In 1955, the first overseas home was established, in Bombay, India. The work started by Leonard Cheshire continues today in Africa, the Far East, Europe (including Russia), the USA, Canada, South America, India and the Caribbean.
When he died on the 31st of July 1992, aged 74, there were 227 Cheshire Homes throughout the world with 77 in Britain alone. The Leonard Cheshire Foundation has grown to become the largest private organisation in the world looking after the physically handicapped whenever and wherever they need help.
The Purpose and Functions of the two organisation- The Leonard Cheshire Organisation and The West Devon Enabling Scheme.
The Leonard Cheshire Organisation.
Their aim is to enable disabled people to live independently and support them when help is needed, whether its intensive support, respite care or just a few hours of support in their own homes.
They also provide-
- Care at home
- Independent and supported living
- Respite care- designed to give carers a break.
- Day care and resource centres
- Services that meet the needs of people with acquired brain injury
- Learning disability services
- A Workability Project which helps disabled people by providing them with computer equipment, training and helping them to find a job
Today Leonard Cheshire operates 140 services in the UK, working with over 19,000 people a year. Leonard Cheshire International supports over 240 services in 55 countries providing day care, skills training and rehabilitation, independent living and residential care.
The West Devon Enabling Scheme.
This organisation was set up to help people with disabilities- physical and learning- live an independent life in their own community. Like the Leonard Cheshire Organisation, it also provides respite care for carers. The enabling scheme helps people to live a life that most people take for granted, such as going shopping and writing letters to family and friends.
In the Tavistock and Okehampton area approximately 28 people use the scheme. However this number is rising and some people have to be turned down as there are not enough volunteers or the scheme does not have the correct sort of person who can care for that disabled person and their needs. The people who use the scheme have to be between the ages of 18 and 85.
At the moment there are 16 volunteers registered to enabling scheme. The scheme is always looking for new volunteers as this number can change because some volunteers are lost due to college or university. Volunteers can be any age but they have to be 75 or under to drive. Many of the volunteers are retired which limits them to the amount of physical work they can do which makes it harder to match a volunteer to a client. If a service user wishes to contact a carer they must do it through Sonia, as they are not permitted to phone the volunteers. The volunteers often provide an extra link between service users and the community, and an opportunity for them to pursue special interests. The volunteers do not receive any money except for petrol money from those clients that can afford it.
If someone wants to become a volunteer Sonia has to make sure that they are actually able to volunteer, she has to sum up what they can do and what they cant and if it is decided that they are able to volunteer then she has to go through the health and safety regulations with them.
Interactions with another service- Social Services.
Sonia deals very closely with Social Services as all people who use the scheme are referred there by the Social Services. A disabled person is requested to fill in a referral form so that Social Services can see what their needs are. If they decide that the scheme is the most appropriate option, Sonia meets them so that she can see if she can match one of her volunteers to their needs. However, she has to contact the volunteer to make sure that they are happy about helping the prospective client. If it found that they are happy with the idea then Sonia will inform the Social Services of this. Once everything has been arranged the client will meet the volunteer to see how they interact and if they get on. If the client and volunteer do get on then Sonia will report back to Social Services.
Analysis of how the Enabling Scheme interacts with Social Services.
Good Points.
- Sonia is in constant contact with Social Services informing them how everything is getting on.
- The client and volunteer have a chance to meet before anything final is settled.
- Sonia is present at their first meeting so she is on hand in case any problems arise.
- Social Services assess the client first so if it is decided that the enabling scheme is not suitable for them Sonia does not have to loose time deciding this.
Bad Points.
- The client and volunteer do not have a chance to meet without Sonia so that they can get to know each other on a one-to-one basis.
- Sonia spends a lot of time organising meetings and phoning clients, volunteers and Social Services.
The bad points could be improved if-
- The client and volunteer have a chance to meet again after their first meeting, where Sonia was present, without anyone else present so they are given more of an opportunity to interact and gain more knowledge about each other so they do not feel awkward around each other if it is decided that the client will use the scheme.
- There could be someone appointed to organise the meetings and phone the clients and volunteers which would give Sonia more time to give to another aspect of the scheme.
The National Framework.
The Secretary of State for Health is responsible for both health and social services in England. Health services are provided in the main through the National Health Service (NHS), whereas social services are mainly provided for by local authority social services departments. In both sectors there is also private and voluntary care provision, in which care for individuals is sometimes purchased using statutory funding.
The Department of Health sets the policy on health and social care, provides funding and monitors performance. There is a national Service Framework for each group of people (e.g. older people, people with mental health problems etc.) and local plans have to be made within those frameworks. Each health authority is required to draw up a health improvement programme (HImP), setting out clear agenda for a three-year period, including action plans for improving the health of the local population and the overall pattern of local services. HImPs are intended to be joint documents, drawn up in conjunction with Primary Care Groups (PCG) and Primary Care Trusts (PCT), local authorities and the public through a process of wide consultation. Social services departments are required to produce plans each year, such as the Community Care Plan, to show how they will meet their statutory duties in their local area. These plans also have to be drawn up in consultation with health authorities and service users.
The diagram on the next page is a simplified picture of a complicated set of structures. It gives an idea of what is covered by the term ‘health and social care services’ and the range of organisations involved in providing them.
PLANNERS
PURCHASERS
COMMISSIONERS
PROVIDERS
SERVICES
acute hospital physiotherapy, children’s day care fostering and
physical care occupational therapy, adoption chiropody day centres,
acute hospital luncheon clubs, child
mental healthcare dentistry, meals on wheels protection
ophthalmology,
health advice and pharmacies volunteer transport interpreting
health promotion services:
counselling residential care- advocacy
outpatients’ clinic adults or children schemes
nursing home care
accident and respite care, family support
emergency services accommodation domiciliary care groups
for vulnerable groups
long term hospital care service user
‘Sectioning’ under the support groups
ambulance service Mental Health Act
Community Health
Services
The West Devon Enabling Scheme would come under the Local Authority ‘provider units’ as it provides respite care, service user support groups and it acts as a day centres although in this case the day centre comes to the clients.
How clients and informal carers gain access to The West Devon Enabling Scheme.
An informal carer is someone who performs certain services for someone else with whom they already have a relationship. They are not paid a wage and they are responsible for the welfare of someone who needs extra help with daily living, because they are ill or otherwise disabled. In many cases the carer is a relative or friend. The West Devon Enabling Scheme attracts most of their clients by word of mouth and this proves most profitable, as it does not cost anything in advertising. If the carer feels that they may need a break or that the person they are caring for may benefit from the scheme then they go to Social Services and fill in a referral form. If the Social Services feel that the scheme is the best option for the person then they will accept them. If this happens then the client will meet up with Sonia and the proposed volunteer.
Barriers that may arise.
- The carer and the person they care for may not have any information about the scheme so they don’t know who to go to gain access or they may not know about the scheme at all.
- The scheme has limited funding so it may not be able to afford to take on another client.
- Social Services may feel that the scheme is not the best option for the prospective client so they will not refer them on.
- Sonia has a limited number of volunteers, which limits the number of clients they can take.
- As many of the volunteers whom Sonia has are female this may cause problems. A male client may not feel comfortable being looked after by a female.
- Another barrier, which may arise but is very rare, is that the client and volunteer may not hit it off.
Possible solutions.
- To overcome the first barrier advertising needs to be improved. Leaflets and posters need to make it clear that if a person wants access to the scheme they need to go through Social Services. They should be situated in places such as the doctors etc where people who are likely to need the scheme will see them.
- The scheme could possibly organise fund raising events, which would increase their funds, and more people would become aware of the scheme.
- The number of volunteers may be limited because people don’t know how to apply to become a volunteer or where to go. They need to put leaflets and posters in places where people already do charity/voluntary work.
- This in turn may increase the number of male volunteers that apply.
- This would also help if a client did not get on with a volunteer because there would be more volunteers so the client wouldn’t have to wait long for some one else.
The organisation of The West Devon Enabling Scheme.
National
Local
Funding
The Leonard Cheshire Organisation receives approximately £102m per year. This money comes from various sources-
- The Government
- Fund raising
- Voluntary income- people give donations, leave money in their wills
- Donations given by businesses, or they are in partnership with businesses which donate equipment such as computers for the Leonard Cheshire Workability project.
The Enabling Scheme receives money from-
- The government. The funds then go through Social Services (they are funded for 3 years).
- Donations
- Fundraising
- The clients themselves who contribute for petrol money.
- £600 a week to look after 1 person in a residential home
Recent changes in legislation, reforms and policies, which have affected the Enabling Scheme.
The NHS and Community Care Act, 1990.
The NHS and Community Care Act incorporates the proposals set out in the Government White Paper Working for Patients (on reforming the NHS) and Caring for People (on care in the community)
The act has six key objectives:
- Promote the development of home care, day care and short stays in residential units, to enable people to stay in their own homes for as long as possible.
- Ensure that service providers also take the needs of the carers into consideration.
- Make full assessments of the needs of the individual and to promote good case management to ensure high quality of care.
- Encourage the development of the independent sector alongside good-quality public provision.
- Clarify the responsibilities of both the social services and health authorities and to hold them accountable for their performance.
- Secure better value for taxpayers’ money by introducing a new funding structure for social and health care.
The Act emphasises a care management approach, based on the assessment of individual need and the designing of tailor-made packages of care. It is important because it introduces a difference between the purchasing and providing of care. The Act also encourages more involvement of private and voluntary sectors in the provision of services.
The Act places an obligation on health authorities to ensure that:
- Health service staff contribute towards needs-led assessments
- Appropriate health care is provided.
- Reviews of individual health care needs take place and service provisions are revised accordingly
Local authorities are also required to:
- Communicate assessments and decisions regarding service provisions to the individual
- Feed back information regarding changing community care needs into a planning system
- Publish information to all users of services on the range of community services available
This Act affects the Enabling Scheme as it is promoting the idea of people saying at home which in turn means that institutes such as large mental homes will be closed. This means that more people will apply for the Enabling Scheme. This may affect the amount of funding that the scheme receives as there will be more clients so the scheme will require more money.
- A rise in funding will benefit the scheme
- A rise in clients may not as the number of volunteers may not rise with this so there will be a shortage.
- If large mental institutes are closed down then more publicity will come to the scheme, as people will be looking for alternatives. This may benefit the scheme.
- This Act also benefits the clients as it tries to keep people in their own community so they will be able to stay in an area they know with people they know.