The Last of the (New) ASWs…

I finished my portfolio for my ASW course yesterday. It’s the last time the ASW course will run because the next lot in the autumn will be doing the AMHP training. And it got me thinking a little bit…

Naturally we spoke a little about the change while we were training. General consensus – that social workers are a somewhat precious lot who have little faith in nurses to remain as independent as they do in Mental Health Act Assessments and in the face of dissenting doctors! (because, realistically, nurses are likely to be the only other professionals who do train as Approved Mental Health Professionals… )

I think it depends very much on the individuals involved, of course. Some doctors can bully anyone at all, be they nurse, social worker or magistrate – just as some nurses or social workers can. Power is a massive issue though. Doctors, I think, whether they like it or not, and want it or not, have a more natural recourse to power than most professionals, due mostly to the close contact that most of us have with them (I don’t think anyone hasn’t seen a doctor!).

Generally, I’ve always thought that it will be a difficult jump from medically trained professional to AMHP, because the emphasis is considerably placed on exploring and examining the social causes and catalysts of mental ill-health. I am also more concerned about the independence, generally, of medical professionals in carrying out the role and have always felt (perhaps it’s some of that professional protectionism… I never said I had to be rational!), that the training ethos of social work adds something very different to Community Mental Health teams that isn’t present in any other discipline.

Of course, on a real level, all the work in CMHTs, certainly ones I have come across, is more or less generic and this is just further recognition of that.

Social Workers, Occupational Therapists and CPNs sit side by side and the workload doesn’t really change although I’d like to think that each professional is able to add to the whole, rather than conglomerate in a mass of ‘mental health professional’.

Truth is, there are too few ASWS and it was a change that needed to happen. Likelihood is, the end result will be positive as there will be an enhancement in the professional status of those who want to enter this area of practice and the wider the pool the more likely the cream may be to rise to the top. Although a part of me is a little suspicious of anyone who actually wants to carry out Mental Health Act Assessments…

n.b. The title of the post is making the assumption that I’ll actually pass the course and get warranted.. !

Money matters

New technology is a wonderful thing. Most of the time. Chip and pin? A fantastic way to improve security for bank cards and accounts. Giros always went missing anyway, much better the ‘direct payment’ with benefits going straight into bank accounts and providing basic bank accounts to ensure ease of access!

These ideas might make sense initially, but having seen the effect of these changing on the day to day lives of older people, particularly those with memory difficulties or mobility difficulties, it has created nothing but headaches and heartaches.

It used to be quite easy with the Giros, a carer could go and pick up the cheque from the post office weekly, maybe doing some shopping on the way back and all is well.

Enter ‘Direct Payment‘ (not Direct PaymentS, mind, that’s another thing entirely!), and you have agencies whose workers are not allowed to be given the PIN numbers for older service users and therefore noone to collect the money or do the shopping. Of course the ease of access for carers has to be balanced against the potential for financial abuse.

Help the aged have done some research on Financial abuse among older people. Personally, I’m surprised that it is the second most common form of abuse in their eyes. From personal experience, it is by far the most common!

It can seem to be an almost impossible balance at times and I’ve certainly felt that I’ve been going round in circles more than once. Banks, of course, quite rightly, insist on speaking to the bank account holder to make any kinds of changes to the account, but when that person is not able to speak on the phone and has poor mobility so is unable to get out and about, it can leave the benefit money trapped in a bank account that can’t be used.

I remember one woman I worked with who was in a similar position. She had a diagnosis of Alzheimer’s and her Pension, Pension Credit and Attendance Allowance were going directly into her bank account.

Her bank card – well, let’s just say, when the card wasn’t lost, the PIN number was. It is possible to speak to the Benefits Agency directly to have payments revert to Giros but it can take a bit of time. We were also reluctant in this case as there was a husband who spent the Giros down the bookies.

Actually, after lots of telephone calls, we went to a local bank (she had poor mobility but between myself and the carer, we had her pretty much safe.. and it wasn’t very far!). When we got to the bank, well, I don’t think the staff knew quite what to do – but they were incredibly helpful and understanding and because the carer had come with us and she had a regular carer – the bank made an arrangement that that particular carer would be able to withdraw a limited amount of money each week to pay expenses.

It was a good outcome. Very positive and all credit to the bank and the banking staff. Mrs X had a fine time out and about as well! But you see, on the database, well, I couldn’t even log that afternoon as a ‘piece of work’.

And the rapid turnover of carers means that it’s not always to have a regular worker with one person. I wonder how much thought was given to the older population when the changes to the benefits system was made.

PIN numbers will be easy to understand for people who have grown up with them – but the amount of homes I’ve visited that have numbers written on calendars or in wallets, is just, well, I’d say it’s the case more often than not.

I’m not sure what the answer is, the Giro system wasn’t perfect, but at least it allowed some kind of access. In any case, sometimes things that can seem like a wonderful idea until you consider the implications across the board.

Who is watching?

I see that the Alzheimer’s Society having published a book called ‘Enabling’ which provides models for observation in residential care facilities in order to improve care, as there was an article about it in Care and Health.

I think it raises an important point about the need for something to be done in care homes for older people where the abuse that has gone on, sometimes wilfully but often through lack of care in staff and either laziness (although that does sound harsh, I have spent a lot of time in and around residential care!) or just awful modelling by bad management.

Good practice is something that most certainly does feed down the chain though and a good and strong management structure, I’ve found, as is the case in most working environments, can produce a positive working environment.

Thinking of the area I work in, I can compare two Dementia Nursing/Residential Homes. They are both run by the same company (which is another story entirely – don’t get me started on that one!) and the company in question, like a lot (but not all) private providers, have a very tight bottom line and emphasis on profit above.. well, above everything really.

But of these two homes, one has, what I consider to be an excellent manager. She runs the home efficiently, she listens to her staff but also talks to them when she spots anything that might resemble lack of care. And the staff that I have spoken to, seem to respect her a great deal (as do I because, in my eyes being a GOOD manager of a residential home, especially when the company behind it is so tight, is one of the hardest jobs around!). Apart from that she is extremely personable and approachable as an individual.

Move to the other side of the local authority, and another home, run by the same company, has a manager that is pleasantly incompetent, staff that basically run each of the floors in their own merry way (which often involves lots of sitting around with cups of tea) and an almost neglectful culture of care or lack of care. They are eager to raise issues and difficulties without any kind of creative planning but more importantly, without any care! (and just as an aside, have been subject to so many complaints – including a few by me – that it makes me wonder what kind of checks and balances do and should exist).

A bit of observational practice would, I think be enlightening in that case.

Care or Control?

I spotted this story on the BBC today which reported that anti-psychotic drugs are being used, perhaps too much, perhaps inappropriately, in residential and nursing care homes for residents with dementia.

This is an area that is fairly close to my heart as I have worked with many residential and nursing homes, many service users who have dementia and one or two psychiatrics who have appeared to be a little ‘prescription’ happy.

Having moved to a multi-disciplinary team, from a pure social services setting, I couldn’t help but notice the hierarchical structures within the NHS where the consultant is king.

I wonder if there would (and should) be more of a role for social workers in these teams to question the use of medication and both its relevance and need. I think it is very easy to slip into the mentality of the team within which one is based, but when the emphasis on social care is lost to medicine then all the teams become truly generic to the extent that they make little sense.

I’ll certainly take an active interest in the National Dementia Strategy which is due to be published later this year. Particularly the mentioned twelve week reviews. That would, indeed, be a wonderful safeguard of the quality of services which are provided – but it just doesn’t seem possible within a system that struggles to provide annual reviews.

Angels and Demons

I went to a friend’s birthday party and as a part of the general conversation, was discussing the differences of perceptions in the eyes of the general public at least, between nurses and social workers. You can probably guess which are the angels and which are the demons of the piece!

My take on it is basically that everyone has some kind of interaction or potential interaction with the health services and nurses. We see a lot of what they do and they have a clearly defined role. You ask generally what a social worker does and vague recollections of children being snatched from their well-meaning parents’ care in the middle of the night spring to mind.

My little theory is that people don’t want to think too much about the reality of the job that most social workers do – it is something that society wants to sweep under the carpet and it’s very easy for the ‘aspiring middle classes’ to detach themselves from any direct contact with social care and social services so it is easy to demonise the work they do.

I am sure there are as many ‘bad eggs’ in the profession of social work as there are in the nursing profession and would never choose to back them up without reason but I think that people judge social workers more harshly because they have no idea what we do and they can point at other people as ‘users of social services’ and take that step away from themselves.

Who pays for care?

Paying for long term care might not be the sexiest issue to be raised in political circles but, probably because it’s something that I deal with on a daily basis at work, it is nonetheless a key one.

I think it’s easy for politicians to say that noone should be forced to sell their property to pay for residential and/or nursing care but on the other hand, it is extremely expensive and the state is unable to pay the costs for residential care to all that need it.

So somehow the bills need to be paid and rationalisation takes place. Already, residential places are thin on the ground and good residential places even thinner.

If the view is that the State should pay, then it is more than a little short-sighted as the state does not have even a fraction of the money that would be needed to fund good quality care.

So for politicians saying that people should not be forced to sell houses to pay for care, I would ask that they explain how the money will be found.

Personally, I think one of the issues is in the quality of care that is provided. I think that more residential and nursing facilities should be run by local authorities directly so that there would be more control of the pursestrings but more importantly of the quality of care that is provided.

I suppose I feel that if people have the money, they should spend it rather than expecting things as a right from the State. The State runs out of money itself from time to time and decisions have to be made about resources and I suppose I’d much rather those resources go to those unable to pay rather than those unwilling to or those who want to leave a property to their children..

Tragedy and Responsibility

This tragic story about a man with learning disabilities and his mother who were both found dead left me with a couple of thoughts.

Obviously it is an enormous tragedy and apart from speculation there are few facts available.

My thought though was on the comment that he had stopped going to his day centre about a year ago and this had not been picked up by Social Workers or at least not followed up.

Firstly, it must be awful to carry any kind of feeling of responsibility in those circumstances and there will always be things that one can have wished to have done retrospectively.

To me, it highlights the importance of regular reviews of carers, even if, and especially if no paid packages of care are involved. Often the focus from the councils is on reviewing to save money or to ensure that money is appropriately spent – but it is the carers without services who do, perhaps, need the most support.

Judging from media reports, this man needed considerable support and although it is an individual case and not everyone can know the circumstances – I think it paints a tragic but exceptionally important picture of the role and support that must be offered to carers.

I remember from some of my own work, some of more satisfying moments have been being able to provide carers support. Sometimes it is just a matter of going in and talking to someone who is taking a lot on themselves because they don’t want to discharge any kind of responsibility for caring for their loved one. But sometimes, it is about preventing burn-out and checking that there is no abuse of vulnerable adults.

All I can say, and say with sadness, is that I’m glad I’m not in the Redditch Learning Disabilities Team at the moment.

The curse is better than the cure

One of the things that was emphasised strongly on the course, is that someone should never be admitted to hospital under compulsion because they ‘refused to take medication’. That just isn’t a reason to apply for an admission.

It seemed to be almost natural to comment on that in the assessment papers but, as our tutor pointed out, not wanting to take medication which may have horrific side-effects, does not, in itself prove anything if you have no idea what the background to that refusal is and why the medication might be refused.

Our tutor felt it was a part of the move towards the medicalisation of the social work profession (if that’s a real word!) that we were accepting what the psychiatrists were feeding us – namely by refusing medication that would make you ‘better’ you must be crazy.

That thought, combined with one of the more powerful and useful lectures, by a man with a diagnosis of schizophrenia who spoke in the most powerful terms possible, of the pain that the side effects of medication had given him and his fear of being medicated, made me consider how I have approached medication in the past and the emphasis on it.

There is no doubt that medication is important. It is more than important – it is vital. But there’s usually more than one way to skin a cat, so to speak. It is only one of a range of therapies that can be useful and valuable and productive.

I hope that it is not a lesson I forget in a hurry as sometimes, we can be caught up in doing what we think is the right thing to do and stop listening to what the difficulties actually are because we are superimposing what we imagine them to be.


It’s interesting that the meaning of Asylum as a place of safety is often lost amid political footballing of the term, backwards and forwards.

I was trying to read through some work-related articles to get some more information for my current work-in-progress which is an ‘as dull as it sounds’ project to link local services in the area in which I work to the National Service Framework for Mental Health (don’t worrry too much about the link – I’m practising and the content is enormously dull!).

Anyway, through my web travels, I alighted on this article on the Daily Mail website which to sum up, rants and raves about how awful it is that failed asylum-seekers should be able to claim free NHS care.

A couple of thoughts jumped immediately to my mind

  1. How can healthcare not be considered a basic human right?
  2. How can people think that it is justified to deny people, regardless of when, where or how they arrived in the UK, basic healthcare?
  3. What would the architects of the National Health Service make of the prosperous middle classes who object to their tax being spent on those less fortunate of any nationality.

One of the things that surprised me more than anything was that everyone seemed to agree with the article that it clearly misuse of ‘our’ money to fund healthcare for all.

Having met and worked with some failed asylum seekers they probably fall into the category of the least fortunate of all. They have invariably gone through a significant amount of pain and loss to arrive in a foreign country – and then have their appeals to stay turned down. Not everyone is on-the-make and a little bit of charity and charitable thought doesn’t ever hurt.

Thatcher did very well to extinguish the idea of community.

And on and on..

Moving into the final stretch now and I’m wavering between feeling fairly confident and feeling completely incapable of finishing off the work. I think I’ve got things in hand more or less – but then I worry about the pieces that I haven’t done yet and how long they’ll take. I’m feeling for the first time though, that I’ll have something to hand in, even if it isn’t great!