Thinking about…

The Vogons (from the hitchhiker’s guide to the galaxy) are a race of interplanetary demolition experts. The problem with them is that they will do nothing without the correct protocol or the right paper work in place…. In one scene, our key protagonist (Arthur Dent) and his friends escape the clutches of the Vogon’s and the Vogon’s decide to give chase – but this can only happen once all the right paper work has been completed and an hours lunch break has been taken.

You may have already guessed that I believe social care and health care can be very ‘Vogon’ in all that social care and health care do.

When assessment and care management was introduced as part of the Community Care Act 1990, I was part of a local authority social care training team tasked with training social workers and health care workers in needs led assessment and how to cost a package of care. As we started the training programme, participants were given free reign to assess peoples needs, work out what funding might be needed to meet those needs and get on with delivering that support. What we soon found in practice was that most needs led assessments and costed packages of care didn’t cost very much at all. Social workers and health care workers were very good at imaginatively enabling people to lead ordinary lives at very little additional cost to local social care and health organisations. But….

All of this imaginative empowering low cost support by free ranging social care and health care workers began to freak middle managers out. After all, what was their role all about if the social care workers and health care workers were getting on with stuff without them?

Obviously social care workers and health care workers could never be trusted to use public money wisely, so the middle managers developed a panel process whereby every package of care had to written up, justified and presented to a panel of wise and knowledgeable middle managers before anything could be actioned. This led to the social care and health care workers that were doing the assessments and costed packages of care, upping the severity of peoples needs and pricing the packages of care much higher than they had been doing in the hope that when the middle managers knocked them back, the service user would end up with a package of  care and support that pretty much resembled the package of care and support that they had planned to give them in the first place. It’s just that this would happen two or three months later than it would have done if the social care or health worker had just been left to their own devices.

At this point you might think that over time the new Vogon inspired way of doing things might start to settle down. But…

The senior managers started to get worried about their purpose. I mean if the social care workers and the health care workers were assessing people and costing up packages of care and the middle managers were taking workers through a lengthy process to get them to agree to the package of care, what was the role of the senior manager?

Of course the only way that the senior managers could demonstrate their importance was to develop a strategy and introduce eligibility criteria that they could use to check that –

• The social care and health care workers were spending money on the people that most   needed it.
• That the middle managers were making sure that the social care workers and health care workers weren’t overspending.
• That the senior managers could demonstrate their importance to elected members
• So that elected members could tell their constituents that everything was under control……

So instead of needs led assessment and costed packages of care leading to innovative, person centred low cost support for lots of people, we have ended up with a system where people with care and support needs either received nothing, or they received more than they had asked for. This is after having waited months and months for anything to happen. And… in order for the system to work, more middle managers were needed and more senior managers were needed to process everything and less social care workers and health care workers doing the needs led assessments and costed packages of care were employed.

And the moral of this story is, if we want social care and health to fail, we need to keep on adding loads more checks and balances so that we spend more time focused on justifying what they do rather then doing anything.

If we want truly personalised care and support for as many people as possible at a price we can afford, we need to have faith in our workforce and believe that if we have taught them well, nine times out of ten they will do the right thing. 

We need to be more human and much less Vogon.

Jim Thomas

December 2024