Do the opening clauses sufficiently reflect the local authority’s broader role and responsibilities towards the local community?
This questions relates to Clauses 2-7
Answer questions by topic
Do the opening clauses sufficiently reflect the local authority’s broader role and responsibilities towards the local community?
This questions relates to Clauses 2-7
Severe and enduring mental health conditions such as schizophrenia, bi-polar + others have long been nelected in rehabilittion, There are cases in witch no specific professionals have accepted resposibility which has resulted in sufferrs comitting offences (some serious) and for which they have received prison sentences. How do the new proposals deal with such cases? one has been quoted on the news today where the perpetrator has had a very unsatisfactory childhood(in care) and committed murder and has been committed to prison. Will this person receive adequate support from a solicitor who is conversant with the condition from which she suffers, should she wish to take it to appeal? Also are there sufficiet small secure places of safety where such patients can receive treatment under the Mental Health Act until such time as they are deemed safe both to themselve and others, with adequate follow-up on release.
Mental health care systems fail patient because psychiatrists just don’t have quality time to help patients. every appointment starts with a ticking clock, and psychiatrist adopt a ‘one cover fits all’ which is far from the truth.
Go into any mental care system and you will find the majority of patents, whatever their diagnosis, are all on the same groups of medication.
It is time psychiatrist treated patents as individuals and meet the individual needs. Anyone can be a psychiatric today, all you need is an ICD10 and a BNF because sadly that is all psychiatrist’s use, many are not up to the job, not helped by being so difficult to understand.
If psychiatrist don’t care, what hope is there fro patents?
The Bill should not go ahead to give local authorities the sole powers listed. Appropriate Health care and services are integral to the promotion of individual well being, autonomy and empowerment. Many people needing care and support are ore significant users of health services- so to separate out functions is wasteful of resources.
I would say the government has not been bold enough in the face of future fiscal challenges.
An integrated single Health and Care System with a very radically different workforce and a complete re-think about whether social services departments with their own directors, staff and resources is necessary. It is possible with the input of local councillors on joint boards / committees to ensure that there is local accountability from a political perspective- this could be enshrined in law.
There could be a health and care workforce where their education and ongoing training involves social care – so that social workers as a separate entity are redundant. It is easier to do this than train social workers for clinical knowledge as the entry into social work has lower standards.
A larger workforce with a tiered structure, including health- care workers who can undertake care assessments, with input from lower band nurses with social services type training and knowledge to arrange services either directly or indirectly, could really improve the type of care provided – with appropriate health led commissioning and inspection / monitoring.
This would lead away from the arbitrary health and social care divide with separate cultures and budgets. Local intelligence, plans and commissioning would be where there was complete flexibility to arrange services to meet local needs for care provision. Where things go wrong there would be no buck passing between agencies e.g. as currently in safeguarding work.
If the government do not take up the baton now the state of politics in Britain with an apathetic and cynical public who will not vote will only worsen.
If you can show savings from an integrated national structure to redesign the whole of health and social care so as to help people better- the issue of ‘paying for care’ will become less troublesome. At present the quality of care across health and social care is showing decline as attitude of staff are lacking. An integrated system can step up to the mark by recruiting only those with the highest commitment to the people who use the services.
IT IS VERY DIFFICULT TO SEE HOW LOCAL AUTHORITY CAN TAKE THE LEAD IN SUPPORT WHEN IN MANY CASES IT IS THE LOCAL AUTHORITY THAT ARE SEEN AS THE ABUSER
I fully agree with you, as it has become very clear that although local authority social workers and safeguarding teams are ready to judge neglect/abuse from omissions of others they equally turn a blind eye to the abuse / neglect arising from their own departments omissions e.g.
- through assessing care needs that give less provision than is actually needed,
- failing to provide adequate respite support to significant carers of disabled relatives / friends and then accusing them of neglect when they are struggling to cope.
- inability to recognise that actions they take to protect can actually harm e.g. putting elders in care homes against their wishes can lead to decline and early death – the average lifespan is 2 years in residential care, for most. Many die soon after the transfer from their own home. The inability to accept risk and promote early death / morbidity in the vulnerable is dreadful.
- And the worst abuse- the failure to deal robustly, using ‘covert techniques’ when home care workers are neglecting, abusing or omitting acts. Here elderly people can die and it will be put down to ‘old age’ not the result of the abuse that, because of the cosy relationship with Care Agencies, they fail to investigate adequately.
- When family carers complain about services, care agencies or keep tabs on care staff, social worker staff are more likely to suspect the family than the abusing care workers.
Safeguarding inquiry would be better as a police function and not local authority one. The police are trained well to assess possible harmful / criminal situations, they are mostly sensible and do not immediately make unfounded judgments regarding people / situations- unlike social workers who are unable to be entirely objective as ‘background book theory’ colours their thinking always.
I absolutely agree that safeguarding should be a police matter, because Health and Social Care frequently protect their own interests first leaving vulnerable people with no hope of decent treatment.
I also do NOT beleive the local council council could manage this problem of care their budgets do not allow this, plus they would not have the expeirence to provide the the quality, and high standards we are used to at this time, but I personely feel as easch year comes and goes,so do the standard of care to local community care for all terminal illness.
Councils need to finally address the issue of abuse which can happen regularly within the care system.(abuse can be more then just financial) Also anyone who speaks against is faced with harassment and neglect. I agree if the police was more involved in investigating abuse then this would act as a much more of deterent as it stands now
What a wonderful post.It was my my pegvilrie to recieve a long placement in a care home for those suffering with Alzhiemer’s during my pre-ordination training. I confess that, upon the first day, I was scared to death. I later recognised that my fear was borne of my greatest fear for my own end to be goen to my loved ones before I leave them in body. However, they kep the stories of each resident, photos of them when they were at work, at play, with families photos of them back in normal life. It was helpful for them, of that I am sure, but also for me. I sat for hours with Ron who was formerly a Spitfire Pilot (and to me the epitome of a hero), so we talked about planes a lot. He liked that as much as I did. The other Ron worked at Didcot shunting trains, so we talked about trains. He liked the ladies too, of that I became very aware, and we chatted about good looking girls too.Without the memories, all is lost and the death already happened. I will never forget my time there, not for the rest of my life it taught me so much about communication, about patience and about loving someone. (Incidentally, if you haven;t heard of it, a book I can recommend on this topic from a Christian perspective:Malcolm Goldsmith In a Strange Land People With Dementia and The Local Church 20004, 4M Publications)
The following from the BBC website actually gives a very interesting take on who should lead on safeguarding allegation investigations.
http://www.bbc.co.uk/news/uk-england-cornwall-19293691:
The number of allegations of abuse against vulnerable adults in Cornwall have risen by 245% in the last six years, police have said.
It will be noticed as I have repeatedly stated the police who have been well trained have a better and more experienced approach to investigating allegations.
Unlike social workers, from my own experience, they do not use some trendy social theory from a textbook classroom lesson to make judgements. They look for information / evidence more accurately to see whether something has actually happened to need further delving. They tend to be much much better at judgements. I have found them to apply more common sense decisions than any of the myriad of social workers I have ever known in similar circumstances.
Please consider moving control of safeguarding enquiries / investigations away from local authority control, putting the police at the helm, to determine if a crime has been committed or whether someone needs social care help.
An integrated Local Authority/NHS care assessment was supposed to have been implemented over 8 years ago. It did not work then and I cannot see how this bill will make it work better. Eligibility criteria have to be national, with no leeway for a postcode lottery of social care. In any case, most social care is needed because of underlying health problems, so why can we not have the funding coming from a central pot?
The new legislation should ensure that local auhtorities have a legal duty to investigate adult safeguarding concerns in the same way as in Scotland. Just relying on policy is insufficient
In common with most people I know very little about Social Care Law and I think it essential that there should be funded, independent advocacy especially in relation to Liberty and monitoring of the safety of vulnerable adults.
Overall, this Bill seems to be a sensible way forward. There can be no perfect system that covers all aspects of care needs without problems, so compromise is necessary. Two aspects that concern me however over the long term are:
1) The funding/charging arrangements allow for too much variation and ‘post code differences’. There is a fundamental issue of fairness that is not addressed – those people who pay taxes and are careful to provide for their own futures through savings will be required to pay for services that anyone who has been profligate will receive for free. (of course the difference between ‘profligacy’ and ‘inability’ is a question here). The recent changes to ensure that more people invest in personal pensions may assist in this area over the long term, but there is a need to address the underlying problem of defining personal responsibility to anticipate and provide for care needs, if a fair and acceptable approach to means-tested charges is to be established.
2) My other question concerns how personalisation will work – health and social services staff will be the ‘gatekeepers’ here and any benefits from broadening access to support (for example from third sector providers) is likely to be severely restricted by vested interests unless qualification/accreditation and quality assurance issues are systematically addressed.
This Bill has to be seen as only the first step in a process of developing a more equitable, effectively integrated system, based on a national consensus on where personal and government responsibilities lie, and on appropriate funding structures. I agree with comments made about a need to integrate health and social care, with the caveat that reliance on only one system, with the GP as main arbiter of service provision (and commissioning), would worry me somewhat!
It is all very positive but clearly the one thing missing is how this will be funded. Can the Bill be delivered if there is still indecision from central government on how care will be funded in the future? The Bill brings in consistency but will local authorities and the NHS be able to act upon it if there is no clarity on how these good initiatives are to be funded long-term?
Overall the bill is very welcome and could significantly improve the well being of carers. I am Chief Executive of a local carers support charity that works with many thousands of carers and I know from our consultations with them that the issues covered in the bill will address many of the problems that they face. From my contact with other carers support charities around the country I also know that overall they are very positive about the bill as well. In particular I welcome the emphasis on Local Authorities having duties to ensure that carers are supported and not just given the right to support them. In my experience, if a Local Authority only has the right to provide something rather than an obligation to do so the provision that results will vary based on local pressures and interests rather than more objective criteria.
NFOP welcomes the principles set out, however the current financial pressures on Local Authorities will make implementation difficult. Unrealistic levels in the assessment of the costs of the provision of adequate care is detrimental to the whole community and will either drive down the quality of care or result in good providers withdrawing from the sector. External monitoring/adjudication would be beneficial. Ensuring that patients are not discharged at inappropriate times and with adequate support is essential and the involvement of Local Authority teams well in advance of discharge is essential and should be prescribed.
We welcome the emphasis on the Local Authority’s broader role and responsibilities in the local community. Under clause 2, we would recommend the inclusion of a requirement for local authorities to provide information and advice on how to make a complaint if an individual is unhappy with the service they are receiving. The ability for people to raise concerns and complaints over the service they are receiving is critical to providing a high quality care and support service which meets individual’s needs and the local authority should provide specific information and advice in relation to this.
Equally, we would encourage a specific reference to providing information on paying for care and support and the financial options available. Understanding how to finance care and support can be a key challenge for individuals and their families and we would welcome the inclusion of this within clause 2, point 2.
If local authorities are going to ‘establish and maintain a service for providing people with information and advice’ on care and support then it must be ensured that this is a complete service and we believe that with the inclusion of both of the above within clause 2 of the Bill, it will provide clear guidance to local authorities on their requirements to enable this.
Under clause 4, point 5, we would question whether there should be specific reference to ‘provider of care and support service’ as one of the relevant partners of a local authority. Individuals will have a choice of providers and we would place a great importance on the relationship local authorities have with providers to ensure each individual is receiving high quality person centred care. In this respect, care and support providers are a key partner to local authorities and should be referenced as such.
BASW broadly welcomes the principles, although in common with others has significant concerns about the implications for implementation in a situation of 20% + to council budgets.
Mental Health and the role of the Local Authority is very clear, Care Programmes and Carers Assessments has been well documented over the years, however faillings by both parties to carry out their responsibilites are for all to see.
An integrated system is still the best way forward, incorporting GP as they offer front line services,
GPs Health and the Local Authority need to work in partnership with each other, and trained accordingly, with strong guidelines on who to contact and when.
Information should be made available in GPs practices Libraries, and Local Authorities on your rights as a carer and user of the services, including who to contact should you have any concerns.
Social care support for MH s.users and Carers has, in my LA, only been available via secondary MH services ie via the CPA. What has been forgotten (deliberately?) for the past 17 years – since the introduction of the CPA is that access to community care services and subsequently carers services is a right under community care legislation. It is not reliant on being in secondary MH care .Under current legislation a person needs to appear to have a community care need to be assessed by a local adult services team ( not CPA ) as do all people (ill, frail, disabled). MH Carers also have this right to access to support via local teams. Why it has taken 17 years until No Health Without MH – is a scandal of discrimination against MH s.users, carers and their families on a massive scale. The new Implementation Framework will hopefully put this right – but all stakeholders in MH need to understand that the rights to all people regardless of disablity have been there since 1976 – Chronically Sick and Disabled Persons Act. I have been fighting this wrong for 20 years now and at long last there is a realisation of how access to social care and carers support for MH users and carers must not be limited to secondary care – a the most medical model of care that has littleconnection to the wider world or to peoples rights.
I have a number of points to be taken into consideration and they are listed below:
1. The inequalities in the current system have to be dealt with so that when a Service User moves from one Local Authority to another, then they should get the same package of care. It should be very clear to all arranging the care that this is what happens and there should be absolutely no means of another authority coming to a different conclusion unless of course there has been a change to the circumstances of the Service User.
2. The criteria for the delivery of a package of care should be standardised across all Local Authorities and no Authority should be able to make changes to the criteria.
3. If a Service User is admitted to care on grounds of ill health for example Dementia then they should not have to be funded by the Local Authority. Their Personal care and Support should be paid for by the Health Authority, no quibbles, if they had cancer they would be looked after by the Health Authority..
4. The whole area of Social Services should be removed from the responsibility of the Local Authority and placed with Health. This is about caring for a Service Users needs in the round; so there should be one point of call.
These comments are from Preston’s Learning Disabilities Forum comprising service users, carers and provider reps as well as some specific local authority post-holders.
The purpose of wellbeing in the bill is felt to be right including the areas identified as wellbeing, though there is a concern about how far the Local Authority would be held accountable for the delivery of this and the principles when they only have to “have regard to” them. The principles in the Mental Capacity Act might be usefully mandated for capacitated people in a much more pro-active way expecting that the Local Authority must do everything possible to ensure the rights and freedoms of vulnerable people in need are protected – the least restrictive options. People with learning disabilities in particular need active support even when assessed as capacitated in a specific area and it is felt that advocacy provision should be mandated to protect the rights of such vulnerable people in need.
(There is some concern about the difficulty of advocacy’s role if tendered for and funded by the statutory authority whom they have to challenge and whether it would be better fr central funding but a mandate that L/authority has to involve advocacy).
The Forum did think the local authority should have this role (this positive promoting well-being role) in the community. However, people felt that the LA should have a duty to ensure the provision of sufficient specific preventive services which included good neighbours schemes, commissioning circles of support, peer support, self-advocacy or support groups and of training courses to assist self-help, including local money management support systems (banks) more flexible to people’s needs than the current set-ups. It should include signposting but also some preventive community services.
It was also felt that the duty to provide information needs strengthening more than 2(a) -(d) to include a wider range of information than types of care and support and providers, but should have information on advocacy, self-advocacy, carers support groups, counselling… and the facilities relevant to their health and wellbeing brief as defined. That providing information should require more than putting things into a care directory on line/websites. The whole area of accessibility should require free access and help in a variety of local places as many people don’t have access to the web. There’s a need for accessible language/there might be a DVD option/other languages. It was suggested that at least annually a leaflet/DVD explaining rights, how to access, criteria for getting specific support could be sent out with the rates letter to all households; There should be basic information points in local places – could be GP, health centres, POffices,libraries… ideally supermarkets. It was also felt that this could be best provided by local community groups/providers/service user and carer networks which the LA could pay for & facilitate distribution. Infomation and advice should not be subject to charges as it was felt this could deter people when they are vital to any preventive agenda as well as to informing choices.Once again access needs to be a proactive duty – and including support from user and carer-led groups and advocacy.
There is concern that diversity might be argued from a minimalist point of view and a worry about price driving contracts to larger and larger providers not linked to the area. Diversity needs some definition to ensure that there must be small local agencies from the local communities in the mix and some attention to suiting the diversity of people in the locality. Quality needs to include the judgement of service users and carers, and it was also said by the training of the staff employed and by some independent (from the local authority) evaluation.
If the local authority has a duty to promote welbeing and prevent escalation to needing care and support services, then shouldn’t the LA have a duty to ensure the range of services includes wellbeing and preventive services – not just care and support?
The duty on the LA to cooperate should additionally be with service users & carers and their representative groups and the local voluntary,community and faith sectors.
In general, there is concern about whether there is sufficient definition/ specificity to hld local gvernment t account and t assure vulnerable people rghts of access to suficient support.
• The Social Care Institute for Excellence (SCIE) welcomes the draft Bill. Building on the Law Commission’s proposals for a single integrated Adult Social Care statute, the draft Bill clarifies individual rights to care and support.
• SCIE considers that it is right that, in the draft Bill, local authorities must continue to “act under the general guidance of the Secretary of State”.
• SCIE is aware of concern among individuals, carers and relatives that very few of the entitlements contained or implied in current legislation take the form of rights the individual can assert or seek to have legally enforced. They are mostly duties placed on the local authority to respond to specified circumstances in a particular way, or powers the local authority can choose to exercise or not as it sees fit. Some tend to be “procedural”, giving access to processes like assessment, rather than relating to outcomes for individuals.
• In the draft Bill, the government’s proposed reforms are still largely framed as local authority duties and powers, with a number of Clauses referring to regulations which must or may contain, require or provide for various matters. Whether individuals feel the draft Bill clarifies their rights will depend a good deal, in SCIE’s view, on the framing and content of the regulations, such as those under Clause 12 on how assessment should be carried out.
• Individuals and carers often feel isolated and at a disadvantage when dealing with the local authority over rights and entitlements, recognising its greater size, power and control over resources. Good authorities take steps to enable user empowerment through providing information and advice in accessible forms, making sure advocacy is available, and working closely with user-led support organisations and networks. SCIE would suggest similar measures be made standard practice through regulations or with the help of Guidance. In SCIE’s experience, co-produced digital Guides can be helpful in these areas of practice.
• The greatest strengthening of the rights of individuals and carers could potentially come from robust implementation of Clause 1, on promoting individual wellbeing. In defining on the face of the draft Bill various aspects of individual wellbeing, and setting out seven principles underpinning good practice in care and support, the statute contains important commitments to participation, personalisation, co-production and quality. SCIE has expertise and experience to offer in helping to implement and embed these principles.
Derbyshire County Council strongly supports the framework for the broader role of a local authority set out in clauses 2 to 7. Our concern is that, unless significant additional funding is forthcoming, much of our preventative provision may be dismantled over the next 2 to 3 years. The paradox is that these preventative services would become statutory duties within the same timeframe.
Commissioning
1. The White Paper will place a duty upon local authorities to promote diversity and quality in the provision of services, which JRF believes is particularly important given the increasingly diverse population of older people, some of whom are poorly served by the current care offer (Falkingham et al 2010; Blood and Bamford 2010).
2. We would, of course, also point out that accessibility and affordability are other important features when it comes to local care markets. The idea of a ‘market position statement’ which sets out a local authority’s plans for the local care market is an excellent one, as it will encourage greater transparency regarding what is needed in the local area and what local authorities are looking for from local providers.
3. JRF would urge the government to ensure the voice of local older and disabled people and their families are central to these market plans, identifying the outcomes local people want to achieve and giving providers the opportunity to be creative regarding how these are met, rather than prescribing types of services that local commissioners believe would fit the bill (Stone and Wood, 2010).
4. With this in mind, JRF welcomes the government’s clear position on the unacceptable “time and task” contracts used to deliver home care and the emphasis on commissioning and assessing services according to outcomes, based on the experiences of service users and their families.
(Research referred to above can be found at http://www.jrf.org.uk)