Care workers maintain hope in the face of adversity
With the deaths of children and abuse of old people making national headlines, social care is under unprecedented pressure but there is optimism in the sector
Author: David Brindle, The Guardian |
Timing can be all important. The coincidence, a fortnight ago, of the conclusion of a trial concerning the death of one child and the publication of the report of a case review into the killing of another, served yet again to fuel the impression of bungling and incompetentchildren‘s services departments, powerless to prevent the abuse of vulnerable youngsters.
The second case, the murder of two-year-old Keanu Williams by his mother, occurred in Birmingham. The city council was one of a handful of councils already on statutory notice to improve its children’s services and critics seized on a candid admission by Peter Hay, its interim strategic director for children, young people and families, that “we cannot be clear that we have reached an adequate standard in the safeguarding of children across the city”.
The first case had taken place in Bradford and involved the starving to death of four-year-old Hamzah Khan by his alcoholic mother. Bradford’s director of children’s services, Kath Tunstall, had in September announced her intention to step down after seven years in the post for reasons said to be unconnected with the case.
Seven years is a long stretch these days for a director of children’s services. The job is hugely pressured and hard to fill: across England, there are currently more than 40 interim directors such as Hay. He has had children’s services added to his role as strategic director of adults and communities – a temporary move expected to be made permanent by the proposed creation of a “people” directorate, a vast brief in England’s second city.
Birmingham, moreover, says it needs to save £100m this year – and a forecast £450m by 2017-18 – to cope with continuing cuts in government grant. So when children’s minister Edward Timpson reminds the council that it is on a “final warning” and that “unless I see a rapid improvement, further action will follow”, Hay and his local (Labour) political masters must need to bite hard on their tongues.
As social care leaders gather in Harrogate today for the opening of the annual National Children and Adult Services conference, the mood will be sober. If children’s services seem to be in crisis in many parts of England, adult services are scarcely any better placed to deal with the twin challenges they face of spiralling demand for care and support, and shrinking funding from government. In three years, adult services directors say, almost £3bn has been taken out of their budgets.
The results are plain to see. For those older and disabled adults still getting a state-funded service – and the numbers have shrunk by 25% in the past five years – that service may well be less than many people would judge adequate.
According to research by charity Leonard Cheshire Disability, six in 10 councils are commissioning 15-minute home-care visits, some of them specifying that time limit as a maximum for three-quarters of all calls. The Association of Directors of Adult Social Services (Adass) counters that fewer than one in 10 councils is using 15-minute visits for washing or bathing purposes, as opposed to checking or administering medication.
Provisional official data has meanwhile pointed to a sharp rise (almost 30% in a year) in cases of reports of suspected abuse of older people, with a smaller increase of 4% in cases referred on for investigation. Is there a connection between this apparent trend and the fact that vulnerable people are having less contact with the care system? Or is this a healthy sign that the system, despite intense funding pressures, is picking up more abuse that used to be hidden?
With the climate of austerity likely to be with us for the rest of this decade, these are the kinds of questions to which we need clearer answers. New appointments at the top of the social care sector may help deliver them, in particular the arrival of Andrea Sutcliffe as the first chief inspector of social care at the Care Quality Commission, and of Isabelle Trowler and Lyn Romeo as the first chief social workers for, respectively, children and adults.
There is much expected, too, of the fast-developing agenda of integration between social care and health. The announcement of a pot of £3.8bn for integration projects in England in 2015-16, funded largely by the NHS, has prompted great excitement. And more than 100 bids were lodged to become “integration pioneer” areas, with 15 expected to be chosen to go ahead immediately.
Norman Lamb, care services minister, thinks the effect of the pooled funding pot “could be revolutionary” and has the potential to “turbo-charge” transformation. He said at the recent Liberal Democrat party conference: “Although £3.8bn is a small percentage of the total spend on health and care, it’s definitely enough to get every area thinking ‘we have got to do things differently’.”
Lamb is in no doubt that the NHS and social care system cannot survive in its present fragmented form. “The pressures are immense and there is no alternative to doing things differently to ensure that the system is sustainable,” he told a meeting last month at the Localis thinktank. Intriguingly, he added: “Local government has been rather good at innovation – probably much better than the Department of Health or the NHS.”
With Labour promising to go even further and faster on integration – uniting health and social care in a single system in which beefed-up local health and wellbeing boards would lead commissioning of services – the long-term prospect for local government is encouraging. It’s the short term that’s so tricky.
Meeting the demand
The paradox has never been starker. With demand for social care at an all-time high, thanks to our ageing society and the impact of recession on families, the system finds itself under unprecedented pressure through cuts on a scale never previously known.
And the strains are showing. As we document in this supplement, children’s services are struggling in many areas. Yet continually beating professionals around the head with process-focused solutions may be a big error, as consultant Max Wide argues inside.
Quality leadership in both children’s and adult services is at a premium, as we reporton page . Sandie Keene, president of the Association of Directors of Adult Social Services, reckons it’s the toughest environment she has known in almost 40 years.
Are there other reasons to be cheerful? Most certainly. We describe innovative children’s services practice in Derbyshire and Hillingdon, west London, which will be showcased this week at the National Children and Adult Services conference. And as Andrew Webb, president of the Association of Directors of Children’s Services, points out, innovative practice can save money as well as improve children’s wellbeing.
But would you want to work in social care? We report on how training is attracting young people into care roles. They had better be: in the next 12 years, workforce specialist Sharon Allen suggests, we may need another million pairs of hands in adult services alone.