Downsizing, Ageism and Housing

There has been much discussion following the publication of a report by the Intergenerational Foundation called ‘Hoarding of Housing : The intergenerational crisis in the Housing Market’.

Perhaps a deliberately provocative title was chosen for the report (no, I’m not completely naive in terms of creating press interest!) and there were the requisite reports  and comment pieces written about ‘Baby Boomers’ who are hoarding homes (via the Guardian) which concludes

As the foundation says, they need to be discouraged from hoarding and made to realise that someone further down the generational chain is suffering as a consequence.

Maybe these property owning,  middle class ‘hoarders’ exist in different worlds from the one that I occupy but I didn’t see that as the main issue with housing in this country. It is not necessarily a like for like swapping of those with property to those without. I also worry about the bitterness with which some of the commentary has been based and that there is an attempt, even in the name of the report, to build an ‘us’ versus ‘them’ type situation where in order for older people with the value in their property to be ‘winners’ there has to be a ‘loser’ – the younger adults trying to build families in smaller houses.

The  failing is not on the older people who live in homes that are, after all, their own homes,  but more the way the housing market has behaved over the last couple of decades.

It’s Mother’s Work posts a great blogpost  on the topic explaining and illustrating some of the undertones to this debate including the difference in the way the government considers under occupancy of social housing as opposed to that of private housing and then those second home owners.

That’s an important issue as the government will increasingly use the ‘benefits’ system to force people to give up rooms that are not needed but this report refers as well to home owners.

The housing market is biased and unbalanced but to place the blame at the door of those who are older and try and use sometimes not terribly masked ageism to force guilt is not, I don’t think the answer.

The large houses which it is proposed that older people move out of will likely be unaffordable for most people with young families. It is hardly likely to be an equivalent swap. The problem is that the cost of housing has risen at such an astronomical level that it is out of the reaches of many who did not jump on the proverbial ‘ladder’ at the right time.

Looking at the report itself, beyond the title and the headlines, there are some  interesting proposals like the abolition of universal benefits for those who live in housing which is valued over £500,000 or taxing the value of property but I would see practical difficulties with that.

I work in an area where housing costs are high and have definitely come across older people who would might be property rich but cash poor who would be terribly affected by these sorts of moves. It is possible to be ‘property rich’ through not thoughts of ‘hoarding’ but just by living in a house whose value has increased due to the location and style and to force someone away from their community due to the cost of their property feels uncomfortable to me.

I do think that more should be done to protect tenants. Short term assured tenancies tend to favour the landlord and the goal of ‘home ownership’ only exists because it is the only possibility of a secure tenure apart from increasingly rare social housing tenancies which are increasingly targeted by the government now – making them less secure.

I have a toe on the ‘housing ladder’ in the sense that I live in a ‘shared ownership’ property. Was I particularly bothered about owning a home? No, not really, but I made this move solely because I had been moved and shifted around by landlords and just wanted to live somewhere where I wouldn’t be asked to leave with a couple of months notice.

I certainly didn’t buy to invest or to rent. More social housing would be an obvious solution, as would longer term and more secure lets but the government doesn’t seem to want to consider that as a possibility. Their proposal of the extension of the ‘right to buy’ scheme seems more than wrong-footed by pushing more to property ownership rather than looking at making longer term tenancies more secure.

We have allowed ‘buy to let’ landlords to make millions on the property market and perhaps the government has no wish to tackle this group head-on to affect their profits but I think that’s the way I’d prefer policy making to go after all, if we look at the Southern Cross debacle, it’s worth remembering that it was an empire built on the value of the property rather than the value of the people who lived inside the homes.

Guilting older adults into feeling they are depriving the younger generation – well, it leaves me with a nasty taste of ageism.

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Meanwhile..

While Z has been writing up the fantastic post about the Mind New Media awards, I’ve also been busy.

As well as contributing to the new College of Social Work blog here I’ve also written up ‘how I became an AMHP’ for the Guardian Social Care Network and have written a guest post on a new blog ‘Connecting Social Care and Social Media’ here about why I think social workers should use social media.

And while I’m at it, a heads up and thanks to Max Neill who included this site in  his Carnival of Personalisation in Health and Social Care which is an interesting link to a wide range of sites that relate to the issue of changing delivery of services in Adult Social Care and increasingly Health services.

Personalisation , Personal Budgets and Demos

I have a lot of thoughts on the push towards the personalisation agenda in general, unsurprisingly as care and support planning plays a large role in my job.

Over the last week, a variety of meetings that have taken place which have pushed this issue to the forefront of my mind locally and have given me time to pause and think, not only about the focus of the agenda and where we are along the path but also where we are going.

It has been frustrating. As I noticed in a Twitter-related conversation yesterday, the language almost seems to have a form of it’s own. I start mentioning PBs, IBs, SDS, RAS, ISF, SSAQ, DP (see Glossary below)  assuming the person beyond knows exactly what I mean in each of those circumstances and you realise how over-complicated what should be a fundamental principal about putting the keys to the power dynamic into the hands of those who use the services.

Rumbling in the background is the government agenda to push personal budgets (PB) as a way to deliver ‘personalised’ care and a push into ‘health budgets’. I think there have been a number of issues that have either not been addressed or pushed under the proverbial carpet in the meantime.

I have tried to express some of my frustrations internally but often came up against the ‘you are either for us or against us’ mentality to those promoting the push towards personal budgets for all at any cost – so by raising criticisms and concerns, that automatically seemed to push me into the ‘controlling professional’ category who obviously just didn’t want to relinquish what I saw as my ‘right’ to dictate forms of care to service users and carers. I dispute that of course. I was one of the few care managers who actively moved many people onto direct payments historically. I am very well aware of the benefits of direct payments but the move towards direct payments for all I felt, was pushed by a few particular groups of people and I was concerned that it was moving the universality of self-directed support away from a large group of people I work with who do not want direct payments regardless of how much support is offered.

I was delighted to read over the past day or so, a report by Claudia Wood called Tailor Made – it’s a long document and my reading has so far been on a superficial level (warning – um. if you are going to print it out  be aware that it’s.. er.. well over 200 pages.. )

It is a document that almost made me cry with joy because it addresses in a more coherent and less histrionic way than I have, exactly my concerns about the way the personalisation agenda has been couched while remaining (as I am) absolutely positive about the process and idea.

We have been too fixated (and Paul Burstow is guiltiest of this) of pushing personal budgets delivered through direct payments as the ‘gold standard’ option of providing self-directed support.

As Wood says in the executive summary

‘The emphasis placed on direct payments as a primary form of personal budget is too restrictive and risks excluding large numbers of people who do not have the capacity or desire to use a direct payment. No one should be excluded from having a personal budget if they wish , but to make personal budgets as accessible as possible for all groups and in all care contexts, we need to think beyond direct payments as the only, or even the preferred, form of personal budget’

For me, Wood expresses clearly my own thinking on this matter. So much energy has nationally focussed solely on direct payments as a delivery mechanism (which is fantastic for some) that local authority managed budgets have become a second-best, second-class service and ‘transferring’ support from standard support to a ‘so-called’ personal budget managed by the local authority has been a fallacy and a lesson in tick box culture at its worst. The issue is that it is  social workers, yes, like me, who have been complicit in this deception. I tick a few boxes and automatically Mr Smith has a personal budget managed by the LA where previously he had a directly provided care package. The delivery is the same service, by the same people in the same way,  but now, after these boxes have been ticked (because he expressly does not want a direct payment) – he is suddenly on the local authority ‘figures’ as having a managed personal budget.

Whereas Mr Brown next door, who has a service of the same cost but a direct payment, is able to access a personally chosen personal assistant and goes to a sports centre instead of a day centre etc etc.

This seems inherently wrong but it is merely because the managed support is so poorly serving Mr Smith. The answer isn’t to give Mr Smith a direct payment because – and this is the issue that Burstow seems to ignore – he doesn’t actually want it.

Wood writes

‘Local authority commissioners… must.. scrutinise their ‘managed budgets’ processes, to ensure they deliver choice and control and are not part of a tick box exercise’

Finally, it feels that someone ‘out there’ is listening to our worries and genuine concerns about a system that seems to have been designed to deliver inequity.

She goes on to say

‘An inclusive personal budget strategy is… one where more innovative uses of personal budgets are developed’

And that, I think is the key. We have had direct payments for a long, long term. Where the real innovation is needed is on pushing out new ways of delivering personalised care within the context of managed budgets.

Wood helpfully specifies the different ways that personal budgets can be used saying

‘There are six forms of personal budget used in social care in England

– a direct payment (held by individual)

– an indirect payment (held by a trusted other – eg a friend of family)

– a trust fund (held by a trust of people)

– a brokered fund (held by a professional broker)

– an individual service fund (held by a provider)

– a care managed fund (held by local commissioners) ‘

and then goes on to say

‘There is a danger.. that as the Scottish and English governments focus on direct payments as the default and preferred modus operandi for personal budgets (in social care at least), people may assume these other forms of personal budget are not capable of ‘real’ personalisation.

This can become a self-fulfilling prophecy, with providers spending less time developing their systems for these other forms of personal budget and them becoming tokenistic forms of personal budget, which do not offer real control’

If Claudia Wood were in the same room as me, I would applaud her. THAT for me is the crucial point in all of this. I want to deliver more personalised services but the only tools I have been given within my local authority are direct payments (or indirect payments)  or care managed fund. All these other options have been theoretical and none have developed any flexibility.

I want to see as much effort nationally in developing new ways of delivering services through all these methods and I want Burstow to at least read this report to have an understanding about why he seems to be fixated on the ‘direct payment or bust’ preferred model.

Of course, when it works, it is fantastic but we need more work on the other models too to ensure an equitable system for all needing care.

As for the report, there is so  much more in it than I’ve touched on about personalisation in residential care particularly. If you have any interest in the subject read it.

GLOSSARY

PB – Personal Budget (delivered by social care – (or health in the future)

IB – Individual Budget (envisaged to include different income streams eg health + social care budget)

SDS – Self Directed Support

RAS – Resource Allocation System (‘points’ that are translated into cash to make an ‘indicative budget’ after an assessment)

ISF – Individual Service Fund where a provider holds the budget on behalf of a service user

SSAQ – Supported Self Assessment Questionnaire – the way that needs are often assessed initially.

DP – Direct Payment

Support or Social Control?

Communities Secretary Eric Pickles’ announcement that he’s going to focus on ‘troubled families’ had a slightly familiar ring to it. It smacks of an attempt to co-opt health and social care agencies into getting those who are a nuisance to behave themselves.

In Child and Adolescent Mental Health Services (CAMHS) we’ve been here before. Pickles’ ‘troubled families unit’ reminds me of the recent fad for anger management classes.

You all know the scene. The violent husband is confronted on the TV chat show. The audience boos. The host gives him a long spiel about how he needs to change. The wife nods patiently. Then the host offers him the chance to save his marriage by signing up for anger management with the show’s in-house psychologist. The husband gratefully agrees, the audience cheers and the credits roll.

What happens next? Quite possibly he goes along to six sessions of anger management, dutifully completes them…and then goes back to merrily knocking seven bells out of his wife.

In CAMHS we keep getting requests for anger management from parents, GPs, teachers and social workers, because a child “has an anger problem”. Anger management came into vogue a few years ago, and I can see why it’s attractive – especially to policymakers. Disruption in the classroom? Youth offending? Antisocial behaviour? Not to worry, it can all be therapied away in 6 sessions. I’ve no doubt that if I spent a while on Google Scholar I could come up with a few research papers to say that anger management is an effective, evidence-based intervention for children.

But here’s the problem. Of all the kids I’ve seen who’ve been sent for anger management, I’ve been struck by how many of them have actually benefited from it.

None of them.

A lot of anger management classes are, quite frankly, a bit dire. They talk about the causes of anger, the fight-or-flight response, about breathing techniques and distraction. All too often, what they don’t ask is, “Why is this child angry?”

Children usually don’t become automatically angry. More likely, something has made them angry. Abuse, trauma, neglect, being in an environment where anger is a default way of expressing emotion. Labelling the child as having “an anger problem” ignores the wider context.

Worse, it can reinforce child-blaming. Sending the child for anger management can give out the message from services, “Yes, we agree. The child is the problem. He’s the bad one, it’s his fault and he needs to go away and sort out the problem.” I’ve seen kids attend an anger management class, and then be handed back to their parents, who start bellowing and swearing at him before they’ve even left the reception. Those parents are the first to us that we’re rubbish, because we still haven’t sorted out their kids “anger problem”. Often they tell us this while going into a long, loud tirade about what a terrible kid he is, while jabbing an accusing finger in his direction.

Anger management not only ignores the wider context, it also focuses on one particular emotion at the expense of others. An angry child is usually a distressed child. Anger just happens to be the problem that others (parents, teachers etc) want dealt with, because they want the child to behave. Others may say that the kid has an anger problem. The kid might just feel he has a problem. Or indeed, a world of problems.

No doubt the ‘troubled families’ that Pickles wants to target will also have a world of problems. He’s even kind enough to list them.

A family with multiple problems has been defined by the cabinet office as “no parent in the family is in work; the family lives in poor quality or overcrowded housing; no parent has any qualifications; the mother has mental health problems; at least one parent has a long-standing limiting illness, disability or infirmity; the family has low income (below 60% of the median); or the family cannot afford a number of food and clothing items”.

So, does Pickles envisage these families getting a comprehensive package of support, or some politically-attractive non-solution like anger management? Here’s a clue.

Pickles revealed a single problem, or troubled, family can cost the state up to £300,000 a year and predicted this figure can be cut by £70,000 annually simply by reducing the number of agencies involved.

Some of these families can be involved with the local authority, schools bodies, drug and alcohol services, the police and an array of social service departments. Pickles claimed less than 1% of the population can cost the economy over £8m a year.

Well, I’ve certainly come across cases of “agency overload” where too many professionals have become involved with a family, but are we supposed to say that if a child goes to CAMHS they can’t also go to, say, a young carer service? If not, what on earth is multi-agency working for?

So, to summarise, the message from Pickles is, “We’re cutting back the support you guys offer. Oh, and at the same time, we also expect you to sort out the stuff that gets voters irate.”

Pickles and ‘Troubled Families’

An article that appeared in the Guardian on Monday has been playing on my mind for a couple of days. Eric Pickles the Secretary of State for Communities and Local Government (who incidentally seems dead set on destroying both) wants to tackle what he calls ‘troubled families’ or more importantly perhaps, he wants to streamline the amount they ‘cost’ the state.

Louise Casey has been appointed as a ‘Tsar’ to oversee a ‘troubled families’ unit which sounds like some kind of Stalinist initiative.

Not that I don’t want people who need help to get help in the most cost effective and streamlined way but there are a few issues on which I would challenge Pickles and the government. Firstly the direct correlation that they seem to draw between the riots in the summer and particular familial issues.

The government really need to make their mind up about what they perceive to be the reasons for the riots. Personally I think they are oversimplifying to the nth degree and trying to ostracise and target particular social groups. Yes, gangs may have been an element but the reasons the riots spread has to be taken much more broadly than that. The subsequent arrests show the age ranges were not necessarily concentrated around ‘youth’ and the class base of those pillaging the country is much broader than these ‘troubled’ families if you include the political classes who continue to twist rules (re: Liam Fox) and virtually ravage public services (NHS) just as those on the street looted the electronics stores.

There are broader issues which have created a ‘must have’ society and it is not only the so-called ‘troubled families’ and ‘gangs’ that need to be tackled but the corruptions at the heart of the political elite that create an ‘us versus them’ attitude to rule and one which is not helped by highlighting those who are ‘troubled’ and targetting them.

Back to Pickles though, the article quotes him as saying

“the common refrain was where are the parents? Why aren’t they keeping their kids indoors? Why weren’t they with them in court? The whole country got a sudden, unwelcome insight into our problem families. The ones that make misery in their communities and cause misery to themselves.”

What Pickles fails to appreciate is that ‘the country’ got in welcome insight in the summer to far more than these ‘problem families’. We got an insight into the way that our society has developed a materialistic and opportunist streak that is by no means confined to the ‘less than 1% of the population’.

Indeed, it was the willingness of those who are  not in this particular group of ‘troubled families’ to join the general lawlessness and looting that was the real social issue evidence in the aftermath of the rioting.

So what is a ‘troubled family’?

A family with multiple problems has been defined by the cabinet office as “no parent in the family is in work; the family lives in poor quality or overcrowded housing; no parent has any qualifications; the mother has mental health problems; at least one parent has a long-standing limiting illness, disability or infirmity; the family has low income (below 60% of the median); or the family cannot afford a number of food and clothing items”.

Let’s see. Unemployment, poor housing, poor education.. oh look, mental health has been thrown in there too to add to the stigma as well as disability and low income. Hmm. That is a ‘problem’ family. Well, has it ever occured to the government that removing access to a comprehensive and supportive benefit system and social housing and decent education might actually cause some of these compounded ‘troubles’  rather than tackling the so-called ‘troubled’ families that arise from these social and financial circumstances.

Surely the proverbial ‘prevention is better than cure’ maxim applies? In which case, why doesn’t the government tackle the issues behind poverty rather than exacerbating them and marginalising and stigmatising poverty and the effects of poverty by dismissing families who grow up with these issues as ‘troubled’.

Labelling hurts. Labelling by a government is pure discrimination and playing politics with peoples’ lives is worse yet.

Troubled maybe, but troubled to whom?

I don’t say these families should not receive further help. Of course they should but they should on the basis of the poor housing, low incomes and ill-health rather than because they are ‘problems’.

Who created these problems and how can they be solved? That should be what the government is asking. How can we build a society with a sufficient and appropriate safety net than creates real community and doesn’t destroy localities and local services. The government cannot absolve itself from all social projects and social services by laying the blame on the ‘troubled families’ line without accepting responsibility.

Or maybe they can but we shouldn’t allow their narrative to become the predominant one.

Not Being Richard Littlejohn Therapy

A few days ago I read this deeply skeptical article about dolphin therapy.

I’ve lost track how many times my disabled daughter has been offered a swim with a dolphin. While disabled people struggle to get a hoist or a few hours’ home help, numerous charities will fly them to Florida to experience the miraculous feeling of frolicking in the water with a friend of Flipper. According to organisations that sell such snake oil, “dolphin therapy” alleviates a wide range of disabilities, from increasing the attention span of a child with attention deficit disorder to curing paralysis.

I must admit swimming with a dolphin sounds like fun, though conservationists point out that it can be less fun for the actual dolphin. Even so, the idea that it can cure your ADHD sounds a little dubious.

“Therapy” is quite a nebulous word that can mean anything and nothing. You can be a beauty therapist, an occupational therapist, a drama therapist…apparently even a dolphin therapist. Even something more formal-sounding like “psychotherapist” can mean anything from a highly skilled professional who’s completed a long, arduous postgraduate training down to some utter woo-peddler with a crystal pyramid. As I’ve previously pointed out the government is currently watering down plans to regulate psychotherapists in the same way as doctors, nurses and social workers. Instead they’re going for “assured voluntary regulation” which will at least give some form of quality kitemark, but will allow the quacks and charlatans to carry on practising.

But, you know what? If you can’t beat ’em, join ’em. I’m fed up with banging the drum for proper therapy regulation. There’s a recession on and I need some ready cash. So, here’s my very own therapy, for which I’ll be promoting a book and a lecture tour. Some impressive-looking research papers will be doodled out, showing an improvement in psychological and social functioning based on an assessment scale that I scribbled on my lunch break.

I hereby announce the launch of At Least You’re Not Him Therapy.

Clients will be taken through a series of activities to enter into the psyche of Richard Littlejohn. They’ll be asked to read through his regular Daily Mail columns. There’ll be readings from his magnum opus To Hell in a Handcart. The client is then taken through a guided visualisation, where they are asked to imagine walking down a street convinced of being surrounded by communists, “pooves”, liberals and immigrants – all of them intent on destroying everything that is decent and wholesome. Finally, they’ll be brought back to their own world with a nice soothing mug of lorazepam, and gently reassured that, whatever their current difficulties and failings, they are at least Not Richard Littlejohn.

“Wow, that put it all into perspective for me! Now that I’ve realised I don’t live in a mindset based purely on malice and fear of the other, I feel so much better about having been done for fiddling my expenses!”
– Some Celebrity You Haven’t Cared A Monkeys About Since 1997

A sequel to the book will follow at a later date. Possibly when sales of the first book are dwindling. For clients with deep-rooted, intractable problems, there will be supplementary modules in Not Being Robert Kilroy-Silk, Not Being Nadine Dorries MP and Not Being George Galloway.