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The Mysterious Disappearance of Social Care Needs

November 16, 2013

Steven has his first FACS assessment on Tuesday. For those not in the know, that’s a “Fairer Access to Care Services” assessment.

Trumpets? Bugles? Oh, okay then – have a quick blow on your kazoo. I’ve read and heard a lot about FACS and as Eminem may have out it, I suspect we’re about to well and truly facked. I haven’t met one person who has come out of a FACS assessment better off than when they went in. I haven’t met one person who has managed to hold on to their existing care package after a FACS. Everyone I’ve met have suffered a loss as a result of their FACS.

And don’t forget once you’ve been Facked – you are then RAS’d. Your FACS is fed into the Resource Allocation System which will produce your indicative budget.

The more I write the Carespeak book, the more a common theme emerges. Whenever a word is used to describe the innovation, the reality is probably producing the opposite of the claim. Don’t claim this is “fairer”. The sleight of hand/tongue will almost certainly produce something very unfair. Read/hear the use of the word “fairer” as an alert that you’re about to be shafted. Be prepared. If the thing was actually fairer, there would be no need to claim that it is – it would just be fairer.

It’s a mean tactic because it is meant to put you on the back foot with its suggestion that what came before was unfair. At the Court of Protection round table meeting, one of the social managers said: “The process of the RAS produces an equitable service for all service users”. No it doesn’t. It produces a reduced service. A need is a need. No two people have equitable needs, therefore to try and assess everyone the same is a nonsense.

In preparation, I’ve been sent a copy of the FACS assessment document. It’s all scores, sliding scales of need and bonkers definitions. 75% of the assessment is about physical disability. None of Steven’s current care package is covered by any of the questions as far as I can see. There is no space at the end of the form to include “needs not covered by the assessment”. I’m nervous about what may pop out of the RAS, considering that none of Steven’s needs will be fed into it. His needs haven’t changed (not fundamentally) but if this form is the sole tool in the assessment, it would look like all his previous needs have evaporated. I suspect in monetary value, the care package will be slashed. I won’t be able to afford the same level of support that Steven gets now. He will either have to cut back on some of the places he goes to or I’ll have to reduce my working hours to fill in the gaps. We could do away with the agency all together and I can pay the support workers through direct payments (I’ve already been told that it is the current direct payment rate that has been used for the RAS calibration). They might be financially better off if it comes to that but it’s an awkward position to be in.

The last page of the form is devoted to the next consequence of the the FACS – the FCP – the fairer charging policy. Doubtless, they are based on the same principle – I can almost hear my friend saying: “The process of the Fairer charging policy produces and equitable charge for all service users”. I think Steven’s bill will be quite interesting. I’ve read the paperwork and you are meant to be charged for a service. Is commissioning an agency to provide support a service? At the moment, the only council run service that Steven uses is a day centre for four and a half hours every Friday – the rest of the week, he organises all his activities himself. There is nothing provided at the day centre. Although, we are long shot of the OT, Steven still makes his evening pizza whilst at the day centre – the rest of the time he sits and watches telly – there is nothing else to do there. Will he be charged for this “service”? If he does, he’ll stop using the “service” and make his pizza at home. There is a rather threatening section on the FACS form called “Possible safeguarding issues”, with one of the being the risk of financial abuse. There is a certain irony that the whole “fairer” stuff – access to care services and charging policy may be the biggest cause of financial abuse of their client base.

I’m running a sweepstake on how much Steven’s care package decreases after the FACS, RAS and FCP. There are no odds on him gaining something. There are no odds available on the package staying the same. How much do you want to wager?


From → Social Care

  1. Pat permalink

    Ah Mark I would love to place a bet but we just exhausted our finances buying a piece of medical equipment that the NHS doesn’t supply. Well they supply a really heavy one that restricts our lives as I have to carry it everywhere we go – whilst also pushing the wheelchair! We have counted the pennies and ordered a lightweight one so as soon as it arrives we will be FREE FREE FREE !

  2. Meg permalink

    Review time does seem to have become a cost cutting exersise rather than a needs based one. Some of the adults I work with have kept their existing package, but only those who are most complex and for want of a better expression, in obvious need of community support. Others have not fared so well, despite being extremely vulnerable. None has had their package increased. I will keep Steven and yourself in my thoughts and cross everything, which will probably be at least as helpful as the assessment form. Good luck Mark

  3. duncfmac permalink

    Scandalous treatment of the most vulnerable members of our society based on lies, lies and more lies.

  4. Nichola permalink

    The manager of my sister’s incredible disappearing day centre told me it costs social services £30 per person, per day. My sister and her friends–and all the other learning disabled people across the country–are being thrown to the wolves. An agency worker can ‘support’ four people ‘in the community’ for a small fraction of the daily cost of funding a place at a day centre. Forgive me, but I think £150 for a five-day week at a safe, stimulating and well-staffed, properly trained centre is a bargain. But the marionettes with the purse strings put even less of a value on our loved ones’ lives. There is nothing fair or equitable–no matter how they try to dress it up in ridiculous acronyms and jargon–about snatching away a person’s right to attend a safe and stimulating (building based) service. The measure of a civilisation is how it treats the most vulnerable members. In good old Blighty, we are sliding back to the Dark Ages.

    • Meg permalink

      I agree entirely. Support workers like myself cost around half the day centre costing. Support workers generally receive less than half of that. I support several learning disabled adults living independently in the community for anything between 1 and 9 hours on a day, average is probably 2-3. So they need something to do to fill their time, in a safe building based space with safe, familiar staff. To cut support hours and centre based services together is mean, short sighted and quite frankly cruel. Sure, there are some who abuse the system. Most of them sit in the Houses of Parliament!

  5. The way you write is so funny yet so full of insight! I wonder how well trained and capable the people are who are doing these assessments.

  6. Sally permalink

    I am very sorry to bet that the package is reduced, but will be glossed with a sickly layer of carespeak to suggest that
    a:its a better deal and
    b:’what you had before was costly and inefficient.and
    c:All Steven’s needs arestill met (because most of his needs aren’t covered by the form so don’t exist)

    You are right that the suggestion that what was previously had was “unfair” -presumably to other service users-is used to put us on the back foot. The aim is to make us all feel greedy, demanding,selfish.Whatever pitiful allocation you have-for us, this started at school with the Statement-is described as :”very generous!” in irate tones.
    I well remember my disabled daughter’s vital OT/Speech therapy sessions going from weekly one to one, to a monthly group, to a once a year “block “of 3 group sessions, to nothing.
    When we complained we were told “but your daughter has had a LOT of therapy already !”, as if she’d eaten more than her share of cake rather than had lost a form of assistance she would require for the rest of her days.
    Why the Hell should we all have to read through that drivelling paperwork, checking the gaps, scrutinising the funding etc etc for our disabled children and young people to enjoy some sort of quality of life.?!
    If our children had a similar chronic condition, say, asthma, diabetes, we wouldn’t be required to plead for every service they need, I hope. Nobody would say: “but your daughter has had a lot of inhalers already!”

    If you and Steven get shafted by this I am sure we are all poised to protest loudly on your behalf to any service you nominate . Good luck-when will you hear?

  7. Ah, the “Fairer Charging Policy”.

    That would be the one where, when I was working on a £30,000 salary I didn’t have to pay anything at all towards my care but, now that my illness and disability have progressed to a point I can no longer work I have to pay £80 per week out of my benefits.

    I’m told it is to give me an incentive to work. I’m in the support group of ESA. Which bit of “unfit for work and unlikely ever to return to the workplace” is hard to understand?

  8. Weary Mother permalink

    If you seek help from any of the theorists onthe law on safeguarding, for example, they will quote the Statutory role and responsibilities of LA’s.

    The fact that LA’s have savaged the amount and quality of support to vulnerable learning disabled people, many of whom are middle aged or older,would indicate that they (LA’s) are breaking the law?

    As already commented, our sons and daughter’s have not got fitter and/or more intellectually able in the past decade. It is even more complicated where learning disabled people are married. They are now seen as each other’s carer. Their learning and/or mental health disabilities may be radically different, and no less serious, but support can be hacked back to well below dangerous levels on ill thought out down right daft assumptions. That two very different disabled individuals, together, make the other more able, for example; assumptions too often made in less than half an hour by , …………………, to put it mildly, ‘ill equipped’ assessors.

    Elderly parents are now picking up crises after crises. For example cuts have been so severe that access to health care has been withdrawn unless old parents pick this up, and where sons/daughters are married – picked up for the couple. And these loving married couple, our disabled sons and daughters. are left with lives of continuous fear and a failure to cope. How do you audit all this on a balance sheet?

    Marriage brings compensations and compromises, but where two very vulnerable intellectually disabled people are left to deal with every issue, without support or understanding, life can become intolerable for both. However much they love each other.

    As Mark has described so cogently, once our children become adults our role in their life, as imposed by LA’s, changes radically. We are outside the system when cuts are imposed, or when things go wrong; we are dismissed as ‘too over protective – too intrusive etc etc’, until the cuts bit.. Now we are ‘it.’ We are the resource that fills all gaps. Parents touching eighty are a/’the’, resource.

    There is a route to a dialogue about all this with our LA’s, and that is through the law. If a legal aided solicitor can be accessed. And this t

    It all takes years, and lives.And through all we have to retain our cool and our dignity; we must ride all the disrespects and the patronising (at best)dismissals. But it is killing us and ours.

  9. Believe it or not one of the guys I work for Just got the results of his review in, wait for it ………..September. He’s kept his existing package. Couldn’t believe it, so read it through 3 times before it sank in. Sometimes it happens.

    • Helen Hale permalink

      They can use the RAS to give an indicative budget but if the budget is insufficient to meet the assessed needs then it has to go to risk and safety. Dan’s indicative budget had to be tripled to actually meet his needs last time around. Points system is totally skewed – they allocate more points to needing 2 people to wash you than they do to needing 2 people to keep you safe! – but which of those 2 services costs the most!?! Just going through a reassessment again ourselves so will keep you posted.

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