Count Me In

Yesterday the results of the 2008 Count Me In Survey were published. Count Me In is a survey conducted of in-patients of Psychiatric Hospitals nationally in the UK.

The purpose of the surveys which have been carried out annually since 2005, is to highlight discrepancies in services provided and in particular address and focus minds on the disparity of services between that which is delivered for white patients and minority ethnic patients.

Firstly, black patients are far more likely to enter the hospital through the criminal justice system as opposed to the primary care route. This was a factor we have discussed at depth both in the training I received and subsequently at work.

The report itself says

Rates of referral from GPs and community mental health teams were lower than average among some Black and White/Black groups, and rates of referral from the criminal justice system were higher

The need really is about a change in attitudes from practitioners but also if the needs of Black and Minority Ethnic patients are to be met at an equal level the needs have also to be addressed at a primary care and CMHT level.  Being able to talk to and seek help from the GP at the earlier stage is really a crucial part of the treatment cycle. As usual, the earlier caught, the easier solved. Perhaps that’s a gross oversimplification but a part of the difficulties lie in the reluctance or lack of knowledge to treat at earlier stages.

Do CMHTs receive the referrals and find that they are reluctant to refer onto hospital letting situations deteriorate because of the fear of being seen to be lacking in cultural awareness or is it a blind racism where they just don’t offer the same services across the board? Of course, there are many different factors but my instincts would perhaps lend me to consider the first of those two ideas.

This report also confirms that

Rates of seclusion were higher than average among the Black Caribbean, Black African and Other Black groups, and among the Other White group

This figure has stayed pretty much consistent throughout the last four years that these surveys have taken place. I can’t really think of any reasons that this might be the case, unless I fall back to the ‘picking up illnesses later leads to more serious manifestations’ but that wouldn’t necessarily follow through to active treatment.

The other ‘feature’ highlighted in the report is the proportion of mixed sex ward accommodation

68% (the same as in 2007) of patients were not in a single sex ward

There has been no improvement on this. I honestly think that the provision of single sex facilities would work towards an improvement of care overall. The Healthcare Commission‘s definition of ‘single sex’ is broad enough to allow for different areas of a ward to be designated as single sex if there is enough ‘separation of facilities’ to be available – actually, that’s how it is on one of the wards I often frequent – but the proportion of people  who lack this facility is still quite staggeringly high. I imagine there isn’t much change because infrastructures might need to change to some extent – beds as so precious and rare that hospitals can’t afford to have them free to wait for a person of the right gender to fit in. At least it is highlighted as a need though with some hope that it may be actioned.

In fact, the provision of more single-sex accommodation is urged as one of the recommendations at the conclusion of the study.

I have to admit here that I am rather fond of statistics. Hard information. Data. Facts. I know statistics can be twisted but looking at the raw responses to these kinds of surveys allows a more focused determination to produce results.

It’s an interesting document and definitely leaves us with more than a little food for thought.

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I arrived home last night. My mind is still a bit hazy but I have a day at work to look forward to and no doubt wake my brain up with a start.

Just a few thoughts then to kick off the day before returning to something approaching ‘normal service’ tomorrow.

– I’ll stop complaining about the weather here for a little while. It was a Mediterranean paradise compared to Denmark

– Snow is very pretty though, but prettier when on the inside looking out.

– I can’t realistically do as much in a day as I think I can but should just accept when I feel tired that I am tired!

-Hotels always beat Hostels.

– I was struck by this article in a Danish English Language newspaper I picked up at the airport, the Copenhagen Post.

In Praise of.. High Taxes

Thanks to the 22-year old Peter Eastgate, we all became 26.5million kroner richer last week. Thanks to his good card playing skills, the young card shark from Odense won himself a 53 million kroner jackpot in the poker world championship in Las Vegas. But thanks to the world’s highest income tax rates he has to turn half of that to the state. It’s easy to empathise with Eastgate if he feels that the house has taken an unreasonably large share of his winnings, but, in its own grotesquely exaggerated fashion, this is a lesson in why Denmark’s taxation system is so great : when someone else hits the jackpot, we all do.

I can’t imagine a leader like that in a mainstream newspaper in the UK. A bit of a lesson in the cultural differences.

Denmark is a rich country, there is no doubt of that. It has been termed the happiest nation with the best standards of living. Maybe in some circumstances, the society can provide better than the individual.

And just a few photos..

IMG_1066 the pony has felt antlers!







WHAT is this life if, full of care,
We have no time to stand and stare?—


No time to stand beneath the boughs,
And stare as long as sheep and cows:


No time to see, when woods we pass,
Where squirrels hide their nuts in grass:


No time to see, in broad daylight,
Streams full of stars, like skies at night:


No time to turn at Beauty’s glance,
And watch her feet, how they can dance:


No time to wait till her mouth can
Enrich that smile her eyes began?

A poor life this if, full of care,
We have no time to stand and stare.


W. H. Davis

Back in the middle of next week.

The Joy of Targets

We operate to a system of targets. That should be no great surprise. It is how ‘value’ is determined and efficiency is maintained. Social Work is, for the most part in the UK, funded from the public purse and it’s quite right that we should be subject to a checking and controlling system than ensures we give the taxpayers value for money.

But (you could see the ‘but’ coming, I suspect) the types of data that we are expected to collect can provide a false sense of security in the systems. Some of this has clicked with the press over the weekend. Targets were met in Haringey. That does not mean a quality of service is maintained.

image tj scenes at flickr

I’m not against all targets, by the way. One which I think has improved the service is the one which is based on time from referral to contact. It means that noone can sit on a ‘waiting list’ not knowing what is happening to them. Even if it is just someone phoning to acknowledge receipt and give a contact telephone number until an assessment has been completed, at least that is better than hearing nothing.

Some though, are less than logical. There is a target relating to how many cases we close. By the way, I was taught never to refer to cases as case  but as people. So while I’m writing that in my head, I’m thinking ‘people’ but it just doesn’t seem to flow as well!

Back to the case-closing (I couldn’t really write people-closing..). To me, it is one of the more difficult targets to get my head around. I’ll close when I need to – not based on targets or pressure. It’s probably one of the more damaging targets, I think.

Then we have targets set by the NHS Trust and targets set by the Local Authority. The Trust, for example, sets guidance that we should each care coordinate 25 people and that we should register at least five ‘contacts’ per week. The five contacts is usually very easily achieved. Sometimes I might do that in a day.

Their views of contacts aren’t necessarily my view of contacts though. Going to visit someone in their home, ok, that’s an easy one, of course that’s a contact.

Going to visit someone when they are at home and they aren’t in/don’t answer the door. That’s also a contact (actually that doesn’t happen to me too much).

Visiting a carer or any kind of carer support. That’s not a contact.

A telephone call that is over 10 minutes and has some kind of therapeutic value (self-judged) is a contact.

The team I recently left was the worse in the Trust for the contacts. Or the worst at actually entering them on the database……

I think the older adults teams suffer slightly by having the same targets as the other CMHTs though. Our care coordination requires a lot more care management (putting together and monitoring care packages as older people tend to be more likely to need physical help) and our service users never come to our office to see us.

We are out and about a lot  more. I think, although this is gut instinct, that there is a lot more carer support work that possibly goes on in our teams. I know there are some weeks that I have done nothing else.

Then we have the Local Authority targets. I used to be really hot on these when I worked in a local authority office. Now.. possibly not so much. It is to make sure that reviews are regular and timely – but they also include things like monitoring work status without providing any way to put ‘retired’ on the forms they must have spent hours devising.

We have targets for carers support packages (actually providing services), direct payments and carers assessments. Apart from Direct Payments where the only situation where I was going to do this was in progress and was never seen through to completion due to other factors that changed the situation while I was working with it, I’ve been pretty good at the carers assessments and the carers services.

Not bad, actually, those targets. They remind us of the job we need to be doing.

But then there is the target that really rankles me. We have a target amount of Safeguarding Adult Investigations to complete. OK, it isn’t a high target but shouldn’t some things just be. . er.. done on the basis on which they are needed. Luckily, no manager I have ever worked with has ever done anything but be baffled by this as a target. It happens or it doesn’t.

The need to create a tick-box culture does more than anything else to remove the professionalism required.

Targets aren’t going anywhere. Some can encourage good working practice, even, but when they are imposed on a draconian basis, there is a danger that they will attract shoddy and half-hearted work on the basis of ‘completing a target’ or ticking a box. That is the real danger. So by all means, set targets – but make them realistic and relevant to individual services. What works for one agency or service may not work for another.

Paper Trails and Mountains

I spend a lot of time with my computer at work. Inputting and logging. Writing and refining. Reports, contacts, telephone conversations, attempted visits, visits, phone calls from concerned friends and neighbours. It is all logged.

Or rather it is supposed to be. I’m definitely more lax than I used to be with some parts of my job. It’s nothing I’m proud of. Currently, I’ve been locked out of one of the databases that I use because I forgot my password and the people that need to reset it haven’t got back to me yet. Yes, that’s a really childish shifting of blame for something that it completely my fault! I suppose I could Hassle More!

image anomalous4 at Flickr

Recording is vitally important. But sometimes I despair of some of the tedious and repetitive nature of the work. I think it is more of an issue in statutory work. Every piece of work seems to demand replication.

Take, for example, a CPA (Care Programme Approach) review of an older person who has a care package in place from the borough, as most of the people I work with do. We carry out these CPA reviews 6 monthly. It is an indication of both where we are at, and where we are going with a particular person. We involve all those who have a defined interest and discuss plans for the next six months as well as what has been happening. The CPA forms we complete are fairly straightforward. I was going to mention how much less complicated they are than the Local Authority Review Forms that we have to complete when someone receives a service from the Local Authority –  but oh, we have to complete those too anyway – as a result of the same meeting and with the same information.

Two for the price of one.

We then, of course, enter the data on both the NHS system and the Local Authority System. The documents are attached to the databases. The local authority have also introduced a lovely new form that was introduced on 1st Oct but that I have managed to avoid – until yesterday.

We have to complete a form related to the employment status of the person that we have seen. Hmm.. fair enough, it’s just a tick box and it’s fairly quick. So let me see, full-time, part-time, employed, unemployed, length of time employed, previous employment if unemployed, doesn’t wish to answer. OK, I don’t object too much because it’s straightforward and won’t take me a moment to complete. Oh, nothing for retired. Hmm. That’ll kind of make things a bit trickier in a team that works almost exclusively with people who are over 65.

I give up and deciding that ‘unemployed’ probably isn’t a fair statement for someone who is  in their late 80s, I actually settle on the ‘doesn’t wish to answer’ and attach a fairly hopeless rant into the wind about the lack of useful options on their list of about 10 different types of employment or lack of employment.

I know it won’t do anything but it made me feel better momentarily.

So after I have completed my two different reviews for the same person, relating to the same meeting, I ponder and wonder if the time spent doing that is really valuable to my employers.

I send the reviews to the user and the carer. I wonder what they make of it. Sometimes I don’t need to wonder because people tell me directly. In fact it is often a source of merriment. It makes me wonder though.

Currently, as I write this I am at home. On my desk at work is a report I have written. Quite a complex one – it took me a good part of a day to pick through all the pieces and get it written up. I need to write another one today on the same meeting. It will, of course, necessitate a fair amount of cutting and pasting of the same information onto a new document to send to the same person. It doesn’t make much sense to me – which is one of the reasons it hasn’t been my top priority.

It does make my heart sink a teeny bit when I think of it though.

Press views

A lot of mileage over the past couple of days here in the press following the attention which has put the profession into the spotlight following the ‘Baby P’ case which has villified both individual social workers and the profession as a whole.

Without wanting or being able to judge individuals, it is quite interesting to see the press reaction to the failings in a particular case and in a peculiar system. Perhaps it is an unfortunately presented opportunity to put the profession into the public consciousness and to examine what it is that makes a social worker and what it takes to become one. Possibly a theme I’ll return to at some point.

The Guardian offers a statement from the chairman of BASW in a column, along with a personal piece from a practising, anonymised social worker.

Ian Johnston, chief executive of the British Association of Social Workers, said his members were tired of being made a political football, damned for intervening too much or too little depending on the circumstances of the latest case to hit the headlines.

As well as a comment piece explaining the place of social work in child protection cases (the comments to that piece make quite salutary reading).

The Independent also runs comment piece on the support that is needed for social work and some of the shortcomings in the system.

Social work has always been a Cinderella service, underpaid, understaffed and under-resourced. Social work does not enjoy the reputation and intellectual standing of medicine nor the national pay scales and career path of teachers. A social worker with 10 years’ experience will be lucky to earn over £30,000. The result is that the most difficult and damaged children end up being looked after by the least able and worst paid staff.

I wasn’t sure whether to leave that last line in. It grates a little to be classified as ‘least able’ but I then considered that all opinions are valid and I shouldn’t be too defensive in the face of errors having been made.

The Times also presents an interesting piece reflecting on some of the initial errors of judgement that might have focused the minds of the social workers involved in this particular incident and concludes that

But no amount of child protection legislation can ever substitute for properly trained professionals knowing how to think straight amid chaos, with strong leadership from their managers.

And Lord Laming speaks, also in the Times, at the conclusion of the Baby P trial.

On a far less lofty level, yesterday, I was chatting to some of the other social workers in my team. We don’t all work in the same office – the joys of multidisciplinary working! We had congregated in one of the offices though and one of the consultants came to find one of us. She chuckled as she referred to the ‘gaggle of social workers’ (there were three of us!) and asked us if we were feeling defensive that morning.

Well, not until you mention it actually.