Saving Resources, Time and Money in Social Care
I often ponder if I am only one of the few (sad people) who actually read the health and social care legislation and guidance?
If you have read the legislation and guidance, you'll know that the Care Act, its regulations, and statutory guidance is one of the most complete and fully thought-out pieces of law there is. So why do we keep having issues in these areas? The recent white paper in Health and Social Care stated that a lot of issues in the system, are down to local authorities, not following the law or its intentions.
What concerns me more is that a close look at the legislation and guidance shows plenty of opportunities for saving time and money, making the system better and more efficient for all involved.
Here are just some of the things that they could do to make things better. If anyone can give me a reason why they haven't or seem reluctant to, please let me know.
The first thing is simple and has been picked up by the government and others. The new white paper for social care and health preamble states that one of the issues is that social care just hasn't been following the legislation as they should have. The time and money that could be saved rather than all following different process if authorites just did what they were supposed to. The comments and issues nearly all relate to not following the law. Even when someone takes a authority to court and wins a case, say, like the Norfolk Judicial Review on Minimum Income Guarantee, the social care service just ignores it and doesn't implement the decisions made by the courts..
My experience is that staff just do not know the law; this highlights the need for proper training. Trained staff who know the law rather than internal processes would again ensure people follow the rules, leaving less room for incorrect decisions and wasted time in after action from users. A survey I carried out of over 170 social workers on a online social group site, showed 90% of social workers got less than 10% training in the law. One senior manager stated that as he'd been working before the care act came in he hadn't had any training at all.
From the work I do on complaints about social care, it's easy to see and be very concerned about complaint handling and the time, cost, and effort in resources these must take. A simplified quick complaint process was suggested in the original version of statutory guidance with a 30 day turn around would have made things better. why this was not implemented or more worrying why it was removed is a bit troubling.
The people who use services really need to be properly consulted and allowed to sit on commissioning and councillor panels where decisions are made. Reading through council meeting documents and having sat in on one or two, I was shocked and surprised as to what councillors are shown and told by senior officers. What they are told and what happens on the ground is very different. Often mentioned as coproduction and stated how valued it is, little is done to formalise or properly empower people.
On commissioning, lots is talked about, and much is intended, but people really do not understand the process. Again, it's really eye-opening; after a company or orgs puts in a written bid, what they write is taken as gospel. No checks are made on the information they provide; it's based all on how they sell it. My experience from being involved and actually looking at the companies involved showed a huge difference between what the companies promised and what they could actually deliver or had delivered in the past. I was told that checks were beyond the remit of commissioning.
When assessments are carried out, staff should be trusted, and the assessment is accepted. It always seemed strange to me that the actual person who has met you and carried out the assessment has little say on its approval. It goes back to the office where a supervisor or manager or an MDT who has not even met the persons involved makes the final approval of what's given to a person. In essence this means that the person may go through another assessment by people who have never even met the person this doubles and triples the actual process, the cost, time and personel saving from trained staff being allowed to make descion independently is an easy win.
Assesements should include wellbeing principles as a marker to ensure that your actual meeting people need. I've seen many a decision from council including one today where if they had considered these (as per statutory guidance), the outcome would have been very different.
Wellbeing is often touted about as a word and service, but social care seems to forget the Care Act is based on written principles in section 1 of the Act. The guidance then shores this up by showing how these should be used as a check to ensure people's needs are met. Having looked and examined many assessments issues which have occurred would be negated by understanding and including these princples as they relate to considering socio economic factors (poverty), dignity, having day to day control and physical and mental health amongst others.
Another clearly evident suggestion from the statutory guide is a form of self-assessment or assisted assessment. In essence, people do the assessment themselves, and the Social Worker are there to just assist. A lot of professionals say this doesn't work as people don't understand needs. Maybe so, but in my advocacy, I always advise people before the assessment for two weeks to keep a diary. In which they write down not only the day-to-day difficulties they have but also their worries and concerns. I recommend this as when the day of the assessment comes, most people will not remember everything on the day. I would then help them or ask them to list those items next to the needs criteria that I've given them in a picture easy read format. All this is handed to the social worker as a pre assessment and care plan. This saves time and effort. It's unfortunate, but these days, assessments and care plans are done in such a way by authorites that they resemble tick box exercises, with standard wording that do not reflect reality or peoples, situations. The times I hear people say I told this to my social worker and it's not there. Or even there are mistakes in the record that do not reflect what is and / or happens. I've even done an easy understandable with diagrams process that people can use. Heresa simplified version as an example https://haloabletec.blogspot.com/2024/04/diy-social-care-assesments.html
Once budgets are offered after one, year reviews should be light touch instead of a full trawl through document and records every year as happens now ( increasingly pushed by finance department who don't understand the care duites placed on local authorties. If its not broken why mess with it ! This is suggested in the statutory guidance. Again, this could be a huge money, time, and resource saver. If it is done properly, money would not be left to accumulate in user accounts unnecessarily. I had £20k in my account when my care swtiched over to health. It took two years, numerous emails, and finally, a complaint to the Head of service before they would sort the matter out. All left to me! Thus year I've had a full fiancial check. Not against this and it is needeed. After 35 hours of stated work to go through my accounts, they found an error of £40and asked for this to be returned I checked again and found an error of £90 and paid it back In. Yet the ammount of checking dome and work created for both parties costs way more than the errors. I've been running a personal budget for 10 years and this is the first time an error has been found.
One plea from a lot of users; please stop messing with policies. It is so confusing for staff and users. Recently I took a survey and looked at 10 personal budget polices they ranged from 20 pages to nearly 80 pages, everyone different, everyone spent time on by writing it and it being approved ( most of them had not been Equality Impact Assesesd, a requirment under sec 149 public sector equality duty. If it's likely to have an impact on protected characteristics in this case disability and age), everyone missed key information from the legislation or guidance. The only purpose I could see for these processes is to try and restrict people's spending or take away choice and control. From a point of law, though, when you have acts of parliaments, statutory guidance, and case law, if these aren't followed by your local polices, the policies themselves become pointless. I know people want to have local say, but when it comes to law and statutory guidance, which is as law (R V Islington), then you don't have a choice but to follow it. Save the money and expense and if people ask for policy or guidance point them to the National Guidance ( both the statutory guidance in Social Care and Health (yes, there is one) are pretty easy reads.
Another clearly evident suggestion from the statutory guide is a form of self-assessment or assisted assessment. In essence, people do the assessment themselves, and the Social Worker are there to just assist. A lot of professionals say this doesn't work as people don't understand needs. Maybe so, but in my advocacy, I always advise people before the assessment for two weeks to keep a diary. In which they write down not only the day-to-day difficulties they have but also their worries and concerns. I recommend this as when the day of the assessment comes, most people will not remember everything on the day. I would then help them or ask them to list those items next to the needs criteria that I've given them in a picture easy read format. All this is handed to the social worker as a pre assessment and care plan. This saves time and effort. It's unfortunate, but these days, assessments and care plans are done in such a way by authorites that they resemble tick box exercises, with standard wording that do not reflect reality or peoples, situations. The times I hear people say I told this to my social worker and it's not there. Or even there are mistakes in the record that do not reflect what is and / or happens. I've even done an easy understandable with diagrams process that people can use. Heresa simplified version as an example https://haloabletec.blogspot.com/2024/04/diy-social-care-assesments.html
Once budgets are offered after one, year reviews should be light touch instead of a full trawl through document and records every year as happens now ( increasingly pushed by finance department who don't understand the care duites placed on local authorties. If its not broken why mess with it ! This is suggested in the statutory guidance. Again, this could be a huge money, time, and resource saver. If it is done properly, money would not be left to accumulate in user accounts unnecessarily. I had £20k in my account when my care swtiched over to health. It took two years, numerous emails, and finally, a complaint to the Head of service before they would sort the matter out. All left to me! Thus year I've had a full fiancial check. Not against this and it is needeed. After 35 hours of stated work to go through my accounts, they found an error of £40and asked for this to be returned I checked again and found an error of £90 and paid it back In. Yet the ammount of checking dome and work created for both parties costs way more than the errors. I've been running a personal budget for 10 years and this is the first time an error has been found.
One plea from a lot of users; please stop messing with policies. It is so confusing for staff and users. Recently I took a survey and looked at 10 personal budget polices they ranged from 20 pages to nearly 80 pages, everyone different, everyone spent time on by writing it and it being approved ( most of them had not been Equality Impact Assesesd, a requirment under sec 149 public sector equality duty. If it's likely to have an impact on protected characteristics in this case disability and age), everyone missed key information from the legislation or guidance. The only purpose I could see for these processes is to try and restrict people's spending or take away choice and control. From a point of law, though, when you have acts of parliaments, statutory guidance, and case law, if these aren't followed by your local polices, the policies themselves become pointless. I know people want to have local say, but when it comes to law and statutory guidance, which is as law (R V Islington), then you don't have a choice but to follow it. Save the money and expense and if people ask for policy or guidance point them to the National Guidance ( both the statutory guidance in Social Care and Health (yes, there is one) are pretty easy reads.
I also don't understand why Equality Impact Assesments don't have the matters such as mentioned in this blog added. From the Gunning princples judgment on Impsct Assesments, The people who make the decsions must be made aware of all options and give them serious consideration. So why not say well we could cut services or we can change things and make them cheaper and more efficient.
It always astounds me how much money goes to profit making companies in social care. When there's no need for it, I'm not against people making profits, anything but dislike, proftoering from the public purse. Personal budgets should be encouraged and time spent and supporting people to run their own budgets or more members of the family encouraged to do it (again allowed according to stat guidance). Most agencies will have a 50% profit mark up on care charges. With staff only getting minimum wage. When I've tried to discuss this, I'm told they have additional costs. From the figures I've been shown (available to anyone who wants to see them), the difference is less than a pound or two. We really should be encouraging non-profit or community ran services by people who need the services. A recent freedom of information request, (April 2024) showed that in my area care agencies could get 3 times what I'm allowed to pay my carers. Just imagine if DP where better supported how much money could be saved. PAs could be better paid, the main reason why there's a shortage of staff.
It always astounds me how much money goes to profit making companies in social care. When there's no need for it, I'm not against people making profits, anything but dislike, proftoering from the public purse. Personal budgets should be encouraged and time spent and supporting people to run their own budgets or more members of the family encouraged to do it (again allowed according to stat guidance). Most agencies will have a 50% profit mark up on care charges. With staff only getting minimum wage. When I've tried to discuss this, I'm told they have additional costs. From the figures I've been shown (available to anyone who wants to see them), the difference is less than a pound or two. We really should be encouraging non-profit or community ran services by people who need the services. A recent freedom of information request, (April 2024) showed that in my area care agencies could get 3 times what I'm allowed to pay my carers. Just imagine if DP where better supported how much money could be saved. PAs could be better paid, the main reason why there's a shortage of staff.
There is a middle option (intermediarey) to for budgets. Ie shared reaponsbility people doing what they can and the authority doing the rest. Even this as an option would save money and help promote indepednent living.
Interestingly the new Quality framework in personlosation (NHS) states a number of times that treatment of people who choose any of the budget types should all be treated equitably.
There will always be a need for investment. It sits hand in hand with improvements; I'm not against this either. It does worry me though that there are opportunities to do things that can be done easily, and they just don't seem to want to.
There will always be a need for investment. It sits hand in hand with improvements; I'm not against this either. It does worry me though that there are opportunities to do things that can be done easily, and they just don't seem to want to.
The question for me to them is why?
A lot of the suggestions I've talked about are further expanded in my other blogs.
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