10 things learnt in 10 years as a Social Worker

I qualified as a social worker in 2000. I don’t remember the exact date I started my first ‘qualified’ post. It was sometime in the early summer I think –  in those days before registration was required and all I needed to prove I was qualified was a letter from the university stating I had passed the course – of course, the certificate would take a few more months to arrive.

We were eagerly snapped up by employers with open arms. As an HR guy told me a few years later

‘Those were the days when all you had to do was stand on a street corner with your social work qualification and someone would come and employ you’

And I could see  his point. Employers – agencies and local authorities came to our university in our last month in a battle to employ us. We never realised we had it so good.

I had gained in confidence exponentially throughout the course but when I look back on my first days, weeks, months and years in practice, I realise how the initial Masters was just a starting point rather than an end in itself as far as my learning has been.

I wanted to reflect on some of the most important lessons I’ve learnt since qualification.

1. Theories matter.

It was always a little hard on placement to draw out some of the theoretical models I felt. They could seem so distant – or sometimes it felt as if we were superimposing the ‘most convenient’ theory onto the ‘common sense’ approach. That is over-simplifying but putting theory into practice was always something I struggled with initially because the pace of work seemed to see me exist from day to day patching up and making do. When I was on placement I had a gentle introduction of an uncomplicated caseload of six people. I was able to spend time with all of them and gain an understanding. In practice, I had a standard caseload between 30-40. I came down to earth with a ‘bump’

But, as I have developed ways of time management and workload management, I increasingly returned back to the theoretical bases that I learnt about at university. I have read about more as they have developed over the years. I retained a subscription to the ‘British Journal of Social Work’ and learnt that we have to have a grounding of why we do the work we do – the history of social policy and the ways to develop relationships, work within systems and organisations even though it can feel like banging our head against a collective wall at times.

Back in the day, we joked as students about our preferred ‘eclectic’ approaches. Eclectic does have value though. You just have to know which bits to pick – and we do develop favoured theoretical approaches. I’ve been just about consistent in that. I sometimes feel that there needs to be some more research in practice about developing more complex theoretical bases as the nature of the work that we do changes but that’s something for me to ponder in retirement, I suspect.

2. Confidence matters.

This is the biggest change I’ve seen in my own practice. Some days I feel like a bit of a fraud and wonder if I know what I’m doing. I don’t think that will ever go away – but more and more I am able to trust the judgements I make as I refer to experience and different situations I have been in. I remember when I was first asked to do the ASW (Approved Social Worker – now changed to Approved Mental Health Professional) training. I hadn’t particularly wanted to but the service needs required more ASWs. I was reluctant due to the authoritative, control aspect of the role and I’m really a rather woolly liberal at heart.

I wanted to study though. I really wanted to know more about mental health work in general and the Mental Health Act in particular. I like learning and having the opportunity to learn, understand and study at a higher level was too appealing. I tried not to think about the actual assessments too much as I didn’t really like the idea of making decisions about detaining people compulsorily.

Then, during the course, I realised. My power was as much about preventing inappropriate detentions as making applications when they are necessary. I can stop a detention when I have two medical recommendations in my hand but I can’t apply when I don’t. The quality of the increased knowledge base built my confidence. Often it comes with knowledge both formally taught/read/discussed and informal experiential ‘knowledge’.

I have more confidence in my own judgement now. That makes practice more straightforward. I also know my own fallibility and go back to study and learn more independently.

3. Power matters.

Again, reaching into my fluffy liberal side, I talk about ‘strengths models’ and working in a ‘person-centred’ way but there’s no escaping the power role I have as an agent of the state. We like to talk about ‘working together’ but my statutory role and my role as ‘expert’ in the way the organisation (being the local authority) works put me in a powerful position vis-a-vis service users and sometimes other professionals.

I tended to shirk the idea of power. It doesn’t naturally sit comfortably with me. But I have become more aware of it and I think that makes me a better practitioner. As much as we try to pretend there is an equality, we can potentially do a disservice to those for whom we work.  Power doesn’t have to be bad, but we have to be aware of it.

4. Advocacy matters.

This is an extension of the ‘power’ issue. We are placed within an organisation that has many pulls on its time and money. Sometimes it is not easy to give a voice to those for whom we work – especially if we ‘go native’ within the large organisation or have difficulties personally with particular managers but it is important that our voices are not lost, even if it feels sometimes that we are shouting into the wind.  We need to best present those for whom we are guided to work with and sometimes that means challenging systems we work with, especially if they are discriminatory – institutional oppression is alive and well and is best combated ‘from the inside’.

We also need to advocate for ourselves, our profession and people who may need to use our services. Against inadequate management procedures, against chipping away of professional roles.

One of the reasons that union membership is important.

5. Honesty matters.

Honesty to an extent at any rate. When I was in my first placement  I learnt a lesson from my practice teacher who told me never to promise what I couldn’t guarantee that I would be able to deliver. If anything, under-promise. I  have extended that a little to being as honest as I can with service users and with other professionals and colleagues. I don’t assume I know what the organisational response will be to a proposed care package until it has been agreed by those with funding responsibility. I can take a good guess, knowing my managers and the eligibility criteria pretty well  but sometimes they can change or someone can challenge.

When I go to do a community care assessment or, as happens now, validate a Self-Assessment Questionnaire, I don’t promise anything at all initially. I will probably discuss options but until I have a guaranteed budget in my hand or a guaranteed service promised, I will try to talk very vaguely about potential options, making it clear that the decisions often lie outside my power to grant. Which is true. I hold no budget myself. I can only make recommendations and advocate strongly. Which I do. Which I try to do.

Trust requires honesty. Phoning when you say you will. Turning up when you say you will.

6. Punctuality matters.

It is one of the very basic courtesies we are often judged on. When I first qualified I was appalled by how lackadaisical some of my new colleagues were about time-keeping and keeping to appointments. I think it often sets up a relationship. Of course, I am far from perfect. I am also on a couple of duty rotas including AMHP and BIA work as well as holding a full caseload.

More often than not when I cancel or postpone, it is because I have to carry out a Mental Health Act Assessment or deal with some kind of crisis in my own caseload. I am not able to clear my diary for the week that I am on the AMHP rota just because I am on the rota very frequently. I still hate cancelling. I hate being late but I do always phone when I am running more than about 5 minutes later.

I’m far from perfect. The nature of the role is that sometimes I have to be in two or three places at once but I do try to pay attention to the timings because I feel it denoted an element of respect and can be important in minimising some of the power differential. Lateness sends signals that can be hard to explain away..

7. Limits matter.

This was a big one for me.  You come into the job all fresh and excited about the difference you are going to make in peoples’ lives. You are going to change the world. Make a difference. Help people to understand and come to terms with challenges. Sometimes though, you can’t help. You try and you go through the processes necessary but there is just nothing there that you can do. It might be about so-called ‘unwise decisions’ made by capacitous adults – it might be that the criteria and/or budgets don’t allow for it. Sometimes the decisions you have to  make are grounded in organisational policy rather than your own professional judgement. Sometimes I wish I had a budget I could spend.

An ex-manager once told me (when I was having a particularly stressful time of it) to think logically about separating ‘the things you can change’ from ‘the things you cannot change’ and not to worry about the second category as long as you do your absolute best with the first category – sometimes there is nothing you can do. That’s a big challenge.

It didn’t stop me having difficulty sleeping a couple of months ago when I was concerned about one particular individual and their ‘unwise decision’ but it helps me to rationalise my own role in the troubling situations and circumstances that I do see.

8. Discrimination matters.

I work with a wide range of people of different backgrounds and social classes. I enjoy that aspect of my work. As I hear and understand the backgrounds and life histories, I can see the effects of different attitudes and the way that people are regarded and the ways that has shaped lives.

The impact of poverty is one of the underlying issues that hits me from time to time and the utter inequity of the way we live in this country. I have advantages of birth that were not enjoyed by a lot of the people I work with. I can try and discount that but it doesn’t go away.

People do not ‘deserve’ poverty. Society creates enormous inequalities. It is hard to distance yourself sometimes but it’s about boundaries. I wonder if I have become a bit hardened to some of the situations I see but I try to use fresh eyes with each file that (virtually at least) lands on my desk. Sometimes though, what we see and the way we see people and the lives that they have created through enormous difficulties gives me a sense of pride in this country and this city that I don’t think I would ever have if I had joined a different kind of profession.

I see the effects of poverty pretty much on a day by day basis. It makes me so grateful for what I have.

It isn’t just poverty of course that divides but race, class, disability, gender and any number of less obvious forms of discrimination. The learning on paper is very different from the learning in practice but no less important. We cannot remove the glasses through which we see society but we can be aware of the particular tint and hue that they have and through which we see our realities.

My experiences of practice have changed some of the hues and tints but they have not removed them.

9. Humility matters.

I have previously stated that one of my power bases is that I am an ‘expert’ in the ways some of the local authority criteria and organisation functions. I can never be an ‘expert’ in someone else’s life though. I absolutely need to remember that accordingly. Sometimes I tell people what to do. That is a part of my statutory role. I don’t particularly enjoy it but I can’t pretend it doesn’t happen and that all the work I do is consensual. It isn’t. But it is important to listen and not just to a person but to the important people in their networks – family, friends, neighbours and remember that I will be flitting in and out of this persons’ life but others will remain.

10. Reflection matters.

One of the old staples from my course has almost come back to haunt me but I think it is an absolute vital part of my practice and my professional development. I feel that if I stopped the reflection, I would stop learning about myself and the ways that I work and there would be nothing more dangerous to me as a practitioner.  I need to learn continually about why I work in the way I do. What made me choose or avoid a particular piece of work? What are the things I most enjoy and dislike about the work I do? How have my experiences informed my practice and what makes me feel that I am better able to practice now than I was 10 years ago? Am I better now? Have I lost any of the exuberance and freshness? When is the best time to move on to another job?

It helps me to write things down which is how I came upon writing this blog for the first time  in November 2007. Just writing this post has helped me learn, develop, quantify and appreciate the experience. That is reflection.

And so to the next 10 years of practice. I expect social work will be a very different profession in 10 years time, if it still exists in its current form. I think that is the next battle to be had. I don’t intend giving up on it quite yet.

The Financial Management of Personal Budgets

The soon-to-be defunct Audit Commission published ‘The Financial Management of Personal Budgets’ today.  Community Care have a good run down on the basic points but I thought I’d read through it myself, just because I’m actually genuinely interested in the issues.

This report was based on research taken in eight different councils.

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As the report states in its opening words it is

‘Intended for finance staff and staff in adult social care departments with an interest in personal budgets.. ‘

I have to wonder if that is in order of importance. It probably is as far as the councils are concerned.

I had a brief glance over at the report this morning.

What did I learn?

Well, to be frank – nothing in there surprises me,  but then, I’ve probably got more experience of the working of personal budgets than most people.

As I read through the report, I’m just highlighting a few of the issues that I come across as well as my thoughts and responses.

– People with mental health problems are less likely to have access to personal budgets than other service user groups

The report highlights some of the issues of disentangling health and social care budgets being a particular issue for mental health. I’d add that in the ‘mental health’ sphere you have the people such as those that I work with who have dementia and the roll out of personal budgets for people who lack the capacity to manage them has been woeful because none of the training I have attended, and none of the ‘piloting’ was done with the group of service users who need more assistance to manage budgets due to capacity issues and who might not be able to have the imagined ‘choice’ simply because the choice is being made outside their sphere of control in any case. These people don’t make the ‘perfect case study’ examples that the policy drivers want to promote.

Personal budgets are unlikely to result in significant cost savings for councils.

This is a massive issue. We were always told that theoretically the change should be ‘zero cost’ but the hopeless inadequacy of the resource allocation system (that I have been party to, at any rate) and the growing realisation among service users and professionals that actually care might be being cut ‘stealthily’ or re-classified has made it a less than attractive proposition to push.

In fact, another point that the report makes is that the savings which  might be made by achieving better outcomes for users would actually be made by the NHS rather than the local authority. This highlights the problems with the differentiation between the budgets. Would a local authority pay out when it is saving the NHS money? Hopefully after all,  it it is the right and moral thing to do but with eligibility baselines rising and the government constantly harping on about the ‘protected’ NHS budget, I can see a massive timebomb about to explode in the NHS funding.

‘Method for allocating funding to individuals – the Resource Allocation System (RAS) – needs to be affordable, transparent and equitable for all care groups’.

Well, thanks Audit Commission for making me splutter my tea all over the keyboard as I chortle merrily at the utter dog’s ear that has been made of this process so far

(I know, I wouldn’t be able to do better myself so I shouldn’t criticise quite so heartily but I criticise because I find the system quite oppressive and I hate diluting needs into ‘figures’ it seems to depersonalise the human being behind the assessment and quantify needs but maybe I’m just a bit too fluffy and old-fashioned like that ).

Perhaps it is a reason for the lack of take up in mental health services but the RAS seems to work in a world of its own – based heavily on physical needs.  Note the ‘equitable’ not ‘equal’ or ‘equivalent’.

The report extensively focuses on the RAS systems and some of the inefficiencies that exist in the current formats. There are some examples offered of ways that the systems can be made more transparent and simplified. I hope the team in my borough read the report extensively, is all I’ll say.

Reduction of in-house services/block contracts

One of the things that the report highlights is the way that in-house provided services are increasingly expensive to provide and can’t meet the needs of those who wish to use personal budgets. I refer to my posting about the privatisation and outsourcing of care. Where I work, the in-house care service (which has been dramatically reduced) really is the gold standard of care among a heap of agencies that battle to drive costs down. This is what we are being told to give up for the sake of increasing choice. Quality v choice? It shouldn’t have to be an ‘either/or’.

As for block contracts disappearing? Well, they limited choice in any way – restricting the agencies that could deliver services in particular area – but, the lowered costs without doubt so that may be a further potential strain on the ‘systems’.

Figures

The report states that between 13% and 59% of older adults (34% nationally) have personal budgets – we can see the problem with looking at the average figure here –  whereas, on average 50% of adults with physical disabilities (nationally) have personal budgets and one council is reported to have a 94% take up rate for adults with learning disabilities.

The audit commission is being a bit mealy-mouthed with figures here using three different kinds in the same paragraph to show a point. I wonder what the figures were for adults with physical disabilities in the particular councils where 13% of older adults have personal budgets and we have no idea what the spread of take up is for adults with learning disabilities – just that one council is doing particularly well.

The other interesting figure hiding in the report is that most councils manage the personal budgets for service users but up to 36% and 50% in one council are provided by direct payments. I’d love to know what the breakdown of take up of direct payments is across the different service groups but I think I can guess. Higher with adults with physical disabilities and learning disabilities – low with older adults and mental health.

Auditing, Risk and Choice

The latter part of the report that I’ve been skimming through relates to processes for auditing the use of payments and preventing misuse of funds as well as an explicit statement that choice includes the choice to accept risk to ones self. This has been highlighted as one of the problem professionally with personal budgets getting things off the ground for adults with mental  health needs. I expect that is a bit of a smokescreen put up by people who don’t work in mental health services responding to some risk aversion but it is an attitude which I hope will be challenged.

Conclusion

The headlines highlight the slow progress in personal budgets roll-out in the UK.  I think the news organisations, unsurprisingly, find this the easiest point to pick up but as was stated on Breakfast News this morning, the take up is likely increasingly rapidly on a day by day basis  even since the report was completed but it is important to remember this is a ‘snapshot’ piece of research.

None of the findings are even remotely surprising to me. The more important things to take from this report in my opinion are:-

The massive disparities between the take up in different service user groups

The need for much better working between the NHS and social care to allow for even greater flexibility and to work particularly in mental health to promote a cohesive system of care provision

The risk to good quality in-house services.

The increased pressures on informal carers are criteria rise and the expectations made of informal carers rise. That is, I fear, the main way that costs will be saved.

In my mind, there scope for some really strong research in this area and some new ideas. At the moment, there is a reliance on the model used for direct payments and ILF monies. It is all very well telling people to be more flexible – it works amazingly for those people – but there needs to be more support within the local authorities for staff to better understand the processes and for staff to be more aware of their need to promote advocacy and creativity in care planning.

The desire to push self-directed support is absolutely the right way to be moving. I 100% back up the policy aims but the systems and the will has to be there within the services. The grant money is due to run out in 2011 and there will not be any more money to push this agenda. That’s where I feel the real failing will come. This needs to work for EVERYONE and not just those able to articulate and fight for their own corner.

I know I am a bit like a broken record on this but I won’t stop until I see the point being taken up!

Serious Case Review

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Two serious case reviews relating to the circumstances of the death of Peter Connelly (also known as ‘Baby P) were published for the first time yesterday.  I read through the second one (pdf) this morning but to be honest, gained no new information from it. I don’t know how different the first one was so I’ll rely on newspaper reports to inform me.

Interestingly, the second report was demanded by the Department of Children, Schools and Families when the first one was seen to be inadequate. I know for the interests of further knowledge I should read both but honestly, my heart isn’t in it.

I instead refer to Patrick Butler’s comment piece on the Guardian website which teases apart the issues of the two serious case reviews and the politicking that allowed a tragic situation where mistakes were made without any shadow of doubt, into a pillorying of social workers and social services nationally with the explicit agreement of Ed Balls and his government.

What did I learn from the second report? That the case was mismanaged and mishandled by numerous agencies, including social workers, doctors, the police etc.

This shouldn’t absolve social workers from their responsibility of course and there is absolutely no pleasure or pride in saying ‘look, they did it too.. it wasn’t just us’.

The difficulty is that joint-working seems like a far-sighted dreamland where people of with different professional and personal backgrounds come together to battle through their own assumptions and ‘walls of knowledge’ to share openly.

The fact that information sharing and multi-disciplinary working and the problems with it tends to come up with alarming frequency at reviews into deaths of children in care as well as adults who require the same protection, is an obvious result that greater information, better interdisciplinary working and just easier and more open systems will lead to better outcomes.

This is not a work of genius or anything new. The consideration is why hasn’t this been done and what is the best way for it?

IT solutions have proved to be clunky and unpopular.

I go down an old-fashioned but possibly (and this is where the problem comes in) more time-consuming route of both physically working more closely together across agencies but more importantly or perhaps more practically, getting to know who the people are in different agencies and build up those relationships of trust and routes of conversation that allow people to admit difficulties and cut down some of the bureaucracy.

I am of the mind that if police officers responsible for safeguarding came into our offices informally and regularly so we have names to contact and likewise if social workers had the time to meet with the GPs to discuss – and this is the important bit – not just individual cases as they arise but ways of working and getting to know each other as people, it would shore up the ease of the flow of information.

The difficulty is that this takes time and there is little value and even less measureable data on the quality of inter-professional working relationships.

In a world of measured outcomes and performance targets, we shouldn’t forget the human relationships, the informal conversations – the knowledge of where someone stands – when Mr X means ‘serious’ you drop absolutely everything and run but that Mr Y says ‘serious’ to mean anything out of his own personal comfort zone and Mr Z’s use of ‘serious’ is his baseline ‘normal’.

Greater trust and understanding of different systems is crucial. One of the things I did pick up from the SCR that I read relates to poor communication and a lack of understanding between the agencies, perhaps most notably between children’s services in Haringey and the health services.

In my opinion, the best way of tightening links formally is to tighten links informally. Professionals owe it to the public to work well together and they.. we.. work better with people who can relate to and whom we know personally. Systems set up for particular failures can often be weak because they might plug one gap  but miss another than comes out in a SCR the following year.

What needs to be fixed is the underlying distrust and professional silos across individuals who work in health and social care and then the information deficit and knowledge gap can be plugged both informally by Dr Y calling Mrs P who she met on a training course and sometimes chats to when she has some concerns that she isn’t quite sure about and by Mrs P sending a quick email to Dr Y asking to just pay closer attention to child X because she has a few gut feelings or is concerned about the relationship between child X and their foster carer.

It’s hard to quantify how it might happen in practice. That’s why I am no policy writer and just a humble practitioner. What won’t work is developing reams of policy documents in response to every mistake that is made.

We need to work on the structural failures rather than the failures of specific individuals and note that poor practice is sometimes just poor practice.

That isn’t saying we should be complacent, of course we shouldn’t – but sometimes the answers are just very straightforward.

More staff, better management and supervision and more trust and respect between professionals.

Lessons from the Care Sector

One of the flagship policies of this new coalition government and one mentioned in the Spending Review is about outsourcing services from directly provided in-house type provision to a tendering out type market led style of outsourcing services.

This is not new in adult social care. It was an attempt of the 1990 NHS and Community Care Act. We (social workers) were going to be buying in services from many different sources. We were to be care managers rather than care providers. It was a seismic shift in social care provision driven by the ideology of Thatcherism which equated private sector as good versus the clunky inefficiency of the public sector.

Indeed, a part of the ‘Big Society’ ethos is ‘shifting power away from central government to the local level, – to citizens, communities and INDEPENDENT PROVIDERS’.

All sounds nice and fluffy but – we have local authorities in London at least (possibly throughout the country  but honestly, London is what I know best) merging services to create a potential democratic deficit – for the record, I don’t in general have an issue with joint service provision across boroughs but it doesn’t seem to fit 100% into the localism agenda. It is the ethos behind a move towards independent providers that I fear.

I  have seen the future and it is shaky and dangerous without exceptional and firm regulation and honestly if one thing is going in the cuts, it is exactly that.

Let me explain further taking the lessons learnt from the contracting out of services in social care.

Firstly, I have come across some exceptional private care providers but they are a rarity rather than the normality that they should be. That breaks my heart as I move from social worker to care manager. How much confidence can we have in recommending care packages when we know there will be issues in the quality of service provided by profit-making agencies.

We can see with the story that was in the news recently regarding Jamie Merrett, a 37 year old man who is tetraplegic following a road accident and who was reliant on care being provided by nursing staff. A nurse was supplied via an agency who was not able to manage his care and she switched off his  life support machine which lead to permanent brain damage.

Jamie had installed cameras into his home as he was concerned about the quality of care provision and it was this camera that allowed this error to be highlighted.

It isn’t the nurse at fault so much as the agency that sent her. The nurse Violetta Aylward was not trained in ventilator care. She was probably cheaper for Ambition 24 (the agency) to supply as a result.

The agencies must be held to account as much as the individual nurses especially if the nurses have been sent into situations that they are not trained to manage by the agencies.

This agency, Ambition 24, received ‘three stars’ from the CQC in their last inspection round. It will retain those three stars as the star system doesn’t exist any more so no new inspections will be made and those star ratings will not be changed.

Anyone seeking to use them (and I include procurement teams in local authorities and the NHS) might be swayed by those now, redundant three stars which are resplendently displayed on their site.

They are a large multinational firm that provide nursing care through a number of agencies internationally – no doubt making massive amounts of money and the question  has to be asked about the corner cutting that leads to incidents such as this. Where is the morality in the private sector? I know it exists  but it also seems to cost. That is the price that not all commissioners are willing to pay.

Yes, this is one case. One incident. But I could tell a few stories about multi-national care agencies providing poor care at high cost and cutting corners on the day to day care to maximise profit – unfortunately, they are not my stories to tell but rather the stories of those who are most affected.

This is what happens when private companies serve public authorities for profit-making purposes. Sure, they can lower some costs,  but what what cost?

How many people whose family have been actively affected would say that they get a better quality service from agencies than from the directly provided services that have now been decimated through the ideology of the previous Conservative government?

Some would, I’m sure. I think there would be a majority who would despair at the fall in the quality of care provided.

Direct payments and personal budgets will help some people recruit directly, possibly bypassing agencies but not everyone has the same level of choice. A part of my difficulty with personal budgets is that everyone should be equal but some (those who are able to manage their budgets themselves or have active family members to assist) are more equal than others and more likely to get the better services.

Remember for every case we hear about, for every Jamie Merrett who saw to put in a video camera into his home, there are probably thousands who don’t complain, who can’t complain and who we never know about because they either lack the capacity to have an understanding of the quality of care that is being provided or because they don’t want to ‘make a fuss’ because they fear their own carers or they just can’t speak out because the damage has been done.

Most of the safeguarding investigations I undertake involve formal carers. Those are just the ones we know about.

This is what happens when independent providers are left to patch up the gaps in public services and make profit from the care that they provide.

As I say, I know it isn’t all carers or nurses that work for private agencies but it is the agencies that I blame rather than the carers. They push people to work in areas that they are not trained to. They don’t pay for travel between service users’ homes and turn a blind eye or actively encourage shortened visits and less attention to care.

Equally, the local authorities bear a responsibility for caring more about getting services at the absolute lowest cost rather than judging by quality. Contracts are tendered and granted on the basis of cost.

It is a similar story with residential and nursing homes. Local authorities are pushing the payments down, providers are more concerned about the figures than the quality of care. If you pay someone minimum wage for doing such a vitally important job, you don’t provide them with the training and support they need, you don’t keep staffing levels up to staff levels then you will have increasingly poor quality care provided.

This should be a lesson to have been learnt from pushing the privatisation agenda.

Combined with a paring back of all regulatory bodies, this is dangerous. It will be those with the quieter voices who suffer the most.

My plea to the government would be ‘look at the history before you destroy the future’.

I know it is in vain but that won’t stop me shouting as long and hard as I can.

This is why I fear for the NHS in the future. We have seen the future. It doesn’t work.

Preventing Project Prevention

This is a guest post by Stuart Sorensen.  Thank you Stuart!

Thank you CB for giving me this opportunity to post on your blog. It’s nice to have the chance to raise awareness of this organisation’s activities and to show how they might be stopped.

I first became aware of this organisation’s designs upon the UK last April and have been trying to raise awareness ever since.
http://stuartsorensen.wordpress.com/2010/04/10/project-prevention-eugenics-by-the-back-door/
The stated aim of Project Prevention is to prevent the birth of drug exposed children. The idea appears to be that no life at all is preferable to life gestated by an addict.

However, the ‘questions and answers’ section of Project Prevention’s website makes it clear that the prevention of social delinquency and violent crime are just as high on the charity’s agenda. It seems that discrimination based upon parental behaviour and denying the right to life of the socially disadvantaged is just as important to Harris.

It’s a voluntary scheme, began when Barbara Harris failed to get a bill passed in California making sterilisation compulsory and enforceable. It’s worth spending a moment reflecting upon just what such a law would mean.
It’s hard to see how it might be enforced without the aid of state officials quite literally kicking in the doors of hapless victims and dragging them off by force to the operating room.

It’s also worth considering the objections raised by the former drug using community (those ex addicts who have moved on with their lives). Many former addicts would have accepted almost any deal that provided them with the money to buy more drugs. Needless to say they represent the poorer end of the substance-using community. Those with money would hardly consider selling their future fertility for a trifling £200. Only the poorest would think this a reasonable deal – precisely the demographic Harris is interested in. But make no mistake, successful and wealthy people use drugs and alcohol too. But Project Prevention doesn’t seem to mind that.

There are many other reasons for this opposition.

Some of the objections include:
Philosophical arguments about anti-discrimination and the right to life;

Problems taking a controversial American service and parachuting it into UK where we have an effective welfare state and free access to alternative methods of birth control and reproductive health management;

Ethical issues concerning the fact that Project Prevention bribes people to consent to something not designed to be in their best interests but rather to serve the ideological, religious and economic ideals of others;

The inherent pessimism in offering a permanent ‘solution’ to a temporary problem;

The project’s historical focus upon predominantly black neighbourhoods and it’s link to eugenicist and ‘scientific racist’ Chris Brand;

The ethical problems associated with encouraging desperate people to make long term health decisions for financial reasons;

The short-sightedness of a project that aims to prevent life for those it deems fit only for a life of crime (read the Project Prevention website) but does little to tackle the real problem.

http://www.projectprevention.org/objectives/
“Objectives
The main objective of Project Prevention is to reduce the number of substance exposed births to zero. In doing so, Project Prevention seeks to reduce the burden of this social problem on taxpayers, trim down social worker caseloads, and alleviate from our clients the burden of having children that will potentially be taken away.”

http://www.projectprevention.org/the-sad-reality/
“The U.S. Department of Health and Human Services estimates that there were 740,000 substance exposed babies born in 1997. In Los Angeles, CA, 12,338 drug addicted babies were born between 1992 and 1996. This represents an average of eight addicted babies born everyday in one county. Some studies have shown that drug exposed children have trouble with language development and paying attention. Could this be why (according to a 3/7/99 L.A. Times article) special education costs in California have risen 35% in the last decade? Special education costs per child range from $3,000 to $125,000 per year depending on the severity of child’s learning disabilities and behavior problems.”

So why does this sectarian organisation, based as it is in eugenic racism and a philosophy that sacrifices vulnerable children to reduce tax seem so appealing to people in UK? One reason is simply that the amount of information presented by Project Prevention is so limited.

The name Chris Brand isn’t mentioned in the Project Prevention literature. Nor is the word ‘eugenics’. The fact that Chris Brand described the project as something that he hoped “will bring real advances for the eugenic cause”. is never reported on the website either.
http://www.bookrags.com/printfriendly/?p=wiki&u=Chris_Brand
Instead the reader is sucked into a superficial but initially quite compelling ‘black and white’ argument designed to use public sympathy for drug exposed babies as justification for their ‘prevention’. The website is disparaging about drug addicted mothers and dismissive of the prospects either for them or for their children.

The fact that UK midwives and other health professionals deal very effectively with these problems is ignored. Instead the website focuses upon problems such as ADHD and speculates that maternal addiction might be to blame for the rise in the US learning disabilities. The fact that their own statistics suggest otherwise is strangely absent from this argument.

Neither is there any discussion about the right to live a life with disability. Instead the Project appeals to the greed and self interest of the reader by talking about taxation instead. This ‘ready made solution’ approach that combines the carrot of tax savings (beyond Project Prevention’s control anyway) with the emotionally blackmailing stick of addicted babies is powerful. It tricks the reader into an uncomfortable proposition:
‘Support Project Prevention or the babies will suffer’
This is all the more bizarre when the aim of Project Prevention is the eugenic prevention of these babies ever existing.

Not surprisingly a number of professional groups objected. I interviewed Sara Stocks (then director of Project Prevention UK) last July and was given assurances that the UK model would be significantly different from the unethical process operated across the Atlantic. The interview was recorded and although the sound quality isn’t brilliant you can listen to it here:
http://stuartsorensen.wordpress.com/2010/07/09/interview-with-project-prevention-uk/
Since that time the UK directorate of Project Prevention has collapsed under the weight of ethical concerns and opposition from professional lobbyists in this country. However the fight continues as the American founder of Project Prevention, Barbara Harris has continued to target UK from her base across the Atlantic. Harris has been in the UK media regularly of late. It was she who accosted a mother and son in Possil Park, Glasgow with offers of a bribe if the woman (who was not an addict) undergo sterilisation. It was also Harris who handed over £200 cash to “John” from Leicester who had a vasectomy earlier this month.

It’s interesting, given that John could never have passed on any in-utero damage or addiction to any potential child how this meets the aim of preventing disability. However it’s not so hard to understand how it meets the eugenic argument so hotly denied by Harris and her supporters.

More disturbing in legal terms is the secrecy surrounding ‘John’s’ vasectomy. We now know that his real name is Alan and that the involvement of Project Prevention was kept hidden from professionals until after the procedure had been completed.
http://is.gd/gdLOM
This raises major issues around duty of care and safeguarding legislation which I have outlined in letters to front line workers here:
http://stuartsorensen.wordpress.com/2010/10/21/how-to-fight-project-prevention/
UK safeguarding legislation exists precisely to prevent this sort of abuse but we need people to report wrongdoing. There’s a longer explanation of the legal issues surrounding Project Prevention in UK here:
http://stuartsorensen.wordpress.com/2010/05/25/the-case-against-project-prevention/
There’s also an excellent open letter written by ‘Andrea’ to politicians and other ‘officials’ here:
http://stuartsorensen.wordpress.com/2010/10/22/excellent-set-of-questions-from-andrea-at-wired-in/
I urge you to distribute these letters to anyone you may know who might come into contact with Project Prevention and their activities.

You can also get regular updates about the project from my own blog by clicking on the Project Prevention category here:

http://stuartsorensen.wordpress.com/category/project-prevention-2/

Please speak out against this extremely cynical organisation and help us to kick it back over the Atlantic.

Hospitals

The National Health Service Norfolk and Norwic...

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Today, the Telegraph printed a letter sent to them by the Chair of the NHS Confederation which states that

The NHS Confederation has expressed concern that cuts to local government could have a knock-on impact on NHS services.

Less support from council services will quickly lead to increased pressure on emergency services and hospitals. Hospital beds will be blocked for those who badly need care because the support services that the elderly require after discharge will not available.

Of course, this comes as no surprise. This happens today and has been happening for years. It was the impetus behind the Community Care (Delayed Discharge) Act 2003 which allowed hospitals to charge local authorities for patients that they are unable to provide care for when the patients are ‘ready for discharge’.

The difference now is that the services to be provided will be in shorter supply, on tighter budgets and the local authorities won’t necessarily be able to pay the charges that are imposed through this Act.

This Act is one of the sharpest indicators of a ‘robbing Peter to pay Paul’ approach to health and social care funding when money is taken out of one pot to put into another.

Has it speeded up hospital discharges? Yes.

Has it speeded up appropriate hospital discharges? Debatable.

The raising of eligibility criteria and the increase of costs for services to those who are means testing will challenge local authorities as they seek to provide services on discharge.

Indeed, of the £1 billion health service budget that seems to have been redirected to social care, the Chancellor was careful to specify ‘reenablement projects’ which are often exactly the projects that manage speedy hospital discharges, providing a free initial service before the costs kick in.

Only one problem here. The money isn’t ringfenced.

I don’t like referring to ‘bed blocking’. Each of those patients in those beds needs to be treated with dignity and respect. When I was in hospital (as a patient) myself, I saw a consultant berating the woman in the bed opposite me for still being in hospital when it cost so much and she was clearly ready to go home.

Poor woman. So much for dignity.

She explained to the person in the neighbouring bed that it would cost her £12 per hour for the support the social worker said she needed and she wasn’t sure her husband would agree.

It was a glimpse into the future for me and a chance to look beyond the role I have as I was merely another patient in another bed at that point.

This is where we will be going because there will be more people unwilling or unable to pay the means-tested amounts to see them out of hospitals. Hospitals will be under ever-increasing pressure to discharge and the local authorities will be left to pick up the pieces for ever too speedy hospital discharges or to break the news when the ‘re-enablement’ money runs out.

Because it will run out. It will run out very quickly.

But there’s two sides to this. Yes, the local authority will struggle to provide care to facilitate speedy discharges because they will have fewer resources and fewer members of staff but also, higher eligibility criteria will mean that more people come to social services via hospitals than at earlier stages of their needs when the hospital admission may have been preventable.

Spending on social care and widening eligibility does not cost, it saves. It saves pain and hardship. It saves dignity and potentially unnecessary hospital admissions. It saves money. It saves lives.

Future

Yesterday, I wrote specifically about my reactions to the Comprehensive Spending Review (CSR) without a lot of reference to other commentators. This was intentional as I wanted to spew out my initial thoughts pretty much freeform.

Today some of the dust has settled and a lot more commentary has been shaped and published and I wanted to focus more solidly on the way in which I see the developments and announcements specifically in the areas that I know most about and what impact I see the changes in social work in particular.

My experience is wholly in adult services. I started my working life in the voluntary sector working with adults with learning disabilities. Post-qualification, I have worked with adults with physical disabilities of working age as well as older adults and am currently placed within mental health services so I will focus on the areas I know, possibly to the detriment of children’s’ services but, of course, I welcome comments from those with more experience in that area.

The most notable and obvious/immediate change will be the reduction in funding for local authorities and the removal of ring-fencing. Community Care carries a statement by Paul Burstow, explaining that

“There is no justification for local authorities to slash and burn or for local authorities to tighten eligibility as far as the settlement goes.”

He points to the additional £1 billion to be focused on social care – remember, the other £1 billion is coming from the NHS budget.

However the removal of ringfencing and the costs of an ageing population make this a very vacuous statement. Last night, on Channel 4 News, the Leader of Westminster Council said he would be raising the criteria – tightening eligibility criteria (see the link at 3.37).

The removal of ringfencing of budgets and the massive hit that local authorities will be taking will mean that the bare minimum of services will be provided. Anyone who thinks these stories about wonderfully creative individual budgets will be sorely fooled. Charges for services will increase. Directly provided services will disappear by the wayside.

I’m not overly hopeful.

As for the place of social work departments, I refer to the beginning of the clip above.

Westminster and Lambeth are looking at merging services and departments across neighbouring borough. It’s happening across London. That’s where the job cuts will come in and social services will not be as ‘immune’ as we thought we might be.

The problem is that cuts have already been made. Any further cuts are absolutely at the front-line.

The stigmatisation of disabled adults continues. The Independent Living Fund is on its last legs. Many disabled adults rely heavily on this money to provide for a better quality of life that would have been provided solely depending on local authority’s increasingly tightening criteria. I think this can’t go without a fight as this is A LOT of support for some of the most dependent adults who are able to gain measures of independence through this scheme is looking like it will be lost.

[picapp align=”none” wrap=”false” link=”term=disability&iid=8405354″ src=”http://view2.picapp.com/pictures.photo/image/8405354/woman-wheelchair-looking/woman-wheelchair-looking.jpg?size=500&imageId=8405354″ width=”234″ height=”235″ /]

I wrote about changes to the ESA  (Employment and Support Allowance) yesterday and it reflects the perfidious nature of the cuts and a wholesale stigmatisation of disability and inability to work (which the government seems to want to link with unwillingness to work).

Perhaps one of the more staggeringly mealy-mouthed changes was the removal of DLA mobility from people who are in residential care. These really are the most dependent people.

I can’t say it any better than this Bendygirl at Benefit Scrounging Scum.

I urge you to go and watch the video message she has recorded for David Cameron in response to this.

Additional costs, if the standard of life for those with this benefit is to be maintained, will be pushed to local authorities by profit-making care homes and it doesn’t look like they’ll be any funding to plug this gap. This is callous in the extreme.

And finally housing.

Housing, housing. It sometimes feels like it is the bane of my life. Housing issues affect everyone in social services – adults and children alike. Housing always comes up. Poor housing = poor outcomes.

Where is the housing going to come from? Capital spending will be down. Councils will be able to charge more for new tenancies but that will be taken out of housing benefit which will be subject to the ‘benefits cap’. A fully subsidised rent on housing benefit would therefore leave more of the ‘capped income’ for other living expenses  but if housing is going to take out a larger chunk of this ‘capped amount’  because of higher rents – it is giving with one hand and taking away with another (housing benefits would be claimed for the higher rates of rent) but it would also decrease the amount of ‘universal benefit’ allowed to meet the cap.

So the effect I see within the local authority I work in? Pooled services, job losses, higher work pressures, higher caseloads, fewer resources, pushing more to informal carers and that’s if I have a job.

But it isn’t me that I’m concerned about. It is the nature of the NHS and the welfare state in this country and the social fabric and general tenets of social justice that I see being torn apart.

We must hold this government to account and keep fighting for the social justice that brought us into this profession in the first place.

This is why social workers must politicise. We cannot remain neutral as these changes take place. We are obliged to stand by a code of practice and we need to advocate and speak on behalf of those who rely on us for support.

Perhaps the profession’s failing has been its willingness to stand idle as the changes in social policy crept up on us. We need a voice, we need to shout and we need to vocalise some of the voices that can’t be heard so clearly.