You must be Joking: reports and comment from the health and social care frontline

Putting Profits First

In the last couple of years, the Government has announced far-reaching plans to radically transform the way in which social care is delivered to vulnerable members of our community. With the Our Health, Our Care, Our Say White Paper and “Putting People First”, plans to massively extend the use of individualised budgets and self-directed support schemes have been outlined.

So what does this mean in practice? And what are the implications for both service users and their carers?

Well, in a nutshell, self-directed support means that, in future, individual budgets will be paid directly to people in need of help – in theory to enable them to exercise choice, control and flexibility over their support. This effectively entails them acting in the capacity of employer to their carers, or personal assistants (PAs) as they are now called. However, while this sounds all very well in theory, it is actually far more beset with problems than first meets the eye. Research conducted over recent months into personalised budget schemes has exposed a number of serious flaws, and in the process, inadvertently revealed the government’s true incentive for introducing the scheme in the first place.

A joint study conducted by UNISON and the Scottish Personal Assistant Employer’s Network (SPAEN) earlier this year showed that PAs employed by people with disabilities failed to benefit from the minimum wage, statutory leave or maternity pay. Further, service users often reported being left without support if their PAs went sick.

The Chairperson of SPAEN, who is also a service user, expressed concern at the lack of training given to users in employing and managing staff; a recurrent failing which the government is still to address. Skills for Care, the professional body providing guidance on workforce development in social care, found that nearly half of the service users they surveyed had not completed adequate pre-employment checks on the PAs they employed. The implications of this are that a vulnerable person could, in theory, have employed a convicted sex offender or serial thief.
Feedback from one direct payment scheme, “In Control”, in Oldham, revealed that some agency support workers employed were inadequately trained to support people with complex needs such as hoisting. Indeed, self-directed support schemes still do not fund service users to provide the specialist training that the people supporting them may require.

The suspicion that part of the overall plan of the personalisation agenda is to de-skill and de-professionalise the whole social care workforce (thereby cutting costs) was partially confirmed in August when Wirral Council announced plans to cut 29 qualified social worker posts, whilst simultaneously expanding non-qualified positions. Other local authorities look set to follow suit. One North West social worker summed up the concerns of many:

The whole personalisation agenda...is just a disaster waiting to happen. For all the positive spin and rhetoric the government provides about giving people choice and control, the reality is that service users and personal assistants alike are being left wide open to abuse. I cannot understand how the rest of the social care workforce can be required to adhere to professional codes of conduct, policies, procedures and training programmes while personal assistants are not. The whole self-directed support model seems devoid of any regulation and service users have the onerous responsibility of employing PAs without adequate training or support. It is simply inconceivable that the powers-that-be could not have foreseen these problems. Individualised budgets are being extended daily and still nothing is being done to address these fundamental issues. To me the whole thing stinks. It’s all about cutting costs and privatisation by the back door.

Migrant Care Workers Abused

Joint research carried out by Citizens Advice and the TUC published in late August identified the low-paid care sector as having “some of the highest incidences of employment rights abuse”. Nicola Smith, Senior Policy Officer on the TUC’s Commission on Vulnerable Employment cited that legal migrant workers employed by agencies to work in care (who need 12 month’s employment before they are entitled to UK rights and benefits), were often threatened with deportation or the sack if they reported abuse. These commonly included issues on pay, dismissal and working hours. Smith also expressed concern that the government had not extended the writ of the Gangmasters Licensing Authority to cover the care sector.