A discursive look at Napoleonic & ECW wargaming, plus a load of old Hooptedoodle on this & that


Wednesday, 2 October 2013

Hooptedoodle #100 – The Price of Self-Respect?



I had sort of hoped that my 100th Hooptedoodle might be a bit more festive than this, but I had a strange, rather disturbing day yesterday, and I’m still wondering about it. This is not intended as a whinge, nor a sad story of any kind, really, but it contains some elements which seem to be symptomatic of how society works nowadays, and that causes me some disquiet.

Once again, it involves the situation of my mother. My mum is elderly, and she is disabled. She had polio as a child, and – though she recovered – she now suffers from what has become known as Post-Polio Syndrome, which is paralysis caused by progressive degradation of the nerves which were affected by the polio all those years ago. It’s OK – it’s a fact of life, and my mum isn’t given to feeling sorry for herself, so we all just get on with it. To supplement what we can do for her directly, we have arranged for her to have a carer visit every day, and this works wonderfully well. The carer (let’s call her Paula) is a marvelous woman – before she retired, she helped to look after my late sister (who was mentally handicapped), and she and my mother became great friends. They have a private arrangement which works perfectly. Paula comes in for a couple of hours each day during the week, and an hour a day at weekends. Mum pays Paula for her time and her expertise, which is only right and proper. With additional visits and outings organized by the family, we try to ensure that my mum doesn’t lack for either care or interest, and we recently installed a stair lift in her house, which has proved to be a great thing, and has given her control of her own home again. So it works, but all of this obviously isn’t cheap. That’s how it is.

The local County Council did some valuable ergonomic and safety work – putting in grab handles and leveling door thresholds and generally making her house suitable for a wheelchair, and we were also notified that she might qualify for some financial assistance from the Council. So we were encouraged to apply for it – every little bit helps, as I’m sure my grandmother - or was it Tesco? - used to say.

My understanding of these things is not great, but it seems that, if a disabled person resides in a particular county, the local authority has some obligation to assist them, to ensure that their quality of life is acceptable. This may involve putting people in an institution or a home of some sort, or it may result in sending out care-workers and specialists employed by the authority to help these residents, or it might provide specialist equipment. Or, in these days of reduced budgets, there is a direct payment alternative, whereby the disabled person makes their own arrangements for care, in their own home, and the authority makes some financial contribution to help with this. This has a number of advantages, not least being that it is cheaper for the local authority and gives the client more independence. Excellent.


Yesterday my mum got a visit from the keeper of the Council’s purse strings, to sort out the details for a regular direct payment which had already been agreed in principle. Since I have Power of Attorney over my mother’s affairs, both financial and welfare-related, I was there with my official notebook.

The lady from the council (let’s call her Fiona) and I instantly recognized each other as trouble. She recognized me as an awkward beggar who might have the odd opinion, and I recognized her as one of a generation of people with degrees in political correctness and regulatory compliance who gradually took over the Human Resources world and made life frustrating in my last few years at work. These people are astonishing – in the unlikely event of their accidentally allowing something to happen, it will not be their fault, whatever it is.

Fiona told us the following:
  1. An informal relationship between my mother and her friend is not good enough. Since their agreement requires that Paula is told when and where to work, a formal contract of employment is required. The Council’s legal people will advise us. 
  2. If the Council is contributing to care costs, Paula is not allowed to be self-employed. The Council will even oversee her relationship with the tax authorities.
  3. Further, she will have to replace her current professional certification with the new (post 2011) PVG registration (in compliance with the new Protecting Vulnerable Groups scheme - this will cost her some £70), and the Council will not proceed with any agreement until they know what her new PVG number is.
  4. Further, since she is now an employee, she should be entitled to holiday and sickness pay.
  5. Further, since my mother will now be an employer, she will require to take out employer’s liability insurance (about £135 per annum) – the Council can advise. This will, naturally, require someone to come and completely check my mother’s house, its wiring, the state of the stairs, the lighting, the cable on the kettle, etc.
  6. Further, a stand-alone bank account will have to be set up to record every penny spent on care – the Council will require a paper monthly statement from this account. They will also require a very detailed paper return of all care-related activities and expenditure – every month. How some of their poor old, demented clients handle this is a matter of interest.
  7. Further, all payments to Paula must be made through the Council’s own direct salary system, which they will set up for us if we (which means I) go to their office to discuss it with them. I may not pay Paula by online transfer from a bank account of my own choice, which has been the arrangement to date.
  8. Any decisions, changes or problems, and any debates about what Paula may or may not be asked to do must be referred to my mother’s Care Manager at the Council, whose decision will be final.
  9. This whole wonderful edifice, by the way, is known as the county Centre for Inclusive Living’s “Independent Living Service”. At this point, I could feel a loud snort coming on. It begs a few serious questions about definitions of Independent, Service and even of Living.



I had a quick consultation with my mum, and with Paula, and I responded to Fiona-from-the-Council thus:
  1. The proposed amount of financial aid is rather less than £50 a week. While this would be gratefully received, it represents approximately one-fifth of the total outlay on care that we already have in place, and to change everything in the way proposed is an extreme example of a tail wagging a dog. 
  2. The relationship between these two ladies, who have been close friends for years, is very important, and it would be changed in a very unfortunate way by introducing any form of contract of employment – completely inappropriate. All the spin-offs from such a contract – insurance, holiday pay, external vetting and control of payments – are non-starters.
  3. The degree of restriction, regulation and general interference, and the amount of administrative grunt, are unacceptable. These arrangements may well work perfectly for clients who are very hard up, or who require the use of agencies, but it does not fit with my mother’s situation.
  4. Thank you for your time and for the offer, but we shall decline it. The money on offer is not worth the hassle and the bureaucratic oppression.
We did not tell her to stick it in her ear, but it was a close call. I believe that Fiona has never been rejected in this manner before, and she was very visibly shaken. She insisted on passing us the papers she had already completed, and she said to my mum that, if she changed her mind in the future, here were the details for reference.

My mum replied that, since she is 88, there isn’t really a lot of future for this to happen in.

I’m not sure how I feel about it. There is something in there about the value of self-respect, of independence, of freedom from bureaucratic control. I am convinced we are better off without the Council’s contribution, thank you very much, though I don’t expect that either they or that nice Mr Cameron will trouble to thank us for saving them some expense.


12 comments:

  1. There is a lot to be said for preserving as much autonomy as possible in that situation. Well done on getting the social worker out of your hair - they can be tenacious when they're not wanted.

    No doubt the modern world with its multiple layers of accountability and where everything must be quantified is a very fine thing. I can help feeling an instinctive distaste for it though. My best wishes to your mother.

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  2. I rather suspect that you are supposed to turn it down, thereby promoting the contracts in place with 'approved providers.

    I am not sure any of what she says is actually legally enforceable. You have already done all the work writing it all out, why not run it by a voluntary agency such as Age Concern? Copy it to your MP as well and ask for a response from Social Services. They are required to operate a 'Needs based service'.

    County Councils often simply lie, I have sat in a meeting where it was acknowledged that the authority had illegally taken many thousands in care home fees but it would fight each case to appeal as that would be cheaper than complying with the Law. (Unspoken assumption, most would die before getting to court.)

    John

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  3. I could write at length on the level of bureaucratic claptrap prevalent in modern society, however I think the idea is make it difficult enough and nobody will claim the money. And that nice Mr Cameron only comes out every five years to say thank you for your vote!

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  4. Well somebody has to take the side of the local authority so I'll take up the gauntlet.

    Personalised budgets (direct payments) were imposed on local authorities by Westminster with the intention of reducing spend on care and management costs. It was devised by inexperienced civil servants under guidance from organisations like the Care Quality Commission (repeatedly discredited over the past three years or so). The shortcomings you have highlighted were pointed out by just about every authority in the country during the brief consultation period and is repeated with monotonous regularity to an almost totally deaf audience.

    Local authorities have always had a duty of care for all those who come under the various categories of social care, but now have diminishing influence and even more rapidly diminishing resources - small wonder that Welfare Rights Advisers are rarer than hens' teeth nowadays. The part you do not see (thank God) is the level of abuse within the sector; predominantly financial abuse by so called contractors/service providers and, more sadly, by members of an individual's immediate family. So, one set of rules has to fit all; the caring relatives and friends as well as the abusive. Hence other agencies like The Department of Works and Pensions, The Health and Safety Commission, et al have become involved because of the need to establish and maintain a legal and legally enforceable system which is, because if its nature, bureaucratic (though it's not as bad as it seems once it's up and running). However, because it's an integrated system, you can't just 'do it a bit'; it's all or nothing.

    Another issue is that, where the care market was flooded with individuals and organisations whose paramount concern was the provision of good quality care (with the occasional bad egg), it is now commanded by far fewer organisations who are plainly in it for profit (and with an increasing number of bad eggs who don't pay tax or N.I., don't train staff, don't provide uniforms and equipment, minimise or avoid calls and so it goes). So, local authorities are almost overwhelmed by the need to monitor care provision, but are legally obliged to ensure all those who are in need of care are at least given the correct advice. I'm being far from cynical when I sat that the only reason that the failures in child care have dominated the headlines is because old and/or seriously ill people do tend to die as a normal course of events, but eventually you're bound to see horror stories where individuals have slipped through the nets of adult and elderly care. So yes, an authority would prefer people not to opt out because that puts the individual at potential risk.

    Now, friend Fiona. There are good social workers and there are bad social workers and I'm unable to say which type she is. However, she may not have actually been a social worker. She could have been Social Care Assessor (cheap to employ) or even somebody from the finance department. Good social workers are the Holy Grail and, unless there's a suspicion of abuse, they're an older person's dream come true. They discuss the situation with the family, offer help and advice and don't start any balls rolling until everyone's as comfortable as possible (nobody's ever 100% 'happy' in those situations!).

    So, how the hell do I know? well I was Head of Corporate Procurement for Manchester City Concil and,later, Head of Procurement for Salford City Council. My wife is a mental health social worker (the ones who do the sectioning). I've seen the good side of social care and the bad side too and my advice is: if you have (or can get hold of) a good social worker and the family support is able to sustain the required levels (physical and emotional as well as financial), you're better off sticking it out for as long as you can. In the meantime, if you're not happy with Fiona, make a formal complaint about her - you need something tangible though.

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  5. This sort of approach beggars belief and, as you hint, I suspect it has nothing to do with a genuine motivation to ensure the appropriate level of care is provided to those in need. And it probably does a lot to foster the feeling of mistrust of public services - and that does more harm in the long run.

    And to add insult to injury, I wouldn't be surprised if the majority of care workers who do get caught up in this type of bureaucratic net end up being outsourced and on a zero-hours contract.

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  6. Totally agree with John, the default now with all large Public, Private or Charity organisations seems to be get away with as much as you can, deny everything, wrap everything else in regulation and red-tape and use the courts or fear of the courts to keep most of it from ever coming out, or ever being made accountable for it. And NEVER apologise!

    I'd ask Cameron for his opinion in an open letter copied to the Guardian!

    I've been going through it/am still doing with two charities, HMRC, DWP, West Berkshire council, tribunals, CC and Magistrates plus others for three years now and It's aged me! That's without Aviva...but I've sorted that with an escalation to the Consumer Action group website/forum - which I recommend to everyone for everything, seriously.

    Hugh

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  7. Not quite as bad here but almost. There was much frustration about not being able to pay family members to do the work so that for example a family member had to go do home care for some one else and be paid while someone else came in and did the same for my mother. I can see the concern over fraudulent claims but still. They have now introduced an income tax break for those looking after a family member but if, like my sister, you had to quit your job to do it, a tax break on no income was not a huge help.

    Luckily when Mom got beyond home care my brother and sister managed to persevere and get her into a well run home.

    I try not to think about aging without kids of my own and with less than a fistful of nieces and nephew all far away.

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  8. Being a cynical bugger I worry that you have now raised your head above the parapet - government agencies are wonderful at writing stuff down and pursuing via other means, and they very rarely forget.... Fiona or one of her colleagues will be back... :o/

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  9. Gentlemen - thank you all for your thoughts, which have helped me to sort out my own ideas a bit. Gary - thanks especially for the Council's situation.

    I do appreciate that local authorities are short of money and have to protect themselves (and their rate-payers) against abuses and scams, and I guess that any vestige of social conscience I retain realises that my mum is not so badly off, and that the money would be better spent on someone who really needs it, but this has definitely been a phased approach. We saw a series of people - medical assessors, then occupational therapists advising on equipment and hardware for the house, then a lovely lady who worked out how much care time per week the Council would be prepared to pay for, and lastly Fiona, who was very specifically a Gauleiterin from the Finance Section, and showed very little empathy with the human race at all.

    I understand how it works, and I don't feel badly about it. If all the money my mum had was being provided by the Council, and if she was using professional agencies to supply all her care, then the paperwork and the safeguards make sense - you can even picture some 3rd party completing the paper returns. As it is, any court in the world would collapse in horror at the idea of an 88 year old lady who cannot walk and whose hands are partly paralysed being told that she must complete these forms for the rest of her life, and must set up employer's insurance and so on. What on earth is that about?

    In a sensible world, such as a court might hope for, there would be scope among the senior staff to exercise some discretion and apply only the rules that were relevant in any particular case. Discretion? - that's why they have Fiona. Fiona does not do Discretion. It was not in the course. If she exercised discretion then something might suddenly be her responsibility, and Fiona's entire job mission is built around avoiding such a situation.

    I realise Fiona was only doing her job, but what a blot on the human race is the mere existence of such a job? No hard feelings, but I hope they don't pay her too much of my Council Tax contribution, and I hope she has peace in her heart...

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  10. What a nightmare situation. I have little time for social services and very little trust, my wife having spent too may years in social care management before finally being paid off - gagged - under a Compromise Agreement, for flagging up things that were clearly not right within her place of work. Talk about close ranks, senior management became as tight as the proverbial ducks arse, right to the top. It's shocking just how much Kent County Council have paid out in such agreements, you of course sign away your right to discuss the matter with anyone out side of immediate family on threat of legal action, that's how they deal with anybody who dares to take issue with them.

    I think that your Mother will be better off - if not financially then peace of mind - without them controlling her life, but as you say others are not in a situation to be able to refuse and for those people I feel quite sorry.

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