Having semi-retired after more than three decades working as a mental health professional, I continue to undertake some freelance work as both supervisor of qualified social care professionals and I also act as an independent advocate and social care consultant to clients.
Over the years I have seen standards watered down and regulations and professional guidelines not infrequently ignored by managers of health and social services. An unspoken managerialism has covertly abolished democratic controls and safeguards across the a wide swathe of the public sector, hidden behind the rhetoric of personalisation, choice and control.
Over the years I have seen standards watered down and regulations and professional guidelines not infrequently ignored by managers of health and social services. An unspoken managerialism has covertly abolished democratic controls and safeguards across the a wide swathe of the public sector, hidden behind the rhetoric of personalisation, choice and control.
From my own practice and that of colleagues I know, I can say that there is now a form of anarchy rife in public services where top heavy management has diverted resources away from frontline services, according to an ethos forged on the High Streets, in the finance industry and shopping malls of England - and elsewhere.
It wouldn't be too much of an overstatement I think to say that in Austerity Britain pretty well all public services have become the tools of a class of decision makers whose engagement with the needs they're employed to service, becomes more remote and estranged as they ascend the managerial pyramid (where much intrigue awaits).
Take for example the increasingly difficult 'Continuing Health Care' [CHC] funding assessment and appeal processes, as an exemplar of the organisational anarchy I'm talking about here.
This is where people's health care needs are assessed to determine whether or not they meet the criteria for free health care funded by NHS England, as opposed to means tested assessment for increasingly non-existent social care, to be arranged by the local authority supposedly in accordance with their duties and powers under the Care Act 2014.
This is where people's health care needs are assessed to determine whether or not they meet the criteria for free health care funded by NHS England, as opposed to means tested assessment for increasingly non-existent social care, to be arranged by the local authority supposedly in accordance with their duties and powers under the Care Act 2014.
In the joined up vision of integrated services and under CHC rules both social services and the NHS should jointly assess the needs of the person and if they are deemed to meet the criteria for health or social care (or a mix of the two) and come up with a plan and a funding arrangement.
This CHC gameplan is set to ensure the budget holders - i.e. the local clinical commissioning group (CCG) will always have the upper hand and this can often involve creative semantics that changes the meaning of words like 'continuing health care need' loosely sketched out but never defined in the national guidelines, based upon a legislative framework and English common law. However the provision of evidence with reference to such concepts as healthcare need or social needs is often ignored by CHC decision makers because the assessment is often a foregone conclusion, based upon budgetary criteria rather than health care needs in many cases.
I have for eaxmple, heard a CHC assessor say they could not present the evidence given to them at a multidisciplinary meeting (to determine a persons right to health care they have paid for all their working life) because - "I can't take that back to my managers" - on this occasion "that" being a piece of evidence that would have strengthened the person's case for eligiblility for CHC funding. The distinct impression that the decision has already been made over the heads of the assessors prior to an assessment, is a common experience among people trying to get the care they believe they, or their relative needs and is entitled to under CHC rules and the law.
I have for eaxmple, heard a CHC assessor say they could not present the evidence given to them at a multidisciplinary meeting (to determine a persons right to health care they have paid for all their working life) because - "I can't take that back to my managers" - on this occasion "that" being a piece of evidence that would have strengthened the person's case for eligiblility for CHC funding. The distinct impression that the decision has already been made over the heads of the assessors prior to an assessment, is a common experience among people trying to get the care they believe they, or their relative needs and is entitled to under CHC rules and the law.
National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care
One way that the rule book has been torn up is that the guidelines issued by the Government - in the Department of Health National Framework document (which is the only 'rule book' for CHC funding) is entirely out of date. It misguides rather than guides people wishing to challenge a CHC funding decision with regard to often complex care needs.
This is linked closely with the Care Act and is intended to be a collaborative integrated and joined up processes, even though social services often tend to take a backseat in many CHC assessments.
Integration is a priority policy for England's health and social services, pressed ahead by a government anxious to offload free NHS care onto the means tested and largely privatised social care sector, a conduit for the privatisation of most chronic diseases, disabilities and long term care needs across all age groups.
In 2014 the Care Act was made law in England, this incorporated various pieces of legislation and pulled them all together under one heading captured in the slogan 'wellbeing'. The Care Act was hailed as the greatest change to social care for 70 years. The Act has been implemented in stages starting in April 2015 when the first raft of legislation came into force.
Whose Care?
Generally speaking there are two types of care in the UK.- social care: provided and funded by a local authority and means tested
- healthcare and nursing care: provided by the NHS and not means tested - in other words free depending on a persons health needs.
The assessment for CHC funding always is supposed to weigh up the situation a person's health and holistic needs and by applying the criteria in the National Framework, decide whether a persons care needs are health related or social needs or needs that can be met in other ways.
The fact that this doesn't always happen and the assessment is heavily waited on the side of the CCG who want to protect their budgets and therefore not pay for the care and will often go to great lengths to argue why they should not do so. Anyone who has appealed a CHC decision will know what I mean here I think.
But they were often stymied from the start, the rules are simply ignored, social services routinely ignore their duties under the Care Act to people they deem 'self funders', which is frequently shorthand for you're on your own, but this isn't actually lawful, they have duties for example under section 4 of the Care Act which states...
Information and advice provided under this section must be accessible to, and proportionate to the needs of, those for whom it is being provided.
Information and advice provided under this section must be accessible to, and proportionate to the needs of, those for whom it is being provided.
But it still happens in lats of places I hear feedback from, so make it doesn't happen to you or anyone you care for.
Official Misguidance
The guidance for people wishing to challenge CHC decisions hasn't been updated since 2012 when the CHC clocks metaphorically stopped. The National Framework document doesn't mention the Care Act at all - indeed it does worse than that, it guides us to various bits of repealed legislation when it says:-
"LAs (local authorities) also have the function of providing welfare services under section 29 of the National
Assistance Act 1948 (which includes functions under section 2 of the Chronically Sick and
Disabled Persons Act 1970). Section 29(6)(b) of the National Assistance Act 1948 only
prohibits LAs from providing such services under section 29 as are ‘required’ to be
provided under the 2006 Act and so excludes only those services that must, as a matter
of law, be provided under the 2006 Act."
This advice was still in the National Framework guidance in December 2017 when I last looked, even though all the legislation it refers to has been incorporated into the Care Act of which there's no mention, it has therefore been 'wrong advice' for over three years.
This of course massively disadvantages people wanting to take their case up with social services because that are citing out-of-date legislation, they are immediately wrong-footed in any challenge they make to CHC care funding decisions.
This is just one of many pitfalls encountered in dealing with the health and social care bureaucracies, including them simply ignoring appeals to the rules giving a glimpse into the culture within the covertly privatised welfare state.
The rules, except when they can be used to the benefit of the organisation, have been largely abolished except for those complainants able to amass the necessary resources to take these issues to court, for judicial review. That is to say the very, very few - not the very many.
This amounts to the abolition of accountability by notionally public bodies, for example where local authorities simply do not acknowledge their duties under the Care Act and don't attempt to discharge them, nor indeed respond to complaints that they haven't been discharging such duties. Colleagues have told me of instances for example where someone's clear entitlement to an assessment from the local authority of their eligible needs for care and support under the Care Act has been 'stonewalled' by social services management. Enquiries from legal professionals have been ignored on the calculation that complainants will not have the funds to make a legal challenge, there is a culture of complacent disregard for the laws and policies supposedly governing the provision of health and welfare services in England.
The fact that this is unlawful is no deterrent because they local state actually can only act unlawfully in order to remain within the ever tightening fiscal straightjacket central government imposes upon it.
Councils currently pay lip-service to so-called co-production but if we are to restore faith in the health and welfare system, they must be designed by users and involve communities themselves. Services moved closer to the ground and to be more accessible. Austerity England should have community based care and support services in areas of high need and available to all citizens with care and support needs - not least of all because the Care Act says so.
The current mismatch between expectations on both frontline staff and higher management, must be urgently addressed in a long overdue flattening of the currently top-heavy management hierarchies (which incidentally represent some savings in themselves) to help democratise the decision making process and reduce reliance on the interpretation of a few interested parties irrespective of the evidence and without any comeback from any unlawful, or unprofessional shortcuts statutory decision makers might be tempted to take.
A Measure of Corporate Compliance
In case you may think this all sounds a bit utopian it's what such social policy buzzwords as co-production and co-design mean. When these ideas are matched with other statutory duties and professional codes of ethics, policies like wellbeing promotion, personalisation with its choice and control of the user and micro-commissioners of bespoke care packages, adequately resourced for every eligible citizen with care and support needs and their carers who are ordinarily resident in the local authority area. Do this and your MBE is guaranteed, providing you are not critical of course.
This happy state of affairs is not taken from the Alice' Adventures in Wonderland, but reflect best and lawful practice in England now, today in 2018. If the laws, policies and procedures created at all tiers of government that determine the rules health and social care commissioners and providers must comply with, were actually complied with we would have something resembling a fully functioning welfare safety net in this country.
Problem is, it ain't happening. The rules mean very little if you're a consumer of these services trying to get your entitlements under the law, the cards are stacked against you no matter how much national insurance you paid in for all those years to cover you.
Compliance is ultimately a professional fitness to practice issue, otherwise all rules, laws and procedures would be meaningless and not worth the paper they're written on.
Feb 2018
This advice was still in the National Framework guidance in December 2017 when I last looked, even though all the legislation it refers to has been incorporated into the Care Act of which there's no mention, it has therefore been 'wrong advice' for over three years.
This of course massively disadvantages people wanting to take their case up with social services because that are citing out-of-date legislation, they are immediately wrong-footed in any challenge they make to CHC care funding decisions.
This is just one of many pitfalls encountered in dealing with the health and social care bureaucracies, including them simply ignoring appeals to the rules giving a glimpse into the culture within the covertly privatised welfare state.
The rules, except when they can be used to the benefit of the organisation, have been largely abolished except for those complainants able to amass the necessary resources to take these issues to court, for judicial review. That is to say the very, very few - not the very many.
This amounts to the abolition of accountability by notionally public bodies, for example where local authorities simply do not acknowledge their duties under the Care Act and don't attempt to discharge them, nor indeed respond to complaints that they haven't been discharging such duties. Colleagues have told me of instances for example where someone's clear entitlement to an assessment from the local authority of their eligible needs for care and support under the Care Act has been 'stonewalled' by social services management. Enquiries from legal professionals have been ignored on the calculation that complainants will not have the funds to make a legal challenge, there is a culture of complacent disregard for the laws and policies supposedly governing the provision of health and welfare services in England.
The fact that this is unlawful is no deterrent because they local state actually can only act unlawfully in order to remain within the ever tightening fiscal straightjacket central government imposes upon it.
Councils currently pay lip-service to so-called co-production but if we are to restore faith in the health and welfare system, they must be designed by users and involve communities themselves. Services moved closer to the ground and to be more accessible. Austerity England should have community based care and support services in areas of high need and available to all citizens with care and support needs - not least of all because the Care Act says so.
The current mismatch between expectations on both frontline staff and higher management, must be urgently addressed in a long overdue flattening of the currently top-heavy management hierarchies (which incidentally represent some savings in themselves) to help democratise the decision making process and reduce reliance on the interpretation of a few interested parties irrespective of the evidence and without any comeback from any unlawful, or unprofessional shortcuts statutory decision makers might be tempted to take.
A Measure of Corporate Compliance
In case you may think this all sounds a bit utopian it's what such social policy buzzwords as co-production and co-design mean. When these ideas are matched with other statutory duties and professional codes of ethics, policies like wellbeing promotion, personalisation with its choice and control of the user and micro-commissioners of bespoke care packages, adequately resourced for every eligible citizen with care and support needs and their carers who are ordinarily resident in the local authority area. Do this and your MBE is guaranteed, providing you are not critical of course.
This happy state of affairs is not taken from the Alice' Adventures in Wonderland, but reflect best and lawful practice in England now, today in 2018. If the laws, policies and procedures created at all tiers of government that determine the rules health and social care commissioners and providers must comply with, were actually complied with we would have something resembling a fully functioning welfare safety net in this country.
Problem is, it ain't happening. The rules mean very little if you're a consumer of these services trying to get your entitlements under the law, the cards are stacked against you no matter how much national insurance you paid in for all those years to cover you.
Compliance is ultimately a professional fitness to practice issue, otherwise all rules, laws and procedures would be meaningless and not worth the paper they're written on.
Feb 2018
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