My social workers seem to fear me and would rather give into “my demands” than sit around the table
A tenth of social firms are in the social care sector. What are the benefits for staff and service users?
LAs need to be proactive in listening to their frontline workers and their customers to enhance a transparent approach.
Somerset council has been accused of ‘deception’ after a report revealed it used ‘questionable’ tactics to boost personal budgets performance
social care network: adult social care hub Policy Personalisation Social care Older people Disability England
There has never been enough funding for personal budgets – so they can’t possibly meet all service users’ needs
Five years after Winterbourne View, Sir Stephen Bubb says a commissioner is needed to protect the rights of people with learning disabilities
‘…………By Catherine Foot director of evidence at the Centre for Ageing Better
Solutions that transcend traditional boundaries could be key to providing the most effective services for the money available
What do you think is most needed to improve the quality of later life in this country?
You might say money – to reverse the chronic under-resourcing of publicly funded social care, for instance, or to invest much more widely in the housing adaptations that we know can help older people to remain independent.
You might say leadership – a form that brings together planning, housing, care and health, and the private, statutory and voluntary sectors, to work meaningfully together, sharing goals and delivering services that meet people’s needs and priorities in later life.
You might say we need to focus on attitudes and empowerment – to build a society that fully values and includes older people, families and carers and creates services for them that are designed with them.
Or you might say that we need to help more people in mid-life get skills and information to think about and prepare for their financial, social, housing and care needs in the future.
At the Centre for Ageing Better we believe we urgently need better information and evidence about what actually works to improve our later lives.
As with many areas in social policy, high-quality evaluations remain too few. We know much more about the nature of the problems than we do about the essential, transferable and sustainable ingredients of the solutions. We also particularly lack extensive evidence for interventions that cross traditional sector boundaries – that combine elements of social care and mental health interventions, say, or housing.
We need this evidence for a number of reasons. Fuelled by the pressure of continued public services spending cuts, we need more than ever to understand how we can deliver the most effective services for the money available. Services must have increasingly robust proof of their impact or else risk losing their funding. We also need evidence because it is through the cycle of innovating, learning and improving that we can achieve excellent services. And we need evidence because services should be transparent and accountable, clearly able to say what they do, why it works and what impact it has.
Councils should remember they are still accountable for social care functions delivered by third parties on their behalf, the Local Government Ombudsman has warned.
Somerset council has been asked by the ombudsman to pay more than £6,000 to a young man and his family after an inaccurate assessment of his needs left him without direct payments for 14 months.
Third party providers
The council claimed the complaint made by the man’s mother to the ombudsman should have been made to Somerset Partnership NHS Foundation Trust. The mental health trust had been contracted by Somerset Clinical Commissioning Group, on the council’s behalf, to assess and meet the eligible needs of adults with Asperger’s syndrome in the area.
But the ombudsman reminded the council it could not delegate its duty to assess and meet people’s eligible social care needs, even if had delegated the delivery of that function to a third party.
The young man had Asperger’s syndrome and hearing difficulties, and used the direct payments to access community facilities and maintain a social life.
The trust stopped his payments in December 2013 after those carrying out the assessment wrongly believed he would be starting an apprenticeship and thus no longer met the eligibility criteria for social care. This meant that for 14 months, the young man’s only contact with the outside world was through his mother and stepfather. He only started receiving payments again in March 2015, after a reassessment of his needs in January 2015 found him eligible for social care.
Lack of evidence
The ombudsman found that there was no evidence of how the trust reviewed the man’s needs in 2013, no written record of discussions with him or his mother and no evidence of how the decision that he no longer met eligibility criteria was made.
She concluded that there was a fault in the way that the trust carried out the review and stopped his care package and, as the trust was carrying out these functions on the council’s behalf, this was a fault on the part of the council.
She also said that the council was at fault for failing to ensure that the trust kept full records for justifying its decisions.
Ombudsman Dr Jane Martin said this should serve as a reminder to all councils that they remained ultimately accountable for the delivery of statutory functions carried out on their behalf by third parties.
She said: “Councils are well within their rights to get best value for money from care contracts. However, councils remain responsible for the way those services are provided, including dealing with any complaints.”
Martin added that changing models of service delivery had confused the matter of who was accountable for a local service, both for the public and for local authorities.
She clarified that accountability for council functions remained with local authorities when outsourced, irrespective of whether the provider was a private company, third sector organisation or another publicly-funded body.
Somerset council has agreed to accept the ombudman’s recommendations, which include paying the man almost £6,000, the equivalent of the sum he would have received in direct payments from December 2013 to January 2015. It will also pay the man’s mother £500 for the stress and anxiety of having to meet her son’s needs during the period without direct payments.
The council has also agreed to review how it monitors its contracts with third parties to make sure full records of all care reviews and recommendations are kept. …………’
Personal assistants speak out about their isolation as Community Care finds postcode lottery of support and training opportunities
Published in partnership with Unison
Councils are offering inadequate support for personal assistants despite the critical role they have to play in delivering personalised care under the Care Act, according to research by Community Care.
Figures obtained from 117 of England’s 152 local authorities through a freedom of information request show councils are falling short of minimum standards of support published by sector leaders in 2013. Key concerns include:
- Personal assistants and their employers face isolation as 86% of councils don’t facilitate support networks for personal assistants and 65% don’t offer this provision to employers.
- Training is a ‘postcode lottery’ with some councils only offering access to e-learning or free safeguarding sessions. One in 10 councils offering training do not meet the cost.
- Opportunities for career development are also limited, with 82% of councils not promoting apprenticeships to personal assistants.
- Nearly two thirds of councils do not provide a register of accredited personal assistants that employers can access when looking to recruit.
The 2013 guidance, which was developed by Skills for Care, Learn to Care and the Association of Directors of Adult Social Services (ADASS), includes nine minimum standards and states that, due to the growing number of people receiving personal budgets and direct payments, councils need to be offering support of the ‘highest possible standard’ to employers and their personal assistants.
But personal assistants like Heather, who supports an elderly lady with mental health needs, continue to feel isolated. “I don’t know of any local networks and I wouldn’t know where to look for email addresses I could use to make contact with people myself,” she told Community Care.
“I just feel like there is no support out there. Who do I let off steam to? If I witness abuse or neglect, who do I speak to? If you work for an agency you will always have your line manager, but when you are employed through direct payments you have no point of contact. I have no one to turn to.”
‘I’ve got no support, no manager, and no access to supervision’
Sean, a personal assistant to a young man with complex health needs, has struggled to access support ever since his client’s family switched from an agency to a personal health budget, which is jointly funded by the NHS and the local authority.
“I’ve got no support, no manager, and no access to supervision,” he said. “I can talk to the NHS trainer but although he can try and give advice, the only concerns he can really raise are those related to the health needs of my client.”
Sean is also unaware of any local support groups for personal assistants. “The only place I can think of would be the group I take my employer to and that’s not the best place to do it – everyone’s clients are there to enjoy themselves, not talk about the issues we have.”
A survey undertaken by Skills for Care in 2014 also found peer support to be lacking, but said it was recognised by councils as a ‘desirable intervention’. This was, however, the third consecutive year in which peer support was identified as a gap by the organisation’s research.
Responding to Community Care’s findings, Georgia Turner, programme lead for employer engagement at Skills for Care, said: “That support isn’t more widely embedded is indicative of the challenges local authorities need to work to overcome in engaging a group who often don’t comply with our traditional idea of what a ‘workforce’ looks like.”
Matt Bowsher, joint chair of the Association of Directors of Adult Social Services’ personalisation network, added: “There is something very distinct about the personal assistant role itself and where there is a willingness on all parts to do so, there’s no reason why personal assistants could not be put in contact with one another and offer support.
“The technical means for people to communicate with each other have never been so great, so it’s about how those networks are built, informally as well as formally. Not all of this is about what councils do, it’s about how councils could act as a catalyst for how these networks could be made.”
Our investigation also found a significant variation in the learning and development opportunities available to personal assistants (standard 5 of the advice note).
While 77% of councils provided access to in-house training, the quality ranged from e-learning modules or basic induction sessions to a willingness to provide ‘any relevant training’ to the personal assistant’s role. Other councils only offered free safeguarding training and one said it would open training up to personal assistants “only if there were spaces available”.
Funding was also an issue. Of the councils that made in-house training available to personal assistants, 1 in 10 did not meet the cost. Some councils said they costed monies for training into the service user’s personal budget allocation, but would not meet the associated costs such as shift cover for the personal assistant while they attended training (known as backfilling) – the individual employer would have to fund this. Others expected personal assistants to foot the bill.
Two councils said they considered it to be the responsibility of the individual employer and the personal assistant to source and fund learning and development opportunities.
Sean says the external training he has received since his client’s family switched to the personal health budget has not been as good as when he was employed by an agency.
“When I worked under the agency I had access to a five day training package every year but now I can’t remember the last time I had that. For manual handling we were given a one hour online course, before it would have been at least a day of face to face training.”
Skills for Care’s 2014 survey recommended that local authorities support individual employers to access the Workforce Development Fund, which is distributed by the organisation on behalf of the Department of Health. The fund can be used to access additional learning and development opportunities for individual employers and their personal assistants.
Our investigation found nearly half of councils do not support individual employers to access the funding. Of those that did, some only provided information via email, while others assisted individual employers to complete the full application process.
Personal assistants were also missing out on apprenticeship opportunities (standard 3), with 82% of councils not promoting them.
Heather is keen to pursue further learning and development opportunities on top of her existing NVQ level 2 in health and social care. Although she’s done the research, it’s now down to her employer to agree to her attending and to secure the funding, which is a lot to ask of someone who already has complex needs, she points out.
“I rely on my employer to push these issues but because of her needs she’s not able to that, so it means I just go to a lady four days a week and I’m not pursuing my career.”
ADASS’ Bowsher agrees training for personal assistants is challenging. “The very difficult balance that needs to be struck here is how you create the same opportunities for people where you don’t have the same economies of scale that some of the registered providers do – volumes of workforce, training budgets, ability to fund backfilling cover.
“Wherever possible, training and development needs to take place on the job and it’s very challenging to be able to take a large chunk of time where you as the individual employer can do without your personal assistant.”
He added: “We are going to have to very creative in the way that’s done, we don’t have an infinite sea of resources here that can be provided. And I don’t think anybody wants to be responsible for creating a two tier workforce. Both groups should be equally as attractive to a potential carer.”
Our findings also show that nearly two thirds of councils do not keep a register of accredited personal assistants that employers can access when looking to recruit. Of the councils that did, some held an in-house register, while others commissioned an external organisation to manage it.
The 2014 Skills for Care survey reported a 15% increase in the number of councils providing a register (from 41% in 2012 to 56% in 2014), but said encouraging councils to use one still remained a persistent challenge. The figures obtained by Community Care suggest there has since been a reduction in the number of councils providing this service.
Skills for Care’s Turner said: “We must remember that local authorities are working to ensure their actions keep employers and personal assistants safe, without removing the choice and control that is central to personalisation. Local authorities must focus their efforts on enabling informed decision making and effective risk management, rather than imposing arbitrary controls.”
When asked if personal assistant registers are a service councils would be likely to cut as a result of funding pressures, Skills for Care declined to comment further.
Matthew Egan, professional officer at Unison, said the findings were ‘especially worrying’ given the context of funding cuts that are likely to be exacerbated under the new government.
“If the personalisation agenda is being really pushed then it is incredibly reckless to do it unless you have the adequate levels of training, support and funding in place, which the findings show aren’t currently there. It’s not just bad for the worker, it’s bad for the individual employer – they are both being let down by the lack of support.
“It’s also a postcode lottery – you could be lucky enough to be in a local authority area where the council provides a good level of support and training but a lot of other people are in ones where they are just on their own.”
A spokesperson for the Department of Health said: “This data doesn’t show the whole picture – our survey of local authorities over the last three years show most do have support available to personal assistants and this situation is improving year on year.
“We know there is some variation across the country so in 2013 we published advice setting out minimum standards and we also want to make sure we facilitate the sharing of best practice in our work with partners and stakeholders.”
ADASS’ Bowsher added: “Clearly some time has passed since the Skills for Care and Department of Health guidance was published and we now have data that says very clearly that we need to look at this again and ask ourselves the question what can be done to support individual employers and what can be done to support personal assistants.
“We don’t want people feeling isolated like they don’t have any career development opportunities and there is no one to support them, whether they are an employer or a personal assistant.”
He added: “All of these comments are made in the context of significant and longstanding financial challenges, but I do think the cuts themselves should not be used as an excuse to stop us exploring every opportunity to encourage personal choice and control.”