Monthly Archives: May 2010

Shadowing a Social Worker – pre-course reflections

This is a Guest Post by a friend of mine who is going to start her social work course in September. She was speaking to me about the pre-course shadowing and I asked her if she’d write a post about it! I think it’s great – I might ask her for updates as she starts her course (I haven’t told her that yet but she knows who she is!). Many thanks to her! – cb

What I have learned from shadowing a social worker

First thing is, I didn’t see a single cardigan in the office during the whole week I was there.

But I digress. Let me go back a month or two … I have just heard that I had a place at university to study social work in September 2010. Once the paperwork turns up with the unconditional offer, it’s suddenly real enough to make me nervous. I know from past experience that this is a good sign – I love a good challenge and I know I will enjoy this course, it’s another stage on a long journey from a very unrelated profession but I know that I am happy with the direction it is going. I’m still nervous though.

The university send me a friendly email about pre-course requirements, one of which is that I need to shadow an experienced social worker for a few days. It is clear that it’s up to me to make this happen.

Finding a place to shadow

I consider my options. I do know a few social workers and I could ask around for any shadowing opportunities in their workplaces. But they mostly live in London and really if it’s my choice, I’m curious to find out more about the community/ies and local authority where I’ve lived for the last 10 years. After all, I may want to work there when I’m qualified. I realise when I think of it that this is probably cheeky – will they want to do a favour for a random person they don’t know? But it doesn’t hurt to ask, right?

Since I have approximately zero contacts within the local council, I started with the website. It has a page on health and social care which sounds like a good start. I decide to read through all of it in the hopes of finding a name somewhere who I could contact. I pause when I read the articles on social care training. What I am asking seems connected with that. So I drop a polite email to one of the people who is named at the bottom of the page, explaining what I would like to do and asking if it might be possible. I explain that I’m asking because I’ve lived in the borough for over 10 years so I feel attached to the community and it was my first natural choice.

After that, everything happens very quickly. She emails me back that day to say that she has passed on my request and to wish me luck with my studies. And very soon after that, I am in contact with an actual social worker who has agreed to let me shadow her for a week. She says, “How about next week?” I think – crikey, this is all so quick. I say – that would be great, I’ll see you on Monday morning.

Things I have learned about social work and social workers

  • Social work is fuelled by tea and biscuits.
  • A lot of useful work also goes on in the canteen at lunchtime, as people discuss aspects of their cases informally over food.
  • When procedures talk about putting service users at the heart of the work, they don’t tell you that clients can change their mind a lot about what they want. Sometimes twice a day!
  • The rest of the council (e.g. care procurement) seems very phlegmatic and good natured about the above fact. I figure they’re used to it.
  • People in general really care about their work (this is rather different from private industry). This is very obvious when you sit down to talk to them about it.
  • Many people in the public sector have not worked in industry and may have unrealistic assumptions about it. (I laughed aloud when someone told me that they thought that no one had any issues with IT “in the real world”. Sorry, but that’s a constant and local authorities are also the real world ;) )

Yes but what did you really learn?

The shadowing week has been a very positive experience for me. I’ve been able to really shadow a social worker through her week. I’ve seen how she handles her caseload by updating records, arranging service provision, getting agreement from appropriate groups for any extra spend, and by going out and visiting with the client/s. I see how the work expands to fill the available time. I see how many other people she has to liase with.

I’ve seen how a group composed of OTs, community nurses, case co-ordinators and social workers get along and work together.

I’ve been able to sit down and talk to people in different teams about what they do and how they do it. I’ve also been able to read through the procedural handbook used by a live team, which really shows how the social work principles are applied in practice (by that team, and via the procedures.)

I’ve been able to reflect on what I’ve seen. I wrote a short essay about one of the interviews I observed with the person I was shadowing, and discussed it with her afterwards.

And most importantly for me, I can imagine myself doing this job and doing it well. Not yet though. I need that training, and I will need support while learning the ropes, and it will take time for me to become as competent as the people I have been shadowing this week. But I didn’t come away thinking, “Oh no, this is all a terrible mistake.”

The other side to my week is that I think it was also a positive experience for the team. People seemed to really respond to my showing interest in their work – and it was genuine interest.

The woman I was shadowing also mentioned (when we were saying goodbye) that when her manager had first told her that she would have a student following her around, her first reaction was to think, “Oh no, why me?” But she’d enjoyed the week a lot also, and was now planning to take up a training opportunity she had been offered to train as a practice teacher so that she could have a student to supervise herself. I think she’ll be great! (And I told her so.)

Capacity and Surgery

There is a case reported in the Telegraph today which I found interesting in relation to my work with the Mental Capacity Act – a generally very positive piece of legislation that has affected so many aspects of the way we work.

It is interesting partly because of the rarity of public judgements under the Mental Capacity Act (2005) so anything that comes up tends to be jumped on by practitioners as there is still a lot of vagueness that could do with some  legal clarification.

The case talks about a 55 year old woman with learning disabilities who suffers from cancer. She is afraid of hospitals and has consistently refused hospital check ups and treatment due to this fear. Initially she agreed to surgery however her fear of hospitals and needles led her to miss appointments and refuse ongoing treatment.  Sir Nicholas Wall, the President of the Family Division agreed with the application by surgeons to operate in his role as presiding over the Court of Protection.

It seems to have been established that the patient did not have the understanding of the impact of her refusal to access treatment and therefore the process of assessing capacity and the judgement that she lacked capacity to make a formal consent were clearly established.

The decision to sedate her in order to admit her to hospital and to carry out what will amount to major surgery without consent is obviously so drastic that the bounds of the Mental Capacity Act were being tested and quite rightly the case was brought directly to the Court of Protection to judge.

It is a balancing act that should be subject to external scrutiny beyond medical professionals necessarily and obviously not being party to all the details, it can be easy to draw conclusions.

From an academic and professional point of view, it is interesting in the way that the Court of Protection  has been used to make a judgement relating to health and welfare, rather than strictly financial matters as had been the case prior to the new legislation. The discussion about ethics and the morality of forcing surgery on someone who lacks capacity to consent is also healthy in the sense that although the decision has been made to go ahead with the surgery, the discussion allows the consideration of her position and human rights along the process rather than simply allowing a dramatic decision to be made on ‘common law’ principles.

Sir Nicholas stated that he released the judgement to assist with other decisions that might be made in hospital up and down the country. I suspect that when there is a need to sedate someone and remove them to hospital, it would still be necessary to go to the Court of Protection for clarification but it allows us to see what some of the thinking behind the decisions would be.

There are, of course, implications that run through A&E departments constantly. There is a difference too, between planned surgery and an action taken in an emergency to prevent the loss of life. Perhaps the real story to take with us is that if we have firm ideas about our wishes for treatment or the lack of it, an advance directive is the safest way to go.

Protected: R.I.P PC

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Sectioned – A Quick Review

Probably not the most in-depth review as I haven’t had a lot of time to process the programme shown on BBC 4 on Wednesday called ‘Sectioned’ as a part of the ‘Out of Mind’ season about mental illness.

The programme’s aim was to allow a greater insight into some (in this case three) patients who had or were being detained in hospital under a compulsory section of the Mental Health Act (known as being ‘sectioned’).

They followed three men – Anthony, Richard and Andrew and looked at the challenges they have and continue to face and the way they have experienced mental health services – particularly and exclusively (because of the nature of the scope of the programme) in-patient services.

Between them, they had experienced a number of hospital admissions and the programme certainly picked up on the cyclical nature of some of the experiences of mental illness. There isn’t necessarily a beginning and an end but more different ways of seeing things and different places along the scale of wellness and illness.

Rather than recount the experiences that were highlighted in the film, I think at least the film succeeded in presenting the stories of three individuals rather than three ‘patients’.

We had an understanding of who the subjects were and the effect that their illnesses had on them and their closest family.

The story was one of experiences rather than processes quite rightly and I think there is scope for programmes such as these to increase appreciation and understanding of the reality of mental health inpatient wards. There was no indication that any kind of support or process existed outside the wards but I suppose that wasn’t the point of the programme. There was a helplessness though that I was almost left with when I wanted to justify a little more hope than was presented but perhaps that wasn’t within the bounds of the programme makers remit.

One of the most striking things was the declaration that hospitalisation is and was crueller than imprisonment. There is no sentence though, just a revolving door and no crime that has been committed to lead to the sentence and the natural cycle of right and wrong.

It was a decent and sympathetic programme covering an aspect of mental health services that is often ignored. I wonder if Janet Street-Porter would benefit from a little time watching programmes such as these and coming to visit a psychiatric ward..

But then, as I explained to my tearful foster child last night, so long away from her family with no idea when or if she might be going home at all,  life isn’t about being fair.

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The Next Steps

The new coalition government published some of the details about their plans for the next five (gulp) years yesterday. I had a brief glance at the issues as they relate to social care in particular.

I feel distinctly underwhelmed, I have to say. I’m glad the Tories’ ‘insurance scheme’ has hit a road-block at least. It made no sense at all to me and didn’t really address a lot of the more widespread issues relating to social care funding. The Lib Dems  seems to have dragged them back to the idea of negotiations and discussions.

Negotiations and discussions and commissions. That’s a bit of a drag. Haven’t we been here before? A few times. I know realistically there wasn’t another way forward but it feels like there is constant ploughing over the same paths again and again with more consultation documents about the same things. I wonder if the government really are serious about saving money when they just repeat the same consultations endlessly. At least the document mentioned the Wanless Report (which, incidently, I have a lot of time for). I wonder what difference the consultation will bring from consultations raised over the last few years and it seems like just another chance to delay the decision making even more.

All the other policies presented, apart from the completely unsurprising trashing of the ‘Personal Care at Home Bill’ which to be honest, didn’t make a whole lot of sense to me anyway, are just progressions of the ways things were moving in social care anyway.

As the Secretary of State for Health confirms

Today’s coalition announcement sets out how the Government will push forward reform of social care. The Government will:

• establish an independent commission on the funding of long-term care, to report within a year;

Unsurprising – see above

• break down barriers between health and social care funding to incentivise preventative action;

More preventative action can’t really be argued against. Preventative work has been completely neglected in the face of cost-cutting in the short term and meeting performance indicators. I’ll be keeping a close eye on this one.

• extend the greater roll-out of personal budgets to both older and disabled people  and carers to give more control and purchasing power; and

This was always going to happen regardless of which government was in power.

• increase direct payments to carers and better community-based provision to improve access to respite care.

Nice words – actually there has been a massive increase in respite provisions over the past few years and increasing it can only be a good thing.

The government has also promised to increase and prioritise funding into dementia research which is very positive. I wonder how much funding will be spared the scythe of government cuts in general though.

Burstow has been appointed as the Care Services Minister. He has, I understand, a fairly positive background in speaking up on social care matters. It could have been a lot worse, I guess and we’ll see if he has the power to battle it out with the Chief Secretary to the Treasury in order to secure funds for the department and the sector.

So I remain a little ambivalent. It’s hard to argue against any of the provisions made but where the difference will be made is in the amount of money that can be argued away from the Treasury by the Department of Health in the coming months.

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Community Care Live – reflections

Yesterday, I went to the ‘Community Care Live’ event which runs for a couple of days (it’s on today as well). As usual, I had to pick which day had the more useful sessions and ended up with a fairly busy programme yesterday and a few difficult decisions about which sessions to attend,

I don’t want to go into a detailed review of the sessions here. Not least because I’m sure Community Care will cover the particulars far better than I but there was a theme that came up in a few of the sessions I attended.

It seemed that there is much talk about personalisation. Much distress at the ‘old fashioned’ way and social workers’ opposition to the move towards a far more equitable relationship of power between service users and local authorities. It made me sad to hear it.

It made me sad because I did go into social work to work actively towards empowerment and to embrace user choice and freedoms. I love that personal budgets and direct payments have changed the outlook of social care field. I love that there is a move away from care management and the processes that bog you down in the public sector. Particularly I love the creative way that budgets can and are being used – yes, using a personal budget for bingo trips is the way we should be going.

There is an elephant in the room though. The personal budgets and support plans that I see being approved for older adults are not the creative ones because the margins are so tight that the only money there is for people who need personal care. Sure, if you want to sacrifice one ‘wash’ a week for a bingo trip, you’d be able to but there isn’t as much money in the pot for older adults as there is for younger adults with disabilities. Please let’s have bingo trips and trips to be pub instead of day services but there has to be an understanding that older people do not get as much money as younger adults for ‘leisure interests’ so a trip to be pub may be at the expense of personal care – it’s a choice and it’s good that there is a choice but to pretend the system is equitable between younger adults or older adults or to use younger adults as an example for creative approaches is a fallacy because the budgets don’t stretch as far in older adults’ services.

We can look at day services to provide the ‘creativity’ and yes, it’s feasible that they may stretch to some of the more ‘flexible’ services. I hope they do. At the moment though, in looking at day care for someone with very high needs relating to advanced dementia, there’s a limit to the amount of ‘creativity’ you can establish. Not because we don’t want to,  but because there is still a need for carer respite and the budgets are so much lower than adults of working age.

Day centres should be more proactive and certainly have to be more than ‘respite for carers’ centres but that is also about quality control. They aren’t for everyone either but they are for some people.

Of course, there is more paperwork but I can deal with that (ok, I gripe) if I can see the outcomes for the service users that I work with changing fundamentally (as they so obviously do in some situations with younger adults and older adults who are able to and wish to manage their own budgets). The problems I see is that the words are all a smoke-screen. We are being told to implement individual budgets at massively increased bureaucratic levels but then action them through ‘virtual budgets’, buying care in from the same agencies so the effects on the service users are minimal if not negligent but it still ‘counts’ as an Individual Budget for the borough’s PIs (performance indicators).

It feels like a fraud because it isn’t about making the system more flexible but more about allowing the borough to achieve better PIs.

I’m not saying that Individual Budgets are not a wonderful thing. Personalisation is a great step to be taking ideologically and it is absolutely the right way to go. But fitting people into inflexible systems is the problem and not allowing the hours to be taken into account and the training to be widespread and far-reaching – that is the problem.

Again, at Community Care Live yesterday, I cowered as I felt I was being labelled with all those ‘fuddy duddy’ social workers from another era who want to ‘crush’ client choice in their own care services.

I want the opposite. I would love a well-resourced system that allowed us to plan according to needs rather than services. That is what was promised by the NHS and Community Care Act (1990).

I am absolutely and wholeheartedly behind the progress being made in user choice. I just see so many problems with the current implementation as it is led by Performance Indicators rather than a true desire to change the ways that services are delivered to everyone, rather than a smaller range of articulate and able service users. Again, it is those who have the quieter voices who suffer the most from this approach as the money is siphoned to those who are able to shout loudest.

Other thoughts from the Conference yesterday – there is a lot of general uncertainty about where the new government might be taking us. Which policies and frameworks will stay and which might be sidelined in the cause of cost-cutting.

There will always be a disconnect between front line practitioners and policy makers/senior managers who think they might know what it is like ‘in the field’ but work in private consultancies or have managed to ‘go into training’. I wonder sometimes who much contact there is with the front line. Of course, that is tarring a lot of people with the same brush and it isn’t always entirely fair – but sometimes it is. It’s very easy to feel ‘preached to’ by people who haven’t actually been in a front line local authority team for a long long time.

I know everyone has their hearts in the right place but I wonder how much more could be achieved if more front line practitioners were involved in steering and policy groups.

The usual stands with the jobs (mostly children’s services), pens, mugs (didn’t get one this year), mousemats and booklets were all there.

This year I also bumped into quite a lot of people I knew. That’s a sign of my longer service in the field as much as anything. It’s always a good thing to bump into familiar faces – until next year..

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Officers or Nurses

I know I shouldn’t go to the Daily Mail website. It is a form of morbid curiosity but I saw this article headlined and couldn’t resist

Chief Constable Peter Fahy of Greater Manchester Police says that he needs ‘more mental health nurses as much as officers’ because, and I quote

‘there were so many disturbed patients being let out onto the streets by the NHS that officers were having to ‘pick up the slack’.

‘Let out by the NHS’ – I wonder if that’s the new term for a hospital discharge. .

I don’t even know where to start with this. Of course, I don’t have the figures to hand and don’t know what the time spent on s135 and s136 is on Greater Manchester’s police force but it’s a valid use of police time.

s135 is the part of the Mental Health Act that allows an AMHP (who would have a warrant) with a police officer to enter a property to remove someone who is mentally unwell to a place of safety for an assessment to take place.

s136 allows the police to remove someone who they believe to have a mental disorder to a place of safety for an assessment to take place.

And the use of s135 and s136 powers is not about ‘apprehending criminals or ensuring no crimes are committed’ but rather an act taken for the safety of the patients and the general public to ensure that an assessment can take place.

Public safety, I thought that was what we were to expect from the police as much as ‘apprehending common criminals’.

I ponder at his comment that

‘We have to train our staff to a professional level of someone like a mental health nurse to enable them to deal with these cases.’

Seriously? He thinks he is training his staff to the level of a mental health nurse? I have to say I am fortunate to work in an area with some really wonderful police officers but it’s a bit like MPs saying they are social workers because they deal with a bit of paperwork every now and then. It denigrates the work that is done by professionals and that it should be acceptable to make an issue of it is a surprise. If it is acceptable.

The article goes on

He said: ‘Officers are very good at being able to detect the burglars, the car thieves, the hoodies, basically your common criminal.

‘But what we are talking about is a particular type of disturbed individual whose irrational behaviour is outside of the norm.’

He told the conference: ‘I really feel for my own staff who are sent to domestic violence or mental health cases, dealing with vulnerable people when that officer is trying to do his best and then a tragedy occurs.

‘Even if they have done their best, the Independent Police Complaints Commission will treat the officer as if they are responsible.’

Mr Fahy also called on magistrates to lock up suspects until proper risk assessments could be carried out.

So much to pull apart in those sentences. Firstly, I think he is underplaying the skill of his own officers. He distinguishes between ‘common criminals’ and somehow manages to put mental disorder as ‘outside of the norm’. I’d love to know what his idea of normal is. .. oh wait, I think it is very clear. The fact that he refers to ‘hoodies’ says it all really.

I wonder how much he is just riding on the crest of Daily Mail readership but there’s some serious problems with what he says. The assumptions that he draws that mental illness = danger. That domestic violence is ‘just a drag’.

The police should be dealing with ‘common criminals’ rather than ‘domestic violence or mental health cases’. Interesting interpretation when he wants to pick and choose what help to give.

I would feel very sorry for any mental health nurses he did want to employ but I think it was just a matter of rabble rousing.

In the meantime it does nothing for the cause of working together and combatting assumptions and stigma against those who suffer from mental illnesses and need the support of services, including the police force, at some of the most difficult moments.

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BBC Four’s ‘Out of Mind Season’

I mentioned last week a programme ‘Sectioned’ which is on this coming Wednesday. This is part of a season which is starting tonight on BBC4 related to mental health.

It started with a rerun of Stephen Fry’s ‘Secret Life of a Manic Depressive’ with the first part being shown tonight and the second part on Wednesday.

At 9pm tonight, there’s a showing of ‘Mental : A History of the Madhouse’ which looks at the history of the ‘asylums’ through the words of people who worked in them and lived in them. A few of my colleagues worked in some of the larger longer stay hospitals. I’ve heard some of the stories but I think it’s useful to put mental health policy and practice in a historical context and I am actually really looking forward to watching this one.

At 10pm there’s a drama by Poliakoff ‘She’s Been Away’. It is about a woman who had been ‘away’ for many decades in a psychiatric hospital/home and a friendship she develops with another woman. In what was Dame Peggy Ashcroft’s final performance, it is summarized as

‘an agonizing depiction of medical bureaucracy ruining one life and nearly killing two others’

Although it was originally aired in 1991, it offers a great opportunity to see what was a very well-received television play. I’m also hoping to catch this although whether I’ll actually watch it tonight or not, depends on today’s workload!

Wednesday has the airing of ‘Sectioned’ which I wrote about briefly last week. It should be a chance to see a different side of the world in which I work and try to explore it as an outsider. Sometimes we become so used to the types of worlds we work it that seeing it from the outside is both refreshing and thought-provoking.

I think these seasons can do a lot to challenge thoughts and assumptions about mental health services and the people who use and need them. I hope to be challenged about my own assumptions and perceptions as well. I’m sure some reviews will be posted over the next week or so!

The Open University have a tie-in which looks at the documentaries (Mental : A History of the Madhouse and Sectioned) and also looks at how Mental Health can be explored through different art forms. It’s definitely worth checking.  They also have a free CD to give away which connects with the programme series and has five artists explaining how their personal experiences have impacted on their creativity.

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Protected: Winding Down

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A New Government

I had a lump in my throat when I watched Brown’s resignation speech. I thought he spoke with an enormous dignity. But within the hour a new tenant of 10 Downing Street had staked his claim.

My one sadness and this is a very personal one is that my father was always a Liberal/Liberal Democrat. My grandfather stood for Parliament (in a completely unwinnable seat) as a Liberal and my mother stood as a councillor (again, I think it was not a particular winnable seat) for the Liberals.  My uncle was a Liberal councillor for decades. Although I’ve veered at times further to the left, my father who was brought up very much in that political culture and environment would have been so excited to watch the games as they have unfolded. He loved politics. How much he would have enjoyed this process. I’m not sure about the result as he was very bitter about Thatcher’s legacy but nonetheless I’m sad he didn’t live to see it.

So what might a Conservative/LibDem coalition look like? Wow, I just shuddered even typing those words.

There will be a lot more coming out through the day but so far but the National Care Service is dead. Will there be another consultation on funding for Adult Care? Probably.. Eventually.. but the costs will be a factor and costs are going to be a heavy theme for this Parliament.

For the moment the focus will be heartily on cuts. It is a frightening time to work in the public sector although in our team and our Trust, the cuts have been coming hard and fast in any case. Just yesterday, we were told that some of the advertised vacancies which had been covered by now dismissed agency staff, have been retracted and that there will be a recruitment freeze – regardless of current vacancy levels. Not Good.

Incidently, I was talking to the other AMHP in my team earlier in the week and she muttered how we should be reassured that as AMHPs we were in a better position than most regarding job security as there is a big shortage of AMHPs in the Trust and people haven’t been rushing forward to train. Maybe that will change but I don’t take a lot of comfort in it to be honest. There will definitely be more than a few lean years. I can’t say I’m want to be graduating imminently..

On a broader level, I worry about where the Personalisation Agenda will move and how much it will be a transformation into lower costs and scrounging around agencies paying minimum wages at awful conditions for an hour here or there.

I am pleased the income tax allowance will rise to £10,000, helping the lowest paid workers, and the Tories plan to raise the inheritance tax will be shelved.

I was also heartened to see a proposed end to child detention immigration controls.

I’m  glad they’ll be a referendum on the Alternative Vote system.

I expect we’ll know a lot more about the way things will fall together when we know who is in charge of Care Services and pushing these agendas that are specifically relevant to social care through. I hope that the Tories ‘insurance’ scheme against costs of entering residential care is considered and dismissed as the idiocy that it is.

As I mentioned to a colleague at work yesterday, a coalition government is better than a Conservative government.  I have to say I am trying to be hopeful but I have just a little trepidation moving forward.

But I’ll get back to that over the next few days no doubt.

——-

In other news, The Guardian highlights that a documentary called ‘Sectioned’ will show on BBC4 next week – May 19. It will follow three people ‘as they pass through the UK mental health system’. I think it sounds fascinating and will, no doubt, pick up on it when it shows – but something to highlight in advance.

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