Recently in older people Category

A few weeks back I led a tour of voluntary sector organisations providing social care locally. With shrinking public services, these providers are central to the delivery of adult care and this excursion was a response to requests from statutory professionals - from the local authority, primary care and mental health trusts - who wanted to know what voluntary sector resources were available locally.
 
We stopped off at six projects for around 20 minutes each on a circular tour that took us no further than half a mile from the town hall (much to the chagrin of those who were hoping to journey farther afield). What we found was truly inspiring: voluntary sector organisations providing some great services with limited resources.

But much of what we discovered was disheartening. Our tour started at an advice centre where staff reported that enquiries had nearly doubled in recent years, with precious little increase in their resources. We also met with a learning disability provider who had lost a number of supported housing projects through competitive tendering processes. While they had picked up a few new contracts in their place, the unintended consequence of these changes in providers was that many service users had endured a protracted period of instability and insecurity.

The greatest challenges were perhaps faced by an older people's project. Earlier this year, they lost a large day-care contract with a neighbouring local authority. A further blow came when they failed to retain a home care service they provided; the contract was re-tendered and they were outbid by cut-price provider. Faced with a 65% drop in annual income they had just completed an agonising restructure which had made many of their highly-skilled staff redundant.

Like others on this tour, this provider saw little cause for optimism about the current climate in social care where brutal cuts are being introduced and commissioners favour ever-cheaper providers.

by Jane* a home care worker

My local authority is about to start paying home care workers by the minute using an electronic call monitoring system (ECM). I use the service user's home phone to log in or out when entering and leaving their property.

The council claims that Actual Time Invoicing will save money by clawing back precious pennies from unscrupulous care workers who cut calls short. I offer no support to carers who reduce half-hour calls to 20 minutes by rushing. However, there are incidents when reducing visit times is necessary.

My priority on meeting a new service user is to gain their trust and make them feel comfortable with my presence in their home. Sometimes this is simple and they couldn¹t give two hoots about stripping down to their birthday suit to be washed.

It can take time, however, especially if the loss of their independence is still a shock. Recently I started visiting one gentleman who would only let me make his breakfast. After much coaxing he allowed me to wash his feet, then under his arms and now he has full body washes.

Building that relationship was intense work. Leaving when he wished me to and gradually increasing the length of the call was an incremental part of giving him the sense of control he needed. Under the new system I would not have been able to do this without my wages being penalised.

Logging in can be delayed simply because the client is using their phone when I arrive. Once, I walked into a woman's house to find her walking about with her knickers and skirt round her ankles ­ I didn't stop to log in before helping her.

If I finish putting someone to bed in 20 minutes, am I supposed to plonk myself on the sofa with the main carer until the end of the half hour? How fair is that on someone who hasn't had a moment to herself since 6am? What if the family decide to cook tea? After meds and helping the service user to the toilet do I sit at the table with them until the time is up? And what if I feel unsafe in a call? Am I to lose 15 minutes' pay because I put my safety first?

My team leader has told me that if I need to leave a call early she would chase up extra pay for me. I do not know how she will find time for this when she is already struggling with rotas and covering staff sickness.

Although the system could deter carers from cutting calls short it does not address the reasons why they do. Also, an unprofessional carer is unlikely to perform extra duties when forced to stay at a call until the end of the allocated time.

To reward carers according to the length of time spent in one place and not by the quality of our care is to underestimate the complexity of our work and diminish its importance.

*Jane (name changed) is a home care worker who wishes to remain anonymous

(Pic: julianlimjl on flickr)

by Nigel Leaney, manager of a mental health residential service

The government may have been forced to rethink its Health and Social Care Bill by endorsing the main proposals of the Future Forum report but they have quickly regrouped and re-emerged as the government which is all listening, all caring. It's a sickening spectacle, especially when nothing much has changed. But sorry there are no sick bowls available; they've disappeared amongst the stink of efficiency savings.

The reforms to the legislation will now require the NHS regulator, Monitor, to soft focus its role in introducing more competition to the NHS while hyping its duties to promote choice, collaboration and integrated provision between health and social care.

Choice or quality

The rhetoric sounds laudable yet increased choice does not necessarily mean a better service. My cable TV offers more choice of channels than I know what to do with. But why bother when most of them are crap? Quality was better when we had a choice of just three or four channels.

Health and social care would be better served if we concentrated less on choice and more on quality. Yet the legislation and proposed reforms don't seem to grasp this.

Extending local commissioning consortia to include other health and social care professionals as well as GPs is clearly an improvement on the original proposals but hardly worthy of hanging out the bunting and issuing three cheers for enlightened reform.

Privatisation obsession

At the heart of the legislation, with or without reforms, lies the government's ideological obsession with privatisation. And the plans to fully embrace the private sector to meet our health and social care needs will continue as before, with the reforms just slowing the pace a little.

The most telling outcome of the government drive is that vulnerable adults will remain exposed to the risk of abuse of the type recently exposed at Winterbourne View. The Financial Times revealed that sub-standard care is far more likely to occur in homes ran for-profit than in charitable institutions.

Left floundering

Spouting the benefits of consumer choice is a smokescreen to ensure as many private care companies as possible get to dip their bread in an £80 billion gravy train. Good for them, good for all the Tories with personal shares in private healthcare companies and future seats on their boards.

The less profitable, more difficult services, not so attractive to the private sector, such as mental health and the elderly, will be left floundering in a financially bereft NHS after £20 billion is stolen in so-called efficiency savings.

No cherry picking, announce the reforms. And how exactly will the government stop this? Of course! In the same way stern, no nonsense way they reined in the bankers - excuse my cockney rhyming slang.

(Pic: Kreative Eye - Dean McCoy)

by Mark Drinkwater, a London based community worker

I am not usually one for participating in surveys, or reading them for that matter, but the personalisation survey by Community Care and Unison makes for fascinating reading.

Personalisation is the biggest change in adult social care in a generation and the timing of this national survey is particularly important as it gives an early indication of the impact on this agenda of the coalition's drastic cuts to local authorities.

Several of the findings chime with what I have found. First, nearly two-thirds of respondents strongly agreed that the government's commitment to personalisation was being undermined by budget cuts.

This captures the downbeat mood among colleagues who struggle to develop personalised services while working in slimmed-down teams that are expected to adhere to the ubiquitous mantra of "doing more with less".

More bureaucracy

More than half of the respondents reported that personalisation had resulted in more bureaucracy for them. This again concurs with the local mood where professionals regularly grumble that the complex and lengthy assessment processes have resulted in more paperwork.

In answer to an open-ended question on the impact of personalisation, respondents reported broader concerns about the changes to the roles of social workers. These illustrate the fears that the roles will be downgraded by, for example, using unqualified staff to conduct assessments.

Pockets of optimism

It would be wrong to say that all respondents were pessimistic. But, despite some pockets of optimism that the changes genuinely benefit service users, nearly half of the respondents continue to report that "generally people are buying the same kinds of support with their personal budgets".

This resonates with colleagues' opinions that the implementation of personalisation has been much slower and more troublesome than anticipated. For all the talk of the transformation, there is still some way to go in transforming adult social care services.

Personalisation leads to growth in non-qualified social care staff

Social workers says bureaucracy is damaging personalisation

Support for personalisation plummets among social workers

Councils dogged by slow progress on personalisation

How bureaucracy is stalling the spread of personalisation

by Fighting Monsters, a blogger and social worker in an older people's mental health team

We can see it coming. It has been oft-discussed. Working in one of the few local authorities that still meets 'moderate' needs under the Fair Access to Care Criteria in adult services, we've probably had it better than many others but there's all the more reason for a nervous twitch when discussion comes round to eligibility criteria.

The effect of raising the bar seems obvious. Yes, there might be an initial cost saving but over the long term, those people whose 'moderate' needs are being met might never reach 'substantial' or 'critical' need levels. The basic aim of making long term cost savings by providing support to people before they become dependent on care is lost.

by Malcolm Tyler, community health social worker, Hobart, Australia

Tasmania is the island state of Australia (we do have Tasmanian devils they look like small ugly dogs and make blood -curdling howls). Employed by the Tasmanian state government, I am involved in health promotion and since 2008 have jointly developed the Active Cognitive Enhancement programme.

by Jennifer Harvey, who works with people with autism

The post war baby boom generation are approaching the frontline of mortality.  Some of us are there already, and may want to leave before the end, to echo the sentiments of Terry Pratchett.