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Personalisation Vs Profits – Who Wins?

November 23, 2013

I’m entering an interesting and unexpected phase in my relationship with the Council. I’m about to do them a massive favour and save them an absolute fortune.

I wrote on Tuesday that Steven had his FACS reassessment. There was an undertone throughout the meeting that things after the assessment won’t be as good as before. Cuts to his package seem an inevitability. Reference is often made to Steven being “expensive” and in court, I had to listen to one of the care managers say many times that Steven has a “gold standard care package”. Those phrases induce a feeling of guilt and embarrassment in me, which I suppose is the intention. The same thing happened on Tuesday – talk of “high needs” and “very expensive commissioned services” left me squirming. That’s the way it is in social care – the person with the needs becomes the problem, the expensive problem for having the needs they have.

We spent a lot of time in the meeting discussing an invoice from the firm commissioned to supply Steven’s transport. There was a hidden suggestion that I am ripping the council off. The social worker made notes of every journey Steven goes on and questioned the costs of each journey. I was in the dark – the council commission the cab firm – I had no idea what the charges are. The same threat was there with contract they have with the support agency. Some talk of the agency having to charge high fees because of Steven’s “high needs”. Once again – Steven is seen as the cause of the problem, in this case, the large cost of his care package.

Since Tuesday I have had my Poirot head on because I’ve been determined to sort this out. I had an instinct that the package would be substantially cheaper, if they paid the whole lot through direct payments. But I needed evidence to justify my stance. I had the idea of submitting a proposal to the council whereby they cover the package through direct payments but needed firm figures to support my argument. Through a mixture of dogged detective work and two flukey chance encounters, I’ve got all the figures I need and the result is truly shocking.

I want to point out that I’m not going to mention the overall, big figures here. Partly out of preserving Steven’s confidentiality but also out of respect for the support agency and the cab firm. I am not being critical of them. They are both businesses and their first priority is to make a profit for their shareholders or directors. I am being critical of a system that allows such abuse of the vulnerable to take place. Besides there is only one figure that really matters in terms of showing how screwed up the system is. Hang on to your hats…….

52% of Steven’s monthly care package budget currently goes directly as profits to the support agency and the cab firm. That’s 52 sodding %. We are talking four figures here. 52% of Steven’s gold standard package has got nothing to do with his care and meeting his needs and is all about the profit making of two businesses. I’ve checked that figure over 20 times because I still can’t quite believe it.

Steven doesn’t need that 52% – his needs are completely met by the other 48%. And by nudging over 50%, it demonstrates a stark truth about the social care world – the person at the heart of the care package is quite secondary to the many people who can make a tidy sum out of him. Is it just me or is this a huge scandal? Of course it’s not just happening to Steven. Is every single support package that includes directly commissioned services weighted in the favour of the provider rather than the person needing the service.

And let’s not even go into the constant bleating about the lack of money in the pot. There’d be a bloody sight more money if it wasn’t being trousered by so many people after a quick, easy and reliable profit. There’s a fundamental greed in all this too – the agency charge the council more for the weekend shifts but don’t pay a penny more to the workers who do a weekend shift. I struggle to see how you justify moves like that.

So, I’m going to submit a full costed proposal to the council, which will slash Steven’s current package by over a third. All the support, respite and transport to be paid by direct payments. Hillingdon have a set rate of £10.72 per hour. If they accept my proposal, I will save them £6 per hour for support and be able to afford to give each of the current team of support workers a significant pay rise from the present rate the agency pays them. Same with the cabs – the account fares are double (sometimes 150%) more than a cash fare from the likes of you and I. And the cab driver gets the full cash fare, rather than them seeing a reduced rate after the profits have been creamed off the account payments. A win for the support workers. A win for the cab drivers. A win for Steven as he will be able to maintain exactly the same level of support he currently gets. And a massive win for the council who get to save an enormous amount of money.

This is surely what Personalisation is all about. This surely what In Control is all about. Me, on Steven’s behalf, has had an active part in compiling the support package, costing it, chosing who provides it, and managing it once it’s in place. And it should please the efficiency savings brigade as it reduces the budget by over a third.

Any flies in the ointment? Well, Hillingdon currently have a purely arbitrary ceiling on their level of direct payments. I’ve scowered their website and can’t find anything in writing about it but I’ve been told several times in the past that they only allow direct payments to cover up to X hours of support each week. Steven’s hours exceed X. Will they relax this local rule if it means it will save them a fortune? Or will they put policies and power before common sense and financial savings. And before taking a strong ethical position about the funding of care.

I’m reasonably confident that my proposal will be accepted. We have form on this. Do you remember my 2 year battle to get a respite budget? For a year, the council avoided paying anything by insisting Steven’s respite had to take place in the same unit they detained him for a year in 2010 – it was their only respite facility. Then I persuaded them to pay for a support worker to do an overnight shift at home, so I could get a night out. They agreed to this but pulled the plug after six months. The support agency milked it and charged them £165 for an overnight but only paid the worker £55 – the council were unhappy paying those sort of rates. I proposed they pay me £65 (all of which could go to the support worker) from the direct payment budget and save themselves £100. They agreed in minutes. Money talks – Needs and Care doesn’t.

Once again people – a vulnerable person has their needs assessed to enable them to have a decent quality of life. Nothing outrageous – just good day to day support and activities. But in accepting that, you have to accept that the agencies involved in providing the support will receive a huge chunk of the budget for their pockets. 52% of Steven’s care budget goes directly into their pockets.

I’ll lay my cards on the table. This is financial abuse of the vulnerable.

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From → Social Care

27 Comments
  1. Emma permalink

    I wish you all the very best in getting absolutely the best and most appropriate care for Stephen.

    I’m sure you’ve thought of this, but have you factored in pensions and NI contributions you would need to give the support workers if you employed them directly? Otherwise even if they got more cash in hand, they might be worse off overall. These costs can add considerable “overheads” – although probably not nearly as much as your figures suggest are being paid to the agency!

    Good luck

    • Yep – done that Emma. I’m not going to say what the support workers currently get paid by the agency but through direct payments, I can pay them £2.50 gross an hour more than their current gross pay.

      Steven is already getting great care. This is an attempt to preserve that care and in my own small way, challenge the notion that huge profits are readilly available from our vulnerable people

    • Liz. permalink

      Pensions? What on earth am I supposed to be doing about pensions? That never came up! I pay the best hourly rate I can, and tax and NI is deducted from that. I pay employers NI, and don’t really understand how that works. Then there is Insurance, and holiday pay, and finding cover, and CRP checks, hiring replacements….

      In your spare time….

  2. Great style of writing with all the right words that exposes the trickery of the system…….

  3. CathyB permalink

    Surely, the local authority should be monitoring charges, making economies of scale and generally keeping costs down while ensuring services meet the client’s needs? Otherwise what is the point of having a social services department?

    • Weary Mother permalink

      Exactly!

      Just as they should have been monitoring the care (abuse) at Winterbourne Hospital.

  4. Liz. permalink

    Baffling, isn’t it? And quite mad. However, if you hope to hang on to the same workers, you may have to add TUPE to your collection of acronyms. Agency workers can’t come and work for you directly unless you pay an enormous “fine” to the agency. My option was to pay the agency £25 an hour (while the worker got £9) or lose someone very important to my daughter. You have to learn about employment law, do all the paperwork, and account for every penny on DP – and get your head around the mysteries of “on-costs”. In the end it does work better though, and if you use a payroll company, not too complicated. When we swopped to direct payments, I argued for double the hours, (about half of what we needed) and got a budget less than the Council paid for the lower level of hours.

    Very taken aback by the taxi scam. People go on about the costs of disability benefits, but a whole lot of people seem to be doing rather well from the “care industry” – not least those making a good living from making our lives harder.

    Being made to feel guilty for sticking up for our children is a bit much, though, isn’t it?

  5. swanarchie07 permalink

    I am with you on this mark and I gave just done the same as you with my sons package and he is only 6. 2 years in appeals etc bit I won my personal budget (direct payment) saves them so much money. I can’t believe you only get £10.72 per hour in your area we get £11.60 per hour and thats childrens services adults get about 12 something it just shocks me how different each area is. I no my sons needs are met through what he now recieves and aaving them money as well so everyone is a winner. Hope they go for your proposal and good luck mark

    • Pauline Thomas permalink

      It baffles me to why an LA would prefer to pay more money to an agency than to a carer who is going to save them money. They bleat on and on about how much money social care is costing yet are unwilling to agree to someone saving them money. Are they worried that carers are going to rip them off or is there some sort of deal going on between the policy makers in the council and the agencies who suppy the care? Nothing surprises me anymore.

  6. sparrow permalink

    I hope all goes well for you Mark. My son doesn’t live with us and is supported by a vg care agency who train their staff very well and also have ongoing training/recruitment/monitoring. That doesn’t come cheap. How would you go about training and replacing a member of Steven’s team, would the budget cover training costs,sick absence, maternity leave etc? Best wishes

    • Liz. permalink

      The agency my council used was a charity, and did provide other things – classes, social things – and yes, fairly well trained staff. But also of course the wages of the not terribly efficient people who did the admin. I think part of the problem is the shortage of people who want to be carers, support workers, on poor wages and conditions. When the agency was short staffed, they had to hire from commercial agencies, and contribute to their profits. Having one Agency carer (from a team of five), yes, not having to pay extra for cover, figure out leave entitlement etc. is a plus – at a price.

      If Direct Payments are to work, then access to decent carers paid decent wages and properly trained has to be organised somehow, more efficiently than it is now.

      • I’ll be able to pay them a more decent wage than they are getting now. And I can make any training, Steven specific

  7. Sally permalink

    A brilliant article-as you said, the figures are shocking.52%!!
    You are very kind towards the taxi firm and others but how I would love to see the managers in court justifying those charges-especially the weekend increase which is not passed on to the workers themselves.
    Its an appalling rip off and there seems nobody in Social Services interested in doing the figures and asking if this is the best value for Steven’s money. (Value, as in what Steven actually gets)
    I have used direct payments infrequently because I am frightened. I am not very good with pay levels, don’t quite ‘get’ employment law and so on.That and a resentful, bewildered idea that the agency which says its there to care for my son’s welfare should be doing this.You are an inspiration to take it on.
    And oh, I really understand the embarrassment and toe curling when your child’s case is described as “Rolls Royce/gold standard/most generous” asif he/she is being driven around in a Bently and has liveried servants . Usually said with a suggestion of “And yet, this greedy parent who has inconvenienced us all in the first place by having such a child, wants more!? Is there no end?!”

    • Pauline Thomas permalink

      The trouble with you Mark is that you are an enigma. You are not fitting into their stereotype of what they expect someone who is not wealthy to be. They expect you to be uneducated and subservient. How dare you question them! They have never had their policies questioned by someone who should know his place! All I can say is thank god someone like you have at last had the courage to take them on and win. LA’s have all the big guns and they know it. However you have had a truly ‘David and Goliath’ victory. There is a god after all.

  8. Weary Mother permalink

    Chicken pie

    I have received a document from my son’s LA. It is called a ‘one page profile, -” the purpose is to ‘get to know someone easily’.’. Having read the ‘profile ‘ of my son, I am more, more, more than outraged. For it is pure chicken pie.

    This profile could read ”my name is Rover, my best collar is red. I am happy when I go for walkies”'(Waggie tail, pant pant).

    Long ago when my son came from home from school I used to ask him, (probably without really wanting an answer, for I was usually just in from work), what he had for lunch. He always said ‘chicken pie’. AlWAYS! I would then laugh and say ‘OK, no you didn’t have chicken pie,what did you have,and was it nice’. etc, and we would sit and have a chat?’ It took time but I wanted to hear it, and he knew.

    When I see him now, a middle aged man, and I ask him ”how are you’;, he always says ‘ fine;, and I say ;;chicken pie”. We laugh. and he knows I want to know’ and we talk.

    This ‘profile on my son is all chicken pie. For no one cares what it says or who he is. For it is just for the computer. Has nothing to do with him..

    These expensive issues: around competent/ useful assessments, appropriate services, direct payments, costs and charges, best value etc exist because no one is interested in the answer. ……………………..,and for the finger on the computer, ‘ ‘chicken pie’. is just fine.

  9. Mark

    Please don’t let them make you feel guilty about the cost of your son’s care. I’ve paid tax and national insurance all my life, partly to fund those few people who need care. I think I can speak for most tax and national insurance payers when I say we don’t begrudge your son one penny. So next time they tell you about Steven’s expensive care package you can tell them that’s what our taxes are for.

  10. Sally permalink

    I don’t think there any other area in which assistance is so begrudging and you are made to feel like a greedy selfish person demanding more than your child’s fair share at every turn.
    I definitely think this is the underlying message: that we have inconvenienced services/society by having such difficult kids and should be properly apologetic and grateful for whatever we are given. Recently a Daily Mail journo wrote an opinion piece attacking a single Mum who had found work as a journalist/cookbook writer as a result of her blogs on eating well on little money. The journo assumed she was a hypocrite/waster. One woman wrote in to support this and proclaimed: that ALL benefits should be abolished to force these slackers into work.
    She was clearly a very ignorant woman but it shook me. My son can’t work. He can’t support himself through work. He needs enormous help to manage social contact, get around safely, live.He would I’m sure one day love some simple sheltered work , but the sheltered employment places have been closed.We are all stuck between begrudging, can’t-you-be-grateful-for-this generous-package services,and people who clearly believe that all the disabled should either earn or cease to exist.Thank goodness for people like Frank!
    Mark we are all in suspense and hoping the LA see sense..

  11. Liz. permalink

    Have you read this?

    http://www.theguardian.com/social-care-network/2013/nov/26/how-fix-broken-homecare-system

    No need to worry about paying more, organising things better, a properly financed system: just teach people how to manage without!

    It fills me with dismay. Wasn’t “Independence Training” a few back in the list of wheezes that Council’s spend their training budgets on? They tried it – badly and inappropriately – on my daughter and damaged her confidence big time – I am STILL dealing with her fears and suspicions, and if anything it set back her desire for any degree of independence. She KNOWS it is for her a nonsense and a disguise for not so benign neglect.

  12. Sally permalink

    Jesus. That article is appalling.You can train LD people to stop needing help, sorry, to become independent? Our kids’ problem is that they are dependent. I see.
    Mark-have you read it? Help!

  13. Nichola permalink

    That piece by Atlantic is a load of twaddle written by a marketing monkey. Learning disabled people need the support to lead larger lives, not another ‘initiative’ to promote an attack on quality of life. It’s all been rehearsed before anyway–there is nothing new or radical about the ‘ideas’ in this feature.

    • Weary Mother permalink

      Sally/Nicholas

      I agree
      It is also very dangerous twaddle. While LA’s describe our son’s and daughters as revenue costs, and employ poorly/nil experienced people to assess these costs, there will always be believers in snake oil ……

  14. Liz. permalink

    More of the same in The Guardian today – and I would agree that it is dangerous, because it is starting to sound like a conversation that will exclude those of us on the receiving end.

    None of us would have any problem looking at ways of saving money while protecting care, but if saving money becomes the only thing that matters, heaven help us.

    • Saving money isn’t my motivation here Liz – its a by-product of trying to secure Steven’s care package. I’m fortunate because I obviously know the guys who work with Steven and hopefully will continue to work with him – so I could take this stance without worrying that Steven’s care would be compromised. And in a Panglossian world, think how great it would be if that money that currently goes to the firm’s profits benefits someone else struggling to get a support package

  15. Liz. permalink

    Of course it isn’t, I know that. (Though they do make you feel guilty….) Thing is, I tried the same common sense approach – and the LA didn’t, wouldn’t get it. Ended up arguing with their lawyers – much more hard nosed – and their Finance Department – on another planet – , and gave up in disgust. You are made of sterner stuff. Maybe mothers succumb to guilt more easily? Familiar workers and routines are very important to our charges, and consequently can be used against us. You end up compromising to protect.

  16. Kunjufu permalink

    The crime is the growing trend that appears to make ‘vulnerable adults’ a legitimate cash cow, that Care agencies, LA’s and now sadly a growing number of families use as a legitimate way to make money for themselves. The real crime is that if making a ‘profit’ or money at least afforded the vulnerable adults some level of care, as least it might just be bearable that they [vulnerable adults] are used as a financial football. However often in my personal experience vulnerable adults do not even get the pretence of care on any level.

    The biggest crime is the open callous disregard displayed by, LA’s, so called care companies and significant number of families of vulnerable adults who are openly colluding with this state sponsored abuse of the very needy. Personalisation is nothing but the rebranding of ‘caring capitalism’ legitimising the legalised abuse of the Vulnerable. If it is this bad now, what will it be like in 5, 10, 15 years down the road. The crime is not just what is happening now but what is likely to happen if nothing changes.

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