Sunday, 27 November 2011

Avert next big social care crisis - use the economic downturn to invest in training

Guest blog from Richard Banks richard@richardbanksassociates.co.uk

When (if) there is an economic upturn in England and we begin to reduce the catastrophic unemployment figures adult social care will find itself in deep trouble. There will not be enough people to take jobs to support older people or adults with disabilities.

The number of jobs in adult social care is projected to grow by between 24% and 82% between 2010 and 2025. This means there could be between 2.1 million and 3.1 million jobs by 2025, based on Skills for Care 2010 estimates (1). England got close to a workforce numbers crisis in the middle of the last decade. In some regions social care employers where struggling to recruit and retain sufficient staff, there were stories of residential homes unable to fill places due to lack of staff and home care organisations struggling to fulfill contracts. The crisis was averted then due to people coming to the UK from the countries of Eastern Europe that had recently joined the EU and by overseas (meaning from outside the EU) staff recruited by agencies that ‘sidestepped’ the work permit regulations.

Next time there will be no new countries in the EU (Turkey wants in, but there is resistance) and the UK Border and Immigration Agency have some very clear political directives to all but shut down the work permit system. As the economy recovers other industries will adjust their pay and conditions to attract staff. This seems unlikely for the publicly funded parts of social care, restricted as it is by procurement fees. In April 2011 the Low Pay Commission reported (2) that the social care workforce is among the lowest paid in the economy, with 9% of staff earning less than the minimum wage of £5.93 (as of April 2010).

People will be attracted to other employment, in part by pay, but also by intelligent human resource systems that recognise people want to work where they are respected, trained and well managed. Work in adult social care can be all of those things and more, but experience over the last 10 years has been that there is no consistent move to recognise the skills and rewards necessary to sustain the sort of workforce we need. Some social care employers are extemporary in how they manage and plan for their workforce. However they do this against the flow of government policy on service procurement, lack of regulatory attention to workforce issues and funding for education and training. As ever Government Ministers make statements about the importance of the workforce but there are few examples of any positive action and plenty of missed opportunities to directly do anything positive for the workforce.

Conferences and meetings generally resolve that the image of work in social care should be improved. Actually the problem is that there is no image of social care itself. Only at a time of family crisis do most people begin to get an understanding of the issues and support services that social care deals with. Getting people to consider employment or a career in social care is therefore difficult, but made all but impossible by the poor pay and conditions. The existing chaotic state of funding for social care services is only sustainable by staff continuing to subsidise the system by accepting poor conditions. For the last ten years this workforce have been told that registration would recognise their competence and commitment to high quality care and that inspection would require and support initial and ongoing qualifications. In England none of this is now happening. The workforce in social care continues to be ignored, cope with policy and financial failure and yet is relied on to provide high quality care.

The likelihood is that just as the numbers of people needing support increases we may have insufficient staff to do that work. The quality of support will be adversely affected there will be an increase in poor or abusive care leading to care work and workers being mistrusted and causing recruitment to be ever more difficult. With insufficient or poor quality care, relations will feel forced to stop their own work and become carers for older relatives. This has negative effects on the economy as whole and severe effects on individuals moving from employment to reliance on carer’s benefits – such as they are.

Options for government seem to be:

- Ignore the impending problem and hope that something turns up
- Blame social care provider organisations
- Move away from improvements (personalisation, dignity etc) and return to a warehousing system for people needing support
- Permit the importation of workers from somewhere who will not have had time to train for task

Or invest now in education and training as part of a concerted approach to improving the image and actual experience of working in adult social care.

Other countries use economic down turns to retrain their workforce for their best guess at the sorts of industry, skills and systems required in the future. There would be little guessing required in doing this in adult social care. We know very well how many people we will have who will need support and we know the sort of skills and services that work well (aside from a miracle cure for dementia). But in England (things are different in the other parts of the UK) the government is moving away from that sort of planning. Nothing is being done to improve the pay and conditions of the workforce. On occasion there are even attempts to misuse workforce data to pretend that pay and conditions do not matter to social care staff. While it is correct that local work, flexible working and commitment to the proper and dignified care of people is important in attracting workers they still will need to be paid properly. Employer led Skills for Care has again produced a clear strategy 'Capable, confident, skilled' May 2011. This says and plans most of the right things but it is not adequately funded and the implications for other Government responsibilities such as inspection are not taken up.

Just like the bankers with their justification for bonuses social care staff will go elsewhere if better pay and conditions are on offer.

(1) Skills for Care The size and structure of the adult social care sector and workforce in England, 2011 Researched and compiled by William Fenton August 2011
(2) Low Pay Commission National Minimum Wage April 2011

Monday, 17 October 2011

Improving Satisfaction in Social Work Assessment and Care Management

How satisfied are the public with the social work service they are getting when they are ask for support or want to change something? In our experience, the wait for an assessment is most frustrating for families, particularly when the service users’ circumstances are changing and new care packages are required.

There are the changed appointments and rescheduling of visits, particularly if a multidisciplinary team is involved. There is IT systems used for scheduling the care package and billing against personal budgets – but what about the productivity of the assessment and care management teams? How much time is wasted through unproductive visits and rescheduling arrangements?

Probably a call centre already signposts service users but does it use a system based on volume, complexity and risk combined with dynamic scheduling and PDAs/iphones to improve customer service?

Where dynamic scheduling is being used in Councils, user satisfaction increases to over 95%. It improves productivity by speeding up scheduling, taking account of cancellations to reschedule or substitute alternative assessment arrangements and enables communication. Needless to say, it integrates into your core case management systems. In time, this will mean that there will be more effective assessments and undertaken more quickly leading to greater customer focus. It is all about getting it right first time with the most appropriate support to service users

In these straightened times, a short business case should be developed to establish the costs, savings and benefits. For a discussion, please contact janet.pearson@cpea.co.uk

Tuesday, 4 October 2011

Guest Blog from John Papworth: Adult residential homes - is a social enterprise the answer?

Guest Blog from John Papworth CPEA Senior Associate

Recently browsing the news headlines around adult social care, brought to light some depressing and yet all too familiar sound bites - “Council to shed 300 jobs in adult social care”; “Council to shut residential care homes”. All this is painted by the media as a consequence of the financial cutbacks. This ignores:

• The potentially runaway spending driven by the ageing population.
• Falling productivity of the public sector v independent sector, and accompanied by higher unit costs for services run by councils themselves.
• Increased demands for a better quality “product” from the public sector.
• Personalisation of budgets so older people determine their own care package, not the professionals or the provider organisation.
• The need for stronger preventative interventions to avoid crisis driven demand for acute services.
• Protection of vulnerable adults.
• Some independent care providers (eg Southern Cross) having unsustainable financial models that have underpinned their activities.

The fiscal crisis facing local councils and NHS community services is thus overshadowing all these other factors. So is there an alternative way of providing the service, at the same time as reducing costs, whilst increasing effectiveness and quality?

One answer may to be set up a social enterprise or mutual to take over the running of a council’s care homes. Social enterprises are businesses driven by a social purpose in which any profits are re-invested to meet that objective. The former Labour Government and the current Coalition Government was/is keen to see these develop as part of its agenda to encourage citizens take more control of their own lives, and as a way communities or neighbourhoods can help each other out.

Evidence to date in the ‘support at home’ market suggests that social enterprises or mutuals are highly effective in delivering these services (usually at a much lower cost compared with those run by councils - e.g. up to 50% per unit). They attract a committed and professional workforce with low turnover rates – something that is valued in home care. As a bonus the customers are happier too. Examples include CASA who now run adult home care services in Newcastle, North Tyneside, Calderdale, Manchester, Knowsley and more recently Leeds.

A council running its own residential care homes has to face the very same issues as home care, particularly getting its own unit costs down. This is likely to involve an element of reducing running and staff costs, and will not be popular and/or acceptable at the moment in the light of the Southern Cross affair and public sector cutbacks and redundancies. It will also have to maintain and improve the quality of its homes - which will involve refurbishment costs – and at moment the money simply is not there. So what could a council do?

A council could establish one of its care homes as a social enterprise or co-operative, support its early development, and once it is running and has been tested out as a way forward, then transfer its other homes to the new organisation. Or else it could transfer them all at once which might give the new enterprise some local market “clout” and share, and give some assets that could be deployed effectively to raise new money (e.g. a bank loan from the co-operative banks like Triodos or the Co-Op, or a joint venture with a registered social landlord that could provide sheltered residential dwellings on any surplus land). There are a number of issues that would need to be faced not the least of which is current council staff terms and conditions. And yet, as a new social enterprise, has lower overheads and is free from council staff terms and conditions, staff can be rewarded by other ways (e.g. a share of any surpluses, or else given free care when they need it when they have retired – the Joseph Rowntree Housing Trust have elements of such a financial model).

Is it worth a try? After all unless something new is done by councils, all that will happen is slow degradation of service, and ultimately many council care homes will have to be closed as the pressures they face are simply too great to ensure long term viability.

Sunday, 2 October 2011

Why not Yes, Minister?

NCERCC campaign progress report by Vic Citarella

The Institute for Social Care and Education (ICSE) was first set up about fifteen years ago, when it campaigned in Parliament for the registration of child care workers. Past government support for the successful National Centre for Excellence in Residential Child Care (NCERCC), the agreement to registration by the General Social Care Council (GSCC) and the creation of the Children’s Workforce Development Council (CWDC) – all now removed as supports to children’s homes – led to dormancy and possible complacency. After a quiescent period ICSE has now been revived to act as a professional association for people working with children and young people.

In addition to providing membership services through dual membership of the Social Care Association (SCA), ICSE is campaigning once again. Now we are seeking to position the professional residential child care worker centrally in sector-led improvement initiatives. This latter approach is the Government’s unfunded self-help approach to leadership. Our view is that NCERCC (abolished in 2009) was actually a sector-led improvement body that was well on the way towards becoming self-sustaining. We are fighting to get support for a much needed replacement body which we feel will be the most cost-effective way of drawing on the strengths of the sector for the benefit of all.

An ICSE delegation recently made the positive case for an NCERCC type body to children’s and families Minister Tim Loughton – a meeting kindly facilitated by supporter Norman Lamb MP. How was our case received?

Tim Loughton told us unequivocally that he fully supports the residential care sector. He was very clear that he does not see a hierarchy of services with residential care as the least favoured option, which is an important message. Children and young people living in homes and people working with them can be reassured that they are not locked into some sort of ‘last resort’ provision. Rather that residential care is the right positive option for some children. Every incentive there then for professional best practice and that is what ICSE promotes.

Secondly, Tim Loughton gave a (very welcome) shared commitment to the kind of representative and professional body that has been lacking, viz. one that:
• DfE’s Support & Improvement Programme can engage with in dialogue and which can be consulted on regarding issues of design, development, dissemination, implementation, and evaluation;
• forms a cost-effective option for supporting and improving residential homes using sector skills, experience and delivery mechanisms to deliver programmes;
• provides assistance in the identification of homes that require improvement;
• gives the professional residential workers input into improvements in commissioning practice;
• could be an ally of DfE in the event of scandal or crisis (abusive practice or failing business models) – identifying, anticipating and mitigating risks to the sector’s credibility and DfE’s role, for instance;
• supports Local Authorities and the Children’s Improvement Board in tackling significant under-performance of children’s homes in their areas (action to meet OFSTED requirements when owner’s efforts are not effective).

Finally, despite supporting the service and our intentions, the Minister was adamant that government had no intention of funding such a body and he went to some lengths to justify both the absolute curtailment of funds in 2010 and the deployment of his in-house team. What we did establish was that his team may consider innovative proposals that meet the work programme and/or support us in bidding to relevant sources of funding. He was open to ideas around models of social investment but was not persuaded that developing such ideas required his assistance in getting the sector organised to use its time and expertise to such ends.

If not encouraging on money, he was more forthcoming on message. The delegation saw benefit in the Minister being seen and heard to overtly support residential child care and to encourage investment from diverse sources. We intend to take up his offer of a conference address through an invitation to speak at the SCA annual seminar children’s services day on 13 March 2012. Whilst this will not re-establish NCERCC, it is step along the road for ICSE in gaining greater momentum and a vibrant membership.

It is our opinion that the establishment of a professional body for residential child care workers will do nothing but good. We can promote standards and best practice, we can provide support in times of trouble, we can avert the ‘knee-jerk’ responses to crisis but most important we can create value for children’s homes – by valuing the young people who live in them and the staff who have them as a place of work.

Therefore, through ICSE with employer body and sector support but without Government fiscal backing, but at least support as to principle, we must press ahead together as a sector to set up a replacement for NCERCC.

Our campaign looks like being a long and incremental one – we must be alert to steady improvement in residential child care over time and pick up early warning signs of any drop in standards if we are to build credibility. The Department is receptive to our ambitions, but we need to keep the pressure up and ensure that good intentions are realised.

If nothing else, what is already clear from this process and other attempts at grassroots driven reform is that organisations like ours need as much support from our peers to keep the campaign on track as we can get. To that end, we have launched an online campaign to urge the Coalition to address this issue as a priority.

So knowing how busy you all are, nonetheless, can we at the Institute of Childcare and Social Education ask that, if you haven’t done already, please sign the e-petition to re-establish the NCERCC, which can be found by searching on ‘NCERCC’ at epetitions.direct.gov.uk.

In short, as we said to the Minister, you have to have a sector to be sector-led. So if you do nothing else, join ICSE www.icse.org.uk.

Vic Citarella is Chair of the professional association the Institute of Childcare and Social Education (ICSE). (Published on Children Webmag: Saturday, October 1st, 2011.)

Thursday, 15 September 2011

Commissioning in Practice – can social care commissioners step up a gear to meet the challenge?

Guest Blog from Doug Forbes, Director, Institute of Commissioning Professionals www.commissioning.org.uk

Commissioning is everywhere in the public sector. New Clinical Commissioning Groups in the NHS, the white paper proposal that a local authority becomes a commissioning organisation and Justice Commissioning. In children’s services, the area of youth services, the inspectorate OFSTED has said, “In the less effective practice, the process of commissioning was poorly understood; confusion between procurement and commissioning impaired planning.” (August, 2011.) The Institute for Commissioning Professionals’ experience suggests that commissioning is poorly understood within local authorities. Apart from in a few areas, it is not being seen as a tool for leaders to use to reshape provision. It is often seen as a support service which follows process. Clearly, OFSTED would like to see a change and no doubt, the Winterbourne View and Southern Cross issues in health and social care will herald a clamour for change.

At the IoCP, our goal is to improve commissioning standards, an objective shared by Dame Barbara Hakin, National Managing Director of Commissioning Development at the Department for Health. If asked, what is commissioning? It is simply, ‘What to acquire?’. How it is acquired is open to a wide range of routes including, in the NHS, the right to provide and in local government, soon the right to challenge and form a community-based mutual.

The UK Government is making moves to simplify the onerous EU procurement directives and is entering into negotiations with the EU: to free up frameworks which lock out suppliers; eliminate processes which discriminate against small to medium-size businesses; and award contracts to new community based mutuals for 3 years before undergoing a test of competition.

If commissioning is to be objective, it needs to be further professionalised and develop leadership. Currently in Social Care, it is a function for which the Director of Social Services as budget holder is responsible. In the NHS, the National Institute for Health and Clinical Excellence (NICE) is working hard providing evidence based research to determine in care pathways, what should be commissioned. We see no evidence that Social Care Institute for Excellence (SCIE) is performing a parallel task on Social Care.

Without a professional focus on what should be commissioned and a drive to improve the understanding and the practice of commissioning, then the current reforms will become discredited. More importantly in the Winterbourne View situation, where actual harm was caused, it has not been perceived as a failure of commissioning, it has been seen as a failure of regulation. Our view is that it was primarily a failure of commissioning as ‘who pays the piper calls the tune’. No one from the commissioning bodies seemed to be listening to the very expensive tune.

The major challenge in social care and health is how to meet the needs of a growing aged population with limited resources. So where is the leadership in social care commissioning that will challenge existing practice and learn from other sectors which have integrated the client and delivery side of the business at substantial savings? In social care terms, this already happens in aids and adaptations where the Red Cross, for example, can assess and deliver. What it would mean is to put the purchaser provider split under the Director of Adult Social Services and integrate assessment and care management, contracting and the provider arm, probably with a social landlord. How much bureaucracy and cost would be eliminated in that move? We ask where are the social care commissioners who are willing to initiate an employee-led mutual to deliver this vision.

So leaders have a choice, to use commissioning as a tool to deliver more appropriate services and use it to rise to the economic and sector-led support challenge or keep it as a low level support service with a focus on procurement. I know which I’d prefer and I think the inspectorates and tax-payers will think the same.

Sunday, 11 September 2011

Governance and Gloss - Castlebeck

Guest blog from Richard Banks richard@richardbanksassociates.co.uk

How did we get into the Winterbourne View mess? On the heels of that genuinely heartbreaking May Panorama expose of abuse of patients at Winterbourne View, all of the residential/hospital services owned in England by Castlebeck Care were re-inspected. As well as individual examples of poor practice, the Care Quality Commission found a number of company-wide problems across the group: lack of staff training, inadequate staffing levels, poor care planning, failure to notify relevant authorities of safeguarding incidents and failure to involve people in decisions about their own care.

This exercise has found Castlebeck Care was actually not compliant with ten of the essential standards providers of such services are required to meet. Thus, managers did not report major incidents; planning and delivery of care did not meet patients' individual needs; insufficiently robust systems to monitor quality; failure to identify/manage risks relating to the health, welfare and safety of patients; failure to respond to/consider complaints; investigations into the conduct of staff were not adequate; reasonable steps to identify and prevent abuse had not been taken; the company had not appropriately responded to allegations of abuse; management did not protect against excessive use of restraint, did not operate recruitment procedures in relation to persons who were not fit to work in care settings and failed to provide appropriate training and supervision to staff.

That’s quite a list. Yet, before all this came out, the supplier produced, as part of the NHS ‘Quality Accounts’ process, glowing reports of its performance last autumn. Its then Chief Executive, Jon Mann, identified key points of note such as his company building on a long history of outcome measurement to establish a syste “which will consistently measure outcomes for service users across all Castlebeck services”. It had enhanced the use of the so-called “SHARED Approach,” “our person-centred model of care and support”. It had piloted and rolled out a new system to “strengthen local Clinical Governance to complement centrally managed approaches”; it had re-structured its Risk Management Committee, with a revised Risk Policy and a new framework for assessing risk; it had recorded “high levels of patient/user satisfaction with our services” and responded quickly when people were dissatisfied. Great organisation, you’re thinking.

Mann had also reviewed his company’s Medicine Policy to improve the prescribing and administration of medication, including of controlled drugs, had introduced a more accessible system for obtaining service user feedback, including for those with communication difficulties, etc.

The list goes on and I think you will appreciate the point – this was a firm telling the world it was on the top of its game when vulnerable people were being mistreated by the same organisation that the report commends.

Puzzled as to how these Accounts and the CQC audit can be about the same organisation? It would appear that not only was Castlebeck misleading clients, the NHS, relatives and the public; it also ended up misleading itself. To be charitable this kind of disparity between PR and reality is not uncommon in organisations where the need to present a positive, achieving image ends up not just providing a gloss but actually being completely unrelated to reality.

It’s one thing to see this gap in say, how a holiday company talks about a resort and the building site you actually stayed in, or the difference between a bank’s claims about customer service versus your experience of it.

That sort of deceit is never acceptable but it certainly can never be tolerated in the social care and health context. That’s because we’re talking about people’s lives, their safety and their dignity.

This is why governance in social care is so important. Information about the quality of care services is important but the quality and accuracy of that information is also paramount – and that how that information is gathered, analysed and presented also has to be properly and truthfully managed. Governance must start with the people who use the service and spend time and resource ensuring that reports are authentic to their experience.

Whoever is the auditor of the NHS Quality Accounts may want to have another look at how they go about their activity. The SCIE Social Care Governance framework has much to offer settings like those offered by Castlebeck.

Thus we can make the gloss and the governance resonate with each other.

WORKFORCE DEVELOPMENT SCIE GUIDE 38 - Social care governance: a workbook based on practice in England
www.scie.org.uk/publications/guides/guide38/

Author Sally Curtis and a working group developed a definition of social care governance: Social care governance is a framework for making sure that social care services provide excellent ethical standards of service and continue to improve them. Our values, behaviours, decisions and processes are open to scrutiny as we develop safe and effective evidence-based practice. Good governance means that we recognise our accountability, we act on lessons learned and we are honest and open in seeking the best possible outcomes and results for people.

Wednesday, 31 August 2011

Join our campaign to reinstate the NCERCC or a comparable body

Join our campaign to reinstate the regrettably closed quango, the NCERCC at epetitions.direct.gov.uk.

I am chair of The Institute of Childcare and Social Education (ICSE), the sector body behind this campaign, which has set up an e-petition to demonstrate to the Government the strength of feeling in the sector on this issue.

The government-funded National Centre for Excellence in Residential Child Care (NCERCC), based at the National Children’s Bureau from 2004, established itself as an invaluable resource for the residential sector, providing a focus for consultation, developing training and advice, running seminars and conferences, and producing publications and developing policy; but its funds were diverted by the last Government in 2009.

There is an enormous demand for another NCERCC or a like body to be set up - something we hear from residential care professionals, local authorities, schools, professional associations. Residential staff do a highly demanding job and they need support from people who really know about the work.

Setting up such a sector body need not require a huge budget and it could be partly self-funding. Despite the current austerity measures and curb on quangos, the support offered by such a body is a proven and cost-effective way of minimising the well-publicised scandals of the past arising from abuse in children's homes.

Bringing this kind of resource back is the best way to ensure the welfare of the children and young people, who require the most intensive care in our social services system, will always be of the highest quality.


Monday, 18 July 2011

The Full Story

It’s difficult to know where to begin with this story. As a newspaper reader does one start from an assumption that this is all true or untrue or a truth for somebody? As social workers we know that much of the story is unlikely - we tend to enter care proceedings too late rather than too soon; "casual grounds" are just not accepted and there are other significant players in the system (not least local authority lawyers). So if it were true there is either one pretty pointless conspiracy going on and/or we can expect some social workers and other professionals to be losing their jobs soon. However as a newspaper reader (and the Telegraph is a newspaper and Booker a credible writer of long standing) one cannot accept that they have printed a load of untruths. What would be the point of that at a time when the newspaper industry and journalism is at such a low ebb in the nations esteem? So I come to the conclusion that it is a truth for somebody - in this case probably a parent or relative - and all Booker has done is to floridly articulate that, used his skills to satisfy the preconceived appetites of his readers and ramped it up a bit with a campaigning slant - secrecy in the family courts system. There you have it. A one-sided story.

The challenge for social work, then, is to find a way, not to rebutt nor to tell another-sided story, but to tell a fuller story. One that remains newsworthy and has everybody's truth included. Booker concludes his item by criticising judges for not challenging what is before them. A full story would open the roles of journalists, social workers and other professionals to the judgement of public opinion as well as to that of the courts. The question remains, in our partisan media world, of who can write or voice such a full story. For social workers, how do they make their voice and their truth heard? The debate here is important as it is only through some form of collective action that we can get a fuller story before the public.

Sunday, 10 July 2011

Reflections on Directors Forum 2011 for RIPFA

In my role as Social Reporter blogging on Funding for Innovation in Social Care...

“Research is all about evidence ergo Research in Practice (RIP) and Research in Practice for Adults (RIPFA) are both all about evidence. At this year’s Directors Forum, held jointly by the organisations, the theme was Funding for Innovation in Social Care. We all know that innovations struggle to get funding. They are risky, unproven and eat up time and money. Directors need some persuading to innovate – they talk about ‘having to do the day job’. Funders want sight of return on investment. Customers are reluctant to deviate from the tried and tested. Hence at the Forum participants heard about, considered and discussed the contribution of evidence.

What motivated them to do this at a time when they have enough trouble keeping the show on the road and savings to extract?...”

For more go here: http://www.ripfa.co.uk/directors-forum-2011/reflections-on-directors-forum-2011/

Wednesday, 29 June 2011

Guest Blog from John Papworth, Senior Associate, CPEA: Rebirth or Stillbirth – Still Bedevilled

A decade ago SOLACE (Society of Local Authority Chief Executives) produced a document that looked at possible future scenarios for local government (Rebirth or Stillbirth?). It warned of an obsession with targets, processes, and inspections, which would result in the actual services experienced by the public being degraded, or worse not meeting its needs.

About a month ago I went to a care conference sponsored by Vanguard Consulting and the contributions from local authority guest speakers (both front line staff and managers) highlighted a number of key issues that bedevil both children’s and adult care services at the moment. The typical issues are:

• It is easier to give any service rather than what a client wants or needs. Staff are customer focused, but many current systems are not, and this is made worse by targets. For example a Midlands council discovered that when it checked 28 cases, 4 were new, and 24 were revisits of old cases, and they also discovered there is an alternative universe where staff are doing private deals to get things done and give the client what they want or need

• A tendency to try and “close” cases as soon as possible as it “reassures” managers, and ultimately politicians and the media, that things are alright

• There is simply too much information to process on a daily basis

• Too much work is failure demand (i.e. re-dealing with old cases, rather than new cases). And the system has too many stages in the process and hence is slow and fails to meet customer needs in a timely fashion. For example, a council set out the issues with its Disabled Facilities Grant system: preventable demand was 71% of the work and there were 291 steps to the grant process, of which only 20 were required

• The way to cope with failure demand to date has been to raise thresholds to make it more difficult to access services, ultimately leading to higher costs – as inevitably only the most difficult and expensive cases are handled. In other words, work focuses on crisis and not prevention

• Too much energy is spent on monitoring cases, and not solving problems

• The current situation is pre-occupied with assessment, which then unlocks care and treatment. This often results in people getting simple help too late, and particularly for the elderly, this means their quality of life deteriorates, and they then require more expensive interventions

• There is genuine confusion about the role and understanding of the skills the staff have. The current system asks them to carry out roles (e.g. IT based work) for which they are not trained professionally

All of which sounds terribly depressing and could confirm that SOLACE’s warnings were right, yet I believe there is considerable hope for the future.

Now we know the problems we can do something about it. I think there is now widespread acceptance that the top-down process and target-driven approach to running public services (usually steered from Whitehall), that has characterised the last 15 years or more, has not worked. If anything it has driven up costs, failed to deliver what people want and caused public service professionals much pain. There is a realisation that the public really do want services from high quality, highly trained professionals who spend time with them, rather than filling out forms or being on the end of a phone line. Consequently I think there is an increasing focus on the “front line” and what it is doing, rather than looking over the shoulder at inspectors and “the centre”. And services should be designed around the customer and led by inspired and motivated leaders, rather than designed around a target or process and driven by “back room” staff. As the ultimate test of any service (public or private) is that if the customer is happy and gets what s/he wants or needs, then that is all that should be delivered, not all the current “extra” paraphernalia that just gets in the way.

Tuesday, 21 June 2011

Guest Blog from Peter Evans: Children’s Home Leaders... United We Stand

In a week where public sector job cuts, pay freezes and pension changes has reached the tipping point of proposed strike action, Michael Gove seemingly ramped up the pressure on the poorest achieving primary and secondary schools. Yet beyond the headline grabbing threats to turn such schools into Academy status was an altogether different speech on educational reform, from which I found immediate resonance to the Residential Child Care Sector. There were two main focal points to deliver better schools: recognising the role, qualities and vision of leadership within the school and how schools can work together to share and develop best practice.

As a registered manager of a children’s home it is hardly surprising that I stand firm behind the mantra ‘a home is only as good as its manager’. I believe that understanding such rhetoric is a vital to fulfil my position of responsibility, particularly with regard to the leadership elements of our role. We set the tone, underpin the culture, share the vision, and continually drive the standards and practice to do the best we can for the children in our care. We are a role model for staff and children alike. The qualities we strive for from our staff teams we need ourselves in abundance – relationship skills, presence, personal drive, positive outlook, stickability and transparency. Often these aspects of registered manager’s role are disregarded or lost in our managerialist culture of systems establishment, monitoring, controlling risk, directing staff and measuring outcomes. I’m sure the latter focus strongly in the majority of our job descriptions and certainly did in my professional training.

Thankfully, the tide may be turning. Ofsted’s recently released ‘Outstanding Children’s Homes’ publication echoes the view expressed by Michael Gove of the importance of leadership, recognising the majority of the characteristics and qualities of good leaders that I outlined above. More importantly, potentially, it shares Gove’s second point for sector development and places the role of the leader at the heart of this. Its first recommendation is to ‘consider systematic ways in which the experience and skills of leaders in consistently outstanding children’s homes could be used to improve standards across the residential care sector.’ On the back of this is a challenge to find new ways to share best practice across the sector. I see this as a call to arms for passionate leaders; to realise that our responsibilities are not exclusive to the homes we manager or the organisations we work for. In times of increasing financial pressure, insecurity and vulnerability we need to work together to show the true value of residential child care and elevate its status. Also we need to help other’s to do the same – managers and staff teams alike. Yet when Mr Gove spoke from his platform at the National College for School Leadership I couldn’t help but think where is our platform? It’s time we started building.

Peter Evans
Group Organiser of the North West Residential Child Care Forum on the Residential Child Care Network.

Link/Reference
Outstanding Children’s Homes, Ofsted, 2011 available at www.ofsted.gov.uk/publications/100228

Thursday, 16 June 2011

Carers Direct

You know how it is on trains - snatches of conversations and mobile calls drifting across from neighbouring seats. Whatever - they were collecting souls - it was a comedy. He has an overactive thyroid - radiation therapy. There will be no trolley after York. Can you imagine if Graham was gay? You can't do that with the flexi. And then some trigger words make the ears go on alert - social worker.

I talked to the social worker. She had a good care package like and excellent carers. It was more the emotional stuff. She had already been to a counsellor - Relate and all. I says to her why don't you use the money to get something for yourself - with other women - Yoga or whatever. Disability or not you don't want to be stuck in the house do you?. It’s like bereavement - you know.

Good that social work is associated with assisting with emotional needs. Query - how well are social workers equipped to meet this expectation?

As they got off I noted they both carried Carers Direct bags

Sunday, 5 June 2011

Devils Workshop of Winterbourne View

A feature of the Winterbourne View, Castlebeck (Panorama) appalling saga that lingers most with me brings to mind the cliche that idle hands are the devils workshop. The programme left more than a suggestion that the staff behaved as they did because they had nothing better to do. Jim Mansell of the Tizard Centre effectively said this in his comments. That they made entertainment by provoking residents into responses that would justify 'restraint'. Escalation of verbal and physical goading amounting to torture leading to some sort of misguided sense of 'job done' by the shift. Is this what people do when they are bored at work - I don't think so?

This is what happens when management allow unsuitable persons to do the wrong tasks with inadequate training and leadership. Incidents of neglect or cruelty almost always occur in these circumstances as found by J.P. Martin in Hospitals in Trouble 1984. At the beginning of the book he quotes Sir Keith Joseph who said in 1971: 'I must tell you that one day somebody will write a book about the part that scandal has to play in procuring reform.' This is the book, and those who do not know the history it contains may be doomed to repeat it. Management at Castlebeck clearly did not know and thus the circumstances conspired to allow 'Wayne' and his cohort of approval seeking and bored bullies to perpetrate vicious abuse.

So let us be clear bored people are not bad people but they are susceptible to bad leaders. 'Wayne ' was characterised in the programme as typical of a long serving, unqualified and very 'strong' leader - the tattoos adding emphasis for the programme maker. What Winterbourne View, as a private hospital, was crying out for was professional leadership from a qualified and experienced manager (equivalent to the registered manager in a care or nursing home - are they exempt from Outcome 24 of the Essential Standards of Quality and Safety?) backed up by a vigilant and informed responsible person from Castlebeck - all reinforced by effective regulation from CQC. What did they get - disinterested charge nurses, organisation managers who seemed to think that if they had suspended staff when the whistle was first blown all would have been OK and a regulator that has been denuded of professional expertise.

Scandals like this in residential care are not about size of the home, they are not about private versus public care and they are not even about resources for training or better pay. They are about having the right professional leaders of social care practice at every level - care worker, (registered) manager, responsible person, commissioner and regulator. The residents of Winterbourne View suffered in the devils workshop because of a multiple failure of leadership at every level. Castlebeck need not pay Price Waterhouse Cooper to find that out when they can buy J.P. Martins book for £17.50.

Tuesday, 17 May 2011

Why I’ll be shopping at the Co-operative’s one-stop-shop: Turning Big Society rhetoric into reality

Welcome news for directors of services and public sector bodies looking to explore different ways of providing services is the launch of the Public Service Mutuals.

The Co-operative will be sharing its long-established experience of doing business as a mutual with the sector and offering advice and support, at a reasonable cost. My company CPEA is proud to be a trusted partner in this initiative which should shed light, finally!, on The Big Society vision of Social Care organisations running on a co-operative basis as mutuals, which has to be good news for councils and the communities they serve who in the current funding environment need to look carefully at ALL their options for service delivery.

See our website for more: http://www.cpea.co.uk/news.html

Tuesday, 26 April 2011

One portal - a world of social care knowledge

ADASS members received presentations from 5 agencies focussed on supporting sector-led improvement at their recent Gateshead seminar, namely:

· The Local Government Group

· Skills for Care

· Social Care Institute for Excellence

· Research in practice for Adults

· National Skills Academy - social care

The unanimous opinion of those present summed up by ADASS Workforce Network Chair Jo Cleary was – that’s great, we didn’t know that’s what you did and good to see it all in one place in a leaflet.

The challenge was laid to down to take things further through a single portal on the web. Thereby the participants thought life could be made easier for those seeking the best support, advice and knowledge. ADASS members clearly want a cooperative support service where organisations complement and augment each other rather than a competitive one where there is duplication and complexity.

CPEANOSE has searched web for the leaflet to no avail so has reproduced it here as a starter to the single portal:

http://www.cpea.co.uk/knowingwhatworks.html

Monday, 18 April 2011

Help give (residential) child care a professional voice

The Institute of Childcare and Social Education (ICSE), of which I am Interim Chair, held a General Meeting on 14 March 2011. Discussion was lively, and the main thrust was to focus on the needs of registered managers of children’s homes, who hold the key to the quality of services provided, need first-rate support and training, and deserve professional recognition through registration.

It is a time of threats to services because of budget cuts and I believe it is time for the child care profession to get involved, and provide support and leadership to its own; monitoring the impact of government cuts, pointing to alternatives.

ICSE has now been relaunched as a body for concerned professionals to come together and make sure that both practitioners and managers have a voice. It is not only a matter of facing the government’s cuts squarely. There is also a lot positive going on such as the introduction of social pedagogy, educational therapeutics and restorative practice, the development of play and the continued impact of children’s centres.

Ways need to be found to ensure that the positive momentum of these developments is not lost, and that the services survive the cuts till the financial times become easier.

If these matters are of concern to you, join the ICSE and help to give your profession a voice, then please get in touch at info@icse.org.uk

Saturday, 19 March 2011

Reading Time for Social Work

One of the problems for social workers to my mind has been giving priority to reading, both of new research and policy development, and of standard historical texts. Because people seem often to be unaware of much of the material of the past http://www.childrenwebmag.com/ have been publishing two digests of Key Texts per month for the last two or three years, and hope to publish the accumulated digests before long. For more info email info@icse.org.uk