Interested in helping shape London Healthcare Workforce of the future?

We are seeking to recruit two Patient and Public Representatives to help shape and influence the Workforce Programme. As a Patient and Public Representative you will play a key role in, articulating important perspectives and challenges whilst championing a service user viewpoint and ensuring they influence the programme’s priorities going forward. You will bring independent judgement and experience from a patient and citizen perspective, constructively challenge, influence and help the programme to develop and meet patients’ need.

The ideal candidate will a passion for health care improvements, direct extensive experience of NHS care delivery either as a patient or carer, have a broad understanding of the complexities impacting the NHS workforce. The roles are voluntary but travel and out of pocket expenses will be covered. The time commitment is approximately 3-4 hours per month (excl. travel).

To apply please send your CV and covering letter detailing why you meet the criteria in the role description to[email protected]

Closing date: 21st September 2016

Shortlisted candidates will be invited for a face-to-face interview with the Workforce Programme Director and Senior Responsible Office in central London w/c 3^rd October 2016.

The first meeting has been scheduled for 2pm – 4pm on Tuesday 25^th October 2016 in central London.

For more information about the programme visit our website

What’s your experience of the SEND reforms?

They’re carrying out their annual SEND Landscape Survey to look at the progress and challenges of the SEND reforms and would like to hear what your priorities are for the coming year.

Take part in the survey

Patient choice planning and improvement guide

It will also highlight where improvement is required. The guide aligns with the choice framework published by the Department of Health.

Download a copy of the guide here

‘Postcode lottery’ revealed in NHS care

Patients with dementia, diabetes and learning disabilities are being let down by their local health services in many parts of England, new figures show.

A postcode lottery of care across the country has been highlighted as new performance data shows that while some health bodies are performing well, neighbouring organisations are falling short.

More than half (57%) of local health bodies in England are not performing well enough on dementia, 71% are classed as “needs improvement” for diabetes care and 92% need to improve care for people with learning disabilities, the figures show.

The figures, released by NHS England, show that many clinical commissioning groups (CCGs) have been classed as needing improvement in the different aspects of care.

They have been released as part of a package of measures announced by the health secretary, Jeremy Hunt, to improve IT and digital services in the NHS.

Hunt said patients would be able to compare how well their local health service performed against others for key areas including cancer, dementia, diabetes, mental health, learning disabilities and maternity care.

Information on how well each local trust performs on dementia, diabetes and learning disability services was published on the MyNHS website, with more information on other services to be added in the autumn.

On dementia care, CCGs are rated on the number of patients are receiving a formal diagnosis and whether people with dementia are receiving annual reviews of their care plan in primary care.

Of England’s 209 CCGs, 120 need to improve their performance for these aspects of care.

Jeremy Hughes, the chief executive of the Alzheimer’s Society, said: “Over the last few years, our health system has made strides to improve dementia diagnosis rates, but with 45% of CCGs still lagging behind the national ambition, there is a significant way to go.

“People with dementia in York should be getting the same support as those in Bradford – but with diagnosis rates varying by as much as 46.1% across the country, too many people remain in the dark, unable to access the vital information, treatments and non-medical support a diagnosis can bring.

“Given the progressive nature of dementia, which means a person’s needs become more severe over time, the focus on care plan reviews is essential. However, a care plan review must be matched with support on the ground and measures should develop to assess how meaningful these plans are.”

Prof Alistair Burns, NHS England’s national clinical director for dementia, said: “Awareness of dementia is at its highest and we believe that timely diagnosis of dementia allows people to access the emotional, practical and financial support that brings. We have increased the diagnosis rate across the country so now more than 440,000 people have a formal diagnosis of dementia and can benefit from post-diagnostic support.

“NHS England today launched a support package for local areas if they feel they need extra help following the publication of the Improvement and Assessment Framework.”

Meanwhile, 149 of 209 CCGs were rated as needing to improve their care for diabetes patients based on the number of people affected who get the recommended checks each year and the proportion of patients who attend an education course about their disease.

Prof Jonathan Valabhji, NHS England’s national clinical director for obesity and diabetes, said: “People with diabetes, type 1 and type 2, have the best care and outcomes when they receive structured education early following diagnosis and go on to regularly receive and achieve all of the Nice [National Institute for Healthand Care Excellence]-recommended checks and targets.

“This is part of our wider programme to improve care for everyone with diabetes including support to improve achievements of the Nice recommendations, attendance at structured education and a reduction in amputations and improve specialist diabetes support during inpatient stays.”

Care for people with learning disabilities was rated on the proportion of patients receiving annual check-ups and their ability to keep patients out of hospital. No CCG was given the highest rating of “top performing” and 193 out of 209 were deemed to “need improvement”.

An NHS spokeswoman said: “We have seen significant increases in the numbers of people both being discharged from hospital and having their care and treatment reviewed in the last year, but it’s no secret that significant improvement needs to be made across England.

“The real difference will be made over the coming months and years as local councils and NHS bodies implement their response to Building the right support, the three-year, cross-system plan to ensure people with a learning disability and/or autism have greater say in the care and support they receive.”

A Department of Health spokeswoman said: “Work is well under way to help services around the country make progress in key areas, backed with funding to help prevent diabetes, find a cure for dementia and provide suitable supported accommodation for people with learning disabilities.

“All this is shaped by world-leading transparency, focusing efforts where improvements are needed and helping us learn from the best services.”

Carers Trust has launched a new online relationship guide for unpaid carers.

The guide has been developed in partnership with OnePlusOne, a relationship research charity.

Sections and self-help articles

The guide is split into two sections:

• ‘I am a carer for my partner’ and
• ‘I look after a family member, friend or neighbour’.

In each of these sections there are a number of self-help articles, including: the challenges of being lover and carer, caring for a parent and how the stress of caring can impact relationships.

The guide contains real-life examples to help unpaid carers cope and is funded by the Department for Work and Pensions.

Gail Scott-Spicer, Chief Executive of Carers Trust comments:

“Many unpaid carers find that looking after someone else causes problems with partners, family and friends.

They may keep worries to themselves and feel they are betraying the person they care for if they admit their caring role is affecting their relationships.

“This is particularly hard if they are caring for their partner. Our partnership with OnePlusOne will help us support those unpaid carers who are finding it difficult.”

Empowering carers

Penny Mansfield, Director at OnePlusOne says:

“Whether you are caring for your partner, your parent or your child, meeting their everyday physical and emotional needs will affect your own physical and mental wellbeing – and the quality of the relationship between the two of you.

“By working alongside organisations like Carers Trust, who know the communities they serve so well – together we can empower carers to manage the impact of caring on their relationships with others.”

Making the home dementia friendly

However, with some simple adjustments you can make a home easier to manage and more ‘dementia friendly’. This not only helps the person maintain their independence for longer but it can minimise distress and frustration, thereby supporting a better quality of life.

Here are some tips on how to do this:

• Reduce unnecessary background noise such as the TV and /or radio, unless it is being used. People may find it difficult to concentrate on more than one thing at once so it is important not to over stimulate.
• Light is exceptionally important for someone with dementia as it helps with orientation and well being. Try increasing natural light during the day by taking down unnecessary net curtains or blinds, and push back heavy curtains. If possible, have curtains that are a light fabric and light in colour in the living areas as this helps to reflect daylight. To create more light use higher watt light bulbs. You can also get portable low level lights if you want to have lights on at night in case the person with dementia gets up to walk around. Also, pop the person’s favourite chair by a window so they get more natural daylight and they can look out to see what is going on. To aid sleep at night use heavier curtains in the bedroom.
• For safety fit smoke alarms and heat detectors in the home and check the batteries regularly. You can get movement sensors in beds to alert you if a person has left the bed, and there are plugs that automatically drain away water when sinks and baths are too full to prevent flooding. Keep chemicals in a locked cupboard so they are out of harm’s reach. And, there are devices available to help people open jars, lids and so on.
• A wardrobe of clothes can be overwhelming for someone with dementia, so lay their clothes out for the next day the night before or in the morning as it encourages the person to dress themselves with the clothes that are readily there. Also, if you change your clothes into night clothes it tells the person it is now night time and they will do the same. Or, put a dressing gown over your day clothes to look like night clothes if your bedtimes are different.
• Labelling rooms and what’s in cupboards can be helpful but try not to introduce new systems as this may increase confusion. For example, for the bathroom door put up pictures of a toilet, sink and bath. In the bedroom, use a picture of socks on the front of a sock drawer, and so on. Images can be found on the internet and printed off or specific signage can be purchased.
• In the bathroom, leave the light on at night so the toilet is easier to find and have a toilet lid and seat that contrasts with the colour of the pan for visual ease. Avoid toilet and bath mats as someone with dementia might think these are barriers they need to step over. Have a free stand toilet paper holder that is easy to find and have toilet paper that is a different colour to the holder, walls and floor so it stands out. (Also, use high quality toilet paper as it makes the end easier to find). With towels, keep these a different colour to the wall too, so they stand out.
• In the kitchen remove clutter and make things readily accessible; so for example, you could take cupboard fronts/ doors off. Mark hot and cold taps (either writes the words on the labels or use red and blue signage). If possible, use plain plates with a coloured solid band to make the food stand out, and contrast the plate with plain coloured place mats and table cloths to make the food easier to find. Put cups and cutlery into people’s hands to stimulate memory to lift them to their mouths.
• Where possible have matt flooring and walls as anything shiny may be mistaken as being wet or slippery. If you’re changing flooring try to pick one colour rather than patterns, and try to keep it the same throughout the property. People may misinterpret changes in floor colour as a step or water so may avoid stepping onto it. Keep walls a different colour from the floor so there is a contrast to avoid confusion. Don’t use rugs as they are loose and easy to trip over.
• Try to keep important items in the same place to aid memory such as keys, money, note books, medication, and phone book.
• Try using a white board to have reminders for the person, which can include appointments or events.A large calendar and/or clock which indicates the day / date alongside this will also help.
• Finally there are a number of useful websites which advertise aids and assistive technology for people with dementia, which can make day to day activities easier to manage. We recommend that you choose carefully as some aids may not work for everyone. Think through what the person is finding difficult first and then look at possible aids or adaptations. Not all changes have to be expensive! AT Dementia is a charity that provides information and advice on assistive technology for people with dementia: https://www.atdementia.org.uk/ Also take a look at http://www.adaptawear.com/, www.completecareshop.co.uk, http://www.modernlivingaids.co.uk/ , http://www.unforgettable.org/

Warning over ‘severe’ AMHP shortages as hundreds leave

Councils are struggling to replace more than 200 Approved Mental Health Professionals who have quit or retired in the past three years as demand for their services increases.

Figures obtained from 120 of 152 councils in England through Freedom of Information requests reveal the number of AMHPs, the group of mostly social workers qualified to carry out Mental Health Act assessments, fell 7 per cent from 3,139 in 2013-14 to 2,915 in 2015-16.

Councils are responsible under the Mental Health Act code of practice to make sure “sufficient AMHPs are available to carry out their roles” but several admit they’re short of what’s needed.

Some are struggling to tackle “severe” shortages, with councillors at one authority worried shrinking AMHP numbers pose a “significant threat” and another council warning of a “high risk” of its AMHP service facing “a crisis in the near future” unless more staff are found.

One council that had enough AMHPs “on paper” said its capacity had still reduced in recent years, as some AMHPs had gone on long term sick and several had cut their hours.

Growing pressure

While some AMHPs have simply left after reaching retirement age, responses from councils reveal fears that many are opting to quit due to growing pressures on teams, with staffing shortages and problems finding beds for patients increasing the strain on staff.

The number of Mental Health Act detentions, the only official indicator of demand on AMHP teams, hit a record high in 2014-15, the most recent year figures are available for. The number of patients being sent out of area for beds due to local units being full rose 13% last year, with some sent hundreds of miles.

In response to shrinking AMHP numbers, several councils have set up dedicated AMHP teams to boost assessment capacity. These see AMHPs working full-time on Mental Health Act assessments, rather than traditional rota systems where they carry caseloads when not on AMHP duty. One council said the case carrying model was simply “not viable” given the stress staff were under.

‘Lack of workforce planning’

Social workers accused local government leaders of a failure to carry out any national planning for AMHP provision despite repeated warnings about the pressure on this part of the workforce.

Ruth Allen, chief executive of the British Association of Social Workers, said: “We hear from members that some AMHPs are handing in their warrants because they’ve had enough of the risks around lack of access to beds and lack of effective prevention and crisis services.

“That won’t be everywhere, we know it’s a mixed picture in services, but it’s a dreadful situation to have a key area of specialist statutory work where you’ve got doubts over whether it is even bearable for staff.

“ADASS [the Association of Directors of Adult Social Services] and the Local Government Association need to show more leadership around workforce planning in this particular area.

“It has been left with individual local authorities to work out, some of whom are doing some really good work around AMHPs and the wider social work role in mental health, but there’s not been a strong push from the national bodies to really get to grips with this.”

Longstanding concerns

Steve Chamberlain, chair of the AMHP leads network, said concerns that the AMHP workforce was reaching “breaking point” had been raised for years but not heeded.

In 2013 the network warned AMHPs were being placed in “intolerable” situations, after a survey it carried out revealed the impact of bed shortages. A year earlier an academic paper warned of “unacceptably high” stress levels among AMHPs, with four in ten respondents reaching the threshold for depression and anxiety disorders.

A 2016 CQC and Department of Health report identified concerns about councils’ ability to provide a 24-hour AMHP service, the lack of data on AMHP numbers and lack of council oversight of AMHP provision where this had been delegated to NHS trusts.

“The signs have been there but we’ve seen no real urgency to make sure there’s proper workforce planning or succession planning,” said Chamberlain.

“There hasn’t even any central monitoring of AMHP provision so we are reliant on figures like yours to gauge the situation.

“Some AMHPs are saying they see the role as an important, interesting, valued job but the resource problems they’re facing every day, such as finding beds and sometimes being left unsupported working late into the night, is making it so stressful it’s not worth it. It takes two years to train an AMHP from start to finish – if we’re losing the numbers these figures indicate then it’s worrying.”

In February the chief social worker for adults, Lyn Romeo, wrote to directors of adult social services to tell them to ensure they had “effective workforce management and succession planning, to enable ongoing sufficiency of AMHPs and good workload management”.

Ray James, Immediate Past President of ADASS, said: “The AMHP role is one of the most important, complex and challenging of all social work roles.

“We recognise the growing challenges experienced by many councils in recruiting and retaining skilled and experienced practitioners, and remain keen to work with government, the LGA, the Principal Social Worker Network and others to do all we can to support this important work now and in the future.”

The government plans to introduce a national system of registration for AMHPs in 2018 – a move welcomed by both Allen and Chamberlain.

CareTrade – Employment project for 18-25 people with Autism in South London.

CareTrade believes passionately that all young people should be given the opportunity to reach their potential and lead fulfilling lives. Just 15% of adults with autism are in employment – its our mission to change this. One of the ways we are tackling this issue is by offering support to help adults with autism gain the skills, confidence and experience they need to succeed in employment. We are now recruiting for two projects:

The Autism Project is a full time course; students attend 9am-4pm, Monday to Friday, for 36 weeks. The aim of the course is to help young adults with autism (18-25) prepare for employment by offering work experience placements in a supportive environment at Guy’s & St. Thomas’ Hospitals.

Employment Opportunities is a part time, 24 week job-finding programme that aims to support adults with autism (18+) who are already “work ready” into the jobs they want to do. Participants are expected to attend 1-2 days per week. CareTrade continues to provide ongoing support once a job has been secured.

Both projects will start in September 2016. Places are on a “first-come, first-served” basis so if you’re interested, make sure you apply now!

For more information and an application form please email [email protected]

Government ‘has stripped Paralympians of their Motability vehicles’

Some Paralympians have spoken previously of the importance of the support they receive from the benefits system, particularly through disability living allowance (DLA), but this is the first confirmation that any of them have lost that support as a result of the government’s austerity programme.

The concerns were raised by wheelchair-racer Ben Rowlings, one of the young track stars of the British team, who is set to compete in the T34 100 metres and 800 metres in Rio, and holds the British record at 100, 200, 400 and 800 metres.

He currently receives the higher rate mobility component of DLA, which has allowed him to use that payment to lease a vehicle through the Motability scheme.

But like hundreds of thousands of other disabled people, he has been told he will be reassessed for the government’s new personal independence payment (PIP) – introduced in 2013 in a bid to cut working-age DLA spending by 20 per cent – and that an assessment of his eligibility will take place next year.

The Shropshire resident does much of his training 50 miles away in Coventry, alongside fellow Paralympians Kare Adenegan and Mel Nicholls, and told Disability News Service this week that the PIP reassessment could put his career in jeopardy if it results in him losing his Motability car.

He said: “It is something that’s on my mind because without the access to having my Motability car… I wouldn’t be able to get to any of the training that I do.

“I need my car, I need the support to get me around to places, and training and work, because racing is my job, and without the support of the Motability [car]and the DLA, I wouldn’t be able to get to training.”

The 20-year-old said he knew of fellow Paralympians who have already lost their Motability cars after being reassessed for PIP.

He said: “There have been Paralympians who have been told that they are too able to claim Motability and they have had to fight to get the cars back because they have been taken off them.

“I don’t know too much about it, I haven’t spoken to them about it because that’s a personal matter for them, but it’s something I’m a little bit concerned about.”

He said he was not comfortable providing further details about colleagues, and could not say how many fellow team-members had lost their Motability vehicles, but added: “All I know is anyone with disabilities is getting assessed at the moment, so it’s a possibility for any of us.”

Last month, another ParalympicsGB star wheelchair-racer, Hannah Cockroft (pictured with Rowlings), told DNS she was “scared” that she would lose her independence when she was reassessed for PIP.

Cockroft, who won double gold at London 2012, has also yet to be assessed for PIP, but she said that she was dreading her eventual reassessment, the possibility of having her support cut, and potentially losing the car she leases through the Motability scheme.

Motability has said that it expects 35,000 vehicles will have to be returned by disabled people during 2016 as a result of the PIP reassessment programme.

Of Motability customers reassessed for PIP so far, 44 per cent of them have lost their entitlement to the scheme and have had to hand their vehicles back.

Activists who took part in a national day of action last month – organised by Disabled People Against Cuts (DPAC), WinVisible and the Mental Health Resistance Network – said they believed PIP was “rotten to the core”, and pointed to growing evidence of the “shoddy nature” of PIP assessments, which are carried out by the government’s contractors, Capita and Atos.

The British Paralympic Association – which manages the ParalympicsGB team – has not responded to a request for a comment.

Asked how removing a Motability vehicle from a Paralympian training for Rio would have helped their medal efforts, a Department for Work and Pensions spokeswoman said: “This question is unfounded.

“Decisions on Motability are made based on claimants’ individual needs and after consideration of all the evidence, including an assessment and information provided by the claimant and their GP.

“All claimants have the opportunity to appeal their decision.”

Asked how many Paralympians had lost their Motability vehicles after being reassessed, she said: “We do not ask PIP claimants whether they are Paralympians, and they are not required to disclose this information when making a claim.

“Therefore, we are unable to answer this question.”

But she said there were now more people on the Motability scheme than before PIP was introduced*, while the “majority of people leaving the Motability scheme will be eligible for a one-off payment of £2,000**, which will help ensure their mobility needs continue to be met”.

Asked if DWP accepted that DLA and PIP played a vital part in providing the support that disabled people need to live independently and contribute to society, she said: “Yes. DLA and PIP provide important support for those who have been assessed as meeting the criteria for the benefit(s).”

Meanwhile, research by the MS Society suggests that up to one in 10 of the 100,000 people with multiple sclerosis in the UK could lose the highest rate of mobility support as a result of the PIP reassessment process.

The charity has estimated that more than 1,000 people with MS have already had their benefits cut since PIP was introduced.

Under DLA, 93 per cent of people with MS who received the benefit [not everyone with MS claims DLA or PIP]were awarded the highest rate of the mobility component, and of the 4,349 DLA claimants with MS who have so far been reassessed and awarded any kind of PIP award, only 70 per cent have received the equivalent rate.

The charity is calling on people with MS to share their experiences of the reassessment process with the government’s second independent review of PIP.

*The Motability scheme is still growing slowly overall, at about 1.5 per cent a year, because of the number of new members joining, and currently has 651,000 vehicles (636,000 through the car scheme and 15,000 powered wheelchairs and scooters). Motability expects the overall number of customers to start falling at some stage in the reassessment process but does “not expect the number of vehicles to fall below 600,000 over the next few year”.

**This payment applies to those customers who joined the scheme before January 2013.

Problems with personalisation run deeper than ‘gaming’ targets

It’s been six years since the government set a target designed to trigger a radical shift in the way adult social care was delivered – and three since most councils claimed to have met it.

Councils were told to move 100% (later reduced to 70%) of eligible, community-based service users and carers onto personal budgets by April 2013.

The target symbolised a shift in power from the state to individuals and their families, and promised people more choice and control over the support they receive.

But just last week, a report released to Community Care under the Freedom of Information Act threw the validity of this target – and the performance reported by councils – into question.

The report was commissioned after Somerset council’s personal budget figures rose dramatically from 7% in 2012-13 to 33% in 2013-14. Auditors brought in by chief executive Pat Flaherty in 2014 found this increase had largely been achieved by sending a letter to 3,000 clients in receipt of home care services, telling them how much the council spent on their care.

The report suggested that a similar approach was also being used elsewhere.

The auditors concluded the tactics were ‘questionable’. Former care minister Norman Lamb described the findings as ‘appalling’. Sector leaders ADASS declined to comment.

‘Failed delivery’ 

But for many the real issue here is not ‘gaming’ statistics, it’s the underlying culture.

The personalisation agenda was about more than just rolling out personal budgets – it required a shift in staff attitudes towards empowering service users to make decisions for themselves, considerable reform of local authorities’ financial and management systems, and a reduction in the use of inflexible block contracts so that people could have a choice of providers.

The Somerset report (produced in August 2014 but never published) simply confirmed what personalisation experts knew all along – the true principles of the policy were not delivered.

More recent publications, including a report from the National Audit Office on personalisation in adult social care, suggest some of the same problems persist.

The NAO found that some staff they spoke to did not distinguish between a council-managed personal budget and a situation where a person did not have a personal budget at all. It concluded that this implied that “the move to a personal budget can be administrative and not reflect genuine personalisation”.

‘No strength in the system’

Simon Duffy, director at the Centre for Welfare Reform, says the responsibility for this failing lies with the Department of Health and its flawed strategy for implementing personal budgets.

“The buck stops with the Department of Health. These targets were defined in ways that were easy to reach, so that’s what everyone did.

“If everyone is doing it and the DH sets the system up and pressurises councils to effectively arrange their numbers, then I don’t see how you can blame local authorities.”

You can ask why ADASS and other bodies haven’t raised it as an issue though, he adds.

“Local authorities have been hit massively by cuts that they’ve not been able to defend themselves from, so what we’re talking about here are public bodies with no effective strength in the system, they are the weakest parts of the welfare state.

“They are utterly unable to defend their basic economics, so expecting them to be able to also insist on some integrity from the Department of Health is impossible.

“It’s a sad way of looking at it, but that’s the truth.”

‘Insufficient challenge’

The other issue, Duffy says, is that local authorities have never been supported to change their existing contracting and commissioning arrangements.

“Local authorities and people committed to an old fashioned way of doing things in social care didn’t want to change the contracts they had with domiciliary care providers.

“If they had moved away to either direct payments or individual service funds, things would have changed radically. The target allowed them to maintain their old procurement processes.”

Indeed, figures published by NHS Digital (formerly the Health and Social Care Information Centre) show that council-managed personal budgets remain the dominant form of budget. In 2014-15, 350,000 (57%) of the 609,000 people receiving support in the community had a council-managed budget, while a further 115,000 did not have a personal budget at all.

Duffy argues that more local authorities should look at individual service funds (ISFs) – a mechanism that enables a person’s budget to be managed by a third party.

“So many people with disabilities and their families are saying ‘I want flexibility, I want control but I don’t want a direct payment’ – so why the hell haven’t councils been encouraged or challenged to shift their commissioning arrangements to the use of individual service funds?

“ISFs were successfully implemented in Glasgow 20 years ago. They are associated with very high outcomes and many providers [not all] want to work in this way, but are told they can’t because they have to work to these fixed, tendered contracts.”

Figures quoted by the NAO show just 4% of service users had an ISF in 2013-14 and research published by the Think Local Act Personal partnership found they were poorly understood and that many providers were not contracted in ways that allowed them to offer flexible support.

Duffy adds: “The issue that has therefore really been at stake for local authority commissioners is maintaining those structures set up in the early 90s, the model of buying blocks of care en masse in very restricted ways, defined by process and number of hours.

“That whole way of thinking hasn’t been sufficiently challenged.”

‘Lack of transparency’

The principles of personalisation are of course now enshrined in the Care Act 2014, which places a duty on councils to ensure anyone whose needs they must or chose to meet receives a personal budget. The act itself defines in administrative terms – as the cost to the local authority of meeting the person’s needs – rather than as an instrument of personalisation.

But this objective is made clear by the statutory guidance, which states that individuals must be given clear information about the money that has been allocated to meet their needs, be able to choose from a range of options for managing their budget, and have a choice over how they are supported, and by whom.

John Waters, research lead at disability organisation In Control, says the act is a welcome development, but councils are still falling short on delivering personalised care.

“We have a picture here where the statute is correct, it’s saying how the relationship should look and feel, the power should rest with disabled people with the support of their social workers, and the role of the local authority should be an enabling one.

“Where we’re falling down it appears is with delivery and the worrying element of that is the inability of councils to demonstrate whether or not they are achieving the degree of choice and control that’s being expected of them – and there’s no easy way of measuring that.”

Waters points to recent research carried out by In Control, which found “a number of typical types of restraint” were happening in relation to how people are supported.

“The places where people can be supported, the ways in which they’re supported, who supports them, and the amount of money available for a particular period of care are all being constrained. This runs counter to the Care Act guidance, which is a concern.”

‘Reducing choice and control’

He adds that “all too often” councils are failing to be transparent about what personal budgets should look like, but acknowledges this is largely due to financial pressures.

“It’s no surprise given the pressure local authorities are under with the cuts. There’s huge unprecedented cuts being raged on them in a way that is uncalled for, unwarranted, and that certainly leads to the frustration of the good developments we’ve seen.

“You’ll see councils reducing commissioned providers in vague attempts to make savings, which will deny individual choice – people can sort their own solutions out better then we can – but local authorities are being forced into acting in ways that ‘reduce’ control.”

These issues need to be addressed and Waters believes the answer lies in frontline practice. He calls on social workers to be honest with individuals about how systems are working, how resources are being allocated and the extent of choice and control available.

“That’s a fundamental role social workers can play – be transparent about what the rules are, but also internally urge their own authorities to be transparent with local people.

“It’s no good having guarantees and rights in law, if you don’t know what those rights are.”