Archive for March, 2011

A day centre we can afford to close

Wednesday, March 9th, 2011

As day centres for older people across the country are closed by cash strapped Local Authorities the most lavish and the most expensive to run remains open. I refer of course to the House of Lords. Where those who have served their country go for their subsidised meals, cheap booze and the opportunity to keep up with current affairs or just doze.

Unfair I hear you shout it’s been ‘reformed’. Is it now an elected chamber? Does it now represent a cross section of society in age and ethnicity? Have we got rid of all those people who were only there by reason of birth or in return for a favour (financial or otherwise?). Does the second chamber now have real power to challenge the decisions of the House of Commons as in other democracy’s?

Well then it’s still a day centre for the privileged and we clearly can’t afford it.

Blair McPherson author of Equipping managers for an uncertain future. Published by www.russellhouse.co.uk

Return of card board city

Monday, March 7th, 2011

Westminster council has announced a ban on sleeping in the streets, in expectation of a steep rise in the number of homeless people as a result of the housing benefit changes. Fearing a return of card board city it has also banned soup kitchens for the homeless. Those attending the opera will be saved the embarrassment of having to step over rough sleepers or having to ignore the requests of beggars.

Banning rough sleeping is an attempt to remove the homeless from sight not an attempt to end homelessness. Card board city was removed last time not by making it illegal to sleep on the streets but by offering more places in hostels and drop in centres. This was effective because it was linked with services to help people get back into main stream society. In some cases that was dealing with a drug and alcohol problem in other cases it was help with reading and writing to both improve self esteem and job prospects. In some cases the help and support started a process of reconciliation with families in other cases healing the scar of a childhood in care. Often it just provided a platform for getting your life back together.

Now these services are also being cut back due to the financial pressure on local authorities. The result will not be less rough sleepers but less well supported more desperate rough sleepers. And that is not embarrassing that’s disgusting.

Blair Mcpherson

Author of Equipping mangers for uncertain future published by www.russellhouse.co.uk

500 Channels and nothing to watch

Friday, March 4th, 2011

T.V.in the USA tells you a lot about life in America and if things keep going in the current direction what life will be like here. The USA is the land of choice where paradoxically there is very little variety. There may be 500 channels on cable t.v. but you will be hard pressed to find something to watch. So if t.v. doesn’t get better the more choice you have do other more important things like schools and hospitals?

The Public Sector doesn’t offer much in the way of choice so will the care of older people be better if there is a choice of Older Persons Homes and Home Help services?

In the past the argument has always been about the balance with in a mixed economy, some state ,some private. Now the argument seems to be do we really need any state services as long as we have a choice of private services? We are assured it will no longer be the rich that will have choice, every one will! The state will fund your choice, up to an agreed limit. But does this mean you won’t have a choice of going Public? Does it mean your local authority Social Service Department won’t run any Old People’s Homes or a Home Help service or Day Centres? That you won’t be able to send your child to the local state school because there won’t be one. And all hospitals will be private but take state funded patients.

In terms of television it would mean that there was no BBC. 500 channels but nothing worth watching.

Blair McPherson author of Equipping Managers for an Uncertain Future published by www.russellhouse.co.uk  

 

Over night the over 55’s disappeared

Friday, March 4th, 2011

Over night the over 55’s are disappearing. This is not a case of alien abductions but it is evidence of a management cull. To demonstrate their commitment to reducing over heads and living within a greatly reduced budget local authorities have been cutting management posts in some case by 25%. This is being achieved by voluntary redundancies and early retirement although if there are insufficient volunteers compulsory redundancies will follow. In the current employment market voluntary redundancies are only attractive if you have another job lined up otherwise your lump sum payment is likely to run out long before you get another job. Due to the pension rules early retirement is only on offer to the over 55’s. The result is that on1st April there will be a lot of empty managers’ desks in local government and a lot fewer experienced old heads.

Can any organisation afford to lose so much experience so dramatically? We are about to find out. No doubt some will argue that it is no great loss to lose people who were increasingly seen as square pegs in round holes, managers who were struggling to come to terms with the dramatic changes taking place and perhaps some did no longer have the fire in their belly and would have coasted to retirement. Others will point out that new management structures will mean new management posts and the chance of accelerated promotion for the talented and ambitious. Some will be apprehensive that they will be put through a competitive interview process the prize for successful candidates being they keep their job but with twice the work load and half the staff.

 Identifying where the budget cuts will fall and reducing costs by cutting management posts is just the start. Delivering the savings and transforming services needs skilled managers at a time when some of the most experience and skilled managers have left the organisation. Energy and enthusiasm can achieve a great deal but with increased spans of responsibility covering services they don’t have a professional background in and a remit to implement unpopular budget decisions inexperienced managers are going to need advice and support. Where will they get it from? Traditionally advice and support comes from HR who will dig you out of the hole, from members of your peer group who have been through it and from your line manager who has seen it all before. Trouble is HR have been “rationalised” and don’t/can’t offer that level of support any more, most of your peers are like you going through it for the first time and your line manager is new to the post and is more “strategic” than operational and is very busy.

It’s sink or swim. Some will find the stress too much but the majority will learn quickly. Unfortunately some will learn by their mistakes let’s hope they are working for a forgiving organisation.

Blair McPherson author of Equipping Mangers for an Uncertain Future published by www.russellhouse.co.uk

Revolving doors

Friday, March 4th, 2011

Hospitals talk about the revolving door, patients who are admitted and then discharged only to reaper in A&E. In some cases this is caused by the sheer speed of through put, in others it is the lack of adequate support services at home and in some cases it is the lack of a home.

Homeless patients cost the NHS eight times as much to treat. Homelessness is one of those social problems that is everyone’s problem and no one’s problem. Everyone thinks it is a housing problem just a case of ensuring there are sufficient beds in hostels and council flats. Every one that is except the Housing department who point out that homeless people typically have multiple problems which are beyond their remit. People living on the street often have drug and alcohol problems. Understandably a hostel won’t provide a bed even for the night to someone who is drunk or under the influence of drugs. The staff have to consider the safety of other residents and alcohol and drugs are often associated with aggressive even violent behaviour. A high proportion of young people on the streets have been in care, in prison or in the forces which means they are known to other agencies but not necessarily still receiving support from them. They may also have mental health scars as a result of their experiences prior to ending up homeless. Many homeless people left school without qualifications severely limiting their job prospects and a significant proportion have difficulty reading and writing.

Once in hospital it is understandable that staff would want to fix the medical problem and discharge the patient as quickly as possible even if this is back on to the streets and even if it means that it is only a matter of time before they are back in A&E in a worse condition than before. So this is a clear case of the need for a multiagency response prior to discharge.

 Local Authorities and PCT’s have in many parts of the  country  jointly funded “re enablement services” for older people which provide short term intensive support on discharge motivated by a desire to prevent bed blocking and unnecessary readmissions. So there is a model in place the problem is that in the current financial climate there is a very strong temptation to think short term, stick to core business and argue that it is someone else’s responsibility.

Blair McPherson is a former Director of Community services his latest book is called Equipping Mangers for an Uncertain Future published by www.russellhouse.co.uk

Travelling backwards

Wednesday, March 2nd, 2011

The hospital porter was pulling the wheel chair at speed from the x ray department to the ward. The elderly patient was tipped back in the chair, griping the arms tightly her face frozen in fear all she could see was the ceiling lights flashing past. It was like someone persuaded against their better judgment to go on one of those big rides at Alton Towers. As they speed in to the ward sister halted their progress and demanded to know why he was pulling the wheel chair backwards. The porter replied “it’s faster”.

This incident seemed to sum up the NHS transformation journey, going backwards fast without any regards to the patients experience and no way of seeing where they were going.

Blair McPherson