The Human Cost of Cuts in Social Care

Yesterday I was sent a link to this blogpost by Lucy at The Small Places. I highly recommend everyone involved in social care read this post. It is written by someone who uses and needs support that is provided by the local authority, however their services have been, are being cut significantly.

The narrowing of the eligibility criteria isn’t a ‘paper cut’ made in an office within accounting departments of local authorities, it has a harsh and detrimental effect on the day to day quality of life of another human being who is dependent on the way that provisions are allocated. These are the choices that have been and are being made in the context of cuts and these are the people, actually, we are all the people that Burstow has to justify himself to when he talks about no money being taken out of social care budgets.

The author of the blogpost explains

Yesterday, my care plan was reviewed, and despite the social worker agreeing that I have substantial ‘needs’, to every question that I answered regarding what my carers do for me, the reply was: ‘we don’t fund that any more’. So from now on, no one is allowed to do: laundry, from putting into the washer, putting on a ceiling clothes rail, ironing and putting away…

no shopping allowed or putting it away; paying bills or doing any post office visits; carers aren’t allowed to accompany you out any more either socially, or to hospital/doctors/dentist/opticians or other practical appointments where you need someone to propel your wheelchair; they can’t put the bins out; can’t stack or empty the dishwasher or do any kind of clearing up whatsoever: the list goes on and on. All of the things that I cannot do for myself.Just about anything you can think of that a healthy person would do in the home or outside the home on a day-to-day/week-to-week basis is no longer allowed.

I recognise this. From the ‘other side’ so to speak. I have been, I am, that social worker (well, not in literal terms) but I have to explain that we no longer provide hot meals delivery, we can’t count time for someone to be taken to medical appointments, we deprive people of assistance for some of the tasks we, ourselves, take for granted.

There has always been an issue of resourcing with some user groups benefiting more than others. In older adults services, for example, it was always rare to allow carers time to accompany service users to go to the shops – however, wasn’t the new and wonderful era of personalisation and choice supposed to change this?

We are now able to offer the choice between the hours (and money) spent on someone helping with a bath and use it instead to go out for an hour to the shops. Not necessarily a palatable choice we would expect for ourselves, is it?

The author of the post goes on

I am supposed to have everything delivered now, but they don’t understand the costs of that. Fresh food (and I say that in the loosest sense since they mostly send you stuff that’s about to go out of date), in terms of fruit for example does not last a whole week; you’re lucky if it’s a few days. I can’t eat processed food because I also have IBS. So I’ll have to do an internet shop twice a week which will cost £8 delivery and I will also have to spend a minimum of £25 per shop, that means my four weekly food bill would be £240: I cannot possibly afford that. And since no one is allowed to put it away, what do I do with it when it arrives?

Cost transfers from local authority to user and is the ‘personal budget’ supposed to allow for this? You’d think so.  This was one of the more baffling parts of the post

Ah, now the very helpful social worker had a suggestion for all of this: I can use my D.L.A. to employ someone to do all of the other things now and pay for any transport needs! That’s what D.L.A. is for isn’t it? As I replied however, I pay ALL of the care element and part of my severe disability element back to the local authority for my care, so how can I use that?

Well, exactly. Disability Living Allowance (or Attendance Allowance for over 65s) is non-means tested however it is counted in terms of assessments for charges so there is an expectation in the finance departments within Local Authorities.  This allowance is seen by the local authority as a legitimate  target for charges to be recouped back to the Local Authority for the costs of care – and to be honest, I can see the point. These benefits (at least, the care component) are paid because there are care needs specifically. However for the social worker to lack this information is no doubt rubbing salt into the wound of cuts.  The social worker sounds to have been put in a difficult position and I know the feeling. We are tasked to pass the news of cuts to those who can least afford it and who rely most heavily on the provision of services – but it’s a duty to give fair and honest advice at this point.

It does make it clear though that ‘better information’ and shiny web sites providing directories of services or new ‘Trip Advisor’ type sites rating services are all very well and good but the real thing that social care needs is funds to meet basic needs. The focus needs to be on quality of life not ‘how much can we slice off budgets’. There no easy answer but being disingenuous about the nature of ‘choice’ available and being honest about the realities of decisions being made is significant.

This post speaks the truth of many others who cannot speak up – and this is someone who has been able to use a direct payment positively. There are many many more who haven’t.

As a social worker this post spoke the realities I see every day and highlights the benefits of social media to improve my personal practice – it shows me how social workers are perceived with an honesty I rarely get in terms of feedback on a day to day basis due to the power differentials which exist.  I hope I don’t respond to people in the way that social worker did but I will be more aware of my responses and how they are interpreted when I am in people’s homes.

And I will continue to fight against the cuts agenda all the harder. We have a powerful collective voice as social workers and we have to use it to tell the stories that we say, to not passively accept some of the hardships and injustices we see on a daily basis.

We can and must do so much better.

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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.