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One Man’s Safe Care is Another’s Maximum Expenditure Policy

October 18, 2014

I’ve been feeling so bloody low since Wednesday. First up was the news on Tuesday that my request for extra nights won’t get to Panel. I was advised that the LA now operate a policy whereby when deciding on funding a care package, they compare with cheaper options that they feel will still meet the assessed needs. I was given the example of a recently opened block of “independent supported living flats” where at nights, there are two support workers present per nine residents. This is obviously cheaper than 1:1 in someone’s own home. Then the following evening around 7pm, I came past the same flats and noticed all the lights were on. Nobody was in the communal room. One support worker was sitting on a chair in the passageway, reading a paper. All the residents must have been in their rooms.

What kind of life is that? Where is the engagement? Steven is very busy between 7pm and 9.30pm. He does lots of shared things during that time, either with me or with his support worker. We do lots of talking at that time of night. I think he would be totally freaked out if he was left alone in his flat from 7pm until whenever the support arrives the next morning. I think he would be very very scared.

Two years ago, Lucy Series wrote the following blog post about Worcestershire Council’s brazen plan to operate a “maximum expenditure policy” – The bottom line is that anyone with care needs that cost more than a residential placement would only get their needs met up to the level of the placement, or be forced to go into a residential placement. This was their statement on the plan:

‘It was noted that application of the policy could result in services being delivered that would not be people’s first choice about the way they receive care. In such circumstances there will be a range of options discussed with service users, including arrangements liked shared living, assistive technology and other types of appropriate support to meet assessed eligible needs rather than expectations. This aims to balance available resources with the duty to meet assessed eligible need and to do so in a way that was transparent, equitable and enables the best use of resources. It is expected that this will lead to an agreed positive outcome in most cases. An appeals process will be available if required

Shocking deception and use of language to cover the true situation, isn’t it? But it looks like it’s catching on. I’m not sure how they can square an assessed need of 1:1 support at all times with 2:9 support in a supposed “independent environment”. And of course, if the person has to move into a residential placement because their needs WON’T be met at home, there is no way they will get 1:1 support there either.

A couple of years back, there was the infamous case of Kensington & Chelsea where, fed up with paying for night time support for a client, the LA “reassessed” her needs and decided that her night time needs could be met with incontinent pads (she wasn’t incontinent). (the full judgment is here – It was totally cynical to argue that her needs were still met but sadly, the court agreed with the Royal Borough.

These decisions are important because they shift the social care foundations. Forever on the lookout for a loophole, LAs seize on these decisions and push the boundaries even further. Humanity and decency are long forgotten ideals. Compliance with the Mental Capacity Act a forlorn hope. Nothing is pure enough in it’s intent that it can’t be manipulated into an abhorrence like a maximum expenditure policy.

And then today, Chris Hatton posted the following link on Twitter – A lovely, heroic company who’ve built a “seclusion room contactless monitoring” system. Every single word in that “system” chills my bones. But why should it, the people in the independent living flats the other night might just as well have been in a seclusion room. The residents had a “contactless” evening and night. Don’t dare hope for your loved ones in these places to be engaged – being monitored is the best we can aspire to.

All this horror has got inside my head. I keep fantasizing about what is going on behind the locked doors of those flats. Would the support worker ever put his newspaper down and go and talk to one of the residents? And I keep getting pictures of Steven in one of these places. Frightened. Lonely. But he wouldn’t be there for long. He wouldn’t;’t be able to cope with the anxiety of the situation. His behaviour would deteriorate and he’d end up in a locked ward or the criminal justice system.

And it wouldn’t matter to anyone because the maximum expenditure policy hasn’t been breached

The #LBBill is all about allowing people to live in their own home or a home of their choosing. Faced with the likes of Worcestershire CC, Royal Borough of Kensington & Chelsea and Vitalguard, we’ve got one heck of a job on our hands.

From → Social Care

  1. weary mother permalink


    If the anxious, lonely and isolated residents are given a generous cost effective tablespoon of sedative syrup after tea, they won’t know they are anxious, lonely and isolated till the morning? Then who needs the man with the newspaper………

    Brave new world.

  2. Until we get rid of the main Westminster parties this is what we will get and what we will subject our children to. Here in Scotland we had a chance at change but it was taken from us by lies and manipulation. We live in a society with no value placed on the care and welfare of the vulnerable, frail, elderly and disabled. The seclusion room is absolutely disgusting as an idea that any civilised society would consider. We pay carers minimum wage or marginally above for providing one of the most important and responsible roles you could have to carry out. At the same time we spend billions on wars and WMD. The media portrays benefit claimants as scroungers and chancers while the Tories give tax breaks to the rich and attempt to balance the books by villifing and penalising the vulnerable. Britain is a failed rogue state. Human Rights legislation will be removed if the Tories/Ukip get power next year – a move justified by stories about people in jail perpetuated by the gutter tabloid media. This Seclusion room and authorities considering using it is just the very type of issue that illustrates exactly why Human Rights legislation is more relevant in the uk today than it ever has been. I can understand why you feel so low Mark. I do as well every time I consider these types of issues.

  3. I’ve just emailed the company to ask if the system picks up on altered breathing, which might indicate emotional distress, or just stopped breathing as in the case of cardiac arrest. Is this seclusion, or bloody solitary confinement?

  4. I am in the US but have been following your blog for awhile. I have two friends who have siblings with autism-one high functioning enough to live in a supported apartment and another who is non verbal and needs 24/7 care. I’ve seen how difficult it has been for the families to figure out future care options and with our rather minimal social care it has come down to oldest sibling forget having a life or family you are the caregiver. I hope thought that with the better social care the UK has at least you guys have a fighting chance of building something from an imperfect foundation that may in the future be more fit for purpose.

  5. Lisa permalink

    Mark this horror is always etched in my head. I totally understand. Lets
    pray we live beyond our vulnerable kids.

    J, Yes lets hope so.

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