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A Care Co-Production (with bit parts for the Nearys)

October 23, 2013

Clumsily, I’m pulling together two things that happened yesterday.

Firstly, I got involved in a Twitter discussion about “Co-production”. Embarrassingly, I had to admit to not having a clue what it meant. I read the TLAP definition and have to say that my experience couldn’t be further from co-production. Certainly, when it’s come to chosing who supports Steven, the LA have made all the decisions. They have a very small bank of agencies that they use to provide care and won’t entertain the idea of going elsewhere.

Secondly, one of Steven’s longest term support workers resigned yesterday. he started working with Steven during his time in the Unit. I think he got fed up with the small number of hours the agency were allocating him, so for the past two years, he has worked with Steven on a Sunday and worked elsewhere during the week. He is a great guy and has built a fantastic relationship with Steven. It brought home again, how fragile our support system is.

Lying in bed last night, I found myself running through the previous agencies that Hillingdon commissioned and our dreadful experiences with the first three. I do consider us blessed that we found the current agency because I’d hate to go back to those early days.

Agency One:
This bunch were commissioned when Steven was about 13/14 to provide 5 hours per week. At the time, I was programme leader on a counselling diploma course and working one evening a week. The idea was for the agency to support Steven whilst I was at the college. My sense of time has shrunk over the years but I seem to remember they were employed for about five months. One night, Steven was upstairs and there were two support workers with him, the regular guy and a trainee shadowing. They were doing Steven’s homework on the computer. Suddenly, Steven came running downstairs in tears and hid in the kitchen. The staff left soon afterwards. The computer was in my bedroom and when I went to bed later, I noticed the duvet was soaking wet. I talked to Steven and it came out that he had thrown a glass of water at the support worker, who in turn punched him in the face. I reported it the following morning and then things turned very sinister. 24 hours later we received an unannounced safeguarding visit from the social worker. The same support worker had reported that inappropriate behaviour had been taking place at home and at the same time denying that he had hit Steven. It was clear what they were thinking – My (Steven’s) allegation was made up to deflect attention. And what was the safeguarding issue? For many years, Steven laid out on the sofa in the evening whilst watching TV. He liked to put his feet up on my, or my wife’s lap as he snuggled under his Buzz Lightyear duvet. The inference was horrible – something untoward was happening under the duvet. This went on for weeks and of course, diverted attention from the punching incident. We never found out what the outcome to all that was.

Agency Two:
This was the agency that supplied staff at the Unit and after Steven’s first stay there in 2008, the LA commissioned the agency to provide Steven’s home support. Three weeks after coming home, we had the dreadful incident at the airport where Steven was arrested. That investigation revealed that the agency didn’t have the licence to supply home support. Three weeks after that, Steven was assaulted by one of their staff and was kicked three times and had a hot cup of coffee thrown over him. The CPS pressed charges: the LA tried to cover it up by leading us to believe it was another service user who carried out the attack. Once again, we were never told the outcome of the internal investigation but it was a shock when Steven was back at the Unit during his unlawful deprivation of liberty to discover the same agency were being used to supply the staff there.

Agency Three:
Agency three lasted three weeks. They only had one worker. He couldn’t swim. This was shortly after Steven had joined Virgin Active and the gym expressed concern that one of the staff supporting him was a non swimmer. Three weeks after accepting the contract, the agency pulled out with immediate effect.

Eventually, that led us to Agency number four, who were brilliant. Their staff looked out for Steven during his year at the unit and continued to provide his support after he came home. Then in March 2011, the manager left the agency and most of her staff followed her to a new agency. Obviously, we wanted to follow them too but the new agency weren’t on the LA’s list of registered suppliers and here co-production suffered a hiccup as it took weeks before I could persuade the LA to commission their services. Thankfully they did and we are still with that agency to this day.

Before anyone mentions it – direct payments/personal budgets aren’t an option for us. Some of Steven’s support package is met through direct payments but the LA have their own local ceiling on how many direct payment hours can be awarded – Steven’s package exceeds that limit. Even though it would be cheaper for the LA to cover the whole package with direct payments, they refuse to do so – something about “an equitable service for all”. I’m not fussed. It’s their loss. I couldn’t give a monkeys whether the support comes from an agency or direct payments – it’s the quality of the support that is the most important thing.

And that is the Neary’s experience of co-production. Most of the time, we are sat in the audience taking no part whatsoever. Occasionally, we are allowed a small walk on part.


From → Social Care

  1. oh Mark I’m sat here with tears in my eyes. What you guys have gone through is horrendous.

    Let’s hope now there are happier times ahead x

  2. Sally permalink

    Horrible, horrible, horrible. How can it ever be suggested that there is any sort of partnership involved.I find its more often a combination of rigid restrictions but no responsibility-they are very strict about from where you get the help-but have no interest in what the nominated service is like. Detatched interest is the most you can expect. (“OOh, you weren’t happy with service X? No doubt you’ll chase that up with them.”)
    So you find some nice people, but you’re right Mark, its fragile. They leave. The hours and pay are pathetic, there’s very little incentive to keep doing it.
    Question: how the hell have we all got into the situation in which terrible services and nasty/inadequate workers are for us alone to sort out?

  3. Weary Mother permalink

    This ignored issue of agencies employing people who at best are not up to the job, and at worst can abuse and exploit, is not uncommon.

    No matter how serious the issue, no matter how much time we spend explaining, emailing, and writing up all that happens, all that we hear from the agency is ‘we held a meeting’, and we cannot tell you the outcome.

    In our case, very serious exploitation and life threatening behaviour happened, repeatedly. I took enormous care in laying out what I had discovered hoping at the very least the carer had been sacked. Then I found out that this carer had only been moved on to another learning disabled client. As far as I know this carer is still contracted by the LA, and employed by this agency.

    There is a much deeper issue. Like you Mark, we have not accepted direct payments. This agency is engaged by the LA. There has been, to my understanding, nil monitoring of the agency by the LA. This agency is ‘cheapest/lowest cost’ provider, and the principal competency on the LA standards/caring list is too often, cost..

    There have been a number of high profile exposures of abuse of vulnerable people in care homes and other care settings recently; in LA day care for example. The CQC is under scrutiny and there are promises that they will be more effective in monitoring care in future. But why have LA’s slipped off the responsibility radar. How often/rarely do we see that the abuse etc was in care settings contracted/commissioned or delivered directly by the LA?

    Or how often are questions asked around how often the LA monitored their own ‘quality’ standards and promises, or those in the letter of these contracts?

    And when the bad things happen, where is the LA accountability, usually………zilch …….and complete silence.

    • Sally permalink

      Weary mother, when bad things happen, surely you will hear at least 4 things from the LA:

      1.We are comitted to supporting the highest standards of care.
      2.Lessons will be learned.(Not by anybody specifically, that would suggest responsibility.Just in a general sense.)
      3. What happened is very unclear-we’ll have some meetings about it. (Finding anything out would take up more time than we planned to give to this family in a lifetime!)
      4. Its not for us to monitor the agency-that’s for the parents. Or police. Or someone. We are doing whatever we can to write ourselves out of any responsibility for anything-but we are jolly empathic!

  4. Carole Cliffe permalink

    Same here Mark i was in the pool with my boy when the support worker supplied told me he couldn’t swim.reported it to the agency and the owner came round and asked me not to report it to SS!! needless to say i did. We had issues with respite care where he was definitely drugged without authorisation or a GP having attended him plus he came back with a massive bruise after being restrained by staff he was traumatised and refused to return!! i called SS they actioned and sent the intake team to my home asked if they had a vigorously investigated their own centre with the same intensity, no paperwork of the incident ever materialised despite requests for it!! SS are the biggest abusers and turn a blind eye to the weak services they commission probably based on the fact no others will do it for the price they offer Social Service departments need seriously investigating by CQC

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