I was pointed in the direction of  the link of Caring with Confidence directly by some of those responsible for its implementation – not having been aware of its existence – but having checked it out briefly (to ensure authenticity – because often I am pointed in the direction of people paid stuff or other dodgy businesses!) I’m more than happy to share the link!

It is a free programme sponsored by the government as part of the Carer’s Strategy  to provide support, information and particularly access to training to informal carers over 18  across England. Having looked at the site, I think it seems to be a positive step and definitely a resource that I would add to my ‘toolkit’ and follows on in the footsteps of the Expert Carers Programme. I haven’t had any experience of people I personally know following the Expert Carers Programme but from those that I personally know who have followed the Expert Patient’s Programme, the feedback has been enormously positive so on that basis I’d think it can be no bad thing.

It seems to be a very flexible approach to providing the information that is all too often ‘out there’ but has, sometimes, needed to be sifted through and they are offering online courses as well as face-to-face group sessions and workbooks to help carers access a full and substantial training programme to ensure that their needs are met or at least, an awareness of where the needs haven’t been met or that entitlements have not been offered.

I’m almost ashamed to say I had never come across this before – especially as in our team, we do a massive amount of work with carers and anything that will be able to add support to the structures that all too often don’t do enough.

I have been a little rushed over the past couple of weeks but I hope that over the next few weeks, I might have more opportunity to investigate the material but as it’s freely accessible, I’d also welcome any feedback from anyone who does so..

As far as I’m concerned, the more free and accessible resources available, the better!

It is not uncommon that I might ‘put my foot in it’ but I had a very narrow escape earlier in the week. I needed to place Mrs J in a residential home. There were no beds at the preferred home of choice of her family members and she had needed to be discharged from hospital weeks ago really.

I sent them lists of other homes with vacancies in the nearby area and while none were akin to the first choice home, there were a few that were in the local area that I hadn’t had as much contact with.

Mrs J’s daughter went to see one. She said it was passable but not quite ‘perfect’ so she went to see another couple.

After a few days, she came back to me and said that the family felt a placement in the first home they had seen would be the best as it was far better than all the other homes they had seen although really, they would have preferred the ‘first choice’ place.

I arranged the discharge and Mrs J left. I popped in to see her during the week as I had told her and her family that I would and I wanted to check out the residential home at closer contact. It seemed efficient and well-run – as far as is possible to tell at first sight.

So on Monday. I received an email from Mrs J’s daughter – furious about the standard of the care home and appalled that it had been ‘recommended’ by the council. She felt it reeked of urine and there were  no staff around. She was appalled that anyone could consider a placement there.

I probably read the email a little too quickly as I was rushing out.

I answered in fairly neutral terms saying that I had visited and had not picked up any of the concerns that she had stated (which was true) however, I forwarded her the contact details of CQC and advised her that if she wanted me to, I would also be happy to speak directly to CQC and make a complaint on her behalf.

When I returned from my visits, she had replied, saying that she hadn’t been referring to the care home in which her mother was placed but rather the other homes that she had been sent to.

I was just relieved that my response had been so neutral in the first place and hadn’t rushed into apologetic language or sympathising about the awful situation..

Community Treatment Orders – Supervised Community Treatment – however it is termed it is one of the aspects of the amended Mental Health Act that I thought I would likely not have significant contact with on a day to day basis. I was right. But my experience might be far from typical as the take-up of these Community Treatment Orders has been much higher than was estimated by the government.

As Community Care reported a couple of weeks back

The statistics revealed that 2,134 community treatment orders were issued in England from November 2008, when they came into force, to March 2009. The government expected there to be 450 CTOs in England and Wales in the first year.

That figure of about 2000 is only until March – currently the whispers (from various training courses) say that the figure is nearer 4000.

So what are they for?

And who do they affect?

This was one of the more controversial parts of the amended Mental Health legislation in England because it allowed for conditions relating to treatment to be placed on patients in their own homes. It allows for a process of ‘recall’ to hospital is the conditions relating to treatment are not met.

We, in our training and discussions, are often signposted to people who may have a very clear history of ‘revolving door’ admissions with similar sets of circumstances and the CTO provides a means of enforcing treatment with the threat of recall to hospital in the background and a legal framework being provided in order to do so.

The general discussions that I’ve been party to in my local trust area seems to revolve around a few consultants being very much in favour of using them and others not using them at all so the national figures are high. It is another way of managing risk through compulsion and in an increasingly risk averse culture, it can be seen as an additional safeguard.

I have been involved in a couple of CTO-related decisions in my role as an AMHP (Approved Mental Health Professional). Generally the RC (Responsible Clinician) will be the one to arrange the CTO however before it is valid, the forms have to be signed by an AMHP in order to serve as one-man check and balance system to ensure that the conditions set are fair and appropriate and that the least restrictive path is met.

The other role of the AMHP is in the revocation of a CTO. If, when a patient is recalled to hospital by their Responsible Clinician it is seen fit that they need to revert to the section that they were detained under prior to the CTO, a signature of an AMHP is required on the paperwork in order to validate it.

The only CTO-related issues that I have been involved in so far have been to revoke a CTO – in the situation, the patient was not someone I knew very well but I had been involved in the initial community assessment and bringing her into hospital as a result. I was asked to consider the revocation of the CTO and saw that she was extremely unwell – at least as unwell as the point of the initial assessment considered that it was far more appropriate at that time that she was in hospital for a while longer.

The other decision is more recent so will probably come back to it at a later date and is, as of now, unresolved which is more reason for me not to dwell on details but it has raised interesting dilemmas about how much influence can be placed to sign some of the pink forms (all Mental Health Act forms are pink – for the record) if it will ‘make life easier’. As I said, it’s probably something I will return to at some point.

I was involved in some in-house training about the new Mental Health Act legislation and to be honest, because of the time involved, we skimmed very briefly over CTOs – thinking that they wouldn’t necessarily be relevant within over 65s services however, we are considering a few refresher sessions because, as Pope wisely said ‘A little knowledge is a dangerous thing’..

The GSCC (General Social Care Council) is a mess. That’s pretty much confirmed. It was set up to regulate social care workers and plans to roll out the registration of all workers in the social care sector has stalled with the registration of qualified social workers and social work students. Apparently it is improving but that might be fudge.

The Guardian today has an article explaining the lack of will for any roll-out. Due less to the incompetency of the GSCC (although that has been proved) but due to a mish-mash of government directives. And it doesn’t make a pretty sight for a government that is struggling by on its last legs and joins a heap of discarded promises in the trash bins of Whitehall. Although I doubt many will care too much about the lack of registration of care staff in the mix of a general election, it is an indication of muddled thinking all round.

Back to the GSCC though. Having suspended her Chief Executive, Mike Wardle, back in July after the enormous administration problems came to light and the weight of the backlog of conduct cases came to light, has again come under the spotlight as the CHRE (Council for Healthcare Regulatory Excellence) has reported that the GSCC deliberately stalled investigations of poor conduct in order to save money – as is reported in Community Care

The most damning evidence came from GSCC conduct officials, who told the CHRE they felt pressurised by their managers from 2007 onwards not to proceed with cases for financial reasons, “regardless of the public protection implications”.

The existence of a backlog of cases was “well known at all levels” of the organisation but the council, the regulator’s strategic body, failed to take action because it did not understand the implications of the failures.

Even the the Department of Health was aware of the situation, and council members said they believed the DH had approved the management decision to allow cases to remain unprocessed.

I think that pretty much speaks for itself. I am completely in favour of regulation, for the record. I think it would be beneficial for the registration of social care staff to be rolled out although that looks nigh on impossible at this point.

What is disappointing is the lack of input of actual social workers in the GSCC. The social workers on the council might have practiced for a few years decades ago before moving to strategic management or the ivory towers of academia but there are few bodies that represent truly the social work values inherent and necessary for front line practice.

The irony is that the GSCC can remove the registration of a  social worker for building up a backlog of cases and failing to complete vital work to schedule and ensuring it was allocated when looking at their own systems, they hardly did any better themselves.

However, there does need to be regulation of that there is no doubt. The profession functions better and with more public faith than the previous process of anyone being able to term themselves ‘social worker’ whether qualified or not and allows some kind of admonishment for poor practice by removal from the register and barring someone from practising as a social worker.

But the implementation has along the line, been poorly thought out and poorly executed – from the initial registration process which was hopelessly organised through trying to get every single social worker to register within a short period and now, of course, all those who were registered in the very first wave, come up for renewal at the same time, leading to a backlog again. I wonder if there would have been a better way of organising registration – by some complicated system such as alphabetical order…

I wonder about the role in ‘improving social work education’ too. We have stories of universities desperate to fill places even though they are not able to provide appropriate placements for all the students on the course. The PQ (Post-Qualifying) Framework takes at least a postgraduate degree in the first place to try and understand the processes of Specialist/Higher Specialist/Advanced Social Work – which are the three levels of PQ award.. I’m not sure how proud the GSCC can be about setting up the ‘new’ degree in 2003 when various more recent reports, not least that of the House of Commons’ Select Committee for Children’s Services have found the training of social workers currently not fit for purpose.

So we are left with a quango that has little moral authority writing the guidelines for conduct of a social care staff who are obliged to pay for the privilge of retaining a registration.

Hope remains though as it always does that criticism and wide, public criticism, at that – will instigate changes in the processes and workings – to become more transparent and dependable as an organisation. There is no alternative.  Apart from moving to Wales or Scotland…

We have grown used to the ‘you are what you eat’ notion and it is both obvious logically and well-known scientifically that health is affected by the foods we eat. Indeed, there is little escaping the fact and I say this, having a natural affinity for chocolate and other sweet stuffs (in moderation of course!).

Apparently though it isn’t just waistlines that are affected..

The BBC website reports on a research study which claims that depression is linked to eating processed foods.

The report is published in full in the British Journal of Psychiatry and the study involved 3500 civil servants and any links between their diets and the development of depression – with other factors taken into account.

There was a significant difference in the risk of the development of depression depending on the diet. As the article says

Those who ate the most whole foods had a 26% lower risk of future depression than those who at the least whole foods.

By contrast people with a diet high in processed food had a 58% higher risk of depression than those who ate very few processed foods.

There are a number of thoughts I had about this. Firstly, and one picked up in the article (so I’m not claiming an original thought!) is that often processed foods are cheaper and there may be a link with poverty levels and difficult circumstances and depressive illnesses. Of course, the base group taken for the research were employed civil servants so that wouldn’t necessarily be the case for this study but if the conclusions are extrapolated to the general population – we can assume that levels of poverty may increase the risk factors.

Also it is oft-proved that physical and mental health are closely related – a poor diet may bring about poorer physical health which may be a cause of more depression.

It’s an interesting study and one that further encourages me to reach for an apple rather than the coco pops in the great Breakfast decision of this morning.

Something of a theme on my caseload at the moment is one of ‘delayed discharges’. I have three people in hospital medically ready for discharge and am waiting for residential or nursing placements to ‘pop up’.

It’s a warped kind of waiting game with no beds being available locally and people increasingly being shipped further and further out of London or at least towards the suburbs as the hospitals become desperate for beds and the lack of resources becomes painful.

One of the three has been on the waiting list for a local residential home for months. Another has a devoted wife who has constantly cared for her husband for decades through his progressively deteriorating dementia and another – well – the hiccoughs are proving to be way too many to detail succinctly..

But the result is the same – people who have strong local attachments, families and spouses are having to be placed outside the local areas.

It’s a subject matter that I have personally brought up again and again – going directly to commissioners when necessary but there is no aspect of my work where I feel ‘less heard’. Of course, placements can’t spring up overnight although some people imagine they can – and the brutal truth is that a placement usually only becomes available when someone dies.

That’s why the dementia residential placements locally have been so sparse – often they are taken up by people who could be very well physically and this means that those who need the beds are waiting longer and longer.

A part of the problem is that there was a feeling that ‘Extra Care Sheltered Accommodation’ – namely sheltered accommodation with additional 24 hour support on site – would ‘divert’ some people from residential care. In fact, the extra care sheltered properties, which we were told when they were established would be an ‘alternative’ to residential care, are not – at least in the local area I work (and it really could change from borough to borough) – not geared to meeting the needs of those who have 24 hour support needs. This is a particular issue at the moment as they seem to be incredibly reluctant to take anyone who doesn’t fit in to the ‘kind of person they want and would be ‘easy’ to manage’ making it more of an alternative for sheltered housing than for residential care.

I would love for there to be a widespread rethink of residential and nursing care provisions in the context of meeting individual needs. Prior to my qualification, I worked for about 7 years in a small group home for adults with learning disabilities and there was a massive focus on individuals and meeting particular needs. Of course, the funding is massively different level and that will always be the ‘sticking point’. There are vast amounts of funding available for younger adults compared to over 65s – simply because there is not the money there to provide the same levels of funding. Local authorities are not able to pay high care fees and the cheapest fees often involve large care homes. That isn’t to say they can’t involve personal care but more often than not they don’t – and certainly not where they need to be.

For every problem I find though, money is the answer – unfortunately – and in these times of shrinking budgets, we are left to provide what constitutes poor outcomes. I’d love to imagine a world where some kind of charity or donor could set up some smaller group-home like care structure for older adults too but the costs are way too high.. maybe that’s a project for the future..

Working in central London probably exacerbates the problem in some sense that the housing prices and land costs in the area that I work are particularly high – definitely favouring residential redevelopments for bankers as opposed to more substantial community resources.

But there is something incredibly cruel about ‘shipping out’ the older and the frailer to outlying areas. I know there is a move towards less residential care services but that isn’t the answer as there will always be some need for the provision.

I don’t like to patter on about the fostering I do but at the start of a new placement, some of the work-related issues shift onto the back burner temporarily in my thought-process. It also tends to lead to a slightly less regular post schedule to the blog but half-term as rewarded me with my early morning peace again so I felt like reflecting on some of the issues that have been mulling for a few weeks.

The experiences of fostering children has been challenging, thought-provoking, rewarding and a part of a learning experience that my work has never offered. I am not blind to some of the issues that lead a child to be ‘looked-after’ by the state but I have distanced myself from some of the day-to-day workings as I moved into adult services after my generic ‘social work’ MA.

I wondered how possible it would be to separate the two roles and worried about having to manage a heavy workload with coming home and stepping into the role of a foster carer. All I can say is that most of my worries have been unfounded but it is very useful to have a sympathetic employer who understands that sometimes I have had to come in a bit late to work or have needed to leave early on occasion. Of course, I could never have considered taking on this role were it not that my partner is the ‘main carer’ although it is still quite difficult to convince the local authority that we foster with of this fact as they automatically seem to revert all correspondence and phone calls to me… I suspect this is partly a gender-based assumption combined with the fact that my first language is English and his is not -  but I’ve stopped challenging that so often now, it’s just as easy for me to deal with the bits and pieces that arise and then just pass the information on to him.

So what have I learnt, well, firstly I am far from an expert about anything. We have only had three placements and all have arrived as short-notice ‘emergency’ placements. The latest occasion, the only information we received was age and gender. Even the name we were given was wrong.  I’m surprised at the lack of any kind of matching but I know that this is mainly due to the lack of placements that exist in the area where I live – which happens to be one of the inner city boroughs with some of the highest levels of poverty in the entire country.

Two out of the three children are recent arrivals to the UK and did not have English as a first language. This, of course, has it’s own issues and difficulties although rather coincidently, of these two, they do have the same first language so we were able to make use of the picture dictionaries and DVDs we had bought for the first child, with the second child. That was not something we were expecting – especially as it isn’t one of the more common ‘second languages’.

On all occasions I have felt disappointed by social workers and social services. I wonder if my expectations are too high but honestly, to have left a child with us late one night and then not contact us again until after the weekend and a LOT of chasing around and phone calls from us. No, that’s not good enough. I know that social workers are busy people, really I do. I’m probably more prone to sympathy and empathy than most. But leaving a child who IS old enough to understand and process the information without any kind of information whatsoever has seemed harsh. On chasing, she (the social worker) explained that she had had to make other emergency placements that week and that as she knew child was safe with us, she hadn’t prioritised. I think that says it all about staffing levels to be honest. We still have a child who wants some explanations and some answers.

Things are settling down now and we have as much information as we need to provide but then again, we know we are trustable and ‘decent’ and want to do well by the children placed in our care.

One element that I have been pondering on which has had a massive impact on my thought processes is that of poverty. I have seen poverty up close through my work. I know it is there and I know it is there, quite literally on the same street that I live in. Noone can accuse me of moving to the softer suburbs or any kind of ivory towers (indeed, anyone reading this who knows me will testify that I seem to have found myself in one of the less suburban parts of town!).

But the poverty you see when a child spends time with you on a day to day basis, and marvels that you have a functioning oven, hot water on demand,  the ‘massive’ 32” TV (especially when I was griping about wanting a larger one) and the fresh food that arrives on a daily basis – it is much easier to comprehend.

It is a wrench not to want to go out and do things, buy things, put right the easiest things there to make differences, namely by buying nice new things. New outfits, magazines, DVDs, games, toys – and in some ways, it has been the hardest thing for me not to just rush out and ‘buy stuff’. Because that it isn’t realistic – life isn’t about buying things to make you feel better when you are low.

That isn’t to say some things aren’t right and proper and that we haven’t bought things that are needed  – season-appropriate clothes, a favourite film or toy, soft toys etc – but money can’t be a panacea on a short term basis.

I’m trying to focus on educational visits and trips and outings – experiences perhaps, rather than items. We have been to the theatre, the zoo, various museums, we have spent a lot of time making things – pipe-cleaners are wonderful, cardboard boxes and a few sequins – ways and means to spend an enjoyable hour or two. The library and swimming pool are very local and have been fantastic – things are settling down now after three weeks but it’s still a case of judging the pace – especially as the child with us now is older than the others and has a better understanding.

We have no idea of timings and how long she will be with us. I have a hunch it will be a month or so and there will be attempts made for her to be home by Christmas but that is just a thought. Really, as with the last times, we had very little notice.

I have had a few people telling me that they are interested in fostering after I tell them it is something that I and my partner do. I would certainly say it has been illuminating, not always easy  but we never expected it would be. It feels right though. Some of the changes and effects have been different, sometimes I wonder if I am too prone to reflecting about the situations and if I am too generous with some of the professionals involved. I have seen how easy it is to become critical of them and try to temper that with some more understanding.

Support isn’t as available as we were led to believe it would be and it isn’t something I could do alone but we have had and got to know some incredibly bright and resilient children and tried to allow them understand, I hope, that horrible things happen that we can’t always change but we can come out the other end and sometimes in the fairy tales, you have to wait a little while longer than you want for the happy endings..

There was a curious headline in the Mail on Sunday yesterday. I was not curious enough to buy the paper but curious enough to investigate on the Mail website. Apparently, according to the journalist,

Secret court seizes £3.2bn from elderly… and even forces furious families to pay to access own bank account

Without any reading, I knew the reference was to the Court of Protection. I know I am in a slightly specialised area but I hadn’t considered it was a ‘secret’ court. I suspect that in mail-speak that means that they cannot sit in on its hearings but I had honestly thought it wouldn’t be something that most people would be interested to see covered as much as anything – let alone the fact that as all its hearings involve people who lack capacity, obviously the people in question are not often in a position to give permission to have the details of their lives and finances plastered around in public.

Archway Tower (where the court is based) by markhillary at Flickr

Now, I am no great supporter of the Court in its current manifestation, not least because, since the Mental Capacity Act 2005 came into force with its adjustments to the court processes, the time lags in making a referral have been horrendous -  but – it does provide an important safeguard to those who lack capacity and I was surprised at the vitriolic and sometimes plain incorrect language of the article in question.

The court and the system in place is a crucial protection to those who lack capacity to make decisions about financial decisions although it is not solely restricted to financial decisions – that is the basis of the article.

It can be very long-winded and involving. Basically when someone loses the capacity to make a decision regarding the management of their finances, a power of attorney can no longer be taken out, and although a lasting power of attorney can be registered – that can only be done if the decision and the person taking up the ‘attorneyship’ had been made in advance of the loss of capacity.

Otherwise, a lengthy application is made to the Court of Protection. Often it is just a matter of extensive forms and there is an application fee – which the Mail rails at. I expect the Mail would rail more if the all fees were paid from the public purse but, for the record, these fees are means-tested – meaning they are paid only if the estate can afford it – otherwise, they are waived.

The Mail article of course, concentrates on some individual matters where it has been so difficult for families to access the money of their loved ones – but, and this is a crucial matter, the court is bound to make Best Interests decisions and some families’ ideas of the best interests of their relatives’ money is not the same as an independent solicitor or judge.

For the most part, in uncontentious matters, the court appoints a family member as an ‘attorney’. Indeed, that is by far the most favoured options. Deputyships are used when there is either no family member or sufficient concern about the money in question and how it might be used by the family member.

The Mail, using it’s obviously sharp reporting skills, quotes some users of an internet forum set up to gripe about the Court of Protection. I would venture a guess that any story they write about anything, they could drum up some anonymous quotes from random internet forums to concur with whatever they wish us to believe.

I can’t defend everything the Court does. It is slow without doubt and it is very far from transparent but a body such as it is, needs to exist. All that is needed to avoid its role is for a more widespread knowledge of Lasting Powers of Attorney which can be set up at any point prior to the loss of capacity as, in a sense, a ‘living will’ and there would be no need for these processes (except, and I know of at least one case, where these LPAs have been challenged on the basis of some adult protection concerns).

The Court of Protection is tightly wrapped in the processes of protecting those who cannot advocate for themselves. It is very very far from perfect but it has a crucial role. I’m both surprised and not surprised that the Mail is blaming the existence of this court on the Labour government saying

The first Court of Protection was set up by Labour’s 2005 Mental Incapacity Act, which for the first time formalised the arrangements for dealing with the assets and care of people suffering from dementia and other similar illnesses.

Before this it was left to families and social services to make arrangements – but it was argued this ad hoc system was open to abuse by both family members and by officials.

That’s blatantly false, for the record. The Court of Protection existed long before 2005 Mental Capacity Act (note – NOT Mental INCapacity Act), its form has changed somewhat and if anything, I’d say it is more transparent rather than less although by the comments on the Mail article, you’d think it was all some evil plan by the Labour government to ‘rob’ people of the money their family members are rightfully entitled to spend on their behalf..

Perhaps I have a distorted view due to the levels of financial abuse of older and incapacited adults that I have seen, by family members, due to my job. Of course, most people can be trusted completely and most want the best for their family members but money and greed does strange things to people, even some of the closest of families and it is vital that these checks and balances are in place in the form of an independent body.

Ultimately, in the words of a ‘spokesman for the Department of Justice’ quoted in the article

The OPG (Office of the Public Guardian) recommends that every adult considers making a lasting power of attorney. This enables people to choose someone they know and trust to make decisions about their property and affairs or their personal welfare, should they become unable to make decisions for themselves.’

And with that, I would have to agree. I try to tell people again and again to use the Lasting Powers of Attorneys while they can to avoid any difficulties in the future. I share that advice out of the ‘work’ environment as well as I think if there is anything to be taken from this article – apart from shabby journalism by the Mail – it is that point that no-one knows what may or may not be around the corner and if there is someone who you know and trust to make decisions on your behalf – appoint them formally..

It looks like Andy Burnham, the Secretary of State for Health, has ruled out any use of DLA (Disability Living Allowance) to fund a ‘national care service’. DLA is one of the few non-means tested benefits that is provided to people aged under 65 who have ongoing mental or physical health difficulties over a long term.

There have been campaigns to protect DLA and Attendance Allowance (the equivalent benefit for over 65s) but, worryingly, no mention has been made about Attendance Allowance and I can’t help thinking this is either because it is proving too expensive or that those who receive it have quieter voices to engage when shouting.

It was suggested earlier in the year that funding for a more comprehensive and ‘fairer’ system of paying for care would leave DLA at risk however this might have proved to be just too politically sensitive at a time when it has been to be fair game to pick on benefits for those who are sick.

I remain concerned about the lack of commenting on Attendance Allowance though. Already those who are over 65 receive less in payment for exactly the same presentations of disabilities as those under 65 and it remains one of the more obvious ‘age discriminations’ in the ‘system’. We are told that the costs would escalate if the same criteria and funding were applied to those under 65 as those over 65 but it becomes something of a game and a reason for more inequities across the board.

If someone applies for DLA before their 65th birthday they retain the higher rated allowances for the rest of their lives whereas if they wait and claim one day after their 65th birthday, the receive the lower Attendance Allowance for life.

I remember one woman I worked with whose daughter was furious that she was only advised to claim a month or two after her 65th birthday, meaning she had lost out on the higher ‘lifetime benefit’ she would have had under DLA. We are advised to recommend making applications for these benefits as soon as we become involved but often this is after 65.

I hope very much that the differences between treatment of Disability Living Allowance and Attendance Allowance will be addressed. Especially as, in the same speech, Burnham vowed to abolish age discrimination in the Health Service.

I attended some training on Personal Budgets a while ago. It was fairly comprehensive training that was surprisingly well-presented (it isn’t that I don’t always expect good training but sometimes it can be something of a curate’s egg.. ).

It leaves me in the position of being able to now set up pilot Personal Budgets, having a greater awareness of the process. I immediately, during the training, thought of two people whom I felt that this new system could benefit but first to the details.

Individual budgets or personal budgets as they are also known, are a key part of the programme of ‘Personalisation’ of adult care services. It is detailed in the ‘Putting People First’ paper but was first mooted in the 2005 Green Paper, Independence, Wellbeing and Choice. The idea is that the cost of the services will follow the individual and will involve different sets of choices about how that money is spent.

There is no doubt that the moves towards a more fine-tuned way of meeting needs opposed to making resource-led decisions about services that can be provided is a wholly positive outcome.

The idea is that you would start with a Self-Assessment Questionnaire which is completed either independently or with the support of either a care manager or an independent advocate (I am using ‘care manager’ broadly to mean an allocated employee of the local authority/health trust who would usually be setting up the care plan).

This questionnaire is then ‘validated’ by an employee who needs to ensure that the dreaded (in my view anyway) Fair Access to Care Services criteria are met and then a RAS (Resource Allocation System) defines an indicative  budget.

This budget is used to discuss a personal care plan with the service user and the idea is that the budget should not be a ‘cookie cutter’ type care plan but should indicate the person who needs the service within the financial constraints, of course. Care can be provided via a direct payment or the indicative budget can be used to purchase ‘in house’ services and a wide variety of mixtures in between. The people that I am considering taking through the process, as a part of the pilot stage, both really would benefit from more mainstream day time activities rather than going to the provided day centres (which are great, in their way, for people who enjoy them – and many do).

One person wishes to do some computer training and keep in touch with family all over the world as his daughter is on the verge of emigrating to Australia and he already has family there. One of the examples given to us during our training referred specifically of someone who wanted a computer and internet access to ‘keep up’’ with the times and I think there is a good case that this would provide this particular man with a much richer life if it were to be provided.

The other person is a woman whose husband is providing substantial care for her. She is subject to very low moods but has expressed an interest in pottery and she is very experienced and skilled in various art mediums. Although the day centres offer art activities, she wants to be challenged and we are looking at a lot of courses across London – however this has financial implications. I am hoping that we can use individual budgets in these contexts.

So we can see how wonderful they could be – however, my fear remains the quantity of paperwork they have generated around them. There is no question that the idea is positive and would provide better services but they are, at present, very far from simple and straightforward. My hope, in my ever-positive light, is that the pilot scheme will iron out and streamline the process – my fear is that in the system that is local government bureaucracy, paper is seen as a good thing and forms as positively exciting! Even in these days of ‘paperless’ offices.

Our trainer assured us that we wouldn’t find the process too draining on our time and days of increasingly caseloads as the people who were able to complete their self-assessments independently, would balance out those who needed a lot of support – however, I think she was gearing that comment towards those who work in general adult teams. My main worry about the new system is that it will be very difficult to plan the time to put together these budgets, although in the back of my head, I am remaining positive overall.

Like Direct Payments the focus seems to be on younger adults with disabilities, those who are able to advocate well for themselves and adults with learning disabilities. My thoughts on returning from the training was that little thought and time seems to have been spent on the consideration of people who may lack capacity in some areas to make judgements about some of the choices that are expected in this process.

I hope very much I am being overly cynical and am proved wrong. Today, David Brindle in the Guardian writes about RAS and its more helpful nature towards informal carers, whose contributions are recognised.   He makes some excellent points and it restores some of that positivity about the process.

I have some niggling doubts in my mind though – perhaps it is reminiscent of the introduction of the 1990 NHS and Community Care Act – when we were promised that ‘Care Management’ would be needs-led rather than resource-led, however, the fact is that those needs became more and more narrowly banded into large block contracts involving very little choice or flexibility.

Plus ca change..