Without straightforwardly admitting - it or acknowledging the massive damage inflicted by it - the RAS is being quietly buried. And in its place is being proposed an equally half baked idea for deciding the serivce user's cash entitlement with even less chance of being taken seriously. I have placed a short paper in the Resoruces Section (under CS) that takes a looks at what is happening.
Colin Slasberg
Interesting - but i can't find your paper - could you post a link?
Do you have any suggestions for an alternative?
We do need some form of making allocation of resources fairer. I have been allocated a fair few clients who, despite having very different levels of need, have had roughly the same level of support - that can't be right.
- Money allocated should always equate to the local unit cost of agency/PA time.
- people requiring double cover should not loose out. Why should someone who requires two carers only get 1.5 hours a day and yet someone with the same 'needs' get 3.0 hours? It seems the higher dependency someone is the less resources there are focused on their emotional and social wellbeing (even if low mood, apathy, poor appetite, poor nutritional intake result).
- whatever system is used it must be able to deal with the complexities of service user reality... someone with parkinsons may move slower or someone with COPD may keep stopping to catch their breath (thus the care calls take longer despite the tasks being the same). Also true of challenges to communication, if manual handling is required, if due to confusion take longer to reassure or achieve co-operation. Simply ticking "needs assistance with personal care daily" is never going to be an effective or appropriate way to allocate resources.
southerner: - whatever system is used it must be able to deal with the complexities of service user reality...
- whatever system is used it must be able to deal with the complexities of service user reality...
Hi southerner,
A formular based computer system is the least likely method to deal with human complexities. You list some typical flaws in the system but the list can go on and on and on. A flexible and multilayered system which is capable of accounting for the unique individual and diverse situations is what is required. The best system I would suggest is well trained staff committed and skilled in undertaking a holistic and needs led assessment. Bring back SOCIAL WORK. To me the RAS is not a system to make things fairer its a system designed to manage an authorities money. This system is so concerned with money it forgets that some of the most complex human problems cannot be fixed by money but the value of relationships and problem solving.
Hi Darrenh,
You make several good points. I am not, in my comments above, defending RAS - far from it. Well trained staff with autonomy are of course absolutely vital. That however does not address the multitude of situations as described in which people of vastly differing needs have, rather unfairly and inefficiently, ended up with roughly the same care packages. Whilst I agree with you that the decision process should be largely human rather than formulaic there needs to be some sort of national bench marking to guide this process - this could be similar to FACS or CHC rather than a all-controlling RAS calcuator.
As to bring back social work... as far as I'm concerned it never went away. Increasingly what we do is care management (been that way since 1990) but the way in which we do it (i.e. values, skills, theortical underpinnings, code of ethics) is social work. Many disagree but that is my view.
Hi Southener
Yes I do have a suggestion for an alternative. it is to bring to an end the attempt to make the resource allocation before support planning. That means changing the definition of what a personal budget is to mean only that the support plan has been created without reference to a menu of services and chooses the services/supports that will best deilver the outcomes agreed at the best possible cost. That means Councils freeing up their resource base as cash to the greatest extent possible so that choice is real. The actuall allocation of money does not have to take place until the plan has been put together. The complexities of needs are such that each person is unique and the cost of meeting their outcomes unique.
I have posted a couple of short papers on this theme in the Resouces Section. It would be great to know your thoughts.
linjamma - if you click on the Resources tab at the top of the page, you will find the paper there.
Hi CS,
It is certainly best practice to explore what goals and aspirations someone has as part of the assessment process, long before even support planning. This can lead to some very creative solutions from the very beginning. I remember one lady who was a trained pianoist attending day care not as a paying client but as a performer, giving her a day out, free meal and a sense of purpose...
In following your plan however there does not appear to be any means of cost control or spending equity which is, if we are honest, why RAS was introduced. I sense your intentions are very good (especially with regards to getting away from traditional services) but I simply don't see it happening in the real world. Something like the RAS is here to stay just as care management and electronic records are.
Lastly I have a concern that support planning before resource allocation is setting many people up to fail, leaving them with expectations which cannot be reached (at least not through funded services). It is almost like going shopping, putting all the things you would like in your trolley and then realising you only have a tenner on you when you get to the check out...
I absolutely agree with the concerns you raise about the way forward I am proposing.
My answer to the first is that what is required is a complete rewrite of FACS. It must make real sense to service users, practitioners and politicians. it must serve the interests of both service users and Councils. I believe this is possible to do and am working on a paper that proposes how it can be done that will be published shortly.
And you are right that my approach will mean the assessment will have to be holistic which will mean identifying needs that cannot then be afforded. There can be no escape of the need for Councils to manage within budget. My view is that it is right to be honest about unmet need, firstly with the service user at the individual level. Most people are reasonable when they can understand the situation. Also, surely its best to build a support plan around fully understanding the whole person and whole situation. It is the whole plan that is important, including managing any gaps.
Secondly its hugely important to be honest with politicians and expect politicians to be honest in return. at the strategic budget setting level. Current systems hide unmet need by gving the impression it doesnt exist, or is just called 'moderate' and 'low' level, which sounds like stuff public services shouldnt be doing anyway. Politicians need to know the full cost of meeting the needs that have to if we are to deliver the vision of independence and well being they have declared they want for service users. They need to know in terms that are meaningful to them the needs not being met as a result of current funding levels. There needs to be transparent decision making abuout priorities based on real information.
Sounds very interesting - I look forward to reading your proposal.
How are you going to address the inevitable administrative burden? It should not, of course, be the reason for not doing what you are suggesting but forming such a comprehensive support plan sounds like a very time and typing intensive thing. God knows what performance indicators would be attached.
You have my respect for what you are suggesting but on an honest front I don't forsee it happening at all. The care management system is completely engrained in both law and culture (it is what new graduates are being taught). CHC is not going to change anytime soon as it has proved a effective way or rationing resources - rightly or wrongly. If anything FACS will be made more like CHC, merging it into the assessment process rather than being a stand-alone categorisation of the service user.
The question will be asked - what is to be done with this list of unmet needs, how does it benefit the service user to say they would like to go on foreign holidays or daily to the gym but their budget does not cover the support for such? It sounds like it would tell use something everyone already knows, that there is not enough money in social care. I can't see how your proposals link need with an individual's support plan - i.e. how we as a profession would be able to tell that yes person A has a desire for support to do A, B, C but actually on a needs level only needs help with prompting medication and preparing a hot meal.
Well this exchange is getting to the nub of the issues Southener!
Of all the Dilnot recomendations, the one that says we need a new eligibility framework is one where there is best reason to hope of delivery. There is wide consensus that FACS is dysfunctional. I am hoping the DH will see the sense in the thorough going review that it failed to deliver in last year's. A key element of that dysfunction is a serious mis-representation of the law which feeds the myth that it is unlawful to acknoweldge unmet need.
Your point about the distinction between need and service based demands/wishes is really important. But, if I may say so, you show what has become part of the culture in this country which holds that "need" is all about the survival needs. They may be the highest priority needs, but when did we stop believing that things like self worth and personal fulfillment are no longer universal human needs? And whats more, when did we stop thinking that the impairments that bring people to social care prevent people from meeting such needs no less than the survival needs? I dont think unmet need is just a list of the things service users say they would quite like - they are no more than the start point for the discussion that creates an understanding of the issues being faced, the needs put at risk, the outcomes to seek and the best, most cost effective way to meet them.
And if this is done as it should be, it is not a bureaucratic nightmare. Yes, there has to be structure around teh way the plan is set out to support clairty and accountability. But the key is not usiing bureaucracy to shackle the actual assessment process thorugh any of those apalling tick box devices currently in use. It should be a matter of open discussion within a structure that ensures issues, needs, outcomes and resources are covered.
Yes - it is major change in culture and practice. But if politticians are serious about making the lives of service users better, and if they want to do so through a workforce that is skilled, engaged and effective, it has to be done. The current strategy - based on personal budgets through up front allocations - paradoxically has served only to re-inforce the worst elements of the current culture.
Again you make excellent points CS.
I am part of that culture, something which I acknowledge, regret and try to remain mindful of. As previously indicated this is what my university was teaching - care management. I have provided many a creative solution focusing on an individual's holistic needs and have felt particularly proud of those examples. Sadly I also recognise that whilst social, emotional and recreational needs are absolutely vital it has been my experience that management only approves funding for personal care, medication and nutritional needs (aka survival needs). So, if you will forgive me, I am working with what I am given - which is not the same as that which I would wish to do if the procedures and resources allowed.
I often wonder where we, as a profession, went so wrong. I believe being part of local government with its bureacratic appetite may be a major factor. District Nurses are allowed to leave their answer phone on to stop being endlessly interrupted and as far as I am aware we are the only professional in health and social care banned from simply handwriting our assessments onto pre-printed forms. At some point we rolled over and accepted a horrifying administrative burden which takes us away from client facing time and locks our mind into a world of tick boxes, drop down lists and RAS calculators. When did we passively accept such little autonomy?
Do you believe that we could simply start from scratch - a blank piece of paper? The truest form of professional accountability would be to allow social workers, as trained professionals, the ability to record only what they feel is appropriate and be held accountable should that be insufficient rather than putting them into the demoralising straightjacket that is the 30 plus page forms I deal with on a daily basis.
I eagerly await (not sarcasm I promise you) more details of how we could be both truely holistic and creative whilst working within a framework of limited resources.
Hi Southerner and CS,
I have found your conversation to be very interesting. I am a Newly Qualified Social Worker, despite all of my training at University about 'needs', running alongside our values teachings about self-esteem and self-worth etc, I had a placement in the Statutory Sector using the tick boxes and RAS system.
I totally despised having to 'discard' issues classes as low to moderate needs, as these seemingly would have made such an improvement to the individual's situation.
The sad part of this for me is, now jobhunting I feel as if I cannot be true to my genuine feelings on these subjects, as I feel I would possibly be rejected as a 'troublemaker' who wouldn't work with the system. How do we deal with working with systems we HAVE to use, if we truly think they are not necessarily advantageous to the Service Users we devote our working lives to?
I would be pleased to hear you opinion on this
Sorry didn't mean to just acknowledge these two individuals. Without listing all of the participant's names you can all reply please !!!
Hi Jols,
I am also interested to hear CS's views on the important issue you've raised. I dealt with it by accepting the current system as so far as providing funded services (including creatively using direct payment of personal budgets) for those with substantial plus needs on the 'survival' side but employing true social work values, theories and sensitive approach to listen, reflect, encourage and call upon non-funded opportunities such as befriending, horticultural therapy (be that formal or the local gardening group), free guided walks, benefits advice, etc. We even paired up two service users (with their mutual consent) - one mobile but with emotional difficulties and another with mobility problems and they have gotten on fantastically, going on trips and providing each other with the time and support which formal services can rarely provide.
It is possible to be a true social worker even in the current climate, I hope I have through these little snap shots demonstrated that. Please don't be downheartened. It is my view that in a supportive team and an understanding manager (they do still exist) you will find opportunities to practice that way you desire to - at least some of the time.
Further to that I think it important to emphasis, as you are no doubt aware, that everyone has a legal right to assessment and you can make that assessment visit what you will. You can decide to be frustrated by the limitations of the FACS criteria (which CS has rightly highlighted is due to be reviewed and hopefully replaced) or you can view it as an opportunity to do what you can for that person in terms of providing information, advicen and emotional support even if they don't meet funding eligibility at this time. It is that sense of know that you did what you can which I find fulfilling and gives you the energy to continue through more difficult times.
All the best to you in your NQSW year.
Hi Southener and Jols
I truly feel for you both, and countless others up and down the country whose conscience is troubled by the way the system requires you to work. All I can say to you is this - those in authority can make you behave in the ways they want, but they cannot make you think in any way you choose not to. If you retain your independence of mind and your critical faculties, you never know when moments and opportunities arise to influence things. You have to apply skill and judgement when and how you challenge those in authority or even propose an alternative view, as you say jols, not to be dismissed as a trouble maker. You have to do as you are instructed - and do so with as much grace as you can muster. But every opportunity to make points constructively, either case by case or in management settings, can have an impact. And, of course, discussion is free amongst peers and can be a real force for change if a momentum can build.
For myself, I am hoping to have some influence on thinking nationally via the White Paper consultation currently going on. It may, of course all fall on deaf ears - but if nothing else, we all owe it to the people who rely on social care to make our best possible effort to help shape the system so it works better for them. I hope to be able to put the paper I am developing in this site soon. It will be great to know - if the ideas were to be adopted - if you think it would work.
Thank you for replying.
Despite the situation being as it is, I hold dear to the reasons which pulled me towards this career path. I know I can't change the world but wil be happy to know I did as much as I could. I am hoping to gain employment soon and intend to practice with as much grace and effectiveness in whatever sytems I have to work within.
I am grateful that my university was very much radical Social Work oriented and I intend to fight through social action for the rights of both Social Care staff and Service Users alike, as we all deserve to be treated more fairly than the system is currently dealing with us.
I admire you both, Southener and Jols - attitudes like yours throughout the workforce would create a huge force of energy for change and improvement