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.
I read a lot about ‘leadership’. Tips on being a great leader. How to lead. Even, rather comically in my view, on the Frontline site, something about social work being a ‘leadership profession’. Most of the advice comes from other leaders – or people who claim to be leaders. I’m not a leader. I’ve not read or studied anything about ‘leadership’. I’ve not, and can’t honestly believe I ever will go on any ‘leadership’ programmes. It’s not who or what I am about. Perhaps that gives me more of a vested interest in good leadership because while I am very contented to be a follower, there’s nothing more I want than to be led well.
I’m fortunate to have generally, in my career, had good managers with a few notable exceptions. It’s above that first-level management position that I want to consider how we, as competent professionals are led and thought it might lead to some reflection on what I would like to see in a leader. There’s an ongoing contention that leadership and management are different. I’m not entirely convinced by that. Leaders have a ‘position’ and management gives that role a concrete base. Managers are told to lead but people are drawn to leaders – perhaps that’s the difference. I’m yet to be entirely convinced by people who say that leaders can lead from without a management or authority position.
So what would I like to see in a leader in order to feel that I am being ‘led’ well.
I have to feel that the person who leads comes from a position of authority. Maybe that is a management perspective but I am more considering an element of expertise. They have to be able to know what they are talking about. In health and social care, I think this is where there is a strong push for patient/service user/carer leadership can come from because the expertise is in the understanding not just the processes of services which are delivered but having experienced them and working through them. In most ways, the expertise garnered in being at the end of services is the most precious one that some ‘professionals’ find hardest to garner. That feeling of being powerless in the face of the powerful state leviathan – whether it be the hulking hierarchical health service or the unfathomable processes lurking within the local authority and being victim to its resource allocation systems. Experience isn’t the only base for expertise, although it is a uniquely precious one. Leaders could be experts in a particular way of working, communicating, understanding or interpreting. There has to be a basis of authority though based on knowledge – although that knowledge can be achieved through many different strands.
As well as knowing what they do, they have to be good at actually doing it. I have often reflected on the days I started working in social care, firstly as a volunteer, then as a support worker. I did ‘hands on’ care work for a number of years before I moved to do my social work training. When I was working in residential care and in care management, I’d often say that we should never be asked to do something by someone who wasn’t prepared and able to do it themselves. ‘Hands on’ care shouldn’t be ‘above’ anyone and certainly not above any so-called leader. This worries me somewhat about people who ‘fast track’ into leaders. When I went out to review people in residential homes or to review home care packages, I knew what the constraints on time for staff were. I knew that you couldn’t provide someone with a dignified shower and breakfast in a 30 min call. Although I couldn’t always change the local authority commissioning, at least I was able to empathise (for what it was worth) with the people who were using the service and the care workers who had to carry out the tasks which often institutionalised poor practice through the lack of time. Of course, I’m not anything special but extrapolating out, in my previous job, I knew my manager was not just a competent social worker, she was an excellent social worker and I saw her at work from time to time and remained (and still do) in awe of her competence. So I followed and took advice and strived to be as good as she was and is. My main sadness is that was rarely acknowledged from ‘above’ for her. I wasn’t as convinced that our Assistant Director was a competent social worker because I’d never seen him in a practice environment and suspect it had been many many years since he had ever come close to face to face practice. How could I be effectively ‘led’ if I wasn’t sure of his competence, not in the management role but in the tasks the organisation was being asked to achieve. Of course, I’m not unrealistic. I wouldn’t expect every Chief Executive to be able to do all nursing tasks – especially if they aren’t nurses but I would expect a deep understanding and appreciation of the work done by everyone in the organisation, from the person cleaning to the catering staff to those out in the community.
This is where I think these graduate ‘leadership’ programmes slip up because I think a good leader needs humility. They need to be aware of their own power and the effect that has on people. I feel a little intimidated by power and yet, simultaneously, I can be unaware of my own power at times. In some ways that’s what I see as humility. It is an appreciation of both the power that the leader has and the effect that has on other peoples’ interactions with them. The conversations I have about work with someone in my team who I see as a peer, are very different from the ones I might have with my manager, which, in turn, are different to those I might have with a director or chief executive within the organisation I work. So likewise, an awareness of that power I think, is very important to lead as well as an understanding that learning comes from different sources and is rarely a top-down process. One of the great blessings of social media in my view is that it has reinforced my learning from different angles and has weakened my inherent respect for the assumption that learning has to come from ‘teachers’. That’s something I’d extrapolate to ‘leaders’. You who lead can and must learn from those who follow in order to lead well. Just because you have a higher paid salary with greater position and power doesn’t mean the expertise you have is broader than all those ‘below’ you. A dose of humility is needed because without it, none of us can continue to learn and grow. I see this on Twitter sometimes when you see who some of the so-called leaders follow and interact with. There are those who will not deign to converse with those whom they assume to be ‘below’ them. I imagine their learning curve is more shallow than those who are open to conversation, learning and interaction from all-comers.
4) Reflection and Empathy
I see reflection and empathy in the same bracket because I believe that critical reflection leads to empathy and the two can’t be separated. A leader who is in a position to be able to ‘make a difference’ has to be able to consider their own role in systems that sometimes work and sometimes (perhaps more often) don’t. They can’t delegate constantly but sometimes need to think through what they can do to make changes. It might be something little or something major – depending on the position or the context. Then, they have to be able to look back and consider if they acted in the way that best served those who are being led. They have to be able to accept and learn from mistakes and acknowledge them. This is a key part of growth and understanding. This is a key part of being able to retain the confidence of those who follow. This is what I want from a leader. When things are being done or have been done badly, I want honesty not fudging. Reflection is a part of that where we learn to understand our own motivations and influences in the choices we make. Empathy grows from that as they begin to learn from others and understand better how it is to see things from different angles.
Perhaps this is the most difficult to define but I think it’s a core difference between leaders and followers. This explains some of my lack of faith in ‘leadership programmes’ because I’m not convinced that inspiration can be ‘taught’. It is the ability to move people in a particular direction because they believe in you and want to work towards your vision. It’s people having faith in you and your decisions. Maybe I’m not able to define it well but I think it is definitely an area that can be refined but it has to be genuine and honest. You can’t read a book about how to inspire others and expect to learn from it. You have to learn it, I think, and as is very clear, I’m far from an expert, by truly believing in what you do and having a passion for it.
So there’s my very uninformed and personal plea to leaders in how to lead me. That’s what I want from you. I don’t want to be a leader, but more than anything I want to be led well and I want to feel we want the same things, you and I. We want to make things better and we want to work together for those whom we serve. I don’t want to be engaged in battling against the organisations I work in to feel that I’m serving those who use the services to my best. I will feel well-led when we move in the same direction.
I understand leadership is tough. That’s one of the reasons I don’t want to do it. I’m lucky that I feel well-led now and there’s no better feeling as a member of staff than to have that utter confidence that we move in the same direction and have the same goals. I realise that’s a very good place to be. Lead well and we will follow well and with all our hearts and you will have much more power to achieve those great outcomes with committed and focused followers behind you, supporting you all the way.
I don’t have time for a long post today, just a few brief thoughts that came to me as I considered the unsurprisingly critical report on Castlebeck by the CQC.
Of course it’s easy to be wise after the event but it leaves a bitter taste in the mouth when the CQC comes down hard on Castlebeck after it required a TV undercover programme to uncover the widespread abuse at Winterbourne View. Where is our faith in the CQC? Well, personally, I didn’t have any to begin with but this report is not a solution, it smacks of a desperation to gain any kind of public recognition of the CQC itself rather than a real attempt to improve any system of regulation.
Regulation costs. Good regulation costs. In the week that the Ofsted is planning two week, unannounced inspections of childrens’ services, I ask why services for adults have been allowed to be neglected?
Yesterday I heard Paul Burstow on the radio on my way home. Two things struck me, firstly that he didn’t seem to have any understanding of the difference between a hospital such as Winterbourne View and a care home. He seemed to be happy to blame local commissioners for the quality of the placements that they commissioned in hospitals without an understanding of what had led to this situation – namely chasing the lowest prices. He still is banging on about his so-called Excellence scheme which, if anything, will make things worse as I wrote here. The Excellence scheme is opt-in and it is for companies to pay to be a part of. That is not about excellence, that is about money-making.
The CQC should be demanding excellence from every single service it inspects. Every day. It doesn’t. It demands sufficient paperwork every couple of years, at most. That is how it inspects. Actually, the CQC doesn’t inspect any more. It does not have enough people to inspect, control and check.
We have allowed companies like Castlebeck to rake in millions of pounds of profits on the back of providing poor care to vulnerable residents and patients. We have allowed this because noone is calling the CQC and the government to account for destroying adult care services.
The CQC criticising Castlebeck – of course it will but remember this is on the back of one television programme with hidden cameras. What about the thousands of homes without hidden cameras? Where are the checks? Where is the scrutiny? Where is the excellence?
- Winterbourne View company’s failures at 11 more care homes (telegraph.co.uk)
- Castlebeck care ‘concerns’ raised (bbc.co.uk)
Sometimes, some days feel filled with sadness. I had one of those days this week. I don’t like to use the word ‘hardened’ but to put it this way, in over 10 years of frontline social work practice in some of the most deprived areas of the country and in the inner city, I’ve seen a fair bit of what society has to throw in terms of crumbs to those who are some of the most vulnerable members of it.
I look at the high rises that skirt around the cities and I see hundreds of lives being lived, families existing and stories being told. Some with hope and pride. Some with desperation and despair. All different, all a part of this community and society we live in. Poverty is real. Despair is real. The two don’t have to go hand in hand though.
I have a strong stomach and don’t bat an eyelid at all sorts of things when I walk into a house. I’ve probably seen worse.
In some ways, human misery is a part of my trade. Not always, of course, because there are the wonderfully reassuring smatterings of hope but difficult social circumstances and social deprivation run a theme through my career.
Although I often emphasis that mental ill-health is certainly no respecter of social class or financial assets, it is sometimes the level of deprivation and the difficulty and shame of poverty that I see that reminds me of the way that this political class intentionally ignores and isolates some members of the community.
Perhaps the most difficult part of my job is wrapped up in the AMHP (Approved Mental Health Practitioner) role. It is a mirror into my ethical compass and while I enjoy the aspects that were involved in training and the support and development and even community feeling I have with other AMHPs, the process of making a decision about someone’s forced detention in hospital or a forced medication regime is never one that can be taken lightly and I don’t think it is one that should ever be ‘enjoyed’. It is power, writ large. It is control.
Sometimes people thank you retrospectively for ‘making the right decision for me at the time’ but more likely that isn’t going to happen.
This week, I carried out a Mental Health Act Assessment in a hospital. That is very far from unusual. When I read the background and the circumstances, when I conducted the assessment and made the application for detention, which I did, I was overcome with a feeling of sadness for the action that I had taken and for the life that it predominantly affected.
For obvious reasons I won’t go into details – anyway, even if I did they would possibly sound fanciful and unrealistic. To people who think that I have a ‘difficult’ job, I would say I have had a walk-on part among some fine and very strong people who have had to contend with sickness, pain and family circumstances that have rolled all the dice against them in the lottery of life.
And when I sign the papers and write up the report, I don’t forget. I think, I reflect and I try to learn. What could we have done to prevent this situation from having occurred? Sometimes the answer is nothing but sometimes there might have been a different path, a different action or different guidance that might have led to a different outcome.
Sometimes, some days, I just feel overcome with sadness. Sadness at the injustices that are meted out by life, fate and circumstance. Sadness at the way that this society perpetuates and builds on those injustices of circumstance. Sadness at my role my own complacency in accepting that we have created such an unequal and unfair society.
In a community where people who live on state benefits are treated with an intention to humiliate and scorn and where the government not only condones and supports this, it tries to create further barriers between the ‘haves’ (with ‘have’ meaning working tax-payer) and the ‘have-nots’ (meaning those who depend on the state for income) it sickens me as I know that the rhetoric of ‘choice’ and ‘community capacity building’ are empty words which mean nothing without the world of privilege. By privilege I don’t mean money, necessarily, but include the privilege of having family or friends around, the privilege of being well enough to build up networks of support, the privilege of being a part of a community. There is so much more to privilege that cash assets or income.
Sometimes I want to shout against the system that I am a part of. The social care system in this country is not ‘fair’ – it reeks desperately of unfairness and the pushing of ‘choice’ in very narrow terms onto a wide range of people who in reality have no choice whatsoever further marginalises and discriminates against poverty, incapacity and isolation.
But I continue in my job. I go into work and ‘buy into’ the system. In my own defence, I fight as hard as I can from the inside and I don’t forget the names, the faces and the stories of those whose lives touch mine.
I remember, I note and I learn and sometimes, that just fills me with sadness – but when I stop feeling that sadness, I stop learning, growing and trying to create a better world. One person at a time. In spite of the system I work in and with rather than because of it.
What of the 31,000 residents who live in their properties? Well, the government has given us its assurance that they will be ok so that’s alright then.
On the day that the Open Public Services White Paper was published (which can be found here – pdf) – which couched in the comfort of positive words like ‘choice’ , we would do well to heed the warnings of the way in which social care was sold off in chunks, from public to private and reflect on whether it is better to allow care homes to ‘fail’ in order to prove that the strongest will rise to the ‘top’.
The problem is that Southern Cross WAS the strongest. It did rise. It also speculated on property and ownership transferred away from the core business base of providing care and homes for those who needed both.
But on a more pressing issue, what will happen to those who live in Southern Cross homes and work for Southern Cross homes.
Analysis by the GMB union revealed the names of 80 landlords who own 615 of the homes, many of which are subsidiaries of larger companies registered overseas. This makes it much harder to obtain financial information about the companies as rules governing accountability and transparency, especially in “tax havens” such as Jersey, Cayman Islands and British Virgin Islands are significantly more lax.
In addition, the GMB was unable to trace more than 120 landlords, which mean thousands of people are living in care homes where the identities of the owners and directors are unknown.
In the absence of full company accounts and other relevant information, such as the names of directors, it is “nigh on impossible” to assess whether they are suitable to run care homes funded in large part by public money, according to Andrew Craven, GMB statistician and researcher
At least the ‘Department of Health’ spokesman says
“Whatever the outcome, no one will find themselves homeless or without care. We will not let that happen. Today’s announcement does not change the position of residents. The Care Quality Commission will continue to monitor the services provided… We have been in constant contact over the course of discussions and remain ready to talk to all parties.”
That’s reassuring. Or not. Would that spokesman or anyone in the Department of Health want that level of uncertainty lying over their head or the heads of one of their parents? The residents of the homes will not know who their landlords are or whether they are fit to run care homes at all. Of course no-one will find themselves homeless – it will be the local authorities, the elected local authorities who will have to spend and fret themselves out of this one – nothing to do with the Department of Health’s reassurances – unless the Department of Health is going to compensate those local authorities for the time and cost they spend to ensure the welfare of residents of Southern Cross homes that may close.
As for the CQC, I think we have established that it is unfit for purpose and unable to regulate a care industry that has grown too large and too costly to be regulated efficiently. How about an idea? The Department of Health invests very heavily directly in the CQC so that they can provide at least twice-yearly, unannounced inspections together with a host of lay visitors attached to every single residential and nursing home?
No, the Department of Health is weedling out of this crisis as it will weedle out of the cost of ensuring that the residents of Southern Cross Care Homes are not made homeless.
Now, I want to link some of these issues to the Public Service White Paper that was published yesterday and particularly one or two sentences I picked out.
In the context of rolling out more extensive ‘choice’ in other areas of government, the paper says
‘We will ensure that individual service providers are licensed or registered by the relevant regulator for each sector (e.g. the Care Quality Commission) so that those choosing services can known that providers are reliable, without stifling cost”
Does that not lead to a tiny little shiver down ones spine? The CQC is being held up as a reason to trust in this extension of ‘choice’. Has noone mentioned the cost of good quality regulation, either. It’s worth reading this post at The Small Places for more consideration of the way the CQC regulates social care services. The CQC has failed to regulate and the care sector is failing to deliver on personalisation so far. The care sector has had time to learn as well. We had direct payments for many years and before that the ILF (Independent Living Fund) which allowed payments to be made directly to adults with disabilities to choose care. The system should be sophisticated enough by now to deliver good quality, equitable services but it has taken many years even to reach this point. There’s a long long way to go.
“The wider public sector has much to learn from local authority successes in commissioning, for example, in adult social care”.
See, look at us, government, we’re a success! Success. This is the end-result of success. Adult care commissioning is not a success. It has not extended choice unless of course (and I think I’ve found the key) success is based on the principle of privatisation and provision of contracts to the those who deliver at the lowest cost regardless of quality. That is the adult social care ‘success’ that the government is lauding in the Open Public Services White Paper.
We are dazzled by words such as ‘choice’ and ‘open government’ but they have no meaning outside ‘lowest cost’ and ‘discharge of responsibility’.
Think of Southern Cross. Think of Adult Social Care. It’s coming to our homes, our hospitals, our high schools and our highways.
So much for my week of positivity!
- Thousands face uncertain future as care home chain is broken up (independent.co.uk)
- Elderly care at the mercy of firms in tax havens as Silver Cross shuts (independent.co.uk)
- Public services reform to slow down, white paper suggests (guardian.co.uk)
Tags: care, Care Quality Commission, david cameron, Department of Health, GMB (trade union), government, nursing home, open public services white paper, opswp, Public services, social care, social work, Southern Cross, Southern Cross Healthcare Group, uk, uk government, White paper
Scheduling and exhaustion meant I didn’t have time to look at the Dilnot proposals in detail yesterday so this morning I have fired up my browser and am going to make a few initial comments on the baseline main recommendations and hopefully over the next few days can look at some of the details.
The Dilnot Report on Funding of Care and Support runs at 82 pages. It attempts to forge a solution for the currently antiquated and inequitable system of care funding that is currently in place. Much talk has been made of the current threshold of £23,250 of assets, at which people currently become responsible for paying for their own care services but little made of the current discounting of homes in certain circumstances and the ability to raise a charge on a property to postpone payment of costs for care services. Nevertheless, this threshold was deemed as being too low. People who own houses like to keep houses for children. People don’t like those who ‘haven’t worked as hard’ or ‘saved as much’ getting something for free.
The system is broken though, don’t get me wrong, I just think the focus of the discussion has been too much around middle class fears of actually paying for something they believe should be free. Now, I’ve got that off my chest, back to the report.
The main recommendations are
- to cap lifetime costs of care between £25,000 and £100,000 – with a suggested threshold (which is used throughout the report for ease) of £35,000
- means-tested assistance will be extended to those who have between £23,250 and £100,000 of assets.
- Those who ‘enter adulthood’ with support needs will not be means-tested and care will be provided free.
-Universal disability benefits will continue but may be some differences in names regarding Attendance Allowance. (erm.. DLA?).
- There will be a cap on so-called ‘hotel costs’ in residential care between £7,000-£10,000
-There should be a national, portable eligibility framework which is more transparent.
- A government awareness campaign about planning ahead and preparing for potential age-related disabilities. And their costs.
- There should be a new information and advice strategy to help people through the confusing forest of knowledge.
- Better carers support and information.
- More health and social care integration
Of course, these recommendation run alongside the Law Commission’s report for changes in adult social care law. Together they could create a much better and clearer system than we currently have.
The ‘lifetime cap’ allows for insurance policies to be generated and probably very profitable ones too for the insurance companies. Most people do not need high level social care provision but the fear generated by the media is enough to drive right minded people into the arms (those who can afford it and who have substantial assets) into the arms of the insurance companies. I’m not sure how comfortable I am with the lifetime cap on care costs. It means the more wealth someone has, the more they are protected. I understand the logic behind it in that noone chooses ill-health and disability but the more than government spends on those who do have substantial assets, the less there is for those who cannot afford it and the higher the criteria to access support rises.
I just have a few queries which may be answered in the details. If Mrs Smith has a house worth £300,000 and she lives alone with no other substantial assets – say, for example, she has savings of £10,000 – is her house sold to release the asset worth up to the cap of £35,000 – assuming she doesn’t have an insurance policy? If she chooses to live in a care home which is private, but then the money runs out, will the local authority still move her? Will she ‘top up’ the local authority fees, paying above the ‘cap’ to do so? What is she lacks capacity and has no family? I suspect all these answers are in the report but they will be questions I will be looking for. The system of deferred payment is mentioned and I’ll hunt around for clarification.
The cap though, seems to be there to protect middle class votes.
I do, however wholly support the increase in the level of means-testing. I think it is entirely right to continue to means test up to £100,000 and I’d even go further than that. I don’t have a problem with mixed funding, I am just not entirely comfortable with the capping.
Again, the clarity of the coverage of those who ‘enter adulthood’ with care needs is entirely right. There is a necessary distinction between working age adults with care needs and older adults with care needs but quite rightly it is wrong to have a distinction fixed at a specific age. Indeed, Dilnot proposes that those who develop long term care needs before the age of 40 should continue to have a zero cap and costs should be met fully by the state. Above the age of 40 there will be some kind of tapering of the cap up to retirement age where the full proposed £35,000 cap would be reached.
Regarding the accessibility of universal disability benefits, Dilnot clarifies that he does not propose any reform that would lead to anyone losing their disability benefits and that attendance allowance will continue. I do wonder though how this ties in with the government plans to remove 20% of DLA claimants.
There are some recommendations though to change Attendance Allowance (AA). Firstly to change the name to something more understandable and an appreciation that many who are eligible for it do not claim it. That absolutely reflects my experience. People who reach the cap when the government takes over payment will not continue to receive Attendance Allowance (or whatever it will be called) because the government is fully paying for their care needs – which makes sense to me. The Personal Expenses Allowance (PEA) is proposed to continue – this is the payment that is made to people whose costs are met by the government in residential care and is currently about £23 pw – there is a suggestion that it should increase but not a recommendation.
The cap on hotel costs is excellent news in my view because I saw this as a potential ‘get out’ clause for residential homes. I do want to know how some of the private homes will adapt to these new systems though and what the cap will mean for overall quality of care provision.
The idea of clearer, portable assessments is a good one and long overdue. Eligibility criteria interpretation can differ wildly and there needs to be more transparency. The minimum threshold would be applied at the ‘substantial’ level of care so I wonder how this portability will work for those who live in areas that meet lower levels at present. It seems that there is some kind of recommendation to do away with FACS over the longer term.
Can’t be soon enough – a new assessment framework will be developed ‘with experts’. Please please please can front-line practitioners be involved in these developments – not just people who professionally develop policies and have never needed to use assessments in their lives. This is why we end up with unusable systems. There is also a way of building self-assessments into these new models. That’s the idea anyway.
The last recommendations about building awareness and improving quality of information seem to be sound all round. Nothing to argue about there.
I am interested in the recommendations as they relate to carers. As far as I am concerned, I want more than just an assessment for carers, I want the provision of more services. Supporting carers very well both financially and with practical and flexible support is probably the one aspect which can potentially save the government more money in the longer term than anything else – but more than that, it is an issue of ethics and morality. I know that doesn’t often come into government services but it’s something I feel very strongly about.
I also recommend Arbitrary Constant for links and discussion about Dilnot.
Tags: Andrew Dilnot, british politics, care and funding, dillnot report, dilnot report, dilnot report on funding of care and support, dilnott report, Funding, funding of care, health, local authority, long-term care, Means test, nursing home, old age, social care, social work
Yesterday, Community Care published the result of a survey they had undertaken about ‘personalisation’ among social care professionals.
The headline figures while wholly unsurprising, make for interesting reading where only 41% of respondents felt that service users would benefit from the implementation of personal budgets and 83% felt that cuts would impede the progress of the personalisation agenda.
To which my first thought was ‘only 83%’?
Anyone who has read some of my previous writing/ranting about personalisation will be pretty clear where I stand.
While the idea and the concept of introducing more person-centred support planning and opening up direct payments to a wider range of people is absolutely fantastic as a concept, the implementation has been dire.
There has been a complete side-lining of service user groups that don’t fit into the ‘easy’ mode – namely those with mental health problems, older adults and those who might not have capacity to involve themselves fully in the support planning process, the same figures and quotes that the government and her agencies roll out again and again about the man who pays for a PA to go with him to a football match instead of a day centre are so completely off the radar when the smaller pool of money available for care services exist that they are almost insulting to those for whom a) the thought of having enough money allocated to pay for two tickets to a football match would equal 7 showers a week – so it’s football or cleanliness and b) that group of people (because, yes, much as the government don’t want to accept it, they do exist) that actually WANT to go to day centres.
And so we plough on.
But even though I have had many criticisms of the way that personalisation and particularly personal budgets either managed centrally by the local authority (where the end effect is exactly the same for the service users in most situations) or delivered by direct payments (where someone has to have capacity and desire to take on the direct payment and employ assistants or have someone who is willing and able to do that for them) – there is more to the personalisation agenda and process which is in danger of being lost in the process.
Personalisation as a value base and an approach to work and social work in particular with people who need or who are eligible to receive services for care ties in perfectly with aims of re-addressing the power differential between provider and ‘receiver’ and the imbedded dichotomy between ‘giver’ and ‘taker’ in society.
That model of giver/taker which is bound within the welfare state system can create an imbalance and the potential to give back some of the ‘control’ and some of the decisions to the person who receives services may, in some way, redress elements of this balance. There is no way that my training and experience has taught me better than anyone else, what YOU as a recipient need. Yes, I learnt my theories and my models and understand that building social networks is important but if you prefer to do that at a coffee morning at the local museum instead of at a day centre that’s perfect. If you want your neighbour’s granddaughter to help with your personal care rather than an anonymous and frequently changing ‘carer’ from a local agency who is paid at mimimum wage and has a day full of appointments and who isn’t paid for travel time by her agency so she needs to cut short on some of the time – perfect.
But we already had that system with Direct Payments. Where is the difference?
Ideologically, the difference was that everyone would know how much money they were ‘getting’ – whether directly or managed and they would be able to be consumers. Our society tells us that money is power. Money creates consumers and the market will right itself.
Even, theoretically, when a personal budget is managed by a third party (and I include the local authority as a potential ‘manager’) you will know how much is ‘allocated’ to you so that you can ‘spend’ it in the way you want.
This doesn’t happen in practice though because local authorities need to save money and are still tied up into procurement contracts that make agencies unequal when ‘bidding’ for the funds that have been allotted via personal budgets.
I know this is getting a bit technical and complicated but it’s important to understand. I don’t think anyone can oppose ‘personalisation’ as an approach regarding empowerment and ideology.
The implementation, however, reeks of money-saving and penny pinching. It also has pushed the responsibility for services away from the local authorities and onto individuals and their carers.
You have £100 per week, find the care yourself – then we (the LA) aren’t responsible anymore.
I’m wholly in favour of contracting out assistance and advice on self-assessments and support planning to local voluntary sector organisations. My own LA tried that. We referred lots of people to them. They withdrew because we were referring too many people to them and the local organisations didn’t have the resources (or the contract) to undertake as many support plans as were being referred – but the idea is not one I have any problem with and in fact, I rather like it.
But this wasn’t offered to people who do not have the capacity to lead in their own self-assessment and support planning. The organisations couldn’t do that because they were not experienced in non-directed advocacy work – it takes longer.
It is hard to see through the budget cuts as well towards a future where, as Burstow as said he wants direct payments to be the ‘preferred method’ of delivery of personal budgets. I don’t want to detract from the fact that this is and will be fantastic for some, perhaps most people, we move to a model where there is – again – a ‘one size fits all’ approach.
The true tragedy of the personalisation agenda is that is has and is coming to fruition during a period of cuts – the government (and the previous Labour government too) want to pull back the responsibilities of local authorities and with the criteria for accessing any support is rising rapidly it may well be that more and more personal budgets are delivered directly from peoples’ own savings or disability benefits (while they still exist).
I am fearful of the future for adult social care but I’m not necessarily unhopeful.
I think there is potential for change and development but unfortunately the ways I see of improving systems come at higher cost. There has to be some major research and debate about the delivery of personal budgets and the way that personalisation encompasses people who lack capacity and lack advocates (family and friends) and how they can best benefit from this process – perhaps access to additional funds to pay for the trust fund type system of management we were assured would happen but in practice is not feasible for a relatively small sum of money as it costs more than it might deliver.
We need to see more about how support planning can work in the voluntary sector as, speaking personally, I genuinely don’t have time to do the process of support planning any justice as a part of my day to day job. It ends up being rushed because I can’t devote a couple of visits of a couple of hours to talk through and develop a truly person centred support plan.
The process of self-assessment needs to be reconsidered because while the idea is fantastic for some people – our self-assessment forms are biased towards physical disabilities and look scarily similar to a DLA form where people are asked to explain how they are on ‘their worst day’. That doesn’t really help with confident-building when you are working with someone who has very low self-esteem and depression/anxiety. The process of self-assessment in itself can and has been traumatic – let alone the person who is not able to engage with the assessment process due to a lack of mental capacity where questions about ‘dreams, hopes and wishes for the future’ while well-intentioned, can be hurtful and hard for families to listen to when they are asked to their parent who has advanced dementia.
I fear we have allowed a great conceit to be steamrollered into simply another ‘one size fits all’ approach to developing social care. It doesn’t have to be like this but that seems to be the government perception about what ‘personalisation and personal budgets’ are.
Choice is fantastic of course, but sometimes people want quality as well. It shouldn’t ever need to be an either/or. It does feel like it at the moment with the promotion of choice above all things.
So where are we going? Personalisation isn’t going away and nor should it. Personal budgets aren’t going away and nor should they. Local authorities, however, might be going away – further and further away from social care and the responsibilities that they hold towards it.
We keep up with the advocacy and with the systems that are failing because we owe it to those who are reliant on these systems to make them work as best they can but we keep trying to pinpoint and pin down the flaws in the implementation with the hope that sometime, some day, someone will listen.
As professionals we don’t oppose personalisation. We have always been trying to use person-centred approaches. We just dislike injustice and inequity and that seems to be painted all over the current implementation and the frustration is that so few people (if any) in government seem to be aware. Am I disillusioned? Yes, definitely. We were promised new ways of working in a more person centred way.
Desperate, no, not yet though as long as there’s some fight left in the belly to keep banging on and on and on about what personalisation SHOULD be and why it isn’t working yet. Not for everyone.
- Personalisation in Mental Health and Older Adult Services (fightingmonsters.wordpress.com)
- Personal view of personal budgets (fightingmonsters.wordpress.com)
Tags: budget, burstow, care in the community, direct payments, implementation of personalisation, individual budgets, local authority, local government, paul burstow, personal budget, personal budgets, personalisation, personalisation agenda, Personalization, social care, social work, uk
I’ve been engaged in an interesting conversation on Twitter over the past couple of days about guidance being developed or potentially being developed about use of social media for social workers and more generally people who work in social care.
Our sector seems to be dragging its feet a little in this respect – certainly in comparison to some of the more sophisticated writing and communities that exist in other professional domains.
Can you imagine, for example, a social care blogging event taking place on the same scale that a legal blogging event is taking place today?
Or a weekly twitter chat about social care and social media strategies as happens with the NHS.
I wonder how long many of my colleagues and managers are going to be left ‘out of the loop’ and continue to let the world develop and grow around them.
The reasons that I am so strongly in favour of guidelines is that the bars are being moved regarding contact, discourse and discussion constantly and with many people testing out new ways of communicating and engaging, there are certain difficulties that lie ahead for the front line practitioner.
One is the anonymity vs named issue which I covered a couple of weeks ago. A part of me (the part where pride is based, I guess) would love to write under my own name but I worry about the impact that would have both on the service users I work with on a day to day basis and I am genuinely unsure if I am breaking any kind of contractual rules with my writing and can’t afford to risk my job.
Another is sheer openness of the debate and discussion. Just as I told one of our foster children not to put anything on Facebook that she would not want everyone in her school and family to see, the same applies for me but more so. With Twitter/Blogs/Facebook, privacy settings can be tightened but security is always an issue and even behind an anonymous persona, being a prig or prejudicial or just ‘having a moan about a visit’ might come across very differently to a service user who has just had an unpleasant and forced encounter with a social worker – does a search – and sees social workers complaining about seeing the ‘druggie’ or about people with ‘too many children’. Everyone likes a moan but having a moan about having a busy day is different from having a moan about some of the more particular things you might see on a day to day basis.
Then there is the illusionary barrier that is provided by a screen-name. Anyone can be a ‘social worker’ if they say they are. Anyone can be a ‘judge’ or a ‘professor of social work’ or a ‘psychologist’ if they say they are. While I have a healthy degree of scepticism generally, I tend to take people at face value but I add a hefty pinch of salt as the ‘internet’ and by extension ‘social media’ can be a great way to invent less than useful ‘personalities’ if you are so minded to do.
I remember when I did some research back in the day into the use of social networks for self-help groups – and this is over 10 years ago when I was initially doing my MA – and came across lots of research examples of online confabulation. As I say, a healthy pinch of salt.
I hope that the baton is picked up by the social work profession because more than media guides and focus groups and the odd press release here and there, we, at the grass roots of the profession have an real opportunity to be heard by those who are able to make changes and help them get an understanding of what is happening beyond those focus groups but we can also change the perception of the profession and the sector and while I certainly don’t see ‘social media’ as a cure-all, I do see it as yet another tool to be added to our arsenal regarding communication.
Where previously a bad experience with a particular social worker might have shaped someones’ perception of the profession forever, now we have the chance to join in the discussion on blogs, give advice and thoughts in different forums, add support and information on twitter and show that social workers can do a lot more than just become mouthpieces of their employers.
But our employers and our College (whatever form that takes) need to take up the baton and run with it so that guidance can allow for safer practice and inform and education others in the profession about the opportunities that are now open to them.