Category Archives: social care

Choice, Control and Obfuscation – How the Personalisation Dream is Dying

In the bold move towards a transformation in adult social care, it feels from where I sit, that control has completely overtaken any pretence of ‘choice’ in the so-called move towards more idealised ‘person-centred’ care and support planning.

I hope I’ve been clear over the years in which I’ve expressed a remarkably consistent view that I love the idea of people being able to choose the support plan they like from a wide menu of options with ‘professionals’ taking less of a role.  I am a massive fan of direct payments. I want people to have more personalised care and more creative care. Desperately. The options just aren’t there yet for people who lack capacity and that is a terrible disservice and inequity that is being served throughout the care system.

Removing care planning from my role doesn’t concern me – unlike those people on the training courses who bang the drums blindly about how wonderful and bright it looks when we allow people to choice whatever they like to put together packages of care, I don’t want ‘retain control’, I truly don’t believe that I, as a professional ‘know better’,  but likewise I know that with the user group I work with, it is rare that I can just hand someone a support planning tool and a list of potential providers and tell them to ‘get on with it’.

That is as far from reality now as it was 20 years ago in my work. While I can say that everyone I care co-ordinate who has a ‘package of care’ is now officially on a ‘personal budget’ and some even have direct payments, it hasn’t really increased choice or control for any but a couple of those people.

If anyone for a moment wants to ponder the duplicitious nature of those in policy making ivory towers who dribble down policies which they want to couch in ‘soft’ language so they are difficult to challenge, one only has to read a fantastic piece of research conducted and published on The Small Places site.

It is worth reading through the piece in detail. Lucy, the author, made a number of requests to local authorities to ask about how their Resource Allocation Systems (the link between the ‘assessment’ and the ‘cash’ – basically) was calculated.  She seemed to come up against a wall of obfuscation but it’s worth looking at her research in detail.

This reluctance for me, seems to relate to the lack and reduction in spending on care and support – the key ‘missing piece’ as to why a council can ‘reassess’ someone as needing less ‘cash’ than they did last year with a more traditional care package.

My personal experience is that the council I work in (and this is similar to things I’ve heard from people in other councils) probably doesn’t want to share it’s RAS because it’s ashamed of the utter dog’s dinner that it’s made of it. It doesn’t ‘work’. It doesn’t make sense. It is frequently changed. There is more emphasis on physical health needs as opposed to mental health needs and while there can be manual adjustments, some of the figures that are ‘spat out’ just seem nigh on ridiculous (and that works for sometimes calculating care ‘too high’ as much as a figure which is ‘too low’).  It comes down to everything needing to be qualified and fitted onto a spreadsheet when actually the needs of two people who might fill out a self-assessment with the same ‘tick boxes’ might have very different needs in reality – no RAS can account for that. One person might under-score because they are embarrassed by the process and don’t want to admit to being incontinent on an initial visit from a social worker because they haven’t been able to tell anyone other than their GP – another person might be anxious and think they can manage less well than they can. Sometimes and this is what local authorities and health services seem to find hard to account for, you just have to treat people and their needs as individuals rather than the subject of outcome measures, tick box performance indicators or resource allocation systems.

Shouldn’t personalisation be about putting the user at the heart of the system? Every user should have a copy of the RAS and how the figure was determined. Which questions are weighted and which aren’t. Without that, there flow of money and the control rests solely with the local authority.

I’m fully against ‘traditional’ care packages. Having someone anonymous and constantly changing pop in for a 30 min welfare check once a day isn’t about improving the quality, control and choice in someone’s life, it’s about a local authority doing the absolute bare minimum that they can get away with to fulfil their statutory duties of care.

The lack of openness about the ways that the RAS shows the true colours of the reasons for these pushes towards the Eden of ‘Personalisation’.

While I have no doubt that for some people, as I keep saying, those with advocates, family or who are able to voice their own needs clearly, have and will continue to benefit enormously from having direct payments – it’s worth remembering that direct payments have been available and accessible for many years now.

Forcing everyone onto personal budgets has only discriminated against those with carers by reducing the amounts of money they are entitled to through the RAS (that’s my own experience of how our local RAS works) and has discriminated against those who lack capacity by promising all sorts of ‘creative’ ways of exploring third party management of support plans but without providing any real ways of accessing it (this is my current bugbear as I have been requesting assistance with this for months for service users I work with but have been told it is not possible for older adults yet as only those with learning disabilities have budgets large enough to make it cost effective – thereby clearing discriminating on the basis of age and type of disability).

I have changed from a fervent advocate of a system which was supposed to be so much better for everyone to a bitter opponent of a system which favours some kinds of disabilities over others, some kinds of service users over others, some kinds of carers (those who are willing to put a lot more time in to manage and support plan where necessary) than others and all to provide fewer services under the guise of choice.

No wonder Burstow is pushing everyone towards direct payments. He is pushing everyone towards a system which masks the way that payments are determined and discriminates openly against people who lack capacity or who have the ‘wrong’ kind of disability or family support.

Now we know that the local authorities can hide the way they make financial calculations, it becomes much more obvious to see behind the facade of the ‘Wonderful Wizard of Oz’ who promotes choice as the final goal to achieve at all costs.

I feel tricked and betrayed by the implementation of the personalisation agenda and the lack of any of the services around it to tackle directly with the problems at it’s heart.

I was deeply disappointed, for example, that the Mental Health Foundation’s ‘research’ and work with people specifically with dementia only focussed on people who either had capacity or had family.  Their advice talks lovingly of setting up trust funds, appointing brokers – well, that is a fantasy rather than a reality and exists only on paper as a choice. They merely replicated a lot of work which was done when direct payments were rolled out around lack of take up for people with dementia and they hadn’t said anything new (I happened to write my dissertation about the lack of take up of direct payments for older adults so did actually do literature researches at the time..).

Anyway, I’m getting ahead of myself.

For now, I think it’s important that we who see through the cosy policy makers congratulating about a ‘job well done’ speak up and speak up loudly for those for whom the system is a further barrier for true individualised care because these self-same policy-makers see them as ‘too difficult’.

My title explains that the personalisation dream is dying but it isn’t dead yet. To be brought back to life, all those involved need to embrace the principles of honesty and openness and not blind themselves to their successes if they can’t see the continuing barriers.

Interviews and Ideas

Please forgive the blatant self-promotion in this post but it’s Friday and I’m feeling a like I have a bit of a cold coming so I’m less ‘perky’ than usual.

Dorlee from Social Work Career Development has published an interview which she did with me and it concentrates on what I do at work and some of the ways it differs from Social Work in the United States.  Excellent work, if I do say so myself – but joking apart, it is a good way for us to learn about social work in other countries.

Shirley Ayres has written a fantastic post for PSW, the BASW magazine (yes, I know.. ) and it includes some gems from myself. It’s a piece about social media use for social work specifically and is definitely worth a look.  The PDF is available here

As for my twittering on last week about wanting to work collaboratively on more online social work conferences/learning/interaction – well, it’s VERY rudimentary, but I’ve set up a ‘holding site’ here

Feel free to nose around as the whole point is to emphasise openness, conversation and working together on something that can be led by social work and improve social work without having a cost barrier to entry and that allows all who want to learn and contribute to do so. I’ve also added a very basic forum just to collect ideas.

I don’t have any great desire to ‘run’ this project and if anyone with greater technical skills wants to volunteer them then please please do but it’s a start and I hope someone will – even if it isn’t me – because I think something that adds value to our collective, international knowledge base and moves learning out of universities and into practice will be a real ‘hook’ in convincing more practicing social workers to engage with social media and new technologies.

Enough from me, the forum is here. Do join and share ideas.

(Don’t be scared that there isn’t much there yet.. everything needs to start somewhere!)

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.

Consultations

I was interested in this article on Community Care website yesterday that more than half local authorities did not comply with the twelve week period for consultation when setting their adult social care budgets for 2011-12.

I had to stop and think whether the authority I work for did this. I think they did. I have vague recollections of something like a consultation being circulated but we’ve been subject to a number of different consultations for a whole variety of things and I’ve lost track of which were for what.

Facilitator works with participants for final strategies

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I’ve probably been directly party to more consultations over the past 18 months than I have at any other point in my career and to say I’m disillusioned is an understatement.

Consultations, in my experience, are never about actually consulting. They are about presenting decisions that have been made in smoky rooms, behind closed doors as a fait accompli.

These ‘management consultants’ who are engaged at high cost to produce these consultations only do so to meet statutory guidelines about what ‘consultations’ should be but I’ve been party to consultations which seem to arrive during the Christmas period, at Easter, over the summer holidays – whatever time seems to be the least convenient to actually gain the opinions of those directly affected and in whatever way seems to stymy any kind of criticism the most.

Do I sound cynical? Well, maybe just a teeny bit. It’s because we’ve been blasted by some massive changes presented through consultations-that-are-not-real-consultations and I’m bitter. I’m very bitter.

One of the major issues I’ve noted is the short periods of time between the ends of the consultations and the publishing of proposals as if, by magic, all the submissions could be judged within a week.. oh, not many responses? Well, that’s awfully convenient.

I’ve seen documents accompanying the consultations which don’t even try to disguise what the final outcome to the so-called consultation will be.

I have no doubt whatsoever in  my mind that consultation is about the most misused term in local government and the NHS that I have ever come across and that’s saying a lot.

Large organisations don’t want to consult. Or rather, they want to consult with their own consultants. They want to consult with the same group of people whom they can explain and describe to at detail. Thinking about creativity, if there was a real desire to consult about changes rather than impose them, the organisations should be forced to use more creative means to garner responses. Questionnaires don’t always work. Public meetings attract the same time-rich people who will always attend. What is done in a consultation to seek out those who are least likely to respond? Is three months really sufficient time for this?

As I said, I’m a cynic. I can’t see the work ‘consultation’ without laughing cynically and reading the end of the document to see what is proposed and what will, no doubt happen.

I’d love more openness in the process of putting together proposals and garnering ideas rather than being given consultation documents which appear to be vastly resourced ‘fait accompli’ type documents justifying why ‘we’ are changing what ‘we’ are changing.

Does anyone have any positive experiences of consultations? I’d really be interested in hearing.

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.

Technology, Social Media and Social Services – Finding new ways to ‘help’

iPad con dock y teclado inalámbrico

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I have some across lots of discussions and debates about ways of using social media and new technologies and interactions to ‘help’ social services become more effective. Most of it seems to revolve around building online directories and databases of micro providers and services that are available which build on so-called community capacity to improve the way that personal budgets can or might work.

At the risk of sounding overly cynical there is nothing ‘innovative’ in my mind about building a directory of services.  To me, this is not a particularly innovative way to use ‘technology’ in social services.  It taking a very obvious and well-trodden route to using new technologies. Providing directories while being useful to a certain group of people again exacerbates the isolation of those who are not party to or able to use them.  Being innovative isn’t always necessary to be helpful but it is very important that new ideas are focussed so we don’t just end up with increasingly specialised, localised directories that might have more ‘interactive’ features and feedback, look more ‘user led’ and compatible with the buzz words of social media but in the end they are brushing the surface of possibilities.

It feels more and more as if that there is a growing division between the ‘haves’ and ‘have nots’ as far as personal budgets have been extended and does absolutely nothing to address or use technologies to address those who reside continually in the ‘have not’ section.

While at work, we labour with database systems that have clearly been developed through conversations between commissioners and software companies without any recourse to frontline practitioners, nice new provider directories are being tinkered around with while the fundamental foundations of the systems we work with remain resolutely inaccessible.

I’ve had a few ideas myself and whilst I lack the technological expertise to see any of these ideas to fruition, this is a kind of ‘wish list’ of the sorts of things I’d like to see.  I’m under no illusion that these are ‘new’ ideas. I am sure similar things already exist in some form but they are things I’d like to see pan out in the longer run. Things I’d like to use at work.

I’d like to see more creativity in the use of technologies to assist with decision making for adults who have some kind of cognitive deficit. I’m a great fan of the ‘tablet’ and ‘touch screen’ model as I think it is intuitively an easier interface to understand.  When I see people instinctively reach out to touch the screen of my Kindle (which isn’t touchscreen!) I realise that we are becoming conditioned to seek the easiest input methods which are about touching a screen and speaking into a microphone and perhaps writing on a tablet. Now, voice recognition has improved, I’m yet to come across very successful handwriting recognition (possibly because I have scrawly almost illegible handwriting) but there is potential there. In the meantime, pictures and touchscreens seem like a good way to go.

Using pictures/sounds/music it can draw on multi-media ‘shows’ and explanations of different options – moving beyond the ‘written word’. Providing documentation in aural form or in pictorial/moving form rather than reams of leaflets. Having recordings of familiar voices or pictures of familiar faces might help to reassure. I’m a great fan of telecare in general with the proviso of always being mindful that the human contact is not replaced but in days where human contact is sparsely provisioned anyway, it may be something that can be experimented with.

Why not a YouTube type video to explain how services can be chosen instead of reams of ‘easy read’ leaflets which really aren’t remotely ‘easy read’. Instead of flooding people with lists of providers (which, while good for some ignores those who are restricted in terms of capacity and carers to choose ‘freely’ the types of services they garner) why not explain and expound in different ways the ways that services can work?

Why not explain providers in terms of what they can actually provide and what purpose they serve rather than creating directories that are meant for people with a good understanding of what they want and need?

I was in a day centre last week and there was a seemingly unused Wii. I wonder if he Kinect might be a better project to develop some type of interactive play, exercise and work as it doesn’t need a controller at all and uses the more innovative way of body movement.  Using participatory games with larger screens in company can provide different stimuli. I know why games developers  haven’t tackled directly the ‘older’ market with games that might otherwise reside in memories but why not repackage old school yard games and board games with Kinects and iPads? It may be a good way to introduce the use of these new technologies in a ‘friendly’ manner which may then see them used in other wider ways – such as directories or personalised information sources. Using YouTube video channels for personally designed ‘reminiscence’ therapies could personalise the delivery of memories and digitise memory boxes where items are not there to build up the frames of someone’s life and people aren’t there to fill in the gaps.

There are many ‘dating site’ type services that match people and organisations. Volunteers to voluntary groups etc. How about a type of match between schools and residential homes? I know it’s something that’s sometimes done locally where I work and having spoken to both providers and some of the kids who go in, they seem to enjoy it and it can change and break expectations – each of the other.  I

We talk of social media a lot and often it is used to provide ‘recommendations’ to particular services through these databases. Perhaps more user and carer led general recommendations can be collated. Crowd source an ‘introduction’ to social services provisions by those currently using the service.

Ask ‘what do you wish you’d known?’ ‘what do you wish someone had told you?’ and while taking out all the obviously libellous stuff, a local authority must be brave enough to leave in the criticisms. We learn through complains and criticisms and it can take a lot of guts (or anger) to make a complaint or to criticism and that MUST be respected by the service and the individuals at fault and used as a means of improvement.

I don’t want to see local authorities ‘whitewash’ problems in order to gain sparkling OFSTED or CQC inspections. It sullies the whole process and makes the inspections worthless. Regulation should be less authoritarian and more about actually making improvements and making things better for the end user – not about allowing local authorities to produce the ‘right’ results while poor practice is brushed away from the sight of the inspectors.

But back to my point about using social media to crowdsource – it is important that social media ALONE is not used as an ‘answer’. Crowd sourcing must be honest but it must also be broader than putting out an ‘internet consultation’ and having a Twitter account or blog. There must be pounding of the streets too to engage those who are not able to use digital means to put their points across. There should be knocking at doors and face to face discussions – not leaflets, not inaccessible (for some) groups.

Talking about crowdsourcing though, there’s a much better and perhaps more obvious way it can be used and certainly isn’t being used at the moment and that’s to engage other social workers and professionals into putting together more information and useful methods of practice for ourselves. Sure, it needs time but we remain reliant on organisations to provide ‘guidance’ such as SCIE (who do provide fantastic resources) and BASW and the College of Social Work but why none of these organisations who purport to exist to help social work and social care practice actually engage more directly and use social media and open access blogs/discussion groups/forums/micro blogging etc to engage with currently practicing social workers is completely beyond me.

I’ve become very interested in open access education and resources and feel there is great scope for professional engagement and information to build its own resources and information together with users and carers, together with other professionals but there has to be a push for social workers to see the benefit of sharing and finding appropriate ways to share the information that we learn every day.

I have other ideas which will come in different posts  but I’d be interested in hearing other peoples’ ideas for uses of ‘technology’ in the very broadest sense and how they can develop to help the broadest range of people we see in social services – particularly those who are less able to look information up in various fancy online directories.

Perspectives, Students and Ageing

I enjoy having students around. It helps keep me fresh and enthusiastic and to see my job through the eyes of someone coming into it rather than through the occasionally blurred eyes of someone who has been working for a while.

I had a student shadowing me for a period yesterday. It was a  fairly standard visit as far as my work goes. The person we went to see (who I’ll call Mrs J) was someone I’ve been working with for a few years. While I endeavour to do my best in every aspect of my work, I can’t deny that Mrs J  is someone I have a soft spot for.

I started working with her about three years ago and to say she is isolated is an understatement. For obvious reasons I can’t go into the details but suffice to say since my first encounter with her we have both come a long way. She has had a lengthy compulsory hospital admission during this period and has lived in three different flats (and two different hospitals) in that time. She is now living in a beautiful flat and has a secure tenancy. She is ‘settled’ for the first time in many many years.  She even has a fairly interesting personal budget to pay for a support worker.

I thought it was quite a good visit. We got through a lot of things that needed to be done and things that needed to be discussed.

As we left the student said to me how sad she felt after the visit. She asked me if all the visits I made were that ‘depressing’ and wondered if I worried about ‘getting old’.

It took me by surprise because I thought it had been quite a positive visit and wasn’t feeling remotely ‘depressed’. Then I remembered the perspective I had and the perspective she has. She doesn’t know, apart from the words that I filled her in with, where my ‘starting point’ with Mrs J was. I can explain and expand but it isn’t the same. My ‘starting point’ needs to change and as long as I consider where Mrs J was three years ago, I wonder if I am becoming complacent about the further routes to enrichment and recovery in her life.

It made me think about the way that new eyes can improve the work that I do and shatter some of that selfsame complacency. I shouldn’t look at where I am now necessarily in the context of where we’ve been but rather where we are going.

As for the sadness in my work, I don’t feel it. I feel it some days and in some situations, of course. It’s hard not to and a part of compassion is empathy but I remember a conversation I had a few years ago when I wasn’t long in the job with a colleague who reminded me, while I was expressing my own concerns about age in general, that we only see a small proportion of the population and to constantly remind myself that most people age well. I try to remember that. I wonder if that is one of the reason for prejudice against older people and a lack of respect in the care system.  We just don’t like being reminded of the fact that we will get old. It personalises the work in a way that working in other areas of social work might not. We all hope to grow old. We owe it to those we work with and for to provide the most assistance and to make what can be the unpleasant task of ‘dealing’ with public services as painless and as accessible as possible.

Food for thought.

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.

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