Examination of Witnesses (Question Numbers
360-377)
BARONESS YOUNG
OF OLD
SCONE, MR
RONALD MORTON
AND MR
SAMPSON LOW
12 NOVEMBER 2009
Q360 Charlotte Atkins: You have no
evidence at the moment that people are being pressurised into
taking up direct payments.
Baroness Young of Old Scone: I
do not think that would be evidence that we would necessarily
collect.
Mr Morton: CSCI report, in its
last State of Social Care report, that some people were being
given direct payments and councils were kind of washing their
hands of them and they were left, basically, to fend for themselves.
So the issue of ongoing support is a very real and live one, and
I think that is one that we can perhaps look at, what ongoing
support councils are providing to the direct payment recipients.
On the point that Sampson made about the turnover rates, we know,
people tell us, that people want good quality staff, but they
also want the same care staff working with them. Just to give
you some figures on the turnover, council turnovers in 2007-08
were 10%. For the independent sector it was 18% and in the home
care setting it was almost 21%. So significant levels of turnover
and significant work force issues there, and I think work force
issues are one of the issues that the Committee may wish to look
closer at.
Chairman: I am very conscious of the
time. I am going to ask for brief questions and brief answers,
if I could.
Q361 Dr Taylor: Baroness Young has
really answered my first question. Personal assistants: if they
commission services from provisional providers, you will have
no ability of inspecting or controlling that.
Baroness Young of Old Scone: No.
Q362 Dr Taylor: So that is big snag
of personal assistants, as they are at the moment. Sampson, again,
you have covered some of the things I was going to touch. In your
submission, you have talked about a bank of personal assistants
being employed by local authorities, which seems really to me,
on the surface, a very good idea. You have also mentioned a code
of practice. What would that actually mean, if there was a code
of practice for personal assistants, and the employment of them?
Mr Low: Not so much a code of
practice for personal assistants, but the employment of personal
assistants. We would like it to be compulsory on local authorities
that there was this model code. It would not be compulsory, though,
on individual service users. They could take note of it as they
pleased, but it would come with the direct payments package, this
model of terms and conditions and good practice in employment.
What that then leads on to is that the local authority recognises
that good employment practice does cost extra and that the model
code of practice should be built into the commissioning process,
and we would like to see that built into the commissioning process
and the amount allocated for direct payments. In Scotland, again,
as well as Sweden, I would like to draw the Committee's attention
to the Scottish example of the Scottish Personal Assistants Employers'
Network (SPAEN), which is very good. It is a tripartite body that
brings together micro-employers, UNISON and unions and local authorities
to draw up good practice guidelines agreed by all parties for
exchange of views but, also, has set up now a mediation process
to avoid employment tribunals.
Q363 Dr Taylor: I think you are also
suggesting that personal assistants should be registered?
Mr Low: Yes. There are lots of
registrations, obviously, from the Criminal Records Bureau to
the Independent Safeguarding Authority for vetting and barring
issues. We believe that personal assistants should undergo those
checks, but the final decision should rest with the service user
where the local authority's duty of care is but the user has full
information available to them. On General Social Care Council
registration, though, we would be slightly more cautious. What
we do want to see is a level playing field. At the moment, I believe
(and you will hear from them later) the General Social Care Council
are not currently going to proceed with pushing registration into
domiciliary care. If they had done, we would have felt that they
should have also done personal assistants too, to create a level
playing field. I will stop there.
Q364 Dr Taylor: We are told that
a service user who employs personal assistants wrote in a blog
last year that unions were guilty of spreading propaganda that
disabled people are naturally bad employers.
Mr Low: We would refute that criticism
totally. I think UNISON is unique among trade unions in that we
have since our inception active disabled members groups and disabled
members involved in all levels of our decision-making, and they
have been party to our consultation response, the submission that
went to this Committee, and only last week several hundred disabled
members gathered for their annual conference to quiz Jonathan
Shaw, the Minister for Disabled People. So we are unique among
unions in our decision-making and our involvement of disabled
people in our structures and, as I said, a previous example in
Scotland, we are also a practical organisation. We are more than
happy to sit down and work out common solutions with micro-employers,
disabled people who do employ personal assistants.
Q365 Charlotte Atkins: Mr Low, in
your written evidence you said that direct payments cannot be
used as an excuse to close down local services and that certain
local authority services need to be ring-fenced. Can you give
us some examples and explain how it is in the interests of service
users and taxpayers to keep these services going?
Mr Low: We would like to see some
support for good local services. At the moment it is a lot of
smoke and mirrors to do with budgets, but we are getting daily
reports of local authorities seeking to close day care centres,
and they are saying it is because of the growth of personal budgets,
not efficiency and budget cut pressures, and the users of the
day care centres in town halls and county halls up and down the
country are leading protests and petitions about it. There are
some critical services, good services and common collective services
that need to be protected, which those with personal budgets and
direct payments at some point might want to use as well. So I
think the local authority has a responsibility for minimum service
standards and some core and common collective services for a variety
of different users which should be maintained. Day care centres
are a good example.
Q366 Charlotte Atkins: Do you think
that the personal budgets are used as a smokescreen to close down
day care services?
Mr Low: Yes. In many cases the
users of day care centres are very angry about this sort of smokescreen
used by local authorities to propose the closure of day centres.
What we would like to see, as I think I mentioned earlier, for
those interested, is a more hybrid system where they might be
able to take a partial direct payment for some services they wanted
to commission themselves but, also, could keep some of their budget
with the local authority for services like day care centres and
other services, and that hybrid approach I think would work well.
Q367 Charlotte Atkins: Do you think
that, with personalisation, it is inevitable that some new services
will be commissioned, others will be decommissioned and that is
going to be part of the process, or do you think that facilities
like day centres, inevitably, will fall by the wayside simply
because people do not value the day centre in terms of the money
that perhaps they will need to put into it to maintain their continued
attendance at these day centres?
Mr Low: I think personalisation
will lead to a shift in the types of provision available, without
a doubt, but at the moment the local authorities are incredibly
cash strapped. What we need is a process where day care centres
can be invested in, can be made more flexible and used as a base
for a variety of health and social care professionals servicing
multi-purpose day care centres, not just servicing one group of
the community but several different groups of users in a far more
flexible format. I think there are opportunities there.
Q368 Charlotte Atkins: So you do
not think the day centres have had their day and that they really
ought to be closed down?
Mr Low: No.
Charlotte Atkins: Thank you.
Q369 Dr Naysmith: Both UNISON and
CQC raise concerns about safeguarding vulnerable people from abuse
when they are directing their own care. Mr Low, do you think that
all service users should be offered a Criminal Records Bureau
check of prospective employees?
Mr Low: Yes, we believe that all
service users should be offered a Criminal Records Bureau check
for anybody they might employ as a personal assistant. It should
not bar them from choosing them. I am aware Baroness Campbell
of Surbiton invariably says that her best ever personal assistant
was somebody with a criminal record. She never fails to mention
that in many of the speeches she makes in the upper House. We
do believe that CRB checks and registration through the new Independent
Safeguarding Authority should be done for all personal assistants,
but the final decision for those with direct payments should rest
with them.
Q370 Dr Naysmith: Is it not a bit
patronising not to treat service users as grown-ups who can sort
out these issues for themselves with support from advocacy and
brokerage services as required?
Mr Low: I do not think so. If
those services were provided through other more regulated providers
those CRB checks and Independent Safeguarding Authority registration
and checks would have to be done. For us it is a level playing
field. It is part of a local authority's public duty of care to
make sure that they are done and the best possible information
is put before the service user. Where disputes about personal
assistants have arisen and cases have gone to the Local Government
Ombudsman, the Local Government Ombudsman takes a very dim view
of a local authority that is hands-off in this regard. There is
a duty of care with the local authority and ultimately it is public
money too.
Q371 Dr Naysmith: Lady Young, do
you agree with Mr Low on this?
Baroness Young of Old Scone: We
certainly would expect local authorities to be able to assure
us as part of our inspection of them in terms of their commissioning
role that they have adequate mechanisms in place for safeguarding
right across the spectrum of their activities. There needs to
be a degree of flexibility as far as the personal assistants are
concerned because many service users tell us they do not want
regulation to intervene in the relationship between them and their
personal assistant, they want to be able to make choices and if
they choose not to take a CRB check they want to be free to do
that. The important thing is service users have got access to
support for taking checks on qualifications and proof of identity
and CRB checks if that is what they want. If they choose not to
want those, they have got to have the freedom to do so otherwise
it gets in the way of the real flexibility that personalisation
can mean for some people where they choose very informal sets
of services to give them personal assistant support.
Q372 Sandra Gidley: A question to
Mr Low. The Government would say that personalisation means a
new role for social workers providing information, brokerage and
advocacy, helping service users to put together their own care
packages. Some would say that is a return to a "traditional"
model of social work, instead of just "gatekeeping"
the ready-made care packages. How do your members see it?
Mr Low: They do see the potential
for the personalisation agenda to be more satisfying than being
a gatekeeper but, unfortunately, many employers—councils—are
predicating personalisation on creating efficiency savings. The
assessment process is time consuming to do well and promptly.
Q373 Sandra Gidley: Sorry, you said
personalisation is going hand-in-hand with efficiency savings
and that is not the case in my local council, they are very keen
to say that it might cost them more money. What evidence do you
have to say this is a cost-cutting measure?
Mr Low: Our surveys of the sheer
caseload of our adult social workers show that they are experiencing
the same sort of caseload they have got to work through as the
children's social workers were at the time of the Baby P incident.
Quite frankly, their workloads are extremely large. Although a
council might be saying personalisation can involve more staff
time, the point is it is a workload issue. Secondly, some councils
are deciding to slightly re-profile the assessment process and
often it is not professional social workers doing the assessment
but support staff, care managers and others. Some of them are
using the personalisation process to re-profile where work is
done in social services teams.
Q374 Sandra Gidley: Is that not the
same as skill mix in the Health Service? Is that not a good thing?
Mr Low: In the Health Service
and education, yes, we are aware that support staff are taking
on more roles. In the NHS it is healthcare assistants and in schools
it is teaching assistants. It is a trade union question that goes
back centuries, is it the rate for the job? We negotiate re-profiling
of work all the time, it is our bread and butter.
Q375 Sandra Gidley: You mentioned
Baby P and I think a few months ago UNISON warned about the possibility
of a Granny P tragedy in adult social care. What evidence do you
have for coming out with that remark?
Mr Low: As I said earlier, our
surveys of adult social workers produced remarkably similar results
to our surveys of children's social workers in the size of their
caseloads and the pressures upon them. Many find themselves doing
their paperwork for court at weekends and evenings. With the rationing
of care there are possibly many vulnerable adults who could slip
through the net who do not get the number of home visits that
they should.
Q376 Sandra Gidley: Baby P had plenty
of home visits.
Mr Low: The situation there was
also a multi-agency one. Often the social workers are telling
us their caseloads are still incredibly large and that 70% or
80% of their time can be taken up on paperwork as well. I know
the Social Work Commission, under Moira Gibb, is looking at ways
to reduce bureaucracy and improve the IT systems that are often
the bane of social workers' lives.
Q377 Sandra Gidley: Is that what
is needed to prevent such a tragedy, smaller workloads and better
IT?
Mr Low: Smaller workloads is key
and, yes, more streamlined administration and IT would go a long
way to improving outcomes.
Chairman: Could I thank all three of
you very much indeed for coming along this morning and helping
us with this inquiry.
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