Tuesday, May 18, 2010

Once more into the breach dear friends

So what happens when a nurse, for very good reasons, has to ring in just before her shift to say she won't be able to get in? Well, in an ideal world there would be a contingency plan - and there is - and it doesn't work - again! This time we didn't step in to fill the breach ourselves, as usually happens. Because nobody told us it had happened - we only found out when we rang to see how he was. There was a fallback but in our view it was inadequate, so brown stuff hit fast rotating object again. Fortunately all was well and he behaved himself for once.

Our package of care predates the 'Personalisation Agenda' - it doesn't need things like Direct Payments to get a Person Centred Plan, even under the old systems - they just make it hard (translation - impossible). If we'd had Direct Payments we'd have had to organise all this as well as doing his care and I don't think we could cope with that level of admin. as well as the medical etc. care. There's no allowance for recruiting, staff admin., contingency cover organisation etc. - Personalisation for us would mean care on the cheap (for the authorities). It would save them money, because we'd have to do the extra work. The reality would be that we'd step in all the time - unpaid.


  1. I work for a Local Authority and out of the 500+ people that have taken up Direct Payments so far, only two have decided to go back to Council commissioned support. I take your point that Direct Payments are not for everyone, particularly if you have very little time to manage the administrative side, but for the vast majority they can make a huge difference by offering a level of flexibility that is simply not possible if the Council holds and manages the money.

  2. Happy for there to be Direct Payments - they're good and right for some people. Where I'm not happy is where the Local Authority (here for example) puts all new commissions and as many existing ones as it can shoehorn, cajole, browbeat or force into personalised budgets, preferrably Direct Payments, making it the only game in town in practice. Our Local Authority has also used it to reduce costs (services), targetting high cost (high need) care packages for reassessment. Where it works OK but not as a 'one size fits all solution'.

  3. The coalition document (http://www.cabinetoffice.gov.uk/media/409088/pfg_coalition.pdf) doesn't look too hopeful.
    From the section "Social Care and Disability":
    * We will extend the greater roll-out of personal budgets to give people and their carers more control and purchasing power
    * We will use direct payments to carers and better community-based provision to improve access to respite care.
    Of course, that could just mean making direct payments and personal budgets available to all who want them. But call me Mrs Cynical, it looks like they might be trying to push them onto all carers, whether or not it's suitable for them, or what they want/need.

  4. The worry is that that is exactly what some Local Authorities are actually doing - govt's extant directive was to get 30% on personalised budgets. For some people it's the right way to go, just doesn't fit all.

  5. Chipping in as another worker in local authority social care (and about to become a qualified social worker) - but to agree with you, unlike the first commenter. 'One size fits all' does not work whether the 'size' is commissioned local authority standardised care or DPs/IBs.
    I imagine that the 498 people who stuck with their personalised services in anon1's example were 498 people who really wanted them and whose situations were suited to them. What proportion of the total service users of that local authority did the 498 represent I wonder?
    The risk in using stats to 'prove' a case is that individuals/families needing support are just that: individuals/families, not units.

  6. Thanks for commenting on 2nd June. My second biggest worry on Personalisation is around the 'one size fits all aspect'. My biggest worry is that, in practice, some Local Authorities (my own being a master at this) are using 'personalisation' as a vehicle to review 'cases' downwards to save money and implement service cuts.