Adults with learning disabilities on the rack

Social Care

I am a Senior Social work practitioner in a London local authority social work team, working with adults with learning disabilities,  For most of my working life, I have worked in this field and have seen so many changes over the years.   In the 80s I worked in a project helping to move people out of St Lawrence ‘s,  a long – stay hospital for adults with learning disabilities,  into flats or houses in their original local areas. It was such a positive time, and we all felt that we were supporting people to at last  have some choice in their lives.

Since then, I have continued to support people to have more choice and control in their own lives, and worked within the personalisation agenda with people having their own personal budget.When this first came in, we were all encouraged to support people to be as creative as possible with their personal budgets, and to meet needs in a more individual way.  I have worked in four different London boroughs since I qualified as a social worker – I was a mature student (42!) when I did my joint nursing and social work degree specifically in learning disability,  and we were all told we were going to find jobs as joint practitioners – though that never materialised.

During the last ten years, since I qualified,  I have seen the situation slowly change in Local Authority social work from encouraging people with learning disabilities and their families and carers to be involved in arranging their own support, to being told that due to austerity and the cuts, they have to use the cheapest options possible. In the borough where I work, we have been told we have millions of pounds of savings to be made, purely in the adults with learning disabilities team.  Where we used to talk about good practice and the best way to support people, we now have endless meetings about how to cut costs in every way possible.   We use the Resource Allocation System (RAS) where once an assessment has been completed, the answers to certain questions are fed into the RAS and an indicative budget is being calculated.  However, recently this RAS has been reduced across the board by 30%, with no consultation and nothing to do with needs.  My role involves supervising social workers who are having to take cases to panel and argue and advocate on behalf of their clients,  only to be told that they have to go back to these families and say that not only can they not have what has been requested, but are having further cuts made to their support package.  It is completely destroying any trust and good feeling there used to be between social workers and their clients, and leading to social workers being completely demoralised and clients and families not wanting any input from social workers.  I know of cases where people are receiving a certain number of days at day centres which are being arbitrarily cut, having a very great impact on clients and their families,  to such a degree that some families are saying they can no longer cope and so their son or daughter has to move into residential or supported living accommodation.  It is such short term thinking, and leading to such distress on the most vulnerable of our society. As social workers, we often debate how we can continue in these roles as it goes so against our code of ethics, and what we went into social work for.

Another issue we constantly come up against is who should be funding specific cases, health or social care. The amount of time spent discussing Continuing Healthcare cases is so high,  and in our borough it is becoming so hard to get anything agreed as Continuing Healthcare that we are getting an expert in to advise. We also have Ordinary Residence cases still going on, with battles going on between different local authorities around funding responsibility.  However,  none of this is to do with what will make people’s lives better, it’s just about funding.  We are also constantly told that our borough has provided more support per head than other London boroughs, and so told that we have been over providing.  It’s never considered that we might actually have been providing a good service!

We have been told that we are in an even more dire financial situation than we thought.  Our Director of Social Services told us last week that we have no financial reserves; he came to our team meeting to tell us that although he admires the work that we do, we have to be making more savings. Learning disabilities services are always seen as the ones eating up most money – but we have many v complex issues to deal with, including the expectation of funding very expensive services coming up from children’s services,  working with people with autism/ Aspergers who fall between the net and who we are not funded to work with but just cannot leave unsupported, lack of health funding etc etc.  Several of our providers are struggling as the money paid to them is being cut again and again – there will come a point where some of them will not be able to survive and still provide a safe service.

I have read the posts where others have talked about volunteers being used. We are constantly told we should be using ‘universal services’ which I agree with where possible, but where are these services? And when they do exist,  they are not always suitable for adults with learning disabilities.  I think younger people with learning disabilities and their families are now growing up with different expectations, but for those who are older, they seem to be taking the brunt with their services being reduced more and more, and they haven’t developed the resilience and skills to be more independent.

I have been in the Court of Protection and High Court this week with a very difficult case. So far, the Local Authority have had to pay £12,000 up front for 3 barristers (2 representing the Official Solicitor ), as we haven’t been able to get benefits information from the DWP to prove legal aid eligibility.  On Thursday, they said they couldn’t continue representation until we paid another £6000 !  Luckily the judge ordered them to pursue the DWP for information, as he couldn’t allow any more public money to be used in this way.  But this happens constantly.  Legal fees eat up money which could be used elsewhere.

  I am also a qualified Best Interests Assessor (BIA) authorising Deprivation of liberty safeguard  (DoLS) applications.  However, I have recently made a decision to stop doing these as I am sickened by the amount of money being poured into this area. When the DoLS first came in, it was generally to protect the most vulnerable.  However since the Cheshire West ruling, which has lowered the threshold for DoLS, the flood gates have opened.  I know it is all meant to be being looked at by the Law Commission, but this process seems to take forever, and meanwhile all this money is being wasted.  A lot of it is a tick box exercise now, and you get independent BIAs touting for business, which goes totally against the ethos of the original reason why DoLS were introduced.

I will finish with one story about DoLS.  I have been involved in a project moving 10 adults with learning disabilities from 2 residential homes into 5 supported living flats (The Care Quality Commission deemed the original homes unfit for purpose ). It has been such a positive project for everyone involved,  but it nearly didn’t happen. All 10 people lacked capacity around signing a tenancy and around their care treatment. So we had to go to the Court of Protection around signing the tenancies and around agreeing the Deprivations of liberty (as it is Supported living, this has to go to the Court of Protection not the DOLS team). I cannot begin to tell you how much work this involved! Myself and a social worker, with help from our in house legal team had to fill in the endless forms, consult with everyone involved etc etc, as part of a court process which kept changing so we never knew where we were. Eventually the whole process was taking so long that the housing association providing the flats threatened to pull out.  We made the decision to approach our Director of Social services with this, and he agreed to take the corporate risk of moving people in before their tenancies were signed and before the DoLS were authorised.  So at last people could move in and the whole project has been very successful.  But the whole court process took 18 months to complete!  And I dread to think how much money has been involved in the whole process. And this is not an isolated project.