Enough is enough

17 Feb 2016Feature

Care services are being managed in such an inappropriate way that the only means of getting results is to manipulate the system

We have all had our experiences of the social care system in chaos, but I find myself incredibly frustrated. After all of the time and money spent on the new Care Act, things seem no better for the people who need care and support.

My client, Mrs C, lives at home. She has dementia, is 92 and has limited mobility. She has become more confused and anxious over the last few years, but she remains adamant that staying in her own home is what she wants.

After a few lifeline calls resulting in an ambulance being called out when she fell, social services came in to assess her needs. The resulting care plan said that Mrs C should see a carer four times a day, every day of the week. The shortest visits should be 30 minutes. Three times a week, Mrs C should have a 45 minute visit in the morning to assist with a full body wash, and there should be a 60 minute visit on a Monday to do 'shopping/domestic'; I have a copy of this plan on Mrs C's file.

On a recent visit to check on her, the carer took me to one side to say she thought that Mrs C needs more support. She told me that the house wasn't clean, they were finding it difficult to get Mrs C washed as she needs persuading to allow them to do this, and they don't have time in their 15 minute slots. She also wasn't eating well, as she needs the carer to stay with her to make sure she finishes her food.

I questioned the timing, as the care plan allows for more. The carer told me that all visits are limited to 15 minutes (bar the hour on a Monday) and they had been told to come in just three times a day. Mrs C goes to bed when it gets dark so in these winter months, she's tucked up by 4pm - as a result the evening visit has stopped.

This set in motion a dialogue with social services that is still going round in circles, some four weeks' later. There is only one phone number available, and this goes through to a member of staff at a 'hub'. It can take several attempts to get through and when you do, there's no opportunity to discuss cases; you give details and are told someone will call you back.

When I have been able to talk to a social worker about Mrs C, I'm told that three 15 minute visits a day are enough to meet her assessed needs, and that the care plan does not include any time for cleaning the house. This is despite me being able to read back sections of Mrs C's care plan to them, which allows for more visits, for longer visits and for 'domestic' help.

Play the system against itself

Having had some insider information on how the systems (don't) work, I have telephoned the hub again to raise concerns about Mrs C, as has her friend, as well as a nurse from the local GP surgery. Apparently, three calls about the same person moves them to the top of 'the list' and means they might get a visit for re-assessment within the next month.

What is so frustrating about all this is that the correct processes have been followed: Mrs C has been assessed, she has had a care plan drawn up, her finances have been assessed, an agency has been found, carers are going in, but the difference between the care she should be getting and what she is in fact receiving is vast. And while I can stop paying and raise complaints and barricade the carers into Mrs C's property until the assessed time is up (well, maybe not that) I should not
have to.

The system is not working. No wonder Lord Carter's recent report found that hospital patients aren't being discharged as soon as they are well, as the care needed to support them when they leave the hospital have not been organised. The infrastructure for looking after vulnerable and elderly people in the community simply isn't there, and this has to change.

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