Changing the World

Regional Leadership Forum

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This weekend I met up with a friend of mine whom I first met when I started my MA in Social Work roughly 12 years ago.

Since graduating and qualifying, our careers have taken different but in some ways parallel paths. She works in childrens’ services and currently works in a fostering and adoption team.

We’ve both spent a couple of those years ‘out of the workforce’ for various reasons (travel, family).

When we met, I was trying to persuade her to come to the SWAN event in London next weekend.  We discussed the way some of the idealism that we had had back in the day when we were students had gone and how easy it was to become distracted from the ‘bigger fight’ for social justice on a societal level when you are struggling from day to day in a job where sometimes it’s difficult to see beyond the ‘care and control’.

Some days, at work, it might not feel that we are making a change for the positive but it needs to remain absolutely key to the process of the work and we need to draw on the spirit that took us into this profession in the first place.  With a little bit of prodding and perhaps more importantly, active reflection, we can uncover those roots.

I remember, and we discussed this, how much I wanted the world to change 12 years ago. How much injustice there is and how much more I have seen since qualifying.  Society has a whole lot of changing to be done before my head can rest easy on the pillow at night. It’s just sometimes, at the end of a day when I’ve been rushing around and an preoccupied with primarily ‘fire-fighting’ crises in practice, it’s hard to free up those parts of the brain for the ‘bigger fight’.

This is why it was refreshing to meet and discuss where we are at – a decade later. The political climate has always marginalised the ‘dependent’ but the lines of battle are more sharply drawn  now. The differences are that we have far many more weapons in our arsenal for the ‘fight’ ahead.

On reflection, I was fairly ambitious as a student. If someone would have told me 10 years ago that I wouldn’t be in a management position 10 years after qualifying, I would have been sorely disappointed.  I had struggled hard to get to the point of actually taking the course, it hadn’t been a smooth path – but I was so determined that in some ways I would make a mark and make a difference to more people than those whom I directly worked with.

As it is though, I’m not remotely disappointed. Perhaps I’ve got a better insight into where that management leads and I’m not sure I want to ‘buy into it’. If I thought I couldn’t make a difference for the positive and good, I wouldn’t last in this job. Yes, I need money to survive but there are easier ways of making enough to live on. I’ve got a healthy disrespect for money.

Last week, the National Skills Academy for Social Care initiated a consultation about the role of leadership in adult social care.  I haven’t yet read the Consultation Document but I will. I fully intend to submit a response having worked in adult care for well over 15 years now (gulp, that ages me!)  . For me, leadership and management are absolutely not analogous and it is an important distinction to  make. Management positions don’t make good leaders and good leaders are not by necessity, good managers. If anything, management is a functional role. It has left its inspiration behind it but more of that when I actually read the document.

You see, I feel that we have more ways at our fingertips to lead outside of the management role and that is the way to form opinions, grow roles and make a difference to a wider range of people. Perhaps even to change the world.

Through various ways and means, I am more radical though than I was when I was a student. Perhaps because I have been exposed to more injustice and am more au fait with the systems that create injustices.

I am having something of a reawakening of my radical soul and it is coming back stronger.

I do think I can change the world again. I am returning to my postmodern/social constructionist theoretical bases and it can explain to me – as all good theoretical models should be able to explain – the way that not only the modernist structures and assumptions are breaking up but also the modern modes of communication and perhaps the modern roles of ‘management’ and ‘leadership’ as cohabiting the same identity and space.

Information and the power behind information is fragmenting. Anyone can gain a presence on the web and use the voice piece to find and contact people who might be either of a similar mind or in other similar organisations.

We can organise ourselves without waiting for permission from management.

We can reach larger audiences without having to necessarily shout louder.

And the role of the social worker as advocate can really come into the fore at this point.

To do this though, we, as social workers need to get to grips with new media, new technology and most importantly social media.

There are many more ways to change the world.

I’m still convinced, no, in fact, I’m more convinced I can do it now than I was ten years ago.

Weekend Links 7

Been a bit of a disjointed and very busy week and likely to get more so over March but still, there are hints of spring arriving and that’s good enough for me.

Here are some social work related posts that caught my attention over the last week.

SocialJerk discusses the usefulness of a second language as a social worker. I can affirm that even a few words of mispronounced Urdu or Turkish can make a massive difference in building a relationship.

Melinda Lewis on Classroom to Capitol  has a very interesting post about community building and ‘commons’ that should and do exist. She explains far better than I do.

Community building is a strong current interest of mine and I am trying to link it to diversification of methods of communication within postmodern frameworks. We need to look at different ways to understand and improve society. This is one.

Malcolm Payne on the St Christopher’s Blog, links to a fascinating research piece which emphasises the importance on relationships in delivering public services. Some of my favourite research is that which confirms something I believe so I can ‘prove’ my hunches. This falls into that category!

At ‘Always Something to Complain About’ the writer has been sick and is pondering that eternal quandary about feeling guilty when taking time off and worrying about what you are leaving behind/leaving for colleagues/not doing as a result.  A particularly timely piece as I woke up this morning with a pronounced sniffle..

Jae Ran Kim has also been sick and uses the time to link to some thoughtful adoption related articles.

On How Not to Do Social Work there’s a piece about a look into a future that Cameron foresees where the state monopoly on provision of public services is eroded.

It worries me, quite frankly. I think some areas of work need to remain in the public domain. I have seen the private sector rip apart the adult care sector – and that isn’t to say there aren’t fantastic private providers but the regulatory system has been chipped away and little protection and accountability remains.

Social (Over)Worker makes a welcome return with her thoughts about the UK government’s diktat that social workers should not bar inter-racial adoptions. As piece, tellingly says she ‘didn’t realise we were’.

SocialWkr24/7 writes on Eyes Opened Wider about foster children on psychiatric medication. Fortunately, it has never been an issue with any of the children we’ve fostered but she raises good points.

Dave at the Diary of a Social Worker talks about salary discrepancies in social work. I didn’t actually realise how low social work salaries are in the US. If we think we have it bad over in the UK, just look at some of his figures. I know I am a well-paid social worker as things go, I get London weighting, AMHP and Practice Teacher increments but still, that’s after almost 10 years experience. Whenever I think about complaining I’ll go back to that post!

Dorlee at Social Work Career Development (she’s changed the name of her blog!) asks about what to do when someone you love but who is not close geographically has cancer. I didn’t offer any particular advice, because my experiences have been much closer to home but I’m wishing her and her friend all the best.

Finally on a bit of a tangent and in the fine spirit of Mental Nurse’s ‘wildcard’ post at the end of their fantastic weekly round-ups .

Tim Thornton on ‘In the Space of Reasons’ discusses the use of philosophy in a mental health research paper. I don’t think we use the precepts of philosophy enough in our day to day work. I love his blog and his insights for something a bit different from the usual mental health perspectives.

Bullying

Bullying on IRFE in March 5, 2007, the first c...

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Bullying – it’s a very loaded word. As adults we’ve been through the school experiences where, if we didn’t experience it and weren’t perpetrators, we’d probably know people who were in one or the other camp.

School is just a community where identity takes hold and is shaped and as such, with children growing and developing there personalities and thrown together merely on the basis of age and location or wealth(in the case of private schools) there is no reason to believe that everyone will get on and live happily together.

Fortunately, there are some wonderful resources and help available for children who might experience bullying. Often parents will be very supportive.

Let’s turn that perception on its head though because this week, I have been discussing and processing the implications of bullying in a residential care home for adults with dementia.

This is not bullying by managers of staff or bullying of residents by staff.

This is bullying of residents by other residents.

In some ways, I’m surprised that there isn’t more debate and discussion about this. After all, in some cases, people who require residential care and who have dementia may not have many decisions about where they live. Adults are proverbially thrown together merely on the basis of age (and diagnosis), location and wealth (in the case private homes).

Why is it more surprising that the tribal nature of the human condition becomes any less apparent than it would with children?

We are still working with and alongside people who are vulnerable but are there any resources available for adults who are bullied in these circumstances or the families of adults who are bullied in these circumstances.

As mentioned above, I am involved in various safeguarding processes for an adult in a residential home who is being unfairly targeted by another resident.

Without too many details, the decisions that are taking place around the people involved  relate almost entirely to series of best interest meetings and discussions.

Should we move the target who is not even necessarily aware of what is going on around them but who is settled and has already moved a couple of times?   Or should we move the perpetrator who is adamant that they do not want to leave?

At what stage does this ribbing and teasing or just two people who don’t get on, become an imbalance in power that is usually present in ‘bullying’.

While we have come to a solid and I think, acceptable decision that is protective for both parties (and as the care coordinator for the ‘target’, she has been my primary responsibility), this case has led me to reflect on and consider other cases that I’ve been involved with where abuse has taken place between older adults in residential care settings and day centres.

I’m very surprised there isn’t more research and information about it and some of the staff in these settings seem to be constantly amazed that all people regardless of background, culture and history don’t just ‘all get on’ in the lounge to sing ‘Knees Up Mother Brown’.

Are we denying the humanity of older people by trying to pretend that they are somehow less human because they are not succumbing to some of that most human activity in ‘community environments’ of picking off the weakest or the most ‘different’.

I think by not actively and forcefully discussing issues of bullying and having plans around them, we are doing a disservice to all older adults for whom we, as a society, have a duty to care.

One day, newspapers, communities and the public will be as interested and as horrified by the stories of bullying in older people’s communities as they are in schools.

It shouldn’t really surprise us when you think about it. As I’ve said many times in person over the last few days, this is what happens in communities of humans – and there are various almost tribal elements at play as communities form into ‘stronger’ and ‘weaker’ elements. Why should this be different when we age or become unwell or a memories begin to fade? We don’t stop being human.

As a service and as a profession, we need to have plans that are as strong and protective for older adults experiencing bullying as we do for children as often there aren’t the forceful parents around to protect and defend. It is left to us, as professionals, to take that advocacy role.

There also has to be a broader understanding that things don’t always happen in the way we would like them to and more care homes and placements need solid guidance and frameworks for managing and working with communities where sometimes people don’t get on or choose to be and particularly where were a very different power balance elements at play due to differing physical and mental health needs and differences of dependencies – dislike can lead to bullying within the environment if it is not addressed.

Bullying is about power differentials. That doesn’t cease to exist when we leave the playground or the workplace. It is the unfortunate aspect of community building and the human condition and it can’t and mustn’t be swept under the carpet.

One day I want to see the same resources, organisations and policies around bullying within care homes and sheltered housing communities as exist around bullying in schools.

Podcasts and Social Work

I’ve found it hard to locate useful podcasts at times. As you may have noticed, I added an ‘audio resources’ tab to my blog yesterday. I wanted to explain a bit about it today.

I  listen to the Social Work Podcast but it has an obvious US bent. I do enjoy the different perspectives it gives though and would recommend giving it a go.

I have found some useful predominantly UK-based resources and have to share them!

The Institute of Psychiatry has some excellent debates and lectures available to download.

Earlier this week, I listened to the lecture about ‘How Mental Health Law discriminates unfairly against people with mental illness’ and I can’t recommend it highly enough.  The lecturer compared some of the tenets and assumptions made about compulsory treatment under the Mental Health Act with similar cases regarding physical illness under the Mental Capacity Act and came up with some thoughtful conclusions. I’d definitely recommend anyone who works with compulsion under the Act to listen.

I also listened to the debate ‘Capitalism Cares – This house believes the NHS mental health services should not fear the private sector’. I know which side I come down on but it was really useful listening to the old-style debate format for a subject that is very topical and fascinating.

I hope to work my way through the ‘back catalogue’ of IoP (Institute of Psychiatry) podcasts and I think anyone with even a passing interest in mental health at any level would find something that is interesting and useful there.

Not least, I’ve noticed an interesting sounding ‘Mental Health Social Work’ event which was recorded back in 2007.

I have occasionally attended public events at LSE and they have some great podcasts which tend to, unsurprisingly, have a broader focus on social policy, politics, economics and sociology but they are a great way of picking up a wider understanding of the context of world politics.

IRISS (Institute for Research and Innovation in Social Sciences) is a Scottish organisation and they also podcast some of their events and debates. I see they have a series up about personalisation in Scotland – I haven’t listened to those but I did find Lena Domenelli’s lecture about Culturally Competent Social Work really useful.

There are others than I’ll add to and I’ll put on my ‘Audio Resources’ page. If you listen to any podcasts that you find useful, let me know so I can continue to add to the list!

I’m also trying to develop my own podcast at the moment which will be primarily about social work practice in the UK. I may be asking for guests and interviews soon but at the moment, I’m just trying to work out how identifiable my voice is and how to audio edit files but very happy to take suggestions.

Thanks

When Teenage Meets Old Age – Review

Generally, I tend not to watch anything that might be deemed to be ‘work-related’ but last night I sat down to watch ‘When Teenage Meets Old Age’ on BBC2 (available  on the iPlayer).

It’s only the first of a three-part series and the idea was pretty much evident from the title.

The programme focussed on four young people who went to work in a retirement village (which seems to be a mix between sheltered housing with a sheltered/nursing home on site) and tried to challenge intergenerational perceptions.

I am not sure if the generational divide is larger now than it ever has been. I have my doubts but I do think that intergenerational work can be neglected just as, in their different ways, younger people and older people are marginalised by a society that focuses on the ‘majority’.

I also watched through the eyes of my own recollections and attitudes to age when I was younger. By the time I was 18, all my grandparents had died. When I was 20, I first worked in residential care with older adults.

I remember, as the programme highlighted, my utter embarrassment at having to do personal care for an adult – having to help someone who was naked in the shower to wash and confronting the look of an older body.

The programme related some of this discomfort. It was clear that the residents had given consent to the programme being made but I did feel a little uncomfortable at the nature of some of the filming. It didn’t seem prurient though. I think it was important that the nature of care work was presented as it is and the reality of embarrassment on both sides is definitely a reality.

One of the most important things, as I suppose would be self-evident in a programme like this, was that there was a feeling of difference between the older adults and younger adults. Although the focus of the programme initially seemed to be about how the younger adults coped and managed, presenting the older adults as the ‘guinea pigs’, as the programme went on there was more of an effort to get to know the individuals masked behind the older skin. Who they were and who they had been. They had equally fixed perceptions of ‘young people’ and the attitudes on both sides became more open and understanding as they got to know each other.

There were some really touching moments as some of the attitudes were being worn down. I had a theory that working with older adults is not valued because age isn’t valued in our society. This was an interesting attempt to broaden out understanding  of age –  both younger and older people – to a wider level. Yes, it can be frightening to see what age does to the mind and body but it isn’t something we can run away from however much we might like to. The young people they chose were all enthusiastic and wanting to do well. That helped, of course. I want to know how they get on because I want them to succeed.

Last week, I visited a care home and I saw a picture board of all the residents. It had not only their names but their previous professions and some words about favourite things/experiences.  The reason it was there, the manager told me, was so the staff saw the residents as individuals and people who had lives, aspirations and hopes.

The programme seemed to take us through this to learn about the people who live and need residential care. We understand the people that they were as well as the people that they are. I think that is one of the most important things to remember in care work and any work actually – a respect of the individual, their experiences and their hopes. One of the reasons I rail against some of the forms and documents we need for the individual budgets is that I feel they have not been designed for older people – because the agenda was and is being driven from the experiences of adults of working age.

Some of the challenges when working in residential care can be about personal relationships and reactions to people. Sometimes you just get on better on a personality level with some people than others. It can be hard to accept that at first when you have to provide an equal service and it’s the same in my current job. I can’t deny that I like some of the service users I work with more than others. The realisation that you can’t differentiate levels of care between people you like and dislike is one of the most important lessons to be learnt. One of the younger women told the camera that she just didn’t like one of the older women that much – because she felt that the older woman didn’t like her. A fair point actually. I think it did raise the issue of personal attitudes and preferences. We don’t cease to be swayed by personal responses to people but the aim is to work through them and ensure they don’t affect professional practice.

Equally, there has to be the counter-understanding that some care staff will be liked more than others. When things ‘match up’ the ideal outcome is reached  but would you like someone who you don’t get on with to be washing you? For many older and disabled people, that is a reality and there is little choice in residential care when staff are rota’d.

You could claim that in the ‘new world’ of personalisation there is more choice but that choice tends to be open to those who are able to choose. It certainly isn’t as open in residential care and hospital settings.

The next parts of the programme will be looking at some of the older adults being taken out of the village by the younger adults to enjoy different activities.

I realise that I’m not the target audience for the makers of programmes like these. I have worked with older adults for a while. I do think anything that presents older adults and moreover disabled and dependent older adults as individuals with histories, likes and dislikes is a positive.

I’ll watch the next episodes to see how the people in the programme get on because I want to know.

For me, working in a residential home at 20 provided the route into a profession that I would never have imagined for myself at that age.

One of the sadnesses that I felt when I watched though was about the lack of intergenerational work that takes place now – and the dichotomous split that seems to be absolute between childrens’ services and adults services in social work. It’s as if adulthood is not seen in the context of childhood and vice versa except where there are other disabilities when ‘transitions’ teams exist.

Unfortunately, now, among the cuts and ravages of the Comprehensive Spending Review, is not the time to be proposing new projects when everything around us is being cut but it would be good to think in the future that the gap between generations could be closed with a bit more effort and understanding from both sides and a bit of encouragement from those of us in the middle.

Weekend Links 6

As usual at the weekend now, I’ll just run through some posts that have caught my attention over the week relating specifically to social work and social care.

Hessian Pepper at The Small Places has a wonderfully useful summary and commentary on the MIG and MEG Court of Protection judgement which raises a number of questions about the definition of a Deprivation of Liberty. I would strongly advise anyone concerned with the Mental Capacity Act to follow his/her blog because I’m finding it a great resource!  Another great legal resource which has a broader remit but is a fascinating and useful read is the UK Human Rights Blog.

On How Not to Do Social Work,  there are thoughts and reflections on the transition into legal adulthood as an 18th birthday looms.

Social Worker-to-Be (who isn’t a ‘to-be’ anymore!) tells us about her first weeks as a Newly Qualified Social Worker.

SocialJerk deconstructs some of the toys she (um.. her clients?) use. Fantastic stuff. I quite like stuffed animals myself but they might not demonstrate some of the ‘interactions’ as well and anyway, I’m not the best at passing toy judgement!

Kyrss on The New Social Worker Blog had an interesting idea of writing a ‘Valentine Letter’ to ‘Social Work’. I’m not sure might would have been so poetic.

At Always Something to Complain About, the focus is on paperwork and it’s clear that some issues really are truly international.

Malcolm Payne at St Christopher’s Blog has a fascinating post about the Ombudsman Report into End of Life Care that was published this week from a perspective of a Palliative Care Practitioner.

Nancy Smyth at Virtual Connections has a fantastic post about using therapists using social media with trauma survivors. It’s a really interesting perspective and  as social media becomes increasingly a part of the mainstream ‘life’ we live, we do have to think about how it is used at work.

Another interesting post is the ‘Behind the Scenes at the Social Work Podcast’ episode and interview with the founder. As I’m thinking and planning a podcast myself, I’ve found it very timely.  My respect has increased no end after trying to edit even 5 minutes of audio myself last weekend!

Finally, on a lighter note, Jontybabe tells us 5 things that make her feel good..

And in that spirit, here are my five (excluding the obvious family and friends!)

1. Waking up on a Saturday Morning and realising you have a full weekend ahead.

2. A good novel that you can’t put down

3. Chocolate. Any form really (although I was too scared to try Marmite Chocolate so that might have to be qualified – now why did I never think about a Chocolate Blog.. oops, getting distracted).

4. Travelling to a new places

5. Learning new things.

Making Work Pay – Thoughts on the Welfare Reform Bill

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Yesterday Iain Duncan Smith unveiled his ‘flagship’ welfare reform bill amid much nodding and clapping on the part of the government. He was, he declared, going to end the ‘benefit culture’ and ensure that work pays.

There is something disconcerting  in the tone of IDS’ statement. It seems obvious to assume that work should be something that is a default option but I still find it hard to understand the emphasis on ‘the feckless’ and ‘the idle’.

To try and shame and insult people into work when there is no work to be had seems particularly callous.

I don’t have any moral problems with the changes to a universal benefit type system incidently. The current system does need reform and there are always changes and improvements that can be made but there are a couple of elements of this Bill that I feel particularly strongly about.

As anyone who has worked alongside me can confirm, knowledge of benefits is not my forte’. We have a team in the council (for the moment, very likely to be cut) to whom we refer people who we feel might not be getting as much as they should. Note that, because it’s crucial and absolutely shapes my ‘real life’ knowledge of benefits. That’s PEOPLE WHO ARE UNDERCLAIMING.

And yes, there are many whom I have come across over the years.

But back to the main points of the Bill announced – the BBC list the main changes as being

  • A single universal credit to come into force in 2013
  • Tax changes to enable people to keep more income
  • Changes to the disability living allowance
  • More details of the back-to-work programme
  • Those refusing to work facing a maximum three-year loss of benefits
  • Annual benefit cap of about £26,000 per family
  • Review of sickness absence levels

The first two elements are fairly  uncontroversial.

Changes to the disability living allowance

Changes in the disability living allowance is anything but.  publication of changes in the DLA and referring to the Personal Independence Payment (PiP)  in the Part 4 of the Welfare Reform Bill seems to run counter intuitively to the fact that the actual DLA consultation ends today – you know, the day AFTER the publication of this bill. I wonder how much there actually is to consult on.

There is a little subsection about ‘persons of pensionable age’ which confirms their exclusion (as is currently the case) but I read it as meaning that there will be a change in that currently if you receive DLA prior to 65 (or equivalent pensionable age) you continue to receive DLA (Which is higher than the ‘over 65’ benefit ( Attendance Allowance). It seems that this will stop and all PiP will stop at pensionable age (which, of course, will be above 65 in the future).

This will mean a potential significant disadvantage to those who are disabled prior to their pensionable age.

DLA will also be removed from those who are not resident in the UK which I assume will affect some of those who currently claim within the EU. That has been taken away.

I am not expert at reading legislation but that’s how I  have read it. There are few details but then again, the consultation on the change between the DLA and the PiP is still in progress as this Bill has been published.

More details of the back-to-work programme

There are going to be four categories of ‘work related activity’ specified  required of claimants who are unemployed.

Work focused interview requirement, Work preparation requirement, Work search requirement and work availability requirement. I won’t go into the details of these because they are available on the DWP website.

More interesting, I found to be the four groups of people and what would be required of them in order to be paid their universal credit.

So there would be those with:-

‘No work-related requirement’

This will be applied if the claimant ‘has limited capacity for work’ – which is yet to be determined – probably by a private company like ATOS. If they have ‘regular and substantial’ caring responsibilities for ‘a severely disabled person’. I have only to listen to the government spokespeople and wonder about definitions.  If they are the main carer for a child under 1 or meet ‘other conditions’ which are not specified but obviously given the framing of the legislation some flexibility.

‘A work focused interview requirement only’

This is specified for a main carer of a child between 1 and 3.

‘A work preparation and interview requirement’

This is specified both for carers of children aged 4-5 as well as others who may have limits to their ability to work.  This is the part, that, for example, includes a ‘health assessment’.  It also includes taking part in employment programmes.

‘All work-related requirements’

Fairly self evident and that’s everyone else.

Those refusing to work facing a maximum three-year loss of benefits

Sanctions are to be imposed if the work-related requirements are not met.  These are set out in 26(1) (chap 2) of the Bill.

So basically if someone fails to apply for a specific vacancy that might be suitable (lots of scope for interpretation here), doesn’t take up a specific job offered or is sacked (because of misconduct) or resigns from a job – ‘with no good reason’.

Currently sanctions apply in some of these cases but the main difference is the length of time that they may apply.

I do wonder who this is meant to punish and am concerned particularly about the effect it may have on children who are dependent on their parents for income.

Annual benefit cap of about £26,000 per family

The benefit cap remains associated with a family rather than listed per individual. I wonder if this links with Mr Duncan Smith and his ilks’ promotion of marriage..

Personally, I’m very uncomfortable with the idea of a specific benefit cap because families come in all sizes and with many different needs. Yes, disability benefits are going to be excluded from the cap but it is important to remember that disability benefits are going to be reduced substantially (at least 20%) in any case.

As a Londoner, living in one of the highest cost cities in the world, it also doesn’t make sense to me that a blanket cap be placed nationally with no thought to the different costs of living in different areas. I’m not saying that £26,000 isn’t a fair whack. Of course it is, the figure is based on national average earnings, but, and this is a bit but, we are not all uniform in our needs and costs.

A definite benefit cap seems more about deterring some of the front page stories in the Daily Mail about ‘scroungers’ rather than a real chance to get to grips with defining and working on need.

Review of sickness absence levels

Cameron and his proxy Iain Duncan Smith, also announced a ‘war on sick note Britain’.

I suppose this is the relation to ESA (Employment and Support Allowance) which is replaced the previous ‘Incapacity Benefit’ and is given to claimants who are unable to work due to illness or disability.

(Note – DLA is NOT an out of work benefit – it is non-means tested and it given in relation to meeting additional costs related to the disability itself – hence it allows a lot of people to continue to work – it’s a bit of a red herring to stick it in with all of the work-related benefits here).

For ESA, the government are reducing the people that a contributory (generally higher) rate is paid to one year only. This will significantly affect people who have long term illnesses and disabilities.

The ESA claimants who are in the work-related stream will be subject to the same work-related requirements as detailed above.

I have no doubt that there are many details that I’ve missed. This is just a precursory glance at the Bill and some of the writing around it this morning.

While there are elements that need to change the focus on a deserving and undeserving claimant does not credit to our society.

The victimisation and ostracisation of people who cannot work or cannot find work particularly in a climate of rising unemployment creates the potential of a much larger underclass and people who feel they have no stake in the future.

It doesn’t help that the cabinet that introduce this legisalation is very much one of privilege that have never known and understood hardship and the desperation that comes from not being able to find work when you really do want and need to.

No, they can buy their own children internships..

This creates more of a dichotomous state.

Us v Them

Rich v Poor

Deserving v Undeserving

There has to be a better way to live than to punish, force and shame people into work.

Press, Perception and the Court of Protection

Having had to study the Mental Capacity Act in fairly great detail, I often have to turn to judgements made by the Court of Protection to extend my general legislative knowledge.

The Court of Protection has a number of functions that can get easily interwoven but generally, it makes judgements about issues of capacity.

It’s always interesting to me how the press report Court of Protection judgements as in general the court sits in private . It isn’t thought of very highly by the press – probably for the very reason that many of the cases take place behind closed doors – which is particularly unusual for a court in the UK. Indeed, it’s traditional journalistic byline seems to be ‘the-secretive-court-of-protection’.

There was a case this week which was heard which involved a pregnant woman with learning disabilities and a decision which was to be made as to whether she should be subjected to a sterilisation following the imminent birth of her child. It is very emotive and difficult as an ethical subject.

The Court decided, unusually, to open up the case to the media with the usual and understandable constraints of anonymising the parties.

What I found interesting was a comparison of reporting about the story before the case was heard and afterwards.

The Daily Mail is a case in point. On Tuesday Morning it published this piece.

They quote a spokesperson for Mencap

David Congdon, of disability charity Mencap, urged the court to ‘tread very carefully.’ He said: ‘It is a gross invasion of someone’s basic rights unless there are clear medical grounds and there do not appear to be in this case.

‘Using sterilisation as a form of contraception is totally unacceptable.

‘Years ago there were lots of cases like this but we hear of very few these days.’

Applications to sterilise women with learning difficulties can come from local authorities and do not require the backing of their families, he said.

‘The family’s position in these issues is not that great, because the person is an adult,’ he added.

‘They have to be consulted, but the application may have been made by social services.’

I can’t say I disagree with Congdon, it is a massive potential infringement of human rights to forcibly sterilise anyone but the weighting in the quote implies that the court disregards the family and it is a cunning and devious decision made by social services. Regardless of the fact that it is a medical procedure and any application would have to be made by the Trust employing the medics who would be responsible for carrying out the task.

The Telegraph use the same quote. As does the Independent which adds

Since the Independent’s battle to open up the Court of Protection, the paper has received numerous calls from people who allege that local authorities have been using the automatic secrecy governing the Court of Protection to severely restrict access to their loved ones. Because the hearings are largely held in private and no court listings are generally published earlier than the afternoon before hearings, it remains difficult to investigate and analyse such allegations.

You see, it’s easy to make one-sided complaints about a Court or a local authority when you only have a part of the story.

It’s easy to accuse ‘social services’ of being overbearing and evil when they are not able to construct any kind of counter-argument for the sake of the service users they represent. I say this having been involved personally in a case which could have been presented in a very one-sided way and would have been prime meat for the front cover of The Daily Mail – however the background of abuse within the family meant that what might have appeared to be callous actions had to be taken. We could never disclose that so would never have been able to defend ourselves.

But back to the secretive Court of Protection. The judgement or lack of it came yesterday as more information about the case was revealed.

It so happens that the woman’s mother was in favour of the sterilisation of her daughter. This is not a situation where the family have been side-lined by any means.

As the Mail put it yesterday

The woman, known only as Mrs P, broke down as she explained the drastic procedure was the only way to spare her 21-year-old daughter the heartache of having further children and being forced to give them up for adoption.

The daughter, known as P, already has one young son and is due to give birth to a girl today by caesarean section.

She was described as ‘sexually healthy and active’ but unable either to exercise restraint, or fully to comprehend the consequences of her behaviour.

Her mother told the Court of Protection that while her family would support these two children, they could not cope with any more.

She said: ‘I want the best for my daughter. We want to keep the children together as a family unit. But obviously we can’t keep on supporting more and more children.

Not really the evil social services taking action behind the backs of families that might have been implied the day earlier from the reporting.

It is an incredibly difficult decision to be made and as it happened, no decision and therefore no sterilisation order was made. The judge, ordered that at present there was no sufficient evidence to meet the criteria for such a drastic action under the Mental Capacity Act and while the best time to perform the sterilisation would have been at the time of the caesarean (which I believe was to take place this week), further hearings will happen over the next few months before a final decision can be made.

Clearly it is not a body that makes heartless and unconsidered judgements for the sake of it and loathe though I am to wander into the comment sections of Daily Mail stories, the difference between tone in the first story where the situation had been set up and has comments such as

‘All those in favor please show us your Nazi membership card as this is exactly what they did, So be very very carefull, many alive now do not understand the implications of what is potentialy a dangerous and devastating and far reaching precedent bought on by these council jobsworths. ‘

And

‘OMG, my blood is boiling reading this tragic story. What right do the council have to do this? How severe are this woman’s learning difficulties? Why not give her a contraceptive jab every 6 months, given at home if need be? Are social services and a representative of the secretive family court going to be present at the birth of the baby, whisk the baby away as soon as it is born and put up for adoption? If this is given the go ahead by the judge and forced sterilisation takes place, this is just the start. We will have crossed a line and the ‘Brave New World’ will begin. ‘

I know the Daily Mail comment section is not the place to look for rational argument and debate but we get a feel of the general perception that this is somehow a ‘council decision’.

After the information is shared in the second article, the tone of the comments change to

It’s sad but i have to agree with the mother. I think she has a very valid point. She will be looking after the children and it will break the WHOLE family’s heart should they have to give up any children for adoption. Also what happens if she falls pregnant every year till she can’t have any more children. The daughter clearly does not understand the situation because of her disability.

And

Unfortunately due to the Human Rights Act, this mother’s desperate plea will be ignored despite the emotional, psychological and physical turmoil this young girl will go through again and the stress and pain for her family. Very sad situation for everybody involved including the unborn baby.

Please don’t assume that I am ‘in favour’ of the sterilisation as a matter of course. I’m not but I do think the decision is absolutely taking place in the right arena where the considerations of P and her family need to be wholly taken into account under the law.

It’s just easy to see, in this case, how easy public perception and tone can be altered by reporting styles and language.

Scrutiny, CQC and ADASS

Yesterday, I read on the Community Care website that ADASS (Association of Directors of Adult Social Services.. and Housing Departments or whatever else they direct these days) are seeking a meeting with the CQC (Care Quality Commission) about

‘a new ratings system for providers will reduce scrutiny of services, to the detriment of users.’

I see a problem.

This is Adass’ (I’m not sure where you put apostrophes on acronyms.. ) response to the government’s consultation document ‘Transparency in Outcomes – A Framework for Adult Social Care’. I’m glad I came across this article because the consultation had completely passed me by.

This is a part of the government’s push from measuring targets to measuring outcomes. I remain more than a little sceptical regarding the measurements used in these systems and neither seem to devote much credit to quality over quantity and cost of support.

According to Community Care

The government has proposed replacing the quality ratings system, under which the CQC graded all registered providers as poor, adequate, good or outstanding, with a voluntary “excellence standard” for the best providers, in consultative plans to overhaul the adult care performance system.

The article goes on to quote Adass saying that this

‘”could be particularly disadvantageous to self-funders and people using personal budgets to arrange their own support, particularly as this new system does not distinguish between ‘adequate’ and ‘better than adequate’ service or between ‘good’ and ‘excellent’ service.”

It warned that the system may also favour larger providers that had the financial muscle to apply for an excellence rating, and may lead councils to increase their own monitoring processes, increasing costs.

Quality ratings were scrapped last August, but Adass warned: “Further we are concerned that there is no timeline, implementation plan or agreement about how this system will operate.”

So we are currently in a period where ratings have been scrapped and they have not been replaced – meaning that there is no quick, easy and current way to check the standards are being met or exceeded by care services. The system intended to replace the previous one is reliant on voluntary standards which will be easier for large companies to achieve to the detriment of smaller providers.

More costs are being pushed from the CQC and the ‘central pot’ towards local government and quality assurance teams which are being cut (certainly in my own borough) due to central government cuts.

You know those ‘back office staff’, and ‘non frontline staff’, Mr Pickles? Those were the people who were checking on the quality of the services provided to your proverbial grandmother.  Why did they need to check so much? Because the CQC is a shadow of what it should be and has had all funding removed and is no longer fit for purpose and reliant on voluntary systems of regulation.

Would OFSTED be allowed to operate in this manner and haphazardly decide that they only wanted to check children’s services when they felt like it or when they fail? Or you know, that school should be ok because it hasn’t been so bad as to be reported to us? No, we demand more for our children so why don’t we demand as much for our older and disabled citizens who need  more regulation not less.

The government pushes direct payments and personal budgets but washes her hands of any regulatory support to promote quality. They are gearing up a system that will be heavily favouring large companies like Care UK – you know, the organisation that funded Lansley’s private office and is geared up towards taking over whole swathes of the NHS.

Even if you think you have no interest in adult care, you would be wise to listen and learn to the Cassandras like myself who constantly shout while the regulatory body is being stripped away.

This is exactly the way the government want to take the entire NHS.

We must learn from these lessons and not be fooled by the language of choice. Choice has to be a choice of quality rather than solely cost. Often the two are not the same. That has been the lesson of the deregulation of care services.