The Case for Change

The latest Government consultation relates to a 'who pays for care' argument known as "The Case for Change - Why England Needs a New Care and Support System". The fact that the system needs overhaul is not in dispute; Care Services Minister Ivan Lewis says himself that if he were devising a health and social care system now, he certainly "wouldn't start from here".

But with hundreds of thousands of patients, service users and family carers feeling the pinch of the credit crunch; rising fuel prices affecting care staff and meals on wheels; and social care departments nationally at breaking point, how is this question - arguably the most critical issue affecting public services in years - being asked? A website has been created - and you can find it by clicking on this link.

Local authorities are being asked to "create forums, networks and task groups which involve staff across all sectors, people who use services and carers as active participants in the change process". A very big ask, you might think. A very large price tag to convene all these groups and ensure fair consultation. But help is at hand - the Government is giving local authorities funding to assist.

How much does Kent County Council, with its forty thousand plus staff, its one and a half million residents and its twelve district councils get?

Five hundred pounds.

The Margate Drop In Centre

Went down to Margate again today, to visit the Margate Drop In Centre. This church hall facility is open from 10am until 3pm on Mondays, Wednesdays and Thursdays. I'd promised to come to the centre once or twice before, but sadly the diary hadn't worked out until now. Even then, traffic on Detling Hill was solid and I was half an hour late!

Many of the learning disabled service users of the centre were out and about, which of itself is good news, but there were plenty of users to chat to and find out what a very special place this is. My host was Vanessa, herself learning disabled, who works for KCC as a volunteer. At the Drop In, she's also the treasurer and the cook!

But what struck me was the confidence shown by those who use the centre. As well as the support from professionals, there's a huge amount of self help. I spoke to one chap who hadn't travelled on a bus since an accident a decade ago took his confidence away. With help from another user, last week he took his first bus ride. Other users go out to local schools to talk to pupils about hate crime.

The centre has an excellent website designed and built by service users themselves - click this link to see it - so I won't waste time repeating everything. But as well as a packed programme of activities (the users recently went on holiday to Butlins!) the centre provides professional expertise, advice and support on communication, benefits, housing, supported employment, placements, and even gives advice on personal safety, equality and diversity from the local Community Police Officer. It really is a wonderful service, and a credit ot the staff and those who use the service. I'll be back there before too long.

Roger Gale - a dedicated and hardworking MP

Dashed back from Margate to County Hall to meet with Roger Gale, Member of Parliament for North Thanet. I've met with Roger several times over the last few months - usually over social care issues. I don't always agree with him, but no one can doubt his passion, and I'm often told what a dedicated and hardworking constituency MP he is.

We spent an hour and a half discussing social care issues, both locally and nationally. Roger was particularly concerned about the modernisation of learning disability day services in Canterbury and Thanet, and I was able to detail our plans for the future.

I explained my visit to the Margate Drop In, and that I was concerned about some of the Labour Government's regulation and legislation as it related to those with disabilities. I'm concerned that when 'housing' is offered to disabled people, it's sometimes in quite unsuitable neighbourhoods. When disabled people manage to find employment, their benefits are often reduced or stopped completely if they work any more than a token number of hours.

This really isn't the way to achieve the kind of change we all know is needed, and I intend to work up some detailed proposals for change in due course. I hope Roger and other Parliamentary colleagues will lend their support to lobby the Government for change.

It's so obviously overdue.

Photo taken from Roger Gale's page on www.conservatives.com

Working across party divides is so powerful

I drove down to Ashford Borough Council's offices this afternoon to attend one of the regular Member Briefings organised by Kent Adult Social Services (KASS). Since I became Cabinet member for KASS, I've been really keen to ensure that County Councillors were both kept up to date with social care developments in their area, but also briefed on the issues and pressures facing the Directorate in general. More important than either of these, is that our Councillors need to know that they're being listened to - after all, who better to keep us up to speed with the latest local feeling and the politics behind the scenes?

And crucially as I said this afternoon to County Councillors Elizabeth Tweed, Mike Angell, Derek Smyth and George Koowaree - when KASS does something to affect the delivery of social care in their area, they'll be the first to get calls from local residents, so it's vital that we keep our Members up to speed.

It was a really productive meeting - senior officers from social services were joined by colleagues from the NHS and mental health to update on a range of issues, and we also had a chance to discuss some of the major strategic issues affecting the delivery of health and social care - such as the cost of choice; the effects of the credit crunch; Ashford's future development plans and the excellent work being done by the Ashford District Partnership Group for those with learning disabilities.

What a shame our outcomes so often become embroiled in party politics - working across party divides is so powerful.

Dartford, Swanley and Gravesham - a brave new world

Yesterday morning, I met with officers from Kent Adult Social Services, and County Councillors Christine Angell (Lab - Dartford), Maureen Newell (Lab - Gravesham) and Mark Fittock (Lab - Swanley).

I wanted my colleagues to see for themselves the services we were putting in place to replace the Queen Elizabeth Resource Centre in Dartford. We're decommissioning the existing day centre service from October, and officers are busy making sure that services are replaced in the communities of Dartford, Swanley and Gravesham.

It was invaluable to walk round the various day centres, community buildings and leisure centre with Christine - being hearing impaired herself, she has an eagle eye for disability access. A tough critic, she pointed out narrow doorways, steep ramps, too-small disabled toilets, lack of hearing loops and a range of other issues - all of which we put on the list for attention.

Of course there's always a huge amount of apprehension when services move from one location to another, and a deep-seated suspicion from service users that somehow we're "only doing this to save money" - that their new facilities either won't exist or won't be as good.

But as we move into the brave new world of personalised and community-based services, I can honestly say the new services in Dartford, Gravesham and Swanley will provide more choice, better locations and closer to home for hundreds of people, young and old with disabilities.

A long and productive working relationship

A really useful meeting this morning. I travelled up to London for a meeting at the Mencap head office in the Barbican with Dame Jo Williams, the Chief Executive, and Heather Honour the Campaign and Policy Manager, and Director of the Learning Disability Coalition.

Dame Jo and I had been keynote speakers a few weeks ago at an event at the St Stephen's Club on the future of learning disability services, and found that we had very similar views. We agreed to meet up to discuss points of common interest.

Our time together was really productive, and I agreed to share two Select Committee reports commissioned by Kent Adult Social Services - one on Transition and the other on Learning Disabilities. I also agreed that our policy officers would work together with Mencap to work up proposals to Government as to how Social Services, Health and partners such as Mencap could better work together to provide more appropriate services in line with the personalisation agenda which we all agree should be the way forward.

I sense that today was the start of a long and productive working relationship. For the sake of thousands of learning disabled service users, let's hope so.

The day from Hell ... and a curious case of double standards

I was invited to a Ministerial Launch of the Whole Systems Demonstrator Action Network by Care Services Minister Ivan Lewis today. Kent was recently selected by the Department of Health, along with Newham and Cornwall, as one of three national pilots for TeleHealth equipment. TeleHealth allows people with limiting long-term conditions such as COPD, high blood pressure or diabetes to remain independent in their own homes by monitoring their vital signs themselves and sending them to their GP by telephone.

The event started at 2.30pm at the King's Fund at Cavendish Square in central London. I had ordered a County car for 1pm, which at 1.20pm had still not arrived. By 1.35, my PA had ordered a taxi, which turned up at 1.40pm.

My friendly but inexperienced Eastern European driver followed his SatNav to the letter, on a scenic and circuitous route throught the Blackwall Tunnel, through the City - High Holborn was a particularly notable traffic jam - and eventually, in torrential rain and at twenty past three, into Cavendish Square.

The one saving grace was that, although I was nearly an hour late, I was not the last to arrive. That priviledge was reserved for the Minister, Ivan Lewis who arrived at half past three. He spoke for around fifteen minutes and then apologised for having to leave for a Commons vote.
My County driver had been told to pick me up at 2.30pm - the start time of the event rather than the end time! - and so he had to wait around for two hours until we finished at 4.30pm. The drive home was equally fraught, the driver claiming we had broken all records for the longest return from London, at around three hours.

I did feel that the formula was a little skewed - around sixty people travelled for what would have totalled hundreds of hours to Central London, to meet a single Minister who travelled five minutes down the road. Whilst I appreciate it would have been impractical for Ivan Lewis to drive miles out of town, for the sake of his fifteen minute address could we not have used an M25 venue and a video conferencing link?

From a Government who espouse green values and seem to want to heavily penalise road travel, it seems a curious case of double standards.

Vocation? For some, but clearly not for all.

On a visit to a respite care unit this afternoon, I was introduced to a chap who was clearly much younger than the others. He'd been there for seven weeks, he thought, and began to tell me his story. He'd been a scaffolder, until two years ago when his career had been ended by a stroke which left him paralysed on his left side. He was duly admitted to the Stroke Rehabilitation Unit at Sevenoaks Hospital.

One night, he'd wanted to use the toilet and pressed the emergency call button. The nurse took a while to come, by which time he's messed the bed. This happened twice, at which point one of his nurses "turned against him", and among other hateful taunts, had told him "of course, you'll never walk again."

Well, two years later, and he's been coming to our KCC unit regularly to give his wife and son a break. Whilst there, he's been working with the physiotherapist, and - at last - he can now walk along parallel bars, and last night, walked from the dining room round to his room aided by a four footed walking stick.

I was struck by the courage, spirit and sheer pluck. He admitted he could be "a bit grumpy", and that it took a while to get over the humiliation of being changed and bathed by staff, but full of praise and admiration for the care staff.

And - clearly a far better man than I - bore no malice against the nurse who got into his head and gave him so little hope.

Vocation? For some, but clearly not for all.

Even young carers deserve childhood memories

This morning, along with around a hundred other attendees, I went to the Ramada Maidstone, where Oliver Mills and Graham Badman, Directors respectively for Adult Social Services and Education - celebrated the launch of KCC's Young Carers' Strategy, "Invisible People". In the photo above (from the left), Chris Wells Education Cabinet Member stands with Oliver Mills, Managing Director of Kent Adult Social Services, raham Badman, Managing Director of Children, Families and Education, and myself.

Graham Badman spoke about the close work with voluntary sector partners, and thanked the young people themselves for making sure that "Invisible People" captured the poignancy of being a young carer, and the challenges faced by the public sector in developing their potential. He stressed the importance of them having lives of their own, and being able to achieve what they want for themselves.

He talked of the survey KCC has undertaken in its schools; of the importance of them identifying who their young carers were and what their support needs were. He especially suggested that schools could do more to behave in a 'non-conformist' manner to support the issues young carers regularly face.

But the biggest impact of the event was from a group of young carers, wearing "Face Behind The Label" t shirts. Holding up an 'invisible people' banner, they introduced themselves, then asked society to develop more creative solutions. They stressed the need to build up trust to find the hidden carers; since many families were afraid to admit their children care for Mum or Dad, in case the child is taken into care. Of most impact to me was the number of young carers who - to escape the reality that is their lives - are substance abusing.

Explaining that the credit crunch was affecting vulnerable families, Graham Badman spoke about the need for quality food. Most memorable of all, he suggested that children to deserve their childhood memories. It is incumbent on us all to do what we can to make sure they get the childhood they deserve.

A priviledge to be in local government

Following my two days of crisis innoculation training this week, I hot-footed it down to Bournemouth, where the LGA (Local Government Association) Annual Conference. This is a great opportunity to meet with colleagues old and new; to discover best practuce in other parts of the country that can be used back at home; and to share our own initiatives for the benefit of councils up and down the country.

It was in this last respect that I dashed down, checked into my hotel and rushed off to the Royal Exeter Hotel to give a presentation on the Kent TeleHealth Programme. KCC Leader Paul Carter gave a presentation on our Supporting Independence Programme, whilst other officer and member colleagues presented on Kent TV and the revolution in parent choice for those with learning disabled children.

The audience included Sir Simon Milton, Chairman of the LGA, senior policy staff from the IDeA and several other county councils as well as many district councillors from Kent.

As the presentations unfolded, I realised how lucky I am to work at Kent County Council - where innovation is a stock in trade, and where process and regulation takes second place against outcomes for the people we serve. Of course, as a large authority we have a little extra scope to try out new things, but all the same, it's a priviledge to be in local government at an authority such as ours.

Another vague "customer knows best" plan?

So it's finished. After a painstaking twelve months of work and after collating the views of around sixty thousand patients and staff, Lord Ara Darzi has finally pronounced on his review of the NHS. I well remember in early September last year going to the London Beach Golf and Country Club in Tenterden to join a luncheon hosted by Lord Darzi and David Nicholson, Chief Executive of the NHS. The small but select audience were treated to a few opening comments about the review. It promised to be exhaustive; to be brave. It promised to be innovative and not to be sidetracked. So?

It's the patient, stupid. Their views will affect funding, their death rates will be published, their choice of drugs and treatments will be respected, and their GPs will be funded differently to make it easy for them to change practices.

But how many times have we heard this? The GPs I've spoken to since taking responsibility for Kent Adult Social Services have all told me how heartily fed up they are with bright idea after bright idea; with reorganisations on average every five years, and never enough time allowed to bed down changes before the next bright idea comes along.

Some ideas - like personal care plans or access to personal budgets for those with long-term conditions - are things which social services departments have been doing for some time now. Others - like the option to travel to Europe for treatment in UK waiting lists are too long - rely on the patient being able to travel, and the preferred country having the right medical team, the right pharmaceuticals, and hospital or clinic capacity.

Judge for yourself. But I'd rather have seen some real blue-sky thinking building on the dedication of the hundreds of thousands of dedicated staff in the system already, rather than another vague "customer knows best" plan.

At the sharp end of the biggest issue in politics

Last evening, I attended a meeting at Portcullis House in Westminster with Stephen O'Brien, MP for Eddisbury in Cheshire and Shadow Health Minister. With me were my opposite number Social Services Cabinet Members from Surrey, Oxfordshire, East and West Sussex and Hampshire.

It was an interesting and productive meeting, and we gained a valuable insight into the direction of travel of Conservative social care policy. We asked for the meeting since our group, SECASC - South East Councils Adult Social Care - represents the adult social services of all the south east counties, and we wanted to see how we could work alongside our Parliamentarians to shape the future agenda.

Stephen was generous with his time and consummately professional. We discussed safeguarding, learning disability funding and transfer, VAT legislation, dementia and the personalisation agenda. Whilst the detail of our joint work is clearly politically sensitive, we all felt there was a clear forward direction, and understand the constructive role local government in general - and our group in particular - can play. Stephen observed that we were "at the sharp end of the biggest issue in politics". Let's hope our joint work can start to make a real difference.

A fantastic ambassadorial effort

Today I went up to the House of Commons with Deputy Leader Alex King and Chief Executive Peter Gilroy, where Kent County Council and policy group Westminster Advisers hosted a conference on TeleHealth; an innovation which uses new technologies to assist those with chronic long term conditions to monitor their vital signs, such as blood pressure, blood oxygen and blood sugar from the comfort of their own homes, sending the data to their GP by telephone.

Just under a hundred delegates attended from the NHS, local authorities and primary care trusts, as well as service users and their carers and families. I made the point in my welcome that it wasn't about the cost, or the process, nor about whether it was health or social care who got most benefit. It was about the outcomes, about how this programme was changing people's lives for the better.

Speakers from KCC, the NHS and the British Heart Foundation came next, together with a fascinating question and answer session chaired by Nigel Hawkes, Health Editor at The Times.

After the formal session, there was a formal lunch in the Cholmondeley Room at the House of Lords, where Earl Howe, the Shadow Minister for Health gave an excellent address in support of our project and giving a clear vision of health and social care under a Conservative government. Finally, Peter Gilroy gave a typically incisive view of how demand was moving forward rapidaly and what KCC was doing to shape future provision.

Alex King summed it up. "One of the best seminars I've been to in years..." he said "...and a fantastic ambassadorial effort by KCC."

Waking up in another country

I see from today's Saturday Observer ("Attitudes to autism must be changed, page 15) that the National Autistic Society has spoken to 1400 people with autism to compile their latest report on the condition. In an effort to explain the condition, they describe autism as "like waking up in another country where no-one speaks your language and people live by a set of social rules which are completely alien to you."

The NAS report claims that 63% of sufferers of autism simply don't have adequate support to meet their needs.

The article describes Harry Roberts of Tenterden, whose 37 year old daughter Nadya has had autism since she was twenty. Although she now has adequate support, in 2005 Nadya spent a year in a 'mental hospital' because the residential home where she lived was unable to cope with her challenging behaviour.

We simply have to do more. I hear again and again from families and carers dealing with autism that the biggest problem is understanding - that autism isn't a "mental illness", and that not everyone with autism is like Dustin Hoffman's 'Rainman'. In fact, high intellectual capacity, or 'savantism' is only found in around 2% to 3% of those with autism.

I've asked for a Select Committee on Autism at Kent County Council, so that a group of Members and officers can spend properly resourced time interviewing experts and talking to those with autism and their carers and families, to give us a better idea of how to provide the best support and care services.

Because the notion of 'waking up in another country' isn't something I want anyone to have to go through.

Nothing short of a national scandal

With around four hundred thousand elderly and frail people being looked after in residential care - a figure which by 2031 will almost double to three quarters of a million - the quality and standard of the care provided in our residential homes has never been more critical.

And so it's all the more worrying that a report by the Chief Constables of Cheshire and North Yorkshire to Home Secretary Jacqui Smith today highlights the crisis in UK which sees many of the hundreds of thousands of migrant workers being allowed to work in care settings without even the most fundamental criminal records checks.

The problem arises because there is simply no system in place whereby UK authorities can cross-check criminal records in the worker's country of origin. Of almost a quarter of a million migrant workers employed in the British care sector, nearly half of these provide care in the home or residential facilities. The European Union has been trying to set up a reliable system of checks since 2005, when a Directive was agreed where every member state would nominate an oficer to coordinate the sharing of criminal records. Yet to date the Labour Government has only set up pilot schemes, and then only in five UK counties. The new Independent Safeguarding Authority, which will come into being next year will still only flag up whether an individual has offended since coming to this country.

At a time when many of our frail elderly find their eyesight or hearing decreasing by the day, it's difficult enough to understand or be understood by a foreign care worker. That they also can have little or no confidence whether that person has a criminal record is nothing short of a national scandal.

Just another talking shop?

What a fascinating morning! I was at St Stephen's Club in Westminster on Thursday attending a 'Chatham House' roundtable on the future of specialist care for adults with learning disabilities.

The event, chaired by David Brindle from The Guardian, was attended by professionals from the Department for Health, Commission for Social Care Inspection, the Valuing People Support Team, IDeA, and the Institute for Public Policy Research, along with several other care organisations and charities.

It began with keynote presentations from Dame Jo Williams, Chief Executive of Mencap, and myself, along with a provider viewpoint from Bob Lewis of the Care Management Group, and then a two hour discussion on a way forward.

Overwhelmingly, the message was clear. We need to raise the awareness of Learning Disabilities; we need Government to be clear in their expectations - and harder still, to stick to them long enough for us to deliver. We need to accept that there's no 'silver bullet' quick answer, and although we can make efficiencies in our own organisations, this of itself isn't enough to balance our collective books.

As I said in my presentation, I hope this morning wasn't just another talking shop, and that we'll see some real actions and outcomes as a result of our morning together.

A night with the angels

I was at the Marriott Tudor Park Hotel this evening, for the Kent Adult Social Services Quality Service Awards.

These awards are run every year to honour the staff who, nominated by their colleagues and clients, really "go the extra mile".

Radio Kent's Pat Marsh compered the evening, while Managing Director Oliver Mills and I had the easy job of presenting awards and posing for photographs.

Inevitably, the stories which led to each nomination were amazing, tear-jerking, inspiring and humbling.

Ordinary people performing extraordinary acts. Going the extra mile for the good of those they care for. Away from their job, these special people are also often going home to care for others - parents, brothers, sisters, and so on.

As it turned out, the event ran on and I was not asked to deliver the speech I'd prepared for. But I wasn't upset. It wasn't my evening. It belonged to those very special people without whom tomorrow would be a little less bearable for thousands of frail, elderly and vulnerable Kent residents.

A New Settlement

In the light this week of Gordon Brown finally owning up to a funding crisis in Social Care, I was interviewed by Kent TV on the subject a day or two ago. Entitled "The Ageing Timebomb" - http://www.kenttv.com/programmes.php?CID=27&SCID=63&PID=1269&Title=The+Ageing+Timebomb I discuss the demographics in Kent which will see an extra 60,000 pensioners in the county over the next eight years. I tlak about the complexity of people's needs and the cost of providing the levals of freedom and choice which the Labour Government espouses.

In the second part of the film, you'll see an explanation of TeleHealth and TeleCare initiatives which use new technology to provide freedom and independence to hundreds of people across the county.

Kent has been successful in bidding for funds to extend its TeleCare and TeleHealth programmes, and was recently selected by the Department of Health as one of three national pilot projects, alongside Cornwall and Newham, representing the 'Whole Systems Demonstrator' exemplar of joint working between Social Care and Health.

Health Secretary Alan Johnson has this week announced the start of a six-month consultation on models of funding for health and social care. Care Services Minister Ivan Lewis admitted at a recent event where we spoke form the same platform that "you wouldn't start from here".

Let's just hope that this time the Government are serious. We need a new settlement with Government for health and social care.

The lives of thousands of frail, elderly and vulnerable people depend on it.

Democracy came second after politics.

At the end of the KCC Cabinet agenda yesterday, those Cabinet Members who had appeared before the last meeting of Cabinet Scrutiny were asked to confirm that they had set in place actions to comply with the recommendations of the committee.

For me, it was an opportunity to reflect on over two hours spent questioning KCC's decision to recommission the day centre service at Queen Elizabeth Resource Centre in Dartford. Various postings to this blog have outlined the protests, media coverage, petitions and general concern about this decision, yet still the Labour-led Cabinet Scrutiny committee saw fit to invite two vulnerable wheelchair-bound users of the service, with no rest break, toilet break or any thought for medication times, to sit for over two hours at the table giving evidence.

Both Liberal Democrat and Labour spokesmen were invited to stand and read prepared statements which neither furthered the debate nor uncovered new evidence. And when the Managing Director of Kent Adult Social Services asked to correct the biased and misinformed statements, he was denied the opportunity.

And after all that, the committee recommended that we undertake the same degree of public consultation whether we commission a service or whether KCC owns that service. So when, last month, a national care home provider went out of business - calling us on the 16th to tell us to have all our clients out of their homes by the 20th - we should have refused and begun a six-month public consultation? When we received complaints from staff, users and carers about a day care facility, we should have 'put them on hold' for twelve weeks while we sought public opinion?

No. We will react with the same speed and compassion that we always have, because that's what social care is about. Not bureaucracy. Not box-ticking. And not posturing and political grandstanding while real life problems get put on the back burner.

I was pleased to have been asked to comment on my recent "brush with scrutiny". And a little more pleased to be able to shed some light on a biased meeting where democracy came second after politics.

Without a separate agenda

Last week, I was called to appear before the KCC Cabinet Scrutiny Committee with the Managing Director of Kent Adult Social Services, Oliver Mills http://www.kent.ukcouncil.net/site/player/pl_compact.php?a=11772&t=&m=wm&l=en_GB#the_data_area. We appear from time to time to account for decisions made in the delivery of social care. This cross party committee usually provides a healthy challenge and a trasparent way to open up the democratic process.

We had been called to explain our decision to decommission the Queen Elizabeth Resource Centre in Dartford, which provides a day service to adults with physical disabilities. Over the last few weeks, the issue has appeared on television, radio and in local press on numerous occasions, and I agree more than anyone that we need to make sure we get this right, for the sake of the service users themselves.

But there was an uneasy feeling of politics at last week's meeting. The Committee called as witnesses two disabled service users, and throughout over two hours of questioning, one leading question followed another. One opposition Councillor stood up to "read a prepared statement" which was little short of a political press release.

I felt saddened by the lack of quality and rigour in a process for which, over the years, I have come to have great respect. The final act was to ask another opposition Councillor, who did not even sit on the Committee, to stand and deliver a tirade of accusations and half truths. When my officer colleague tried to respond, he was denied.

After the meeting was terminated by a power cut, I spent an hour discussing the issues over a coffee with the two disabled service users who appeared as witnesses. And guess what? In many ways, they felt as let down by the process as I did, and we achieved more from a coffee and a chat than through two hours of "open democracy".

There's a legal maxim which goes something like "He who comes to enmity shall have clean hands". In other words, if we're going to challenge and question, do it without a separate agenda.