Shifts in Support Planning

Pen and Paper (1024)
Community Care alerted me to a new report developed about a great model of support planning  called ‘Empower and Enable’  that is being proposed as a way to invigorate the ‘personalisation’ agenda and move it back to the roots of putting the user at the heart of support planning and removing this from the scope of professionals.

In the process of developing and implementing care currently, after the assessment has been fed through the ‘resource allocation system’ and an indicative budget has been established – the ‘support planning’ comes in to build, yes, you guessed it, a ‘support plan’ which would be what might have been called a ‘care plan’ in the past and details how that support will be delivered for the individual to whom it relates.

Groundswell  Partnership , the ‘personalisation consultancy’  who wrote it, explain that councils should change their models of support planning and move the focus back towards the users of the services provided.

I couldn’t possibly agree more. This is what we were told when the whole personalisation agenda was moved out and I can’t honestly see what’s different apart from the lack of roll out to wider groups than those that  benefited from direct payments. This was the ethos behind rolling  ‘personalisation’ out beyond those who were receiving direct payments previously to everyone in general.

The model presented is one of ensuring that information is more freely available and that ‘professionals’ don’t need to take hold of support planning. It  talks about shedding the ‘belief’ that professional support is necessary to enable support planning. Absolutely right.   I would counter that councils have been trying to move away from professional support for support planning as it is more expensive but are too slow to change and stuck in systems of commissioning and getting services ‘approved’ to have moved quickly enough on this.

Currently, I am deeply concerned that the level of access to support and different kinds of support can be based on the particular social worker or care coordinator allocated in terms of our own knowledge of available services – particularly as regards managed personal budgets. I agree that the way around this is to make as  much information about resources and services open access – including costs and deductions and details of block contracts and how they are delivered,  so that anyone and everyone can have equal knowledge.

I love the idea that support planning should take time but there needs to be some thought to the more immediate support planning that might take place in a crisis situation and looking at how that can feed into these models and look at ways that people can – as far as possible – build in contingencies and forward planning into the current support plans.

The report also talks about building on community capacity to provide support and support planning. Wonderful. Truly wonderful but it fails to tackle those who are excluded by the communities in which they live. Working with a number of people who may lack capacity to manage their own support planning, lack informal support and are isolated or excluded by their community, I often wonder when a realistic report is going to tackle this issue properly – rather than a sentence saying ‘some people may need professional support’.  Maybe it needs it’s own report. I’d love to see that. Honestly. I want to cheer these reports as they flow out of the ‘personalisation consultancies’ and I often do but I need to see some innovative thinking that looks at the realities I face daily.

I would counter that ‘these people’ who lack capacity require independent advocacy on top of professional support. Relying on a social worker for support planning, particularly in work with older adults where the case loads and expectations regarding quantity of work undertaken is particularly high, is absolutely going to  produce a poorer quality support plan. I don’t think anyone is denying that – including the local authority employers – I suspect they would love to tender out this role however the clunky nature of contracting and commissioning makes this slow moving.

I know I put together some poor support plans myself. It doesn’t make me proud. I don’t go to work thinking to myself ‘today I’m doing to produce a poor support plan and I’m not going to ask Mrs Brown or her family about what she actually wants’. I try to consult but the time needed is squeezed. I try to engage family and friends, but you know, believe it or not, some families or friends actually don’t want to be actively involved and some people don’t have family and friends.

These reports are fantastic. We need more. We need more reports to explain why we are doing a poor job about providing support planning.

But what we also need are properly assessed and arranged targets set to local authorities that demand involvement by users in more than a peripheral box ticking way.

We need resources to provide effective and independent advocacy which will allow for equality of access to innovative support planning tools for those who are not able to independently access them for themselves.

My own dream was to break free from the LA yoke and establish some kind of local social enterprise type organisation that would be able to offer dual support planning and non-directed advocacy for those who lack capacity to produce really good support plans and support networks to fill in the gaps for those who don’t have the informal networks or whose family want to support and help but might not be able to to the extent expected sometimes.

If anyone wants to fund me or pay my salary while I do that, please do let me know.

There are better ways. I’m sure of it. While I enjoyed reading the report as it is,  my brain was buzzing about how this model could work with the people I see every day – I’m still waiting for a report to deal with that. And if noone will fund my little social enterprise project, perhaps they could commission me to write report – for myself – about ways it could work better.

But I don’t think I can promise what these reports promise – which is zero cost.

And possibly that’s the key.

KM v Cambridgeshire: the Supreme Court’s decision is not about assessment

“I’m just hoping that after tomorrow the link between value of cash payment and cost of meeting need is not utterly broken!”

…I tweeted yesterday, contributing to a debate about our hopes and expectations for today’s Supreme Court ruling in KM, R (on the application of) v Cambridgeshire County Council 2012] UKSC 23 (31 May 2012). This blog is about that case. I’m pleased to say that my hopes have been fulfilled. But I had set my sights low. I am utterly bemused by some of the other claims being made for this judgement.

Community Care: three key questions

Adult Community Care issues can generally be boiled down to three questions:

  • Assessment: deciding what needs should be met
  • Funding: deciding who is going to contribute what to the cost
  • Delivery: deciding how the needs are going to be met

The KM case was about direct payments, so where do direct payments fall to be considered? Answering that question is key to understanding this judgement. Although direct payments involve the flow of money between local authority and service user, they are not about how the package is funded. And although there are tools to determine how much a direct payment should be, these need have little to do with assessment of eligible need. Direct payments are, pure and simple, one of a number of ways of delivering a service.

What the Supreme Court said about assessment

To be fair, the Supreme Court said a fair bit about how to assess eligible need:

  • It set out the legal framework (paragraph 11ff);
  • It affirmed that the statutory guidance ‘Prioritising Need in the Context of Putting People First’ gets the framework right (paragraph 16);
  • It reaffirmed that once a local authority has determined eligible need, it must meet that need (paragraph 21);
  • It decided not to revisit the case of Barry, which held that resources could taken into account during the assessment process (paragraph 43);
  • It decided that the assessment of eligible need in KM’s case was not irrational (paragraph 38).

What the Supreme Court did not do is say anything new. It certainly said nothing that would turn a previously ineligible need into an eligible need. And therefore it said nothing that would turn someone who was previously ineligible into someone who is elible.

And therefore I am bemused by the Guardian headline, ‘Court ruling means thousands more disabled people could get access to care‘.

Where the RAS fits in: service delivery

Roughly, local authorities have three possible approaches to delivering the services to meet eligible need. One is to deliver it directly. One is to commission someone else to deliver it. And one is to allow the service user to commission services themselves.

It is here that the RAS fits in. Essentially, the RAS is a tool used in the process of converting eligible need into a cash value, so that the service can be delivered in cash instead of in kind.

Though this is hardly a secret, I am very cynical abut the RAS. Not only is it a tool used to convert eligible need into a cash value, but it is used to obscure the process. In theory, there is a scientific basis. The RAS uses an algorithm. According to that reputable source, Wikipedia,

“Algorithms are essential to the way computers process data. Many computer programs contain algorithms that detail the specific instructions a computer should perform (in a specific order) to carry out a specified task… Thus, an algorithm can be considered to be any sequence of operations that can be simulated by a Turing-complete system.”

Sounds scientific? But according to Luke Clements (2011) ‘A Sideways Look at Personalisation and Tightening Eligibility Criteria’ in Elder Law 1 pp47-52, along the way, “any science in the process is jettisoned in favour of witchcraft.” The computer does the sums, but what the end result has to do with the original assessment of need is anyone’s guess.

Remember, there are two other ways of delivering services. They can be delivered directly, in which case the local authority must have a fairly good idea how the service delivery meets the eligible need. Or the local authority can commission directly, in which case it will also know how much it costs to meet the eligible need.

It is ironically only when the service user is commissioning their own services that the algorithm – or witchcraft – which obscures the link between the eligible need and the cost of meeting it comes into its own.

Back to KM v Cambridgeshire

KM had his needs assessed. He was seeking direct payments to meet those needs. He has considerable disabilities. Cambridgeshire used the RAS, then another algorithm called the Upper Banding Calculator. Then it jiggled about with the figures a little bit more. Ultimately he was offered £85,000 per annum. But he thought he should get £157,000 per year.

That is a big difference. But was the dispute about what his needs were (i.e. the assessment), or was it about what it would cost to meet them (i.e. the service delivery)?

Here’s the simple answer: Cambridgeshire was so effective at obscuring its decision making process that KM couldn’t tell what the dispute was about. The Supreme Court criticizes Cambridgeshire for three things:

  • Failing to be open about its assessment of the mother’s contribution to care (paragraph 30);
  • Failing to be open about its rejection of the independent social worker’s assessment (paragraph 34); and
  • Failing to explain how it arrived at its own sum (paragraph 35)

It would be correct to characterize this case as being ultimately about transparency and not about assessment or resources.

So is the case good news for service users at all?

A brief history of transparency

Having dismissed the notion that thousands will become eligible, having highlighted that the case says nothing new about assessment, having said ultimately it was just about transparency, is it just a storm in a teacup?

No! It is well worth remembering where we were at before:

In Savva, R (on the application of) v Royal Borough of Kensington and Chelsea [2010] EWHC 414 (Admin) (11 March 2010), the high court upheld the principle of transparency:

“without being able to properly understand the use made of the RAS, the service user and anyone acting on her behalf, is left totally in the dark as to whether the monetary value… is adequate to meet the assessed need… The process of conversion made by the Panel is not explained to the service user. It should have been underpinned by an evidential base, and it was not.”

And as I commented at the time,

“What is being said is that there is a duty to give effect to the rhetoric, and actually demonstrate how the cash payment is adequate to meet assessed need. If the duty to give reasons goes that far, it may help to ensure that the cash payments actually do link to assessed need. Which in turn may undermine the approach of ‘Points mean Prizes’, and defer the day when a computer programme completely replaces the social worker.”

The judgements in KM’s case in both the High Court and the Court of Appeal below were bad news for transparency, and therefore bad news for anyone like me who wants a link between the cost of meeting need and the value of the cash payment. In KM, R (on the application of) v Cambridgeshire County Council [2010] EWHC 3065 (Admin) (26 November 2010), the Court said this:

“[The Claimant] criticises the Defendant for failing to provide an explanation setting out the services required to meet the Claimant’s needs. That appears to me to be a complete misunderstanding of the system of self-directed support. Both the RAS and the Upper Banding Calculator, compared as they were with the assessment and operated using the skill and experience of social workers, were assessment of needs and not services but the RAS was a tool for translating needs into a sum which was adequate to provide the services for those needs by reference to the average costs of the provision by the authority of meeting those needs for other disabled people.”

Upholding this decision last year, in KM, R (on the application of) v Cambridgeshire County Council [2011] EWCA Civ 682 (09 June 2011), the Court of Appeal observed that, “There does not need to be a finite absolute mathematical link” between payment and need.

In short, the history of this case is a history of judicial approval of algorithms and witchcraft, of obfuscation and lack of transparency. The beauty of today’s ruling, the reason I can consider it a victory, is that it reaffirms Savva on the need for transparency. Particularly poignant is the observation in paragraph 36:

“that a local authority’s failure to meet eligible needs may prove to be far less visible in circumstances in which it has provided the service-user with a global sum of money than in those in which it has provided him with services in kind. That point fortifies the need for close scrutiny of the lawfulness of a monetary offer.”

Or to put it another way, it is concerning that it is too easy to use direct payments to obscure potentially unlawful cuts that would be quite obvious if they were delivered or commissioned directly.

The RAS should still go!

The RAS has survived another level of challenge, see paragraph 26. But I still think it should go.

The argument in defence of the RAS in paragraph 24 of the judgement is:

“To set about costing each of the services identified in answer to the question at the [eligible need] stage upon, as it were, a blank sheet of paper would be unacceptably laborious and expensive. So a mechanism has been devised in order to give the exercise a kick-start. It is called a Resource Allocation System (a “RAS”); and many authorities, including Cambridgeshire, have developed one for their own use.”

I am resolutely unconvinced. If we can cost the services to meet the needs on a blank sheet of paper when we need to commission them, then we can cost them on a blank sheet of paper when the service user is going to commission them.

If the RAS is only “the generator of a “ball-park” figure, subject to adjustment up or down” (paragraph 26), then it is a wholly unnecessary extra step rather than a kick start to the calculation.

This is the heart of my concern. Arriving at a cash value of need by generating the starting figure by computer and the final figure by magic is not the most simple way of doing it, it is the most complicated. @TheSmallPlaces has shown in a series of blogs how local authorities actually value the complexity of the process:

In this, the Supreme Court got it wrong. It was right to approve clear and transparent reasons. It was wrong to approve the RAS as simplifying the process. The RAS is the very antithesis of clear and transparent reasons. In this case, it helped to obscure not only the reason for the sum itself, but also disputes about the assessment. It should go.

Allan Norman (@CelticKnotTweet) is a registered social worker and a solicitor at Celtic Knot – Solicitors and Social Workers.

The Costs of Home Care

Today, the Guardian published an article about the inequitable costs of home care services throughout England and the shrinking of access to council-paid support for care in the home.

The article refers to a survey and report comprised of a number of Freedom of Information requests. It says

The survey, seen by the Guardian, shows the average charge for an hour of home care has risen by 10% in the past two years – from £12.29 to £13.61.

Also stating

…there are wide disparities in the price people pay for care depending on their location. Home care, for example, is free in Tower Hamlets but costs £21.50 an hour in Brighton and Hove.

The data show that fewer older people – in excess of 7,000 – had their care services fully paid for by a local authority in 2011 a reduction of 11% compared to 2009.

This certainly reflects my experience in practice. There are a number of concerns that result from this report which merely confirms what everyone in the sector knows.

Eligibility criteria are moving upwards.

If we look at the Fair Access to Care Services which are the supposed ‘standardised’ entry point to ‘care provision’ in local authorities – the lower ‘access’ point has moved higher. From moderate needs being ‘covered’ more local authorities are moving to only allowing ‘substantial’ or ‘critical’ needs to be covered. This moves a lot of the preventative work away from local authority provision.

This has a significant impact on the manner which personal budgets are implemented. A lot of the leisure type activities we see as examples are being pushed out in favour of budgets which are strictly intended to meet immediate personal care needs. Options for choice are much more limited in this context, particularly if a person does not have support around them.

More people refusing care on the basis of cost

This is something I’m seeing much more as my own council has increased the costs of care. More people whom I assess as needing care are refusing it or refusing discharge from hospital solely on the issue of cost of care. There may be an assumption that ‘working hard all my life’ means that social care provision will be free in the future but it’s very hard to argue the value of a personal budget at (for example) £10 per hour when the charge will be £10 per hour. It is counter-intuitive and yet by bypassing the local authority ‘processes’ there is potential support that can be lost in terms of assistance in recruitment of staff/tax related issues. We are forcing more ‘cash in hand’ work sourced via Gumtree or notes in the newsagent windows.

Longer term costs as people supported at home less

This also means that people remain at home without the support if they do not wish to pay for it and the potential for much higher costs will come at a later point. Either through preventable or delayable hospital admissions or by admission to residential care sooner than might have otherwise been necessary.  Seems obvious but I see it happening every day. We can’t ‘force’ care on anyone (putting the capacity issue aside for one moment) and if someone is adamant they don’t wish to pay for care which is assessed as being needed, we just sit on our collective hands and wait for things to deteriorate –by which case, it may be too late.

Personal budgets and the ‘personalisation’ agenda.

I’ve mentioned some of the counterintuitive ways that services can cost as much as they are charged for – that’s particularly evident if we are considering a direct payment. There’s another problem with the implementation of the systems of ‘personalisation’ as they exist in reality. We were told initially it was intended to be a shift in ‘power’ from professional to user – which is fantastic – however the reality is often far from that. Assessment forms look similar (and ask similar questions in similar formats) to DLA application forms and focus heavily on physical rather than mental health needs.

The RAS (resource allocation system) pushes these assessments through an accountancy system which is non-transparent and spits out an ‘indicative budget’ based on a number of often unknown factors. So you get more money according to lack of ability to do things which perpetuates a top down model which doesn’t build on strengths of what someone CAN do – rather what they CAN’T do.

This process is convoluted and opaque. However well explained, sometimes people want good services delivered. Choice is only choice when it’s actually offers options. Seems obvious but it isn’t the reality.

Commissioning decisions

I am sad to say when I arrange support via a managed personal budget, I can’t necessarily guarantee quality of care to the user. We use agencies that have won their tenders for the contracts with the council purely on the basis of cost rather than quality. There may be carers rushing in and out on minimum wage without being paid travel time, between 30 min visits in disparate geographical locations. Is it any wonder that people are refusing these kinds of services when we can’t guarantee consistency or quality of support. There are some fantastic care workers. Really, they are gems but it can be hit and miss because the way that costs are being driven down mean the agencies cut costs at every moment. We aren’t delivering value for money.

This shrinking of provisioned support for older adults and people with disabilities will lead to much higher long term care costs both with costs shifting to health care services as people are admitted sooner into hospitals and care costs as residential care becomes an option sooner. In some ways, more importantly, it will and does lead to a reduction in independence and quality of life which is much more important and can’t have a price put on it.

The Queen’s Speech and Adult Social Care

The Queen at the State Opening 2009

I was expecting little from the Queen’s Speech in relation to adult social care and I was exactly right in my assumption.

The one line

‘A draft bill will be published to modernise adult care and support in England’ made my heart sink from the outset.

‘Modernise’ is one of those words that could mean anything. Sure enough the details followed.

The Department of Health website expands on that sentence.

The main elements of the draft Bill are:

  • modernising the legal framework for care and support, to support the vision of the forthcoming White Paper on care and support
  • establishing Health Education England as a non-departmental public body
  • establishing the Health Research Authority as a non-departmental public body
  • creating a London Health Improvement Board
  • carrying out engagement and pre-legislative scrutiny on the draft Bill, as many in the social care sector have called for, to enable government to listen to people with experience and expertise, to make the most of this unique opportunity to reform the law

What is missing is more important that what is contained in that short statement from the Department of Health.

We knew already that the Law Commission report was likely to be incorporated into legislation. I feel confident that there will be a streamlining of legislation and systems around them which will be positive.

As well as improving (or ‘modernising’ as they like to call it) the hotchpotch of legislation into one Act, the recommendations, lest we forget, include strengthening safeguarding processes for adults and imposing duties on local authorities to provide services for carers.

Which brings me on to the part that is missing.

Funding.

There was no mention of tackling the immense funding gap in these proposals. There is talk about rolling out ‘choice and control’ but without knowing that this will be funded (which it won’t – we were always told this would be zero cost process of change) it leaves a bitter taste in the mouth.

The Department of Health talks about ‘building on progress’ of personal budgets and my hope that will mean plugging that gaps that were introduced in the first place. I have my doubts as plugging those gaps will lead to significant funding increases as it will mean investment in statutory advocacy to extend the same levels of choice to wider groups of users.

My concern is that what will actually happen is that we will be given more meaningless targets to reach that will be very beneficial to the few  but will leave a large swathe of people behind as the pot of money available for care simply runs out.

One of the ‘benefits’ the Department of Health elucidates is

simplifying the system and processes, to provide the freedom and flexibility needed by local authorities and social workers to allow them to innovate and achieve better results for people

Now, if anyone can translate this ‘policy speak’ into real language for me, I’d appreciate it.

I read it personally as a push towards ‘social enterprise’ type operations which push social workers away from local authorities but I could be totally wrong on that.

‘Innovate’ like ‘modernise’ is an easy word to throw around, especially by those who have no conception of the actual meaning of the word. Innovation needs a lot more than the proposals on the table. It needs much more inventive and open thinking from areas outside the Department of Health. I’d like to see more emphasis on co-production. We want users to have the flexibility to innovate rather than necessarily the social workers. And I say that as a social worker.

I will wait with interest to see the coming White Paper on Social Care. I set my expectations very low. But I do expect a lot of words like ‘choice’, ‘modern’, ‘innovative’ with no mention of funding at all.

photo via parliament_uk flickr

What is Choice?

Lansley and Burstow and those in the Department of Health have extolled choice as an aim to strive towards in both health and social care. ‘Choice and Control’ was used as the key phrase as the agenda moved in Adult Social Care and it has been picked up as the NHS and Social Care Bill made it’s way through Parliament. After all, who doesn’t want choice? Who doesn’t want control? The answer is that not everyone is has the capacity or desire to make a number of choices in critical situations . It worked to an extent in social care in so far as those who are able and willing to choose or those who are well equipped with better funding and family advocates are able to choose.  However we have also seen the policy struggle behind in promoting true choice or in fact, any choice to those who are not as able to pick up the mantle themselves nor who have informal social networks to assist in this respect.

Does having ‘choice’ mean seizing control? Are choice and control two parts of the same coin? Does one lead to the other? Perhaps. My concern is with those who are either unable through issues of capacity or illness or unwilling (because – you know – sometimes that’s a real choice to be made too) to actively ‘choose’ the type of care they receive or the way the care is divided into a support plan.

Where we see the ‘managed’ local authority support plans, we see little ‘choice’ and no control. We see the same large agencies with block contracts tied into providing the same packages of care on the same terms that they always did. The promises of more flexibility have evaporated into the ether of local government spending cuts.

I’m not against ‘choice’  but I’m completely against false choice. I’m against the meaning of the word ‘choice’ being warped into something that makes good political capital for the government with no meaning when ‘choice’ has not been extended in any real terms. I’m against lazy use of the word ‘choice’. The government (and that’s the last government as much as this one) seem remarkably fond of it. Funny, that.

I urge anyone who hasn’t read Max Pemberton’s piece in the Telegraph a couple of days ago to take some time to read it. He writes about contract won by Virgin Healthcare to run services in Surrey.  He explains this notion of ‘choice’

. The emphasis on choice was something that was repeated ad nauseam by ministers in an attempt to sugar the bitterest aspects of the Bill. The legislation would provide choice, we were assured. Everyone likes choice, don’t they? And we all nodded in innocent agreement.

I have argued before that in a healthcare setting, choice is a misnomer: all hospitals should provide an excellent level of care because so many people – the old, the infirm – are unable to exercise choice because of geographical or physical limitations. But only now that we can see the shape of the NHS Bill can we truly assess what choice actually means.

And this is the reality as it exists more starkly in health care than in social care.

I chose my local hospital for treatment because it was the only one I could reach within an hour by public transport. The people who live where I live will be making similar ‘choices’. Those with access to cars may make other choices and go to ‘better’ hospitals further away (although I have to emphasis my treatment was great at the local hospital even though it’s ‘ratings’ and ‘feedback’ are poor!). Those who can only access public transport will have less choice.

Similarly, my GP is on the same road as me. I have had gripes. Do I go to another? No, because when I’m sick, I want the nearest surgery. I don’t have time to research the different specialisms and natures of the GPs around me. This would be even more notable if I were in a rural area.

So who is this ‘choice’ for? For the class of people that the politicians pander to. Those who have the means and ability to choose? How can we truly make choice genuine and meaningful in systems which inherently try to blind themselves to the different cultures. attitudes and natures which do discriminate in the way access to choice is made.

Perhaps this is a way to increase equitable services and access to services across health and social care. I have long believed that advocacy may be a solution. Sometimes I walk away from work and realise that the people that I spend time with on a day to day basis are not the people that politicians either speak for or to. That’s why, as a social worker, it’s important for me to remind and nip away at these groups of people who won’t be clamouring for their pens (real or virtual) to engage elected members.

We have left behind a whole swathe of people who have not been able to ‘choose’ are a part of the personalisation agenda. We must push on and the voices will grow louder as others see this happening in healthcare.

Choice is a luxury of the more able. Good universal services for everyone must be the essential bedrock.

The NHS and Social Care Act has passed, but the voices must increase. We who can choose much speak for those who cannot.

What would be better than the Resource Allocation System?

The Resource Allocation System (RAS)  in adult social care in England is the means by which local authorities determine the size of the ‘personal budget’ pot in social care and the money that will be paid (or services in lieu) to the recipient.

The ethos of the personal budget, whether delivered by a direct payment or a ‘managed’ budget or an Individual Service Fund is clarity. The user/recipient of the service knows how much ‘money’ is in the pot to spend – even if they aren’t making those spending choices directly.

So why is there a problem with the RAS? Lucy at The Small Places explains in her excellent and highly recommended post here. She has undertaken a piece of research asking various local authorities for details about their Resource Allocation Systems. What this means in effect is asking how the algorithms are calculated that assigned particular values (money) to ‘needing help with preparing meals’ or ‘having a family member to help’.  Lucy explains that two reasons she was given by different local authorities for not disclosing were that revealing the formula might ‘distort’ future requests (i.e. people could fiddle the system if they knew which questions were weighted in particular ways) or that the RAS is a commercially sensitive document.

Quite rightly these arguments are picked apart in the blog post referenced so I won’t go over that again.

I did want to consider a question that was put to me last night (via Twitter) namely ‘What’s the solution?’.

I’m sure I’d be in a position in a very different grade to the one I’m in now if I had a bullet proof solution but it raises some thoughts in me that needed longer than 140 characters.
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Will Adult Social Care Reform Stall?

younger hand and older hand

The Health and Social Care Bill currently limping through Parliament is a mess. Even though I try to take an active interest in its progress, even as someone who is desperately concerned and involved (working, as I do, in an NHS team), I lose heart at trudging my way through some of the details which have been changed, adjusted and repackaged beyond the level of human (oh, ok, maybe it’s just me!) comprehension.

I was baffled though by this piece which turned up on the Guardian website yesterday.

Announcing that Lansley, having been stung and having lost credibility as his health reforms (hopefully) hit the buffers, is going to be delaying his announcement of reform in social care.
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