howard mcsweeney1- Location: Dover
- Registered: 12 Mar 2008
- Posts: 62,352
#1
courtesy of the independent on sunday.
David Cameron is set to embark on a fresh round of public service reforms, radically changing the way services for children, patients and the elderly are delivered.
The Sunday Times reported that the Prime Minister was preparing to legislate to give individuals "personal budgets" to buy for themselves services which are currently provided by local authorities.
the paper said that the Government's long-awaited public service reform white paper, setting out the plans, would be circulated to ministers this week ahead of full publication next month.
Proposed changes to the law were said to include:
:: Allowing the elderly to choose how money is spent on their care;
:: Enabling people with long-term health conditions to choose their own therapies;
:: Giving parish councils powers to take control of local parks, playing fields, parking and traffic restrictions;
:: Allowing parents of children with special needs to make their own decisions about schooling.
The move comes after a bruising week for the Government in which it was forced to water down its controversial NHS reforms in the face of fierce opposition from healthcare professionals and patient groups.
Guest 675- Registered: 30 Jun 2008
- Posts: 1,610
#2
A few things sprang to mind when I read the article.
'Allowing the elderly to choose how money is spent on their care'. As this will inevitably be done on a set budget it will mean the elderly needing care in their own homes having to chase around looking for the cheapest options then possibly/probably having to decide which they can 'do without'. The danger of meals and cleaning coming low on the list of those who think they are better able to care for themselves than they actually are is only one of the concerns. For those needing residential care the choice of care home would be limited by the same budget.
The choice of therapies can too easily be coloured by social, religious or family considerations, not always in the patients best health interests.
The 'taking over of parks etc' is something the District Councils would already like but will Town/Parish councils be given the budgets or means to raise funding to pay for them?
Decisions about schooling would have to depend on the availability of school spaces and the accessability of the schools. Will we now get a long term and messy review of the education system?
While I do agree that the health system does need a major reorganisation so far there has been little sign of a workable alternative.
Politics, it seems to me, for years, or all too long, has been concerned with right or left instead of right or wrong.
Richard Armour
#3
Another factor that should be noted is that "unregulated" workers could be used by service users in order to cut costs, and that could leave people at risk.
Guest 698- Registered: 28 May 2010
- Posts: 8,664
#4
By "unregulated", Bern, do you mean workers who don't enjoy civil service or local government levels of salary and pension arrangements but only get paid a market wage?
I'm an optimist. But I'm an optimist who takes my raincoat - Harold Wilson
#5
No, Peter, I mean those who are not registered to deliver services, including private individuals and organisations. Those who therefore do not have to meet standards and regs and are not inspected.
Jan Higgins
- Location: Dover
- Registered: 5 Jul 2010
- Posts: 13,931
#6
To be honest, I am fed up with the moans from the civil servants. I seem to remember them complaining about something with their threats of strikes all my life. Most of them are in secure jobs, why should they be treated any different to anyone else.
I say this as the mother of a civil servant, who frequently says how inefficiently his department is run.
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I try to be neutral and polite but it is hard and getting even more difficult at times.
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Guest 698- Registered: 28 May 2010
- Posts: 8,664
#7
I take your point where work of a social, healthcare or teaching nature is concerned; but laws already exist to protect users of such services. Where work such as maintaining parks and gardens can only be offered to organisations large enough and expensive enough to afford ISO accreditation, (such as English Landscapes, a national contractor maintaining Dover's green spaces) then the local economy will suffer because small businesses ( who are invariably cheaper than national groups) are shut out from such opportunities.
I'm an optimist. But I'm an optimist who takes my raincoat - Harold Wilson
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
#8
Peter is absolutely right of course. This reform removes power from one-size-fits all beaurocracy. The record of our beaurocracy is not exactly perfect of course, far from it, they cause as many problems as they solve and the idea that they know better how to spend our money than us is a fallacy. This is a brilliant move, a real power to the people reform that will create competition and choice. Those people who lack the mental capacity to make such decisions are of course covered under LPOAs or the Court of Protection provisions in the 2007 act.
#9
Agreed - up to a point. The laws existing to protect potentially vulnerable service users depend upon registration and regulation. I only refer to social and health support services - I absolutely agree that competition for services delivered to the public sector is essential.
BarryW - many people in need of some protection do not fall into the category needing POA work. There are degrees of vulnerablity
Guest 675- Registered: 30 Jun 2008
- Posts: 1,610
#10
As I said before, one of the most vunerable groups are those who don't like to complain and think that they are better able to cope than they are. These are the people who will almost always slip through the net. The appearance of coping and/or the desire to manage for oneself is not always coupled with actual ability.
Politics, it seems to me, for years, or all too long, has been concerned with right or left instead of right or wrong.
Richard Armour
Guest 698- Registered: 28 May 2010
- Posts: 8,664
#11
You can't force people to accept help, Chris. Some refuse help out of pride and will not accept what they see as charity, even though it be taxpayers' money paying for it. If you force changes on people you are getting into Brave New World territory or worse.
I'm an optimist. But I'm an optimist who takes my raincoat - Harold Wilson
Guest 675- Registered: 30 Jun 2008
- Posts: 1,610
#12
Never said we should. My point is that there is a vunerable group who will be either left out or easy pickings for those 'cheap' providers who have no skills and hidden costs. It is not a matter of forcing them to accept help but rather of monitoring the help they get or need. The danger is the changes will be forced on them by cutting them loose with their own budget.
Politics, it seems to me, for years, or all too long, has been concerned with right or left instead of right or wrong.
Richard Armour
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
#13
Chris - the information should be available to help people make decisions for themselves. It should be clearly and simply set out and presented well in a range of formats and easily obtainable. Yes some will make better decisions than others and that must be accepted as part of life's rich pattern. There is only so much you can or should do to protect people from themselves. Naturally that does not apply to those who are mentally incapacitated, as I said there are provisions in the 2007 Act for them already.
#14
And all nurses should be patient and kind...........we have to operate in the real world!! And, Barry, we cannot rely on "legislation" to protect everyone who needs it. I have seen too many people failed by and ripped off by people who were supposed to be supporting them to have any faith in blanket legislation.The fact of the 2007 act does not create sufficient protection.
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
#15
Bern - I agree with you about legislation and that is why I support this move to decentralise power in this way enabling people to take control of their own lives.
That does not get away from the fact that there will always be people suffering from mental incapacity, alzheimers perhaps or from the results of a serious accident. These people will be catered for through a LPOA or provision made by the Court of Protection under the 2007 act. In these cases those given the power to decide by the Court or under the provision of a LPOA will have the power to make those necessary decisions and take control on their behalf.
Anyone else can make their own decisions and it is they who need the information to enable them to do so in a simple easy to understand format. We have to accept that some will make good decision and some bad - we cannot and should not protect everyone from their own mistakes. Lets face it - wherever 'big brother' state gets involved they hardly get it right for everyone now anyway. In fact I would suggest that because of the tick-box/lowest common denominator/cover backs attitude in public services more people will make the right decision for themselves. If they do make a mistake, perhaps contracting the wrong carer , then they would have more power to correct that error without a beaurocracy to fight.
#16
Realistically that is not so, BarryW. It is true that specific incapacities can be managed usin g LPOA etc, but the fact is that people who are in receipt of care and support often feel disempowered in the same way that sometimes patients in hospitals or nursin g homes feel unable to complain, even about the most appalling things, because they fear retribution or some consequences. For that reason we have regulations and standards which organisations and individuals have to meet in order to register to deliver services. It is true that these regs and registrations are often inappropriate or open to too much subjectivity because the very people policing the regs are themselves flawed, but I am afraid they are a necessary evil and better to have registration and regs than a properly open market in which cowboys can operate without fear of complaint.
I should add that I vigorously support ones right to make bad decisions! My view is that it is better to make a free but wrong choice than not have freedom. That is not the same issue as the above.
howard mcsweeney1- Location: Dover
- Registered: 12 Mar 2008
- Posts: 62,352
#17
i still hae doubts about the elderly taking responsibility for important decisions about their care.
they don't need to be mentally incapacitated or have alzheimers to let the "bloke from the water board" in to loot their home.
every time we hear of a new scam that is laughable to most of us, we can be assured that there will be elderly people taken in by it.
#18
And not just elders - freedom to choose does not exclude the potential to regulate appropriately in order to reduce risk.
Guest 655- Registered: 13 Mar 2008
- Posts: 10,247
#19
Bern - you make some good points but in #16 you are assuming that the new rules giving power to people will not have any safeguards. I am not against regulation as such but I do want it to be proportionate and not over-the-top. Competition and choice may well be that added element, empowering and freeing people from that tick-box beaurocrat. Howard - it is not only pensioners who get ripped off by cowboys though yes they are more vulnerable.
#20
Forgive me, your lack of direct experience in social and care services shows. It is not possible to bring the exact same processes to social and care services as other services such as gardening and cleaning. There are more complex factors at work and a different approach to regulation and registration is needed. It is not as simple as wheeling out a set of standards or safeguards and making them fit.
