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Welfare Reform on the Web (March 2012): Social care - UK

Better late than never ... independent adult social work practices finally have a legal basis

E. Mitchell

Journal of Integrated Care, vol. 19, no. 6, 2011, p. 33-36

In 2010 the Department of Health announced its intention to pilot arrangements for independent adult social work practices to exercise local authorities' adult social care functions. Unfortunately, so far as local authority functions in relation to social care were concerned, powers to contract out were limited to arranging for third parties to provide services. New legislation was required, which was not made until August 2011. This paper presents an analysis of this legislation, the Contracting Out (Local Authorities Social Services Functions) (England) Order 2011.

Blurred vision: direct payments, funding cuts and the law

A. Thornton

Social Care and Neurodisability, vol. 2, 2011, p. 218-225

This paper seeks to focus on legal issues concerning direct payments for social care for adults. Its aim is to consider whether the aspirations for choice, control and innovation, central to successive governments' purpose in introducing direct payments, risk being undermined by budget cuts within social services departments and whether the legal framework provides sufficient guarantees to those in need. It summarises the legal basis for direct payments, considers issues of choice, brokerage, resource allocation and commissioning, and looks at relevant legal challenges made up to May 2011. It finds that severe budgetary restraint is likely to undermine the original vision for personalisation and direct payments. Particular factors are reductions in management and delivery staff, the weakness of the provider base caused by reduced demand, poor brokerage support, and the redirection of the resource allocation system to the primary end of controlling limited budgets. There are substantial legal risks to local authorities, but the courts have so far proved unsympathetic to disabled people whose challenges have implied criticism of the basic rationale of the new system.

Joint strategic needs assessment: reconciling new expectations with reality

E. Harding and M. Kane

Journal of Integrated Care, vol. 19, no. 6, 2011, p. 37-44

The Health and Social Care Bill places a revised duty on each upper tier local authority and clinical commissioning group (CCG) to prepare a joint strategic needs assessment (JSNA) together through the health and wellbeing board. It furthermore requires both partners to commission with regard to the JSNA and to apply it in the new Joint Health and Wellbeing Strategy. The Bill also details how the JSNA will be used by the NHS Commissioning Board to quality assure CCG commissioning plans and performance. This paper presents a critique of the readiness of the JSNA to respond to the new roles and functions proposed for it. It is concluded that, despite significant improvements in the quality of JSNAs 2008/10, raised expectations pose a serious challenge.

Personalisation in social care: what does it really mean?

S. Duffy

Social Care and Neurodisability, vol. 2, 2011, p. 186-194

The social care system in England is institutional in character and poorly understood by the general public. Pressure from disabled people and others has led to progressive reform of the system and personalisation is the latest phase of that process. Although central and local policymakers have struggled to implement these reforms, significant progress has been made. The idea that users of social care services are also citizens, with rights that include the right to direct their own support, seems to have taken root. This change does not resolve every problem, but seems like a better foundation for protecting the rights of older and disabled people and their families than the previous paternalistic model. However, further changes will be necessary before personalisation can be properly established within the wider welfare system. The coalition government supports personalisation in principle, but its main concern is to cut public spending. It therefore seems likely to see personalisation more as a route to financial efficiency than as a tool for improving the rights of older and disabled people.

Professional boundaries in social work and social care: a practical guide to understanding, maintaining and managing your professional boundaries

F. Cooper

London: J. Kingsley, 2012

Professional boundaries between worker and client underpin all areas of practice in social work and social care, and the mismanagement of these boundaries can lead to unprofessional conduct and negative consequences for both worker and client. This reference guide to boundaries explores what they are, why they are there and how to maintain them, from legal boundaries and policies governing behaviour to rules surrounding confidentiality. Presenting a flexible framework of rules and guidelines which can be applied to any client relationship, the book offers practical advice and suggestions on how to judge boundaries and how to manage a situation when they have been crossed. It also explores the benefit to both worker and client of establishing a good rapport whilst maintaining a professional, emotional distance.

Quality, risk and governance: social workers' perspectives

B. Taylor and B. Campbell

International Journal of Leadership in Public Services, vol. 7, 2011, p. 256-272

Social work seeks to provide the most effective help to people within resources (quality) and to protect the most vulnerable (manage risk). In large organisations, these dimensions of quality and risk are coming together in what is known as social care governance (SCG). Clinical and SCG is a framework within which health and social care organisations demonstrate continuous improvement in the quality of services and safeguard high standards of care and treatment. Northern Ireland is pioneering the development of SCG in parallel with clinical governance in health care. A survey was undertaken to seek the perspectives on social care governance of social workers in the South Eastern Health and Social Care Trust in Northern Ireland where clinical and SCG is formalised in the integrated health and social care service.

Safeguarding vulnerable groups: the ISA scheme

N. Wikeley

Family Law, Dec. 2011, p. 1365-1369

This article describes the current system for barring individuals from working with children or vulnerable adults set up by the Safeguarding Vulnerable Groups Act 2006 following the Bichard Inquiry. It covers the statutory conditions for barring.

Social care

Health Committee

London: TSO, 2012 (House of Commons papers, session 2010/12; HC 1583)

It comes as a great shock to many people that whilst the care and treatment provided by the NHS is free, home care services are means tested and many people will have to pay for them. The NHS, social care and social housing are most frequently used by older people, and these older people often have several needs at the same time; a need for NHS care from their GP and a specialist for a long-term condition like diabetes, a need for help with washing, dressing or getting around that is often provided by their council, and a need for housing that keeps them warm and well. The best test of such complex services is whether they work well together from the point of view of the older person, or whether they provide care and support in the most effective and efficient means possible, from the point of view of the public purse. The Committee has come to the view that these separate systems are inefficient and lead to poorer outcomes for older people. Indeed, trying to define NHS care and social care as two separate and distinct things will only make matters worse for older people. The Committee recommends that, whilst integration is not an end in itself that it can be a very powerful tool to improve outcomes for older people and people with disabilities and long-term conditions. To that end, each area should establish a single commissioner who will bring together the different pots of money that are spent on older people. This single commissioner could then best decide how this resource should be deployed in order to improve outcomes for older people. A similar task needs to happen at the national level, with the Government coordinating policy and regularly rebalancing spending across health, housing and care services. The Government should also develop a single outcomes framework for older people to replace the three overlapping but confusing frameworks that currently exist. In order to achieve the level of integration that is required, a number of steps need to be taken. The Government must face the issue of the existing 'funding gap' in social care services i.e. the gap between the number of people who need care (and the level of their care need) versus the amount of money that is currently in the system to deal with their needs, The Government will also need to outline its proposals for responding to the Dilnot Commission on how the individual contribution to their care costs can be made in a manner that is fair and equitable. It is essential, however, that services are shaped by the objective of providing high quality and efficient care delivery, and the funding structures are fitted around that objective, not vice versa. The millions of informal carers in England must also get a better deal. Despite the clear case for supporting carers to continue to care, the majority are not being identified, assessed or offered support. The Committee is clear that a new offer needs to be made to older people. A new, integrated legal framework is required which supports integration of health, social care and other services around the needs of the individual.

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