T&M Greens respond to consultation on adult social care

4 November 2016

KCC held a consultation on their plans for adult social care from 30th September to 4th November 2016. Two members of Tonbridge and Malling Green Party (one with a health background and one with a social work background) provided a detailed response:

"On p2 ‘Strategy at a Glance’ we noted that there are already insufficient staff to carry out safeguarding, and that there is a backlog of cases. There should be a clear and well advertised complaints procedure. In KCC social work caseloads are too large, averaging 200. It would help if active caseloads were separated from nonactive, as in other areas, and the individual social workers held only the active loads. (We are aware from talking to social workers at the grass roots within KCC that case loads are excessively high. This has led to KCC being unable to retain professionally qualified staff and in turn has affected the delivery of good front line services reflected in an increased level of complaints from customers during the last year).

Safeguarding investigations have been delayed and standards lowered given KCC’s inability to retain suitable professional staff. Question: Why are staff holding onto their caseloads active assessment/safeguarding cases as well as services users who are stable but receiving an ongoing service? This creates feelings of overwhelming workloads and a realistic chance that when previously stable cases suddenly enter a crisis the case manager or officer can quickly become overwhelmed by their workload. In most LAs, adult departments' stable cases are held by the organisation or a reviewing team. KCC requires better systems and management in order to prevent staff burnout and retention problems. How will this be incorporated into the new proposed structure?

We broadly agreed with the need for health and social services to work more closely together.  We both felt that these had become more fragmented since payment for social care became involved.  Both services tend to try to offload responsibility to the other, and the client tends to want the needs to be met by health since the NHS is free. There is a need for a single assessment in order to prevent the service user from enduring multiple assessments. Potentially this could be a joint assessment between a health professional and a social care professional.

The idea of a common hub and common caseload and boundaries to make communication between services easier is good.  However, we had reservations about the hubs being based in GP surgeries. This could work where a GP is based in a publicly owned health centre; but there could be problems in privately owned GP premises. Private practices could be unreliable, could change their minds over what rooms are available when and to whom, could suddenly increase the rents, or sell the premises. The GPs would feel that they were in charge rather than one of many partners in the provision. As owners of the building they could call the shots.

We like the idea of a good, integrated IT system. There would need to be safeguards as to who could access what information on a ‘Need to Know’ basis. We also felt that common paperwork would be a good idea, so as to lessen time spent duplicating information onto different forms.

IT systems cannot replace human contact for the public.  Many people do not have access to computers or are unable to use them, especially the elderly.  We also noted that people do not like speaking to answerphones, and that it is often difficult to understand messages the public have left on answerphones.  It would be good if each hub had an admin person to take messages clearly, and relay them to the appropriate service. The admin would be trained to prioritise those that are urgent and need to be passed immediately to an appropriate member of staff. 

p9. ‘free professionals up from rules and bureaucracy’ is an ambiguous phrase!  We agree that there is unnecessary duplication of paperwork both within and between services, but surely you should not make rules that you expect to be broken!

p29 Payment by outcomes focus rather than time and task focus. We understand the thinking behind this being that just providing the same old care day in day out may not progress the client. It may take longer in the short term to encourage a client to do things for themselves, but over time will improve independence and be cheaper.

However some peoples’ condition will never improve, and there is a need for repetitive monotonous care, and it would be unrealistic to expect any change. We thought that outcomes would need to be carefully thought through and clearly agreed and defined between commissioner and provider. They are usually quoted in terms of money saved. Private providers could be more used to using these tools and quite creative in thinking of outcomes of money saved – so KCC may find that instead of saving money this way, they actually spend more.

We liked the stated aim to use fewer locums and improve career pathways. This needs to be more than a paperwork exercise.  Staff are often employed by private companies and there is no control over the employment terms. At present carers are often not paid for travel time, and may sometimes be on zero hours contracts. This is unreasonable, and leads to a high turnover of staff.  We feel very strongly that care staff should be shown respect and paid properly.  They should be offered guaranteed hours, unless they choose a zero hours contract to fit around family. They should be paid mileage and travel time. There is an over emphasis on the use of private companies and volunteers. For the most vulnerable groups in particular, there should be directly employed paid staff.

We noted that when there are innovative schemes like the ‘home from hospital’ scheme (now known as Enablement), it can be confusing for clients as there will be many different staff coming to the home. These tend to be different from their regular home care staff. The staff who were involved prior to admission and will be involved in the long term should be involved in this service.  It is not helpful for it to run as a separate service and it should be better integrated.

More information is required on how the new proposals will be structured and systemised across KCC, Health and Provider Services in order to improve customer outcomes.

How will the theory of this consultation document be implemented in a way that reflects value for money, improved provision of services and essentially supporting dedicated professionals who aim to delivery quality services and care?"