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Direct payments, personalisation... who now cares for whom?


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By Steve Arthington 

Amid talk of choice and freedom, service users must remember they also gain more responsibility under personalised services

Roles and responsibilities used to be clear but these days border lines shift frequently.

A carer responsible for a service user was more often than not supplied by the local authority or domiciliary care agency. They came, they delivered, they left; and they were paid by the "system". Carers reported to managers unknown to the service user and the care plan dictated what, how and when it was delivered. The service user had little influence over the process.

The evolution of direct payments, individual budgets and personalisation was, for most, a breath of fresh air and is leading to more independence. The care plan still prevails but some service users have six or more personal assistants each with a different skill set, managed by users themselves. Users are supposed to be the most important people in this new relationship. But are they?

With freedom of choice came responsibilities. Service users who are now employers of carers have to consider employment contracts, grievance and disciplinary procedures, minimum wage regulations, discrimination dangers along with liability insurance, tax and national insurance deductions. Service users now have to "care" for their carers. What a peculiar world this has become.

As a strange twist to this new arrangement, health and safety regulations don't always apply. Crucial provisions of the Health & Safety at Work Act 1974 (HSWA) do not apply in relation to the employment of domestic servants in a private household. The Health and Safety Executive  cannot therefore enforce the provisions of HSWA against the employers of carers or domestic servants who are exempt from the act. That's why risk assessments should not be mandatory for all insurance policies.

Sure, it is sensible to check where dangers lurk. No one wants someone to get injured in their home but risk assessments ought to be optional. The Occupier Liability Act 1984 states that the occupier or person in control of premises owes a duty of care towards visitors, ensuring that they will be reasonably safe in using the premises.

Everyone in the land has a general duty of care to ensure they do not cause harm to others but that applies equally as much to accidentally poking someone in the eye with your umbrella as it does to your carer tripping on the step. Service users' homes have no higher legal standards to meet than other private houses.

So in this evolving world with freedom of choice, consider this question, "Who cares for whom?"

Steve Arthington is a specialist care insurance manager at Ellis Bates 

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Can my fiction below begin to answer the question 'Who Cares For Whom?'

The Wellness Papers 2

The Assessment: Social Work and Painting and Decorating

They could easily be the people labelled and satirised in television documentaries, social services departments, schools, colleges and workplaces across the country.

The ones cut off from the mainstream by the mainstream and then, expensively, let back in. The ones the police, court, agency representatives and buy to let landlords can make a pensionable living out of, offshore assets from.

They are the ones unleashed against an unsuspecting public. The sensational story of poverty of opportunity that it is not my place to change.

But this is wrong. My wellness is my social reward for a particular type of dishonest communication with certain types of people, helping them accept being let down as a way of life.

The final painting should have looked like this: an oil of a slim, elderly woman sitting in an armchair in her bra and knickers, platinum hair, side parted, eyes alert, cautious, looking across the room, it appears, towards the young sculptor in a back lit corner, as if she is going to tell him off…

Not because her face was used to public show and her body was not; it wasn’t that. It was somewhere in the way that the light fell, making the skin translucent and it was beautiful. But the sensuality, if there at all, was measured and controlled not by me, but, it seemed, by the subject’s awareness.

Painting becomes her.

Although the incandescence of the woman appeared to come from the way light had been used, the way the window behind the figure provided and held light around the trees, that same light, light outside the window, seems opaque, unimportant. Light seems to gather around the woman, tracing a path around her figure, but coming from inside her body, making her skin appear matt, fine, like alabaster but somehow irrelevant.

She allows the sculptor and me, the artist, into this time, her body pliant, an arm on each arm of the armchair, her frame erect. Time for which we are skilled and commissioned to produce work between a moment, for us, between the initial preparatory photograph and the moment where we recreate that sense that she is not there, that she is always only tentatively describable; but in the moment that I begin to paint, I see that she is willing me to paint myself, to let her go free.

She draws strength from everything that art pretends to be, conscious that she has allowed light in on the energy that she created. To her, all the paths, lines, repetitions, crossings out of her fifty years in England in this small house, matter, not in an acquisitive sense, but in the sense that she is aware and asks valid questions about everything, not just about the things that affected her, she cares about democracy, about why parliament doesn’t debate the poor as people with aspirations any more.

She thinks it’s a given that the quality of life of everyone, not just her own family, is important and this pulls me up in a culture that encourages her to know nothing about anything except her own business and to gossip about others.

At first I hadn’t equated her struggle to be a decent human being with what I do. What she saw, felt and experienced were anecdotal. I didn’t see her as a creative person, preparing the ground for this moment, to tell me something small but important about her life. Then, she had been a sitter for our assessment, me the older man, the father painter/mentor for a young, creative middle class trainee with a young family on the way.

You see I was only thinking about myself.

Until I made this final painting, I had not seen that a deeper connection existed out there, between ordinary people and social artists like me: a relationship where the people I studied were, at the same time studying me, were willing me to find the connection between their hopes and my work. Underprivileged people if you like, but I realise now that vision and aspiration can only come from a genuine humility, a willingness to see what’s important to them.

Underprivilege affects everyone, from all walks of life.

People privilege me with their desire to know my social art, to show me that they made meaning and sense in the same way I, in this privileged role, make meaning and sense.

The first assessment was thorough we thought: A Triptych of interrelationships: the grandmother: the grandmother and the son
and the sculptor, blacks, whites, greys and yellows: the extraordinary luxury of line without boundary: photographic certainty without giving anything away. The kind of image that could be used as evidence but again, the kind of image that I realise now, cries out for proper explanation.

The paintings were always in my head, the lines, the colours, the squalor of the way they live now. I’d made a comfortable living out of them until now that I realise that what I’d made were caricatures, social satires.

A middle aged man sitting at a computer at the end of a room which looks untidy, bookcase full to bulging, papers over every surface.

The man sits at the computer screen, hypnotised, stuck, if you like, although he is an adult, although he is working, to my eyes, then, he is about five years old and he is sitting at the end of the room with a plastic steering wheel, pretending to drive a car.

He is playing working because this is the way I saw him, conjuror, joker, sleight of hand artist, hiding behind a cruel moment of light that he is trying to control.

I had assumed that this was my light. If I’m honest, he’d frustrated me with his obsequiousness. He wanted something, I thought, and began to search the littered, overwhelming space for a way out.

He had given me his friendship, instantly, and I had rejected it.

He wanted to show me things as they were, the pressure he feels, the workload, the corners he has to cut to balance the attention he wants to give to all of his clients and the love he has for his mother. Something he developed out of nothing, here, in this small house, in difficult circumstances, without network or family privilege, he wanted to show it as it is.

And I misread him: disorganised, chaotic, weak, undisciplined.
I had made an assessment. A con, I thought, too much of the nod, nod, wink, wink, pretend school, hiding something, I thought and then, I could see nothing beautiful in his way of life because, instead of looking, I listened to what I thought was his need to produce an alibi.

Everyone is always hiding something.

So that’s what I painted. All the lines of the papers worked up around him, distorting his relation to every thing, blocking who he is out of the viewer’s perception, cutting the connection between the man and his life as he sees it.

I made her look out absently as if she needed to be rescued, as if she was being abused or demented in some way. In the picture I considered the mother’s story at the expense of her son. My painting of their relationship has no complexity. I was so certain of the truth of my observations that I worked the surfaces of objects to make them obstacles: computer, TV, table, walking frame and the piles and piles of white papers into a distractive shield against any possible understanding of communication between them so that, at first glance, you don’t see that there’s someone else in the picture, until, following the light, you notice the glimmer of a walking frame.

Your eyes wander along its contours and you find the same woman from the final painting, sitting in the same chair. Only now the white cover has gone and the light has gone from her body. She is wearing any old cardigan and looks outward towards the television screen. Blank.

I am wrong.

My painting, I realise now, echoed the outside, the exterior version of their story that punishes them daily and intimidates them. My painting was really ‘I am the Carer’ and makes them both victims of a negative surveillance that I contributed to.

Because he fights, every day for a balanced connection to this home, to the people he works for, to a decent world he feels is slipping away. Wanting the truth.

We live our lives…as though we have evolved from a highly plural and diverse society, here in Nottingham, but then we go out into and come back from St Ann’s, Radford, Hyson Green, Top Valley, like Dr Livingstone, having met the people who lived in strange land outside the professional middle class called ‘Chaos’.

I was threatened by his trust in me.

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This page contains a single entry from the blog posted on July 22, 2008 3:25 PM.

The previous post in this blog was Practice placements are the key; not separate social work degrees.

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