Social Services, meeting the needs of service users – and the role of carers from the informal sector Lesson objective – to learn how the NHS, Social Services and Child Care is funded. PPT 2 -

Who is responsible for funding Health Care in the British Isles?

Funding comes from four main areas Statutory Sector Private Sector Voluntary Sector Informal Sector Q&A - What do you think these mean?

AfL Statutory Sector is governed by statutory regulation to protect the public against risk of poor health services. A statutory health service is one that has levels and tiers of service that consist of; primary care service that can both provide treatment. They can also refer on to another service, secondary care service is a general service that is normally hospital based, and usually comes by referral from a primary care service and tertiary care service which is a specialized service for example, led by a neurosurgeon or orthopedic Surgeon. Private/independent sector is insurance that is handled by private companies and not the government. Voluntary Sector – are organisations that look after the interests of a particular client group. Many of these organisations depend on the money earned from services they provide for social services. Some operate on a national level where they represent their client group and provide information through leaflets, websites, and brochures. Local branches are responsible for providing a range of services, and they are also represented on local health and social care committees. Informal sector - Home-based care of patients is increasing in importance in many societies, particularly where health facilities are overwhelmed. Care is mostly provided by close family members who have no formal training in health care, though in some cases they may receive guidance from professional health visitors.

Funding and – Standard Spending Assessment Once government has assessed the standard of spending to be directed at specific health care facilities in your Local authority (LA), the LA will also raise funds from local council tax. Local councils are monitored on performance and spending by government and by the Commission for Social Care Inspection (CSCI) Some services relating to education and children e.g. child minding, nursery school provision are monitored by the Office for Standards in education (OFSTED)

1998 White Papers March 2005 Green Papers – Independent Well-being and Choice plans for the next 10-15 years In 1998 White Papers ‘Modernising Social Services’ set out the programme for change in the social services. Staff were to be trained and standards of care staff would be improved. A national register of care staff was to be set up. Protection of vulnerable client groups, such as older people, people with leaning disabilities, people with mental health problems, and children, was seen as a key issue. All staff had to receive training on protection issues related to abuse. This was in response to news stories of abuse by social services staff of people from a range of client groups. The White paper also called for closer working between health and social care services, with joint budgets. These areas are still being developed. This was a consultation paper setting out proposals for the future direction of social care for all adults in England. It is expected that the rest of the UK will develop similar proposals. The emphasis in the Green Paper is on: Helping people remain in their own homes and giving them greater control and choice over the way their needs are net. Encouraging adult social services to work with a range of partners, including PCTs and the private and voluntary sector, in order to provide services that are cost –effective and meet the needs of a diverse community. Making sure no one is margialised in society – social inclusion must underpin all services. Ensuring services are of high quality and delivered by a well-trained work force or by informal carers who are themselves. Ensuring technology is used to support people especially related to housing. Ensuring that people with greatest needs should receive the support and protection they need. Ensuring that vulnerable people are supported and risks to them assessed.

*Social Services continued: What is live-in care? Live-in care is primarily for people who want to continue living in their own home, but are no longer able to look after themselves properly and need daily help with personal care and household tasks. Instead of their going to live in a care home or nursing home, a carer comes to live with them in their own home. Local council provides social care services to those who are assessed as being in need. However, many services provided by the council are means tested (i.e. people who apply for social services have their income assessed as well as their needs), and some payment is usually required. Know your rights – arguments for client care If the person you care for has mobility needs and requires extra help with personal care, such as dressing or washing, they may be entitled to claim either Disability Living Allowance (DLA) or Attendance Allowance (AA) Has the person you care for been assessed as needing help from social services?  If so, they may be eligible for direct payments, a way to choose and pay for services yourself to meet your assessed needs. http://www.careathome.uk.com/?gclid=CPW2qYPP0KkCFcsb4Qod6FK_Mg

Emergency social worker support Older people People with disabilities Babies and young children Residential care Supported housing Emergency social worker support Social worker support Directed payments advice Family centres Information and advice Domiciliary care Liaison with education and health services (Sure Start) equipment Needs assessment Home adaptation Child protection Transport Respite care Support for children with disabilities Day care Specialist social worker support Family support Equipment transport Fostering and adoption services Supported/sheltered housing Specialist social workers

Community Living Brief – Use of pdf – Community Living Brief – The use of technology to allow people to stay in their own homes: The increasing use of technology to support people with specific needs is a good example of the kind of change suggested in the Green Paper. Through the provision of equipment and making adaptation to their homes, people can remain in their own homes. New technology has been developed that may help clients with a range of different needs – task 1 now carry out the case study use the Venn diagram to highlight which equipment is helping to keep the client in their own home. Task 1 – Risk Assessment and Solutions Case Study – Mrs. Macauley lives at home with her carer (her husband) she suffered from a stroke at the age of 58 due to having a brain aneurism. The operation resulted in a major stroke leaving Mrs. Macauley paralysed down her right hand side. Looking at the Community Living Brief – can you assess which technology assistance would be suitable aides for Mrs. Macauley so that she can remain as independent as possible. http://abaiconference2009.blogspot.com/2009/05/use-of-technology-to-promote.html

Supportive Responsive Preventative Assistive home technologies - Reminder unit dialysis machine, personal heating system, wheelchair (advanced), keyless entry systems Gas monitor, falls detector, blood pressure monitor ,panic pendent alarm systems, smoke detector, respiration monitor, chair/bed occupancy monitor Predictive systems falls predictor event, monitoring room, occupancy monitor, activities for daily living equipment (supportive systems) Supportive Responsive Preventative

Taken from theory work of 2005 – Smart technology for aging, disability, and independence: the state of the ...  By William Charles Mann

Exercise promoting technology Rehabilitation programmes for people with dementia

Be-friending services Sitting services Supported living Social Clubs (i.e. Gateway Clubs) Advocacy (in many forms - see later notes) College courses and evening classes Health and fitness Summer schemes Supported Employment Carers groups Day Trips and Outings Day Centres and Drop in Centres etc . Voluntary (Independent Sector) In addition, to the services provided directly by Learning Disability Health and Social Care Partnerships, many may be able to access other help, either independently or often through Social Services, from a variety of voluntary and independent organisations. Many of these will be available at no cost. Some of the services provided by voluntary and independent sector organisations in Yorkshire are: http://www.personalitypathways.co.uk/service_directory/community_services/Voluntary_Sector_Contacts

People in hospital Older people in the community Babies/children in the community People with learning disabilities and their carers Discharge support Meals on wheels Parenting groups Holidays Visiting hairdressing Playgroups Support groups Hospital care services Gardening Toddlers clubs Respite care Canteen for patients and visitors shopping Homestart-support for parents Baby sitting Hospital shop Transport Family support groups (NCH and NSPPC) Holiday play schemes ‘Friends’ of the hospital befriending Leisure clubs Advocacy Therapies – Art Music Reflexology The range of services provided by the voluntary sector to different client groups Day centres Lunch clubs Exercise classes After school clubs

Task 2 - What is advocacy? During health issues advocacy schemes are put in place to help patients remain vocal about their health situation. An example - in ‘Mental Health Advocacy Scheme’, they define advocacy as a process, which enables a person to represent their views. Independent advocacy is vitally important when people are experiencing mental distress. While a person is unwell they may find the nature of a mental health problem itself reduces their ability to access information or represent their own interests effectively. People often feel disempowered by the mental health care system. People who have experienced mental distress can find themselves the victims of discrimination. At the Advocacy Scheme they believe that the most favourable use of advocacy is within the independent/voluntary sector. The ability of health care workers to perform as advocates is limited by their obligations as service providers and agents of control/protection, meaning that they cannot view a patients care needs without prejudice . Find out why this third party is the better option to aid the patients/clients opinions about their care. AfL – to come up with a research report that highlights how advocacy has helped clients or patients.

Community service contracts Task 1 – look at the figures, what patterns do you see? Task 2 - Contact a private hospital and find out the range of services it provides. Compare the services it offers with those at the local NHS hospital Legacies Donations & appeals Community service contracts 37% 27% 31%

Census 2001, for the first time, asked a question about whether people provided unpaid care for a family member or friend and for how many hours. Overall, the results showed that a considerable amount of informal care was being provided – estimated around 5.2 million carers in England and Wales, in addition, over a million providing more than 50 hours a week. Carers are estimated to save government 57 billion a year – almost as much as it costs to run the NHS http://www.carersuk.org/ The government are complaining that the cost and efficiency of the service is under review, recently they have completed an audit into this, they say – ‘we estimate the total cost to the department of providing support to carers through benefits and employment services is up to £2 billion a year’.

Secure - Exam style questions Q&A Define what is meant by the term voluntary organisation. Define what is meant by the term statutory organisation. Evaluate the contribution the voluntary sector has made to the provisions of services in the community over the past 30 years. AfL A statutory organisation is one that has to exist - by law.

A carer is someone who looks after a relative or friend who, because of their age, physical or other disability, cannot manage at home without help on a regular basis. Carers support people with a range of different needs, usually as a result of a long-term illness or disability such as - physical disability sensory disability (loss of sight and / or hearing) learning disabilities mental health problems (eg. Alzheimer's disease or other diagnosed mental illness) long term, life threatening or terminal illness children with disabilities people with HIV, etc. Who are carers?

Who becomes a carer? According to Carers UK, the leading organisation for carers in the UK - 1 in 8 of all adults are carers Every year over 2 million people become carers Carers save the economy £57 billion per year- the equivalent of what the entire NHS costs to run - an average of £10,000 per carer Over 3 million people juggle care with work Carer’s Allowance, the main carer's benefit, is worth just £44.70 for a minimum of 35 hours - £1.30 per hour 1.25 million people provide over 50 hours of care per week People providing high levels of care are twice as likely to be permanently sick or disabled Over 1 million people care for more than one person 58 per cent of carers are women; 42 per cent are men By 2037 the number of carers could have increased to 9 million

Different types of carers Young carers Young carers are children who help look after a member of the family who is sick, disabled or has mental health problems, or is misusing drugs or alcohol. Their day to day responsibilities often include: cooking cleaning shopping providing nursing and personal care giving emotional support. With so many adult responsibilities, young carers often miss out on opportunities that other children have to play and learn. Many struggle educationally and are often bullied for being ‘different’. They can become isolated, with no relief from the pressures at home, and no chance to enjoy a normal childhood. They are often afraid to ask for help as they fear letting the family down or being taken into care. Young carer facts The average age of a young carer is 12. The 2001 census showed that there are 175,000 young carers in the UK, 13,000 of whom care for more than 50 hours a week. More than half of young carers live in one-parent families and almost a third care for someone with mental health problems. In the past young carers did not have the support they need in order to cope with their studies alongside caring for other people. In a London centre the youngest was six.

Task – charities are helping to promote and support young carers Task – charities are helping to promote and support young carers. Find out what you can about the work of Barnardo’s: What health sector is the support given from? What support are they giving? How will this bridge the gap between young carers and their educational needs? What are your views on government policy linked to young carers? AfL – your verbal feedback from your notes during lesson Barnardo’s runs 15 projects across the UK which work to support young carers and their families in a variety of ways: http://www.barnardos.org.uk/resources/research_and_publications.htm?pub_subject=&pub_type=KWD-1744&pub_phrase=&submit=Search

Different types of carers Young Carers Have Rights- The UN Convention on the Rights of the Child

Too Much to Take on 1999 In a study called ‘Too much to Take on (1999)’ 20 young carers’ groups were questioned about caring and bullying. 44% of the carers that responded were aged between 11 to 13. This can be a difficult age for young carers, as they are changing schools and making new friends while coping with their caring responsibilities. Of the young carers in this study, 35 per cent were 10 or under, which means they were coping with a lot of responsibility at a very young age. More girls than boys taken on the caring role: 60 percent in the study were girls and 40 boys. Young primary carers are more likely to look after someone with a physical disability. 49% of the boys were caring for their mothers, 18% of the girls were caring for their father. In this situation caring for the personal needs of the cared person can prove very difficult, especially during bathing and dressing.

ALEX'S STORY IN HIS OWN WORDS "My week is quite annoying sometimes, because I mostly spend my time indoors. I take care of my sister and my mum, who has been ill. I don't know what it's like to have a dad because he left when I was only 18 months old, so basically I am the man of the house. During the week, I cook twice, do the washing up, drying up, the hoovering, feed the pets, do homework with my sister, go shopping and give emotional support. Basically, I do all the housework. But it doesn't stop there. On the streets where I live it's a whole different story. I get bullied because all the kids think I'm the odd one out. They call me names and groups of them throw things at me. Sometimes I cry in my room and erase everyone's number from my mobile phone because I don't trust anyone. In school it's all right, because I don't get bullied there. But I do get into a few arguments and I get very tired and then get told off by the teachers. My school is really small, with only about 40 pupils, so it's pretty cool and fairly easygoing.

Parents as carers – their issues A parent carer refers to someone who is the parent of a disabled child. Many parents do not see themselves as carers., just as parents. This could be a problem, as they many not be aware of the various carers’ allowances and support available. http://www.direct.gov.uk/en/Parents/Schoolslearninganddevelopment/Optionsafterschool/DG_067577 Department of Health Standard 2: Supporting Parents or Carers Vision We want to see: Parents or carers who are confident and able to bring up their children in a way that promotes positive health and development and emotional wellbeing. Consistent information provided for parents or carers, which supports them in their role and is responsive to their needs. Appropriate help and support provided for parents or carers who find it hard to access services and professionals.

Carers who work outside the home Many older carers also do full-time work, and studies have shown that many carers have to leave work or work part-time in order to fulfill their caring role. This affects their opportunities to contribute to pensions (including young carers) access work and training opportunities. From 2006 the rights of working carers will be formally recognised and they will help safeguard pension rights which have been affected by their caring role.

Q&A Tasks Define what a young carer is in the informal sector Define what a parent carer is in the informal sector List some of the emotional issues they face everyday and how can social services and the voluntary sector support these carers? AfL assessment piece