Briefing on the Care Bill published

I’ve blogged recently in response to the government’s Care Bill. We have a particular interest in the changes to the Bill which attempt to build a framework for a more strengths-based and community development focused social care system.
We’ve now published a full briefing on those aspects of the Bill and how we see them impacting upon people who use services and family carers, with five partner organisations:

• Community Catalysts
• In Control
• Inclusion North
• Inclusive Neighbourhoods
• Partners in Policymaking

Every truly effective social care intervention leaves an individual better informed and connected and more confident. Every intervention should support the individual’s unpaid relationships and informal networks of support and avoid undermining key relationships or isolating the individual from natural support networks.

Current social care law governing assessments and eligibility is set up to focus exclusively on eligible needs and how services alone can meet those needs. Assessments are designed to ‘gate-keep’ services and can require people to go through a demeaning and disempowering process focused entirely on proving their vulnerability, often only to find they are deemed ineligible. Support which is or could be offered by family carers and others is often invisible in the current system, with any needs which are currently being met by carers treated as non-existent.

We think the Care Bill could be the beginning of changing that culture. But we are aware that others are more sceptical about the changes and fear they could add to the ways in which some councils try to avoid their duties to provide services. We think those are the right risks to focus on, but that, even in the current climate of cuts and fear, we need to be bold if we are to create a system which really works.

The briefing is available to download here:

http://sharedlivesplus.invisionzone.com/index.php?/files/file/190-strengths-based-approaches-in-the-care-bill/

The sixth question

England’s care inspectors, The Care Quality Commission (CQC), have published their strategy.

To much relief in the sector, their plans include going back to inspecting the quality of services, as well as whether services are compliant with minimum standards. They were stripped of this responsibility with the end of the ‘star ratings’ system and have now had it restored to them by government.

The old star ratings system was a blunt instrument at best, although we liked it in the Shared Lives sector because Shared Lives always came out as being about twice as high quality as other kinds of regulated care. Things have moved on and it’s encouraging that CQC is trying to become less reliant on inspections or data collection alone in rating services. They have started using experts by experience and I hope that this move is accelerated: no one is better placed to judge whether a service is really good than people who use services and their families, and no one is better placed to gather those views than other people who have had personal experience of services.

CQC faces the challenge of regulating NHS as well as social care services. This is a vast range of organisations, from large hospitals to small Shared Lives schemes, for instance. The quality rating system for the NHS is being developed first, so it’s vital that the social care system is not just adapted from the health version, but is developed with social care’s very distinct ethos at the forefront. That means that co-designing the new system with citizens, providers and local commissioners is a must.

The five things CQC says it will consider whenever it looks at a service are all very sensible, but if the new quality rating system is to work for social care, a sixth is needed. The five questions it says will always ask about services are:

− Are they safe?

− Are they effective?

− Are they caring?

− Are they well led?

− Are they responsive to people’s needs?

This feels a comprehensive list as far as, say, a hospital A&E department is concerned. A social care service, however, could answer ‘yes’ to all of those, but the people living there still be unhappy. The sixth question which CQC must ask and which any good quality social care service will be able to answer is,

- Are you helping people to live good lives?

The Joint Committee reports on a new care laws

Update to the original text: I’d read “We agree” in paragraph 29 as referring to all the points made earlier in the paragraph where it is reported that the law commission and others argued for a statutory footing for resource allocation systems. In fact, the commitee agreed only with Richard Humphries’ point in that paragraph about a muddled of picture of 152 allocation systems as is clear from the later recommendation in bold. Paul Burstow MP, the committee’s Chair, kindly clarified this: “we only recommend placing RAS on a statutory basis for the purpose of arriving at notional costs [for Dilnot care accounts - see below], not for determining the amount in a personal budget.  On the more general use of RAS we recommend in para 204 that the “Government should review the efficacy of RAS and ensure that the code of practice or guidance makes clear that the development and application of any methodology for calculating the cost of meeting eligible needs is transparent, has regard for the well-being principle, and is subject to the duty to meet eligible needs.”" Some text below amended accordingly.

The Joint Committee chaired by Paul Burstow MP which has been examining the draft Care and Support Bill has reported today.

One of the most interesting aspects of the report is what it has to say about Resource Allocation Systems, which are the complex sets of calculations (algorithms) which turn an assessment of need into a cash amount to pay for an individual’s services. The recommendations taken individually are very sensible. For instance, the committee urges the government to put beyond any doubt that nobody’s resource allocation should be reduced because of the presence of a carer, without having gained that carer’s consent to carry out the caring which is seen as reducing the need for state funded support.

The committee identifies the fairness and transparency of Resource Allocation Systems as a crucial part of the delivery of personal budgets and Direct Payments and suggests that a RAS will be just as crucial to developing the “care account” by which the amount and individual is seen as having spent on care will be totted up under the new Dilnot system of capping the maximum amount anyone has to spend on care. The Dilnot system will not add up what a person actually spends, which could vary according to the care provider they choose to use, but will instead be based on a notional spend, proportionate to their level of need and typical or expected support costs for someone with their level of need.

The committee agrees that having 152 different resource allocation systems is “muddled”. This is part of the current “Ordinary Residence” problem, in which non-transferable care packages can stop people from moving from one council area to another for fear of losing an existing care package and the committee notes that this challenge will extend to those with a “care account” unless there is a national system.

This shows how far away from the original brief the reform of care laws has come. When the Law Commission was charged with tidying up and modernising social care law, it was very clear that it had not been given a brief to draw up a law for personalisation. Of course, sweeping away all existing social care law, was an opportunity for precisely that – why would we just tidy up a law which fits badly with the vision for a personalised social care system? – and the committee are calling for the new system to be built around personalisation.

Personal budgets and Direct Payments are of course just one aspect of personalisation. I can see a risk with establishing RAS

Why we need the government to act on the Choice Review

With some of our partner organisations, we wrote an open letter last week to Care Minister Norman Lamb MP, urging him to act on the recent Cabinet Office review of choice in public services, which recommended that people should be free to spend personal budgets as they see fit so long as they meet broad outcomes, with the removal of ‘preferred provider lists’ and other traditional commissioning approaches which hamper start-ups, micro-enterprises and other innovators from competing with bigger, more established providers. There’s no point in having control of the money if there’s nothing new or different to buy with it. As reported in Community Care, we warned that without these ‘supply side’ reforms, the risk of personalisation failing in its own terms is high.

A great illustration of the problem is in this Guardian article about how council procurement processes left one social entrepreneur literally starving (at least around lunchtime!) due to their inabiility to renew a contract in a timely fashion. When the basics are so wrong, having an impressive virtual online marketplace for providers and a marketing programme to encourage people to take personal budgets will fall flat.

Our report on Ten ways to stop bashing -and start boosting – micro-enterprise shows how councils can learn from the best work of their peers and get this right, so that we can ‘Make Personalisation Real’, not just another box-ticking exercise.

Learning the economics of the economy of regard

35 social care professionals, local authority representatives and policymakers discussed reforms to the draft Care and Support Bill at an event hosted by the Royal Society of Art’s 2020 Public Services Hub. My guest blog about the event and Bill is now on the RSA website:

There can be few people unaware that there are NHS reforms afoot in the UK. Yet few are aware that the most sweeping social care reforms in post-war history are now taking place, with existing ‘poor-law’ based social care law to be replaced by new legislation outlined in the draft Care and Support Bill. The Care and Support White Paper which preceded the Bill set out a new vision for the ‘personalisation’ of social care. This takes the idea of individuals having an individual choice of service and control over their lives as read, but recognises that even a well-funded, well-tailored service does not always add up to a good life, particularly if your support needs are social rather than entirely physical…

Read the full article here: http://bit.ly/XU0Vgx

Equality or fairness?

I’ve never accepted an invitation to speak at an event abroad during my time with Shared Lives. The opportunity to learn something completely new is tempting, not to mention the chance of seeing another country, but usually the bill would fall upon Shared Lives Plus and the cost plus the time can seem hard to justify when there’s so much to do in the UK. So it was a real pleasure to receive an invitation from the British Council in Finland to speak at an event on public service reform in Helsinki, not least because they were willing to fund and organise all the travel arrangements as part of their mission to foster shared learning between the two countries. I’m writing this on the plane home, wishing I’d had more than a one night whistle-stop tour, but the event was sandwiched between a meeting with Care Minister Norman Lamb on Wednesday and the first meeting of the White Paper Implementation Board the next morning.

Helsinki in late November was just having its first proper snowfall. We walked to the event at the British Embassy in semi-darkness just before 9am, past a gaggle of nursery children in bright orange vests, playing happily on a playground in the gloom and horizontal snow. It was about -2°C. I didn’t notice how long daylight lasted, but it was dark again by mid-afternoon when I left. The garden of the Ambassador’s residence was under a blanket of snow and host to the kind of squirrels you can’t find in Britain any more, with cute tufty ears. Naturally I expected Ferrero Rocher, but these are straitened times.

Sometimes it’s the small things which give you a sense of how different another country’s culture is. Finland

Good government isn’t just wise spending

I was asked to write a response to the ‘Purple Papers’, published by the ‘New Labour’ pressure group, Progress. The Papers aim to start a debate within the Labour party about what decisions a Labour government would take on the big challenges of the day, if the party won the next election. We try to engage with all political parties so I was happy to write a response which you can find here: http://bit.ly/TMMhs5.

My argument is that both Left and Right take a narrow view of what government can do, based on spending decisions, and that both sides of the political divide need to take a broader view of the country’s resources and how government can help to develop them. Nowhere is this more clear than in social care, where the state’s contribution is tiny compared to the contributions of individuals themselves, families and communities.

The right to live untidily

I chaired two lively fringe meetings at the Lib Dems and Conservative party conferences at the invitation of the ResPublica think tank. Both discussed the relationship between choice and making social care personal. Most people at these discussions were positive about the principle of being able to make choices about services. One attendee pointed out that “those with least control or power should have the most choice” and there was concern about the extent to which cut backs in advocacy services were stymieing attempts to redress the power imbalances in our system, or replacing them with new power imbalances and bureaucracies, or even “new lies”, in which people had the illusion of choice, but no new services from which to choose. There was also concern about the “lie” of offering choice without responsibility. Council and NHS Finance Directors remain legally responsible for balancing budgets and are understandably reluctant to create a system in which individuals might be able to make expensive choices which take no regard of limitations on resources.

One way past that impasse is to recognise that a policy of introducing personal budgets and Direct Payments does not, on its own, change the status of people who use services. Discussions can still be about what “we”, the expert professionals, are going to let “you”, the service user, have to meet your needs. Instead, we need to create a system of shared responsibility for the use of resources and this is often done best where individuals are helped to pool budgets, or to come together with community groups, so that there can be a collective discussion about how people will make best use of all kinds of resources, including money, but also including people’s time, and the collective expertise of people who use services, their families and communities. The key to a good life is not just what we choose to receive, but also what we choose to contribute to those around us.

One participant told a story to illustrate how far we can sometimes be from that picture. An older person was entitled to a Direct Payment to buy support. Her pet dog

“It gives me a good feeling inside”

This year’s Shared Lives Plus conference was co-chaired by Paul Croft, who lives in a Shared Lives household and Richard Jones, a Director of Adult Services and one of our trustees. This is what Paul told the conference – he has kindly given me permission to re-print it here:

 “Good morning ladies and gentlemen.  I would just like to say how pleased I am to be here and would like to thank John Dickinson for asking me to Chair this conference.  I think it is a great honour and am delighted to be talking to you now.

I would like to tell you just a little bit about myself and how my life has changed since I joined Shared Lives and moved to Waterloo, just a few miles from here, to live with Geoff my carer with PSS and Bob who Geoff also cares for.

I was at Derwen College in Shropshire at the time and lived there in term time studying catering and office management.  At first I went to Geoff’s in the holidays.  I really enjoyed being at college but we were supervised most of the time and had very little independence. 

When I first went to stay with Geoff my care plan said that I wasn’t allowed to access the community without someone being with me.  I remember wishing I could be like Bob, who was a train driver before his brain injury and would go off regularly visiting places round the country.  At that time I even had to be taken to college at the end of holidays even though I had made the journey many times.

Geoff realised that my life was being restricted because of this and so we started to work on this problem.

I began by posting letters at the end of our street and then going to the shops and bank on my own.  We went out together on longer journeys but when I felt ready we decided that it was time to go on the train on my own.  The station is only 5 minutes from where we live.  I have a very good sense of direction and had no problem going places on the train and also learned to use the bus. Geoff and I have discussed this and both feel this was the real turning point in my life.

When I moved into Geoff’s permanently

The end of the party

I’ve been on my annual three week pilgrimage to the three main party conferences. I’m going to blog very soon about the two fringes I chaired for ResPublica, which both felt like they weren’t the usual social care discussions which can sometimes blend into one morass of demographic time bombs, resource shortages and people wondering if we shouldn’t be talking more to the housing sector.

In the meantime, I wanted to say something about the whole idea of party conferences. If you’ve never been lucky enough (!) to attend, there are essentially two events going on in parallel. In the big hall those increasingly rare eccentrics (sorry Tris!) who actually participate actively in grassroots party politics listen to speeches and clap. Only the Lib Dems actually let party members vote on anything of consequence, and even then on the strict understanding that the party leaders can, when push comes to shove, ignore most of what they say. Almost entirely separately, in countless hotel meeting rooms surrounding the hall, half the charity sector pitches up to hold debates and meetings about their particular issues. Many of them have banded together into partnerships around particular themes, based on our sector’s Health Hotel partnership.

This twin-track approach to party conferences has worked for years. The party members do their thing, and with civil servants not allowed to attend, the lobbyists and charities get unchaperoned access to Ministers and their shadows, whilst making some new contacts with interested MPs and the odd councillor and stocking up on a year’s supply of post-it notes from the exhibition stands. It’s exhausting – this year I went to 7.30am breakfast meetings and receptions which were still going strong towards midnight – and the quality of conversations can be variable, given that Ministers