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23.Nov.2009

Self-funders of social care are to have a new avenue of redress after legislation was passed giving them access to an independent complaints review service run by the Local Government Ombudsman.

The LGO was given the additional role after the Health Act 2009 received Royal Assent. The service will be made available from October 2010.

Once the Care Quality Commission completes its new registration programme of providers, the LGO will be able to review complaints about privately purchased care services made by users, their family or others affected by the actions of a regulated adult care provider.

Tony Redmond, the Ombudsman, said: “At present, under a private care arrangement, people have no redress for anything that has gone wrong except by using their provider’s own complaints procedure, or going to court.

“This compares unfavourably with people whose care is funded or arranged by a local authority – they have access to a statutory complaints procedure and to the LGO if dissatisfied with the outcome. We will be able to correct this through our new service.”

The LGO acknowledged that the diversity of the independent care sector, and the complexity of its relationships with regulators and service commissioners, will demand a very different approach.

“We welcome the views of providers and their associations in developing the new service and also the input of organisations who support and represent users of adult social care services, their relatives, or carers,” Redmond said.

Good practice in complaint handling within the sector will be highlighted through a range of training and support materials. The LGO added that it will identify any general learning from the cases it receives that may help to improve services more widely.

 

 

 

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21.Nov.2009

A pilot scheme at the Inner London Family Court designed to support parents with drug problems is showing encouraging signs of success, writes Louise Creighton.

It is a fantastic day when a young mum with drug problems leaves the family court with a final supervision order made by consent. The advocates congratulate the mother and chuck the baby under the chin,  recalling the first hearing, over a year ago when the child was removed on an interim basis from her care.

The depressing reality, though, is that even the most veteran family lawyers can recollect this experience of a successful rehabilitation only a handful of times. It is this reality which drove the resident District Judge based at the Inner London Family Court, Nick Crichton to devise and pilot a scheme known as the Family Drugs and Alcohol Court [FDAC]; it is based on a model from the US. FDAC operates within the framework for Care Proceedings for S31 Children Act 1989 Proceedings and so the issues of establishing the threshold criteria remain the same as in usual court proceedings.

The scheme, which received some government funding together with funding from three Inner London Boroughs, forms part of a pilot project which will last three years and combines a 30 month study by Brunel University. The system has now been running since January 2008 and the outcomes are becoming known. The questions are: How does it work? Does it work? Will it be rolled out?

The Inner London and City Family Proceedings Court serves 15 London boroughs and it is estimated that more than 80% of cases before the court have an element of substance misuse. Following the removal of children within care proceedings, the court and advocates attempt to identify what steps the parents should take to address their, often deep-seated, addiction problems.

Attempts are made to access those services which will help to deal with the myriad of psycho-social difficulties prevalent within the family, for instance domestic violence, drug misuse, and neglect. Counselling and mental health interventions as well as often daily contact and expert assessment are set in motion.    

A coordinated approach

FDAC aims to streamline this process by offering a coordinated assessment and service provision at the court, signposting the clients to outreach services and employing a cross-borough network of support. The idea is that the services will be brought to the parents.    

The advantages to the local authority in this arrangement are that the unenviable logistical task of co-ordinating the parents’ attempts at recovery are shifted from the busy social worker. It is intended that the assessment services are tailored to meet the parents’ needs, leaving no gaps in the evidence. There is frequent monitoring of progress with regular drugs screening and fortnightly hearings.

There is no wait for an expert to become free as FDAC are working with the Tavistock Family Centre, which is a multi-disciplinary resource of psychiatrists, psychologists, independent social workers and so on. The costs of the assessments are generally by way of block funding. Lawyers are not required to attend all the hearings which saves time for the local authority lawyer.

Where contentious or substantive issues arise, it is usual that the lawyers will be asked to attend. It must be said that, at times, what the FDAC team recommend or consider an appropriate course of action, can be at odds with the local authority's view. It is not unusual for there to be a differing of opinion between the professionals. At those times, the court would, of course, adjudicate.

Early warning

The theory is that failure on the parents’ part to engage or remain abstinent will be detected early on. The parents cannot coast whilst their children drift in the care system.

It appears that the parents value the continuity of the judges in non-traditional interventionist roles and value the input of the FDAC team. This enhances their ability to work with professionals including the social services team.

The scheme has provided support and assessment for 63 families in the last 20 months. Eleven parents have exited the project early, placing the children within their family or for adoption. Nearly half of all the families entering the FDAC programme from the three pilot boroughs had been known to social services for over 5 years or more. Nearly a quarter of the children were over one.  

What is clear from the first year and a half of this project is that rehabilitation takes a long time, there are nail biting lapses by the parents and  entrenched life style choices for the parents to extricate themselves from. But the long road to recovery existed as an option for the court before the FDAC scheme was in place. What the local authority and the parents are supposed to obtain from FDAC is a more cohesive testing system, designed to detect difficulties early on to enable earlier more decisive planning for the children.  

The signs are promising

Will  FDAC become a feature in all our family courts? The interim evaluation report by Brunel University in September 2009 shows notable successes. So far 12 families have come through successfully and hopefully it will be 14 or 15 by the end of the 2009.  

Success is, of course, uncertain for another five years but ongoing local authority monitoring  can be achieved by way of a supervision order. Success can also be measured by finding out more quickly that a child cannot remain with his birth parents and moving the child on to alternative permanence that much sooner.  The interim report sets out that the project’s strengths lie in the commitment of the innovative and knowledgeable team and their determination to drive assessments in care proceedings forward.   

Back to the fantastic day, before the buggy has reached the lift, a residual doubt and anxiety settles over the professionals and lawyers as they worry about whether this mum can make it with the stresses of parenthood and the pull of substance misuse. But the FDAC model provides for regular testing, a prompt gateway to the appropriate support and resources alongside rigorous assessment and if there is any hope for maintaining the family unit, it is surely worth a try.    

Louise Creighton is senior partner of Creighton and Partners

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21.Nov.2009

Interest in merging the organisational structures of local authorities and primary care trusts is growing. Helen Mooney reports on the opportunities – and the challenges.

In the summer of 2008 Herefordshire County Council and Herefordshire Primary Care Trust took a leap of faith. They became the first local authority and PCT  in England to merge their organisational structures.

Although local government and NHS organisations have a legislative duty to work together, none before had made such a bold move. The council and PCT in Herefordshire now work under a single management team and chief executive, although the two are still separate bodies, with their respective responsibilities and funding.  The organisational structure has been developed to increase joint working. More recently, Hammersmith and Fulham council and PCT leadership teams have also started to work jointly under one management structure in a similar vein.

At present a number of London Boroughs led by Barking and Dagenham, as well as Powys County Council, are all understood to be looking at developing a similar model. So why the renewed interest?

Geoff Alltimes, chief executive of Hammersmith and Fulham’s joint organisation management team, says that it was the logical step given the “shared vision and priorities” of both organisations.  “It makes sense to have a shared leadership team to deliver on these aims,” he argues. “For example, how can the council seriously look at renewing deprived areas without taking into account the health needs of our residents?  Improving the life chances of our residents overall means that we have to look at the complete picture.... we need to ensure that residents have access to quality healthcare, education, housing options and employment.  “Neither the PCT nor the council can deliver that on its own. That’s why it makes perfect sense to have one leadership team to deliver on that bigger picture.”

The two organisations have since brought together a number of services which are managed and delivered jointly, including the commissioning of children’s services, the human resources and payroll teams, and emergency planning. From a legal perspective, joint working can have its challenges. Alltimes explains that in Hammersmith and Fulham, the council and PCT are still two independent organisations with parallel governance arrangements.

“They remain legally constituted as before, with minor changes to their constitutions to allow for a joint chief executive,” he says. “The main impact is on operational management and covers issues such as delegation of powers, managing people and finance, most of which we believe we have overcome through the framework we are putting in place.”

One reason it has become more attractive for local authorities and PCTs to form closer links is that it could provide more resilience against current and financial difficulties. Fiona Taylor, acting legal partner for safeguarding and partnerships at Barking and Dagenham, says that future public spending will be dominated by tighter controls over resources and the focus will be on localism and shared services.

“This is one of the key drivers for the renewed interest in closer links between local authorities and PCTs,” she suggests. “The rationale for joint provision is clear, cutting costs by merging senior posts within both organisations, directing resources in line with community priorities and sharing expertise in key back office functions.”

However, Fiona Taylor adds that in order for a merger to be successful, training staff on liabilities and conflicts of interests is essential. “Many of the conflicts will surround the issue of finance. For example, if a local authority chief executive also sits as the PCT chief executive and has to make difficult decisions about funding regimes that overlap between social care or the NHS, clear protocols and governance arrangements need to be in place to deal with conflicts and withdrawing from a debate.” Taylor says a joint strong internal audit team is also necessary to advise on such issues.

David Lock, head of the public law team at Birmingham’s No5 Chambers, thinks that merging organisations and management teams can provide real opportunities.

“By and large, the NHS is accountable upwards and government provide the funding, whereas local authorities are accountable downwards to their local communities, so there is a conflict of national targets versus local targets which has to be managed,” he points out. “But this is a great opportunity because it means aligning health services with local needs and local authorities with national targets. Both local authorities and primary care trusts have a statutory duty to co-operate with each other, they are not stand-alone organisations, but merging the management teams enormously assists that obligation to work closely together.”

Lock, however, cautions that there can be some dangers and cause for concern in merging organisations.

“Firstly, by and large the NHS is free at the point of use whereas local authority benefits are means tested. Because of this, in delivering services across the health and social services divide, local authorities need to be very careful about which charges apply. Under Section 75, pooled budgets can be used, but there are no exemptions regarding people who ought to contribute. I understand the attraction in wanting to merge boards – because of the duty of cooperation and the aligning of services – but at an operational level it can be impossible to ask a single member of staff to deliver a means-tested and non means-tested service. It is a recipe for chaos,’ he warns.

Susie Rogers, a partner at health service specialist law firm Capsticks, agrees.  “Things need to be transparent when local authorities and PCTs form closer working relationships,” she says. “Getting the right documentation in place will allow councils to continue to charge for services and for NHS services to be free.”

Rogers also warns that both organisations need to make sure that they look closely at their key performance indicators in terms of service delivery, to make sure that the right standards are in place across the different services provided by both organisations.

“Ultimately local authorities and PCTs which merge need to focus on why they are doing it, they need to focus on the results and outcomes for their local population,” she says.

Helen Mooney is a freelance journalist.