Social Care

NHS reforms: House of Lords debate live

Posted by Paul Owen on October 12, 2011 Comments Off

Peers vote today on amendments to government's controversial health and social care bill that may derail the legislation permanently

10.34am: Hello and welcome to today's NHS live blog.

The House of Lords is due to vote today on two amendments that could wreck the government's controversial health and social care bill.

Lord Rea has tabled an amendment that would deny the bill a second reading. Rea said in the Lords yesterday that the plans had not been in either the Lib Dem or Tory manifestos, or the coalition agreement, so peers ought to oppose them.

And Lords Owen and Hennessy have tabled an amendment that would kick the bill into a special select committee, which would delay its progress so much it could fail to get royal assent and fall. Owen and Hennessy want to see the third section of the bill, which deals with competition in the NHS, sent to the select committee, as my colleagues Allegra Stratton and Sarah Boseley explain here.

If all crossbenchers opted to support the Owen-Hennessy amendment, along with all Labour peers, the government could be defeated and forced to endure the bill being funnelled through the Owen-Hennessy special committee.

Under the amendment, the special committee would report back by 19 December, increasing the prospect that the legislation would not be completed by April.

Lord Howe, the Tory health minister, has written to peers warning that such a move could prove "fatal" to the bill.

The health and social care bill abolishes primary care trusts and strategic health authorities, replacing them with consortia and commissioning bodies led by GPs. It also potentially increases the use of private healthcare within the NHS.

Yesterday 85 peers were scheduled to speak in the Lords debate on the bill, with a further 13 due to speak today from 11am. The final speakers, Lords Hunt and Howe, are due to speak about 1pm. Peers will then vote on Rea's amendment, and, if that does not pass, on Owen and Hennessy's.

NHSHealthHouse of LordsSocial careHealth policyPaul Owenguardian.co.uk

Health and social care bill: decision time for Lib Dems | Editorial

Posted by Society: Social care | guardian.co.uk on October 11, 2011 Comments Off

Liberal Democrat peers must decide whether to acquiesce over a botched law their leader says was the best deal he could get

It hardly needs saying that the original health and social care bill was awry; after all, the prime minister himself agreed to large chunks being rewritten. Nor could anyone fail to spot that the process has been a mess – first there was the extraordinary legislative emergency stop, and then indecipherable organograms emerged from the wreckage. But amid the confusion sight has been lost of how high the stakes remain: up for grabs is whether the English NHS will remain truly national. In two crunch votes in the Lords on Wednesday, Liberal Democrat peers in particular must decide whether loyalty to their leader requires acquiescence in a botched law which he says was the best deal he could get.

Ordinarily, an unelected Lords properly restricts itself to tweaking the work of the democratic house, but the basis for such restraint depends very much on the mandate. While the Conservative manifesto signalled rejection of the sort of top-down reorganisation now under way, the coalition agreement promised to democratise the care trusts that now stand sentenced to death. Knock down the straw men that Andrew Lansley's office has constructed, and only one serious argument for passing this law remains: the health service has just suffered a year of chaos and it cannot afford any more drift. Already some staff are picking up redundancy cheques from one NHS body before being rehired elsewhere in the empire, and even before GPs' consortiums are fully established they are being forcibly reshaped. It is thus understandable if hapless health managers now crave stability above everything else. Labour and crossbench peers, however, must reject this as the logic of the cowboy builder – who first creates ugly new facts on the ground, and only later asks for planning permission. They should vote against second reading.

For Lib Dems who wish the coalition to succeed, things are more complicated. After Nick Clegg rashly welcomed the summer's ambiguous Field report with premature declarations of victory over the Tories, outright rejection of the bill could now test the blue-yellow partnership to breaking point. The party must pick its fights. It must stop being distracted by secondary issues about the precise powers of public health boards, "clinical senates" or the other organisational fixes with which Field answered every controversy. Peers must get to the nub of the matter, as it exists in the minds of worried patients up and down the country – namely, the drift from an internal to an external market in which commercial logic takes the place of political responsibility. Happily, the crossbenchers David Owen and Peter Hennessy have devised a neat means of getting the all-important powers of the secretary of state right, without scuppering the legislation. The pair propose tasking a dedicated select committee with ensuring the health secretary retains the authority the public would expect – not to micromanage, but to step in where things go wrong. The current bill does not guarantee this: Lord Owen warned the chamber on Tuesday that it is not even clear how far Whitehall's writ would run in a pandemic. As the forensic analysis of the Lords constitution committee shows, the bill that emerged from the chaos of spring tinkers with the foundational political responsibility of the NHS – and not for any purpose that has been plainly stated.

As health budgets are squeezed, it will be more important than ever to have clarity on the underlying principles, such as where the buck stops. The coalition might have hoped to evade blame for problems that arise from the financial climate, but after the ruinous row over these reforms, every dropped bedpan will inevitably reverberate back to Whitehall – whether that is desirable or not. The descendants of a liberal party which helped to found the NHS now must decide whether they are prepared to risk a row to defend it. Capitulation here could carry a higher price than raising student fees.

HealthSocial careLiberal DemocratsHouse of Lordsguardian.co.uk

Strong leadership is key as London boroughs share services

Posted by Colin Barrow on October 11, 2011 Comments Off

The tri-borough project can improve organisations but it's all down to effective leaders, says Colin Barrow

There are seven major lessons from the first year of the tri-borough project across three London boroughs. They relate to: political relationship, the quality of advice, accountability, the business case, the level of trust, the need to break new ground, and the ability to communicate the vision and plan.

Political relationships are a test of political leadership; whether you are prepared to pool resources and power to achieve better outcomes. There are sceptics in our majority groups about tri-borough. Their arguments have been heard and listened to. They have helped to make the proposals better and many hours of public and informal discussion on these plans have taken place. But the decision to press ahead rests with the leadership and the plaudits or criticisms have to be taken by political leaders who are prepared to advocate, sell and motivate to deliver these massive changes.

The tri-borough programme has been blessed with strong managerial arrangements. The leaders meet every few weeks with the chief executives to assess strategy and progress. The chief executives and senior colleagues meet fortnightly to track progress and consider next steps, and the leads for each project and corporate support meet and unblock problems. There are then individual programme groups and support teams on human resources, communications, property, legal and finance. We have been clear from the outset that we have expected officers to deliver and members to fully scrutinise the proposals. Chief officers have been tasked with delivering to time and budget. We had a deadline of May for completing business cases. Without this, the projects may have dragged on and fizzled out.

Underpinning this project has had to be real savings. The final reports put the figure at £33.4m. Some savings are already being made. Having one director for children's services, one libraries director and one director for adult social care replaces nine roles with three, saving around £740,000 in salaries alone.

Early meetings between officers and members were characterised by understandable suspicion and scepticism. Our councils had done well on their own, so why the need to combine? The chief executive group led the way by meeting and working together. This work built trust and this flows into the service agreement which will govern each of the major parts of tri-borough.

We are clear that the tri-borough project should not replicate old fashioned approaches to service delivery, effectively rationing services. Instead, we have adopted a commissioning model where the desired outcomes are agreed and then management seeks to find the best solution using a combination of private, public and third sector providers.

Retaining local sovereignty, to adapt services to local circumstances, has been central to the project. The three authorities have agreed a 19-point sovereignty guarantee which sets out the rights and responsibilities of the contracting parties. It affirms that all three councils are committed to continuing to represent the needs of people in their neighbourhoods; that basic democratic arrangements will not change; that "each council will continue to set its own council tax and publish its own budget and accounts"; and will "continue to be able to set its own spending priorities".

It allows a veto for one of the three on decisions so that no council can be "out-voted" by the two other councils. It also confirms a commitment to "shared learning, innovation and value for money" and for the parties to "share what works in service delivery and encourage their neighbours to learn". Finally, the guarantee allows for terminating where we are sharing services based on a 12-month notice period and allowing for the "costs arising from termination [to] be fairly shared between the councils in a pre-agreed manner".

A project such as this can energise organisations to do better if they have the leadership to challenge and praise.

• Sir Colin Barrow is leader of Westminster council. This is an edited extract from Driving Change: Leadership, Trust and Money, co-authored with Stephen Greenhaigh, leader, Hammersmith & Fulham council and Merrick Cockell, leader, Kensington and Chelsea council. Full report at http://bit.ly/nw1Vej

Local governmentPublic sector cutsPublic services policyPublic financeSocial careColin Barrowguardian.co.uk

Where’s the support for autistic young people?

Posted by Amelia Gentleman on October 11, 2011 Comments Off

Autistic teenagers like Danny Hornby have nowhere to go when they leave school. A new campaign hopes to develop post-19 services that open up life chances and opportunities for all

When Virginia Bovell realised there were no schools offering the intensive support that doctors said her three-year-old autistic son needed back in 1997, she got together with four other families and set up a specialist school offering intensive, autism-specific teaching.

Fourteen years later Treehouse, the school they created in north London, is recognised internationally as a model for how children with autism should be taught.

But Bovell has recently found herself confronted with a new challenge.

Her son Danny, now 18, is on the brink of leaving school and she has been searching for a suitable place for him to continue his education. Dismayed at the quality of what's on offer for children with autism after school, once again she has joined forces with other parents to campaign for radical improvement.

A report published next week by Ambitious About Autism, the charity aligned to Treehouse school, reveals that only 19% of children with autism continue with any kind of education after they leave school, and concludes that this is because there are so few colleges equipped to accommodate them. About 85% of adults with autism are unemployed.

The report, Finished at School: What Next for Young People with Autism? says: "Families often feel there is nowhere for young people with autism to go once they have finished at school."

Most autistic children are faced with what Bovell describes as premature "retirement" in their late teens, with the option of living at home with their parents for the rest of their life, going to live in a residential community (of which there are very few), or spending time at daycare centres, often full of people who are two or three times their age.

Without continued support, the skills that children have been taught can be lost, leading to a "huge waste of funds", the charity states.

"Dedicated teaching staff say that one of the saddest, most frustrating aspects of their job is that they put in all this effort and see all this progress for a young person at school and then find it totally heartbreaking to see that nothing was available afterwards," Bovell says.

"Hearing about adults with autism who can't access learning opportunities post-school is desperately dispiriting."

Although their campaign focuses on improving opportunities for young people with autism, the charity's findings will resonate with parents of children with other disabilities, who often find that state support throughout childhood is replaced by a black hole once they reach 16.

"For young people with autism, school is all too often the end of their education," writes Robert Buckland, the Conservative MP for Swindon South who sits on the all-party parliamentary group on autism, in a foreword to the charity's report. "By failing to support young people to continu e learning beyond school, we create a barrier to them living more independently and gaining employment. This ends up creating large long-term costs to society."

Adult social care services face increased costs "due to our failure to support young people to live in their community and contribute to society," the report argues. The annual cost of supporting people with autism in the UK is estimated to be £27.5bn, the report says.

Bovell's new campaign is significant because the work she and other parents (including her ex-husband and Danny's father, the novelist Nick Hornby) did to improve services for children with autism had a profound impact on expectations nationally, showcasing what was possible and encouraging parents to demand more from their local authorities.

Three years ago, a permanent complex of beautifully-designed school buildings was opened for Treehouse, complete with specialist playground equipment, music rooms and facilities for teaching children to cook and live independent lives. Over the past decade there has been greater recognition that autism, which is a lifelong neurological condition, affects a larger number of people than was previously accepted. Despite this, local authorities have not responded to the growing need.

"When we were starting, one of the reasons there was very little provision was that people were still working on a prevalence rate of four or five per 10,000, now it's widely recognised that the autism spectrum affects 1% [of children]," Bovell says.

"No one knows whether this is just to do with improved diagnosis or an actual increase in prevalence. But autism is no longer a very, very low incidence condition which we can ignore. There need to be more services. Campaigners have been talking about a ticking timebomb for some time, pointing out that if there are this number of children coming through education, when are adult services going to wake up?"

The charity is developing plans with a number of further education colleges to support young people with autism to continue their education. There is no autism-specific college in London and the charity wants to change that.

"You can make a national difference through your own school, if you are putting up a template to illustrate what others can be doing as well. What we've done here has been codified and replicated elsewhere. We want to do the same in further education," Bovell says. "It has to be replicable. We are trying to change the environment for all young people with autism wherever they live."

The government's green paper on special educational needs published earlier this year offered a proposal to extend support for disabled young people up to the age of 25, and the Ambitious About Autism campaign wants the government to create a legal right to educational support up to the age of 25. However, there is growing pessimism about this ever becoming policy, given the

Tom Keogan obituary

Posted by Society: Social care | guardian.co.uk on October 11, 2011 Comments Off

My friend Tom Keogan, who has died of heart failure aged 68, went into social work with a passion for the empowerment of deaf and hearing-impaired people.

As principal social worker with Leeds city council from 1974 until 1984, he forged close links with Doncaster and Beverley schools for the deaf, and was hugely supportive of the work of the Leeds Deaf & Blind Society. In 1986 he was appointed head of service for Cleveland county council's Sensory Loss Services, and while there conceived a scheme to establish a "home for life" for deaf people with additional disabilities.

Tom worked to establish a partnership between Tees Valley Housing Association, which provided the building; the Royal National Institute for the Deaf, which employed the residential care staff; and the county council, who funded the placements. Tom's aim was to "bring home" those who were living away from their families in placements as far afield as Bath and Scotland. Ransdale House opened in Middlesbrough in 1993, with Tom as manager.

Tom retired in 2007 after almost a decade working for Darlington borough council, where he succeeded in forging an alliance of 12 health organisations and local councils to create the Tees Valley and Durham communication service (TVDCS). He was appointed MBE in 2007 and was given an Equality North East award in 2008 for services to the deaf community.

In retirement, he switched his considerable energies back to the voluntary sector, as service consultant for the North Regional Association for Sensory Support (NRASS). The service was on the brink of financial collapse when he took charge in 2007, but Tom transformed it into a solvent and highly regarded regional provider.

Tom never looked back to his first career as a professional drummer. He was born near Consett, Co Durham, and started work as a blacksmith in the mines, but his talent for percussion led him out of that community and into the music industry. He toured Britain and Europe as a backing musician. He switched to social work after an experience with a deaf colleague in a welding job in Wakefield. He understood then, and at first hand, the access and communication barriers faced by deaf people.

A visitor to Ransdale House once asked Tom if he would direct him to the manager's office. Tom walked the man down the corridor and introduc- ed him to one of the residents. The visitor looked a little confused at this point and suggested there might be some mistake, as he had asked to see the boss. Tom replied: "This gentleman is the boss. This is his home. I just work here."

Tom is survived by his wife, Kath, his son, George, and his daughter, Mary.

Social workSocial careDeafness and hearing impairmentDisabilityHealthguardian.co.uk

Joyce Carol Vincent: how could this young woman lie dead and undiscovered for almost three years?

Posted by Society: Social care | guardian.co.uk on October 10, 2011 Comments Off

When the film-maker Carol Morley read that the skeleton of a young woman had been found in a London bedsit, she knew she had to find out more…

On 25 January 2006, officials from a north London housing association repossessing a bedsit in Wood Green owing to rent arrears made a grim discovery. Lying on the sofa was the skeleton of a 38-year-old woman who had been dead for almost three years. In a corner of the room the television set was still on, tuned to BBC1, and a small pile of unopened Christmas presents lay on the floor. Washing up was heaped in the kitchen sink and a mountain of post lay behind the front door. Food in the refrigerator was marked with 2003 expiry dates. The dead woman's body was so badly decomposed it could only be identified by comparing dental records with an old holiday photograph of her smiling. Her name was revealed to be Joyce Carol Vincent.

I first heard about Joyce when I picked up a discarded copy of the Sun on a London underground train. The paper reported the gothic

The new owners of Southern Cross care homes must embrace transparency

Posted by Society: Social care | guardian.co.uk on October 10, 2011 Comments Off

For too long the management of care homes has been cloaked in secrecy. We must strive to increase openness, says Peter Hay

• The Guardian is mapping what happens to each Southern Cross care home as the data becomes available. See the data

The names of the providers that will take over Southern Cross care homes are starting to appear, with the company providing details on the timescales and business processes that are now in play.

My organisation, the Association of Directors of Adult Social Services (Adass), will lead on shaping local markets. The work that we do will feed into the forthcoming social care white paper, and give interested parties the first glimpse of the future in this sector.

We heard the Labour party leader condemning failed business models – his words possibly reflecting wider public unease over what the collapse of Southern Cross has exposed. It's an unease that some care providers are already starting to respond to – with talk of better governance, models of business that involve people at all levels, and transparent data presented in ways that engage the public.

At a recent "masterclass" Adass held in association with the Social Care Association, we heard registered managers actively support the development of live time and customer-led feedback. In the world of TripAdvisor, care has been slow to respond, but this latest development represents a seismic shift in the attitudes of staff who head up care homes. As leaders, we now have to develop tools that support better management of care - and increases openess and transparency. We know too well that great dangers lie in secret institutions, so hallelujah to the commitment.

In their handling of the Southern Cross crisis, councils have tried to model some of this new transparency. There's much we could do better, but our use of council websites and the Guardian's Datablog are first steps. For too long care has been obscure. For a service that makes up at least a third of every council's expenditure, its costs, fee rates and quality have not been presented clearly and transparently enough to the people who are footing the bill. Council taxpayers should be able know who the providers are, and how much public money they receive for doing what they do. Local commissioning needs to command respect and confidence that public money is buying the best service it can.

If your business is in the care sector, then you should be embracing these new forces. The successors to Southern Cross have to address anxious carers, relatives, residents and staff, and must accept that they will have to work long and hard to win the confidence of new customers.

Silence erodes confidence and allows those who want to draw inferences to fill the gaps. If the lessons have been learned, then let's now hear it from those confident and transparent providers who deserve success.

Southern Cross was a failed model of poor decision making – its eyes weren't centred on its customers. But in many of its homes, lead managers laboured away to make something happen. And in many places, relatives and residents want to continue with the care they currently get and the staff that work with them.

Residential care for older people is about making sure that people who choose to live in care homes live in safety and with dignity. The vast majority of staff work daily to meet all the challenges - not least the challenging behaviours that come with many dementias. Care is about the front line, not just the bottom line. Providers must promote a peace of mind. The relatives and residents who have spent this year facing the uncertainties of Southern Cross surely deserve it.

• Peter Hay is president of Adass

Social careSouthern Cross HealthcareHealthcare industryOlder peopleLong-term careDisabilityCarersLocal governmentguardian.co.uk

Public sector cuts: ‘I had to sack a third of my staff’

Posted by Patrick Butler on October 10, 2011 Comments Off

What does it feel like to to have to make cuts of 30% in public services and tell hardworking colleagues they no longer have a job? Here, a senior manager tells of her experience

I was contacted by Manager 'A' after I ran a piece on my blog recently about public servants' experiences of being made redundant as a result of spending cuts. She explained that she hadn't lost her job (as a senior manager in a large urban public sector organisation) but she had had to tell a third of her team that they were losing theirs. This is her story, of cuts and redundancy from the managers' perspective.

"I've loved being a public servant. It's given me opportunities to do a vast range of different things, to test my abilities and skills, to grow as a person. Most of all, its allowed me to have a positive impact on people's lives, directly or indirectly, in every job I've had. It's given me a palpable sense that what I do is worthwhile, and pride in the services my employers deliver. That's all changed in recent months."

Manager 'A' and her colleagues realized before the last general election that their organization, in common with the rest of the public sector, would face a significant funding squeeze. This was expected, and while daunting, it felt manageable:

"We'd already done efficiency. This has been normal practice for the last four years. We no longer do conferences, we stopped the biscuits, and secured economies of scale in our stationary purchase. Anyone who wants training or qualifications has to contribute to the cost. We don't subscribe to trade magazines any more. We've squeezed our contractors, restructured, cut the number of jobs, stopped using agency staff and reduced sickness absences. Our productivity is measured and I know how much it costs to deliver every piece of work my team does. I was confident that I could justify what we do to local taxpayers and explain why it improved their lives and their community."

She and her team started to think hard about how more savings could be delivered by redesigning the service. Ambitious service transformation plans were drawn up aimed at making big cuts while as far as possible protecting essential services for local people. But these were knocked off course by the unexpectedly massive scale of the government's spending cuts, and the speed at which ministers demanded they be delivered:

"We were taken by surprise by the pace of the cuts. We thought we'd have 18 months to two years to make the savings and genuinely transform services. In the event we had about six weeks to deliver an agreed budget, along with robust plans for how we were going to deliver the change. Out went my plans for co-designing the future. To make the books balance, I had three months to reduce my own team by more than 30% – in budget and most importantly, in that pleasant euphemism 'headcount'".

Having to make people redundant was not a new experience to Manager 'A'. In the past she had felt confident that the people she had let go were not suited to the work, or were unhappy with the strategic direction of the organization. In many cases she had watched them flourish elsewhere in the public or private sector. Rarely had she felt redundancy was the personal or organisational catastrophe it might have been for those on the receving end. This time, however, it felt different:

"That euphemistic 'headcount' was made up of real people. Individuals who have responsibilities, ambitions and commitments. Some of them were people who loved the public sector as much as I. Most were people who have been working really hard to improve the lives of people were we worked. Most of them were going to find it really very difficult to find other, similar work in a reasonable amount of time. The options aren't out there. This time it wasn't about giving people choices – it was about me choosing who I wanted, who was good enough. I went home and sobbed, many times."

Making efficiencies is never easy. I asked manager 'A' why delivering cuts this time around was such an emotional and traumatic experience:

"I don't know – there was some guilt, undoubtedly. I've still got a good job, and can pay my mortgage. There was some frustration that we weren't making the right choices – that there were other areas of the business where successful defensive positioning meant we were taking an "unfair" hit. I continually felt frustration that I should be doing more to protect and support my team; I began to feel personal concerns and uncertainty – lack of confidence even – about the decisions I was complicit in. It felt like I was standing up selling a false future – that public servants are valued, important and have a future. But inside, I was not really sure that they have."

It didn't help, she felt, that the political climate in which the cuts were being made was relentlessly, and aggressively anti-public service:

"What definitely made it worse was the overwhelming feeling that public service isn't worthwhile any more. Time after time I read negative stories in the media about the public sector – the "fat cat salaries" and "gold-plated pensions", the so-called "non-jobs" and the "wasteful practices". As a manager of a support service, it feels like I, personally, am at the centre of wastefulness. My bosses work hard to ensure that I remain valued, but I know I'm struggling. I work in one of the best and most innovative public service organisations in the country. I absolutely love working there, and being part of that change. But I can't carry on if it's more about slash and burn and less about improving the service to local people."

How does it feel being a manager in public services at the moment?

"I ask myself: have I fallen out of love with public service? I've certainly never felt so much like leaving – but this is quickly followed by a feeling of hopeless that there is nowhere else to go. For the first time in 20 years, I don't want to tell people what I do; the gloss of my pride in public service is fading and I really wish it wasn't."

Public sector cutsLocal governmentNHSSocial carePublic sector careersPatrick Butlerguardian.co.uk

Social Care

Recent Posts

Recent Comments

Archives

Categories