Interesting proposal from Department of Health to enable parents, families and independent user trusts to buy unregulated home care through a personal budget on behalf of a service user.
Currently, in England, they must buy services registered with the CQC. In many cases, this means individuals having to register with the CQC, which is no doubt very bureuacratic, but could there be safeguarding risks in this?
Interesting question. I know a childrens home provider that is actively supporting young people into independent living. Its a gradual process and many of the YP need a few taster periods in flats or lodgings houses whilst they make the transistion. Staff from the home go with them to support them, initially staying at the accommodation overnight and then gradually withdrawing support.
The problem is .. technically the community outreach is an unregistered service. CQC are very clear about this. But arguably it should be registered as the organisation is providing 'personal care'. Its usually only prompting with remembering to take meds or reminding YP about the need for good pesonal hygiene, but under CQC definition this is personal care and the organisation should be registered as a dom care provider.
It simply can't afford to do this, nor has the time, capacity or admin resources. It's a growing issue and the organisation may be in a ridiculous position whereby it cannot legally provide care leaver support, despite the fact it has outstanding services and staff know the young people well.
For this one example, I am in complete favour with lowering the requirements on registration.
Absolutely not!
Rainbowarch - This is not about lowering the requirements but removing them. We have enough problems with CQC registered organisations that we have direct contractual relationships with let alone dealing with ones who will be operating below the waterline.
Yes something needs to be done to allow the market to grow to offer real choice to people on personal budgets but didn't the last market that the Govt de-regulated go into melt down taking the worlds economy with it?
If the family care for their own family members, the family are the carers and not CQC registered. If the family choose to use a private care option which is free from CQC standards, but good enough for the family (who are paying) then why should this option be prevented?
CQC has a history of missing problems during inspections. A family paying for private care are likely to want to monitor the services they are paying for.
It's interesting the question that is posed - should families be able to buy unregulated care rather than should service users be able to buy unregulated care. This is because it is about buying care on someone elses behalf. The person purchasing the care is not the recepient and not all families (believe it or not) have wonderfully clear motives. If unregulated care is cheaper, it might be more tempting as well.
While I think there is an argument for some situations people being able to employ more informally, I don't think that people who lack capacity for whatever reason should have unregulated care bought 'for them'.
The problem may be one of regulation. If the CQC don't do their job, they should do it better - rather than saying that regulation shouldn't exist.
If I had to pay for care for myself and I had two options. Expensive regulated care with was only as flexible as the regulation permitted or unregulated care which let me decide about how I spend my money, I would want the ability to choose and I would want the option available to me.
Where people don't have the capacity to make decisions for them self and the family are disinterested, then perhaps care provided by associations who are regulated should be the best way forward. The scope for abuse and misuse is reduced for people who can't manage their own affairs.
Regulators aren't very good at spotting abuse or dealing with it once it is identified; good providers who fail on something a regulator defines as crucial can end up under measures or even barred; de-regulation will make it far easier for people who wish to abuse to do so. So there are no easy answers.
The government's approach in this, and just about everything else, is ideological. Being on the left of the spectrum I totally disagree with them, and would maintain the current requirements. But don't assume that any ideology based practice, on the right or the left, will stop or prevent abuse.
What about corporate parents? And their motives and cost? Should LA's be trusted to buy unregulated services for children in care or care leavers?
I'm afraid...until we see corporate parents putting needs of YP ahead of cost, there seems little point in arguing whether or not this should be allowed for families.
Many people are doing this already in adult care by using neighbours, friends and families to provide care via Self Dircted Support. Most people are trustworthy and will stick to the rules but there are people who will take advantage of the fact they are not regultated. But carers choose this option because sometimes it is far more flexible than a tradtional care agency and for that they are willing to take the assoicated risks.
Another issue is that there are some fantastic local person centred support organisations out there that cannot become council registered because preferred provider lists are closed. Meaning that the provider can't really get any council business because there not on the list so they rely on people who are self funders taking a risk. Meaning that for once some self funders in my area are getting a rolls royce service. But people who are recieving fully funded care have to use traditional care agencies that may send different carers every day, don't always know whats expected of them and might not even stay there allocated time.
I am speaking from professional and personal experince of the difficulties sounding this issue.
cb: It's interesting the question that is posed - should families be able to buy unregulated care rather than should service users be able to buy unregulated care. This is because it is about buying care on someone elses behalf. The person purchasing the care is not the recepient and not all families (believe it or not) have wonderfully clear motives. If unregulated care is cheaper, it might be more tempting as well. While I think there is an argument for some situations people being able to employ more informally, I don't think that people who lack capacity for whatever reason should have unregulated care bought 'for them'. The problem may be one of regulation. If the CQC don't do their job, they should do it better - rather than saying that regulation shouldn't exist.
Indeed - regualtion is there to basically protect people who have no power at all or lack the power afforded by choice - as children are one of the most powerless groups then I fail to see how this would work.
It also raises the question that if some services for families can go unregulated - and apparently thats fine - then why isnt it fine for all services for families (and perhaps thats the path we are heading down)
Though I do agree services will only ever improve and meet peoples needs accurately and timely if service users have the power of choice and removing barriers to market is the best way of increasing numbers of providers - Im just not sure we are in a position yet to empower children in that manner.
most families do carefully choose and monitor rthe support given to their relatives--whatever the persons age/needs. (not sure what you mean by them paying--if we are discussing personal budget then surely its the state paying at least some of it.) but this does not mean that they cant be deceived by someone they thought they could trust. doing the neccessary checks can be time consuming and difficult and by not asking the right questions or knowing danger signs things can be missed. also there are families who are not themselves working in the best interests of their relative--i am aware of two people who are each 'employing' a relative who is taking a lot of money to provide support that is just not being provided. in one case not enough food, heat, hygiene. if a registered carer or agency abuses clients they can and should be given the very harshest sentance---what happens when it is a relative/friend? as they are unregulated who would prosecute? would a person who has spent their lives having to trust and rely on a relative then have the strength to take out a prosecution--would they have been supported to seek an advocate to speak for them?
seguine: most families do carefully choose and monitor rthe support given to their relatives--whatever the persons age/needs. (not sure what you mean by them paying--if we are discussing personal budget then surely its the state paying at least some of it.) but this does not mean that they cant be deceived by someone they thought they could trust. doing the neccessary checks can be time consuming and difficult and by not asking the right questions or knowing danger signs things can be missed. also there are families who are not themselves working in the best interests of their relative--i am aware of two people who are each 'employing' a relative who is taking a lot of money to provide support that is just not being provided. in one case not enough food, heat, hygiene. if a registered carer or agency abuses clients they can and should be given the very harshest sentance---what happens when it is a relative/friend? as they are unregulated who would prosecute? would a person who has spent their lives having to trust and rely on a relative then have the strength to take out a prosecution--would they have been supported to seek an advocate to speak for them?
ive worked in adults and have friends who are carers and friends who have carers - and while I agree with choice and self determination the potential for exploitation is absolutely huge and very worrying. Though you could argue that we can all be potentially exploited and often are at some points in our lives - whether it be jobs relationships offspring etc
- the whole" the worlds a dangerous place for everyone and in order for those cared for to be accepted by society they have to take the same risks as everyone else " argument
As a Family carer of my brother who is mid 40's and mother who is in her 70's one having diagnosis of SLD, autism complicated with Challenging behaviours and the other having chronic MS and OsteoArthritis I have been running the direct payment for one of them for over 4 years.
The main issues we have is that under section 7 we do not have to be registered with the CQC because we employ the support workers to work from our family home through Continuing Healthcare Funding, social care and ILF funding. If we were to have to register then the direct payment rates for local authorities would have to significantly increase. If we were to access through an agency then again the costs would be significantly higher and the social care budget would be bankrupted.
We are already suffering significant financial burden due to HMRC requirements and have had already received threatening letters from HMRC over underpayment of tax. The Carers schemes are not treated as full businesses and therefore we are unable to capitalise on tax reliefs that would be available if we were and could in theory save social care and health millions if taken nationwide.
We are all well aware of poor commissioning happening by professionals from companies with glossy magazines and corporate images to protect that quite frankly have increased the BBC documentary portfolios recently but we have to accept that some families are not going to cope with becoming a manager and will require much better support that is family led and appropriate to the needs locally. My own situation has not been helped by the commissioned services where we have a history of extremely poor support, inefficiency and broken promises.
Families are already taking a lead in some areas and as a result the relatives quality of life and self esteem has rocketed - are responders advocating throwing that away without thinking of the consequences. We have seen people who society has washed their hands of actually blossoming and all the hard work of the families concerned being ripped apart due to an ill thought out system such as the resource allocation. It does not work and local authorities using so called quality panels to cut budgets assessed as eligible needs under the Community Care Legislation.
To say to go to agencies would result in packages having to double to pay extortionate agency rates and there is no guarantee that the staff would be suitable or qualified to cope with the individual. Yes they have to be registered to operate as a dom care agency but they would not have adequate staff matching, experience to cope or intimate knowledge or continuity of support guaranteed.
I will of course read with interest the proposals from the government bearing in mind when the CQC consulted on its essential standards I advocated the need for some accountability structure that supports families to deliver true personalisation which is something that local authorities are failing abysmally to do.
What about if the individual providing the care had to be registered as SWs are with GSCC (soon to become HPC)? This would offer some measure of protection (altho we have to be realisitc - there will be some unscrupulous people who will exploit service users and are doing so even as we speak and registration as paid carers with HPC or another agency or indeed with CQC will not prevent this). The aim always was that GSCC would progress to register social care workers across adult and children's services, domicilliary and residential - over the last 10 years I heard at least 3 Govt Ministers announce this was about to start. It seems completely off the radar now but would some tragic incidents of abuse bring it back on?
This surely is a development ONLY for those not managing their own PB....?
There appears to be no restrictions [this *may* differ from LA to LA?] on what services a PB holder buys for themself...
The whole opening up of opportunities for those intent on abuse and defrauding older vulnerable PB holders is mindnumbingly obvious without control and overseeing..
It is not a question of restricting choice ... it's a question of safeguarding that choice for people who are vulnerable.
pj
of course therewill be local accountability to the local social/health dept responsible for the assessment of need. The question to be answered is should there be a national watchdog also watching over the individual families/trusts.
Lets not get silly there is no question about letting people have the money without local monitoring.
serenity69: of course therewill be local accountability to the local social/health dept responsible for the assessment of need. The question to be answered is should there be a national watchdog also watching over the individual families/trusts. Lets not get silly there is no question about letting people have the money without local monitoring.
Not the same thing as allowing [...a great contradiction to the notion of a PB, of course] unregulated "care" ....
Of course we cannot accept or allow anyone to just provide *care* on a personal basis. It's a recipe for disaster, accidents, fraud and abuse.
...but that is what is happening in many, many places already.
Personally I see the accountability aspect, if the LA is paying for the care, I feel they have a responsibility to see that money is spent in a safe appropriate way. Other wise you could end up with headlines like "LA pays for granny bashing care".
What next? The abolistion of CRB checks? ( although I do have many views on these)
happymonday: Personally I see the accountability aspect, if the LA is paying for the care, I feel they have a responsibility to see that money is spent in a safe appropriate way. Other wise you could end up with headlines like "LA pays for granny bashing care". What next? The abolistion of CRB checks? ( although I do have many views on these)
What is your understanding of PA's..........? Are you aware there is no framework or system that implies or insists a PA is CRB checked.....I see ads where the services of PA are advertised stating they come with a *CRB* check...! That's not how the system works and CRB's are not transferable from employer to employer. Second, CQC are not interested in single provision PA's. That is, someone who works for just one service user/client. However, I cannot see much of a system in place that identifies those PA's working for more than one service user/client (...and hence, a requirement to register with CQC) or registers or lists identifying these people.
The great problem is the head on crash between *personal choice* and control of the money (so to speak) but this PA business is certainly below the radar on lots of levels.
HMRC rules are similar in that if a PA works for one service user/client they are (or can be, self employed) if they work for more than one they MUST be employed by the service user/client and the subsequent legal regulations on Tax & NI, holidays etc., (for example) must be met. Who checks these things in Local Authorities...?
In my view, (possibly contentious) no recipient of a PB/DP payment should be able to buy 'personal care' from anyone other than those providing regulated care..... that means CQC registered. Unfortunately, that's not happening..
carewatcher
Not my field this but is it not an example of whom society values most and governmental double standards.
Private fostering regulations were adopted in 2005 (2006 Wales) , for the leetle* children. This specialism, of some people just as vulnerable, seems to have gone the other way.
* deliberate spelling.
If this non-regulated trade is allowed, so anyone can care for some one as long as the official carer says ok, when some thing terrible happens, and it will, who will the public and the law hold responsible? And, although this is not my area, does it mean that all individuals and organisations need not be on a register? because if one does not have to, why should anyone?
oab: If this non-regulated trade is allowed, so anyone can care for some one as long as the official carer says ok, when some thing terrible happens, and it will, who will the public and the law hold responsible? And, although this is not my area, does it mean that all individuals and organisations need not be on a register? because if one does not have to, why should anyone?
Here's the problem. A PB/DP holder is awarded a sum of money to buy their own personal care. Once awarded, the PB holder is, or becomes, a private client of any care provision they wish to buy. (now, some LA's impose some/few/many restrictions on how the money is spent but the debate spreads out across the true personalisation mantras of giving the ultimate choice of how PB holders want to spend their money..generally speaking).
Comapnies and individuals who provide care to more than one client/service user ...MUST be registered with CQC (this registration is the key, frankly, since it, in turn, imposes conditions, rules and regulations on CQC registered organisations/individuals). Individuals who provide care to one person/client/service user only do NOT have to register with CQC. (and therefore, do not have to comply with regulations).
The problem is, who is policing this? Who is to know if a PA is working for more than one client/service user? It is an enormous blind spot in the whole sector of care provision and one that will be exploited by those with dubious intent.
In answer to your question, when this happens - abuse, "terrible things", etc, (it's already happening, of course, hidden away from view by safeguarding teams) who will be responsible...? The older vulnerable person of course. The LA's will not be interested in taking responsibility (the PB holder, after all, made the choice!). It's a nonsensical situation...individual *care* providers have to register already with CQC - for example a sole trader working as a chiropodist, a physiotherapist. a hairdresser even visiting someones home, and so on......... but not a 'single service user' PA!!! It's a complete and utter nonsense.
As the OP says, let's start with our own MP's on this....the system is inequitable, wrong and open to abuse....