Care plans – Now and Future Me.

This morning I read a post by Mark Neary (whose blog I highly recommend) which highlights the hypocrisy and inaccessibility of the language of social care. I am used to jargon. I have been working in health and social care since 1993 so a lot of the language comes easy to me and I can almost forget what is jargon and what is usable by ‘normal’ people. It is posts like Marks that remind me of where our sector has lost its humanity. When we talk about ‘accessing the community’ rather than being a part of it as a part of a personal budget, we seem to have lost the idea of what community actually is.

 

Mark’s post got me thinking about how my life would be in the care and support plans I used to write so I’m going to imagine and put myself in that situation and see what my care plan would say. It’s not quite going to be ‘me me’. It’s going to be the me who, in 30/40 years time is living with a dementia which has affected my cognition. I’m in my 80s. I’m living alone and have no children. I’m a bit of a loner because I always have been and don’t have many friends living nearby.

Because someone in an office decides I may not be able to make decisions about what care I need, those decisions are made for me. I have a personal budget, of course, because everyone does. It isn’t a snazzy flexible one because I get confused by money and finances and am not sure I’d be able to make decisions about money management. I get my £5 and my £50 mixed up and that’s got me into all sorts of trouble at the local supermarkets. Sometimes some of the local lads offer to clear my garden. I give them £100 for an hour’s work because it seems fair to me and they are such nice lads. They always smile and they come every week. So my ‘personal budget’ is managed by the local authority.

 

Between 7.30am – 8am I have a carer to come and give me a shower or strip wash. The carer often doesn’t turn up until past 8.30am. I’ve always been an early riser so sometimes I try and get up and dressed within her help. I don’t like waiting till 8.30am when I’ve been up since 5am. I can’t manage the shower though and she thinks it’s a shame to change me after I’m already dressed.  “Carer to help with shower or strip wash”. Sometimes I’d like a bath. There isn’t enough money for that. That’s a shame. I last had a bath four years ago. I remember it sometimes.

 

I sit in the lounge. The carer sometimes puts the television on before she leaves. I don’t pay much attention to it. Because I’m over 65 now, I don’t get any ‘day opportunities’. The day centres have closed and I don’t have any family to visit. I sit and watch TV. It’s ok. I don’t want enforced company so I’m not so lonely. I miss going out to the shops though. Accessing the community? That would take too long and cost too much so I just have a carer come once every fortnight to do my shopping. I write out my shopping list in advance. Mostly it’s the same from week to week. I don’t do spontaneity anymore.

The carer comes at 12pm to make my lunch. Lunch is a tuna sandwich. Lunch is always a sandwich because there isn’t time to cook. It’s always tuna because I once mentioned I liked tuna 2 years ago. Now I have tuna sandwiches every day.

“carer to prepare light lunch and cup of tea. Clean up afterwards”. Sometimes I miss coffee.

 

It’s Thursday which is shopping day. Shopping day is only once a fortnight. So shopping is lots of instant meals which don’t need to be prepared. I wish I could go out sometimes and potter around in the supermarket. But that would take too long. You see, my allocated hour wouldn’t be enough because I’m a bit slower on my feet. It’s tins of spaghetti hoops. Bread for the freezer. Milk for the freezer. Chocolate hobnobs. Some cheese. Lots of tuna. I like all these things but sometimes I miss sushi.  “fortnightly local shop. Collect list. Leave change”.

 

It’s nice when it’s shopping day because it means something different happens. Mostly I just sit and watch TV. That’s my meaningful activity.  I have a personal budget. Look how well self-directed support works for people like me. What do you mean it’s no different? This is innovation. I know how much my care package costs now. That’s changed my world.

 

I can’t wait until dinner. At 5.30pm my carer comes and makes me something ‘light’. But this time it’s a hot meal. Spaghetti hoops on toast. I like that. Sometimes I put some cheese on the top but have to be careful with the toaster. I can’t manage it on my own. At least I get another cup of tea and help to the toilet. Sometimes I miss coffee.

“5.30pm – 6.15pm Prepare dinner – leave with cup of tea. Help to toilet if necessary”.

After dinner I watch TV for a while. Usually I fall asleep.

The carer wakes me up when she comes at 9pm to assist me to bed.

 

So that’s what the day looks like. I get up later at the weekend. That’s nice. But I like getting up early.

 

Now coming back to my present self, I wonder how my own care plan would look in the language of, as Mark calls it, ‘Carespeak’.

So snapping out of reality, this is my current ‘care plan’. I wake at about 5.30am and interact constructively with other household members, which is problematic to those who don’t want to be awake at 5.30am. This is evidence of my self-centred nature and need to mind my anti-social behaviours around waking early. Sometimes I don’t have breakfast. This presents a risk to my nutrition and hydration. Occasionally I might eat an unhealthy breakfast, like a croissant. This is high in fat and could lead to unhealthy habits and putting on weight which could affect my health.

I have a shower and this means that my needs related to hygiene are met. I ensure that I wear clean clothes which are appropriate to the season. Although sometimes I judge poorly before leaving the house and this means that I may not be protected from the risk of inclement weather. I don’t own an umbrella. This is a risk as it often rains in London. I am able to meet my personal care needs.

I go to work. Now, I’m accessing the community and engaging in a meaningful activity because I have economic worth. Although sometimes it isn’t meaningful. Sometimes it’s sitting in front of a screen staring at spreadsheets. It has economic value and therefore it is meaningful. Daytime activities, I have them, you see. All is good.

I might go out after work. This means I am socially active. I am engaging with my informal support network i.e people who are not paid to be with me. I can tick off my ‘social network’ tab on my care plan. I have friends.

When I get home, I should really clean the house a bit. But I sit on the sofa and fall asleep in front of the TV. This is a risk. This means that I have not been able to meet my domestic care needs. The washing up is in the sink. I am, therefore, in a house, where there is a concern that I am not managing domestic care sufficiently. This worries those people who write care plans. All is not well.

I go to bed at a reasonable time. I don’t have any problems with sleeping and am not worried or concerned by my lack of sleep. All is well.

 

So why is it worth considering? These two care plans say different things but in the same way. We can look at aspirational documentation and what we should strive for. I always want to strive for better. But those who are striving, don’t forget the people like me or the future me. Don’t get carried away with the language that can actually mean less than it should. A personal budget does not mean choice. Choice does not mean choice as often as not. If we want to solve problems, we have to know the problems and how they would affect us.

 

It’s worth considering how are lives are and how they would be in the context of ‘care planning’. Would we plan care for others, the way we would want it planned ourselves? And if not, why not?  Food for thought.

Burnout and Avoiding it.

I attended an event recently for newly qualified and student social workers. There were a number of speakers of which I was privileged to be one. Although it wasn’t a part of my ‘talk’, some of those speaking began by talking about how long they’d been in ‘social work’ and how they had managed to ‘stay fresh’ and counter burnout. It’s something I have appreciated more since I moved out of my social work job and moved into less intense, less stressful role. I don’t think I ‘burnt out’ but I do think I left at the right time. Things had been getting increasingly stressful at work due to the cuts and the increased workloads and a couple of incidents in the lead up to my applying for other roles made me realise it was probably a good time to take a step back.

While I can’t make the claims that some at the event did of having 20/30 years in social work ‘frontline’ practice and remaining fresh, I think there were a number of things that helped me in the 12 years that I did. I probably wasn’t helped by my having had a particularly difficult last few months at university. I sailed through the exams and modules but struggled with (and eventually failed) my MA dissertation. That meant I qualified with a PGDipSW rather than an MA in Social Work and although it made absolutely no difference to my career in the sense that I could work as a qualified social worker, it did give my ego quite a knock. In retrospect, although I’d never have said it at the time, it set off a chain of events which actually made me far more competent and able to deal with challenges, it made me realise I could fail and yet, succeed at the same time. It made me realise that intellectual achievement isn’t defined by qualifications or what particular tutors think. I did go back and retake the dissertation eventually (actually it was 5 years later) so I do have my Masters now, but at the point that I failed my dissertation, I had never failed any academic test which had been thrown in my direction, indeed, I’d pretty much sailed through without much effort.

On qualifying, I went into a fast paced adult social work team in inner city London. I thrived and was both excited and terrified as my caseload went from the six I  had on placement to around an average of 45. I’ve written about these experiences previously so won’t go into details. The things that got me through weren’t so much the management because, as I’ve realised since, my first manager was the least competent manager I’ve had through my professional career. It was my colleagues. I was extremely lucky to work in a team with very experienced, very kind practitioners who were patient with me as a newly qualified, agency social work – earning more than many of them, but they helped and guided me without anything but generosity and kindness in the absence of structured managerial support, in fact, sometimes in the context of an organisation where there was bullying from ‘above’.

I won’t list all my professional experiences and teams but it did get better. I had moments, not in my first or second year of practice, but in my third, fourth, fifth year when I wondered how long I’d last. When I first qualified, I didn’t have time to stop and think – it was doing and learning, doing and learning without any space to grow. By the time I settled into a good team, with a firm but fair manager who had a strong ethical focus, I looked around me and wondered if I would ever be as ‘good’ at my job as the person who sat next to me. The key that got me ‘on track’ was taking the old PQ1. I don’t think PQ1s exist anymore – this makes me feel old – but it was the first stage in the post-qualifying process. This was before (this is where I really DO feel old!) the NQSW/AYSE-type schemes. We were expected to practise on the ‘front-line’ and then think about post-qualifying practice awards. So it was I started the PQ1 in Social Work Practice at Brunel University which was a part of a London consortium. At that time, as well, it was a generic first step. I did the PQ1 alongside social workers in children and families and mental health. We had slightly different tinges to our work as I’m sure can be imagined, but we came together to share our learning.

The PQ1 gave me an absolutely amazing mentor, who was a very experienced social work manager in the same borough as me, but in a different team. She was someone I wanted to be like. I wanted to know as much as her and exude as much kindness, thoughtfulness, generosity and competence as she did. Most importantly though, I learnt what ‘reflection’ really was about. Of course, like any social work student, I’d studied, learnt and thought I understood ‘reflection’ when I was at university. I’d studiously completed reflective diaries and written reams of essays about reflection through my course – but it was at the post-qualifying stage, when I’d worked for a few years and held a fairly hefty caseload, that I grew to understand reflection far better. I have no doubt whatsoever that the PQ1 saved my career and saved me from burnout. Having a mentor who ‘got’ it and helped me create time and strategies to ‘remain fresh’ saved me.

It was this reflection process through the PQ1 and the encouragement of my mentor, that pushed me back to university to retake my failed MA dissertation. It also pushed me to apply for a different job and that, in turn, led me into the move to Mental Health services – so it really did change my life.

‘Getting’ reflection saved me and helped me to grow. The other part of that came a few years later when I started to write this blog. This writing process, and I did ‘force’ myself to write daily over a number of years – gave me the space to consider how my work fit into a wider health and social care system. It gave me a voice that even though inconsequential on the larger scale of things, meant I didn’t take my frustrations with work, into work. It pushed me into directions I had not considered, for example, a desire to learn more about current research and policy documents. It meant I read far more about health and social care and understood my part in it. I became more active and more vocal at work in areas and became involved in BASW and later, the College of Social Work as a result, realising that influence doesn’t always necessarily need to link itself to management or leadership.

So what would I advise to a newly qualified social worker to avoid burnout? Well, it wouldn’t be the newly qualified social worker I’d be most worried about for a start. It would be the social worker 2/3/4 years into their career where I think the difference can be made. While I don’t think I’m necessarily in a position to ‘advise’, I would say, rather, what worked for me.

 

- Asking for help. I didn’t ‘ask’ for my mentor to turn up. She was ‘assigned’ to me but she was one of the key people who had a significant influence on my career and my life. I have never told her that. We can’t always have that handed on a plate though and hopefully there are different sources for mentorship other than people turning up at your desk saying ‘I’m here to help you’. Maybe it’s something that experienced practitioners have a responsibility for. I am no longer a practice educator, but I was, and I miss having students but I think having an oversight or interest in the careers of ‘younger’ (not through age but through work experience) professionals is something we can all do.

 

- However well you think you ‘get’ reflection, you can always ‘get it’ better. I’m learning massive amounts about  how to develop skills to reflect on my practice and the effect that I have on other people’s lives. I had some skills which started to grow at university and through various experiences of supervision but different environments and different experiences need new skills to learn and grow all the time. I’m absolutely convinced that it is reflection that leads to good and caring practice so we need to create space and learn from ourselves in different ways. Sometimes we don’t have mentors. Sometimes we work alone. Sometimes we don’t get the supervision we should. Sometimes we don’t have environments which allow us space. So we create this for ourselves, in our own way, often in our own time to learn. It might be writing things down, it might be unpicking things internally, but it is necessary to all aspects of work with other people that affects their lives.

 

- Being interested in broader issues. I got involved in BASW and when BASW imploded in pique of rage, I got involved in the College of Social Work. I was and am just a ‘lowly’ social worker without any managerial responsibilities but I decided that didn’t mean I didn’t have a useful perspective to bring to the table. Indeed, in some ways, it was more useful than all the managerial perspectives put together. I found that reading and trying to understand policy issues and papers as they were published meant I could relate some of my day to day work to broader social justice agenda goals – which it didn’t always feel like on a micro level.

 

- Support each other. I didn’t have much management support when I first started but was pulled along through my first year by colleagues. I hope, in turn, I’ve been supportive to those I’ve worked with over the years. Sometimes it’s hard to explain the work to anyone who doesn’t do it. While work/life balance is essential of course, sometimes you need to speak and share with other people who ‘get it’ and can support from a non-managerial viewpoint.

 

-Work/life balance Say it often. There need to be some boundaries between work and life. I know it’s not always easy, I’m not always great at it myself but doing things that are ‘not work’ really does help!

 

- Knowing when to go and when to return Although it may not be for me to judge, I don’t think I ‘burnt out’ but I could feel myself getting more frayed around the edges before I left my last job. I increasingly had begun to feel I wasn’t necessarily being a ‘good’ change in the lives of the people I worked with as my work became more about telling and less about asking. As I felt I was taking away more than I was giving. I never stopped caring, I don’t think, but I felt increasingly frustrated with the amount of change I could affect and my role in the system. I became more frustrated – not with my immediate managers – who were always incredibly supportive, but of the organisations I worked in and the lack of my voice within them. I think I left at the right time. Now, I miss my old job. I think, in the back of my mind, I hope to return to ‘frontline’ practice someway, in some capacity. When I do, I expect I’ll be enthusiastic and re-energised in a way that was very necessary.

 

So those are some of the things that helped me. I am in another job now but the same tools help me through. I try to take time to reflect and whilst I don’t write here as regularly, I have other ways to ponder and learn from the ways I affect people’s lives.  It would be interesting to know other people’s tips for not burning out.. especially if you’ve been in the job for a few years.

Personalisation in Practice

(Note – I wrote this for something else where it was not used but thought, I’ve put the work in and might as well see if anyone else finds it useful/interesting! That’s why it’s a slightly different style from my usual rants and definitely drier#.. and why there’s a bibliography!)

Personalisation policy and the principles of developing person-centred care have promised a great deal in terms of increased choice and control for service users, and a change in focus towards greater user participation in services. While putting people at the heart of services is fundamental to a progressive and ethical social care culture, the gap between practice and policy in relation to the personalisation agenda can look like an insurmountable chasm to the practitioner. This is an area where promises have bounded ahead of practice experience.

What is personalisation?

Personalisation is a process which puts people who use services at the heart of decision-making about what is right for them and how their care and support needs will be met. The opaque jargon of social care can be a barrier to communicating key concepts, and defining ‘personalisation’ is crucial as the term is used in different ways and attracts meanings which can depend on the agenda of the speaker. Sometimes personalisation can be used as a synonym for person-centred practice and support. Gardner (2011) explains that ‘personalisation’ incorporates “different strands of ideology, theory, policy and practice”(p2). Not all definitions are inclusive of the groups of people who may lack capacity to make decisions for themselves about their care needs so it is easy to see how the rhetoric can overtake the reality.

The ‘personalisation’ agenda as it has been known is more than moving people to ‘personal budgets’ and the roll out of direct payments as a default mechanism for delivering social care. It is about moving the paradigm of ‘power’ away from the centre and towards the individual. The development of this personalisation agenda took place in the context of a great deal of excitement and promise. In the early stages where the Independent Living Fund (ILF) was created in 1988, allowing for the first time people who used services to directly commission and purchase their own services. This continued through the various configurations of direct payments (initially introduced through the Community Care (Direct Payments) 1996 Act) as they made their way through different user groups and the scope extended, leading to Putting People First (2007) which pushed through the ‘transformation agenda’ in adult social care to move towards personalisation for all.

It is important that we don’t confuse ‘personalisation’ with ‘direct payments’ nor ‘personal budgets’. Different models of providing people with more choice and autonomy over decisions which are made regarding their care can be done in many different ways and in some ways, the handing out of money and telling people to get on with it – with or without the requisite support – is a very narrow attitude to take in terms of allowing choice. Choice has to include a choice in the way that we can choose about what we receive, but there has been a political emphasis on direct payments as the gold standard of choice and that leaves some at a much greater disadvantage than others in terms of having control over their own support packages. The jargon and language attached to the change in adult social care creates a layer of professional knowledge so that in itself, it removes elements of knowledge and control from people who use services.

Gardner (2011) states that “Personalisation reinforces the idea that the individual is best placed to know what they need and how these needs can be best met. It assumes that people can be responsible and make their own decisions but people need information and support to do so” (p34).

Personalisation is about far more than ‘cash in pocket’. The system embraces models for establishing different routes to choose but in practice some of these are scarcely developed. For example, using individual service funds to buy support for older adults and people with mental health needs. This focus on the individual being at the heart of the process of choosing and having more control over the care that they are provided with and establishing a framework for person-centred practice lies at the heart of the ‘personalisation’ agenda. However, the path towards a goal that it is impossible not to support wholeheartedly has become muddied with the realities of spending cuts, local authority processes and challenges which have been continually ignored rather than addressed.

The policy has been driven by the wish to overpromise in terms of extending personal budgets (and hence the ‘personalisation’ agenda) to all within specific time frames where the reality has not been able to keep up. So we have seen the reinterpretation of ‘personalisation’ to represent care and support packages that in reality look no different at all to those which were delivered 5 or 10 years ago but with a different layer of language and bureaucracy layered on top of them. This creates further disillusion within the profession, especially as the social work profession is committed to increasing person-centred practice and empowerment of individuals in the face of the ‘system’ which can sometimes be oppressive and dictatorial.

The implementation challenges for the personalisation agenda have been extensive. While this is to be expected in any process involving widespread changes behind both the philosophy of a system and the systems themselves, the agenda of promoting user involvement, choice and co-production has moved at different rates for different user groups. For example, while the roots of the personalisation agenda lie in the Independent Living Fund and the processes built on driving forward choice and control for adults with physical disabilities and learning disabilities, SCIE report 40 (Newbronner et al , 2011) explains that “There is a risk that people in later life are being squeezed into a ‘one size fits all’ model of personalisation designed with and for younger people with physical and/or learning disabilities”.

Practitioners on the ground who are often the key to success of failure of these policies in practice perceive that there is little interest in addressing their experiences or hearing their feedback.

Why personalisation?

Personalisation is an important policy aim and it is important that it works. The idea of self-directed support (or personalisation) has been a process and direction through which policy has been travelling for decades. It touches on the fundamental aims of what social work is about and how it is used in practice. There have been many changes in the way adult social work has operated since the NHS and Community Care Act (1990) was rolled out and particularly as ‘social work’ developed into ‘care management’ through this period. So why was ‘personalisation’ needed? As local authorities disavowed themselves of delivering services directly, the logical step, as purchasers of services would be to ask people who used those services to have a greater input and role in making decisions about which services were commissioned. That, at the heart of it, is personalisation. One of the main criticisms within the care management model of services and care plans being written by social workers with services being defined by block contracts was that there was that this was very much a ‘one size fits all’ attitude which left people with little choice apart from accepting or declining the services which were on offer (Maclean, 2011).

The policy move to change this and to shift the ‘power’ from the provider to the user has been wholly positive. There is no professional expertise in deciding what meets the needs of individuals that cannot be trumped by the individual deciding for themselves. For this policy to move into practice, there have been accompanying bureaucratic and process-driven changes, such as the introduction of self-assessment processes and attempts at rationalising resources with some transparency (with mixed effects) around the amounts of money spent on care so that people can make their decisions about the services which best suit them. While the direct payment model is the most touted, there are also routes through local authority managed budgets and individual service funds (ISFs) where budgets are shifted to service providers to deliver as required by the service users.

How is personalisation?

The barriers to extending personalisation have been addressed in numerous research literature. There is much evidence which seems to repeat the same conclusions that the progress of different models of delivering care, because ‘personalisation’ is about more than direct payments. This leads to frustration among practitioners that the current barriers are exactly the same barriers which were identified to the same groups of people as those to direct payments five years ago with little progress in some areas.

SCIE carried out research (Newbronner et al , 2011) focusing on people with mental health needs and older people which were the groups of people where the take up of personal budgets has been slower to gain traction. They looked at the different ways that personal budgets were offered: namely those which were directly commissioned and managed by the local authority, third party managed accounts, direct payments or a mixture of these things. They found that there was a risk that inherent processes to assess and allocate resources such as the RAS (resource allocation system) and the assessment process which may be initially a self-assessment or a facilitated process of assessment depending on the local authority and the individuals’ needs, needed to be tailored more finely towards the relevant user group.

“Where a generic system [for RAS] was used it highlighted inequalities for resource allocation between client groups. Older people, especially those with high care needs, appeared to be the most disadvantaged.” (Newbronner et al , 2011) p9

This lack of equitable access through the ‘front-door’ leads to increased disillusionment with a process which is supposedly designed to be enabling and supportive.

Another barrier is that of attitude of social worker and organisation, which is mentioned in an Age UK report “Personalisation in practice” written in 2011.

“There was a concern among support providers and some LA/Trust staff that many PB (personal budget) holders, especially older ones, were being steered away from direct payments and towards managed accounts or services by the LA (local authority” p9.

This indicates that some of the ‘blockage’ on progress and implementation is within the systems which are meant to promote it.

The intransigence of social workers and the lack of desire to embrace new models of service provision which move the locus of ‘control’ away from the professional and towards the person who uses the service has often been argued as a reason for the poor take up of direct payments first ( (Littlechild, 2002) where they say, in relation to direct payments, the forebear of the current personal budgets “it is not disabled people making informed decisions to reject the idea of a direct payments package, but their social workers effectively depriving them of access to direct payments by failing to provide information and support” (p138). This is a harsh judgement to put at the feet of practitioners but it is one that is popular among policy drivers as it is easier to blame the attitudes of practitioners than to evolve methods to promote and simplify the methods of delivery of the personalisation agenda.

Unfortunately the ‘blame’ agenda took hold early in the development of policy making and has led to greater alienation of practitioners who do want to try and make things work. There is a sense of being blamed for not embracing personalisation when the system is flawed, not because they are negative but because the processes are inexorable and have been built to reflect the needs of particular service user groups whose needs, priorities, and abilities are not universal. Effectively, policies are designed to fit some service user groups at the expense of others. Glasby (2012) states “one danger [of the roll out of personalisation] may be that current policy rhetoric is so strong that it is difficult for people with legitimate concerns and questions to raise these in an open and safe environment. Speaking to front line practitioners, some feel as if expressing doubts can be seen as ‘heresy’ and they are reluctant to say what they are thinking. While this may not have been the intention of policy makers, it could be a significant barrier in change if people feel concerned about a policy but don’t feel comfortable exploring this further, and simply disagree in silence.” (p8)

In some of the legitimate concerns, (Newbronner et al , 2011) explains that there is an inherent biases present. Referring to resource allocation schemes (RAS) the study found that “Where a generic system was used it highlighted inequalities in resource allocation between client groups. Older people, especially those with high care needs, appeared to be the most disadvantaged.” (p6)

There are therefore, many legitimate concerns which have been evidenced through research into ways that personal budgets have been used with different user groups has shown. It is vital that the cautions voiced by less enthusiastic practitioners and service users are embraced by those who are guiding policy, rather than being written off as being ‘negative’ without having the chance for their voices to be heard and for lessons to be learnt as a result.

Another challenge that is faced in practice is one of time. Quality support planning needs the investment of time. In the ideal world, presented by those who ‘run with’ the agenda, everyone is able to take an active part in making decisions for themselves and choosing their own care to meet their needs, as defined by themselves. The reality is that some groups have not been able to engage in the process of taking an active role in their own support planning; they are effectively excluded. This may be because they lack the capacity to manage a direct payment or organise a personal budget themselves, or because they lack support systems around them, such as family to help them do this.

SCIE report 40 (Newbronner et al , 2011) emphasises the fact that older people are more likely to need care during a crisis. People undergoing a crisis are likely to be less able, at least initially, to engage in the process of planning and organising their own care. Intermediate care teams typically assess and set up a temporary interim care plan and budget. Support planning then takes place a second time once the person is in a more stable situation and able to take stock. The time taken to set up a more personalised care plan in terms of the administration hoops to jump through are a significant barrier to some people and some ways of providing support.

Where does Personalisation go?

The ideology behind personalisation is sound and needs to be embraced wholeheartedly.

As practitioners we want work to support, involve and include people who use our services. The future must involve a stronger focus on services and delivery of services in conjunction with people who use them, but in order to get there, we need there to be a realistic, no-blame space for discussion between those who make policy and those who implement policy, as well as those who use services who lie at the centre of the social care system. There is still a disparity in terms of those who are best served by current practice. People who have benefited most from personalisation are those with the best advocacy and loudest voices. For the policy to embed itself in practice, it needs to offer the same quality and opportunity for flexibility to all user groups including those who are not able to raise their voices and who don’t have family advocates to speak for them. That’s where the role of the social worker has scope to be established to a much greater extent. As practitioners on the ground they have some of the most acute understanding of the challenges faced by people they work with, particularly people who are not able to best articulate their own concerns. If personalisation is going to work for everyone, we need to hear the voices from practice.

 

Biblography

Age UK. (2011). Personalisation in practice : lessons from experience. London: Age UK.

Netten et al (2012). Personalisation through Individual Budgets : Does it work and for Whom? . British Journal of Social Work , 1556-1573.

Gardner, A. (2011). Personalisation in Social Work . London : Sage.

Glasby, J. (2012). The controversies of choice and control – why some people might be hostile to English Social Care Reforms . British Journal of Social Work 1-15

Littlechild, J. G. (2002). Social Work and Direct Payments. Bristol : Policy Press.

Maclean, S. (2011). Personalisation and Person-Centred Care. London : City and Guilds.

Newbronner et al . (2011). SCIE report 40 : Keeping Personal Budgets personal : learning from the experiences of older people, people with mental health problems and their carers. London: SCIE .

On Capacity and Deprivation of Liberty

Having been a Best Interests Assessor since the position came into being, I have a particular interest in how the deprivation of liberty safeguards (DoLS) work (or don’t) in practice. I am a fan of the Mental Capacity Act (2005) to the point of becoming quite defensive in the face of opposition to it. This is because having worked in older adults services (and more specifically in dementia services) since before the Act came into force, I’ve seen the big changes that it has made in codifying and protecting the rights of people who may lack capacity to make specific decisions at certain times in their lives.

What was a previous reliance on ‘common law’ principles of professionals/family members making decisions which were more often than not ‘in people’s best interests’ changed to become codified and provide protections to people who are in these situation where no specific legal reference existed before. While the ‘Daily Mail’ crowd grumble about decisions being made by ‘shady secret courts’ or even shadier ‘professionals’, the reality is that for decisions to be made on behalf of people, all those involved including family members and professionals where necessary, should decide together what is in someone’s best interest on the basis of previous wishes where they are not able to explain. The legislation and code of practice sets out, what was lacking before, in terms of expectations (nay, demands) of involvement and the responsibilities for decisions about capacity to be made by the most ‘appropriate person’.

Criticisms come, of the Mental Capacity Act (2005) through the Deprivation of Liberty Safeguards. I have written before about them here as I’ve been involved in making decisions and carrying out assessments. There is no doubt that the system in place is flawed. We identified some of the flaws when we did the training before the provisions came into force. Subsequent case law has not always been helpful. In the light of the CQC report published this week about the use of Deprivation of Liberty Safeguards, I thought it would be useful to reflect on some of my personal experiences of using them and observing others using (or not using them) rather than look through the report which others do far better than I would be able to.

The Deprivation of Liberty Safeguards (DoLS) were intended to provide a level of protection to people who lacked capacity to make decision about care and treatment either in hospitals or care homes, regarding situations when they were being deprived of their liberty and therefore had no recourse to any appeal process – unlike, for example, people who are detained under the Mental Health Act (1983) who have access to a tribunal system. Deprivation of Liberty Safeguards have their own Code of Practice (which is useful but got out of date rapidly in the face of changing case law). There are particular processes required for an authorisation to be made (by the supervisory body – which is the local authority) and it is based on assessments made by two people. One is a Best Interests Assessor (which was the role I took) and the other is the Mental Health Assessor (who  is a doctor with special training although I wouldn’t lay too much confidence in the ‘special training’ as I’ve known it to be as little as a day). Having attended some joint training with Mental Health Assessors, I have to say, I wasn’t inspired with a great deal of confidence about some of the understanding of the processes but perhaps that’s changed in the year since I’ve practiced.

Problems with DoLS

One of the main problems I see with DoLS is that people are told ‘They are complicated’ and that seems to act as a disincentive for managing authorities (the care homes or the hospitals who may be depriving people of their liberty) to actually think about them too much.  Or staff who work in these areas think they are ‘someone elses’ business. I’ve come across that before – hospitals who have one DoLS/MCA lead who is seen as the only person who needs to know about them. I would say that’s possibly not the most helpful way to think about it. As long as people think they are complicated, they will ignore them in the face of busy work environments.

I try to tell people, when and if they are interested, that everyone doesn’t need to know the intricacies of whether a particular practice is a deprivation or a restriction before making a referral – it is the job of the Best Interests Assessor to make that call as a part of the Best Interests Assessment and it is something that will depend, very much, on the individual circumstances of an individual person. What is important though, is that staff can identify some key issues that may come up that could trigger a referral at the very least. If staff are to be provided with such a list by their employers (which I’ve seen) then at least those employers should ensure that they update this checklist frequently in line with case law and they emphasise that it is not exhaustive. As frontline practitioners, we talk about hating check box lists. This is exactly an area where a check box list is supremely unhelpful unless it is changed frequently and concerns strong provisos – allowing some professional judgement.

The name is a bar too, of course. Deprivation of Liberty Safeguards – people seem to concentrate on the deprivation part and ignore the safeguards bit so they are seen negatively. Actually, it’s a way of protecting the person whose liberty is being deprived and without the safeguards they would not have the same level of protection. When I see the Mail/Express headlines like this we can see the danger of misinterpretation of the language. I don’t believe for a  moment we have ‘more people subject to chemical cosh’ or ‘older people being tied up’ or ‘people denied from seeing their relatives’ than we did 10/20 years ago. We just have more understanding of when it’s happening and some of those people have had specific assessments to determine whether it’s in their best interests – where before it would just be a decision made without those safeguards.  The language is troubling to tabloid news journalists who don’t look beyond the ‘deprivation’ word. Mind, it’s not just tabloid journalists – it’s care home managers who see it as a ‘bad thing’ if they make an application. Personally, I’d be delighted to see more referrals drip through as it means that there’s a possibility that some people will have access to the protections.

Some people want a list of things that are a ‘deprivation’ and what isn’t. The lack of such a list leads to an ‘it’s complicated’ charge. The reason there isn’t a list is what may be a deprivation of liberty to me, might not be to you. I’m generally quite a solitary person and am quite happy spending a day pottering around at home, doing not very much. My partner needs to go to the supermarket every day to get fresh fruit and vegetables. He will not buy fruit or veg a day in advance and doesn’t believe in weekly shopping (this is sometimes an issue between us!). Not allowing him out of the home (if we both lived in a care home) would have a far greater impact on his liberty than it would on mine because of our usual habitual behaviours. Whereas keeping me away from a television for more than a day would have a big impact on me but wouldn’t bother him in the slightest. Silly examples but it’s the reason we can’t make blanket decisions or say ‘locked doors = DoLS application”.

The interface between DoLS and the Mental Health Act (1983) is a particular bone of contention – in my experience. Having worked in older adults’ mental health services, I saw many situations on older adults inpatient wards where, if someone wasn’t battering down the door and actively attempting to leave at any opportunity, they were deemed to ‘comply’ with the detention without the need of any of those awkward legal-type powers. Unfortunately I haven’t seen a great deal of progress in this and some psychiatrists seem to dislike using the Mental Health Act (1983) to detain people who lack the capacity to consent to treatment/admission. DoLS does allow, potentially, another avenue although case law has been quite fluid in terms of where we stand. What I’ve seen FAR more of is a lack of use of either Mental Health Act or the Mental Capacity Act and somehow thinking that ‘informal admission’ is the ‘right’ answer if someone isn’t battering the door. Sometimes opposition to a detention can take other forms – increased levels of distress, lack of engagement with staff/family but I fear there is little flexibility in interpreting the ‘objecting’ patient when people are not actively saying ‘I want to go home’ every second – and even sometimes when they are ‘Oh, they are just like that’ or ‘that’s the dementia talking’.  The thing is, this needs to be challenged and sometimes hierarchies within hospital systems don’t allow it. This is why I think the BIA role is crucial and that hospitals, in particular, should engage with genuine understanding of DoLS and what their actual purpose is rather than assuming they know.

I have a slight problem with the assumption that the Mental Capacity Act is ‘less restrictive’ than the Mental Health Act. To the person who lacks capacity to consent to treatment or a hospital admission – they are being kept in a place they don’t want to be and treated against their will regardless what legal framework (or none) they are subject to. The Mental Health Act offers more and better appeals processes (and more automatic checks – and of course, although this shouldn’t be an issue, the right to s117 aftercare) than the Mental Capacity Act so saying that DoLS offers a least restrictive alternative, is, I think, (whether judges agree with me or not) a false premise. One thing is for sure, there needs to be SOME legal framework and having none, certainly isn’t the least restrictive alternative.

What would work better?

I think there needs to be a streamlining of the DoLS process – perhaps more along the lines of the Mental Health Act which is better developed – certainly in terms of rights to advocacy for all and a similar type tribunal system. There needs to be much better understanding of the processes and what RIGHTS mean to people who lack capacity to make decisions. Local authorities need to provide better information and access to advocates all the way through the process – they are supposed to but it sometimes gets lost down the line.

CQC need to actually inspect and enforce when organisations are not telling them and they need to understand the processes better to judge organisations against what they should be doing.

Changing the name would help too, something about protecting rights not depriving of liberty – perhaps that’s a bit flippant but language is important.

Everyone within organisations needs a better understanding of them from care workers/health care assistants to consultant psychiatrists who seem to regard them as an optional extra if they can’t be bothered to use the Mental Health Act because ‘they don’t do that’ when people lack the capacity object in the only way that they can recognise.

These aren’t new now and they aren’t optional but too many organisations seem to write them off as ‘too complicated’. Too many supervisory bodies seem to ‘pre-screen’ referrals. There are too many discrepancies nationally to think that they are anywhere close to being embedded in our health and social care systems (despite CQC’s positivity on this).

We need access to clear information including current case law in a central space – perhaps the Department of Health can offer up some space – in easy to read language which explains rather than complicates.

I’m sure there’s far more than needs to be done. I don’t have all the answers – not by any means, but I do know we all, who have any interest in this sector, need to do a whole lot better and understand what the current law is. These safeguards aren’t an optional extra and just nice for people to understand a bit better. They are the current law and the current law is failing for as long as no one is actually checking or caring whether they are used properly or not.

On Kindness and Compassion

This weekend, I’ve been reflecting a lot on kindness and the way it impacts on my job. On Friday,  I had a conversation with someone I work with (in a different organisation) in which they demonstrated a level of kindness towards me that I was not expecting in the context of our previous conversations and professional relationship. It surprised me. They could have dealt with the situation in many different ways, as could I, but the kindness took me aback and I’ve been thinking about it ever since.

We hear a lot about the need for compassion in health and social care. There has been a ‘lack of compassion’. After the Francis Report publication, organisations within the NHS but on a broader level have been asking about whether there has been a deficit of compassion shown in services. I’m far from convinced of it. Cruelty happens. Neglect happens. Organisations develop toxic cultures. Does that mean there is a general lack of compassion by staff who do their jobs on a day to day basis? I don’t think so. I’m also confused by the language that is used.

I like to think I’m a kind, compassionate person. I try to be. I wonder though, what kindness/compassion is in the role that I have and have had and whether they are the same thing. Wikipedia tells me

English noun compassion, meaning to suffer together with, comes from Latin. Its prefix com- comes directly from com, an archaic version of the Latin preposition and affix cum (= with); the -passion segment is derived from passus, past participle of the deponent verb patois, patī, passus sum.

Whereas kindness is again, according to Wikipedia

a behavior marked by ethical characteristics, a pleasant disposition, and concern for others. It is known as a virtue, and recognized as a value in many cultures and religions (see ethics in religion). Research has shown that acts of kindness does not only benefit receivers of the kind act, but also the giver, as a result of the release of neurotransmitters responsible for feelings of contentment and relaxation when such acts are committed

Would we rather, on these definitions, that someone treat us with kindness or compassion? Personally, I’d go for the first. I have no desire for someone else to feel my pain or suffer with or alongside me. When I was working with people on a daily basis, we used the rule of thumb about treating people as you would like to be treated or as you would like a member of your family to be treated. As a simple baseline, it’s a good start and it’s easy to understand but perhaps we need to look beyond the self and beyond the ‘compassion’ which is about putting yourself in other people’s shoes or imagining they are in your shoes, and thinking how we treat people to create a better, more caring, kinder society as a whole. Compassion, perhaps, is about the individual but kindness can be broadened out to a wider group of people that we might not ‘feel’ for.

If we are looking at the word, compassion and compassionate in terms of the care I delivered when I was in a social work role, I’d like to think that I regarded everyone I worked with respect and kindness. Was I always able to feel their difficulties and suffer with them? I hope not as it would have burnt me out far earlier but I think I did my job well and tried to remember that I was in the position of power that flitted in and out of the lives of others having significant influence on their wellbeing and making fundamental decisions which I never took lightly. However, I had bad days too. I remember one time when I was annoyed with someone whom I was working with. It was a family member of a man I was working with and they had acted in a way that I thought had not been helpful. I remember actively biting my tongue and being short with them. I returned to the office and had a long chat with my manager. I phoned them and apologised. I was not compassionate. I was not kind. I don’t think it made me a bad person but gives us an awareness that people who see themselves as compassionate (however that’s defined in the context) can act in ways that aren’t. Does that mean the system is broken or that the people in the systems are human and have good days and bad days? Of course, cruelty and neglect are not ‘bad day’ things but I have never come across anyone working in health and social care who has not considered themselves ‘compassionate’ or ‘kind’ but sometimes that isn’t necessarily what I have seen in their actions.

So telling people to ‘be more compassionate’ doesn’t work. Telling people to ‘think more’, doesn’t work because we all think, to a large extent that we are doing our best.

Teaching Compassion

I’m far from convinced that organisations need to buy in external agencies to ‘teach compassion’. My gut feeling is that there is something of the snake oil salesman approach to those who peddle the ability to ‘teach’ organisations how to be compassionate. It’s not rocket science, as we like to say. I don’t think anyone (apart from the few who fall into the ‘cruel’ group for which no teaching will work) believe we are not kind or don’t want to be kind. We need space to develop kindness and in my view that comes through reflection. Just as I’ve spent a day or so, reflecting on a very simple act of kindness towards me, it has led me to think about how I can be kinder, in unexpected ways, to and with those people and organisations I work with. So one act towards me has had a ripple effect. Similarly others, if they have that space, can think about how they have been influenced by kindness and thought from others in professional and personal settings and how that can be passed on.

Are organisations needing to buy in external consultancy firms to do this? I hope not. My hope is that any organisation in this ‘trade’ has sufficient professional expertise to grow their own reflective practice. It’s far cheaper and more productive to ask your own staff what would help them than getting a consultancy in to tick the ‘done compassion training’ box and tell them. I’d have far more confidence in any organisation that sourced the space and time to embed reflective practice over one that bought in a firm and got 100% compliance with ‘compassion training’.  The key is that kindness and thoughtfulness start at Board level. If staff feel engaged with an organisation and a part of it, they want to do their best – sometimes they do, even if they don’t feel connected but it’s better for everyone if we do.

Kindness needs to drip down. Focusing on value based recruitment for health care assistants is great. Blaming health care assistants for all the problems in organisations when a lack of compassion has been identified is not. Staff treat people how they are treated. I’ve worked in different organisations and seen that those that have the best cultures are the ones that have most visible and responsive leaderships. Then the rest will follow. Staff teams that are well-led will filter out the team members who are less thoughtful in their approaches. Those that are poorly led will embed poor practice and culture. It doesn’t need any fancy training sessions to ‘teach’ that. It just needs, in my opinion, thought and time to reflect.

Reflection

I’m aware that I can sound like a broken record at times, but fundamentally, I think the gap that is perceived to exist in kindness and care can be solved through reflective practice. The problem comes with the space that is given for individual staff members and organisations to reflect and the value given to it within the world that is driven by cuts and outputs. To ignore the need for reflection and consideration though, leaves individual practitioners and organisations at a far higher risk of delivering care that is thoughtless. The wellbeing of staff knocks on directly to the wellbeing of patients or people who receiving services from an organisation. A stressed and anxious social worker will by less effective, less kind, perhaps, than one who feels that they are a part of an organisation that shares their values. I know it’s easier said than done. In my previous team, we took time to talk through cases with each other, even when we were at our busiest because it made us stop – and think – about what we were doing and the impact that it had. The skills we learn to reflect and reflect well and often are imperative to good and safe systems. Reflection should also allow space to challenge practices within organisations which are faulty or unkind. We need to look after ourselves as practitioners and we need to demand it from our employers if they do not provide it.

Kindness

So back to the initial kindness that was shown towards me. It made me realise what a difference it can make especially when it comes from an unexpected source. In my theme of hope for the new year, I think that I’m going to try and be kinder, if I can, for as much as I can, to those I work with and around. While kindness cannot solve the financial difficulties the sector finds itself it, it might be able to make the work environment more pleasant and more caring for those who use the services proved  but also for those who work within them, at all levels.

Looking back and looking forward

I haven’t posted much here over the last year and most of my posts have been about looking back rather than looking forward. 2013 was an important year for me in a lot of ways. By moving out of a social work job, I’ve developed new layers of understanding about what social work is and what it means to me, and to us all to have strong and value-based social work practice in society. Also, despite having worked in an NHS team for years, by moving out, I’ve learnt a lot more about this messy, wonderful healthcare system that we have in this country. It’s something to be thankful for as a concept but we can’t shy away from being critical at the details where necessary. Criticism can come from people who have broader political agendas but sometimes it comes from people who have been damaged by poor care and treatment and sometimes it comes from people who want to be ‘critical friends’ and we shouldn’t confuse the motives for criticism. Sometimes those who love us the most can be the harshest critics – not because we want to destroy but because we want to improve – for ourselves, our families and for those who have the quieter voices and aren’t able to raise them. Sometimes.

I worked in the same geographical area for ten years – the same local authority, the NHS Trust which covered the same area. As my focus became broader and I saw, up close, how things operate in other local authorities and in other NHS Trusts, I have come to realise how narrowly I focused on extrapolating the general from the particular. My main theme of 2013 has been one of learning and really, that’s an incredible opportunity. To me, there is no greater privilege and opportunity than to learn.

For 2014 I have a further opportunity to learn and to use the learning I have gained to good effect. I want to focus and share some of my thoughts on the year ahead how I got to where I am now.

Power

Everyone working in health and social care has power. Everyone. Because we see and work with people who have vulnerabilities at the stages of their lives when they need to use the services which are provided. A dentist can see the most confident politician shifting into a blubbering mass of fear at the sight of their drill. A care worker on minimum wage, not being paid for travel time, can have the measure of someone’s entire day, week, month in their hands with rough handling, a harsh word, or worse. Sometimes when we feel we are ‘on the frontline’ we forget about the power we have. I’m definitely guilty of that. I think back to my previous job and how we used to grumble and moan about ‘managers’ never listening to us – while forgetting the immensity of the powers over people’s lives that we held in our hands.  We can fall into the trap (and I’ve done it myself so this isn’t me intending to preach) of thinking we are powerless in organisations when we have enormous power in our own hands.

Now I’m in a position where the power I have is more explicit. I’ve never been entirely comfortable with the thought of having power. I laugh it off sometimes, because honestly, sometimes it scares me. When I stop to acknowledge it, I have to deal with it. I have to use it well and I have to use it to improve services and advocate better for people who use them. This year, I’ve found myself in rooms with ‘important’ people and often thought “what on earth am I doing here?”, “why would anyone be interested in what I have to say” and no one else (to my face, anyway) seems to be thinking it. So I’ve had to grapple with my own change in ‘status’ although the more I think, the more I see the power I had before but never acknowledged as fully. If I don’t feel comfortable with it, that’s my problem and if I don’t realise it, I’m not using it to its best. So this year has been a year for me to get to grips with it. I still need to work on my self-confidence and not running out of meetings, into the bathroom to look in the mirror and wonder if I’m still the same person that they all seem to see and treat with respect, and listen to with interest. I know I need to work on that but I’m coming round to it.

Constructive Criticism

This year I started a creative writing class which runs weekly. I don’t really see myself as a budding novelist. I’ve had that dream sometimes but I think if it was going to happen it would happen by now. We are a disparate group of people who have different jobs and move in different circles and are different generations. Each week, we write one (or more) pieces and then bring them back to the class where we critique each others’ work. It’s taught me an interesting and useful lesson about constructive criticism. Sometimes when you write sometimes, particularly if it has an autobiographical tilt to it, then you can be very sensitive to criticism. One of the first weeks, someone in my creative writing class wrote a story about the death of her son. I was asked to provide constructive criticism. It was very hard. It wasn’t the most beautifully written piece but the rawness and  heart in it together with the honesty was something I will never forget. It reminded me of some of the ways we react to criticism and how we can be constructive in our criticism of services without tearing them down or destroying the people who you are criticising. Being a social worker, I’m used to press criticism. My view was always that we should worry less about what right wing commentariat and government ministers say and get our own act together to develop more professional self-confidence and that will batten back some of the foul and most unfair criticism. People will never love social workers as long as social workers whine about not being respected or mutter about press conspiracies against them. People don’t know and understand what we do and often see the ‘iron fist’ of state functions as the ‘velvet glove’ of tirelessly working alongside people to get to grips with systems isn’t as interesting a story.

Now we see more entrenched criticisms of other professions in the health and social care sectors – GPs, A&E, mental health services, nurses. I hope they learn from us as social workers. We can and should never, ever defend poor practice for a start. It shows no credit to anyone. We should accept there are people out there who share our professional background who might not be committed to the same values that 90+% of us share. If we defend them BECAUSE they are social workers, doctors, nurses – we do everyone a disservice. We have to prove and show how the good works and not allow the bad to define it. But that means we have to condemn the bad too, alongside the press. We have to learn the skills of constructive criticism of organisations that we love. We have to teach the public about the role we have so it doesn’t become defined by a press with an agenda – especially as we move into the election period. We have more channels now to share what we do and how we do it – we can take advantage of that.

Change management

I’m probably not the one to harp on about ‘change management’ as I’ve never had to manage anyone else – but the coming year is going to be a significant one for me in terms of changes and mostly managing my own changes.  These changes will come through work and out of work. I’m about to move house and leave an area I’ve been living in for many many years. Both these things terrify me. Although I can come across (to people who know me) as quite laid back – I’m actually terrified of uncertainty. I will deal with it. I always have and will continue to because we can’t and wouldn’t want to construct lives in tiers of certainty I guess. Keeps me on my toes. How I deal with change will very much define my year though. I am not the only one – again, this is common in the sector I work in. We might not all be moving house, but we all have to deal with endless reconfigurations, rewriting of roles, adjustments of responsibilities. I joke that I have got good at it but that doesn’t make the underlying anxieties disappear.

Then I think it’s a microcosm of life. We all have to deal with unexpected changes and being asked to deal with things we never realised we had it in ourselves to do – a weird analogy with death. I remember when my dad was very unwell and near to death. His health went up and down like a yo-yo and there were many times when we thought he was close to death and then, he managed to continue on, despite all the odds. I often had thoughts about wondering how on earth I could imagine a world where he was dead. I tried to imagine it in my head sometimes and found it too difficult. He had always been there. I knew, obviously, he wouldn’t always be, but I couldn’t understand how I would continue to manage in a world where I couldn’t pop round to my dad’s or where he wouldn’t be on the end of the phone when I needed to talk to him. Of course, he died. And I went on. It’s a kind of ‘change management’ isn’t it? I didn’t know how I would do it, but I have, and I do continue in the world where I can’t pop round and where I have photos to replace the reality. So it is with other kinds of changes – sometimes we can’t imagine it beforehand but we deal with things because we don’t have any choice and we deal with it well, because we have to – we are human and resilient. In some ways, my experiences of bereavement as much as reconfigurations at work – prepare me to change. I don’t know what it’ll be like, but I’ll deal with it because I have to.

Hope

This possibly isn’t apparent to too many people, even those who know me quite well but I’ve probably lost a lot of my hope this year for various reasons. I have become more cynical and developed a more pervasive and lingering sense of despair about where services that I love and have been a part of over many years have gone or are going. I have to force myself to believe more now and I worry that I have lost hope. This is an area I am going to actively rather than passively focus on for the next year. I need hope and I miss hope. Yes, the financial situation has been dire and local authorities, NHS Trusts, voluntary sector organisations and central government are all strapped for cash and this is having a real impact on people but there are genuinely decent people doing fantastic work in all these sectors. Money is important and I can’t forgive some of the funding and political decisions made but on a micro level, we can all improve lives and experiences for individuals and that’s what I need to focus on more. Sometimes I forget.

2014 is going to be an interesting year, for sure, and my wish is that we all have a chance to realise how we can make a difference and recapture hope –even on a small level  – but preferably on a much larger one – and what we can each do with the power we  have to make these sectors whom people rely on, much better for 2014 and many years beyond.

Happy New Year

What I’ve learnt about Social Work

A couple of ‘anniversaries’ have come up recently for me. It’s six years since I published my first post on this blog. It’s one year since I left my social work job. These milestones have caused me to reflect on the nature of the profession and the sector that I work in in a number of ways.  I read my first post yesterday and it drew me back to why I started writing in the first place. I’d tried writing blogs before this one. I wrote a stupid little diary as an angst-ridden teen which was much more interesting when I looked back on it than while I was writing it. I made a conscious effort here though, to write about social work and social care.

Over the years, writing and publishing posts has helped me in ways I can’t begin to elucidate but I’m going to try. I’ve written about social work and social media many many times but in looking back over the six years and learning more as the conversations grow and develop, I’m going to indulge myself again and share some of the things I believe that writing here has changed and shaped my perception of the career I chose.

What I’ve learnt about social work by writing about it.

I never really ‘expected’ a career in social care when I started working in the sector. I didn’t know what I expected to be honest – possibly because I didn’t ‘expect’ very much. In all honesty, I was grateful to have a job that didn’t involve me having to work in a shop or an office. I was grateful that I could be paid to do something that I actually enjoyed doing. My expectations weren’t exactly stellar but I never really thought about ‘career’. That wasn’t for people like me. I’ve written a few times about how I moved from a support worker in residential care to a social work student and then a social worker. It wasn’t something I was planning or expecting but a happy coincidence. My first job after I qualified was busy and I constantly felt incompetent or that I should be doing something different or better – most of the times, I was probably right. My manager at that time ranks as one of the worst I’ve had. She was, quite frankly, a bully. I didn’t bear the brunt of it though. I kept my head down, did as I was told and relied a lot on the support from older and more experienced colleagues.

I went away, returned to social work and new legislation, procedures in a much better place. When I started writing this blog, I was finishing my ASW training. In the borough I worked in, we completed the training ‘full time’ with placements in other teams. I’d moved from adult social work into mental health social work for a few years and the ASW training was the logical next step. The service needed more ASWs. I wasn’t actually too keen. I remember a conversation I had with the service manager at the time when he told me that it would probably be the last opportunity I would get (I was on the last ASW training) before the rush of nurses and OTs and the shift towards AMHP training. Last chances. They can be quite a pull. I was struggling at work too for various reasons and to be brutally honest, welcomed the idea of taking some time out to do more training. I didn’t really think too much of the thought of what it would mean in the long run.

The course was the best I’ve ever done. Far surpassed my initial social work training in terms of quality of teaching, level of understanding, support and knowledge gained. I started writing here as my thoughts moved towards returning to work and a job I wasn’t sure I was even very good at. I’d had time out to study and I’d enjoyed it and I was worried about going back to the day to day ‘grind’ and becoming jaded. The ASW training lifted all the lingering inertia out of me. I wanted to do well. I wanted to learn. I was sad that the learning was coming to an end. So I started writing.

After the first few months, I forced myself to write something every day (giving myself weekends off). I wrote a post before work religiously for a number of years. Yes, the quality varies massively – but it forced me to find things of interest either in the news, from work or from my ‘outside work’ life to trigger. Some posts were longer than others, some more interesting than others. It was a good discipline, looking back and I don’t think I could return to it.

It taught me much more about the profession – I’d thought in terms of myself as a ‘adult social worker’ or a ‘mental health social worker’ but I hadn’t really thought about ‘social work’ per se because the work and the culture in childrens services, as I saw it, was so very different.

Then people seemed to be interested in what I was writing and I saw it was an opportunity to ‘sell’ social work. I explored for myself what being a social worker meant to me. I’ve been through the tunnel and out the other side with it to be honest. I’ve had, as we all do, those good and bad days. By writing I was able to share some of that. I was able to better reflect on what I was doing on a day to day basis and how it fit back in the profession as a whole more than my own little part of it.

As I wrote, I learnt how proud I was to be a social worker. That was something quite new for me. We joked about it but I didn’t realise, until I was writing for an ‘external’ audience, how important it was to me to represent the good work that is being done, by good people – often unnoticed – in the sector.

The blog also gave me a voice. I’ve made an issue of the fact that I’ve never been a manager. I was able to tell people who would never otherwise have listened, what it was like to work in the field and to have changes happening around you when there was no thought or consideration given to the experiences or voices from the ‘coal face’.

I was, and still am, amazed that people listened to me. Me. I’m not anything or anyone special. I don’t have any particular professional status. I haven’t written reams of peer-reviewed papers. But people seemed to read, listen and respond to me. That helped my confidence as an individual and as a practitioner enormously. So this blog and the other things I’ve written over the years, have given me confidence and have helped me to reflect on what it is to be a social worker, what it is to work in social care – and health services – and to realise that I could use my voice in different ways, even if I couldn’t always say things to my managers or in the Trust or local authority I worked in, someone, somewhere might listen and make things better in some ways.

I learnt a lot from blogs and comments from people who use social work and social care services particularly. I could never have the same interactions with people I worked with on a day to day basis because however pleasant and approachable I think I am, there is an undeniable power that I had in my statutory role. Reading about how people feel when they are detained under the Mental Health Act or have treatment forced on them, is an insight which – while hoping I was always sensitive – I could not get from other sources. Listening to how people felt when they experience crappy social workers or crappy carers or crappy systems, reinvigorated me to stop feeling so powerless in relation to the organisations which I worked in and realise the immense power I have in other people’s lives and to make sure I used it well. I may not be able to help those who have experienced the worst of statutory powers but my growing awareness of the impact would, I hope, help those who crossed my path.

Ultimately, and ironically, writing about social work, understanding its important and having more confidence in my own voice and opinions is what led to me having the confidence to leave it behind me. Isn’t life funny.

What I’ve learnt about social work since leaving it

I’ve written  my ‘goodbye’ piece to my Trust and local authority so won’t go over that ground again. It’s been an interesting year as I’ve left behind  a specific ‘social work’ job and moved into a job that doesn’t require a professional registration. In some ways, it’s solidified my determination to identify and pretend I’m still a ‘social worker’. It’s also though, allowed me to see the profession ‘from the outside’. When people meet me now, they don’t necessarily know what my professional background is so I have heard some interesting perceptions about social workers and can distance myself when I choose to.

A few weeks ago, I was at a meeting with various people from various places. When we drew to a close and had that brief chat before we headed off in our separate directions – we were talking about some of the difficult situations that had arisen. The person sitting opposite me said “You should try being a social worker”. In the skip of a heartbeat, I responded “I am… I mean, I was.. er.. I’m still registered”. Then I realised, coldly, that of course, no one in that room apart from me knew that. That was an odd feeling. I had, so long, identified as a social worker than having it not be either immediately obvious or relevant was another step away for me.

I get pangs of wanting to go back. Particularly, I miss some of the day to day work with people that I don’t get now. Then I try to remember what it was like, last summer, when the cuts bit hard and the stress levels were enormous. I’m happy where I am now, really I am but it’s not quite the same as sitting in someone’s front room – building a relationship with them and their family – and being ‘there’ to help see through some of the complications of ‘services’ to make things work out a bit better. Or meeting someone in hospital – or when you rock up to carry out an assessment and being able to follow it up through discharge to a better place. I have to admit i’ve occasionally glanced at social work jobs just to see if they tempt me back. I wouldn’t say ‘never’ but the longer I am away from the ‘coal face’ the harder, I think, it will be to go back. Maybe I’m kidding myself into thinking I will. I need to have that comfort blanket of believing that if I applied for my old job tomorrow, I’d be able to slot back into it.

I’ve learnt that social work is about so much more than local authority social work or social work within the NHS. I knew this, theoretically, of course – but now, as one of the ‘outsiders’ I see how important it is that social work doesn’t become pigeon-holed into only meeting statutory social work with a job title that includes ‘social worker’ in it.

I am using all the skills I gained through my training and my experience in my current job. Being a social worker, I believe, with my knowledge of assessment processes, experience, use of legislation and value base make me able to to what I do. Could someone without that do it as well? Yes, they can and they do – sometimes far better – but for me, it’s a good fit.

I now have a little distance from the profession which allows me to cast a more critical eye too. I was incredibly frustrated by the battles between BASW and the nascent College of Social Work back in the day. I see some kind of impasse has been reached now but I do wonder how sustainable it is to have two organisations – in a profession which has never particularly clung to representative organisations – battling for the same space.

With initiatives such as Frontline and the posts of the Chief Social Workers (who, it seems, have turned out to be mouthpieces for the govt – but I wait for them to prove otherwise to me) it has become really important for social workers to help define social work and not allow it to be defined for us by the Department of Health and the Department of Education. It isn’t only about child protection social work. It isn’t only about statutory social work. I am still as much of a social worker as I was last year, even though I don’t NEED to be a social worker for my post – perhaps I need to convince myself of that too but if we allow others to define the profession too narrowly, we will all lose out by it. In a world where I see the profession increasingly fragmenting, the real strength and voice can only come in unity. That’s what I’ve learnt.

In all, I remain incredibly proud to be a social worker. Although I was desperately sad to leave my last job and can’t help feeling tinges from time to time about whether I did the right thing, I can’t go back now. I have landed on my feet and the amount of learning I’ve done over the last year has been enormous. Mostly it’s about building on the skills, knowledge and values. You can’t be a social worker without all three of those. I’m still working on all of them and so very much locate myself within the profession. Will professional organisations, voices and representatives acknowledge that? I hope so.

Social work allowed me to create a ‘career’ when I never really thought I would have one. It’s allowed me to build confidence in myself so I can better represent and advocate others. It’s given me a great gift and I never expect to lose sight of that, forget the opportunities I have been given and stop fighting for the necessity of good social work. That’s done together though and we can build a better ‘social work’ with more voices.

That’s what I’ve learnt.

As I move on with both the writing and the career, I can’t help but feeling rather self-satisfied too. I am proud of what I have achieved so far but know there’s a long way to go. Pride isn’t particularly pretty but I’m hoping the confidence I’ve gained can be used to better represent, advocate and drive improvements for others as well as for me, rather than allow me to sit in a self-satisfied space and relax.