A future for adult social work?

Community Care carried out an investigation a couple of weeks ago which found that vacancy rates in adult and children and families’ teams were roughly equal therefore the news that the Migration Advisory Council have dropped specifically adult social work jobs from their list of ‘shortage professions’ while children and families jobs have remained may seem curious.

Further investigation though makes the move seem a little more nefarious.  The Guardian reports that

The decision to remove social workers involved in adult services from the official shortage list follows the introduction of new initiatives to increase the number of students on social work courses and to improve the retention of more experienced workers.

The decision to ban recruitment of international qualified social workers, however, will not apply to those involved in child and family services, where it is considered that a national shortage remains. The MAC’s report says recruitment difficulties in this area have been exacerbated by the negative media image of social workers responsible for children.

Understandable but it does beg a lot of questions. Are all the proposed new graduates expected to go into adult social work jobs? Or are there just going to be less qualified jobs to go round..

Hilton Dawson the new Chief Executive of BASW (British Association of Social Workers) writes in Community Care that

BASW regularly receives complaints from members in adult services who speak of major reductions in social work jobs and, significantly, of a devaluing and lack of understanding of the social work role. Social workers are beginning to feel excluded from personalisation. The unique and vital contribution that social workers can bring to this crucial agenda is being dismissed and ignored.

The Personalisation Agenda remains largely mysterious. There are a few pilots usually with capable adults who benefit massively from being able to design and determine their own packages of care and where the money should be spent but little of the literature (that I have come across – and I have looked) seems to approach those user groups that were and are poorly served by Direct Payments – namely older adults, adults who lack capacity and those with mental illnesses who have not benefited to the same extent as other groups. It makes the right noises though – user choice is, of course, an incredibly positive goal – more holistic, devolved power and services.

Although the aim of the NHS and Community Care Act was to create a role of ‘care managers’ who could help to pick and choose services from different providers and put together user-centred care packages in a holistic manner – and look where that ended? With councils bidding each other down to provide ever cheaper services from private companies who pay a minimum wage salary to inexperienced care staff to rush in and rush out of many homes and houses on tightly implemented limiting packages where there is no scope for any ‘leisure’ activities apart from local day centres – is that was what envisaged when it was laid before Parliament? I don’t want to be over-cynical but it’s hard not to be.

So where does that leave adult social work?

There is likely to be a continuing need in adult protection but the sizes of teams will not be equivalent. In mental health teams which move more progressively towards generic roles, Approved Social Workers have transmuted into Approved Mental Health Professionals – and although the place of a voice for the social model of mental health care remains more than necessary, there is a move towards job adverts more generically calling for ‘mental health professionals’ rather than Social Workers, or CPNs or Occupational Therapists.

There is no doubt in my mind that a signposting role has significant importance for older adults and some people, even those who might not fit into the criteria for a mental health team, do need more outreach work  but is that a place for statutory services?

Perhaps the future of adult social work is actually in the voluntary sector?

It isn’t surprising that protecting children is seen as more ‘urgent’ but really the levels of abuse of older adults is often overlooked – and although it shouldn’t be a case of ‘compare and contrast’ it is difficult to ignore the push to marginalise further vulnerable adults when honestly, abuse of a person is abuse of a person – cruelty is not dependent on age.

As care services become more tailored to the ‘30 min’ rush-in rush-out visits that rarely last 30 minutes there is a greater scope and need for a more cohesive protective and preventative service in a sector that has almost no lee-way to work on any preventative measures apart from for a very small group of people who might fit into specific criteria in a specific service.

All the focus and interest remains very much in the domain of those who work with children and understandably so – it is more emotive and of more immediate concern to the general public.

I wonder why it is so few people are actually concerned about the services or lack of them, provided for older adults. Personally, I think it’s because we don’t want to think about getting old – young people, children – they are ‘other people’ – older adults, they are our parents, and us – eventually. Sometimes we just don’t want to be reminded but one day we are going to have to be.

There’s no place like home

I wrote a couple of weeks ago about a tentative hospital discharge that had been adding a few grey hairs to my head. I have, of course, followed this up with a number of visits to said man who I’ll call Mr A, but managed to squeeze another visit yesterday which confirmed what I had suspected all along – that basically with or without capacity (and through many assessments there wasn’t any doubt that he did not have the capacity to make a decision regarding  his placement) , at home is most definitely where Mr A wants to be.

He has fairly advanced dementia and although there are reams of risks and concerns about him being at home – the pleasure he showed on his face when asked about being at home and the expressiveness he displayed when we talked about hospital confirmed to be that any doubts I’d had at the time about discharging home (and believe me, there had been many – mostly egged on by hospital staff and some by my more senior management) might have been justified – but the right decision was made.

image genvessel at flickr

Possibly the thickest risk assessment that I’ve written in a long time accompanied him home but the importance of home is never lost and lack of capacity does not mean lack of choice. It’s just that sometimes reading through the obvious risks can be a little scarier – as a professional.

When you read about ‘bad’ choices made by professionals (ok, who am I kidding – by social workers) it does promote an almost risk averse culture but without any elements of risk then an element of humanity is lost. Of course, had Mr A not expressed and consistently expressed for years, his attachment to his home and his cat a different decision may have been made.  I still get that pitter-patter of concern when I knock on the door and an accompanied gulp when I arrive in the office after a weekend, or in the morning to a telephone flashing with messages.

I expect that before the end of the year, Mr A will need to move though. The situation currently is sustainable but I’m not sure for how long it will be. The concerns that exist still remain but I’m hoping we might be able to look at an ‘extra-care’ sheltered option where he can have access to 24 hour support but within his own flat and still have his own space – rather than a residential home environment.

I’m just not sure if they accept cats.

Still, I don’t want to get ahead of myself although sometimes it’s hard not to think in both long and short terms simultaneously..

Tips for Good Mental Health

The Mental Health Social Worker pointed me to a campaign being run in the US by Mental Health America to ‘equip people with tools to deal with stressful times’.

The campaign is called ‘Live your Life Well’ and has a nicely designed webpage with some surveys, tips and ‘success stories’.


I took the ‘stress screener’ myself and came out it told me ‘I could be doing better’. I guess no surprises there because I do have a fair bit going on at the moment!

They explain that

The Live Your Life WellSM program details the 10 tools and many of their benefits, including:

  • Connect with Others. Research suggests that people who feel connected are happier and healthier – and may even live longer.
  • Stay Positive. People who regularly focus on the positive in their lives are less upset by painful memories.
  • Get Physically Active. Exercise relieves tense muscles, improves mood and sleep, and increases energy and strength.
  • Help Others. Research suggests that those who consistently help other people experience less depression, greater calm and fewer pains.
  • Get Enough Rest. People who don’t get enough sleep face a number of possible health risks, including weight gain, decreased memory, impaired driving and heart problems.
  • Create Joy and Satisfaction. Positive emotions can boost a person’s ability to bounce back from stress.
  • Eat Well. Eating healthy food and regular meals can increase energy, lower the risk of developing certain diseases and influence mood.
  • Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.
  • Deal Better with Hard Times. People who get support, problem-solve or focus on the positives in their lives are likely to handle tough times better.
  • Get Professional Help if You Need It. If the problems in life are stopping a person from functioning well or feeling good, professional help can make a big difference.
  • The site goes through each of these points and explains some pretty substantial and extensive tips so it’s well worth going to the site and having a nose around!

The Drugs Don’t Work (or do they?)

Medication is not my forte’, but working as I do, in a multi-disciplinary team where there are doctors and nurses present, I have a great opportunity to check any information I’m need clarification about.

I make liberal use of the BNF (British National Formulary) website which lists comprehensively all the medications that are used, I also found particularly useful a book called ‘The Approved Social Worker’s Guide to Psychiatry and Medication’ which I’d recommend highly as a non-medic’s text to, well, psychiatry and medication which assumes some background knowledge of mental health (although it has a clarity which makes it useful across the board to non-experts).

Anyway, with that proviso, I came across a couple of articles at the weekend relating specifically to medication.

Firstly an article at Psychminded which challenges the assumption that schizophrenia needs to be necessarily treated with medication. Medication has it’s place but it not exclusively.

image rselph at flickr

Then an article I have to say I found a little sobering from a magazine called ‘Woman’s Day’ which publishes ‘Six tips towards Choosing an Antidepressant’. As we know, information is empowering but I just found it a little incongruent that drugs should be compared like candy. The article itself is useful in that it points towards possible factors that should be discussed in order to best choose but honestly, I’d hope any prescribing doctors would (and do)  take these factors into account anyway.

I wonder how much there is a culture of leaning on medication as the ‘easiest’ option through a period of difficulty. I am by no means anti-medication. I have seen some almost miraculously positive results and pharmacology is a vital part in most treatment plans but something about the normalisation of antidepressant medication seems to sit uncomfortably.

Working the Media

Community Care are running a campaign ‘Stand up Now for Social Work’ which aims to highlight both the good and the bad in reporting of social work. It’s a fascinating campaign and a positive one and also, as we can see by recent news stories, one that is desperately needed.

Indeed, the magazine which is a mainstay for UK social workers, has set up a blog specifically to cover the campaign and media issues as they relate to social work called The Monitor.

image ernst moeksis @ flickr

A couple of posts there have caught my eye specifically over the past couple of days. Firstly a piece about social workers not being so wary of journalists and the importance cross-pollination of positive news stories relating to social work and social care as well as a need for a more realistic knowledge of social work by some sections of the media.

Perhaps it is easy to put the barriers up when you see some of the coverage that exists and some of the generalised hatred that seems to exist for the social work profession as a whole. I wonder if it is something that is relatively unique to Britain and the red-tops/Daily Mail style of reporting that seems to find anything connected to government somehow evil and controlling and fails to appreciate some of the actual day to day work that happens.

I have no wish to be ‘appreciated’ to be honest. Of course, on an individual level it is rather nice but as a profession it is wholly unrealistic.

As for speaking to journalists, apart from contractual restrictions, it is as much as matter of time!

Another post from the blog titled ‘Ten reasons why Social Workers must speak to the media’ provides exactly that.

Rather than re-listing all the points, I’d recommend reading the post as it provides some pertinent posts that almost made me want to go out and collar a journalist or two.

Until I considered that the new forms of the media are allowing us.. and me.. to have a distinct voice without the need for a conduit. I won’t have the readership of the Times or Telegraph but I do have the ownership.

Community Care reports that Behan, the ‘government’s social care chief’ (really? I’d never heard of him.. I didn’t know the government had one!) has called for

directors and social workers to stand up for themselves and stop “playing victims” in the face of public criticism.

and he goes on to say

“How much have you been doing to get stories into the Guardian and Community Care on adult care?” he asked delegates yesterday at the Association of Directors of Adult’s Social Services spring seminar .

But I humbly suggest  he’s got things wrong. We don’t really need to target The Guardian and Community Care because those news sources are naturally sympathetic. We should be focussing on the Mail, the Sun and television news and drama as well.

Not least, now we are living in an age where anyone can publish a blog, record a podcast and build an audience, albeit a small, niche audience. It might not change the world today, but it’s the way we are moving and social work needs to embrace more fully the possibilities of web-publishing, social networking and moving away from a mainstream media if the mainstream media shows little interest.

The stories are there – we just need to promote them and through it a greater understanding what what ‘social work’ actually is and does.


The Mail, as well as a variety of other news sources, report today on the tragic story of an elderly woman, 86 year old Betty Figg,  with dementia who has been ‘’snatched’ by social workers from the loving home provided by her daughter, Rosalind Figg, and returned, with police assistance, back to the residential home from which she was taken.

image badlogik at Flickr

Horrific, scandalous, indicative of the police state we now live in, evil interfering social workers, direct result of the government policies. Well, that’s some of the milder comments on the website.

Reading this story (with accompanying photos in the newspaper) really chilled my bones. Because I, myself, have done almost exactly the same thing. I didn’t write about it at the time for the sake of confidentiality but it follows a very very close mirror to the situation described in the newspaper and I will say no more.

What I can say is that on the basis of my knowledge of the law this can be the perception of what happened but it does not bear a relation to what would have been the reality.

The local newspaper, for example, describes the need for an assessment to take place – namely a Mental Health Act Assessment. Therefore it’s a fairly safe assumption that  Mrs Figg has been removed from her daughter’s property under section 135 (1) of the Mental Health Act for removal to a ‘place of safety’ for an assessment.

The ‘place of safety’ in legal terms may be a specific place and isn’t necessary making any assumptions about the safety of her daughter’s home but of course this is the language that will be used by the local authority to describe the process – not necessarily the language that will be automatically understood by The Daily Mail. This application requires attendance by an Approved Mental Health Practitioner (probably the social worker in this case) and a doctor.

It would have been a decision made within a Community Mental Health Team and while a social worker might have been the AMHP, it is the Trust rather than the local authority with whom the responsibility for the decision would lie – so grabbing a quote from the local social services seems a little simple.

These circumstances just wouldn’t come into play with  your standard ‘pleasantly confused’ elderly patient – this is someone at significant and imminent risk.

The BBC report that

The warrant alleged Betty Figg was being mistreated or neglected.

Well, yes, that’s what all section 135 warrants basically say. Either that or that someone isn’t able to look after themselves but there has to be a reason that the warrant is required. A warrant was gained for entry. This means that the situation had to be presented in court to a magistrate with evidence of why it was needed. This is not a rubber-stamping process and magistrates can question and turn down warrants that are requested – however it was granted meaning there has to be more to this story than is shared by Rosalind Figg.

Rosalind Figg then comments

“They have not got any proof of that. Maybe my mother does forget a lot and she is confused – but we were having a lovely time.”

I know nothing of the situation in Coventry but you do not assess people who are comfortable and ‘pleasantly confused’ under the Mental Health Act. Especially not if you need to take them forcibly from their families’ home. There has to be an over-riding best interest.

The team and local authority are obliged to pay heed to the human rights involved.

This is not a question of overbearing social workers – the law does not allow that. The fact that the police were present indicates that inter-agency planning had gone ahead and that the event, however unpleasant, was following the legal procedures – which mean that the background situation and level of distress caused had been balanced against the level of immediate risk.

It is not a decision taken lightly or without significant proof of very real harm. Of course, the social workers and social services department are in no position to explain their case due to the limits of confidentiality.

It is though, cheap and lazy journalism. Anyone who had done an iota of research into the legalities of removing someone to a place of safety for an assessment would have a better understanding of the sensitivities of the situation.

I don’t really expect much more though.


Something of a hotch-potch of a post today – I hope I can be forgiven a little stream of consciousness relating to some thoughts and stories that have caught my attention.

Simeon Brody at Mad World points out a rather narrow-minded article in the New York Times which questions the value of programmes that aim to reduce stigma relating to mental illness.

The Guardian publish an interview with the head of the Social Work Taskforce, Moira Gibb. A couple of points that jumped out at me were that the entire conversation focussed solely on children and families social work – I wonder if there is a general perception that no other kind of social work exists – if anything that is my fear relating to the task force.

As the questions are asked about standards of child protection and the focus remains on vacancy rates within children and families teams, the work that takes place within the adults’ services and the needs of vulnerable adults will be forgotten.

Another interesting point from the interview I thought, when Gibb, the Chief Executive of Camden Council was asked

‘Could the Baby P case have happened in her highly successful borough of Camden?’

Well, there’s a journalist that might have done a bit better research and asked her directly about Rhys Biggs.

I think I’m in rather a contrary mood at the moment, if it doesn’t tell.

I have many thoughts at the moment about seeing social services from the other side, as a new foster carer – it’s amazing how it flavours your experiences and although I am loathe to say it, three weeks into our very first placement, I’m yet to speak to or see the social worker who has apparently been allocated to work with us.

I say that with the full knowledge of the pressures, workload and harrassment that is involved in working in this field.  I am, have and do try to be as sympathetic as it is possible to be. It’s a fascinating place to be from the outside. I’ve had a lot of general thoughts about the experience of fostering but have made a general decision not to write about it here however in the context of being a ‘client’ of social work and social services, it is an eye-opener. I try and get on with things as I can but it’s hard to even be overly sympathetic when calls aren’t returned, emailed aren’t answered and the only time any kind of movement seems to happen is by direct and bolshy telephone calls to managers.

It does, however, provide me with a lot of further sensitivity of how it feels to deal with social services ‘from the other side’.

And today, the Chancellor of the Exchequer announces his budget . Among much reporting of financial doom and gloom, Carers UK are holding a protest march in London and Edinburgh to draw attention to the poor financial support for carers – and quite rightly too, in my opinion.

Age Concern are drawing attention to the needs of older people and urging the Chancellor not to forget them and Action for Children are calling for the young not to be forgotten!

Finally, MIND announced their shortlists for Journalist of the Year and Champion of the Year – certainly some interesting names there!

Hopefully back to something a little more coherent tomorrow!

The Cost of Mistakes

I have a draft post written about making mistakes but while I was compiling, I remembered this story about Jesse Moores and on the scales of mistakes it has a much more important and tragic consequence.

Jesse Moores was a resident at The Chines Home in Enfield, London. He had autism and Tourette’s syndrome and required 24 hour care. That care was to be provided at The Chines, a home run by Robinia Care and unfortunately, Jesse Moores choked to death in 2005 while under the care of Robinia Care Group.

Enfield Council took the company to court and according to the article in Community Care, the home itself closed in 2006 after a scathing report in 2005 found that there were a stream of requirements that the home needed to meet in order. Basically it was a sub-standard service at a sub-standard home and poor practice has been seen to lead directly to the death of a resident.

The sentences were delivered yesterday after the verdicts had been decided (namely that the company and the deputy manager were guilty).

The home’s deputy manager at the time, Patience Etchu-Abangma, who was on duty at the time of the death, was fined £1200.

The London Paper details some of Etchu-Abangma’s actions that day

Etchu-Abangma is accused of:

failing to make sure everyone was aware of the risk of Mr Moores obtaining food and choking on it;

telling the care workers to call her if something happened instead of calling 999;

failing to leave an instructions about what to do in an emergency; failing to give any suitable instructions when Ms Ojobar (agency member of staff) phoned her to tell her there was a problem with Mr Moores;

directing her to do nothing and saying she would call an ambulance herself;

delaying calling an ambulance for at least 15 minutes after receiving the phone call;

untruthfully telling the emergency services on the phone that efforts were being made to resuscitate Mr Moores;

failing to take any action when she returned to the care home even though Mr Moores was unconscious and not breathing.

It is all really pretty damning under any circumstance. Apart from the individual though, it is hard to believe that a management structure can exist where these issues remain hidden. I expect that is why the company itself has been found culpable as well as the individual.

Robinia Care or whatever they are called now, were, indeed,  fined £250 000 for the breaches in health and safety legislation which led to Mr Moores’ death.

The Robinia Care of 2005 has been through different hands since these occurrences including Bridgepoint – an international ‘private equity group’ who owned them at the time of the incident – clearly a company with its heart set on providing a good quality residential care service – although to be fair, they were already planning to sell it at the time – for a cool £80 million. I wonder how much money they were paying in wages to ensure they had a high quality of care staff.

I wonder how long profits can be squeezed out of the caring sector into private companies that have little interest save the in the profits that can be generated by putting in place poorly paid and inexperienced and possibly incompetent care staff.

Robina pseudoacacia bloom April 22, 2003 Hemin...
Image via Wikipedia

At least I hope to see more of these types of fines when there is proven culpability. It should not be easy for companies that make massive profits to wash their hands of their responsibilities – and for that reason, I welcome the verdicts in this case.

Depression Awareness Week

Just a quick post today as I need to get myself to work earlier than usual but I noticed that the Depression Alliance are kicking off  ‘Depression Awareness Week’ today.

The Depression Alliance have published some related research (pdf) in time to mark the start of the week which

reveals the majority (79%) of people diagnosed with depression in the UK feel disclosing their condition to colleagues would have a detrimental impact on them, and nearly a third (32%) believe they have been turned down for a job

I can’t say that any of those figures strike me as particularly surprising but it goes to show how important it is to combat the stigma that is associated with mental illness.

Meanwhile the Depression Alliance’s website, which I’ve been browsing through extensively this morning, has an impressive list of links and useful sites that I know I intend to explore more fully in time!

My First Best Interests Assessment

Yesterday I completed my first Best Interests Assessment since the relatively new Deprivation of Liberty Safeguards went live on 1 April 2009.  In brief these assessments grew from the need to clarify the legal position of those who lack capacity when certain restrictive conditions apply which ‘deprive them of their liberty’.

The generally communicated opinion seems to be that rather than the onslaught of assessments from the “live” date of 1 April – there has, instead, been something of a trickle and those who took up the Best Interests Assessments courses to supplement retirement income might be having a few second thoughts now. I’m not wholly convinced by the lack of referrals coming in though and personally expect there to be a slightly higher rate of referral as information trickles out to residential homes – possibly as review processes come around or the CQC (Care Quality Commission) begins to inspect the homes regularly.

Being in a relatively unusual position therefore, of having actually completed a ‘live’ assessment, I thought it would be a useful experience to share.  I don’t intend to look particularly at any of the details of the case that I was presented with but more my responses to the processes.

We are still in the ‘transition’ period. This means that the legal time limits on carrying out the assessments have been extended just for the period of April 2009. So rather than the seven calendar days that I would usually have to complete an assessment, I had the rather more comfortable 21 day limit.  This was particularly useful as the time period fell over the Easter holidays.

I received a telephone call from our DoLs co-ordinator who asked me about my availability to complete an assessment. I agreed to undertake the assessment, not least because after the training course and the written work, I was eager to see how things panned out in practice.

They then sent me copies of the forms that had been completed by the Managing Authority – in this case –  a residential home. There was the request for urgent authorisation of a deprivation of liberty, the request for a standard authorisation of a deprivation of liberty and a comprehensive care plan as well as the request form for a Mental Health Assessor (who has to be doctor).

Myself and the doctor involved seemed to play telephone tennis for a couple of days, leaving messages for each other at particularly inconvenient moments – until in the end with an awareness of the time limitations, she left me a message saying ‘I’m going to do this assessment tomorrow – are you with me?’  At that point, we were able to make contact and I postponed for a day in order to gather more information but at least we had a day when we could both assess at the same time.

In that period, I called everyone I could find that had had come kind of contact with the person involved – Social Worker/Care Manager, CPN, staff of residential home, GP and most importantly, next of kin.

I requested a couple of extra ‘background’ documents from the social worker and CPN, just to give me a better idea of some of the background history as the signs pointed to someone with very significant cognitive impairment.

On arriving at the residential home, I had a chat with the key worker and a look through the file. When the doctor arrived, we made a quick decision relating to who would complete which forms – I did the age assessment (!), eligibility, no refusals and of course, the Best Interests Assessment and she did the Mental Health Assessment and the Mental Capacity Assessment.

There was an obvious path to take with the way the interview progressed. We had agreed to start with capacity but as it happened, it was more a type of discussion/interview that we both added to but that provided all the necessary answers.

After the interview part, we discussed briefly the recommendations that we were making. She had expected me to hand her a claim form and we commented on the differences with the Mental Health Act Assessment – namely that our role is to make recommendations to the Supervisory Authority rather than to make the immediate decisions.

A couple of thoughts then from the process – the forms didn’t actually take as long to complete as they look like they might. The paperwork is enormous but comparing to my work as an AMHP,  I would say a Mental Health Act Assessment is significantly more time-consuming and involved. Partly this is because with the BIA (Best Interests Assessments) the ‘setting up’ is done by the supervisory body and while there is still a necessity to gather information, there isn’t the same responsibility for engaging doctors, police if necessary, ambulance and hospital bed.  For this assessment, apart from the prior information gathering, I turned up and assessed.

Of course, it has to be considered that the assessment I carried out was fairly clear-cut in that it could have been written up as a model case study in some respects so obviously if decisions are more borderline that is a different matter entirely.

I had some thoughts about the time limit on the authorisation (because I did recommend an authorisation of a deprivation of liberty). I did not go for the full allowable one year but instead a shorter period because I felt it would be useful to reassess the position to see how and if things were progressing. In retrospect, I wonder if this was a slightly arbitrary decision.

It was extremely useful doing the assessment jointly with the Mental Health Assessor – especially as we are still feeling our way around to a certain extent. I think it generally leads to a better experience for the person being assessed as had we visited separately we would have repeated a lot of the same questions.

My slight concern remains that the seven day limit will seem to be a little tight.

I am though, relieved to have finally completed an assessment and seen through the process in action.