The day was presented as a joint strategic exercise by Norfolk County Council, NHS Norfolk (Norfolk PCT) and NHS Gt Yarmouth and Waveney (Yarmouth and Waveney PCT). Presumably, this was at least a wave in the direction of the spirit of joint working.
Each participant attended four workshops throughout the day. My four were: Objectives 8, 2, 1 and 4 which were respectively:
- improved quality of care in general hospitals
- good quality early diagnosis and intervention for all
- improving public and professional awareness and the understanding of dementia
- enabling easy direct access to a contact who can signpost and facilitate health and social care input following diagnosis.
Unfortunately my good feeling about most of the day was soured by what came across strongly to me as two underlying agendas. These were:
- The practical invisibility of Norfolk County Council Adult Social Services responsibilities in the workshops and the feeling through out that NCC was working hard to avoid those responsibilities.
- An anti-social work hostility present in the last workshop I attended - to the extent of a Community Mental Health Nurse leaving the workshop in high dudgeon when I insisted on following through my comments on the social work role. Adult social services services social workers at the workshops were conspicuous by their absence.
"Improved community personal support services"
This is the strategy’s Objective 6. However, and I suspect at the behest of Norfolk Adult Social Services, Objective 6 was pushed well into the background at the workshops with it being identified on the priorites voting list as ‘Personal support services.’ - so underplayed that I think mine was the only vote for it.
Yet objective 6 is, containing elements such as ”Access to flexible and reliable services ranging from early intervention to specialist home care services.“ ”Implementation of ‘Putting People First’ personalisation changes, and adult social work services, as the implementation plan points out - one of the main priorities.
The Implementation Plan, in its section on local authorities, also says: " CQC (Care Quality Commission) make judgements about adult social care outcomes forming the annual performance assessment process for local authorities...CQC and council Directors of Adult Services (DAS) will jointly agree any necessary plan for performance improvement and development."
In Norfolk’s case, let’s hope they agree a ‘necessary plan’ for performance initiation!
The last workshop of the day that I attended was on Objective 4:
“Enabling Easy Direct Access to a Contact Who Can Signpost and Facilitate Health and Social Care Input following diagnosis” (sic)
Contributing to this workshop was Norfolk County Councillor David Harwood, Cabinet member for adult Social Services. Member Champion for Supporting People. Addressing Councillor Harwood, I first pointed out the apparent absence of Norfolk Social Services input as above. I went on to tell the workshop that there should already be well tested means of addressing objective 4: social work assessments under the NHS and Community Care Act 1990. This was immediately labelled nonsense by Councillor Harwood, Chris Humphris from NHS Norfolk and Waveney and a Community Mental Health Nurse. As I continued to insist on pressing my point they got angrier with me and the CMHN eventually walked out of the group.
As I was there as service user I suspect these people selectively assumed I was talking out of my bum. Well, since a copy of this pplog will be going to both, let me explain my credentials:
- As a Mental Welfare Officer prior to 1979 I was, as well as with other adults and children, working with people with dementia and their families doing exactly what Objective 4 requires.
- In 1979 I moved to work with Norfolk County Council based at St Nicholas Hospital, Gt Yarmouth working as a team with the newly instituted Community Psychiatric Nurses, ward nursing staff, psychologists and consultant psychiatrists. Much of the work was with people with dementia and their families’ needs. In 1981 I was giving a presentation to the hospital staff and consultants on the various pathologies of dementia and their and their families’ social care needs.
- In 1985 I moved to work for Suffolk County Council in the community (Beccles then Lowestoft) continuing work with people with dementia and their social care needs as well as other adult mental health problems and child protection. The excellent working relationships with the hospital and other community mental health services built in my hospital based work continued.
- Post 1990, all of us in the mental health social work team applied the functions of the NHS and Community Care Act taking referrals from GPs, the secondary mental health services and sometimes directly from carers and families to quickly make community care needs assessments to “Facilitate health and social care input.”
Section 47 of the National Health Service and Community Care Act says:
“Assessment of needs for community care services
(1) Subject to subsections (5) and (6) below, where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such services, the authority—
(a) shall carry out an assessment of his needs for those services; and
(b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services.
(2) If at any time during the assessment of the needs of any person under subsection (1)(a) above it appears to a local authority that he is a disabled person, the authority—
(a) shall proceed to make such a decision as to the services he requires as is mentioned in section 4 of the [1986 c. 33.] Disabled Persons (Services, Consultation and Representation) Act 1986 without his requesting them to do so under that section; and
(b) shall inform him that they will be doing so and of his rights under that Act.”
The Alzheimers Society (representatives of which were at the workshops) says:
Under the NHS and Community Care Act 1990, local authority social services departments are responsible for assessing the needs of people who may need care services to enable them to carry on living at home. Services can also include care in a care home if that seems to be the best option...The Community Care Assessment Directions 2004 LAC (2004) 24 introduced directions that placed good practice guidelines within a legal framework, meaning that local authorities are required to comply with them by law. If a person with dementia is assessed as being in need of certain services, social services have a duty to provide the services that fall within their eligibility criteria (locally set rules about what type of needs the local authority will meet). It is not necessary to wait for a diagnosis of dementia before requesting a community care assessment. What matters is that the person needs certain types of care or support.
And finally, for the benefit of Conservative councillor Harwood, I’ve included these quotes:
Caroline Spellman, speaking about the Lyons Report said: ”When looking at funding we have to move away from the notion that health care and social care are separate, or as David Cameron describes it: “the artificial and damaging barrier between the NHS and social care services”.
From “The Patient will see you now, Doctor, How the next Conservative Government will create an NHS personal to all”:“For many living with long-term illnesses or disability, the divide between health and social care is a constant source of frustration, uncertainty and bureaucracy. For those whom we look after, services which should be seamless are not.”