Weekly Social Work Links 15

I’m away for the weekend so a quicker than usual round-up for this week

SocialJerk is pushed to the limit. Oh, I’ve been there – many times.

Dorlee has an interview with the author of Fat Social Worker.

Back in the UK, Malcolm Payne writes about the affect that child protection failings have had on other branches of social work (particularly in palliative care).

I loved this post a A Case Manager’s Verse which links to pictures of elderly animals.  We’re so used to seeing pictures of baby animals it draws an interesting contrast of perceptions about age.

Interesting post on Gamer Therapist about professionals, boundaries and making connections.

At How Not to Do Social Work the author is feeling frazzled (I can definitely empathise)

Nechakogal writes about a moment of emptiness and a feeling of abundance. Living in one of the most densely populated countries, I can’t help feeling a little envious.

Back in the UK, Going Public picks up on some warning signs for the health sector from social care’s experience of ‘contracting out’.

And I’m going to end with a tale from an Occupational Therapist, rather than a Social Worker – in OT on Wheels – but I think it needs to be read by everyone who works in adult care in the UK about the effect of our action and inaction on those whom we work with and for. It shouldn’t be like this.

Have a good weekend. I’ve got a train to catch Smile

Calm Down, Dear – and Why I Won’t

DAVOS/SWITZERLAND, 29JAN10 - David Cameron, Le...

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This isn’t really a social work specific lesson although it helps, it’s something that comes in handy in all professions.

You give respect, you receive respect. Sometimes it can be a bit more complex and sometimes you work with people from whom you can never be expected to get that respect back from – because of underlying attitudes or because of personalities but it doesn’t matter too much – water off the back and you continue to treat those whom you come into contact with with respect.

It doesn’t hurt and you have to have a bit of a thick skin.

There are many of these reciprocal ‘lessons’. Never ask someone to do something you wouldn’t do yourself is one that draws me back to my work, pre-qualification, as a care assistant. Don’t place someone in a care home you wouldn’t be happy to place your parent/child in. That can be more problematic because the supply and demand are not equivalent and sometimes geography limits the choice of residential care settings but I do think it is the best point to start from at the very least.

Provide services that you would want for yourself or your (insert close family/friend) would want. It’s fairly basic stuff.

So I think it indicates some of my discomfort about Cameron’s ‘calm down, dear’ moment in the House of Commons yesterday but more broadly, the level of banter and conviviality in Parliament that seems to replicate an  poor debating society for under 16s in a private school.

Sexist? Probably but did we ever think he was anything but? Intentionally so? No, I don’t think so. It’s the kind of talk and ‘rebuttal’ that comes naturally.

Disrespectful? Absolutely. It was a put down intended to diminish the speaker to whom it was addressed. That is more of my objection. Whether the person he was talking to was male or female, it is the kind of patronising tosh I don’t want to hear from a Prime Minister, although  I do think there is an agenda to diminish the sexist aspect and write off women who may be offended as ‘not being able to take a joke’ which  even further demeans those who might be offended by his comments or worse, use the feminist label to somehow make itself equivalent to having ‘no sense of humour’.

Honestly, if that is the level of humour that I should be chortling about, I’m very happy to be labelled as just ‘not getting it’ in favour of being a very proud feminist.

And how would you react if your manager said that to you? Well, not very positively. I know I wouldn’t.

Perhaps it is the ‘cut and thrust’ of the House of Commons? Lame response. As one of the people who doesn’t necessarily ‘enjoy’ the adversarial and frankly, childish response of our politicians waving and cheering like sheep in a  herd, I find it hard to understand the appeal of this rambunctiousness.  Oh, it’s tradition? Well, change it.

It is an indication that behaviour in the House of Commons follows a clear path from their schooldays. It is an attitude that automatically appeals to a certain type, and yes, a certain ‘class’ of person who feels comfortable in an environment where respect is a far distant imagination.

It is a work environment that encourages pieces like this in the Daily Telegraph. Seriously. Oh, what? I was supposed to find this ignorant and childish ‘blog’ by a major ‘quality’ newspaper which puts a little red ring around the breasts of a female MP and asks readers to ‘guess whose boobs these are?’ funny? Smacks of harassment to me. It actually sickens me.

Yes, sure, say I have ‘no sense of humour’ if that is your recourse but what kind of society condones this as humour? Not one I feel comfortable in and is ‘having a sense of humour’ so important that it can bypass respect, well, I’m happy to lack one.

Cameron talks of jokes and throw-away remarks but what he and the Daily Telegraph display is a lack of respect that he has probably never been party to by virtue of his position. The view of George Osborne laughing heartily at David Cameron’s intensely patronising ‘joke’ makes me realise how detached these politicians are from the reality of life in the UK at the moment.

We get the politicians we deserve though. That’s the tragedy. I just think we can do a whole lot better than these who seem to make a mockery of the political class of which they are members.

Secret Courts

There has been a lot in the news about super-injections and hyper-injunctions with the Press attacking this most obscene threat on our (their) freedom of speech. Perhaps I’m too lackadaisical about our first amendment   rights to a free and open press or perhaps it is seeing the way that the press push in when it is their own issues that are at stake but to be honest, I don’t really care to know which TV celebrity or footballer is having an affair with which model/ex-big brother contestant.  I presume granting of the said injunctions relate to the protection of children in general being identified rather than the celebrities themselves (although knowing absolutely nothing about the legal processes, that is an assumption of mine so feel free to correct me!)

I think there has been a blurring of the lines and issues between the reporting of these kind of ‘kiss and tell’ mega-hyper-super injunctions and the type that have also been targeted in relation to Family Court and Court of Protection decisions and there needs to be a greater understanding and separation of the issues between the two types of cases. It is a separation that I have seen little appreciation, understanding and knowledge of in the press who seem to be lumping these ‘secret courts’ in with the other injunctions when in fact, the issues and the roles of protection of individuals’ identities are different.

I think there are issues about having more open judgements in the Court of Protection – the Court that deals with issues for people who lack capacity – not least because the decisions of that court relate directly to my practice when working with the Mental Capacity Act every day at work (which I do). Decisions can be made public without any need to necessarily name individuals. Names can be redacted. Sometimes they don’t help themselves. Although I have no experience of Family Courts, I presume the issues are similar regarding identification.

The problem is that without clear reporting of the facts of a case, those who feel wronged by the courts (rightly or wrongly) have free rein to use Facebook/Sympathetic MPs willing to break these injunctions through Parliamentary privilege to cast the details of the ‘travesty of the court’ in their own terms.

Yesterday, I did a little basic research on a name that came up in one of the discussions about a name that is subject to one of these ‘hyper-mega-super injunctions’ – a name that came out on the social networking sites. I’m not going to link any further information here because it’s all ‘out there’  and the details are not the issue but the sites that I found and the language that I found did not seem to amount to a reasoned and level-headed information source of what the truth might be. The language was very histrionic, there were no holds-barred relating to naming young children and making accusations that can never be more than unsubstantiated unless another party in the case chooses to ‘go public’.  That isn’t to say a major injustice might not have been done. It could have been  but it is hard to know without the details that the Court itself was privy to.

So the Courts remain ‘secret’.

Perhaps I have too much faith in the ‘system’? I can’t help but admit that my job relates to my views on this matter.  I’ve been  involved in a case that was open to major misinterpretation in the press because we could never ‘go public’ about the abusive family dynamics and circumstances which meant that they (the family) couldn’t ‘care for granny’. All that was apparent was ‘granny being ‘held’ as a ‘secret prisoner’ in a care home’.

I know that I run the risk of being too trusting of the Court processes and am the first to admit that mistakes can and are made – certainly social services departments are far from always right –  but I also know that there seems to be so little understanding and knowledge of the Deprivation of Liberty Safeguards the area of the ‘secret courts/secret prisoners’ that I do know reasonably well for me to be sceptical of any newspaper reporting of it.

Wrong decisions are made and social workers should not be above the scrutiny of the press but it is  hard to make judgements about the truth of the decisions being made when only part of the story is known is that of the ‘wronged party’.

Conversely I also know there is a lot of misunderstanding of the Deprivation of Liberty safeguards and defensiveness  within local authorities too but I’m not sure the pages of the press are the best places for these misunderstandings to be ironed out.

Better the Courts actually allow more redacted reporting, perhaps, so that some of the more complex issues that social services, social workers and ‘secret’ courts deal with can be understood.

Weekly Social Work Links 14

I know, not quite weekly as I was away last weekend and I’m off for the Easter break so I’m starting the long weekend with a few links from the last couple of weeks.

The Masked AMHP continues his series about Mental Health Tribunals with a post about nearest relatives and their roles in the process.

Dorlee at Social Work Career Development has a great post about ‘termination in therapy’. I still find ‘closure’ quite difficult so it was interesting reading about her reflections on this vitally important process.

SocialJerk writes a very touching piece looking back at someone she has worked with and still thinks about. I do that quite a lot as well.

Melinda Lewis in Capitol to Classroom shares her best career advice.

Nancy Smyth has a great post about skills for the digital age and how we need to adapt.

How not to do Social Work looks at ‘low risk’ placements and foster care. How risk is determined can affect the rest of a child’s life.

Social Worker in the South reflects on liking her job and being exactly where she is. I am fortunate enough to feel the same.

Mel at My Skim Cap writes about the ‘when people become numbers’ and hospital discharges. Some things are the same all over the world.

LCSW Mom at Just When I Think I’ve Seen it All writes a thoughtful post about a death.

Diary of a Social Worker writes about the public perception of social workers

Chris Mill’s Child Protection Blog looks at the increase in calls reported to children’s helplines.

Shirley Ayres has written about the ‘must attend’ social work conference this year on 4th July at the Institute of Psychiatry in London. Looks really good. Would love to go but there’s no external training budget. Anyone want to sponsor me? Smile   (free places for service users/carers/unwaged)

On ‘A Social Workers View’ S. Wangene talks about the beauty of the night sky and noticing it. Speaking of which she has had a lovely redesign of her blog. Go and look!

Ladybird writes about some of the difficulties of writing anonymously and not writing what you want to share sometimes. Oh, I feel that pain!

My last post for the week is not from a social worker but it relates directly to my practice and is a fantastic post about whether the Deprivation of Liberties Safeguards are compliant with Article 5 of the European Convention of Human Rights. OK, it might have quite a specialist audience but Lucy’s blog is an absolute must-read for anyone working with the Mental Capacity Act and Mental Health Act in the UK.

I’m away now for the Easter break. I can’t promise there won’t be any posts at all as sometimes I can’t resist but certainly any posting will be less frequent for the next week.

So happy Easter/Spring!

Eligibility, Birmingham and Cuts

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While awaiting the details of the court judgement, there was an important ruling yesterday that Birmingham Council’s attempt to limit eligibility to social care services to those who have ‘critical’ care needs is unlawful.

Drawing out some of the definitions to what this actually means and could mean requires a look at the details of those who brought the case to court.

There were four defendents which the BBC explains include

a 65-year-old woman with severe learning difficulties who receives 24-hour care in a home paid for by the council

25-year-old man with a rare genetic disorder and severe learning disabilities who receives overnight respite care, also funded by the council

30-year-old deaf, autistic man with severe learning disabilities who is prone to self-harm. His specialist day care would also have gone under the plans

and

a 36-year-old woman with severe learning difficulties whose day care centre will close and who is also set to lose respite care

It’s useful to go back to the definitions of what ‘critical’ and ‘substantial’ needs are to understand fully the implications of councils moving the eligibility criteria from one stage to the next.

Critical needs exist where -

• life is, or will be, threatened; and/or
• significant health problems have developed or will develop; and/or
• there is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or
• serious abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out vital personal care or domestic routines; and/or
• vital involvement in work, education or learning cannot or will not be sustained; and/or
• vital social support systems and relationships cannot or will not be sustained; and/or
• vital family and other social roles and responsibilities cannot or will not be undertaken

Whereas Substantial needs (those that Birmingham are stating they are no longer able to meet) exist where -

• there is, or will be, only partial choice and control over the immediate environment; and/or
• abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out the majority of personal care or domestic routines;
and/or
• involvement in many aspects of work, education or learning cannot or will not be sustained;
and/or
• the majority of social support systems and relationships cannot or will not be sustained; and/or
• the majority of family and other social roles and responsibilities cannot or will not be undertaken

A couple of things to be noted here. A differentiation is made between ‘abuse’ and ‘serious abuse’ so that one will be covered and the other won’t. What kind of ‘legal’ test would there be to determine when abuse counts as ‘serious’ or not? Can we see children in similar cirumstances being subject to a differentiation of level of care available depending on whether abuse is ‘serious’ or ‘not serious’? And who is doing the judging? Well, I can answer that last question. It is the social worker involved as I am asked as a matter of course to ‘band’ people according to these criteria.

The obvious glaring point is the lack of thought of any kind of preventative work that sticking so closely to the criteria will create. Where is the hope of creating those very creative personal budgets when only the very bare minimum of essential needs are being met.

I can’t claim anything other than relief that Birmingham case was challenged in court. These criteria and these levels of need look at people as lists of what they cannot do. That goes against everything that we know and the ways in which we practice by looking at strengths and looking at people as individuals. However, the reason the criteria were brought in in the first place was to end some of the ‘postcode lottery’ of care provisions and to bring consistency to who was offered what nationally. Of course, the problem remained that interpretations of these criteria vary so the consistency which is objected by ticking boxes (the only way the officials seem to know to apply it) depends, as mentioned previously on the social worker who is doing the ‘judging’.

Back to this case though, it was brought under the Disability Discrimination Act and hopefully the judgement will be available soon. Hopefully too, local authorities around the country will be leafing through it and realising that the wholesale and slapdash cuts that they are imposing are not legal.

As for the government of millionaires, none of them will be reliant on social care support from the council. They can buy in any support that they might potentially need and cannot understand the distress of those who are totally reliant on the availability of services.  They cannot understand the implication of their gung-ho ideological cuts and the thought of Cameron, Clegg and Osborne claiming ‘We’re all in this together’ sticks painfully in the throat.

Although I fully expect Birmingham to challenge this ruling, I hope that the case is held and that some of the trigger happy cutting is stopped and the very real effect of the cuts agenda is shouted out more loudly and more clearly – not just for those of us who are personally losing services but to raise our voices with those who cannot always shout so loudly.

That is what social justice is about and that is what social working is about.

Ethical Practice in the Face of Cuts

How can I compute the process of going into peoples’ homes, often relying on good relationships which have been built up over weeks, months or years and telling them that there is no money left, that services need to be cut with my ethical compass and my adherence to a code of practice for a profession which has, at its heart, a struggle for social justice?

It’s something I’ve been toying with mentally over the past few weeks and months. I suppose in some ways this post is an attempt to become an apologist for my own practice but while I know many would argue against my justifications I can’t honestly afford to throw away my job so what can I do to ensure that my moral compass is retained.

Well, I can do my best to advocate. I can tell people about complaints procedures and urge them to use those self-same procedures to make their voices heard. Maybe when council members see the letters flowing through their respective mailboxes from constituents they will pay heed to the effects of the decisions they are taking but I’m not confident that many will take that path. Complaining, unfortunately, is too closely associated with negativity. It shouldn’t be. A complaint is, in some ways, the best way of learning about what a service needs and lacks. I wish everyone complained more. I have been subject to a fair number of complaints over the years and after the initial jolt of damaged pride, I honestly think they have been extraordinarily helpful in the long run.

The last complaint I received which referred specifically to me was from a woman I had been seeing for a while and we went through the process together of setting up a personal budget and support plan. The indicative budget though, was not enough to provide the services that she felt she needed and so the support plan was lacking in some areas that she felt were important to her – simply because there were limited resources. So she complained. She complained that I had not been able to meet her needs and also that I didn’t visit her often enough.

By the time I had explained my actions to my manager and written a draft response to the complaints department, I had been able to give everyone along the way an earful about exactly why I felt the process of determining an indicative budget from a Self-Assessment Questionnaire was fundamentally flawed and discriminated against people with mental health needs.

Her complaint gave her and others like her a louder voice.

I object and shout and discuss the processes that I see within the local authority systems but I still implement them. Does that make me less of a social worker? Again, other issues that I ponder aloud. I have tended to think that outside statutory services one might be able to take a more idealistic view but the building of competence, relationships and understanding within statutory services are a key part of the role as well.

Interestingly, when I think about the moral dilemmas of my work and how I practice, it is far more the issues that come up on the care management side that vex me because they are about the scarcity of resources. It might be more obvious for me to think about the controlling statutory role and power that I have as an AMHP (Approved Mental Health Professional) to deprive people of their liberty by making applications to detain them in a psychiatric hospital without their consent.

I find that part, ironically, a little easier to equate with my role due to the best interests aspect and knowledge that decisions that I make under the Mental Health Act as an AMHP are ones that I, alone, am responsible for and in that role I am not a functionary of a local authority machine but I am responsible for my own decisions to admit or not to admit.  While there is, without doubt, an ethical dilemma present in almost every compulsory admission, it feels different when I am solely responsible for taking that decision and can weigh up the issues myself.

So is this post an apology for the actions I take on a day by day basis in being an instrument of some of the harshest cuts in the social care systems? Yes I think it is.

As much as I strongly disagree with the way that the cuts have been weighted against those who have least, I am still instrumental, amid growing caseloads and shrinking resources in being the front ‘face’ of them to many people I know and who know me. I’m the one who tells them respite services are closing. I’m the one who tells them they have to have a pre-cooked meal delivered rather than a carer actually making a meal for them.

If everyone had what they needed though, it would be a delightfully easy job.  As it is, I continue in my role and yes, complain about it, but try and use all my energies outside my work to take the  fight back to the politicians and the officials who rely on people like me to implement the cuts they decide on behind the closed doors of power amongst themselves.

I genuinely think that it is not possible to be an effective social worker without a thought or concern for promoting social justice and both equality and equity of resource distribution.

And with that, I try to ease my struggling conscience.  It is a struggle though.

Which Care? What Care?

Lakeview Care Home. One of two modern care hom...

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Another day, another story of sub-standard care in residential homes in the UK. Today, the Guardian publish a story which relates to a Which? investigation

It explains some of the way the survey was conducted

In the most extreme case, a member of staff was witnessed dragging a resident towards the toilet by one arm, while another was repeatedly pushed back down into their chair by the head and shoulders when trying to stand up. Which? reported this to the health and social care regulator, the Care Quality Commission (CQC), which suspended admissions to the home immediately.

Anyone spot the problem with this? Yes, that’s right, the CQC waits for incidents like this to be reported to them and then subsequently take action. The CQC or any regulation or inspection authority should be the ones uncovering poor practice rather than being solely reacting to complaints that are made to them.

The Guardian goes on to say

The care homes were selected at random by Which? – one had previously been rated as poor by the CQC, two were deemed satisfactory, and one had been rated good – and the actors’ resulting diaries were analysed by a panel including an expert in inspection, an expert in activity and daily living, and a dietician.

Again shows a problem that has occurred since the scrapping of the ‘star’ system. Homes are still advertising the ‘stars’ and claiming to be ‘good’ or ‘excellent’ when it is outdated system demonstrating outdated inspection reports but still it is the first thing that people looking for residential care for family members.

It is very telling that a Consumer Organisation found the evidence rather than the official regulatory body.

But back to these homes and we’ll see the real fallacy in the ‘ratings’ and the inspections because despite the so-called ‘good’ inspections,

n three homes, residents sometimes had to wait 16 or 17 hours between dinner and breakfast without food, and in one home lunch was served just 1.5 hours after breakfast at 10am. For dinner one researcher was served a small sandwich and a chocolate-covered ice cream, despite them previously stating they didn’t eat chocolate.

There was a worrying lack of activity in all four homes. In one, residents constantly said they were bored, and in another not one of the advertised daily activities (including exercise, a quiz and a singing session) took place.

Does any of that sound ‘adequate’? Let alone ‘good’?

How is this allowed? Because the reduction of age and disability to irrelevance and unimportance in our society. Because care homes illicit a sense of guilt that we barely want to look behind what actually happens behind those closed doors.

This Which? investigation took four homes at random.

The CQC chair, Jo Williams is quoted as responding

The evidence Which? shared with us describes care that falls below what people using social care services have a right to expect – in one case so seriously that we acted immediately to ensure admissions to the home were suspended, and are now considering the best action for residents currently living there.

So this random sample of four included one home where the treatment and findings were so bad that it warranted an immediate suspension of admissions.

She goes on

“CQC listens to the views and experience of people who use services and look at what data tells us in order to identify possible risks, then reviews and inspects services. Seeing for ourselves what is going on in care homes is a key part of our regulatory regime – and almost all of our visits are unannounced. Where necessary, we require improvements against clear timescales or take enforcement action, following up to ensure these improvements have been delivered.”

Almost all of their visits are unannounced and they are ‘regular’ but tellingly, they are NOT frequent. Why is she not proud of the frequency?  The views and experiences of people who use services are important but how often will people feel safe in complaining.

Lest we forget, the Chief Executive of the CQC is a Cynthia Bower, who was Chief Executive of the  West Midlands Strategic Health Authority which was responsible for overseeing the Mid-Staffordshire NHS Foundation Trust where over 400 patients were found to have died due to neglect and poor care. How was she seen as able to take up the role of Chief Executive of the CQC? Not exactly a glowing track record on the regulation front.

Yesterday, Bower was facing the inquiry into the appalling levels of care in Stafford Hospital.

The Independent explains that

She told the inquiry, chaired by Robert Francis QC, that it had been “distressing to learn of the failings of care at Mid-Staffordshire Hospital and I offer my utmost and unreserved sympathy to patients and their carers and families. “I am deeply sorry for what happened and for the fact we had oversight of the NHS in the region at that time and we didn’t pick up failings in care.”

In addition to complaints, there were other alarm signals, such as reports of poor care from the Health Care Commission, the CQC’s predecessor, and of serious untoward incidents. But she said these were not enough to reveal what was going on.

“I wasn’t conscious at the time there was intelligence that we could have put together that would have said there were major failings of care,” she told the inquiry.

“I accept there were some issues we lost track of that would have generated more concern, but I don’t accept there were serious failings to put the pieces together.”

Ms Bower said the SHA did not have the capacity to have a detailed oversight of all of the region’s health services. She said the last NHS reorganisation in 2006 had caused a big upheaval and staff cuts of 60 per cent.

The first thing that springs to mind is ‘didn’t she learn anything about her role in the Stafford tragedy about the importance of GOOD regulation in the care system?’ The second thing is amazement that she should have been appointed to the CQC position anyway after such a horrific track record.

The government’s solution to this? To increase self-regulation and to out-source the so-called ‘excellence’ ratings for those care home providers that can pay.

The answer? Well, it would be more expensive but it would be more spot checking of the things that actually matter to the quality of life of users and residents in these services. How about a radical proposal that every care home is subject to the ‘excellence’ ratings whether they pay or not?

In some ways, nothing saddens my heart more than pounding on and on about poor quality care homes and poor quality inspection regimes – especially as I know that there are many very good care providers out there but unfortunately with a system of inspection which is so broken, those that are good are not recognised and those that are not good are not castigated and closed as quickly as they should be.

How have we ended up with a system that offers so little protection to some of those in our society who are in the most need of advocacy and support? By not caring enough about these stories.

Perhaps  more advocacy is a solution but it costs. Everything that is a potential solution costs. And that’s the problem.

But this is not something that can be swept under the carpet. These stories will return and I hope they do return to haunt those who are responsible for the destruction of the regulation system.

Because until they develop a conscience and a backbone, they will not go away. It’s just a matter of how many stories can remain hidden. And for how long.