The Lack of Care Act 2014: Service users’ perspectives of a failing adult social care system by Donald O’Neal

The Lack of Care Act 2014: Service users’ perspectives of a failing adult social care system

I am tetraplegic and an adult social care service user. I wrote this book based on my experience and that of other people I know or have been introduced to. This book illustrates the sad truth of the difference between the rhetoric of what the Care Act 2014 offers and the reality of how adult social care is actually administered. The Care Act 2014 promised so much, but it seems to be business as usual for the people on the receiving end of adult social care services. The Care Act 2014 was destined to fail, because the gatekeepers of the care funding finance – social workers – have not changed.

The book contains a collection of case studies which show how some disabled people are living in a state of fear, desperation and left to struggle without the appropriate information and care and support they need to live a happy life. The case studies are a powerful insight into the alarming and disturbing treatment of some disabled people at the hands of social workers and the adult social care system.

The Care Act 2014 is about well-being, viewing the service user holistically and empowering them to live the life they want to live by providing the care, support and information they require to do this.

The days of popping in for an hour in the morning to get someone up and give them breakfast, then popping in at lunchtime for 15 minutes to make a sandwich and toileting, then popping in at teatime for 15 minutes for toileting, then popping in at 7pm for an hour for supper and putting the person to bed, should have been consigned to history with the enactment of the Care Act 2014.

That type of care regime does not help people live, it just help them exist, at home. Under the Care 2014, people should be given a care budget that that enables them to play a full part in their community.

I suggest that direct payments should be rolled out more, so that people have greater control over how their care is provided and who provides it. Just giving people a direct payment and expecting them to get on with it is not enough. They need to be supported to work out what the care options are within their available budget. People need support to find, employ and manage carers and with managing their finances in a way that utilises their care budget for their maximum benefit.

Support is sadly lacking and many disabled are being failed by the adult social care system.

The way local authorities administer adult social care should be improved. Many people are not getting the care budget they need and the care they need, because they are not supported enough, or at all, through the needs assessment process undertaken by social workers. Once someone is given an initial care budget, it is often very hard to get that increased.

I suggest that support is needed in the initial needs assessment and the annual care needs review, so that people start off with an adequate care budget and do not have that care budget slashed for improper reasons at an annual review. It is not uncommon for people to have their night care taken away and be told to ‘just wear a pad’ at night instead.

Bullying and threats by social workers and local authority administrators needs to stop. The expression of ‘Do …. or we will cut your funding’, is too often heard.

One only need look at some of the complaints regarding adult social care that are taken to the Local Government and Social Care Ombudsman to see just how appallingly some disabled people and their families are treated. This would rarely happen if frontline social workers did their job in compliance with the Care Act 2014 and they were overseen better by their managers.

Well-being of the service user is at the heart of the Act and it should be at the heart of the delivery of the service. Disabled people should not have to endure a living hell for months or years and take a case to the Local Government and Social Care Ombudsman, just to get the care and support they are entitled to.

I suggest that adult social care should be provided free at the point of use and the money needed to fund it should come from general national taxation, as that is the most efficient way to raise the money. Preventing and delaying the need for care and support is also fundamental to the Act. However, many adult social care users are being charged to contribute toward their care an amount which they cannot afford. This results in them being driven into debt or simply not using the service they need.

In the long-term this damages their well-being and increases the risk of their care needs turning into medical needs. When this happens, the cost to the state is greater, as medical staff earn more than care staff. It may even lead to hospital beds being taken up by disabled people, whose needs would have been far less, if they were given the appropriate care and support free of charge in the first place. The more independent a person is, the less the cost to the state.

More money is needed in adult social care to provide people with the care they need. This can be done in two ways: local authorities could making the money they have go further and government putting more money into adult social care.

I suggest that local authorities could manage the money they have better by not wasting it on pointless initiatives, getting rid of unnecessary staff and providing services that people actually need. When spending money, local authorities should be asking themselves ‘how will this improve peoples’ lives on a day to day basis?’ If the initiative doesn’t, then they should question whether they should do it. The same question applies to staff.

When considering creating a new service, local authorities should be involving the people who would be using that service from the start. Getting service users around the table and starting with a blank piece of paper, will enable local authorities to provide services that disabled people actually need, in a manner that they want and in a more cost-effective way.

Purchasing 8 hours of care from a care agency is far more expensive than an individual getting that care by employing a carer directly or utilising self-employed carers. Properly supporting people to avoid using care agencies can save money.

I suggest that local authorities need to get adult social care service users intricately involved at every level in the administering of adult social care, in order to provide a better adult social care service for less money. The best way to do this is to publicly fund user-led Centres for Independent Living in every local authority. This will facilitate local authorities to hear service users’ voices and work with them as equals to provide a good adult social care system, with well-being at its heart of delivery.

There are pockets of good practice around the country where some things are done well in some locations. Why, though, is everything not done well in every location? There is the Association of

Directors of Adult Social Services, but one wonders, what on earth do Directors of Adult Social Services do when they meet up – just share their holiday snaps? Why are they not sharing best practice and replicating it throughout the country?

What I suggest is not rocket science and nothing I have said is new, it just needs to be done. We have the Care Act 2014, now local authorities need to deliver what it promises. Do what it says on the tin!

Donald O’Neal

The book can be found at

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