August 2011 Archives

Today, Community Care reports that 10% of councils may have broken equality laws when setting their budget this year.

One in ten councils left zero days or less between consulting on their adult social care budget and setting it, raising serious question marks about whether they fulfilled their duty to have due regard to disability discrimination.

How did your council do? Find out on our map below.

View Adult social care budget consultations 2011-12 in a full screen map

The Guardian has outlined in a datablog quite how large the failed care home provider Southern Cross was.

It brings home how serious the crisis was for some areas and potentially could still be if there are last minute problems in arranging sales of homes.

In particular there's a concentration of homes in the north east including Durham, North Tyneside and South Tyneside. The list also outlines who owns what. 

Alongside this, Southern Cross chief executive Jamie Buchan is stepping down and will forego a £430,000 payoff, the company said today.

Buchan will leave once the process of restructuring the group is "well advanced", the care homes provider said.

Community Care has been following the Southern Cross story in detail.

A report into the care of a Tyneside ex-soldier, who shot four members of his family, revealed failings in the mental health care he received.

Reports say David Bradley killed his aunt, uncle and two cousins in July 2006. Bradley was sentenced to a minimum term of 15 years after admitting manslaughter. Bradley had served in Bosnia and the first Gulf War.

The report concluded: "This was a complex and multifaceted case which presented difficulties both in diagnosis and in management. The essential approach to such cases is a comprehensive, coherent and well executed package of multidisciplinary care. There
were plainly deficiencies in the care package that was provided for David Bradley."

Report recommendations included:

• There should be a clear three stage approach to the question of clinical risk; first
the identification of any risk, second a detailed assessment of any such risk and
third a clear plan for the management of that risk.
• A full social circumstances assessment must take place in any case in which issues
in that area have been identified.
• Engagement with patients ought to be achieved by acknowledging their
expressed needs and developing an agreed care plan based on those needs.

Fighting Monsters has outlined the importance of being an advocate when arguing for your service user's budget in front of a funding panel.

Her illuminating blog outlines their work and her job as an advocate with relation to them. She sees her job as not to save money by not agreeing to a particular package but to authorise an assessment because it is in the user's best interest.

This is of course with the caveat that all money should be well-used and underscores the tensions that all social workers face, and increasingly so now in these days of austerity, between the best interests of the user and the best interests of the council.

"My job as I see it, is to bring the paperwork and paper assessments 'to life'. I am not only writing about a person on a pro forma, but I'm able to flesh out the requested questions and documents with a person, with a family, with relationships," she says.

The English Community Care Association have forwarded me some interesting data and statistics on funding in-house and external providers of care.

This follows our story on the city council recommending that councillors agree to cut fee to independent providers.

The data has been calculated using statistics from the Department of Health and shows expenditure on adult social care in Leeds up to 31 March 2010.

Older people's residential care - external providers

• External services gross total cost: £28.4m
• Average number of people supported in residential care: 1,257
• Gross total cost per week: 433.62

In-house services

• Gross total cost: £22.8m
• Average number people supported in residential care: 523
• Gross total cost: £839.20

Care at home - domiciliary care external providers

• Gross total cost: £21m
• Average number weekly hours: 29.9
• Gross total cost per hour: £13.49

Care at home - inhouse services

• Gross total cost: £29.9m
• Average number weekly hours: 16.799
• Gross total cost: £34.19
  

Victims of domestic violence will struggle to receive unemployment benefits, as they will need to provide written evidence of their abuse from the same charities and refuges that are being cut or closed as a result of government spending cuts, the TUC has warned.

The 2009 welfare act, due to be implemented by the government later this year, states that domestic violence victims claiming JSA are eligible for an automatic deferral period of 13 weeks. This means that those affected by such violence can receive the financial support for around three months without being available for work or actively seeking work (the normal criteria required to qualify for the benefit).

Jobcentre Plus advisors can use their discretion to extend this deferral by a further 11 weeks giving up to 24 weeks grace for the most serious cases, so it is vital those affected by domestic violence qualify for the initial period, the TUC has argued.

The government proposes that victims of domestic violence must provide written evidence of their abuse from their doctors or relevant support organisations to receive the grace time period. The TUC is concerned that these support organisations are the same refuges, charities and shelters that are being cut back or completely closed due to reductions in government funding, leaving them under-resourced and ill-placed to take on such commitments.

For a bit more background on domestic violence, take a look at our special report.

Martin Green, chief executive of the English Community Care Association and government dementia champion, could face the sack if pro life campaigners get their way.

Over the weekend Green told the Telegraph he backed the legalisation of assisted suicide for adults with capacity, with appropriate safeguards. He argued it was a logical extension of the choice and control mantra of the health and social care sectors.

Now the Society for the Protection of Unborn Children has lashed out by calling for him to be fired from his government dementia advisor position.

Paul Tully, general secretary of SPUC, said: "Mr Green is clearly not interested in caring for some dementia sufferers. He seems to want them dead.

"Not only would legalising assisted suicide for the elderly create insecurity and a sense of worthlessness among older people, it would also provoke discrimination and prejudice among carers and care home staff. Imagine a government advisor on race relations saying that immigrants found it difficult to commit suicide and so should be helped to do so," he added.

I don't think it's likely he'll get the sack and here's why: Green was expressing a personal view. A view, which doesn't necessarily conflict with his role and ECCA or the DH and, in 2011, is fairly mainstream.

What the Telegraph article doesn't mention mention is that Green has previously suffered with cancer. So it's understandable that he should have a strong view (Green rarely has anything but strong views) on what should be allowed at the end of life as I imagine most people faced with such a diagnosis would find themselves giving it some thought.

Therefore, I suspect that he has given it a more detailed appraisal than most. Adding that to the debate, which is a heated one on both sides, can hardly be seen as irresponsible and whether you agree or disagree with him surely forthright reasoned voices are just those that you want advising the government on assisted suicide, dementia or any aspect of policy.

Council bosses in Leeds are preparing to press ahead with the closure of six residential care homes and four day centres and to cut fees for publicly funded residents.

Senior councillors are to be asked next week to confirm the closure proposals under plans to save money and modernise the council's services for older people.

The council's own release and this related story says it all.

Thought I'd share the trailer for a really great looking documentary produced by the Muscular Dystrophy Trailblazers campaign. The film trailer, appropriately, focuses on disabled access (and the lack thereof) at cinemas, with cameos from Nick Frost (I now have another reason to love him!) and Sigourney Weaver. Worth a butcher's.

The figures above come courtesy of legal researcher Lucy Series (who blogs and tweets as The Small Places) and demonstrate the large and widening disparity between inspection levels for children's and adults' residential facilities in England.

Here are a couple of caveats:

• One caveat worth pointing out is that the figures for CQC inspections of care homes for 2010-11 are based on doubling the total for the first six months of the year. We know that inspection levels plummeted during 2010-11 due to the impact of the CQC's efforts to re-register all social care providers, before recovering in the early part of 2011. Series is trying to get hold of a final figure for 2010-11, which is likely to be higher than this estimate.
  
• CQC will inspect a greater number of care homes in 2011-12 as a result of the pressure of registration being lifted. It intends to increase levels further still - to one inspection per service per year - but this will require extra funding from the Department of Health.

However, neither of these cancel out the massive differential between inspections of children's and adults' services that is in place now and will be in the future.
What conclusion you draw from that is up for grabs; is it a reasonable acknowledgement of the difference between a group that is somehow inherently vulnerable (children in care settings) and another that is vulnerable under certain circumstances (adults in care settings); or something of a dereliction of duty?

Here is more of Series' research in this area for background. 

We all know of the worries homelessness agencies have for their client grouping during this era of cuts.

But we had been left with the impression that the government was united on the cuts programme and that both Tory and Lib Dem ministers were satisfied that while there would and will be pain, the most vulnerable would be protected from adverse harm.

Well not any more. It transpires, according to Inside Housing, that deputy prime minister Nick Clegg has written to housing minister Grant Shapps warning that council cuts in Sheffield were resulting in cuts to services for excluded people.

Clegg, writing in his position as local MP, warned that the supporting people fund was not being used for its correct purpose because it was no longer ring-fenced, hence the danger to excluded people.

This isn't the first time we've heard this concern and I'm sure it won't be the last.

What areas of social care are being funded by primary care trust money specifically transferred to local authorities for 2011/12?

This is the latest missive from the Men from the Ministry - aka the Department of Health - to look at how well and on what the £648m that was transferred from PCTs to local authorities is being spent.

Readers will remember that the department ruled transfer had to be on something in social care that would also benefit health and that this had to be agreed by both parties.

It helpfully drew up a list of suggestions such as prevention services, telecare, re-ablement and mental health.

It appears the transfer has gone quite smoothly, suggesting that health isn't retreating to its silo just yet. Interestingly the letter, which is from David Behan, social care director-general and David Flory, deputy NHS chief executive, says the information is required to help set up a mechanism for allocating social care funding for 2013/14 and 2014/15. 

I had an interesting chat with a local authority senior manager the other day which got round to the thorny question of whether social care creates dependency.

Their view was that this was what the introduction of care management in the early 1990s had done. That adult social care became about assessing people, rationing resources and purchasing services for people who made it through the hoops of eligibility, creating a relationship of dependency between the council and the service user.

The manager contrasted this with the approach that obtained when they themselves became a social worker: you worked with people going through difficulties in their lives by connecting them with sources of support within their communities. You didn't, or often didn't, purchase anything for them: you simply knew your community inside out, asked the right questions of the individual you worked with and played a problem solving role, rather than a professional-client one.

Since the onset of personalisation, optimists have talked about the revival of this kind of community social work to replace care management. The assumption that this approach may be also cheaper in the current age of austerity also helps its case.
However, it appears that shaking off the care management ethos is not so easy - as the bureaucracy that has sprung up around personalisation illustrates.

And of course abandoning care management cannot involve washing your hands of people and not meeting basic needs like personal care.

But the manager I spoke to seems set to give community social work a whirl in their area. It would be good to hear of other examples and we'll report back on what we find. 

The extent to which service users are using social media to collaborate, find and share information has been analysed in a paper by Aspire Knowledge.

The future for personalisation? Service users, carers and digital engagement describes how users and carers are using the internet, using sites such as Facebook, Twitter or YouTube, and highlight the scope for creativity and innovation.

However it also points out that front-line workers may struggle to engage with these networks  stemming in part from policies that routinely block access to Facebook, Twitter,
YouTube etc.

As Ayres says: "If professionals working on the front line are unable, or not encouraged, to gain experience of the language and cultural norms of, say, Facebook, they are effectively disempowered from understanding and empathising with their increasingly fluent clients."

She adds it is important therefore to have guidelines and policies at work on using social media at work and to ensure that staff working for public sector organisations develop confidence and competence in its use.

A fresh wave of law centre closures and redundancies is feared as the government introduces plans this week for an additional 10% cut in legal aid fees, reports The Guardian.

You might wonder why I'm pointing to this on a social care blog, but think on this. The sector represents some very vulnerable and poor people who have as much right to decent legal representation as anyone else.

We've already seen the closure of the Immigration Advisory Service and Refugee Migrant Justice and now another legal aid firm, Law for All has shut its doors. More closures are anticipated.

CarerWatch, an internet forum for sick and disabled people and their unpaid family carers, has been taken down due to a threat of legal action by ATOS healthcare.

CarerWatch has said it is unable to get in touch with all members for the moment because contact details were lost in the sudden shut-down, but has published its letter to the ATOS legal department, urging the importance of the forum to so many lives:

"We have many members who are very fragile and the sudden disappearance of a support group has caused a lot of distress and fear. Some are ringing us in tears. We cannot get in contact with all of them though as we have lost their contact details through the closure.
 
"All this distress could have been avoided if you had had the courtesy to contact us first and tell us what had been posted on our site that you considered libellous. Obviously if any post was possibly libellous we would have removed it and all this distress could have been avoided."

Community Care is trying to get more detail about ATOS's reasons for taking legal action, but even CarerWatch is in the dark for the moment. A forum spokesman told ComCare: "The only detail we know was given to us by our hosting company, who said: 'carerwatch.com are under threat of legal action by ATOS and have been taken down'."

We are waiting for a response from ATOS.

English councils are spending £1.5bn more than they on residential care because they are failing to support carers and provide care in the home, according to a report from The Princess Royal Trust for Carers and Crossroads Care.

Supporting Carers: The Case for Change estimates that there are about 1.3 million delayed transfer of care days in England's hospitals, partly caused by carers not being involved in discharge processes, costing an extra £150 million every year.

The report says English councils need instead to spend at least £119 million on carers' services to save billions.

It argues that increasing support for carers not only improves the health and wellbeing of patients and recipients of care but also improves the health and wellbeing of carers.

The report also includes examples of services - breaks, counselling and training - that have shown success in helping carers maintain their health and quality of life and that of the person they care for.

Following the announcement yesterday of the closure of a third Castlebeck facility, the BBC has dug up some interesting information on Winterbourne View. 

Most of the reports were official incidents reported by the hospital (see our guide to what providers must report to the CQC) though some were complaints from third parties.
One incident report says: "It was alleged that the support worker had squeezed the patient's neck during a restraint and that the patient had found it difficult to swallow following this incident. The patient also stated that the support worker gets rough when angry."

With Mum In Mind is one of a suite of films launched today by The Mental Health Foundation aimed at raising awareness about dementia and the use of self-directed support in helping people with dementia, their families, carers and social care professionals.

The 10-minute film tells the story of Terry, and how self-directed support has helped her mother get the right care to enjoy a more independent life in the comfort of her own home.

The films are part of a range of resources launched in response to the findings of Dementia Choices.

This two-year project found that people with dementia, their carers and social care workers are in need of more practical information about how self-directed support (including direct payments and personal budgets) can help improve their care.

Other films include "With John in mind", which is a 30-minute film telling Mary's emotional journey from the moment her husband John was diagnosed with dementia as well as a series of short films answering specific questions about self-directed support.

The Mental Health Foundation has also today issued a policy briefing for selected MPs and decision-makers on ways in which the Department of Health, the Care Quality Commission (CQC), and local health and social care providers can do more to increase the uptake of self-directed support.

The briefing recommends greater promotion of self-directed support amongst people with dementia, their families and carers, and health and social care, and new duties for the CQC to ensure this is being done effectively.

This comes following concerns that choice and control was not being extended to service users with dementia.

Sixteen people had to be rescued from a care home in Croydon, South London, after a fire broke out. Of these 10 were taken to hospital suffering from minor smoke inhalation and shock. Its cause is unknown.

Recently London Fire Brigade deputy commissioner Rita Dexter outlined for Community Care what social care staff could do to help reduce the risk of fire deaths among older people at home and in residential care. It's worth having a look.

Some interesting stats from Time to Change regarding who people go to the most about mental health problems.

Changes to the rules on disabled people employing personal assistant to drive them to work could cost people up to £600, the Essex Coalition of Disabled People claims.

The rules applying to help with transportation mean PAs can no longer use their own cars to transport their disabled employers, leaving disabled people with few options, all costly.

Disabled people must now either insure PAs to drive on their car, use a company care or get a taxi.

The ECDP has collected several case studies which show that this is likely to be costing people up to £600 in one off payments or £300 a week.

Plus, the charity says this is in contravention of rules issued recently on the use of care from the Department for Transport, which were designed to reduce the administrative burden on disabled people who employ PAs to drive them.

The impact could even be more wide ranging than expected as the government is expected to plump for greater roll out of Access to Work, following a review of schemes designed to boost employment among disabled people by Liz Sayce, chief executive of RADAR.

You can get all the details on this fairly technical but impactful change on ECDP's website.

Image by rbrwr on Flickr

An elderly woman was overcharged £10,000 for her residential care in Edinburgh because social workers failed to tell her savings had fallen below the £14,500 saving limit, the Scotsman reports.

While this is obviously not desirable I'd be interested to know if people think this is really social workers responsibility. After all, if the old lady in question has the capacity to manage her own finances surely she is responsible for this?

Care workers at Southern Cross care homes should be finding out today or later this week who will actually be operating their homes for the long-term.

This is important to many hundreds of staff across the country because while we all knew who would own and operate around 500 of the portfolio, there was still deep uncertainty about who would operate 200 to 250 homes.

Paul Saper, director at consultancy LCS, said landlords were keen to sort this out as quickly as possible for their own financial reasons.

What we know so far is that ex-Priory Group boss Dr Chai Patel will run NHP's 249 homes through a new company, while another 250 were returned to landlords who are themselves operators, such as Four Seasons,  or have close links to operators.

Twelve doctors at Atos, the company which conducts the government's work capability assessment for disability benefit claimants, are under investigation, the Guardian reports today.

It won't do the company any favours in the eyes of claimants or politicians since it has come under criticism from MPs for it's conduct of assessments lately.

A national challenge called Living well with dementia has been launched today offering five teams a share of £360,000 to develop new design-led ideas for products and services to make the lives of those with dementia and their carers simpler, better and more enjoyable.

Launched by The Design Council and the Department of Health, the aim is to recruit teams with a variety of expertise, including designers, social entrepreneurs, businesses, service providers, support groups or individuals who may already have good ideas.

Details can be found on The Design Council's social network or on its website.

The closing date for entries is 30 September with final teams to be announced on 14 November.

Interesting story from the Daily Mail that small amounts of exercise can protect the elderly from memory loss. This is highly suggestive for care staff who work closely with elderly adults, I'd suggest. 

Reading through this interview with track star Jessica Ennis in the Evening Standard I saw a reference to her mum, who is a social worker.

Are there any other famous children whose parents are social workers out there?

Picture courtesy of adifansnet on Flickr.com

I've just read through the judge's sentencing remarks in the case of a boy and his mother who have been convicted of conspiracy to murder their grandfather/father, who has dementia, and am speechless with shock. The motive was to secure inheritance money to help them both deal with money troubles. What is perhaps most shocking is that the woman convicted was her father's carer (and was apparently well thought of by the local Alzheimer's Society). Here are Mr Justice Foskett's comments.

Interesting this. Apparently a national day of protest at the ongoing injustices and disadvantages facing learning disabled people is planned for 22 September.
The Back to Your Roots campaign is designed to encourage self-advocacy groups to return to campaigning on issues like transport, employment and the quality of social care. Groups are urged to use the 22 September as a day to highlight these causes.
The campaign comes courtesy of Inclusion North, who employed two people with learning disabilities, Gary Bourlet and Ian Margerison, to lead it. They found that learning disabled people wanted user-led groups to find their campaigning edge and not just be social groups.
Their work led to a live broadcast last month (see below) to highlight the campaign. Gary and Ian are also planning to produce a campaign pack for self-advocacy groups, including advice on writing letters, petitions, using the media and gaining supporters. Have a watch and feel inspired.

Rioters torched this Age Concern ambulance in Leicester, causing £45,000 of damage, during a spate of copycat attacks in the Midlands.

The ambulance, owned by Age Concern Leicester Shire & Rutland, was one of a number stored in the charity's compound, which was broken into by a gang armed with petrol bombs on Tuesday.

Another of its ambulances was badly scorched by the flames.

More later......

What do you think? Have your say on CareSpace

A survey aimed at groups, advocates, supporting staff and carers who have direct engagement with people with dementia has been launched today.

The aim is to find out about how their dementia initiatives work, how people with dementia are currently engaged in influencing the issues that affect their lives, and explore the approaches and structures through which they can most effectively do so into the future.

It is part of a project led by the Mental Health Foundation and also involves the community interest company, Innovations in Dementia, the Alzheimer's Society, and the Joseph Rowntree Foundation.  

Health chiefs in Hampshire are considering closing nearly a third of hospital beds for people suffering from severe mental illness in a bid to save £4.5m over three years, reports the Hampshire Chronicle.

I'd suspect this is a part of a worrying trend for mental health nationally as there's often the perception that mental health is more vulnerable to cuts than the acute sector as we outlined earlier this year.

However a blog written by Martin Lindsay, GP lead for mental health in Haringey, north London, and Dr Marc Lester is clinical director of Barnet, Enfield and Haringey mental health NHS trust, suggests ways in which the limited funds could be used more effectively.

The idea is to provide GPs with greater training and support to ensure greater alignment between primary care and mental health trusts.

Social workers and social care professionals need more training when it comes to dealing with end of life care.

Moreover primary and community care services need transforming to allow more people to die at home as outlined in the Government's End of Life Care Strategy, requiring proactive, integrated, collaborative planning and commissioning.

These are two key conclusions from a report out today by the National Council for Palliative Care, which points out that training is variable and that for many people, death is still a taboo subject.

Harrow is seeing a number of events focused on removing the stigma of mental illness in south Asian communities. Following their report earlier this year about the particular challenges faced by people with mental illness in these communities, Time to Change, a charity consortium focused on ending mental health discimination, is targeting Harrow with an eye to expanding the campaign to other parts of the country and more ethnic communities.

On 13 August Time to Change is celebrating Raksha Bandhan in Harrow, handing out their own Rakhi bracelets (like the ones pictured above) along with information about the campaign. On 30 August, Time to Change is hosting a screening of the short film Open Secrets, which considers the stigma of mental illness within a British-Asian family. The event is free and will be held at the Vue cinema in St George's shopping centre. To book a seat, contact: campaign@time-to-change.co.uk.

We'll be keeping an eye on similar events as the campaign expands.

photo credit: shriyashjichkar

Here are a few things that have nothing to do with riots that you are worth looking at:-

• Claims of abuse of residents at a care home are being investigated by Gateshead Council and the Care Quality Commission.
  
• Scottish Labour is banging the drum about Southern Cross after finding that one in seven of its homes were without a manager, raising concerns about quality of care.
  
• The Court of Protection is to allow the media to report in real time the case of a 92-year-old man whose son claims he has been forced to live in a care home against his wishes, under the Deprivation of Liberty Safeguards. 

Thanks to (in reverse order) The Guardian, the BBC and the Evening Chronicle in Newcastle for those.

In a sign of the times, care home group Choices, has called in administrators Zolfo Cooper.

The group, which runs care homes throughout the North East and Scotland, provides supported living, domiciliary care and residential services to around 800 individuals with learning disabilities and employs 1,400 staff.

Zolfo Cooper says it has received numerous inquiries for the residential and domiciliary care aspects of the business, while the supported living business has already been sold to Mears care Scotland Limited, saving 500 jobs and ensuring continuity of care.

I'm not sure of the reasons for the administrators being called in, though I wonder if this is another example of councils forcing operators to reduce costs. Zolfo Cooper says the business has faced ongoing cashflow problems.  

How do we enable people to make the right choices about the care they need?

The Mears Group has just published a policy paper on care advice.

It's based on a round table discussion with numerous social care experts that I also attended.
 
The paper sets out some sensible solutions, such as one-stop signposting services, changes to local authority budget cycles to enable long-term investment, and the use of local resources that are already in place such as home improvement agencies.

At the moment, information and advice for service users is poor, particularly for self-funders. 

All too often, people don't know about the many alternatives to residential care. This can have huge financial consequences - both for the individual and the state.

Improved information and advice for older people and their families can not only save money, but enhance wellbeing, allowing people to stay in their own homes for as long as possible.

But who should give this advice?

I think there's a pretty strong case for developing more specialised roles. This could include peer-to-peer support as well as bringing in charities who already give advice.

A high-quality national information service would complement this work and replace some of what local authorities and district councils do now.

Alan Long, Mears Group executive director, told me: "There's going to be more work for social workers in the future and they need to be given the chance to focus on that professional health-orientated advice and expertise, helping people to deliver care plans.

"If we see a world where social workers are having to give individuals advice on finance and which provider they need to go to to get their adaptations done, we are wasting the expertise of social workers."

Enhancing the role of home improvement agencies in giving such advice is a solution that the Mears Group is keen on.

Andy Chaplin, director of Foundations, the body for home improvement agencies, says home improvement agencies "are a really important source of information and advice that supports people living independently in their homes for as long as they want to."

You can hear Alan Long and Andy Chaplin discuss these issues in more depth by listening to this Community Care podcast.

Did you know that this week is National Allotment Week? No, neither did I.

But residents of the Clara Court care home in Maidenhead do and they will be celebrating a bumper crop this week after they turned their balconies over to growing veg.

Leigh Reid, manager at the home, said: "The residents are having a wonderful time. The gardening not only keeps them fit and active but also stimulates their minds and encourages them to reminisce. This works particularly well as we are a specialist dementia home."

In a time of cuts it could save a few quid on sprouts too.

The Daily Mail has a story today saying three in four people don't trust care homes to look after their relatives, so they'll do it themselves.

However, it doesn't say who conducted this survey or who it was of. I presume it was done by the paper itself and the 'people' it refers to are its readers.

Given the Mail's coverage of the care sector hasn't, historically, been terribly sympathetic it's not surprising its readers don't trust care homes to take care of their relatives.

On a related note, this story also contains another minor error which I have noticed before (not just in the Daily Mail) and continues to irk me. It refers to Winterbourne View as a care home, which isn't correct. It was a hospital and the care it provided was largely on the basis of mental health issues of its patients.

Ironically, this misunderstanding of the purpose of such a facility makes the events which took place there seem ever so slightly less terrible than they were. I can't imagine that's the reaction which the Mail is going for.

Might be worth professionals working with disabled people checking out this online video training programme, which comes courtesy of disability blogger and trainer Martyn Sibley.
Here's a bit about him.
The training, which is also targeted at disabled people and their families, looks at different stages in a disabled person's life - diagnosis/birth, being a teenager, moving into independent living and broadening your horizons through travel and leisure.
The message from Sibley - drawing on his own experience - appears to be that disabled people can do anything, given the right opportunities, support and attitudes.

Worth checking this out from Mencap - it's a new advertising campaign that features young people, like Ellen Goodey (left) doing everyday things like cooking or studying.
The young people in question just happen to have a learning disability.
Mencap and sister charity ENABLE Scotland have launched Inspire Me, a campaign to improve help change the lives of 20,000 young people with a learning disability by helping them gain access to employment, volunteering and other activities.
It will be funded by money raised through the charities' partnership with The Co-operative, which has nominated them as its charities of the year.

The Lib Dems are set to push again at the drugs policy merry-go-round. The Guardian reports a motion will be put to the party conference to launch an independent inquiry into decriminalisation of possession of all drugs.

It seems to me that the debate on drugs policy just goes round and around in circles and little changes, ever.

Perhaps, like addicts, society first has to admit that the current policy isn't working before it can move forward.

Will this be the end of constant debate?

Image by r0bz on Flickr

It has been a good week for the Care Quality Commission. On Tuesday it released figures showing inspections of adult social care services grew by a third over the last three months.

Today, it announced that it is partnering with Age UK, Challenging Behaviour Foundation and Choice Support to provide experts to help with its work. More partners are to follow.

It'll be a welcome move from those who have voiced concern over lack of expertise at the regulator following the Winterbourne View abuse scandal. Several people have told me that they believe one of the reasons the CQC was not quick to act when a whistleblower told it about the abuse at the hospital, was because it no longer has learning disability experts on the books, who might have kept staff alert to the dangers of learning disability hospitals.

I don't think I've ever come across a social care policy as loathed as the excellence award for care providers, the proposed replacement for the quality (star) ratings scheme abolished last year.
Care provider and council leaders are united in their condemnation of the scheme, in which providers would volunteer to pay to have their services tested against an excellence standard delivered by a multiplicity of accreditation bodies, though not the Care Quality Commission.

According to its critics, the plan would lead to a two-tier system of accredited and non-accredited providers, be delivered inconsistently by the different accreditation bodies, fail to distinguish good services from average or poor ones and force providers to pay for something that should be delivered as of right by the CQC.

So will care services minister Paul Burstow dump the policy?
A statement we received yesterday from a Department of Health spokesperson suggested he just might:
"We are committed to the development of a scheme that helps people choose between providers and recognises quality beyond the essential safety and quality requirements.  Responses to the consultation will now be carefully considered to ensure that the new scheme meets these objectives and has the support of the sector."


Well, on pretty much all of these counts it either definitely or probably fails:

• It has no support from the sector.
• It will not help service users choose between providers, as many (or most) will not apply for accreditation.
• While it will recognise quality beyond the essential safety and quality requirements for those providers who apply, it will not distinguish between standards below the level of excellent.

This statement sets a standard for the government (and CQC's response) to the consultation. We, among many others, will be watching this space.

(Thumbs down image on Flickr from comedy_nose)_

In this guest post, Professor Keith Brown (left), Dr Steve Keen and Andrew Harding (right) of Bournemouth University argue that adult social work needs something akin to the Munro review of child protection to help develop the professional leadership that underpins good safeguarding.

Professor Eileen Munro, in her review of child protection in this country, suggested that improving professional leadership is central to improving services. Recent high profile failings such as Winterbourne View indicate that the same debate should be taking place in adult services, both in the sector and by those individuals tasked with safeguarding adults.

It is worth reiterating why the debate needs to shift towards the issue of professional leadership in adult services. The Dilnot report on the future funding of adult social care is a creative response to a complex issue. However, solely dealing with the economics of social care bypasses a major issue. Social care is a finite resource and although there is an extent to which the funding of the resource is an issue, adding to the resource or changing where it comes from will not necessarily change the way the resource is utilised.

Consideration must, therefore, be given to how to change the working culture of the social care sector. Professional leadership should be exercised in all aspects of social care provision, because it is where a caring culture begins. Although we would argue that people do not go to work in a care environment purposefully to commit acts of abuse, it can easily happen. At Winterbourne View it appeared that the first safety net to safeguard people - professional leadership - was not strong enough to challenge and prevent an abusive culture from being institutionalised. So how should the current culture of professional leadership in adult services evolve?

Just received some sad news from Mind. William Bingley, the charity's former legal director, has been found dead following a fall when out walking in Cumbria.
He was a former chief executive of the Mental Health Act Commission (now part of the CQC) and wrote the code of practice for the Mental Health Act 1983.

Mind chief executive Paul Farmer said: "I am deeply saddened by the untimely death of William Bingley. As Mind's legal director, William was a powerful force for good, in standing up for the rights of people with mental health problems. His contribution to mental health legislation in the 1980s helped to balance the power of the state with the rights of the individual. As chief executive of the Mental Health Act Commission, he acted as the champion for patients who had been detained, to ensure that the legislation was used fairly. The mental health community has lost a powerful advocate and a man of principle. Our condolences go to William's family and colleagues. "

In this guest post, London Fire Brigade deputy commissioner Rita Dexter explains what social care staff can do to help reduce the risk of fire deaths among older people at home and in residential care.






Last year, half of the 33 people who died in fires across London were aged over 60.

What is most unsettling about these deaths is that they are absolutely not an inevitable consequence of being elderly and a large number of those who died were in regular contact with at least one public agency. Whether receiving a full package of care or something less intensive, many of the older people who die in fires are known to the authorities. That means advice and practical help could have been offered, and, potentially, those lives could have been saved.

Mr E is typical of many of the deaths we see each year. He was 95 years old and lived alone in sheltered accommodation. He was unable to walk on his own and spent the majority of his day sitting in a chair. Part of his care package included meals on wheels and domiciliary care support four times a day, including lunchtimes. Mr E enjoyed smoking and would do so when his carer was out of the room or after they had visited.

Early one afternoon, Mr E was trying to refill his lighter, and while doing so triggered a small explosion on his lap. A fire quickly took hold and, unable to stand independently, we believe Mr E was either unable or didn't have time to put out the flames. When firefighters found him, Mr E was very badly burnt, the room had completely filled with smoke and he was beyond help. The watch on Mr E's wrist had stopped just two hours after the time his carer reported having left him. 

A disturbing number of people die in similar circumstances and often there is evidence that they had sustained smoking related burns for some time before their eventual death. 

The warning signs were clear - Mr E smoked, but was frail. In the event of a fire, he would find it very difficult to escape. Despite living in a residential unit for older people the property was not fitted with a sprinkler suppression system.

In order to confront the challenge of preventing deaths like Mr E's, our battle in the fire and rescue service is on two fronts. Firstly, preventing people from having fires in the first place and secondly, protecting people when fires do occur.

Many older people affected by fires have mobility issues and live on their own. They are often confined to living in one room of their home and are ill-equipped to escape a fire. Those visiting, assessing or caring for older people are vital in the battle to reduce fire deaths and injuries and can make the difference needed simply by knowing what to look for or how to ask for our help.

The London Fire Brigade also believes many deaths involving older people could be avoided if sprinklers were fitted. In our view, all residential care homes and sheltered accommodation should have sprinklers to protect those who are most at risk in the event of a fire. This is already the case for newly built care homes in Scotland and it is time England followed suit. But we also believe that there is a strong case for the installation of domestic sprinklers where the risk factors and evidence support it.

The London Fire Brigade is also doing more to identify those most at risk. In 32 of London's boroughs, we now have a borough commander who sits on the adult safeguarding board. This has been hugely beneficial in getting fire safety on the agenda and raising awareness of the risk to which vulnerable adults are exposed. It has highlighted how joined up interventions can result in better outcomes for older people and how, by working in partnership, the brigade can prevent fires among older people and better protect them when they do occur.

In this guest post, Melanie Goodwin explains why social workers need to know about dissociative identity disorder (formerly multiple personality disorder). She is chair and trainer at First Person Plural, a survivor-led charity for people with DID.
It has recently produced a training DVD for professionals, including social workers, providing information on DID.




Trainee social workers are not taught anything about complex dissociation, yet it is thought to possibly be as prevalent as schizophrenia with dissociative features being present in many mental illnesses.
So what is DID?
Mind's guide to dissociative disorders says: "Someone with DID experiences shifts of identity as separate personalities. Each identity may assume control of behaviour and thoughts at different times. Each has a distinctive pattern of thinking and relating to the world. Severe amnesia means that one identity (part) may have no awareness of what happens when another identity is in control."

Like many people with DID, I was abused as a child. In my case, this started at a young age and involved many perpetrators. I developed DID from very early childhood as a survival coping mechanism.
The brain, an incredible organ, enables abuse to be stored in an unprocessed form kept separate from consciousness for many years. The negative aspect is it also has to separate out much of the integrated thinking and processing that enables us to function as well rounded human beings.

Often people who have experienced severe abuse describe themselves as robotic, machine like. The dissociation can separate memory, emotions, thinking, feeling and the body from connecting and moving fluidly from one complete thought process to another. The emotions may be held separately and become personified. The body can have a very limited relationship with the rest of you. It can feel like it 'goes off and does its own thing'. I know from first-hand experience how limiting and confusing this is.

At every information fair I have attended for social work students, they have absolutely no problem in understanding what I am saying - many already know of someone who is DID.Yet they are taught absolutely nothing about the subject so I can only imagine their fear if someone switches in front of them and they have no tools in their tool bag to manage this situation.

So why is it not receiving the attention it needs and deserves?
Maybe it is because currently it has no National Institute for Health and Clinical Excellence guidelines attached to it, although it is in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases-10, and will continue to appear in both.
Maybe it is because there is no medication that can 'sort it out', although some of the secondary symptoms can receive short term relief.
Maybe it is because long-term therapy, the recognised help required, is deemed too expensive.

However, this is a myth. Many people are revolving door patients with enormous sums invested in them at times of crisis with no action being taken to help reach a cost-effective resolution. In one recent study the financial cost was reduced by over 70% in the first year when continuous hospitalisation was effectively supported and very quickly replaced with therapy and the person concerned now has a quality of life that continues to improve.

Many people with DID have experienced extreme, enduring and often organised abuse. This is difficult for people to comprehend and I think many professionals shy away from asking relevant questions that may expose their patients' reality. This is understandable at one level, but means that professionals will have very little to offer their patient as a result.

Therapy helped stablilise me in the present, enabling my identities to work through our individual traumas. This means I now experience more integrated thinking.
My overall behaviour, likes and dislikes are shared and most of the time we work as one brain without the strong, defensive amnesic barriers between identities preventing this happening.

Therapy is a long process partly because you are retraining the brain to form different neural pathways. For examples, those pathways relating to "flight, fight, freeze" responses become less active and others that are of more use in the present day develop and become more easily activated.

A very important part of my own healing is being is being a co-founder of First Person Plural. This allows me to share my theoretical knowledge supported with my own personal insight in helping others to understand the reality of being DID.

Recently we have made a training DVD, A Logical Way of Being, involving three people with the lived experience, including myself, and three experienced professionals in the field of dissociation. The DVD is an excellent introduction to the subject for social workers, students and other professionals. I really hope we are able to get this area of mental health onto the social work training agenda

Our very own Vern Pitt (aka @ComCareAdults) will be live blogging from today's social work strike in Southampton. Should be a lively day so do catch up on his updates.

Private eye has an excellent piece up on its website last week, but I only saw it today, about what a certain former Southern Cross employee has been up to since the companies demise.

Philip Scott, who as chief executive oversaw the introduction of the lease-back model which proved to be Southern Cross's Achillies heal, has apparently been peddling the same trick with his new employer - Priory Group.

The eye, naturally, fears that the results may be the same.

A great entry from Fighting Monsters is up today -- thought you'd want to take a look:

I think there's a lot of misunderstandings about what I actually do at work. What do social workers who are in mental health services do? What do social workers who work in adult services do?

I hope by reading, some people get to learn a little of my day to day role but I also thought it might be useful to set it out more explicitly.

I am an Approved Mental Health Professional (AMHP). That means that I am on a rota to carry out Mental Health Act (MHA) Assessments. There is an important difference between a Mental Health Assessment which is a more generic term for an assessment of someone's mental health and a specific 'Mental Health Act Assessment' which is a formal assessment under the 1983 Mental Health Act which can result in a compulsory admission to hospital without consent.

Sound complex? It is. But get to grips with it by reading the rest of the blog here.

Castlebeck, the company at the centre of the Winterbourne View abuse scandal, is to undergo a radical revamp, according to the chief executive of the comapny. But will it be enough to restore public confidence without heads rolling?

To be honest, Lee Reed, chief executive of Castlebeck, has little choice but to go for a radical overhaul - he was brought into the job to do that anyway.

The problem Reed may face is that while he may be right and may be able to turn the quality of care around, he will have difficulty convincing the wider public that it's different if the same people remain.

When I spoke to him last Friday he was of the opinion it was unfair to single out individuals in the regional or senior management of the company. He said the issues were systemic to the way Castlebeck worked and he seemed to think no one could have realistically kept oversight of the huge areas they were tasked with.

The reaction of Terry Bryan, whistleblower in the Winterbourne View hospital, on Twitter was sceptical. He said: "Lee Reed 'not currently minded to take disciplinary action against any managers for Ca$tlebeck's failings.' OH MY! ! !"

Lucy Series, blogger on Mental Capacity and law, added: "It's a tricky case to argue that regional managers share no responsibility when service failures so widespread."

I am perhaps a little more generous than most. Reed was very contrite and has been apologetic for the failures at Winterbourne View and others (though these were not on the same scale) ever since the news broke. Plus, independent voices in the sector have said to me privately they believe that he was genuine in his desire to achieve this before the abuse scandal blew-up.

But Series and Bryan are far from alone. Commissioners have already withdrawn people from Castlebeck placements since the scandal erupted.

Convincing them and those who want to see faces held to account may be more challenging than changing the system itself.

The case  of Gemma Hayter, a learning disabled woman from Rugby, has opened a number of questions for councils concerned with adult safeguarding. Three people were found guilty last week of murdering Hayter on 9 August 2010. According to reports, Hayter was physically abused and forced to drink urine before being beaten to death. A jogger found her body the following morning on a disused railway line. Warwickshire is currently conducting a serious case review into Hayter's death.

The case is reminiscent of that of Steven Hoskin (left). Hoskin, a man with learning disabilities, was found dead at the bottom of a railway viaduct in St Austell, Cornwall, in July 2006. He had suffered hours of abuse at the hands of a gang, two of whom were convicted of his murder.

The serious case review of Hoskin's death said any life-transforming decisions by a known vulnerable adult should result in assessments of a person's decision-making capacity.

This issue is likely to be a focus in the SCR into Hayter's death. The Daily Mail did a kind of profile of the 27-year-old, in which neighbours said she was incredibly child-like, unable to keep track of her money or time. They said she didn't keep regular day-time hours and never cleaned her flat. While this evidence is anecdotal and the SCR will have more reliable facts about the situation, it sounds like Hayter may have not had as much support from services as she should have had.

One of the saddest details of this case is that Hayter thought her killers were her friends - another parallel with the Hoskin case. They had been on nights out together and were supposedly socialising when the violence began. It's impossible to keep track of how every vulnerable adult spends every hour, so it will be interesting to see what the SCR concludes about the prevention of these crimes.

I was rather moved by this post on the personal blog of Community Care's group editor Bronagh Miskelly.

It's about the therapeutic benefits of craft in care homes.

Her mum has dementia and is a care home. Before she became ill, craft was an important part of her life. In fact, even though she can't do it anymore, it still is.

This extract explains more:

"Yesterday Mum even commented on millinery.

"We were looking through a photo album and came across pictures of her in various spectacular wedding hats - she could always pull off a dramatic piece of headgear. When I commented on the first with a wide sweeping brim she started to explain what it was made of. No longer able to recall the word she wanted she had a look round and pointed to the front of her radio until I came up with the word - 'mesh'. Turning to the next hat, a giant poppy, she told me it wasn't mesh but silk - 'very different'.

"And then sadly the gleam was gone. But for a few minutes colour, shape, fabric, construction - something from her craft skills - brought a bit of my Mum to the surface.

"I don't know what it is or why but it seems that this still can provide a tiny bridge of contact and engagement. As someone with a professional interest in this area I want to know more - as a daughter I'm just glad it's there."

This got me thinking. A Care Quality Commission consultation on a new adult social care excellence award ends today.

This is part of a project to recognise excellence in social care now that the star quality rating system is no longer in use.

The Social Care Institute of Excellence has helped the CQC develop a definition of excellence in social care services.

Scie's definition includes that a service:

• "treats the people who use the service with the utmost respect and dignity as individuals. It gets to know them well enough to truly personalise support"
• "supports people to maintain and develop relationships in ways that suit them, to belong to communities that they choose, and to engage in roles, activities and pastimes that they enjoy and that benefit them"

Helping people in care homes enjoy crafts seems to support these aims, so I'd like to know more.

How much research has been done on the impact of craft in care on people's wellbeing?

Are there examples of excellence - care homes that are using craft to improve wellbeing?

We at Community Care are keen to write more about this, so do get in touch with your ideas.

Me, I'm wondering if there are any craft volunteering opportunities at my local care home.

I may well just get in touch.

Pic:Craft in action: @CommunityCare tea cosy by @bromiskelly to raise money for MSF via @msf_phop