric it's worth outlining just what the government has pledged to do.

Southern Cross

As my colleague Jeremy blogged yesterday, the Guardian reported Number 10 Downing Street as giving residents of Southern Cross a "guarantee" that their care would be secure in future, and they would be found alternative accommodation if necessary.

This was through the following statement: "Our role is to ensure we keep in close contact with what is going on and keep monitoring the situation. We will do what we can to ensure there is protection for anyone affected by this."

This doesn't sound like a guarantee to us (note the language - "we will do what we can"), nor could the government give one.
It has no role in commissioning places in residential care, nor does it have the means to develop one - this is a role for local authorities, the NHS and families themselves.

Winterbourne View/Castlebeck

Again, we've had some fun trying to work out the government's position on this.

On Wednesday, we ran a story saying that Burstow had ordered a review into failings by the Care Quality Commission and councils (in their safeguarding capacity) in relation to the case.

This was based on the following line: "I have already ordered a thorough examination of the roles of both CQC and the local authorities in this case."

The following day we were told that there was not to be a DH-commissioned review into these issues after all - rather the DH would study the results of a series of internal reviews (all of which will come together in a serious case review into the case) by agencies involved.

This got Labour rather excited about a government U-turn. However, we later learned from the DH that we had simply misunderstood the original statement. In fact, what the DH meant was that: "Paul Burstow has ordered the Department of Health to thoroughly examine all the evidence from the investigations under way."

The two statements are - just about - consistent, but would appear to me to have very different connotations, the first implying a government that is getting tough with those who have failed in this case; the second, saying that DH officials would be doing something you would expect them to do in any case, read up on the findings of a very important and serious case.

Are 'therapeutic environments' for people with learning disabilities a sham - a response to the Castlebeck case

By Mithran Samuel, adults' editor, on June 2, 2011 8:05 PM | No Comments

In this guest blog, responding to the Winterbourne View case, a dance movement psychotherapist and speech & language therapist questions the claims of some residential providers that they offer service users a "therapeutic environment".

The residential home for people with learning difficulties and mental health issues that I visited twice a week for 19 months, describes itself as a 'specialist service' offered in a 'therapeutic environment.' As a dance movement psychotherapist and speech & language therapist with thirty years experience working with this group of people, I struggled to find any manager or regional manager in this residential home who understood what a 'therapeutic environment' meant, never mind how they could deliver it!

I would even argue that there seems to be an anti-therapeutic ethos existing in some residential services. For example, I am aware of physiotherapists and speech & language therapists preparing therapeutic programmes and receiving no support for their implementation. In this home where I was working as a dance movement psychotherapist, the management changed and I was unceremoniously forced out with no notice and with no cogent reasons.

I explained to the management that I considered it unethical for me to suddenly stop seeing clients because the clients could experience intense disturbing reactions and I considered it was my 'duty of care' as a professional to end my sessions in a mindful way. In fact, it was only six weeks later (after much argument) that I was given permission to even visit to say goodbye. This was a very traumatic visit as I witnessed how one of my clients was now experiencing high levels of distress and was breaking everything up to the extent that grids had been fitted to protect light fittings and windows. In the 19 months that I had worked with her, she had never behaved in such a challenging way. Two months later I was told that she had been hospitalised in a psychiatric unit.

It is always difficult to argue a direct line of causation around therapeutic work, but I have no doubt that our work together had helped stabilise her feelings of vulnerability so that she was not always on the edge of her distress. This in turn helped her to cope with the high levels of disturbance she often felt.

The treatment she received from this 'specialist' home's management demonstrates clearly to me the lack of understanding around the meaning of 'therapeutic' input and how valuable it is to a client's stability and growth. I complained internally up to regional management levels but to no avail. They have taken no responsibility for the context they have created.

I feel it is now time to wholeheartedly embrace a 'truth' that people with learning disabilities and mental health issues are capable of expressing or acquiring the level of emotional insight and sensitivity necessary to engage in psychotherapy. We now need to step up and create a 'therapeutic environment', which holds safety, care and love at its root; especially after the horrors of Winterbourne.

Southern Cross: The government response

By Jeremy Dunning, senior adult beat journalist on June 2, 2011 1:01 PM | No Comments

What is the government doing in relation to Southern Cross?

If you read The Guardian today you'd have seen a story whereby ministers had apparently announced a "guarantee" that 31,000 elderly residents of the care home chain Southern Cross would be found alternative accommodation if the company went under.

The prime minister's official spokesman was quoted as saying: "Our role is to ensure we keep in close contact with what is going on and keep monitoring the situation. We will do what we can to ensure there is protection for anyone affected by this."

This doesn't sound too much like a guarantee. Some on Twitter have suggested a gap between Number 10 and the Department of Health on this - however compare the above with this from the DH:

"Ministers are following events carefully and officials at DH are in regular contact with the company's senior management, the CQC and local authorities.

"It is for Southern Cross, its landlords and those with a stake in the business to put in place a plan to put the company on a firm footing. That is what they are doing.

"A running commentary on Southern Cross by Ministers or DH officials will not help. However, we are fully engaged with Southern Cross and making sure the interests of residents are protected."

Continue reading Southern Cross: The government response.

Winterbourne View: Providers pressure government for wholesale review of CQC

By Vern Pitt, journalist, on June 2, 2011 9:56 AM | 3 Comments

A wholesale review of the working of the Care Quality Commission must be conducted following revelations of abuse at a learning disability hospital earlier this week, care providers have said.

On Tuesday Panorama exposed a pattern of abuse at the Winterbourne View learning disability hospital in Bristol.

The CQC had been informed of the abuse in December but had not acted, leading many to question the viability of its risk-based approach to regulation.

The CQC is conducting an internal review of what went wrong in the case and care services minister Paul Burstow has ordered an external review of action of both the CQC and the local authority in this case.

But the National Care Association has said this dopes not go far enough and a full-scale review of the operating of the regulator is needed.

"The purpose of the regulator is to regulate services using an assessment process which will protect vulnerable members of society," said Nadra Ahmed, chair of NCA.

"I am writing to the Minister for Social care to ask him to initiate an Inquiry without delay to ascertain whether or not the Care Quality Commission is both fit to deliver the required service and whether it has the confidence of the sector," she added.

'Slow incapacity benefit reassessment or risk suicides' government told

By Vern Pitt, journalist, on June 2, 2011 9:42 AM | No Comments

In the rush to report on WinterBourne View yesterday i neglected to blog a rather interesting letter which was sent to the Guardian.

Mental health charities are warning that the pace of reassessment of people on incapacity benefit is too fast and is having a devastating impact on people's mental health, causing some to contemplate suicide.

It's not the first time that message has gone out.

The government was warned earlier this year that this would be the result of cuts to disability living allowance.

It doesn't take a genius to work out that while these two stories concern two different benefits they concern the same client group and reflect a similar direction of travel and therefore the effect is also likely to be the same.

Panorama: 'End these hospitals on human rights grounds,' says UKDPC

By Vern Pitt, journalist, on June 2, 2011 9:34 AM | No Comments

Specialist learning disability hospitals, such as Witnerbourne View which is currently engulfed in an abuse scandal, should be scrapped as a model of care entirely, a charity has argued.

In an open letter to minister for disabled people Maria Miller, the UK Disabled People's Council (UKDPC) said it was outdated and breached the UN Convention on the Rights of Disabled People.

"The Panorama programme clearly showed that the Convention was being breached on a daily basis at Winterbourne View," it said.

"Article 19 of the CRDP supports the rights of people to live independently in the community, and as you are aware the UK has ratified this without reservation. This does not exclude People with Learning Difficulties. Within the body of the BBC programme, an expert in the field stated there was no reason why the people featured could not live within the community with appropriate support. These locked wards and 'hospitals' have no place in our modern day society," it added.

While the convention has no firm legal standing it does dovetail with the rights accorded to people under the Human Rights Act.

Read the full letter after the jump.

Continue reading Panorama: 'End these hospitals on human rights grounds,' says UKDPC.

Abuse scandal: Castlebeck must put values at heart of care

By Mithran Samuel, adults' editor, on June 1, 2011 10:02 PM | No Comments

Andy Lusk, Ambitious about Autism 200.jpg

In this guest blog post on the Castlebeck abuse scandal, Andy Lusk, director of autism services at the charity Ambitious about Autism, offers advice on how Castlebeck should respond.

In the brief time since the BBC Panorama programme Undercover Care: The Abuse Exposed was screened, the clamour of outrage has resounded in every corner of the media. Castlebeck, the owner of Winterbourne View residential hospital for people with autism and learning disabilities, has certainly experienced the heat. So it should.

The examples of frank abuse secret filming revealed at the hospital are an offence not only to those victims, their families and care providers but to our society as a whole. How vulnerable people are understood, valued and supported is far from exclusively a professional matter. It strikes at the core of what makes a society good to live in. Without the absolute bedrock of respect and dignity, society is turned into one that is fearful, unjust, arbitrary and dangerous.

What we saw at Winterbourne View was an abuse of power. Abusive staff had told themselves - and no doubt each other - that most dangerous of stories, in which it becomes allowed, and even approved of, to dehumanise, strip away, reduce and ultimately violate vulnerable disabled people. This should and must make us angry. We should be sick to our stomachs.

But now what? The obvious and indeed correct commentaries have already been broadcast: who is to blame, the inspection regime's failure, the anxieties, which may sadly be well-founded, that this is not an isolated incident. History tells us 'we have not got it right yet'.

I have tried to put myself in the shoes of a Castlebeck manager, though I am glad not to be in them. I hope I would do the immediate things that have to be done. Readers of Community Care know what these are. I hope I would then ask the questions whose answers will prevent recurrence of this deep offence. Is the abuse of power in the DNA of the organisation? Who walks the job? How often? Do they know what they are seeing and hearing? What are Castlebeck's values? Are they right? If not we have nothing to offer.

Are the values that underpin everything felt by, expressed by, espoused by and practiced by Castlebeck's leadership? How are customers represented and advocated for? How are their voices heard? Without the appropriate values, the respect and dignity Castlebeck's staff must feel for its customers will not be expressed from every staff member. This is the only way to get the culture right, external imposition is always, and at best, temporary.

In everything the organisation does - from recruitment, training, supervision, leadership, planning, and supporting staff as well as customers - these values must be evident. If they are not, this tragedy, for that is what it is, will reoccur.

Abuse scandal provider Castlebeck won best employer awards

By Ruth Smith, editor on June 1, 2011 1:35 PM | No Comments

Castlebeck, the care home provider at the centre of the learning disability abuse scandal, has won two awards for being a good employer.

It was overall winner of the 2010 Healthcare 100 Best Employer Award. It was also recognised by the Top Employers for Working Families, A-Z list and awards - a prize that recognises businesses who do the most to support working families and carers.

Community Care understands that Castlebeck has agreed to remove the awards logos from their website as a mark of respect to the victims.

Last night, BBC Panorama screened secret filming of people with learning disabilities being choked, pushed and taunted by members of staff at the Winterbourne View hospital, owned by Castlebeck in Bristol.

The abuse came to light after a member of staff blew the whistle but his appeals were ignored by company management and the Care Quality Commission, so he approached the BBC.

Both the CQC and Castlebeck have apologised for not acting earlier.

Four people have now been arrested.

National probe of learning disability hospitals - haven't we been here before?

By Mithran Samuel, adults' editor, on June 1, 2011 12:19 PM | No Comments

News that there will be a programme of unannounced inspections of learning disability hospitals by the Care Quality Commission in the wake of the Winterbourne View scandal unveiled by Panorama is undoubtedly a good thing.
Confidence in this type of provision has been shaken and the public, commissioners, families and service users need to know that the many thousands of pounds spent every week on placements in these settings is being put to good use.

However, haven't we been hear before? Five years ago, shocking abuse of people with learning disabilities was uncovered by the CQC's predecessors, the Healthcare Commission and the Commission for Social Care Inspection, in NHS services in Cornwall.

The result, in 2007, was an audit of NHS and independent sector provision for people with learning disabilities, which uncovered poor standards of care nationally.

A follow-up audit, whose results were published last January, found that there was still room for significant improvement and that advocacy provision had declined since the first audit.

A third audit, I suspect, is likely to throw up many of the same issues, begging the question of how much has changed in the light of the other two (and the very high profile of cases such as Cornwall and the abuse uncovered subsequently in Sutton and Merton).

We shall see.

Winterborne View abuse is unlikely to be the only case

By Vern Pitt, journalist, on June 1, 2011 9:58 AM | 2 Comments

"There is a history of abuse scandals that have been made public, such as those in Sutton and Merton, and Cornwall in 2007" said Mark Goldring, Mencap's chief executive, responding to today's story about abuse uncovered by the BBC at a long stay hospital.

"Institutional care means that quite often people with a learning disability live far away from friends and family who care for them, so there is no one to notice any disturbing behaviour," he added.

However, last April the Department of Health revealed that just this kind of provision was still on the rise. It raised concern then, because the government was pursuing a policy of moving people out NHS campus'.

"What we are doing is exchanging one group of people in an outdated setting for another group of people in an outdated setting," said James Churchill, then chief executive of the Association for Real Change.

That was then, now is worse. Earlier this year the government disbanded its central learning disability leadership team. That's the team which found there was increased use of these facilities, which is against the thrust of government policy.

It's not terribly clear how that will continue. Without knowing what's going on in the sector or with a dedicated team to lead change people are right to be sceptical about what improvements can really be achieved.

I fear this is just the tip of the iceberg.

Southern Cross's ultimatum to landlords

By Jeremy Dunning, senior adult beat journalist on June 1, 2011 9:42 AM | No Comments

Ailing care home operator Southern Cross has taken a calculated gamble.

As we first reported yesterday it has delivered a fait accompli to landlords that it will pay them 30% less for four months that would allow the company and its key shareholders to agree to a restructuring deal.

It is betting that most landlords have nowhere else to go and will have to accept the deal, whether or not they like it, which is probably why the company has said that it is confident that a critical mass of landlords will agree to the deal.

I'd suspect that it's also betting that if only a minority say enough is enough and pull out this may leave Southern Cross in a smaller and more manageable state and therefore also helping it in its restructuring deal.

Clearly some landlords will take their homes back and I would suspect those that also operate homes will do this, but what about companies that are in effect property investors?

They have nowhere else to go unless there is someone else willing to enter the market and run the homes, nor is it easy to simply close them and redevelop them into something else.

For one this would be inhumane and secondly redevelopment costs money.

It's possible that someone might want to buy the homes as a going concern, but unlikely in the current climate.

There is a market, but this is in the privately-funded sector - self-funders - whereas Southern Cross's main income stream are councils, who are paying less for care as they seek to clamp down on costs. Therefore why would anyone else want to buy the homes?

Panorama and Undercover Care: The abuse exposed.

By Jeremy Dunning, senior adult beat journalist on June 1, 2011 9:17 AM | No Comments

Anyone who saw Panorama last night on the care abuses at Winterbourne View near Bristol can't have been unaffected by what they witnessed.

As with Fighting Monsters I was also prepared for the distressing scenes, but they were far worse than I had anticipated. What I saw left me angry that the system has failed a group of vulnerable adults.

They were failed by the Care Quality Commission and they were failed by Winterbourne View's owners, Castlebeck, both of whom failed to act on a whistleblower's concerns. They were also failed by the people meant to care for them, including nurses.

This whistleblower - a senior nurse who had worked there - then alerted Panorama who sent in an undercover journalist to detail the appalling scenes at the private hospital, which is run by a company called Castlebeck for people with learning disabilities and autism.

One scene that sticks out in my mind include a woman being given showers fully clothed and then being dowsed with water outside on a cold March day until she was shivering.

How the system allows this is beyond me? We heard today that four people have now been arrested but as Fighting Monsters says: "This was not about 4 rogue members of staff. This was about an environment that allowed them to abuse and for that the senior management up to the chief executive should be responsible.

"Where is the support and training for staff who have to work in stressful environments? Where was the supervision that would have stamped out some of the abuse. That doesn't excuse those who were responsible for mistreatment."

Of course with support staff being paid minimum wage and in Winterbourne View's case not having healthcare qualifications we are not going to get the best staff possible. Surely this requires examination?

Fighting Monsters adds on the CQC: "When the regulator fails so substantially as to ignore someone who whistleblows explicitly, do we not see a problem the 'system' that is increasingly reliant on proactive 'complaints' to trigger assessments?"

We've opened up a thread on CareSpace for you to have your say.

Rates of common mental illness not rising, says new study

By Jeremy Dunning, senior adult beat journalist on June 1, 2011 12:01 AM | No Comments

Rates of common mental disorder, including depression and anxiety, have not increased in recent years, according to new research published in the June issue of the British Journal of Psychiatry.

I'd always been under the impression that rates had to be rising - and I'm sure many others had as well (based on gut hunches) and yet the researchers from the University of Leicester, UCL (University College London) and King's College London, say the data suggests differently.

They looked at three British Adult Psychiatric Morbidity Surveys, carried out in 1993, 2000 and 2007, to monitor changes in the rates of mental health disorders in England over a 15 year period.

The researchers found almost no change in the rate of common mental disorder across the 15-year period for women. It affected 18.1% of women in 1993, 18.5% in 2000 and 18.9% in 2007. However in men, the rate of common mental health disorder was slightly higher in 2000 (12.6%) than in 1993 (10.9%) or 2007 (11.8%).

The researchers did identify an increase in sleep problems among women over the 15-year period. In 1993, sleep problems affected 28.4% of women, rising to 34.7% in 2000 and 36.7% in 2007.

But there was no clear increase for other symptoms such as irritability, worry or fatigue among women or men.

Not what I was expecting.....

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