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Care Without A Middle Man

January 14, 2014

Personalisation? Check.
Co-production? Check.
Choice? Check.

You may remember that Steven had his FACS assessment in November and there were dire warnings issued that it was highly likely the package would have to be cut as it was too expensive to continue. That was the bottom line, although it wasn’t discussed in those terms of course. After examining the invoice from the cab firm that supplies Steven’s transport, we had a long discussion about Steven’s “independence” and how that could be further encouraged by the use of public transport. Etc etc….

After the assessment, I did the sums and discovered (to me) the shocking statistic that 54% of the money the council pays out each month for Steven’s care goes directly to the profits of the firm that supplies the transport and the agency that supplies the support staff. 54%! Acting quickly because I reasoned that once something has been taken away, it is much harder to get back, I submitted a proposal, whereby the council pays me the whole support package in direct payments – reducing the current package by 32%. A win for Steven because his life won’t change at all. A win for the support workers because I will be able to pay them £2 more an hour than their agency was paying them. A win for the council who save a whopping big sum of money.

Today I received the news that Panel have agreed my proposal and I will be visited by a care planner to draw up an implementation plan. My guess is that it will get going in April for the start of the new financial year. I don’t know if the council has to give the agency a period of notice – that’s between the two of them to sort out.

I hope this doesn’t sound too grand but I think this has been a very important moment. I’ve written many times before that so often in the social care world the communication between professionals and service users and their carers is a sham. You find yourself talking about something with everyone knowing that the main agenda is being hidden (i.e. money). From the start, I cut through all the usual crap and spoke purely about money. All those concepts (personalisation, co-production and choice) that I mentioned in the opening paragraph are important but they are red herrings when discussing a care plan. The minute we start engaging in conversations about choice, we have taken our eye off the ball and played right into the game. By laying the money card on the table from the outset, there was no chance of the matter being hijacked.

Importantly, everything about the proposal was in Steven’s best interests. We would have looked right muppets if we’d agreed to a reduction in transport, under the guise of promoting Steven’s independence and then found we didn’t have the money to fund him going anywhere. If we had gone down the independence route, Steven would have become much more dependent. I think this is the way forward. Cut out the agency middle men. Cut out the distracting, deceitful social care agendas. Go straight for the jugular and cost a package that will work for you. If you can demonstrate that your costing will be a damn sight cheaper than anything that could be provided by a directly commissioned service, all the better. That shouldn’t be too difficult as the level of mark ups most agencies charge is obscene. At no point is the person’s needs or quality of care compromised by such a proposal – on the contrary, if you can pay the support staff more than the agency pays them, you’ll end up with a more contented, settled staff.

This will sound grand to end on – I’m also happy today because this feels like a very ethical resolution to the charades of a FACS assessment. I’m not interested in giving it a sexy name, like personalisation. For me, it just feels like a bloody good result.


From → Social Care

  1. Suzanne Morrison permalink

    Well done you and steven you are an inspiration to all us carers who find themselves in similar situations. reading your blogs helps me cope with our situation.

  2. swanarchie07 permalink

    Mark your blogs have always giving me some grwat in sight into adult social care world. I have a long way to go with my son but unfortunately due to very poor health I have entered the care side with my dad and shocking and beggers believe just doesnt cut it. If I really did have the energy and had some more time on my hands I would challenge it but because my father knows no different he is happy with the service he doesnt get the hidden agendas that the likes of you and me see. Dad can make decisions on his own xxx

  3. Mark Grainger permalink

    Hi Mark, isn’t it both amazing and frightening at the same time, that the simple calculation that you made regarding the relative costs of you providing Steven’s transport needs at a much lower cost to the local authority versus the taxi costs, could not be figured out by the “brains trust” that they allegedly employ?!! Hoorah for common sense, and well done you 🙂

  4. Slowly, slowly you are getting there. You are one amazingly stubborn chap, who loves his child.

  5. Louise permalink

    So pleased for you both. It’s about time the council did something right by you both for a change!

  6. Shirley Buckley permalink

    Mark I reckon this is one of the biggest wins ever earth moving! You are now in control The implications of the money that has been wasted are huge and that it has not only been allowed but promoted

  7. Thrilled for you both.

  8. Sally permalink

    Well done you. You are an inspiration.
    What exactly are the Agency meant to be providing to justify the mark up? Some sort of built in monitoring/training of the helpers? Some sort of responsibility to replace helpers who leave/fail? OK, I can see that-however, I am never clear who if anybody is meant to pursue the Agency if they don’t fulfill those tasks-if its us, then we may as well get the money directly.
    The Taxi firm is even more deceitful. What extra service is being provided by who to justify the mark up? Training for taxi staff? Special insurance? What?
    I feel insecure about getting the money direct- because I don’t want to do even more sftaffing/payroll work and am not very good at sussing out poor/unreliable carers.
    I do see the maths are an excellent argument. I have tried to introduce this in dealing with the LA, and am usually met with the bland assurance that “decisions have nothing to do with money”. (!) A complicating factor is when something unsatisfactory will cost more-but won’t cost the service making the decisions more so they aren’t bothered. (“Why should we care, Health will pay for that…”) Congrats to you for getting the figures-not easy to do.
    Could your victory help with the Day Care centres? Could parents show that such a centre could be well run for less than the cost of one of the hopeless Independence projects? H’mm.

  9. Weary Mother permalink

    Thank you Mark

    Your blogs help us to keep going. Your mature eloquence and resilience and your love and belief in your son has taken you to this place for Steven. Not one of us underestimates how much of you and your life this has taken, nor how frequently it will be needed in future. Not all of us can take on the financial management of care plans, but your calm negotiation with people who have so disrespected you and Steven, and after all you have endured, encourages us all.

    It a righteous battle ‘won’ ; in a grinding terrifying ‘war’ that should just be a mutually respectful and ongoing dialogue between peers. We are very little people forced into this battle with only our parental love as our weapon…against a Goliath it seems. Of course this is not always so, but we parents always need more maturity, more resilience, and much much more importantly, WE must always keep our cool, to retain a dialogue with the people paid to help us. This is so difficult to achieve currently where organisations are manned by people focused on the bottom line; people who too often are as worried and frightened as we are. But people who too often, for whatever reason, can make wrong, and at times dreadfully dangerous decisions. As a man once said ‘ the bottom line is always paid by the vulnerable ‘.

    if we could only get these people who feel threatened by us, to understand that we parents of very vulnerable son’s and daughters have only a fraction of a life; the rest is going in caring (with love and intelligence – and both appear too often denied by the BIG people) and the grinding continuous failure to protect: and fear of the next assessment, the next crises, and watching the horrible terrifying deterioration in health and happiness of the amazing real and unique person that is our loved one.

    When the really dreadful thing happens, after we have rallied all that we are, and what we can be over and over, we eventually feel we have lost us, not just the power and strength to protect, We become almost catatonic with this failure; the grinding dread and total powerlessness. This loss lasts for years, if not for ever. Your emotional resilience and strength and your GOLIATH ability to behave with lucid maturity while being continuously kicked deep in the gut, is more than inspirational. Thank you.. Thank you, for your arm.

  10. Meg permalink

    Well done Mark! I have been following your musings and rantings for some months now and I am so happy your determination and perseverance have paid off and you finally got a resolution that will benefit everyone except the profiteers. I wish you, Steven and his support team all the best for the future. And again. Well done you!

  11. Pat permalink

    Good for you!! If only many others had the courage to do what you’ve done these local authorities may actually realise they can’t walk roughshod over everyone in their path.

  12. Pauline Thomas permalink

    Well done Mark. I am so pleased for you but I also admit to being so jealous of your grit and determination. I wish I had your strength. I did try so hard to stop my son’s day centre being taken away but unfortunately the other side had all the big guns as well as an army of ‘shits’ they cal social care managers. Now my husband and I are so tired and old. Lets hope your huge victory will be rolled out across all LA’s for all the carers who want direct payments.

  13. Liz. permalink

    Ummm, I got that far, with the approval of the social worker – and was then told I couldn’t employ the agency’s staff without paying an enormous transfer fee. As they have trouble finding/keeping good support workers (and they did train them) I ended up having to employ them through the agency – and pay their fee.

    The taxi thing is scandalous, though.

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