Gloucestershire LINk held a joint event with Gloucestershire’s village agents on February 10th to learn about the Your Circle idea in adult social care.
Like other events of its kind, this was advertised as a training event but it provided no training whatsoever, just some information.
Carey Wallin, Gloucestershire County Council’s Putting People First programme manager, gave a standard presentation, mainly reading from the notes. You can download the presentation in PowerPoint format here (although the notes in this version do not seem complete) — Step by Step – Joe’s journey through Adult Social Care
The presentation was well designed but tedious. It only got interesting when Ms Wallin deviated from the notes, which she did quite often.
The idea of Your Circle is that when you are in need of care there is already a circle of people around you who can provide you with care. You do not need the help of social services. Go away.
However, at the same time Gloucestershire County Council would like to think it is in some sense in charge of this circle of people around you, so that it can take some of the credit for any care that you do happen to receive from everyone except Gloucestershire County Council.
As the presenter pointed out, deviating from the notes, adult social care is not an entitlement like the NHS (!), but only a minimal safety net for the most needy.
If you still think you might be in need of help, there’s a help desk you can call to have an initial assessment. Actually, the presenter pointed out, deviating from the notes, you are first assessed to see whether you are entitled to have an initial assessment, making nonsense of the word ‘initial’. Beware — in that first phone call to the help desk you are already being assessed to discover whether you can be assessed.
If you pass both the secret pre-assessment and the ‘initial’ assessment, there’s a free six-week short-term enablement programme that might get you over the worst of your difficulties. After that you can have a full assessment, and if its findings are that you have critical or substantial needs, then you’ll get a support plan and a budget.
Deviating again, the presenter noted that ‘critical or substantial’ means very, very serious. People who are just significantly disabled will not meet the criteria.
If you do meet the criteria, you are means tested to determine how much of the budget you can contribute yourself. The Council might contribute, but they only agree to this on a case-by-case basis, with an annual review. You have some freedom in how you spend the Council’s contribution, but it was not clear exactly how much freedom.
Throughout the process, you are supposedly at the centre of things. What matters most in Your Circle is whatever is important to you, what your goals are, so that you remain in control as far as possible. This philosophy is the ‘Putting People First’ part of the whole process.
Deviating yet again, the presenter noted that it is difficult to get the staff doing the assessments to take this new philosophy on board. They tend to be risk averse and to think they know best, over-providing care and ignoring your personal goals.
Questions and concerns
After the presentation the audience had many questions, and most of them hinted at knowledge of bad experiences with the system. No one was openly critical, however.
There are clearly some difficulties with this obstacle course of assessment after assessment after assessment. The presenter (deviating) noted that quite a lot of assessments have to be re-done. There are no built-in performance checks on the assessment process, although standards are now being worked on. Only a hundred or so people in Gloucestershire have ever completed the whole obstacle course and received Council-supported budgets.
Several questions from the audience were about how long it should take the service to respond, but the answers were evasive. I got the impression that audience members knew of cases where the response time was poor, and that the presenter probably knew this too.
A questioner asked about abuse of elderly people, with the concern that it would go unnoticed if the whole system relies on the victim being willing and able to contact the helpline and make an assertive case for being assessed. The presenter seemed to feel that ‘your circle’ would surely include other people who would know about abuse and report it, but many in the audience must have known that this is not typical.
I got the feeling that Your Circle is based on an imaginary Mafia don — elderly and frail, but still the power centre of the family circle, able to control everyone else around him. Real families are much more complicated. People who need social care often have little power in the family or neighbourhood. They are not at the centre of a circle, but at the edge. There was no sense that the presenter understood this.
Information and advice
In Your Circle there is an emphasis on offering information and advice rather than actual help, so that you can resolve issues yourself. To this end there is a special Your Circle website, which has a database of services.
After the event I looked at the website, typed in Chipping Campden (a small town in North Gloucestershire), and pressed the Search button. It displayed two tabs headed, “Located within 5 miles of Chipping Campden” and “Located in chipping campden”, but it was not clear which of these lists I was actually seeing.
The list of services contained duplicates. It seemed to span five pages. I pressed the Last button hoping to go to the last page, but the list disappeared.
Then I tried the “Available in chipping campden” tab, and both the order of the tabs and the wording changed. There was no longer any mention of “5 miles”. The labels were now: “Located in chipping campden” and “Available in chipping campden”. What’s the difference?
I filtered the list for “Mental health issues” and “Located within 5 miles of chipping campden”. This gave just one entry in the database — a domiciliary care agency. For mental health issues?
This is just a joke. Actually, the joke is that Gloucestershire County Council thinks its money is well spent going into competition with Google, Bing, Yell and the rest, in providing yet another way to search for things on the Internet.
I found it difficult to come to any conclusions about this event at the time. What changed my mind was hearing about a very recent social services assessment in another county, where the way the assessment was conducted was in itself so abusive that the person’s ability to cope was severely compromised by it. It put me in mind of the dictum, “First do no harm”, said to be from the Hippocratic Oath, and how distant an ideal that so often is.
Your Circle seems to be little more than a slick public relations exercise. It has glossy leaflets, a DVD of professionally filmed stories, designer PowerPoint presentations, an online database, a template for upbeat press releases — all the PR trimmings. Behind it, constantly hinted at even by this event’s smooth presenter, social services staff still struggle to deliver a humane, responsive, efficient, professional and well-defined service.
Take the presentation, for example, in which the story begins, “Joe needs some extra support.” A professional and well-defined service would be able to tell Joe and those around him there and then on page one, exactly what support is available from the County, but the Your Circle system hides that information behind up to four assessments.
Or take the leaflet. “Live life your way”, it says at the top. But the whole point of all this is that there are people who cannot live life their way because they need so much care from others. “Live life your way” is a deliberate falsehood, one that sets the tone of the entire PR campaign.
The back of the leaflet includes another telling sentence:
Your Circle is Gloucestershire’s approach to meeting the challenges faced by the changing adult social care system.
That’s exactly what it’s not. The challenges of change are not out here amongst the general public, who mostly understand that money is tight and help is limited. The challenges are back in the office, where clarity, standards and performance checks should be at the forefront, not an afterthought. I have the feeling that the resources allocated to this PR exercise would have been much better allocated there.