Welcome to my world

JUDY WURR offers insights into the role of a Lord Chancellor’s visitor and her experiences in dealing with lay and professional receivers.

Sometimes a girl just doesn’t know what to put on in the morning. Should it be the tricorn hat and breeches of the parish clerk (a four hours per week job I hold in my South Devon village – and a completely different story), or the wig and gown of the Lord Chancellor’s visitor (LCV), an office I have held on a self-employed basis for the past seven years.

This world of diversity began when we decided to downsize our lifestyle and move from London to Devon. Shortly after the move, I saw a press advert for self-employed Lord Chancellor’s visitors. Until then, my only contact with the Court of Protection had been when, in the early eighties, I was working as a secretary in the administration department of a north London hospital for the mentally handicapped. My involvement was limited to applying to the Court six months in advance for people who needed £50 for a set of summer or winter clothes. I had assumed that these were people with no family, almost ‘on the state’, whose only friend was the distant and foreboding Court of Protection.

With my appetite whetted, I went on to take a Masters degree in the Management of Disability and Rehabilitation, and to set up a training and work facility in central London, for people discharged from long-stay psychiatric hospital. I therefore felt reasonably well-equipped to tackle the LCV tasks described in the ad.

I attended an interview in the Public Trustee Office (PTO) just off Kingsway, round the corner from the alleged, original Olde Curiosity Shoppe. I considered how apt this was. Old style civil service – dark décor, pokey rooms and people pushing trolleys bearing paper and more paper. Unbeknown to me, the PTO was in the process of change demanded by an Audit Commission Quinquennial Review, which had suggested it should pull itself into the 21st century. One of the recommended changes was that it should become the Public Guardianship Office. Another was that the existing team of six (yes, just six) Lord Chancellor’s visitors should be augmented by open advertisement. The original team of visitors comprised ex PTO staff, with great knowledge of the workings of the PTO, but not necessarily specialised backgrounds in health and social welfare. The new job descriptions recognised the brave new world of the NHS & Community Care Act 1990, where the separation of finances from quality of life became less distinct for people who ‘lacked mental capacity’. It also accepted that six visitors were insufficient to monitor and support 27,000+ UK-wide existing clients and their receivers.

I became one of the nine new recruits, making a total of 15 general visitors (since increased to around 40). There were, and are still, medical visitors – psychiatrists whose main role is to assess clients’ mental capacity in the event of their wishing to be discharged, or appealing against being placed under the Court. The role of the general visitor is to visit clients on the instruction of the Court and to submit a report, currently using a set format, detailing how it is ‘on the ground,’ ensuring that finances are maximised and safeguarded, and making recommendations for the use of those finances to enhance the client’s quality of life. Currently, all new clients are visited within six months of the Order being entered by the Court, and there is an ongoing programme of visits, which should ensure that each client is visited at least every three years. There has been a backlog of clients who have never been visited and this is currently being worked through.

A typical week

A package of up to 10 hard-copy instructions hits my doormat. They will each have a ‘visit by’ date, some five months or so hence. They may or may not contain useful information. They will state the known name and reference number of the client, and the name of the receiver. As readers are aware, if any of us loses mental capacity, no one else has the automatic right to manage our own finances unless we have effected an enduring Power of Attorney, which will then need to be registered. If we have not done so, our affairs are taken over by the COP, which appoints a receiver of its choosing to do so. The receiver may be a close relative such as a spouse, a local authority, or a professional, for example, a solicitor. There will certainly not be any up-to-date casework information and, in most cases, scant financial information.

I cover a large area of the South West, encompassing Devon, Cornwall, south Somerset and west Dorset. Each month, I extract instructions with a ‘visit by’ date two months hence and work out an itinerary whereby I can most cost-effectively cover the visits. I am paid a flat fee per visit, with no travelling time or expenses. Time has to be allowed for subsequent follow-up and report writing. I plan a number of visits per day; for those at greater distances I arrange to stay away for two days, spending the night locally and writing up the day’s reports.

Once I have grouped my instructions geographically, I telephone each client location to ensure that the client is still there. Often receivers fail to tell the PGO when a client dies, or moves. If all is well, I make an appointment to visit and then contact the Receiver with an invitation for them to attend if they wish. Perhaps I am a little more persuasive and give them less scope to refuse if I feel that the client, and I, would benefit from their presence. I continue to be amazed at how many receivers, despite their agreeing to visit at least once a year when they submit the application, tell me that they do not visit. My visit at least gives them the opportunity to redeem themselves and show that they do have the client’s interests at heart. The excuse from some professional receivers that ‘It is too expensive for me to visit’ is not well received by me. Professional receivers are paid a fee and expected, at least occasionally, to check that their client’s money is being well spent on their care.

At the visits I am entirely client-focused. I need to know that the care and support being offered to the client is of the highest possible standard and that people are not paying unnecessarily for it. Clients are either paying for their care themselves, or, if the state is paying, have already paid indirectly through their taxes. There can be two-tier services for those who are ‘private’ and those who are ‘on the state’. Due attention should be paid to clients’ statutory rights to funding and services and I consider it part of my role to ensure that these rights are upheld. I am constantly surprised that receivers are often ill-informed of disabled people’s rights to assessment and review, regardless of means, and to their right to funding from the NHS if they have primary health needs. This funding may be in the form of one of three bands of RNCC [registered nursing care contribution] if they have lower needs, or full continuing-care funding if their health needs predominate over those of social welfare. There is a commonly held, media-fuelled, view that all care funding is means-tested. I regard it as part of my role to inform receivers that health needs are delivered free and those should be assessed first, before local authority social welfare needs are assessed and means-tested. Particularly in the case of hospital discharge, there is a framework that should be followed to ensure that the correct funding is offered. I have had considerable success in recommending that receivers challenge local authority assessments and demand that the NHS pays part, or all, of their client’s care fees. In some cases, large back payments of fees have been reclaimed.

I try to remember that, while the visits are routine to me, to the client and the lay receiver they are often intimidating and stressful. The initial appointment telephone call from ‘the Lord Chancellor’s visitor’ can send a lay receiver into a state of great distress. They are often initially upset at finding themselves in a situation where they are supervised and monitored in carrying out what they would consider to be their natural, caring and loving role. To be then contacted by someone who sounds official and legal only serves to compound the misery. I try to be gentle. On the other hand, some professional receivers are so laid back about their role that I have the greatest difficulty in even getting them or their secretaries, to take any interest at all. Some I have to remind that they are receivers, and, as such, have duties to carry out which cannot be abrogated. I can become Ms. Frosty in these circumstances and exercise a terrier-like ability to extract information.

Day to day

A typical day might start with a visit to a care home to see an elderly person who has advanced dementia, who may be unable to communicate verbally, but who undoubtedly exhibits signs of an inextinguishable character. I try to find out about their life and achievements so that I can offer an interested and stimulating exchange. ‘Where were you born?’, ‘What was your job?’ and ‘What music do you enjoy?’ will always elicit some response and enable some discourse, even if it is disjointed and bizarre. Responses to these questions, and observations of personal effects (I always ask to see clients’ rooms) will enable me to assess whether or not previous lifestyle choices are being reflected in current services. The right environment and staff attitudes can go a long way to mitigating the effects of dementia and disability. A feisty independence and life of self-sufficiency could explain the apparent antisocial behaviour of someone who never expected to be in residential care. They may demonstrate their individuality in angry outbursts. They may be ‘difficult to manage’ when offered activities which do not match their expectations. Receivers should be alert to making funding available for alternative activities.

My next visit could be to a young person with a brain injury who has received a large (sometimes in excess of £3m) compensation award. This could be for a birth injury, or as the
result of a road traffic or other accident. Such awards are received only after protracted proceedings, with insurers for and against arguing incessantly over the amount due. It is usual for the young person to be placed under the Court prior to the award, when they have very little money. Their main carers, often their parents, may feel confused and disempowered by the process, as well as being very short of money while the disabled person’s needs have to be met with scant resources. Often I hear, ‘I wish we’d never started this,’ in reference to the compensation process. I try to offer reassurance and support and to inform the families of the services they should be entitled to by the state, regardless of whether or not compensation is awarded. I am acutely aware of a world of privatised care and support which is ready to capitalise on the compensation award, but which may not be needed if everyone is aware of statutory rights to funding and services. I gently remind them that compensation is just that – money awarded to offer some recompense for a terrible event, not money that must be used for basic needs, which should be provided by the state. Often, once the compensation is awarded, families are so pleased to be at the end of a stressful experience that they accept what seems like a huge amount. It is only later that they realise that there may be many years ahead in which such sums can be easily used up. Every penny of eligible state funding should be claimed.

I may then go on to a secure psychiatric unit where someone with enduring mental-health problems has been placed under Section of the Mental Health Act for their, or others’ safety. I make sure that their financial needs are met and that there is active planning for their rehabilitation and discharge. I ensure that, if they have been detained under relevant sections,
they will not have to pay for their aftercare. They can be actively psychotic, with bizarre notions about their wealth or status. I try hard not to collude with this but remain objective and empathetic. On occasion, they can be dangerous and my presence invokes anger and frustration as I represent yet more restriction.

Finally, on to a person with a learning disability who may have spent many years in a long-stay hospital in the ‘bad old days,’ but has now been resettled in the community, in their own house, with a package of care and support. When they were discharged from hospital, there was an assumption that they would never manage their own affairs. Fortunately, currently enlightened thinking means that I have helped people to apply successfully for discharge from receivership. So, often their new lives have led to an increased confidence and understanding which enables them, with assured support, to successfully manage their own finances and free themselves from the final ties that bound them to an anonymous and restrictive higher authority. Following my visit, a medical visitor may well call to administer tests of capacity, prior to discharge.

After the visits, the paperwork. A report back to the PGO. Maybe a referral or two to local authorities for assessment for services. And perhaps some reassurance to a receiver or carer that their thankless task is appreciated, and some information on organisations that might be able to support them.

Visitors have absolutely no case-working responsibility. We may make recommendations, but cannot authorise actions. Often, because of our experience, we can see the way forward with a clarity which is beyond our remit. We must control our urges to say ‘If I were you …’ and curtail our creativity to ensure that our reports are objective, factual and informative enough to give PGO client advisers sufficient information for them to act.

At the end of the day off come the virtual wig and gown, and I can say that time has been well spent in offering information and support to people and their carers who are, by definition, some of the most vulnerable in the land, but who so often demonstrate strength of character in overcoming disadvantages in a way that is heartening and uplifting.

We all await further changes following implementation of the MCA. However, whatever these may be, the needs of our clients will remain at the forefront and the visitors’ dedication to their role will endure.

Judy Wurr, MSc, and Lord Chancellor’s visitor, can be contacted at judy.wurr@btinternet.com