Cutting through the red tape

(This is based on my experience, written as a personal guide, not an instruction manual.)

I’ve realised that for many people, including me, becoming ill is enough to cope with, without the hassles of ‘The System’ to navigate. So, I thought I would write a blog on cutting through all the red tape, aimed at helping anyone who has just become long term ill or disabled, or if you have family in that situation. I’m only writing from my personal experience. I do not claim to be an expert in this area. You need to check details of your particular circumstances with the DWP, NHS and/or local adult social care. I also highly recommend the CAB (Citizens Advice Bureau). This blog is designed to raise questions, not answer everything.

The first thing I discovered is that there are two separate systems when you are long term ill and about to be released from hospital. The NHS (hospital) and the community. Therefore, if you are in hospital and have a life limiting condition, the hospital have their own OT’s (Occupational Therapists) and Physio’s that are separate to the community ones. This might seem obvious, but it’s important. The significance being that the hospital team assess you and see if you are fit to return home and if so what equipment and care you need to return to your house. They put in place all the initial things you will need. Things like a bed, commode, carers, etc. But the care they setup is only temporary, a few weeks at most, whereas the equipment can be permanent. There is a problem though. They don’t sort out high spec wheelchairs (I believe they may loan push ones) and unless you already have a wheelchair or can get one, they don’t sort out ramps, temporary or otherwise. The reason that’s a problem is because ramps are not just needed for wheelchairs, but also for stretchers. I was returned home by stretcher, so the lack of a ramp was an issue. You’ll also need a ramp for any follow-on hospital visits if you, like me, need stretcher transport to hospital.

When I was last in hospital and due for discharge, the longest delay in getting home were access issues. The hospital transport service sent out an assessor to check access at my home. As an aside I should explain this was in January 2018 at the end of the period of time I was able to walk (look at my other blogs for details). So, we were in a house with normal access. In our case we have a step. How many houses don’t? The assessor said we needed a ramp; he also reckoned our inside access was too tight. It is tight, but I have had stretcher transport several times since too and from. He was prepared to have the crew try the internal access but would not authorise my return without a ramp. The hospital would not supply a ramp as I had no wheelchair at that time. A circular argument. We had returned my previous wheelchairs as I had been able to walk for nearly three years. After my wife had many fruitless phone calls to the hospital OT, a friend of ours assembled a temporary ramp, enabling my return home.

This is where I am really grateful to a wonderful friend for that ramp, and a fantastic ambulance crew, three of them (an extra one joined them at our house). They persevered even though the temporary ramp was not ideal for my weight on a stretcher. This enabled me to get home. Our friend did a lot more than the ramp. He helped Mary prepare the front room for my community profiling bed.

A word about the temporary care package from the hospital. They put your care requirements on a system that gets bid on by a few care companies. The lowest bid wins! The trouble is companies that bid don’t necessarily have enough capacity. They just want any extra business; it seems they bid first and see if they have capacity second. The company that won me in auction, it feels that way, did not have capacity for the hours I was supposed to get. Which meant that I was given less care each day than I needed, even though they had bid on it and accepted the contract for those hours. The other problem is that the care company who accepts the contract has that contract with the NHS. So, they don’t feel they need to meet your wishes, the NHS is their customer. Every problem I had first had to be authorised by the NHS.

Next step Adult Social Care, that’s community, they take over your care and therefore the payment and authorisation of the care package. This still means you are not directly the client of the care company. But it’s a step towards things changing. You start to get choice. Adult Social Care do an assessment of your needs. They decide how many hours care per week you need. If you have a partner caring for you, they look at respite weeks for them and extra hours care that will help them if they have needs. Looking after someone who is long term ill and needs 24/7 care takes its toll on your health and respite breaks help to prevent burn out. If your partner/carer becomes ill, then the state will end up looking after you full time. They want to prevent that.

Once care is granted by Adult Social Care, you have two choices. First you can let Adult Social Care get you those hours exactly, but from a supplier of their choice. You will not be the client directly. So, it will be like the hospital package with all the control out of your hands. Or you can take direct payments which are less money per hour than any care company charges, yes you heard right, than any care company charges. The council get special rates on everything, so a couple of companies have negotiated prices with them that are at the rate they pay if you let Adult Social Care organise your care. But those care companies treat those contracts as second class. That is my opinion, I cannot claim it as fact, it’s how it feels. They send whoever they want at whatever time suits them. So, if you have a problem with smokers, or loud people or if you don’t want male carers or have any special requirement, tough. If you want to get up at a set time each morning, you’ll be lucky. The cheap rate for the council comes at a cost. Yet some of the staff I have spoken to at Adult Social Care seem unaware of this. They are convinced there are agencies that charge the adult social care rates to individuals, I can’t find them. Either they are as rare as hens’ teeth or like Scotch mist.

I just want to say a word of praise for our main Social Worker, she is brilliant and does understand these limitations. She just has no power to change it. She did a fantastic job organising my care and setting everything up. In fact, most social workers we have dealt with are great, they just lack the power to change the system. The current system means you no longer get a permanent social worker. One sets everything up for you, then you just call the ‘hub’ and speak to the duty social worker for any changes. I am always pleased when the social worker who I know is on duty. For some unknown reason three departments organise Direct Payments. Adult Social Care authorise it, a department at the council pay it and a non-governmental charity, in my case Enham, administer it. Three different lots of staff are being paid to sort out one lot of money. Is that efficient? Cost effective and or does it waste the money that would otherwise go to care? You decide, I have my own opinion.

Direct payments buy you less hours than you are assessed for, but you have choice and can get consistency of carers. They buy less hours because of the difference between the amount per hour paid by adult social care and the amount per hour charged by care companies. Normally at least £2-3 per hour different. I think counsellors and politicians who setup the system should be forced to have the council run system of carers provide them care for a few months. Or try to buy care at the amount provided under direct payments. It’s a nonsense to say you need a certain number of hours then give you insufficient funds to buy those hours from any care agency. Even micro providers charge more than the amount given and they are self employed individuals. The system would soon change if politicians had to use it themselves. One other thing, you receive a different rate of Direct Payments if you use an agency than if you use a micro provider. A little higher for an agency as they are CQC registered and have lots of extra paperwork.

The basis of how much, if any you pay is assessed by the council based on your income and savings. I understand we live in hard pressed times and I realise that I am fortunate to live in a country that provides free care to people like myself without other means. But my point is that either the correct amount per hour should be supplied or at least it should be acknowledged that it is impossible to meet the hours assessed with the amount given. To pretend that the hours assessed and payment given match or can ever match is a folly.

The other very odd part of the system is for respite care. That whole system is very upside down. The way it works makes no sense to me. But it’s too complex to explain here.

A lot of things run in parallel when you come out of hospital. An OT and Physio from the community should be assessing you. A district nurse will no doubt call on you and if you need it, your GP. Depending on your level of limitation you can get almost everything done at home. There is a dental access centre in Taunton you can register with, they do home visits. The same rules apply as with visiting a dentist in terms of payment. If you had free treatment before, you still do. The GP can visit you. Even opticians can test your eyes at home. Again, the free treatment rules apply. But, dental and optician visits at home are second best to going into a practice. They travel with very limited equipment and can’t do everything. So, if you can travel, then do.

With hospital appointments if you have no transport of your own, need to travel by stretcher or wheelchair on public transport would be impossible (buses with a large power wheelchair are a nonstarter). There is hospital transport. They question you closely about why you can’t travel by another method. Hospital transport is also a very inconvenient method of transport. You must be ready 2 hours before your appointment time and can wait an hour or more after.

It’s the OT who assesses you for aids. The hospital OT will have supplied initial equipment, but things like hoists, slings, chairs and other more specialised equipment will come from the community OT or they will advise where to buy them. On the subject of hoists, if you are unable to stand or weight bear, the standard type supplied will be a push portable one. Ceiling hoists are only supplied if they are deemed necessary in your circumstances, as they are in ours.

Just recently we have been made aware that there is a specialist OT who deals with housing, both modification and allocation. No one told us about that when I was sent home from hospital into my front room without access to a bathroom and with difficult access to our house. That’s why I am writing this blog for others. Information is vital, we should have been told advise was available about housing. If in doubt, ask.

Wheelchairs are a whole area in themselves. You need a GP referral for a wheelchair. That referral goes to Millbrook Healthcare. They send out an assessor, eventually. It took 8 months for me and apparently, I was marked very urgent. It seems to me that the new privatised system for wheelchairs is slower than the old system through Exeter Wheelchair Services. In Hartlepool, the NHS wheelchair service assessed me and built me a custom wheelchair within 3 months. The way it works with wheelchairs is that you are assessed for the minimum type that meets your need. In most cases that is a push wheelchair. If you need a power wheelchair because of your needs, then you will only be allocated one if you can use it inside and outside your house. Years ago, when I was first allocated a large high-backed reclining wheelchair, it was still a push wheelchair. See my blog ‘Keep on rolling’. You only get a ramp supplied in your house once you have a wheelchair. Some Church friends bought me a second-hand power wheelchair while we awaited the NHS chair, this meant a temporary suitcase ramp was then supplied. But we were fortunate, friends from Church paid for and other Church friends built an even better concrete ramp outside our house. It accesses our front door and back garden.

I hope my experiences have cast a little light on a complex area. You can see there are many anachronisms and it’s frustrating to navigate. Without Mary sorting all this out over the last few years I don’t know where I would be. She has had many a stressful phone call with different departments. I realise this blog may make it sound like I sorted things out. In reality most things were sorted by my wife Mary. I have only really got involved more recently as things have been easier.

May your journey through the red tape be a simpler one than ours.

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