Jackie Rafferty also gives links to press articles on the BASW/College of Social Work spat:

Community Care:
http://www.communitycare.co.uk/Articles/2011/01/21/116155/basw-confirms-launch-of-own-college-of-social-work.htm

The Guardian:
http://www.guardian.co.uk/society/2011/jan/21/social-workers-professional-organisation

And now, the Health and Social Care Bill and end-of-life and palliative care.

First, there is no specific coverage of end-of-life or palliative care, so we have to surmise what the issues might be for us.

Second, there is a focus on greater integration between health and social care systems, and this is given particular force by the role of local authorities in keeping an eye on healthcare services in their area and supporting advocacy and policy advice for healthcare providers and commissioners. There are no more guarantees of reducing health-think blindness than in the present system, and the strong role of GPs in the new system, many of whom are ignorant and want to remain ignorant and moralistic about social issues does not give much hope either. However, not all GPs are totally hidebound, and some are positively thoughtful, so this coordinated commentary and advisory local authority role offers some hope in more imaginative local authorities (as opposed to the Neanderthal ‘we do care management assessments – duh’ places; local authorities can be as, if not more, hidebound than GPs) that social care services and social thinking might have a greater impact on the inward-looking tendency in health services. Also the removal of the PCTs and even more the arrogant SHAs (‘oh, we’re so much more important than you pygmies’) has some hope of removing some of the more blighted buro-think in the NHS; most of them are in PCTs. The impact assessments say that perhaps 40% of PCT and SHA staff will transfer to consortia: let’s hope it’s the imaginatve ones.

The combined impact assessments here: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123635.pdf

Therefore, we might hope for better influence in social care on end-of-life issues and better understanding of social care from GPs. And social work thinking might infiltrate at least some of the commissioning consortia.

Third, since a lot of palliative care in the UK is in the voluntary sector, existing non-NHS palliative care providers will have a clearer role of being licensed providers and will be able to compete. They are likely to be more experienced in getting in on the act than nursing and social care staff setting up social enterprises, and they have a track record.

The problem is gauging what the attitude of consortia will be. You can imagine that GPs will want to do as much end-of-life care as they can themselves, gearing up their own nurses to doing it. This would probably be cheaper, nearer to the community and liked by patients, who of course don’t know how much better it might be with their local hospice. Because patients and families will have a higher degree of choice, assuming a hospice provider is not too expensive, marketing the quality of hospice provision will become more important. However, the local reputation of many hospices and the fact that many GPs and community nurses like the help and support that home care services offer might encourage them to do a deal.

Fourth, however, there is the matter of the tariff, which will set the levels that consortia can pay for a service, unless there are specific arrangements. There is no national tariff at the moment, and previous efforts to create one descended into disorder. But we might move into the American situation in which there may be limits on what the consortia will agree is palliative care, and set requirements for admission, as the American insurance companies do.

Fifth, will private providers come into this? It’s hard to imagine the private hospitals aiming for this sort of thing, they will focus initially on providing predictable elective surgery. But you may well get private nursing homes and residential care homes competing to do end-of-life and palliative care on the cheap compared with the multi-talented hospices. After all, we’ve been working hard to train them to do this better, so they’ve been upping their skills in this area. And you might get private community care agencies moving into end-of-life homecare; it would be a natural extension of their domestic and domiciliary care markets.

One of the worrying things this points to is the advantage, in a competitive system, of not sharing knowledge and expertise. We would perhaps do a lot better not to train hospital and care home staff in palliative care, then they would have to come to us for services. Or are we going to focus on being training and development agencies? That would go against the Cicely Saunders principle of gaining the expertise to train and develop from actually doing the job.

Sixth, I think one of the important developments of recent years is hospital palliative care. To me, it is really important that end-of-life care in hospitals is the best quality, because so many people come to the end of their treatment or are admitted in emergencies and need good end-of-life care because they cannot be moved elsewhere. Are GP consortia going to be prepared to pay for this? They will want quick cure and out into cheaper accommodation. Perhaps the aim for hospices is to get themselves seen as cheaper providers of high-end end-of-life care to get people out of hospitals to cut costs. Here, the nursing home market will be strong competitors.

Finally, there is the general aura of competition in the Bill. Reading the Bill gives you a very clear impression that it is setting up the system to be strongly competitive; the arrangements for competition are there in every section, and priority is given to it wherever they can achieve this.

What is going to be the unique selling proposition of hospices? And how are they going to market themselves?

I have set out below the twelve main parts of the Bill at the end of the post and left in some of the subheadings that might interest readers of this blog; you can go to the Bill to see what it says on particular topics of interest, although you’ll have to know a lot about the previous legislation ot make sense of it. There are also a lot of schedules setting out details. There are no summaries of what every detail might mean; we will get some idea of this as it goes through Parliament and as specialist interests get to grips with it.

On the web: http://www.publications.parliament.uk/pa/cm201011/cmbills/132/11132.i-v.html

This is html; if you want to download and print out the whole thing, go here:

http://www.pulsetoday.co.uk/Journals/Medical/Pulse/2011_January_12/attachments/Health%20and%20Social%20Care%20Bill.pdf

The main pointers

Part 1 sets out the change in management structures, as follows.

The aim is claimed to be to remove the structures that regulated the New Labour system in which the Secretary of State has wide delegated powers to set targets or detailed arrangements across the NHS. Also, the system has been ‘delayered’ with the removal of strategic and primary care trusts. An NHS Commissioning Board would make operational management decisions; the Secretary of State is to be mainly concerned with setting a legislative framework, and would be required to act in the interests of the health service; failure to act on this requirement could be challenged in court.

Commissioning consortia will be statutory bodies consisting of representatives GP practices, who will have to participate. They will commission services for patients of the practices in the consortium (and some other local people) and will have a duty to commission services if this is not reserved to the NHS Commissioning Board (which will provide for things that need a national remit). There are various detailed changes, for example who exercises emergency and mental health powers.

Part 2 deals with public health, where currently both the NHS and local government have responsibilities. The aim is local joint working, led by local authorities. Local authorities would have responsibilities for health improvement (e.g. smoking and obesity) and must appoint a Director of Public Health; the Secretary of State retains responsibilities for health protection (e.g. flu jabs and epidemics).

Part 3 sets out how the system of economic regulation: the Foundation Trust regulator, Monitor, will have increased powers. Interestingly, its role will be (52.1) to protect and promote the interests of people who use health care services – (a) by promoting competition where appropriate, and (b) through regulation where necessary. The main aim is then, we can see, to control through competition not through regulation.

It also makes provision later for Monitor to regulate social care as well as health care (but not children’s services), but it does not seem to be bringing this in yet. You may wonder about a chapter on competition: this is to set out the various functions of Monitor in relation to the Office of Fair Trading, a sign that there is going to be a much stronger focus on competition in the service in the future. There are systems for Monitor licensing all NHS providers and for designating essential local services to ensure that they are protected from the competition requirements. Providers have to provide services within the national tariff, if there is one, or if not, agrees an amount according to specified rules. There are consultation arrangements for setting the national tariff. There are arrangements for in insolvency of providers.

Part 4 makes provision for all hospitals to become Foundation Trusts, that is independent free-standing bodies that can compete for custom from the commissioning consortia; other providers are also free-standing, and there has been talk about commssioning consortia begin able to use any licensed and willing provider. Together, the establishment of the consortia and these Trusts sets up the freer competitive system in which it is hoped a wider range of providers may be used by the consortia – they will not be so tied to a limited range of providers, through ongoing contracts, as under the present system.

Part 5 is about public involvement. There will be a national organisation ‘Healthwatch’ which sets up local healthwatches to provide both national and local feedback by people about their needs and wishes and for local authorities to provide advocacy on behalf of patients. These are bodies rather like the community health councils that we were familiar with in the 1970s. Local authorities are to take part in joint local needs assessments and create strategies to achieve appropriate outcomes with commissioning consortia. Through new Health and Wellbeing Committees will have overall responsibility for promoting a coordinated view of and action on local health and social care needs. This part gives a strong responsibility to the local authority for keeping an eye on local health services. It’s part of the checks and balances associated with a relatively fragmented market system of provision.

Part 6 deals with primary care services. These are relatively minor provisions for primary care, for example dental and pharmaceutical services.

Part 7 abolishes the GSCC and merges its functions with the new Health and Care Professions Council, of which I understand social work will be by far the largest profession. The Council for Healthcare Regulatory Excellence also has its functions extended to social and work and social care. Throughout, the Bill distinguishes between social care workers and social workers. There is provision for further voluntary registers for social care (and other unregulated) workers. The Office of the Health Professions Adjudicator is abolished.

Part 8 extends the role of NICE to become the National Institute for Health and Care Excellence. This, together with 5, 7 and 9 starts to include social care within the orbit of healthcare planning, but it might offer the opportunity of influencing healthcare planning with some social care priorities, particularly if the local authorities use their new health and wellbeing responsibilities well.

Part 9 formalises still further the role of information gathering and governance through the National Health and Social Care Information Centre. If you are going to have a competitive market, you need to have good information about all the providers. It also provides for setting and ‘information standard’ controlling how information in processed in health and social care.

Part 10 abolishes a number of health and social care quangos, as presaged in previous announcements.

Part 11 tells everyone they have to cooperate with one another. The focus is on the regulators, but of course cooperation will be essential in a much more fragmented market. It also makes provision for cooperation with Northern Ireland, Scotland and Wales.

Part 12 is odds and sods.

Offical headings (heavily edited)

PART 1 THE HEALTH SERVICE IN ENGLAND The health service: overview; Arrangements for provision of health services; Further provision about local authorities’ role in the health service; Abolition of Strategic Health Authorities and Primary Care Trusts; Functions relating to mental health matters; Emergency powers

PART 2 FURTHER PROVISION ABOUT PUBLIC HEALTH

PART 3 ECONOMIC REGULATION OF HEALTH AND ADULT SOCIAL CARE SERVICES

MONITOR; COMPETITION; DESIGNATED SERVICES; LICENSING; PRICING; INSOLVENCY AND HEALTH SPECIAL ADMINISTRATION; FINANCIAL ASSISTANCE IN HEALTH SPECIAL ADMINISTRATION CASES.

PART 4 NHS FOUNDATION TRUSTS & NHS TRUSTS

PART 5 PUBLIC INVOLVEMENT AND LOCAL GOVERNMENT

PUBLIC INVOLVEMENT; Healthwatch England; Local Healthwatch organisations; LOCAL GOVERNMENT; Scrutiny functions of local authorities; Joint strategic needs assessments and strategies; Health and Wellbeing Boards: establishment; Health and Wellbeing Boards: functions; Health and Wellbeing Boards: Care Trusts; THE HEALTH SERVICE COMMISSIONER FOR ENGLAND

PART 6 PRIMARY CARE SERVICES

PART 7 REGULATION OF HEALTH AND SOCIAL CARE WORKERS

Orders under section 60 of the Health Act 1999; The General Social Care Council; The Health and Care Professions Council; Role of the Secretary of State; The Professional Standards Authority for Health and Social Care; The Office of the Health Professions Adjudicator.

PART 8 THE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

PART 9 HEALTH AND ADULT SOCIAL CARE SERVICES: INFORMATION

INFORMATION STANDARDS; THE HEALTH AND SOCIAL CARE INFORMATION CENTRE;

PART 10 ABOLITION OF CERTAIN PUBLIC BODIES ETC

The Alcohol Education and Research Council; The Appointments Commission; The National Information Governance Board for Health and Social Care; The National Patient Safety Agency; The NHS Institute for Innovation and Improvement; Standing advisory committees

PART 11 MISCELLANEOUS

Duties to co-operate Monitor: duty to co-operate with Care Quality Commission; Care Quality Commission: duty to co-operate with Monitor; Other duties to co-operate

Breaches of duties to co-operate; The Care Quality Commission

Arrangements with devolved authorities etc Arrangements between the Board and Northern Ireland Ministers; Arrangements between the Board and Scottish Ministers etc. Relationships between the health services; Advice or assistance to public authorities in the Isle of Man or Channel Islands; Supervised community treatment; Transfer schemes;

PART 12 FINAL PROVISIONS

Guardian summary of the Bill:

http://www.guardian.co.uk/society/2011/jan/19/health-bill-main-points?CMP=twt_gu

The Guardian and its commentators on the ‘chorus of concern’:

http://www.guardian.co.uk/politics/2011/jan/20/andrew-lansley-health-bill

The Campaign Company blog comments on the increased role envisaged for local government:

http://thecampaigncompany.wordpress.com/2011/01/20/health-and-social-care-bill-the-increasing-role-for-local-government-within-health

Health Policy Insight blog critique of missing features (e.g. post implementation evaluation):

http://www.healthpolicyinsight.com/?q=node/917

Health Policy Insight blog on risks of the reforms:

http://www.healthpolicyinsight.com/?q=node/914

This is based on a more lengthy comment by Sir David Varney (who has experience running a Foundation Trust) for Civitas (but HPI covers the main points):

http://www.civitas.org.uk/pdf/VarneyRiskequity.pdf

NHS Confederation: 12 pointers on reducing the risks of the change:

http://www.nhsconfed.org/Documents/Implications%20for%20policy-makers.pdf

Nuffield Trust: lessons on GP commissioning from the US

http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=756

Royal College of General Practitioners comments:

http://www.rcgp.org.uk/news/press_releases_and_statements/health_and_social_care_bill.aspx

A lot of relevant stuff from the NHS Alliance (brings together GPs and related groups) cautiously supportive of GP commissioning:

http://www.nhsalliance.org/documents/white-paper

A BBC film of ‘experts’ commenting, reasonably neutrally:

http://www.bbc.co.uk/news/health-12229547?utm_source=twitterfeed&utm_medium=twitter

Access the bill and related offical publications at:

http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/HealthandSocialCareBill2011/index.htm

Access the political justification on the Conservative website at:

http://www.conservatives.com/News/News_stories/2011/01/Modernising_the_NHS.aspx

Early comments from the Royal College of Psychiatrists at:

http://www.rcpsych.ac.uk/press/pressreleases2011/healthsocialcarebillresponse.aspx

Like many medical and union commentators, their concern is speed of implementation and possble chaos. quality going down because there will be pressure to go to the cheapest supplier and fragmentation of services because there will be many potential providers.

In psychiatry, they don’t say so (perhaps being polite to their GP colleagues), but you can understand a concern that mentally ill people will lose out because a lot of GPs will have to, or will choose to, give priority to more popular patient groups.

Other comment later.

Not one to follow soaps, I’m only an occasional Archer’s listener, mainly by podcast nowadays, although in childhood I used to listen every night with my parents (we had no television).

But I happened to catch Lizzie and her mother Mrs Archer today discussing whether Lizzie should be carrying on her business when she’s still close to her bereavement. You may have missed the outpouring of fury when daffy but popular character Nigel Pargetter was killed falling off a roof in the 60^th anniversary episode, and the escalating storylines about bereavement. There was a reasonably good discussion about whether children should attend the funeral on Woman’s Hour last Friday, which if you’re quick you can still hear on iPlayer.

Lizzie was robust about the ‘getting on with it’ aspect of her dual process; I refer to the bereavement theory which says we switch between backward-looking grief and going forward as the business cliche popular just now has it. I’m puzzled about the psycho-speak that ordinary people (Mrs Archer represents sensible ordinariness to the nth degree) put about that explicit distress and taking a period of keeping out of action is the thing to do in bereavement. This is no better than forcing everyone to go into black-edged mourning for a year.

There are ripples of despair: what about listener bereavement, say some comments on the BBC Archers blog, but you can get the full glory of listener reaction on the Archers fan club. Slightly more interesting is discussion about whether writers should spice up their stories with death, made a little bit more controversial by the sudden infant death storyline on Eastenders over Christmas. Of course I am old enough to remember the famous death of Grace Archer which was said (the BBC always denied it) to have been timed to draw media attention away from the first night of ITV in the ‘50s, so the BBC has form in this matter, as indeed does every long-running drama producer.

This is silly; people die. Therefore, of course they will die in continuing stories. Dan Archer (the original patriarch) did not die through the deaths of several of the actors playing him, and his son Phil, whose real-life counterpart, Norman Painting, died before the writers could write him out of the plot with a dramatic departure, popped off in old age. Presumably the long-running new patriarch, David will have his turn around 2030, unless more drama is decreed earlier. And his wife could always get a recurrence of her breast cancer. People are just too sensitive about death, and we should generate a bit more robustness about it, or at least dual process, and certainly writers should never give up on dramatising reactions to it. It gives us an opportunity for people like the discussants on Woman’s Hour and elsewhere to encourage a more nuanced range of reactions in literature and the media.

Extensive comment on the Archers Official Fan Club website (which also contains a ‘catch-up’ so you can follow the story line):

http://www.thearchers.co.uk

The Woman’s Hour discussion can still be heard on iPlayer until next Friday:

http://www.bbc.co.uk/programmes/b00xb0rz

The Harriet Smart blog on writers who use bereavement as a dramatic situation and upset people as a result:

http://www.harrietsmart.com/?tag=the-archers

The Winston’s Wish article on bereavement on the Archers blog (read some of the comments, too):

http://www.bbc.co.uk/blogs/thearchers/2011/01/childhood_bereavement.html

A Twitter conversation about how the proposed legal aid changes (which largely exclude legal aid for social care/social security matters) and the social care vision might impact upon one another. If you’re not used to Twitter, the first heading is the person speaking and if it connects to something someone else has said, you say @their Twittername first. I have edited this exchange to take out a typo that was corrected in a later tweet; the correction is just inserted in its place in the first tweet.

nickiyou Nicola Youern First legal aid reform now new vision for adult social care – I need to spend a day in bed reading- no time for work anymore.. 16 Nov

MalcolmPayne Malcolm Payne @nickiyou Govt’s legal aid reform may enforce a renewed vision for welfare rights and legal support as part of adult social care. 16 Nov

nickiyou Nicola Youern @MalcolmPayne I don’t disagree with that at all. I have long thought that social welfare issues are misplaced in the legal justice system 16 Nov

MalcolmPayne Malcolm Payne @nickiyou A weakness of govt social care vision is no robust appeals against care decisions; local councils/social workers will resist it.16 Nov

nickiyou Nicola Youern @MalcolmPayne I raised the issue of a joined up vision when Labour were in power but the DOH and MOJ seem to be worlds apart. 16 Nov

MalcolmPayne Malcolm Payne @nickiyou Altho if adult social care users cannot go to law under govt’s legal aid proposals, we need a more robust appeal mechanism. 16 Nov

nickiyou Nicola Youern @MalcolmPayne we do and is it in their interest to provide it? 16 Nov

MalcolmPayne Malcolm Payne @nickiyou: Govt social care vision means care decisions are also about finance; therefore, appeals processes are more vital than ever.

If Twitter gives you the zeitgeist, then this is my selection of the zeitgeist on the adult social care vision from the Department of Health so far. My nominee for best comment is (for the rest, see below):

pigworker Conor McBride http://bbc.in/cjvk8U Social care ‘everyone’s responsibility’, not ‘right from the state’? The state is how ‘everyone’ takes responsibility.

Because of HarryKate (mishearing, you might think this is a royal scandal like Watergate) you may not be aware that the Department of Health published two documents on social care yesterday:

On the web: Department of Health (2010) A Vision for Adult Social Care: Capable Communities and Active Citizens. London: Department of Health. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_121667.pdf

Department of Health (2010) Transparency in outcomes: a framework for adult social care A consultation on proposals. London: Department of Health. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_121660.pdf

They’re obviously not spending too much on designers now in DH, no colour pics and so on, just purple swirly covers and standard typeface – the new austerity. There was also a written ministerial statement (not even time in Parliament):

Written ministerial statement: A vision for adult social care: http://www.dh.gov.uk/en/MediaCentre/Statements/DH_121691?utm_source=twitterfeed&utm_medium=twitter

What I said

Starting with myself (I can do that in my own blog), I tweeted early on that the ‘Vision’ (and this is also true of the consultation) contained nothing on end-of-life care, ignoring the government’s own social care framework for end-of-life care:

MalcolmPayne Malcolm Payne Vision impaired: DH Vision document has nothing on end of life, ignoring its social care framework on eol care. Unjoined up coalition.

I saw no other comment on end-of-life care, but Help the Hospices has now issued a press release on the Vision:

On the web: http://www.helpthehospices.org.uk/media-centre/press-releases/response-to-the-governments-vision-for-social-care

This is obviously preliminary, but it makes the point that dying is not just a health issue. Since most of the money for end-of-life care comes from health, we need to emphasise social care’s role more.

Sticking with myself, I asked later about one of the practical problems:

MalcolmPayne Malcolm Payne Govt social care vision doc: great if your life contains informal help but how can we SECURE help if it isn’t already there in your life?

Finally I engaged in one of those Twitter conversaziones about the simultaneous issue of information about legal aid cuts, because this will mean no appeals against social care decisions. I’ll do a separate post about that.

The news: transparency, active citizens etc

Most of the zeitgeist is thought-free retweeting of the government tweets and the major news providers – usually the Guardian or BBC. Looking through these, the focus is on transparency, a million older people getting their own budgets, and the government subtitle ‘capable communities’ and ‘active citizens’. More informed commentators mentioned personalisation – this is the policy that lies behind the personal budgets. Some were listening to the BBC’s programme You and Yours where Care Minister, LibDem Paul Burstow, had an outing and commented on some of the things he said, but he was obviously (I haven’t heard it yet) sticking to the message, so there was not much new there.

I divide the rest of my selected tweets into the supporters and the critics, considered below.

Supporters

The supporters are mainly those keen on personal budgets and the choice they offer; no critical analysis of the problems with these, however, probably because Twitter is for a simple message:

steve4319 Steve Hynd Great news with the role out of the personal budgets scheme, changing the face of social care! #occasionalgoodnews http://bit.ly/9gBa7P

EileenStepton Eileen Stepton Greater ‘choice’ for social care: It also set councils a target of achieving full roll-out of personal care budg… http://bit.ly/c7rE1f

katharinebourke Katharine Bourke A million adults to get their own social care budgets http://t.co/Ti0z9cp via @guardian Bring it on along with person centred planning…

My booby prize for totally uncritical comment from an organisation that you would expect better from is for the King’s Fund:

TheKingsFund The King’s Fund The government’s vision for social care sets out a positive and bold framework for reform – read our full response http://cot.ag/da6iUK

The critics

The critics, typically for Twitter, were in the majority. In the same way that some of the supporters were thought-free, some critical comment was simply dismissive:

Dimrill Dimrill Looks like this government really hates the elderly and infirm. Social care can fuck off, apparently.

An important strand of the critics’ tweets (including mine) is the government’s view that everyone is responsible for social care; I start with an apparently neutral comment that implies a criticism by pointing out that a right is removed in favour of everyone taking responsibility:

neodissedent haynony mouse Social care no longer be seen as a right from the state but “everyone’s responsibility” says government #ukcuts http://bbc.in/dp8U2p

MalcolmPayne Malcolm Payne BBC News – Social care ‘everyone’s responsibility’ http://www.bbc.co.uk/news/health-11761090. Everyone’s responsibility means nobody’s focus

pigworker Conor McBride http://bbc.in/cjvk8U Social care ‘everyone’s responsibility’, not ‘right from the state’? The state is how ‘everyone’ takes responsibility.

zoowar ZooWar RT @robmyers “Social care should no longer be seen as a right from the state” say rich people who leave you with no time to do anything …

gimpyblog gimpy This is unmistakably the privatisation of social care http://is.gd/hd2bD

landtimforgot warhelmet @gimpyblog I’d not disagree but there is a need for change to how Social Care works. I’m working on a project – sc is a mess.

DeGrootD Daniel De Groot Institutionalizing “you’re on your own” || @BBCNews Social care ‘job for everyone’ http://bbc.in/bnoGuZ

gingerly_onward Kate Social care ‘everyone’s responsibility’ says the govt. http://bbc.in/dp8U2p Everyone including children, presumably http://bbc.in/dfKbgD (this refers to a recent Cameron statement on cuts to carers of children)

kazthomas Karen Thomas Social care ‘everyone’s responsibility’ http://bbc.in/bqLaB7 <– Not strictly true! Everyone can’t cope with that situation!

tonybovaird Tony Bovaird Coalition ministers: “Social care can no longer be left to the state but was “everyone’s responsibility” http://bit.ly/dznT1v #coproduction

gwenhwyfaer gwenhwyfaer http://bbc.in/9gEcDC (v @jrf_uk) Social care “everyone’s responsibility”. Everyone except the politicians’, of course.

capnkroaker James Randall Social care ‘everyones responsibility’ and not a right. Quite. But why am I still paying taxes for my own “future care” then?

A substantial strand of critical comment is the way in which HarryKate squished a brief moment in the sun for social care (always likely to be of low interest to the average journo: as mrsblogs comments, even Gillian McKeith on ‘I’m a Celebrity – get me out of here wins out over social care). Octodude wins my prize here:

octodude Helen Lippell @lexij If u can read Guardian articles abt focaccia recipes or the royal wedding, but not abt social care or welfare reform, it’s censorship

Here are some others I liked:

mrsblogs Mrs Blogs Would like to see adult social care fit for a Prince & Princess #royalwedding http://bit.ly/whowillcare

LysIsHere Lys Campbell Welcome to the world of distraction. Two words to get our minds off social care and public sector cuts. Royal wedding. Well played.

sinclairda David Sinclair Much on social care? RT @ForsterAGEncy 19 pages of royal wedding coverage in @Telegraph this morning & a story on front of Business section!

ComCareAdults ComCareAdults Journo I feel a bit sorry for Paul Burstow, his big social care vision announcement has been eclipsed by Will and Kate’s engagement. #royalwedding

bromiskelly Bronagh Miskelly @ComCareAdults Now you need a royal wedding, social care link….

rich_w Rich Watts BBC 1pm news spends 25 minutes on the royal wedding, 2 mins on Guantanamo, 3 mins on weather. Literally nothing on social care vision.

rich_w Rich Watts I suppose there have been papers galore on social care. But when *new* gov publishes its vision, you’d hope it would get *some* coverage.

dontplaymepayme dontplaymepayme RT @rich_w: annoyed something that matters (future of social care) is drowned out today by something that doesn’t (royal wedding).@frasereC4

mrsblogs Mrs Blogs @rich_w thoroughly depressing. even mckeith is trending rather than something like state of social care which will affect all of us

Many tweets are simply to alert you to a wider document. The AgeUK tweet was a very clever come-on, because it told you about problems, but forces you to go to their main site to find out what they were:

sm4uksmes SM4UKSMEs Source : Age UK Age UK concerned about risks of new social care vision Greater choice for care … http://bit.ly/bON2Ms #uk #socialmedia

Special interests: workforce and telecare

One critical commentator focused on workforce issues and pay:

TonyButcher Tony Butcher Q to tweeters not in Social Care: Would you be prepared to provide intimate personal care for people for £6.30 an hour? Pls RT

TonyButcher Tony Butcher Social Care: Govt call for capable and well-trained workforce but presumably still want them on low wage!

Another special interest looked at telecare, a cost-saving enthusiasm of the technically minded, which raises the question whether social care is going to be increasingly no-human care on grounds of cheapness. In this case, the view seems to be it will be wonderful; perhaps some people will prefer the non-human – less goes wrong:

ehireporter Sarah Bruce Government’s social care document highlights role of telehealth and shared services http://tinyurl.com/35uqqob

StevetheFleming Steve Fleming Vision for Social Care launched by @DHgovuk: http://bit.ly/8Xw1Wg – needs digital to enable personalisation, especially from the user end.

Thoughtful

There were also some thoughtful and unusual comments. One of these picked up a point from ‘You and Yours’:

social_care Social Care Charities & callers to R4 Your&Yours worried about reliance on informal systems and ‘gaps in provision’ in Govt’s vision for social care

Another ‘You and Yours’ point critiques reliance on family carers saving NHS and social care budgets:

IndLiving Frances Leckie Rounded off today’s You & Yours on the future of social care: with family carers saving NHS and social services… http://fb.me/ugQxhS75

This tweet focuses on the need for better public understanding; certainly true and the adverse comment about the clash with the (apparently unexpected) royal wedding announcement suggests that this opportunity has been lost:

michael__ellis Michael Ellis Vision for social care must clarify public confusion – http://j.mp/9yKXiO

Another unusually well thought-out comment on funding social care:

mothbitten Robin Rowlands Surely -’ Inheritance Tax ‘- is the -’ fair / sensible ‘- way to fund the social care of the elderly . . .

A broader political point about Conservative policy is well made:

rich_w Rich Watts I don’t recall such a heavy emphasis on #bigsociety in the #healthwhitepaper – interesting what this suggests about NHS “vs” social care.

A social enterprise supporter comments:

GuardianSocEnt Social Enterprise #gdnsocent NH: health, social justice, care – sector has 2% of PS – it can have a bigger piece of the cake if it offers viable options

This is true, although like many commentators on Twitter, you can see the sectional interest; obviously the viable options would include lots more social enterprise.

Some tweets were on funding, and reflect my own doubts about the likelihood of substantial extra value for social care from government sources:

socialcaredan Daniel Parton @monstertalk but I guess the chances of more money coming social care’s way are remote at the moment.

Another commentator usefully points out that no ring-fencing of the social care budget opens the door to simply cutting back in favour of other things councils would like to do (a decreasing number, with schools going centralised it seems) and with the extra social care budget simply mini-money anyway compared with the need:

LalaAdel Adeline Chan

No ring-fence on councils’ extra social care cash, minister confirms: Doubts have been cast on whether the extra… http://bit.ly/akGnIn

Totally political

At the bottom of my interests came a number of tweets came from political sources

Some focused on the fact that it was a LibDem minister making the announcement; this from a LibDem publicist hopes for votes in this, in spite of the fact that the lack of interest from the press probably reflects a broader public lack of interest:

OllyGrender Olly Grender A million reasons for LibDems to be cheerful: A million adults to get their own social care budgets http://bit.ly/9Hlt6d

And clearly the LibDem anti-Labour attack machine was in action:

blogminster Westminster Feed ‘Only Labour-run councils in NE are failing to provide good social care – Swales’ — Ian Swales (Lib Dem) http://blogm.in/8dP2D

There was of course a Labour response:

mulberrybush diana smith shame that @PaulBurstow has to spoil social care announcement by false claim that Labour did little. great consultations White paper etc

The Guardian reports on the Appeal Court case on the former leading ballerina, Elaine McDonald. She was assessed as needing a sleep-in carer to assist her with using a commode and some day-time help. Without a reassessment (that is, looking at the whole situation in the round), this was to be replaced with incontinence pads, although the Council (Kensington and Chelsea) relenting somewhat, the carer has been reduced to four days a week.

The judges are quoted by the Guardian as saying:

The evidence is that the use of pads in circumstances such as those which afflict Ms McDonald is a widespread, satisfactory and accepted practice. Although it does not suit Ms McDonald’s preferences, and it cannot make for perfection in a difficult situation, it provides safety and a large degree of independence and autonomy.

Well, to me, it may be widespread and accepted practice, but it is not satisfactory, where it is not provided within a human relationship. Respectful care is a human, interpersonal activity, in which a relationship is built up over a period. What this makes clear is that non-human provision is accepted because it is cheaper, and although we do not know the details from the Guardian report, it is clear that this was done in a way that did not respect Ms McDonald’s engagement in the process:

The court’s reserved judgment finds that the council was wrong to reduce the care in the way it did, but upholds its action in later reviewing McDonald’s case and concluding that she had a “more general” eligible need for night support that could be met by the provision of pads.

In social work, you interact and engage with the person you are working with; you do not make decisions on financial grounds, enact them and then when there is a protest defend what you did in court as ‘widespread and typical’. This is non-human, non-interpersonal and not respectful. Someone should not be treated as an unreasonable old lady when you started out by responding to her preferences and offering a human alternative. Once you’ve done that, you have to engage with her again to work through the need to provide an option that balances your financial responsibilities with your interpersonal repsonsibilities.

Yes, I think a human carer is better than incontinence pads. But I particularly think that if it is social work that provides the assessment and decision-making, it is core to the social work profession that the decision-making must also be human in the way that it works.

At least so I say much more extensively in my soon-to-appear book: Humanistic Social Work: Core Principles in Practice. (Chicago: Lyceum; Basingstoke: Palgrave Macmillan).

The Guardian report: http://www.guardian.co.uk/society/2010/nov/04/council-social-care-services-cuts?dm_i=4X7,AK7P,162Q9T,SZKN,1