Following a pathway to impact

Valerie Lipman

Valerie Lipman

The Social Care Workforce Research Unit is part of the Policy Institute @ King’s, which is furthering the cause of evidence-informed policy and practice. Valerie Lipman, a social gerontologist and a postdoc Intern at the Unit, reports on an event which examined the questions that arise where academia, funders, policy-makers, and practitioners meet.

I went to a great panel discussion last week: ‘The impact of impact: who are we researching for?’. The event, the last of the year organised by KISS-DTC* was moderated by BBC journalist Mark Easton. Lots of talking about the history of research, its purpose, why do we do it, what’s meant to happen to it when done, and who cares? And that for me is the critical question. Who cares, or rather who do I want to care about the research I’ve done? Why would you bother doing social science research unless you wanted something to be different as a result? This view has been the order of the day for some time now, and the proof is in how money is made available for research, and the ability of those carrying out the research to disseminate and inform others.

From their different perspectives three panellists presented the case about why impact matters. In the academic corner we had Dame Janet Finch, chair of the social sciences panel for the REF, arguing a strong moral case that researchers have a responsibility to make their research available and that the ‘impact’ element of the REF is here to stay. Aileen Murphie, Director, DCLG & Local Government VFM, promoted the need for evidence-based policy, though as members of the audience argued this can result in favouring government priorities occluding an openness to new ideas. And representing a position between the academic and government worlds was Anthony Tomei, former Director of the Nuffield Foundation: the voice of independence, risk taker in what research to support and an advocate of the importance of quality research that can effect change.

The time when research was allowed to be an expression of freedom and a search for the new—an opportunity to delve into the unknown and emerge with the prize that would change the thinking and actions of others to make a better world—seems to have passed. On the other hand I’ve worked with people in university research departments who’ve never thought about what the purpose of their research was. It was the job of others to interpret the findings and take it further. Obviously, you shouldn’t know the answers to the questions before you start the research or skew your questions to meet what you want it to show—’policy-based evidence’ as someone at the meeting described it. But there must be a way of deciding at the start that you’ll want the results of the research to matter, so how about building in processes at the outset that stimulate debate as you go along … following a ‘pathway to impact’, as Janet Finch said, not merely waiting till the obligatory conference and a couple of academic papers at the end?

Valerie Lipman was recently awarded a PhD by the Centre for Ageing at the University of Southampton. She is a postdoc Intern at the Social Care Workforce Research Unit, developing material from her doctorate for publication here at King’s.

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*KISS-DTC = King’s Interdisciplinary Social Science Doctoral Training Centre

 

Personal Budgets for adult social care and support: are homeless people eligible?

With the Care Bill entering the report stage in the House of Commons shortly, Michelle Cornes urges us to take part in the debate over what constitutes eligible need in relation to adult social care and support. Dr Cornes is Senior Research Fellow at the Social Care Workforce Research Unit (SCWRU) at King’s College London and recently completed a major ESRC-funded project examining Multiple Exclusion Homelessness. Her work forms part of the Homelessness Research Programme at SCWRU.

As funding for Supporting People services continues to shrink (see Patrick Butler’s article in The Guardian, 12 February 2014) it is timely to revisit the question as to whether homeless people are eligible for publicly funded social care support (e.g. personal budgets secured through adult social care) or personal health budgets. The Care Bill currently going through Parliament heralds some positive changes that may serve to open the door to this funding stream which has, de facto, mainly been closed to homeless people. As the law currently stands ‘homeless people’ are not eligible for support (though ‘homeless people’ with mental health, physical health, and drug and alcohol problems may be). The Care Bill will remove ‘eligible’ and ‘ineligible’ groups so that any adult with any level of need will have a right to an assessment (Department of Health 2013: 1.9).

Under the existing guidance, the purpose of a community care assessment is to assess need in the round. The guidance is clear that needs relating to social inclusion and participation should be seen as just as important as needs relating to personal care (Department of Health 2010: 61). It is perhaps worth noting that housing related support can be purchased using a personal budget from adult social care. In Scotland, 11% of direct payments and self-directed support packages in 2012 encompassed this element (Rosengard et al. 2011).

Once a community care assessment has been carried out, a decision must then be taken by the local authority (on a case-by-case basis) about whether the needs identified are eligible needs. The eligibility framework is graded into four bands which describe the seriousness of the risk to independence or well-being (Department of Health 2010: 54). This considers issues such as the ability to carry out personal care or domestic routines, whether vital involvement in work, education or learning can be sustained and if vital family and other social roles and responsibilities can be undertaken. Risks are banded as low, moderate, substantial and critical with many councils only meeting those needs identified as substantial or above.

Making decisions about which banding to apply and ultimately, who is eligible for a ‘personal budget’ is open to professional interpretation. With increasing austerity, the regulator has taken issue with those local authorities identified as being too restrictive. For example, Michael Mandelstam highlighted a recent case in which a local authority visited a woman at home, assessed her as managing her own personal care and closed the case—having first recorded that she was unkempt, her knickers were around her knees, there was evidence of faeces on the floor and she was not taking her medication (2013: 123).

Evidence from the Multiple Exclusion Homelessness Research Programme (Cornes et al. 2011) and other studies suggests that people who are homeless fare particularly badly in getting their needs banded correctly, often struggling to access an assessment at all. There is evidence that homelessness is written off as ‘lifestyle choice’ or as a housing responsibility, with the ‘substantial’ and ‘critical’ risks posed to well-being ignored or overlooked. The notion that homelessness poses mostly low to moderate risks to well-being is most clearly challenged by the startling statistic that the average age of death of a homeless person is 47 (43 for a homeless woman) as compared to 77 for the general population. The Care Bill (page 2) makes explicit the need to challenge discriminatory practices so that decisions about the individual are made having regard to all the individual’s circumstances and are not based only on the individual’s age or appearance or aspect of the individual’s behaviour which might lead others to make unjustified assumptions.

The problems with the way eligibility criteria are being applied are acknowledged by the Coalition Government. The Care Bill will introduce a national minimum threshold for adult care and support and there are plans to replace the current ‘Fair Access to Care’ (FACS) eligibility criteria in 2015. A new description of what is eligible need will be put forward for consultation in 2014 and a discussion document is already in the public domain (Department of Health 2013). I would urge all those working in the homelessness sector and those interested in challenging social exclusion to respond to this consultation. Without doing so there is the danger that homeless people will continue to be denied the support they are entitled to and, given what we know is happening to Supporting People services, possibly robbed of the little support many already have.

Dr Michelle Cornes is Senior Research Fellow at the Social Care Workforce Research Unit. She recently completed a major study on Multiple Exclusion Homelessness funded by the ESRC. For work on homelessness at the Social Care Workforce Research Unit at King’s see our Homelessness Research Programme pages.

The Social Care Workforce Research Unit is part of the King’s Policy Institute (KPI) at King’s College London. The Institute is involved in the translation of academic research at King’s to the benefit of policy and practice.

References

Butler, P. (2014) If supported housing is cut, we will see more rough sleeping and more crime’. The Guardian, 12 February 2014.

Cornes, M., Joly, L, Manthorpe, J., O’Halloran, S., and Smythe, R. (2011) ‘Working together to address Multiple Exclusion Homelessness’, Social Policy and Society, 10(4): 513-522.

Department of Health (2010) ‘Prioritising need in the context of Putting People First: a whole system approach to eligibility for social care – guidance on eligibility criteria for adult social care, England 2010’, London: Department of Health.

Department of Health (2013) ‘Draft national minimum eligibility threshold for adult care and support. A discussion document’, London: Department of Health

Mandelstam, M. (2013) Safeguarding Adults and the Law. London: Jessica Kingsley.

Rosengard, A., Ridley, J. & Manthorpe, J. (2013) ‘Housing support and personalisation: observations from the Scottish Self-Directed Support test sites’, Housing, Care and Support, 16(3/4): 136-144.

Nearly there? The Care Bill and adult safeguarding

Caroline Norrie and Katie Graham provide an update on the progress of the Care Bill through Parliament with particular reference to its impact on adult safeguarding.

The Care Bill—described as “the biggest overhaul of social care rules for 65 years” (The Guardian, 9 October, 2013)—had its first reading in the House of Commons last week after completing its passage through the House of Lords. The scope of the Bill is extensive, attempting to amalgamate the dispersed and patchy adult social care legislation and including stipulations around social care assessment and funding changes. However, as researchers working on a project about adult safeguarding, we have been following the new adult safeguarding components of the Bill with much interest.

Katie attended the second reading of the Bill on 22 May. Lord Howe presented wellbeing as a central principle of the Bill whilst outlining plans for care funding arrangements (following, though not implementing, all Dilnot’s recommendations), a response to the Francis Report (not including the recommended regulation of social care and health care assistants), a strengthening of carers’ rights and a commitment to place adult safeguarding on a statutory footing.

The principles behind the Bill appeared to be welcomed by many of the speakers that day in the House, although with important caveats. Lord Howe alluded to one of the fundamental difficulties enacting the vision when saying “[a]s a nation we are living longer, which I am sure all noble Lords welcome. Managing the fiscal consequences of this will be a key challenge in the coming years”. Baroness Wheeler brought into stark reality the dire state of local authority funding, highlighting that councils “…by the end of this spending round, will have been stripped of £2.7 billion from their adult social care services, equivalent to 20% of their care budgets, as demand for services increases”.

More recently Caroline attended the House of Lords to listen to amendments tabled at the Bill’s 1st sitting of the report stage on 9 October. Discussions included an amendment which was successfully tabled by the Patron of Action on Adult Abuse, Baroness Greengross, to introduce a duty on councils to provide people with an independent advocate during assessment and support planning if they would otherwise have difficulty in understanding or communicating information, and have no one else to represent them.

Baroness Greengross also proposed amendments aimed at giving social workers powers to obtain court orders to gain access to enter private homes where they suspect a vulnerable adult is being abused but coerced into silence. These amendments were defeated with ministers arguing that existing legal powers were sufficient and social workers needed to improve their skills and knowledge in applying them to protect adults. (Power of entry is already available to social workers in Scotland.)  A survey of The College of Social Work members last year showed strong support for a qualified power of access by a social worker to interview a vulnerable adult where this was being blocked by a third party. Lobbying on this issue continues.

Other elements of the Bill with specific implications for safeguarding practice include:

Enquiries by Local Authorities

The Care Bill proposes a new legal duty for local authorities to make enquiries when they have a reasonable cause to suspect that an adult in their area has a need of care and support, is at risk of abuse and neglect and is unable to protect him or herself. The local authority must make whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in that adult’s case. The Care Bill also confirms, for the first time in law, that “abuse” includes financial abuse. That includes having money or property stolen; being defrauded; being put under pressure in relation to money or other property; and, having money or other property misused. Advocacy organisations including The College of Social Work have been active in lobbying to ensure that people with complex needs are assessed by ‘appropriately qualified staff’.

Safeguarding Adults Boards

Safeguarding Adults Boards are to become statutory and to be composed of multi-disciplinary members. Again, The College of Social Work, amongst others, has been vocal in lobbying to ensure that the local authority representative on safeguarding adult boards should be social work-qualified.

Safeguarding Adult Reviews

The Care Bill proposes local authority Safeguarding Adults Boards must carry out a formal case review if an adult at risk in their area dies in circumstances where abuse or neglect are known or suspected. It must also carry out a review if it suspects that an adult has experienced serious abuse or neglect. Any review must identify the lessons to be learnt from that adult’s case, and apply those lessons to future cases. The stated aim of a review will be to ensure that lessons are learned from such cases; not to allocate blame, but to improve future practice and partnership working, to minimise the possibility of it happening again. With regard to this issue, The College of Social Work has argued for Safeguarding Adult Review teams to “include a social worker with substantial experience of safeguarding work”. Our Unit continues its work on the current system of Serious Case Reviews for adults.

Last week saw the third reading of the Bill in the Lords; a time for tweaking with no major changes suggested. However, there was considerable discussion over an amendment that was tabled, but which after discussion was removed. This focused on safeguarding of vulnerable adults in ‘approved premises’. Lord Patel of Bradford argued that vulnerable people in probation services are not adequately catered for in the Bill and called for a review on “the discharge by probation trusts of their responsibilities for safeguarding adults residing in approved premises” a year after the enactment of the Bill. Lord Patel argued that planned privatisation of probation provision could make it difficult to ensure effective safeguarding provision for those people using probation services. This abandoned amendment raised once more the question of the clarity of roles and responsibilities of all agencies working with people who may be at risk of abuse.

When summing up her contribution to the second reading of the Bill Baroness Campbell said that much depends “on how local authorities choose to implement their responsibilities and powers under this legislation. There is a great danger that this Bill could be ignored as fine words but without teeth”. We await to see what changes, if any, will be made to the Care Bill as it now proceeds through the House of Commons.

Caroline Norrie and Dr Katie Graham are both researchers at the Social Care Workforce Research Unit, King’s College London. They are working on: Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults – currently in its fieldwork stage.