RIP NHS?

Andrew Lansley, British politician and Shadow ...

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A truly national health service as conceived in the post-war years has been tottering on the brink for a number of years.  As the previous Labour government sowed, so the Liberal Democrats and the Conservatives will reap today as the NHS and Social Care Bill reaches its last stages in the House of Commons  and the Conservative Party  institute their idealised version on a market-led health service which will deliver profits into the hands of investment companies and will place efficiency above effectiveness in treatment delivery methods.

Yes, I feel bitter, very bitter. I don’t see the Labour Party hauling us out of the mess that the both the Liberal Democrats and the Conservative Parties have conspired to leave us with because the Labour Party in their previous guise very much laid the groundwork for this to be done.

I find it hard to believe the audacity and the incompetence of our political elite as they push through a hugely unpopular bill tonight but then, as I pause, I wonder if it is truly incompetence as they are ‘getting away with it’.

We have been confused by details and have been tricked into believing a ‘consultation’ process has taken place. It has taken place very much on the government’s own terms and the listening that has been done has been very selective.

I try not to have a blanket opposition to the ‘private sector’ and ‘profit-making’ in the health and social care sectors but I’ve been burnt by experience. There are some companies that may well be able to improve some aspects of service delivery and I completely accept we all need to move away from the blind public/private being good/bad depending on where you stand on the political spectrum. That’s quite hard for me to ‘get my head around’ as I feel instinctively that profit should not be made from ill-health but equally the government’s obsession with public being bad is equally short-sighted and damaging.

What really sticks is the way that Cameron has blatantly misled the country in the quest for votes. ‘No top down reorganisation of the NHS’ he said, lying openly to the nation and yet we have to accept the mishmash garbage that he is now leading through Parliament as the Health and Social Care Bill and it moves towards it’s Third Reading in the House of Commons today.

I feel angry at the way that language has been turned and stolen from us.

‘Choice’  has become a catch-word but as I have discovered through the ill-spirited and contemptuous way that ‘individual budgets’ have been delivered in social care – choice mostly a luxury of the ‘worried well’ or the more affluent middle classes – in whose ranks sit all those MPs who vote on these changes today.

Choice means very little if you are not in a group that can cost a company money rather than increase their profits.

We have been hoodwinked into believing that ‘choice’ will genuinely exist when these private companies rip up our public services to deliver profit to their shareholders? I think we should ask whose ‘choices’ is it that the government and the health companies that support then, they will be?

Let me turn to the social care sector again because that’s an area I am familiar with. I am very familiar in the ways that privatisation has worked or rather, not worked and the way that ‘choice’ has been promoted – falsely – as the achievable outcome for all end users.

The pushing of the public sector from social care delivery has decreased ‘choice’ in many instances. In the areas I’m familiar with, local authorities have been pushed out as providers of residential and home care services to be replaced by companies such as Southern Cross (RIP), Bupa, Care UK (always worth repeating that they donated to fund Andrew Lansley’s private office)  and homes have closed, block contracts have been signed to provide care at the cheapest costs which increases profits for the private companies of course and limits choice for individuals who need these services.

Anyone who claims that the roll out of personal budgets has or will change this and has increased ‘choice’ I will point to those who have capacity issues – those without family or friends to support them – those who are more marginalised have far fewer choice than the ‘mainstream’ who are able to engage in the process and that suits the government and the propaganda machine just fine.

That is what I fear for with the Health Bill (I am not sure why it’s even called the Health and Social Care Bill as Social Care is so obviously a troublesome ‘aside’ for the government).

Choice may well be nice for making decisions about which hospital is most convenient for a scan but what is being done to assist, support and advocate for those who are not able to make choices?

We are all in this together? Really? I doubt it.

As for me, I’m off to the vigil outside the Houses of Parliament tonight with my local Unison branch.

The TUC have also organised an ‘online vigil’ to oppose the passage of this Act.

And then.. to the Lords. But I will take careful note of the voting as it happens tonight. And I won’t forget.

Why I Quit BASW (British Association of Social Workers)

I felt a tinge of sadness when I finally decided to quit BASW (British Association of Social Workers). I’ve been an advocate and member for a good few years and I have a great deal of respect for a lot of people who work there. I advised colleagues to join over the years amid general  waves of apathy. I wanted to ‘make a difference’. I wanted to contribute to the general good of the profession as a whole and I saw my membership and support as the best way.

I can understand some of their irritation with the way the College of Social Work  has been established but what I couldn’t understand and believe me, I tried to, via their own forums and press releases, to get to the heart of what their anger about was  about UNISON  (the trade union that linked with the College of Social Work) , with the College, with SCIE – who were charged with setting up the College on behalf of the governmentwas all about.

I know it was partly about control. BASW had initially thought to propose the idea of a ‘College of Social Work’ and probably felt that they should have been charged with running it. The problem was and remains that BASW members remain a minority of social workers. I remained a member though. I enjoyed being a part of the professional association. I thought that it added ‘something’ to my arsenal and allowed me, theoretically at least, to hold a stake in the present and future ‘state’ of social work in the UK.

However, for me, BASW seemed to become less relevant to me as a local authority social worker. They run events but they seemed to be focused on either students and newly qualified social workers or independent social workers (I’ve been told that this is a faulty perception but it’s the perception that I have regardless).

I looked at their magazine and I saw what appeared to be page after page of propaganda for their own campaign to disassociate from the ‘official’ SCIE led College of Social Work. There was no space at all for any kind of dissenting or alternate views.  It felt like some ‘official party’ magazine. Sure, there would be some interesting articles but it would be one or two amid the reams of pages about how important BASW was. This is a membership magazine going to people who are already members. The writing felt patronising in the extreme as if we were just being exposed to a propaganda machine and were incapable of independent thought.

I am a member of UNISON as well as BASW. I never saw the two as being mutually exclusive. I certainly haven’t had UNISON bad-mouthing my professional organisation in its literature but BASW seem to find the idea of UNISON so difficult that they have press release playing ‘number games’ with their figures – forgetting the obvious point that some people (like me) are members of both organisations so comparing numbers becomes less.. helpful.. when you consider that some are counted in both ‘fields’.

I think their move towards creating a Trade Union is wrong-footed. I was unable to attend their AGM and when I asked about proxy voting, I was told that they only count the postal votes if those present dissenting reach a certain threshold. With that I realised that my vote against the Union would be discounted as those who would attend would be much more likely to vote in favour. I felt genuinely disenfranchised because my vote would not be counted unless I was able to attend in person.

I am deeply disappointed by both BASW and the College and their lack of engagement and innovation as regards trying to find new ways to build social work links and make progress in an increasingly social world. The same people are being appointed to the same committees to discuss the same issues. It very much feels like that from my point of view.

I was willing to continue my membership to BASW through their gripes and through my increasing concerns with the way they were moving.

However when they pushed out to promote their new ‘Social Workers Union’, that’s when I decided to leave.

They seem to be pushing their union as ‘added value’ to their current members. It would add no value to me as I already have a Trade Union. In fact, in their membership booklet, it even says that they encourage social workers who join to also join a trade union – and so I did. I know my Shop Steward and I admire them greatly. We link very well with the Health members of Unison as a lot of the issues, for me at least, in a Community Mental Health Team, are very similar regarding employment issues.

I’ve had my gripes with UNISON in the past as well but knowing how the local authority is minded, I would rather ‘stick my oar in’ with my colleagues regardless of whether they are ‘social workers’ or not as opposed to being in a union which exists only to support social workers. Currently our jobs are at risk. UNISON is working very hard locally to establish links within the local council and NHS trust to consultation and they are created with being an established partner and union who has members across the council. With unions, however right or wrong it may be, I think there is strength in numbers and I dare not quit my union membership in these current times. If BASW are focussing on ‘being a union’ and I don’t want to be a member of ‘their’ union – why should I pay for it? Especially when I am content with the union representation I receive from UNISON?

I felt sad to pack in my BASW membership and may be back in the future if they steer towards a more conciliatory path. I would still recommend membership for students, I think, because the fees are lower and if they to incorporate the union membership it may well be a good ‘deal’ to assist through difficulties with placements. I would also recommend membership for Independent social Workers as they have good networks and frequent meetings and events for Independent Social Workers and have good insurance packages (so I’m told).

For me,  though, I need to see more and mostly I need to see more positivity. The organisation increasingly feels very defensive and negative and that makes me sad.

Ultimately what  I would like from a professional organisation/college is more local groups/social groups. Spaces both physically and virtually to discuss the future of social work and ‘safe’ places to bring together issues that affect social work as a whole. Not just a forum, online forums are ‘old hat’ but there are more ways to discuss and find space.

I think regional groups would definitely help build connections and membership.

I know there are good people in BASW and that they want the best for the profession but I couldn’t justify continuing to pay over £200 per year alongside my union membership as they move in a path I no longer agree with and in tough financial times, you have to ask ‘Is it worth it?’.

Personally, I felt it wasn’t.

My hope is that there is a move towards more collaboration with the College of Social Work but that those within the College will push away some of the apparently self-obsessed cobwebs from BASWs eyes and create and evolve an institution that can really work for Social Work rather that what appears to be their own ends because unfortunately that’s sometimes how it feels from the ‘front line’.

Committees arguing for their own continued existence. I’m sad to say that but that’s how I feel.

Just one aside, when playing their numbers games and trying to ‘outmanoeuvre’ Unison in claiming to have more ‘Social Work’ members, I commented that I would like to know two things

How many members attended the BASW AGM?

How many people voted in favour of the move towards a Trade Union (numbers not percentages)?

I haven’t been given these figures but if there is anyone from BASW reading, I’d really like to know.

I’m not saying at all that I’ve left forever. I really hope I will be back at some point but I have to see more effort and will towards promoting the profession rather than BASW itself.

Panels

Since I’ve been employed as a social worker one of the constants in my working week has been the presence and existence of ‘panels’ in many different forms. There was a brief stage when we were told not to refer to them as ‘panels’ but rather meetings but it’s all the same thing at least, in the setting in which I’ve been working. They are groups of managers and professionals of a variety of provenances making funding decisions on behalf of the local authority or health service.  Of course sometimes they say it is about joint decision making (which is why the word ‘panel’ is frowned upon now) but that’s really a facade. I make recommendations but I have little authority over funding decisions.

Different local authorities often have different mechanisms so my explanations of the panels that I might attend come with the proviso that things are arranged and organised in a variety of ways.

We have panels which primarily make decisions about packages of care that exceed a particular baseline cost. That baseline has changed a variety of times but generally managers in each team are given a certain ‘threshold’ to which they can approve funding requests but above that and any application for funding for residential or nursing respite or long term care have to navigate a ‘panel’.

We have separate panels for high cost personal budget packages which would be provided for care at home and those which approve residential and nursing care/respite and continuing health care (which authorise applications for long term payment for care by the NHS )

Going to panel generally involves the transfer of reams of paperwork. I’d probably say it’s the most obvious way though that I provide the function of advocating for a particular service user or family member when I ‘present’ the situation to those who make the ultimate funding decisions.

Contrary to what some people might think, I have absolutely no vested interest in the local authority or NHS ‘saving’ money by not agreeing to a particular package – indeed, I won’t tend to bring something to the panel if I don’t wholeheartedly agree with it myself. I am a great advocate of money being spent where it is needed.  I have a general wish to see public money well-spent of course and I understand the need to ration resources but if I bring something to the panel and authorise an assessment, it is because I believe that that is what is needed according to my professional  judgement and as far as that’s concerned, balancing the rest of the local authority’s budget is not an issue I consider (which is obviously why these panels exist!).

Similarly with the Continuing Health Care Panels  I cannot conceive of a situation where I would bring someone to that panel if I didn’t absolutely want and believe that they should get that funding.  If I attend and collate a report it is because I and the multi-disciplinary team behind the report, believe in it.  I absolutely want people to get what they are entitled to and have no ‘secret instructions’ to try and deny the funding. The rules though are not altogether clear but it suits the funding parties and the governments to keep the rules complicated and unclear. There’s a lot of money at stake.

The panels are open to service users and carers but for me, personally, it’s very rare that service users or carers attend with me.

I have more often  had family members attend Continuing Health Care Panels with me and found it is a much better way of working as it allows a lot more transparency and removes one of those bars between me trying to put the words of others in my mouth.

By now, I know the people who sit on the panels and they know me. That’s a massive advantage in being able to persuade and cajole. It makes me realise how useful it is to have built up links and a reputation among the more senior management. I like to think that a trust develops.

Panels used to scare me because I’d be questioned, often in detail about the proposals that would have a substantial monetary implication for the local authority. My paperwork and assessments are examined in great detail and a level of scrutiny applied. Now that I’m more confident, I tend to take pride in presenting my reports and welcome the questioning as I know what to prepare, what to highlight and what to expect.

I’ve had panels where paperwork alone is assessed and where we are not required to attend in person.  I prefer being there ‘in person’ especially when there are any question marks that I feel I can clarify.

One of my favourite tasks in my work is feeling that I am genuinely able to advocate and navigate a person or family through the muddy mired waters of local authority funding streams and decisions. I wouldn’t say I enjoy the panel process although there is a satisfaction in having something approved especially if it is something you feel might be hanging in the balance, but I don’t dread them as much as I used to.

As for now though, it’s just another part of the process of seeing a paper ‘plan’ through to fruition.  I know they work differently in different areas – indeed, I’ve seen them in different forms in the local authorities I’d work for – but that’s how they work – whether they are called meetings or panels, the effect is the same.

And that’s the explanation of what the panels are – the other side of each discussion I have and each decision that is made by the faceless ‘management’ that I sit in front are that they are desperately important decisions to each person who is reliant on the authorisation of that funding to allow them to life their lives more fully, to allow their family to have access to respite services. My job as I see it, is to bring the paperwork and paper assessments ‘to life’. I am not only writing about a person on a pro forma, but I’m able to flesh out the requested questions and documents with a person, with a family, with relationships.

That’s why I don’t mind attending  these panels as much as  I used to. I’m not frightened of them anymore. I see them as an opportunity to take a crucially important role in someone’s life and to speak for them and not  just about them.

Fixing the Broken not Healing the Wounded – a wrong-footed Government response

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

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Our wise leader, David Cameron, clearly being an iconic Philosopher King, spent many days studying the possibly causes for the devastating riots in London and across England. He concluded after much intellectually rigorous pursuit, that the causes of the ‘sickness’ of Britain are – single parents and gangs aka ‘other people’.

Oh well, maybe he didn’t put quite as much thought into his words as I credited him for after all, he’s been toting those policy aims for decades. What more could we expect of him? Complex thought processes and analysis? Don’t be silly, he’s a politician who thrives on sound-bite politics that blames others.

I’m going to share a tiny bit of my own obviously clearly thought through analysis and that is this. There are no ‘easy’ solutions to the endemic problems that created a culture where people feel they can take what they want. This was not about ‘gangs’ although I’m willing to concede that might have been a fraction of one part of a ‘problem’. This is not about single parent families although yes, there may be people who are labelled that way. It seems that when our leaders set about scapegoating some of the voiceless citizens, we are heading for more divisions and damage than healing and unity which is what we really should be seeking. I’m not saying people should not be punished according to the law but they should not have new punishments invented specifically for them just to satisfy the vengence of the middle class who suffered for the first times when Ealing and Clapham burned.

These were Cameron’s words yesterday

Social problems that have been festering for decades have exploded in our face … Our security fightback must be matched by a social fightback,” Cameron said as he described the violent disorder as a “wake-up call” for Britain.

“Irresponsibility. Selfishness. Behaving as if your choices have no consequences. Children without fathers. Schools without discipline. Reward without effort. Crime without punishment. Rights without responsibilities. Communities without control. Some of the worst aspects of human nature tolerated, indulged – sometimes even incentivised – by a state and its agencies that in parts have become literally de-moralised.”

Setting out his personal priorities for government the prime minister promised he won’t be “found wanting”: “In my very first act as leader of this party I signalled my personal priority: to mend our broken society. That passion is stronger today than ever.”

There’s a lot here to get our collective heads around. A lot of dangerous assumptions and a clear view into the simplistic mind of someone who is supposed to be a leader and has proved himself beyond inadequate for the task.  The Financial Times for example, explains that these riots happened in a period where crime figures had been falling consistency? A moral breakdown? Perhaps not.

Irresponsibility? Like appointing a press secretary whom you have repeatedly been warned not to appoint and to continue to give him ‘second chances’ when you don’t consider second chances for the person who steals a bottle of water.

Selfishness? Like the MPs who gorged themselves on expense claims.

Behaving as if your choices have no consequences? Oh, well, for this one I have to reference the Iain Duncan Smith story from The Broken of Britain

Now, all those platitudes, we get onto the real meatiness that Cameron is gagging for.

Children without fathers? Excuse me? Does he realise how he stigmatises and chastises all the fine families that are raised by a single parent? Does he really think the presence of a man and a woman in a family unit regardless of whether they actually want to be together (the usual reason that splits take place) will ‘help’ the children? He is a fool and it is a dangerous message. Male or female role models do not have to be parents and unhappy parenting is not a useful environment in any circumstances. Cameron has his ideal of the perfect ‘Chipping Norton’ family just as he has his ideal of the perfect ‘Chipping Norton’ community. It is damagingly false and it seeks to further stigmatise and alienate those who for very many good reasons, do not conform to his traditional family view. Does he refer to families with two mothers or two fathers or single-father families? What about communities with extended friends as support? He is finding it too easy to paint ‘poor people’ with a brush.

Schools without discipline? Again an easy target. How about actually putting money and effort into the schools that exist then rather than trying to hive them off into ‘free schools’.

Reward without effort? Um.. Mr Cameron.. you know, you with the inheritence of millions. Can you tell us exactly what effort you put into the accident of your birth?

Crime without punishment? – Well, I suppose that depends on definitions but an awful lot of crimes seem to be getting some mightily grand punishments at the moment. Unlike the bankers who ravaged the finances of the nation.

Rights without responsibilities? Dangerous stuff here. See, he has been quoting that awfully subversive Human Rights Act. Possibly because he, in his privileged position would never have need to refer to it.

Communities without control? Interesting one. I wonder what exactly he means. Which communities are these? Poor communities? Communities of people with different minority ethnic backgrounds? Gangs? It’s pretty rhetoric and a nice alliteration but it is meaningless.

You see, I don’t believe Britain is ‘broken’. I think she is functioning as well as she can despite the government though. I think the more that the rhetoric fixes on the ‘sick pockets’ and less on the body politic the more she will begin to sicken though.

Cameron’s ‘solution’ to help to fix (note fix not heal)  this country is to bring in Emma Harrison from Action for Employment as a ‘Families Champion’. Really? That’s a bit patronising and it seems to dictate to us as adult citizens what ‘families’ the government approves of and disapproves of but back to Emma Harrison who has built her millions on the back of the government’s ‘Welfare to Work’ programmes. Is this really a call for more private profit-making?

What message does it send about making money off the back of so-called ‘broken families’ and trying to fix them?

For me, Cameron’s heavy-handed and quite frankly ignorant response to the riots is a sign of a far more broken element of British society. The ruling classes and their detached empathy sensors. That has already caused a lot of damage and is likely to cause far more in the future and we need to be wary of it and try and push the agenda towards healing rather than fixing.

Riots, Poverty and Assumptions

It would be remiss of me not to mention the rioting that took place in London over the weekend. I work and live in some of the poorer areas of the city and felt, indeed, still feel desperately saddened by some of the pictures and reportage coming from Tottenham, Enfield and Brixton among other places.

I can’t begin to make sense of it. I know the initial trouble grew from anger against the police after the shooting of a local resident last Thursday.

Regardless of the details of the initial spark that lit the tinderbox of malcontent across London, my sense is that it was, for many an excuse to cause trouble.

That isn’t to say there may not be real reasons for anger against the police and against the ‘establishment’ but the way the anger was expressed through mindless violence and looting seemed to indicate that there was also a wish to express anger and rage against lots of other things as well.

The places the riot went, so went the Twitter messages, Facebook posts and groups and the less ‘keyed in’ SMS messages letting others know where to come for random violence. Where to come for looting ‘opportunities’. Where to express ‘anger’ even if sometimes it was unclear what the anger was about or to whom it should be directed. It seems harsh that the ordinary citizens of Tottenham will be the ones to bear the deepest repercussions of the violence and aggression – for whatever reasons.

This morning I was listening to the radio. I heard the host say, ironically I suspect that the people of Tottenham deserved this for not ‘parenting their children’ correctly. For allowing their children to run wild. He said, again, I think it was intended to be ironically – ‘Where were their parents? Or rather, where were their mothers as I’m sure most of them don’t know their fathers’.

Wow.

Let’s just think about the way that we perceive people who live in poverty and poor areas for a moment.

I’m no sociologist. I have though been living and working cheek by jowl with poverty. It doesn’t make me an expert and I am fortunate enough to say I don’t have a lived experience of poverty. I’ve had periods of debt problems.  I’ve had periods of difficulties.  I lived in a single parent family but I haven’t experienced poverty.

Even so, I think that poverty is not necessarily one of the flames that fuelled the protest.  I think there’s an element of wanting excitement, wanting danger, perhaps even – wanting to change the way things are in society that lead to so many and so much injustice, discrimination and pain.

The ‘order’ of things that makes some people own and other people beg. A governing class that can take fancy foreign holidays while the streets of Tottenham burn.

Then there is the looting. Wanting something for nothing. The politics or rather the sociology of envy. The kinds of programmes that fill our evenings of reality star mania that make fame and wealth so easily accessible without the commensurate effort. Without seeing something grow. Without working.

Without work. That’s another element. Can it be a sheer coincidence that the levels of joblessness around Tottenham are some of the highest in London?

Probably not.

While Cameron holidays in Tuscany and Osbourne enjoys the delights of Disneyland (or DisneyWorld or wherever he is), I genuinely wonder if they can ever understand the fears and concerns of the people of Tottenham.

We’re all in this together?

Sticks a little in the throat to say it while statements are returned to the country from exotic foreign climates.

There needs to be a real effort and a real desire to make this world and this country better.

As for those who proposed, instigated and enjoyed the riots. Those who looted and ruined local communities already hurt by poverty. I hope they are caught and punished. I’m a social liberal and my views tend to drift leftwards but I have no time whatsoever for mindless destruction.

The pictures I’ve seen have been ones of mindless destruction and people enjoying violence. That needs punishment.

As for now, we need to think about these communities. We need to care about the people of Tottenham and places like that. We need to think about the effects of the cuts programmes in areas like this and why the levels of disengagement and disaffection are so high.

We need to heal this city and this country.

No, violence should never ‘win’. Destruction and crime must be punished.

But creating a better community, society and country need to be the goal.

As for today, I’ll share a thought or two with those caught up in the violence, fear and disorder. The people who live in the communities and particularly the people of Tottenham.

I wish them healing and time to build their community back up stronger and better.

What does a Mental Health Social Worker do?

I think there’s a lot of misunderstandings about what I actually do at work. What do social workers who are in mental health services do? What do social workers who work in adult services do?

I hope by reading, some people get to learn a little of my day to day role but I also thought it might be useful to set it out more explicitly.

I’ve worked in adult services and I’ve worked, as I do now, in mental health services but I’ve never worked in childrens’ services so I can’t comment at all about the work that is done there. This is my attempt, not to explain social work as a whole, but to explain the bit of social work that I’m familiar with.

I work in a multidisciplinary Community Mental Health Team. We have a consultant psychiatrist attached to the team as well as a few (the amount fluctuates!) other doctors. We have occupational therapists, clinical psychologists, assistant psychologists, community psychiatric nurses and of course, social workers. We always seem to have students around, whether psychology trainees, OT students, nursing students or social work students (and even some medical students pop in occasionally).  I sit opposite a psychologist and between an OT and a nurse.

Although no week is typical, I’ll give a few examples both of the generic role and the way that social work fits into a mental health setting, in England, at least (because I’m not sure if there are differences in Scotland, Wales and Northern Ireland).

Work is allocated for ‘care co-ordination’. Care co-ordination is akin to what we would have called ‘care management’ in Adult Services although there are some differences and responsibilities under the Care Programme Approach.  It basically means we take responsibility as a kind of ‘key worker’ for individuals who are ‘taken on’ by our service.

Allocation should be done on the basis of appropriate professional expertise so for some issues that have a more ‘social work’ tilt about dynamics, organising personal budgets or residential placements might be preferred as allocated to social workers, some that are more rehabilitation orientated might be allocated to an Occupational Therapist and more medical or medication management might be allocated to a CPN but that is a very broad brush to paint and in practice – most people are a mixture of all the different needs and so are allocated generically. If I have need a of specific OT assessment for one of the people that I am care coordinating, I will ask one of our OTs and similarly, I care coordinate one person who receives a monthly depot injection from one of my nursing colleagues.

So what is care coordination/care management about? Well, we start by working with and on a care plan and this should be led by the user of the service. If there is a carer involved it would also involve them and we put together plans. In my service which works predominantly with older adults, there may well be care services needed and this is now all delivered through personal budgets so I would take someone through the supported self assessment questionnaire, the resource allocation system and develop with them and/or their carers, depending on capacity issues on a support plan and way that services would be delivered. This would be reviewed and implemented in partnership.

I will also arrange respite placements  and services when they are needed and review services as they are delivered.

Alongside this, I would also be responsible for monitoring any changes in mental state and might provide some brief therapeutic interventions mainly through basic CBT type models according to additional training which has been given in the NHS Trust I work in as they are trying to ‘skill up’ all care coordinators!  When I meet with someone, my discussion ranges for more broadly than about their care needs specifically. Sometimes it is about sourcing and finding ideas, services and people that might be able to help, namely through group work which is run across the service or through referrals to specific psychologists attached to the team. Sometimes it is much more difficulty to quantify – and log – and record.

I work with carers and work through carers’ assessments and services such as they are. Often I feel one of the most important aspects of my work is carer support as we rely so heavily on some carers. I might liaise with different organisations on peoples’ behalf if they can’t manage or need some assistance. Sometimes I help with Attendance Allowance or Disability Living Allowance claims but there are council teams that do that so it would only be in circumstances when I might know someone particularly well and be concerned that someone who doesn’t know them that well might ‘underplay’ some of their needs.

Sometimes it is about liaising with creditors, gas and electricity companies, housing etc with various degrees of success. I like to think of myself as an advocate at times.

Although at times, I am very far from an advocate. I am subject to specific ‘terms of reference’ of my job and have no control over things like budgets that can be assigned to various people with various needs. I would ‘present’ the needs of service users I work with to various internal funding panels so on that basis I need to advocate clearly.

We have to review the services that are in place regularly. I would attend meetings at day hospitals and on wards when I am allocated to people who currently attend or are inpatients.

I work to plan and organise discharges from hospitals both the psychiatric hospitals and the general hospitals when people whom I am allocated to are inpatients. There are some very obvious time limitations on these pieces of work and no-one wants anyone to be in hospital any longer than they have to – but equally no-one wants someone to be discharged from hospital before they are well enough to be – which is another very important consideration.

I conduct safeguarding investigations as well. Alerts come up with what can be surprising frequency and there are prescribed procedures through which we approach these investigations. It’s hard to generalise as they can be very different. Interestingly most of my recent ones have involved residential services in some way or another. I think I’ll come back to the process of investigating abuse in another post as it is altogether a subject in its own right. We tend to get more of these investigations in older adults services than occur in the working age adult services.

I am an Approved Mental Health Professional (AMHP). That means that I am on a rota to carry out Mental Health Act (MHA) Assessments . There is an important difference between a Mental Health Assessment which is a more generic term for an assessment of someone’s mental health and a specific ‘Mental Health Act Assessment’ which is a formal assessment under the 1983 Mental Health Act which can result in a compulsory admission to hospital without consent.

The role of the AMHP could be a post all of its own and it probably should be so I’ll condense here for clarity because it has increasingly become a part of my day to day role. I organise and arrange these assessments by arranging for ambulance service and doctors attendance (there have to be two medical recommendations written by doctors – one should know the patient (usually their own psychiatrist or GP along with an independent doctor who has had additional training). I also attend a magistrates’ court to obtain a warrant to enter if it is likely that we would not be allowed access to a property. I  arrange police support if necessary and would also organise a hospital bed if necessary.

There are legal forms to complete and I have an obligation to be mindful and respectful of legal rights and human rights when involved in these processes.  I am obliged to attend a specified amount of ‘legal updates’ every year to maintain my approval as an AMHP and every five years I have to be ‘reapproved’ which involved me taking a legal test and submitting some reflective pieces and examples of my work as well as carrying out a set number of assessments per year (no problem with the numbers – I’ve done the requisite annual number in the past week!).

I’m also a BIA (Best Interests Assessor). This means I have specific duties and responsibilities to carry out assessments under the ‘Deprivation of Liberty Safeguards’. Again, that probably demands a post or two of its own. Suffice to say that every so often I am called out to do a specific type of assessment on this basis.  I had to attend additional training to be able to do this and have to attend update workshops and training to retain my approval.

Apart from the things I’ve listed, my job involves other pieces of work. I write social circumstances reports for tribunals. I occasionally have been involved in assessments and writing reports for Guardianships and in taking part in the process of approving or extending a Community Treatment Orders. I frequently carry out Capacity Assessments for various reasons.

I’m a practice assessor too so when I have a student, well, I have a student to supervise. I tend to enjoy having students around. It does create more work though and there’s no recompense in terms of reduction of caseloads! And the universities and local authorities wonder why we can’t offer as many statutory placements!

My work is often one of juggling and trying to prioritise and reprioritise on the basis of risk management. What is more important for me to complete on any given day.

I haven’t even mentioned data input or writing case notes but takes a fair bit of time. We have regular audits of our ‘productivity’ – we have to input our ‘outcome measures’ and re-input them regularly so our management overlords accept that we are actually spending our time at work, working effectively and not just twiddling our thumbs and playing Facebook games.

The amount that we have to ‘report back’ is, of course, growing at an exponential rate.

So that is my job – as briefly as I could manage and I have missed out some of the million subtleties that might change on a day to day basis.

I generally enjoy it. I love the variety that is thrown my way on any given day. Some days it frustrates me and there are rarely enough hours in the day to get what I want done, done. This may explain some of my frustration with the bodies who all say they ‘speak for social work’.  Have they explained the role of social work outside child protection? Would you know, if you are not involved in the ‘system’ what a mental  health social worker actually does?

But really, that’s another fight for another day. For now, well, I need to go to work!

But I had over to you, dear reader. Is there anything that surprises you? What you expect? What have I left out – as I’m sure I have missed a lot of things!

Fear and Loathing in the Public Sector – Or Why I despise Oliver Letwin

Oliver Letwin, United Kingdom Conservative Par...

Image via Wikipedia

Yesterday I read this article about Oliver Letwin, who, according to the Guardian article

..warned that it was only through “some real discipline and some fear” of job losses that excellence would be achieved in the public sector.

Letwin added that some of those running schools and hospitals would not survive the process and that it was an “inevitable and intended” consequence of government policy.

A little background about Oliver Letwin. I’m always a little wary of using Wikipedia as a source but a few choice verifiable ‘quotes’  jump out.

He is the ‘architect of modern Conservative party policy’.

He would rather ‘beg than send his children to an inner city school’

Oh and earlier this year he said did not ‘want more families from Sheffield taking cheap foreign holidays’.

So do we have a picture of the man? The Eton-educated man who would not know the real effects of true fear in the workplace? That encompassing, sleep depriving fear of not knowing if you can afford your next mortgage payment or if your job will be there next week, next month or next year.

Does fear drive excellence?

Let me tell Mr Letwin exactly what it means in the working environment that I am based in.

I work in a Community Mental Health Team – our team has been decimated – actually to use that word literally, it is far worse than decimation – over the past two years. No, I don’t restrict the blame to the current government but include changes under the previous government in my criticism.

We have piles of unallocated ‘virtual’ files while we are pushed to the limits by increasing expectations regarding recording and inputting data which is supposed to ‘prove’ our efficiency.

We have had wards closed at the local hospital such that people who need emergency hospital admissions to psychiatric hospitals are placed away from their communities or on ‘inappropriate’ wards. I have police unable to provide assistance because their services have been cut.

Fear drives efficiency, he says? In our service we have been told there will be job cuts including possibilities of compulsory redundancies. Yes, I’m fearful.

The ‘consultation’ about what will actually be proposed for our jobs will probably be announced soon but we’ve known it has been coming for months. We’ve heard rumours. We’ve heard gossip. We’ve heard absolutely zero from our managers though. Nice. Way to generate lots of fear. All boxes ticked.

So what has this fear done for our efficiency? We are beyond demoralised. We have more people leaving and taking jobs elsewhere and  people are  taking longer periods of sick leave.

I know that Letwin wasn’t referring to the ‘front line’ staff in the public sector – oh no, he meant the managers because he is of a class and a mindset that probably finds it hard to hold a conversation on a human level with anyone who earns under £100,000 per year.

The distinction between ‘frontline’ and ‘backroom’ is a false one though as it is impossible that can operate without the other.

Hospital wards are closing. Cuts are being pushed through. We feel your ‘pressure’ Letwin. We feel your fear. But I could not possibly despise  you any more than I do for your ignorance and self-serving words that for me, epitomise what the Conservative Party and their ideology-driven cuts want to do to this country.

I would like to ask Letwin if he is happy to condone a country of Castlebecks. Well, you see, coming from someone who would ‘rather beg than send his child to an inner city school’ – he would never be in a position to actually know or understand the real concerns of people who are dependent on public services because he can always choose the private course for himself and his family.

I know he wants to ‘make a name for himself’. He likes to garner attention and oh, how clever he is to want to drive ‘fear’ into the public sector but that, to me, sounds close to cruelty.

Efficiency? I think we can do with  fewer MPs who feel the need to make claims for repairs to their tennis courts and to have their Agas serviced.

What kind of society have we become when we feel it is appropriate for a Government ‘Policy Minister’ to drive a disdain and almost bullying approach to a public sector that provides services he will never need?

Oh and the speech he made these remarks in?

It took place

at the London headquarters of KPMG, one of the biggest recipients of government cash, which won the first contract for NHS commissioning following the decision to scrap primary care trusts and further open the health service to private companies.

Nice work, Letwin. Roll on, executive consultancy. You are all in each others’ pockets.

Meanwhile I have work tomorrow.

You enjoy your private tennis court today.