Tag Archives: social care

CQC’s dynamic system of regulation

When I saw Mark Easton’s report on BBC News at Six yesterday about the changes in the way care homes in England are to be inspected, it made me wonder – yes, yet again! – whether the world has gone completely off course, heading for a major collision.

Then I read Mark Easton’s blog ‘Care and the Community’ and the words used by CQC have thrown me completely.

We rely on people who use services and those who care for and treat them to tell us about the quality and safety of services. This feedback is a vital part of our dynamic system of regulation which places the views, experiences, health and wellbeing of people who use services at its centre.

Dynamic system of regulation?  Dynamic?

Dynamism presupposes energy and effective action –   not exactly characteristics for which the CQC has ever been renowned.  Lethargic might be a more appropriate adjective to describe the CQC.

The CQC and its predecessor CSCI have been short of a dynamo – or even more than one – for  years, and there’s not much chance of new-found energy coming via a system of informal regulation which will rely on the already depleted energies of older vulnerable care home residents and their relatives.  It’s unfair to place such a burden on their shoulders.  But it will make it easier for care providers to cough out the old chestnut “well, nobody else has complained”.

Care Services Minister Paul Burstow said in Mark Easton’s report “…. we’re determined to actually make sure responsibility sits where it should be, with the commissioners, with local authorities and with the providers”.   Burstow almost implies that those commissioners, local authorities and care providers never had any responsibility in the past to ensure quality care in care homes.  So what were they commissioning, authorising and providing?  Crap Quality Care in the UK?

Anyone who has ever tried to shake awake either CSCI or CQC and to try to get some kind of dynamic action from them will be in a state of severe shock now.  It has never been possible in the past to get anything that resembles ‘concern’ from CSCI/CQC, so I have little optimism for the future.

Especially as the cuts currently being forced through in local authorities up and down the land will make dynamic localism an empty promise.

But if the plans to abolish councils’ legal duties to provide social care come to fruition, there will be no care homes.  There will be no care.  Social care will be gone into the hands of the private providers, available only to those who can afford to pay the charges of those private providers.  I wonder what it will be called if it becomes a discretionary rather than obligatory provision of care.    Local care?  Discretionary local care?  Survival of the fittest via neglect of the needy?

Is that a civilised way to support vulnerable adults in need of care?  It wouldn’t be allowed if it were cats and dogs we were talking about, so it should not be considered good enough for older people.

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Filed under care, care homes, growing older

Seven Ps for the Vision for Adult Social Care

A while ago, I mentioned the The Seven Ages of Man, and continued the theme with The Seven Stages of Dementia .  Then came the Seven Steps to end the scandal of malnutrition.  I did consider then that the number 7 might be powerful, magnificent even and so would emerge again.

Then, along came The Seven Ps, all listed within The Seven Principles of the Vision for Adult Social Care: Capable Communities and Active Citizens.

Prevention – Personalisation – Partnership – Plurality – Protection – Productivity – People

I now have a vision of the brainstorming session that must have accompanied the conception of The Seven Ps.  A kiss (Keep It Simple, Stupid!) was passed round the room, attracting and enticing members not to overstretch themselves.  The Dictionary of Management-speak was lifted from the bookcase; it fell open to reveal the page of Ps.  The Seven Ps were conceived immaculately, provided with perfect pre-natal care and delivered without pain relief.

The Dalai Lama said that if one’s life is simple, contentment has to come.

It’s somewhat strange to see People at the end of the list of principles, but I’m sure our Coalition writers have their reasons.  Shouldn’t People come first?

There are a few missing Ps, as far as I can see, the first being the paradox.  Is it possible to strip and slash local authority funding and budgets while demanding that local authorities assume responsibility for certain functions that were previously the responsibility of National Government?  It does not make sense.

Creating capable communities is a great idea, but the word capable appears just once in the full text – apart from the title and as a heading on every page – on page 32 Delivering the vision demands a capable and well-trained workforce.

This capable and well-trained workforce has yet to emerge, and may struggle to emerge with all the cuts being in place overnight and without much in the way of consultation by our Con Dem Coalition.  I almost resisted the temptation to mention the lack of mandate given by the Great British Voting Public (the real Big Society – the fictional Big Society remains a mystery to me) to this minority-marriage-of-convenience Government – but that really is another story, another irresistible temptation.

New career pathways will be developed, including more apprenticeships and a new care worker role in home and residential care, as well as more PAs.

Is this yet-to-be-trained capable workforce going to create the capable communities?  Will there be a flurry of independent (for-profit private) providers emerging to provide the training?  Will there be a move to create a genuine career for care workers?  Will there be a decision to pay more than the basic minimum hourly rate of pay so as to attract care workers to care about the work they do?  Or will the private profit preferences prevent progress?  (Sorry, that’s only five Ps.)

Is the capable community to comprise family, friends and neighbours only, with the capable and yet-to-be-trained workforce retreating into the background?   An ever receding professional workforce?  The emphasis throughout the whole Vision is on informal support via kind and caring neighbours, willing and able to provide sufficient support to those in need; a Timebank reminiscent of the bartering of old (not much use to those who are already too frail/old/incapacitated to be able to give the little they can now in return for what they need now!).  Active citizens?

The Royal Borough of Windsor and Maidenhead, one of the four ‘Vanguard Communities’ for Big Society, will test a web-based complementary currency approach for care and support, to assess the potential benefits both in reduced demand for formal care and in people’s quality of life. That might work in Windsor and Maidenhead, but it won’t work where I live!  It may work in many places where an existing community spirit and involvement already exists – but it won’t work in areas where there is no community spirit.  Recent decades have demolished communities in some areas; it could take as many decades to create flourishingly caring communities again.  What happens to the people living with needs who happen to live in those decimated communities?

Personalisation and choice sound great, and both are long overdue.  But I’m not convinced by the plan to increase rapidly the availability of Personal Budgets ‘preferably as Direct Payments’.  Personal Budgets ‘preferably as Direct Payments’ won’t suit everyone in need of care.  They will undoubtedly suit some recipients who have the physical and mental abilities and energies (or the family/friend/neighbourhood support) to become an employer, to research and search for a PA if that’s their wish, to hire and fire (if need be) a care worker/PA, to manage the financial aspects  – and good luck to them.   The Vision might be less rosy for someone with mental capacity problems, such as dementia, and who may not have family/friends to support them.  Can the Vision envisage vulnerable elderly people coping comfortably to set up their own care package?

According to Pulse: patients shun personal health budgets

As for Demos: Personal budgets will revolutionise social care delivery, but only if local authorities are fully prepared

The Charities are changing rapidly, too – so if the reliance on charities increases just when some charities are crumbling, what then?

File on 4 programme on Charity funding and fraud  – grassroots rebellion is underway

Transcript available  if the programme is no longer.

The Oxford Student – ‘tax the rich minority and give to the poor majority’ – is on the right track.  ‘The electorate have sleep-walked into a cannibalisation of public services and welfare that will push Britain back seventy or so years, as £8.1 billion of public spending has been cut.

To the people who voted for the Tories in May, think about this: who paid for the Conservative election campaign? Who bankrolled the triumphalist swagger of these men into Whitehall? Tax evader Lord Ashcroft donated £5.3 million to the Tory campaign. That’s a lot of money, and it doesn’t come without strings attached. Nor does the £1 million donated by hedge fund manager Michael Hintze, whose finance group CQS is based in the Cayman Islands tax haven. Nor still does the £500,000 donated by John Wood, boss of SRM Global, which also has 7 hedge funds registered in the Caymans. These donations makes it difficult to believe that the Tory promise to crack down on tax evasion is anything other than shallow rhetoric. And the fact that the chairman of Care UK, one of Britain’s largest private healthcare providers, donated £21,000 to Health Secretary Andrew Lansley also makes it difficult to believe that the (real term) cuts to the NHS were made in good faith.

Is the Vision the first step towards the privatisation of social care?  The LibConDemolition of the Welfare State, of the NHS, of Social Care?  Who gave permission for that?  Not me.

So, Seven Ps from me to the ConDem Coalition:

Properly procured popular permission prevents public protest.

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Appeal court ruling clears way for councils to cut social care services

This Appeal Court ruling – reported here in The Guardian –  scares the hell out of me.  If this is called ‘care’ then show me the way to go home!  I’m tired of what we now perceive as being a caring way to provide care.

Local councils have been given the green light by the courts to cut social care services to elderly and disabled people previously assessed by law as needing them.

In a test case involving care support for a woman who was one of Britain’s leading ballerinas, the appeal court ruled that Kensington and Chelsea council in west London acted lawfully and reasonably in withdrawing some services to save money.

The judgment could affect services to hundreds of thousands of vulnerable adults, including care at home, meals-on-wheels, escorted transport and places at day centres.

Luke Clements, professor of law at Cardiff University and a leading expert on care legislation, described the judgment as “chilling”. He said: “There are two problems with this approach: one, a narrow legal one and the other that it is an indictment of any society that lays claim to be civilised.”

We should take no comfort from this cost-cutting undignified uncaring careless care.  If we do, then we have definitely lost any way to claim to be civilised.

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