Chief Social Worker?

A couple of days ago, I noted a that BASW issued a press release stating that their ‘chief social worker plans gain tentative ministerial support’.

BASW (British Association of Social Workers)  have been lobbying for changes in the Health and Social Care Bill to establish, among other things, the position of a ‘Chief Social Worker’.

I have to say I feel more than a little uncomfortable about this proposal. Perhaps it’s because I don’t understand it but I really don’t see how a ‘Chief Social Worker’ position would fit in to the government advisory framework. Perhaps it is a matter that the status issue troubles me. I don’t think we, as a profession and a young profession at that, need to ape the medical model of having a ‘Chief Medical Officer’ or a ‘Chief Nursing Officer’. We have a completely different function and work to different demands. I don’t want social work to become a profession that needs to ape and mimic others figuratively shouting ‘me too.. me too’ and waving its presence in the face of ministers.  One of the criticisms of the medical models is the hierarchical natures of some of their professionals frameworks and if the proposals of the Social Work Reform Board are to take shape, there are going to be more creative and exciting ways to progress as a frontline practitioner other than management. But this position through the name and nature of the role seems to want to perpetuate hierarchy.

A Chief Social Worker would invariably come from a background of working with children as that is where the public perception of social work traditionally lies and possibly where the most ‘media interest’ lies. How would they be able to comment on issues affecting other service user groups with any authority? Would we need three Chief Social Workers? One for Children and Families, one for Adult Services and One for Mental Health Services? If no, who gets the ‘top job’? I think it is a testament to the death of generic social work that I am even able to ask that question but it is an important question to me as already it feels that social work in adult services and mental health is somewhat marginalised. To me, this one position would do so even more.

Is there a ‘Chief Teacher’? Is there a ‘Chief Occupational Therapist’? I’m asking because genuinely I don’t know. I don’t think there are but could be wrong.  I actually see social work as far more closely allied to those professions in lots of ways than doctors and nurses and fail completely to understand how having a single identifiable officer would help.

I understood that a part of the remit of the College of Social Work, when it is established, will be to provide a conduit of communication between the government and the profession. Far better, in my mind, to have a board structure with a group of social workers with wider ranges of expertise than to have one identifiable ‘Chief Social Worker’.

Maybe I’m completely missing the point – it wouldn’t be the first time – so please do comment and tell me why I’m wrong in my scepticism at this role.

Social Work is a plural profession. Social Work is not only practiced in the public statutory sector. I would feel that it is a way of fragmented the profession further to place one ‘sector’ above others in the implementation of this role but I accept that I am one front-line practitioner who has infinitely less experience than those making these proposals. I just want to know how I would benefit from there being a Chief Social Worker and how it would help me in my practice.

I think that by begging for crumbs from Parliament we are approaching the need for the profession to grow in the wrong way. We need bottom up growth, confidence and development much more than top down legislation. For Social Work to gain the respect that we would like it to, we need to take action and support those coming into the profession to grow, be strong and to support and weed out poor front line management which instils poor values and habits and burns out enthusiastic entrants to the profession.

Social Work would have better media coverage if social workers were better supported in the entry level position and given support way beyond the first year of practice in developing more skills and being allowed to advocate and advance the cause of users of social services rather than being turned into Performance Indicator Drones. I don’t deny my own responsibility in that. I have spent the last couple of weeks madly trying to catch up with the end of financial year targets personally.

What we need to do is to draw on the idealism that we felt when we started our social work training and went through university because almost all social work students feel that. We need to think back on those wishes, hopes and dreams we had of really advocating, working to needs-led agendas and on strengths-based models with and alongside users and remotivate ourselves and re-energise our profession rather than rely on those who left the frontline behind years ago to do it for us.

Yes, it takes time. Yes, it takes effort.  But it needs collective action of more of the ‘social workers like me’ to stand up and ‘be counted’. To involve ourselves in the organisations that claim to speak for us and explain why we do what we do and how our employers might help or hinder us when we do this.

For me, one of the great failings of BASW is on the local level in London (I know there are active local groups around the country) . Perhaps now is a time for local support groups of social workers to form and provide peer support for each other outside the ‘organisation’ and between ourselves. We see the growth of user support groups and carer groups. How about professional support groups – we are busy people and they don’t have to take place in a physical sense but think how useful it might be to  have a resource of cross-authority or cross-borough local social workers to talk about issues affecting the profession outside the banner of a ‘membership’ organisation.  We have opportunities to make connections and build ideas now that never existed in the past.

Grassroots – that’s the way to go.

So I’m asking you two things. Firstly, have I completely missed the point of a ‘Chief Social Worker’? and if so, tell me because I genuinely want to know.

Secondly – would you be interested in a network of local social workers to support each other – not related to cases or management issues – confidentiality is a big issue – but in looking at ways that we can affect the profession in a ground up way.

I have a feeling that might be an idea I come back to.

The State of Healthcare and Adult Social Care in England – a brief glance and thoughts

Yesterday the CQC published their report ‘The State of Healthcare and Adult Social Care in England’.

I have to try and put my criticisms of the CQC and their increasingly lax regulatory process to one side, although I couldn’t help a snigger when they claimed in their statement on the front page of the report to ‘Act swiftly to eliminate poor quality care’. Not exactly my experience when they rely on members of the public to actually alert them to poor quality care rather than carry out their own random and regular ‘on the ground’ inspections but it is the only report we have and there are some useful pointers in it.

The CQC inspection remit is very broad and obviously the quality of their inspections vary.  This report relates specifically to the 2009/10 year.

The report covers four distinct areas – safe care, choice and control, person-centred services and standards of care. All the areas are very broad in their scope.

In summarising the report, I’ll look at it in those same areas and highlight some of the issues that arise.  I will also focus on the areas in which I have a particular interest – namely adult social care and mental  health but there are lots of pointers and lessons for healthcare outside this remit – I just don’t have time to comment on them all!

Safe Care

This covers physical safety such as safety from infection risks as well as safety from neglect and abuse.

The first ‘headline figure’ that the CQC lauds is that 80% of care homes met ‘safe working practice standards’. It does make you wonder about the other 20% though and add this to the fact that this is a self-reporting standard.  Those care homes which met the ‘medication’ standard were 72% for older adults compared to 79% for adults under 65. I wonder what the variation would tell us about the different ways of management and attitudes towards older adults.

In the ‘maintaining dignity and care’ standard which includes responses by local authorities to safeguarding alerts, there was a growth in ‘better’ outcomes as there was an increase in local authorities performing ‘well’ as opposed to adequately (from 89 to 113). There were still 3 LAs performing poorly though on this fundamental duty. Unfortunately they aren’t named.

Safeguarding alerts increased over a third to 103,030 nationally across all client groups but the largest part of these referrals came in relation to older adults. No surprise there. No surprise at the increase either if you’ve been working in adult social care. We’ve noticed a real tightening up of the procedures and ways that we report and investigation abuse allegations.  There was though a significant increase in the reports relating to adults with mental  health problems (up 34% – same as older adults).

CMHTs

There was a fairly low response rate for users of Community Mental Health Team services (17,000 patients in all).  Only a third were asked about physical health needs over the last year. I suppose I have a slightly different attitude as in an older adult’s CMHT we have a lot more interplay between physical and mental health so it’s something that might be more obvious for us to discuss.

Surprisingly only 56% of users had an out of hours telephone number to use.

MHA detentions

There was a large increase in detentions under the Mental Health Act over the last year and the CQC report that only 21% of wards visited met the Royal College of Psychiatrists recommended 85% occupancy rate.  29% were over-occupied and 7% had a 125% occupancy rate.  I’m not surprised by this. My own experience is that wards are closing at a fairly rapid rate and have been over the last couple of years. They cost a lot of money. This will get far worse and it is worth holding Trusts to account over this. I hope the CQC does this.

Choice and Control

This banner is about increased knowledge for users about options available to them as well as greater use of personal budgets to choose care needs and use of advocacy services as well to promote choice.

The number of residential care home places fell but the numbers of nursing home places rose nationally and particularly there has been a growth in provision of places for people with dementia. This is patchy at best across the country with the highest proportion of additional beds in the North East and the lowest in the South West.

I was concerned that the base figures of people on personal budgets was the indicator of how ‘good’ a council was at providing choice. My experience of implementing personal budgets is that all too often it seems like an empty ‘paper exercise’ in upping the councils’ figures for surveys such as this rather than a real and concerted change in mentality towards providing choice to those who require additional professional support to seize more ‘creative’ outcomes.

According to the report, which remember is dated 2009/10, only 3 councils are proposing to increase their eligibility criteria for services this coming year from substantial to critical and one was planning on reducing the eligibility criteria from substantial to moderate. I find that really hard to believe but figures are figures.

In relation to mental health service users, 48% of users said they definitely understood what was in their care plan. That’s a fairly shoddy figure!  And 53% felt that their views had definitely been taken into account when putting together care plans. Perhaps we can see some of the potential difficulties for self-directed support in mental  health arena when these figures are already so low but it is important to note that the low response rate of users is possibily another variant.

Regarding medication and information about medication 29% of respondents said they were not told about the side effects of medications that they were on.

Regarding inpatients both those detained under the Mental Health Act and those ‘voluntary’ patients, the CQC identified that the hospitals had been increasingly focused on security and ‘rules’ and that, more worryingly, more ‘voluntary’ patients were being held on locked wards and potentially were being deprived of their liberty.  The report mentions that they were held neither under the Mental Health Act nor the Deprivation of Liberty Safeguards but the use of the Deprivation of Liberty Safeguards in psychiatric hospitals is generally not done. It may and should lead to a greater number of patients detained under the Mental Health Act for their own protection. I wonder if there will be any affect on numbers from this report.

Person-centred Services

A couple of interesting trends to pick up in this section which will no doubt, be a sign for the future. Firstly that less people as a whole accessed community care services – a fall by 4.7% from the previous year (that’s 83,930 fewer people). The report suggests that in the face of research showing an ageing population, it could be due to increasingly stringent application of criteria for assistance. Add this to the fact that people who benefited from help from grant-funded organisations (often those people who fall short of meeting the council ‘criteria’) also fell, there is a potential for a large unrecorded unmet need to be ‘falling through the gaps’ in service provision between the statutory and the third sectors.

Generally though there was satisfaction with the way that assessments were picked up and the involvement that people had in planning services.

The provision of telecare has grown over the last year, again, unsurprisingly – and I expect it will grow for many years to come and technology and care overlap in  more creative ways.

Demand for the provision of ‘extra-care’ sheltered housing – which is sheltered housing with additional care services attached – was growing, sometimes beyond the provision of some local authorities. I see this as a potentially massive growth area and am often frustrated by a lack of provisioning particularly for those with mental health as well as physical  health needs. If I were to be able to approach our commissioners with any one piece of information it would be that.

Worryingly only a quarter of councils demonstrated a strength in supporting people with complex needs and only seven displayed a strength in specialist services.

Regarding services for carers, there has been a large increase in carers taking up direct payments. This reflects my own personal experience as I have done a lot more carers direct payments this year and this amount grows every year however,  the report worrying raises issues regarding money which was provided to improve the outcome for carers and was not ring-fenced and wonders aloud where this money might have gone. Sign of the times with the elimination of ring-fenced funding.

Standards of Care and Support

It’s interesting that the CQC explain how they judge that a care service is of a good quality or not. Their ‘evidence base’ is interviews of providers and users of services, information given to the CQC by the service, surveys given to staff, users and professionals (I have only once ever received such a survey),  a key inspection (how often? Announced? I know a lot of services that haven’t been inspected for over a year), and information held about the history of a service.

My scepticism shines through because some services can ‘game’ the systems by having all the information required by the CQC written up perfectly but how they perform on simple human care levels differs enormously. I strongly believe that frequently (at least twice-yearly) unannounced thorough inspections are the way to truly judge quality.

Unsurprisingly the highest quantity of top level ‘excellent’ services were provided by the voluntary sector and the local authority. Private providers lagged behind. A sign of the times, perhaps as the government pushes the purchaser/provider split into the health service. Look to the care sector and be warned.  Today it’s the care homes for your parents and grandparents. Tomorrow it will be your hospital services for you and your children. Perhaps then, we as a society, will care more.

Smaller care homes were more likely to be judged highly than larger care homes.  Care homes for younger adults were more likely to be judged highly than care homes for older adults. No surprises here. But anger, a lot of anger. It’s about money, of course and there is less money available for the provision of care for older adults on a per capita basis. So larger homes and poorer quality care is the message given to providers.

The problem as well is the way that ‘good’ and ‘excellent’ are defined by the CQC as well though. I know poor ‘good’ homes and great ‘adequate’ homes. That was always the failing of the ‘star’ system but worse, to have no system at all and out of date ‘stars’ still on the website to give  a wholly inaccurate view of what the level of care is like at any given home. The CQC should be ashamed of the way they have destroyed robust and transparent  regulation and the previous government should be ashamed of how they allowed this to happen.

Finally and perhaps one of the most telling figures to take from the entire report is the one in the final sentence of the last page.

Only 16% of councils demonstrated low absence and vacancy rates and high recruitment and retention rates, which confirmed staffing issues continued to be an issue for 2009/10.

We can only imagine what the effect will be on these figures for 2010/11.

Or 2011/12.

The use of these reports is that it brings to life the importance work that is done in local authorities and the effect that good quality support and provision has on peoples’ lives. Yes, of course service provision is essential and too frequently, commissioners are detached to an infinite level so they have little idea about what is needed ‘on the ground’ but often to, it is the human contact, the ‘being listened to’ and having views acknowledged that also makes a difference and that is dependent on quality staffing, quality training and having the time to spend with people.

My own experience in a pushed, under-staffed team is that I am spending less time instead of more time with people as I chase from emergency to emergency and the outcomes for those people who would otherwise had more intensive face to face contact is falling. This leads to sharper deteriorations, more likely readmissions or admissions to hospital that could have been prevented and eventually higher costs.

But with councils and NHS Trusts looking towards the immediate cost cutting of the next year and not at the longer term costs in 5, 10 years, this is the way we will go.

We shouldn’t be satisfied with delivering lower quality care. We aren’t. We need to speak up and speak loud and build links actively with user groups and carer groups and other professional groups to ensure that the government never forgot whom exactly they are betraying and to remind them over and over again that we aren’t going away.

Dementia Screening

Histopathogic image of senile plaques seen in ...

Image via Wikipedia

I wrote up some reflections and thoughts about my time at the Rally and March on Saturday for Community Care and my piece can be read here.

I also wanted to comment about the proposal that the Alzheimer’s Society suggested that everyone over 75 is screened by their GP for dementia. I can see where they are coming from – there certainly needs to be a greater awareness but honestly, I’m not sure if this is the answer.

The idea of the screening is for the GP to offer a type of MMSE (mini mental state examination) test and to have a discussion with a family member/friend in conjunction with this.

Whilst I agree that awareness and early identification of dementias can and must be promoted, I’m not sure that general screening would be of as much use as the Alzheimer’s society do.

I believe it would probably be the people who are more reluctant to go to their doctors who might need the tests the most. There need to be a way of thinking through better targeting of information about dementia and what can be done for people who are diagnosed early in terms of drug therapies and lifestyle changes.

Perhaps if doctors surgeries make contact with people in that age group with whom they have had little contact for months or even years. My concern is the general screening will focus time and resources on those who are  most likely to access the services in any case.

The problem with this is that GPs surgeries are now routinely ‘deregistering’ patients if they don’t attend and don’t send back letters which ask them to confirm their address/registration with a particular surgery. This has frequently been a problem I’ve seen at work as older people who might be more forgetful or just less engaged with responding to correspondence end up without any GP at all.  I expect it happens less in smaller towns and villages where GPs know their patients better but in large cities and inner cities, it is a big problem.

It doesn’t need to be a doctor that carries out the screening tests and conversations either  – perhaps there is scope to use wider ranges of professionals – not to make diagnoses  but to refer for more extensive discussions with doctors. Perhaps you know, even social workers in adult care settings could be involved in identifying some of those people who might be better targeted or leaving information or even adding a few questions about memory and any concerns about it with the people as they call or are requested to call for assistance .

Day centre staff (where they still exist) could have some information to distribute.

General hospitals could also share information and have discussions (this could be a discrete post rather than adding further burdens on currently stressed staff).

It’s useful to look at the prevalence rates for dementia in England and Wales and it is possible to see how it increases after 75 and why this age is the point at which the tests are being proposed. Perhaps even more useful is looking at the incidence figures (new diagnoses) after 75.  It seems that if there is some type of screening it should be repeated at regular intervals rather than a one-off screening at 75.

Maybe it is the way to go. After all, the Alzheimer’s Society has much more expertise in this area than I. I just see so many people whom I know would not go to a doctor’s surgery for a test and I wonder how engaging the process could be.

Often diagnoses are arrived at by family members discussing concerns with GPs in the first place but how to ‘catch’ the diagnosis earlier? Engage those who are likely to see this section of the population and disseminate information.

Information and awareness have to be the key – get the message out that a diagnosis is the start and not the end of help.

I know there was also some discussion about whether someone would want to know if they had a diagnosis of dementia.

Would I want to know if I had a dementia diagnosis? Absolutely and without doubt yes.

I would want to be able to make plans. I would want to be able to benefit from assistance available.

I don’t think general screening is bad. I think there needs to be more thought in how it could be implemented and ultimately, any discussion about dementia on television is a good discussion.

Social Media and Social Work – Part 2 Social Bookmarking

Bookmarks made of strings. Spin.

Image via Wikipedia

Social Bookmarking is a way to share links (or ‘bookmarks’) with other people or ‘on the internet’ rather than locally on whatever internet accessing device you are using.  The first ‘weblogs’ or ‘blogs’ as they became were social bookmarking sites. They were ways of sharing with others links that you found interesting or useful.

As  a disclaimer I’d say I’m not an ‘expert’ in social media but this is a personal exploration of how I use these tools to help me both in my practice and to keep up to date with issues for the purposes of writing my blog (although those two things can’t be kept separate!) as well as keeping track of interesting random things I find online that I want to come back to whether academic articles, newspaper articles or recipes to try!

Delicious is probably the best known social bookmarking site. It’s future is also somewhat uncertain as Yahoo (who own it) want to close it down or sell it so bear that in mind when I write about it.

It allows me to mark and bookmark sites and pages of interest and create ‘tags’ for them. For example, I have a ‘socialwork’ tag that has all the pages and sites I come across on my random forays through the web that I can come back to when I am writing or thinking of writing a post but also it allows me easy access to the sites that I read most frequently.

I have a ‘newspaper’ tag to group together the journals and standard sites I read and a tag for policy information. The advantage of holding this information online or ‘in the cloud’ is that I can access these bookmarks from any computer I use.

You can add more than one ‘tag’ to each site or post.

The social part comes in that people can share their bookmarks with each other.

My bookmarks are here but tread carefully. I tend to save mostly for myself and my tagging is a bit haphazard (I have a special ‘todo’ tag that means I intend to read a particular article, for example!). I also have some other, random sites in there but you might get an idea of how it works.

This post explains ways of using delicious but it is more adventurous than I have been. I use the Firefox addon.

Pinboard is very similar to delicious but it is a paid service. There is a one-off charge of about £5 (depends on exchange rate) and allows for an online backup of bookmarks and easy tagging. I probably still use delicious more but I signed up in case delicious disappears as I could port over all my saved bookmarks there.

I’ll group Tumblr and Posterous together. They are alternate blogging platforms that while allowing longer form posts referred to in the previous post in the series, seem to be better suited to sharing links, photos and ideas very much along the lines of the original ‘weblogs’.

I haven’t much experience of Posterous but have played around with Tumblr a fair bit.

Tumblr again, I often use as a bookmarking site as much as anything. I use it to put articles and information that I want to come back to but more traditionally, it can be used as a simple blogging platform. I assume Posterous works in a similar way. It is a good way of sharing links, commenting on articles and creates a ‘short form’ blog. Comments can be added via disqus. RSS feeds can be added as well.

I set up a Tumblr account here (although I have another private one!). As you will see, it is basically a mirror of this site so don’t bother following it but it is just as an example of the kind of thing that can be done. It is very easy to add posts direct from the browser (there’s also a firefox extension to Tumblr).

One of my favourite uses of Tumblr is a site set up by Malcolm Payne (of Modern Social Work Theory fame – is there any British Social Worker or Social Work Student who doesn’t have that definitive textbook? (if there is, go out and buy it! Now!)

Basically we live in times when sometimes we can suffer from information overload. We need to develop skills to sift through the information and find what is most important and relevant to us. Whether that is as social work professionals trying to keep up with the debates around us and find different views or whether it is about locating the best recipe for Lemon Linguine – sometimes we might surf past a site and want to keep record of it somewhere other than on the PC we are using at the time.

That, for me, is the beauty and use of these sites. I’m sure there are a million uses and I’d be interested to know how other people use social bookmarking sites and ‘short form’ blogs. If you have a tumblr or posterous site that you want to share, do leave a comment!

Next week – Twitter

See the my previous post in the series – Social Media and Social Work – Part 1 Blogs

26th March 2011 – March for the Alternative

I’ll write more about the March for the Alternative during the week  but wanted to feed back in the immediate aftermath.

As arranged I attended with some friends and our intentions of meeting up with a larger group were scuppered somewhat by not being able to find the group we had intended to join. Still we found people to march with and the atmosphere was cheerful, very friendly and good spirited. There were families and pensioners and everyone in between. Very far from the typical ‘troublemakers’. These were people who cared about the society they live in and wanted to show it. That was community. That was a voice. I marched along people I believed in and who believed in me and the work we do and need to do to create a better, a ‘bigger’ society. I was very proud to be there.

I started a flickr account for my photos to keep them distinct from my personal flickr account  but go and have a look at the pictures.

I’ll leave you with one of my favourite banners.

In Hyde Park

Weekly Social Work Links 11

I am going to have to do a quicker than usual ‘round up’ this week because I’m heading off to the March this morning.

But it has been a fantastic week in terms of the richness of posts.

I’ve already written a post about why I am marching today but this post by SocialJerk about the situation regarding housing in New York opened my eyes. This is where we are heading.

On the subject of housing Malcolm Payne writes about the ways that the social work role is described in literature provided for housing staff and he raises a lot of the issues of the confusion about the definition of the social work role and the issue of  why ‘social worker’ is often confused with ‘local authority social worker’ in the UK.

Ladybird writes about the ‘ripple effect’ of the cuts in her own service.

A Social Worker’s View talks of the problems raised by a shortage of condoms in Kenya. Something to bear in mind from my often anglocentric world view.

The Masked AMHP and the next stage of his explanation of the tribunal process ‘When Detained Patients Appeal’ series and the story of what happens in a tribunal.  Sometimes I forget how alien some aspects of my job may seem to others. I haven’t ever written about tribunals. Perhaps one day I’ll pop up with some of my own thoughts and experiences.

How Not to Do Social Work has a time for decisions and contemplates burnout. A potential hazard of the trade.

And Nectarine on Going Mental  raises the issue of noise in the office. I feel her pain.

While Social Worker Mom asks when it’s no longer healthy to work with a particular client.

A Case Manager’s Verse talks about issues regarding communication via email at work. Many interesting points raised that I hadn’t considered and some I had but hadn’t quantified.

Jamie Middleton writes about the importance of pets to someone’s mental wellbeing.

JaeRan Kim writes another thoughtful post about treating difference and perceptions about mainstream integration and the place of disability culture when moving towards fully integrated societies. Food for thought.

Dorlee at Social Work Career Development has a great interview with an art therapist about her work.

Nancy Smyth at Virtual Connections has a post about the use of Second Life and a PTSD (post traumatic stress disorder) simulation. I remain a little uneasy about this kind of simulation. I haven’t had any experience of using second life and remain generally sceptical but it is interesting to read about these programmes and how they may be used. Maybe I’m just being a fuddy-duddy!

Speaking of which, I’ll sign off with an post from the Social Work Tech Blog about using a ‘Social Work Digital Toolbox’ and there are some useful ideas there if you have an iPad or want to justify the acquisition of one ‘because it would be good for work’.

To sign off though, I’m going to link to this video of the Andrew Lansley Rap.

Managing Stress in Social Work

The idea for this post came from a brief conversation on Twitter last night when a social worker asked about how we manage stress at work.

There was a fine Q and A in the Guardian a few weeks ago on their Local Government Network site which collated the opinions of people with a lot more experience than I but I have developed some ideas that I personally use and thought I would share them in more than 140 characters. Twitter, believe it or not, has its limits. I’m sure and hope that people add to my list with their own techniques. This is an entirely personal list!
meditationHaPe_Gera@Flickr

I’m fortunate enough to work in a good, supportive team with excellent managers who have a realistic understanding of workload pressure. It is important for me to acknowledge that my stresses are not about poor management or a difficult team which may lead to a whole different range of tactics about managing stress.

Supervision is, of course, important but I am taking regular, good quality supervision as a ‘given’ as that is my current experience. It is important that supervision is more than a list of updating cases but is a chance to discuss the ways the work impacts us personally and professionally. A chance to both reflect and learn. My supervisor tells me that she gets as much from our supervision sessions as I do and that is entirely right.

Apart from supervision with my manager and my other supervision with a senior social worker in a different team,  I’m very strong on immediate debriefing. I think it is an absolutely necessary part of the job. Without the time and space to debrief, without that immediate opportunity to hold some of those thoughts together and discuss them, you begin to internalise some of the pain, sadness and distress that you inevitably will see at work and more dangerously, you take it home. Stress can’t help but affect your family and those around you if you let it. That’s why it has to be ‘left at work’ as far as possible.

I call ‘debriefing’ the immediate reflection or observation as opposed to the most considered reflection that comes during a ‘proper’ supervision period. Debriefing is often with colleagues who are around in the office. We are good at helping each other out with this.  If there is no-one around in the office that is able to talk, I will tend to write some thoughts down on a notepad I carry around. Sometimes I might do this in a cafe between visits. It helps me detach some of the responsibility I have from a situation and see it through ‘third person’ eyes.

I manage stress much better now. I detach home from work more and I am far less likely to bring the stress and work-related anxiety home. Part of that is because I have space to debrief and discuss while at work. Sometimes you want someone to reassure you outside the managerial system, sometimes you just need to talk about what you have heard and seen and the best people to listen can be those who are attuned to the culture of the same workplace and environment.

No-0ne quite  understands some of the pressures of the job or at least it can feel that way, if they aren’t doing it themselves.

I have also tried meditation and mindfulness techniques which personally, I’ve found very very helpful. My interest in mindfulness actually started when I was writing about it on this site and I thought it sounded useful personally so I bought some books and MP3s (I was going to write ‘tapes’ there but that dates me!). I then attended a short day course locally to see if ‘proper’ instruction would be useful. I find taking the time each day to relax actively has really helped my mindset. It also helped me a lot when I was recovering from surgery.

MIND have a good resource page and details of courses both online and local. I’d really recommend it, even if you are normally quite sceptical of some of ‘these things’. I was.

Exercise is a classic one. I have been a member of a gym in the past but I didn’t stick with it. It works for some people. I like swimming but I find it hard to build in before work and after work I get tired. But I do like walking. I can walk for hours and days. Nothing ‘releases’ me as much as a long walk. Sometimes in the city and sometimes in the park. I can be alone with my music or in company. I always find it helps me to gather my thoughts.

Most important as well is to have interests and involvements outside work. They can be work-related. I write a lot about social work and social care and read a lot of related books but I still see that as a ‘discrete interest’ as it helps me in ways beyond work.  There are other things I enjoy though whether it’s cooking or playing my ukulele or playing on my Xbox (wow, I LOVE the Kinect), I could also possibly be the only person who plays ‘Lips‘ while on my own at home (it’s one of those karaoke singing games – enormous fun!).

I also have taken many evening classes over the years, from ukulele playing to Art History to Spanish to Greek to Basic HTML to Creative Writing.  I enjoy learning new things and I enjoy meeting new people who work in completely different areas.

I also like to take advantage of being in London and am a member at the British Museum, Kew Gardens,  South Bank Centre … and London Zoo but we have a wealth of museums, galleries and theatres which can be accessed relatively cheaply if not free of charge. I need to look after myself build and work on an identity that is more than ‘work’. So when the stresses build up at work I have other aspects of my life to build on.

What about you? What do you do to work on stress?

Budget 2011 – Reflections

When I go through the budget announcements I think on a couple of parallel lines. As well as the common ‘how am I affected’ line, I try to look at a wider effects of what the respective chancellor is trying to do or say through their budget plans.

For Osborne yesterday, I was distinctly underwhelmed. Not that I ever expected the budget announcement to be anything but irritatingly delivered in his slimy, sneering tones. Oops, did some of my political bias slip out there.

There are some good summaries around. I like this one from the BBC.

My A level Economics doesn’t really qualify me for detailed analysis but I’m always happy to give a point of view.

Ferrari 328 GTShttp2007@flickr

Fuel Duty

This is a purely selfish view and I raise that as an alert that is bound to irritate all my less urban readers but I don’t drive and yes, while I know that everyone doesn’t live in London and not everyone has access to the public transport system I might take for granted and I know fuel costs affect entire supply chains, we still have to account for the environmental and economic damage of our continuing reliance on fossil fuels.

Generally though, I’m fairly indifferent about the ‘headline’ for the budget but I have no doubt that even accounting for the fact that increased VAT will have raised the fuel duty over the 1p reduction which is ‘given back’, it will all make for good, positive headlines for the government.

There is some increase in the tax free car mileage allowance for those who use their cars for work but I pay no attention to these as I don’t drive. I know my transport costs have risen astronomically (thanks Boris) but I guess that will help people that drive. Again.

Income Tax

So the highest 50% tax rate is going to be reviewed? What about ‘we’re all in this together?’. Does that mean while benefits are cut and frozen and  public sector pay (yes, I know, the selfish element again) is frozen and VAT – possibly the most regressive tax in the ‘book’ – is increasing, the government has even considered dropping the 50% tax rate? Incredible. Just a reminder that this is the tax rate for those who earn over £150,000.

Personal tax allowances are going up which is generally good news although as reported the average gain by this will be 90p per week.

Pensions and Pensioners

On a positive note, I do think the idea of a flat rate state pension is good. So many people I come across in my work don’t claim pension credit which they would be entirely entitled to because they feel shamed into living on a pittance by a society that condemns the ‘claim culture’ even for those that desperately need every penny. Taking out the need to make a specific claim could potentially help a lot of people. However this will not affect today’s pensioners, more the shame.  This will take a long time to implement.

Sneakily as well, Osborne has reduced the Winter Fuel Allowance – as the Telegraph notes

Last night, it also emerged that pensioners are to lose out on winter fuel “top-up” payments that help them when bills are rising. This means the over-80s will see their payment reduced from £400 to £300. The allowance paid to the over-60s will drop by £50 to £200.

I haven’t honestly seen much reporting on this. It isn’t as if fuel prices are going down.

Public Sector Workers

Unsurprisingly Osborne bought into Hutton’s report on pensions in the public sector. As a public sector employee, it looks like my pension will be costing 3% more (plus the additional 1% rise in NI contributions that I’ll pay).  It isn’t something I’m overly happy about but it’s not surprising.

Some public sector workers earning below £21,000 will be spared the general pay freezes and receive an ‘uplift’ of £250. I was in favour of this but am disappointed that it only relates to NHS, armed forces, police service, teachers and civil servants but excludes local authority staff such as care workers and support workers.

Inheritance Tax/Charity Breaks

Again, I don’t expect my views to be popular here but Osborne’s provision to allow a tax break for large estates that leave 10% to charity was gormless to say the least. Personally, I think an increase in inheritance tax and yes, a death tax, is an entirely fair and progressive way to reduce some of the inequalities in our society. That won’t win votes though but I do think that there needs to be an examination of how ‘charities’ are defined. As long as Eton College remains a charity, the system of associated tax breaks has to be one that is questionable to say the least.  Did you know the Eton Rowing Club costs £300,000 per year to maintain? And they need charitable funds to help out. Can you imagine now, what £300,000 could do in a deprived area of your choice? How can those charitable donations demand equivalent tax breaks. It is quite sickening.

I missed any reports of anything related to assisting or recognising people with long term illness or disabilities. I didn’t watch the whole speech though. Perhaps I missed it.

Most papers have a ‘winners and losers’ page. It’s worth looking at this one from the Guardian.

Any list that has ‘higher rate taxpayers, drivers of gas guzzlers and people with jobs’ in the ‘winners’ section and ‘people without jobs’ who are going to be subject to the biggest ‘shake-up’ in benefits can’t be healthy and is indicative of the way the country is going.

It would be worth Mr Osborne remembering quite how many ‘people without jobs’ there are – a number that is increasing.

Why I’m marching

The Guardian published an article on their website yesterday titled ‘Why we’re marching?’ and it gave the points of view of six people who were going to be attending the TUC organised rally on Saturday.

Uni brennt Demonstration Wienketu@Flickr

I am going to be attending. I have had a lot of time to consider whether to attend or not and what I think I might achieve by attending.

Firstly, I had to decide whether I attend as a member of my trade union (Unison) as a member of my professional association (BASW), as a member of my community (local group from the area I live are organising) or as  a member of a pressure group (SWAN).  I could also march as a part of a women’s ‘bloc’.

That, in itself is a question of identities and a practical lesson in some of the systems that we build around us and how we choose to identify ourselves. As it happens, I have chosen not to march under any particular banner but with a few friends together who would ally ourselves to different causes and who have different identities.

But back to the reasons and I’ll start with the negative reasons.

I don’t want to condone a government nor a society (because I do believe that the Labour Party have also been complicit in this) that ostracises and alienates people who depend on the support of the state to live dignified lives.  Talk of ‘alarm clock’ Britain is offensive to me. Talk of the ‘deserving and undeserving’ claimants moves our society back to a Victorian age. I am not marching for my own job – I am fairly confident that that’s safe in one form or another – but I’m marching for the people whom I come into contact through my work who I see genuinely suffering and who exist on some of the fringes of the mainstream and will not be marching for themselves.

I will be marching for the carers who have having respite cut and the service users who are terrified to send off claims for Attendance Allowance and Disability Living Allowance because they don’t want to be ‘seen as scroungers’.

As long as programmes such as ‘Saints and Scroungers’ are allowed to be made on our public service network, I’ll not stop fighting and shouting for a change to the attitudes towards social assistance in this country.

I see the effects of this every day and on many lives.

I’m marching to protest against a government and an opposition party that seek to make a wholesale reduction of 20% in claimants for Disability Living Allowance.

The PR machines of politicians have been working overtime to blur the lines between in-work benefits for disabled adults and out of work benefits. There is no subtlety in the government’s agenda and rhetoric and it needs to be challenged

I am marching against a system (and this is the last government as well) that has destroyed the quality of adult social care over the last decade so we remain absolutely dependent on  private companies – their profits and their shareholders – for delivering care or lack of it to the most vulnerable people in our society. I am absolutely not excusing Labour for their role in this – ultimately, that’s why I am marching under my own banner rather than any set up by an organisation of which I am a member.

I also feel that I need to make my presence felt in the face of a government carrying out it’s politically motivated cuts which shriek of the worst Thatcherite policies.

I march as someone who did actually vote for the Liberal Democrats at the last election and many previous elections to ensure that my voice is not lost and my vote was not wasted when I make my opposition  to this government felt.

I also march to express my anger at the government’s proposals to dismantle our National Health Service – helped by Labour’s policies over the past decade, it has to be said – but we need to make sure that the government remember that they have absolutely no mandate to do this.

Those reasons though, are mostly negative so here are the positive reasons that I am marching.

I am marching to show solidarity. To show that one doesn’t have to  march because we are personally feeling the effects of the cuts, to be honest, I am not to a large extent – but because I need to make my voice heard on behalf of those who cannot and THAT is what big society and society as a whole is about.

I am marching to push for a re-examination of some of the cruellest policies and the lack of consideration of where the bulk of the cuts will fall – namely on those who are the least able to resist them.

These government programmes for cuts have been poorly thought through ‘trigger’ responses to a government that has no experience of governing and lives off entitlements themselves.

Is it any more ‘reprehensible’ to be wholly reliant on ‘daddy’s trust fund’? How many government ministers know the true meaning of poverty and how hard it is to work through it? I doubt there can be many.

We do not live in a meritocratic system and we need to prove that when voices are not heard through the ballot box we have other means to make our points.

Our ‘leaders’ say we are ‘all in this together’ but we are  not and they cannot be allowed to get away with such lies. They are not ‘in this’ with us.

I am marching because I want to be a part of proving what we can really do when we are ‘all in this together’.

I am happy to pay higher taxes for services that I personally will never use or need. That is society. That is the society I want. That is the society I want to march with.

These cuts are ideologically driven. They are not ‘the only way’. That is why I am marching.

Fund Our Future : Stop the Cuts - National DemonstrationMatt Dinnery@Flickr

Anyone else going to be there? I can’t promise to meet up because it probably won’t be the most conducive environment to meet and have a chat but I’d be interested in the reasons of others.

On Being Shadowed

Beckenham Hospital. Located in Croydon Road an...

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Last week, I had the pleasure of having a second year social work student shadow me as I worked. She was a student in a voluntary agency that I had come across because she had been doing some work with one of the service users I work with. I asked her if she wanted to come and join me to see ‘the statutory side of things’. Bless her, but she almost bit my hand off.

We usually have students in our team but we don’t at the moment. I have had students shadowing me from time to time and  I try to give people the opportunity when I am asked and am happy to offer the opportunity to students I come across if they are interested in seeing how we work.

I miss having students. I really enjoy the teaching element of the practice teaching but, as I explained to the student herself, the reas0n I didn’t take a student in this ‘round’ of placements was because I was not convinced I would be able to protect them from the pressure of work in the office at the moment and I was concerned that they might be used as an ‘extra pair of hands’ in an extremely sparse office. It might not have been the best learning environment, although, come to think of it, it would have likely been a realistic one.

I am toying with the idea of being an off-site practice teacher next time round.  I enjoy talking students through linking theory with practice. I enjoy discussing recent policy and research and the implications for practice. I enjoy teaching all in all, actually. I enjoy the enthusiasm and the realisation what they learn at university can be used to practical effect.

There is something wonderfully invigorating about showing an enthusiastic student the work that makes up practice. We visited a couple of people and she watched as I completed some paperwork – ok, that bit might not have been so thrilling – but it allowed me to talk through the process of writing and the reasons that the forms are compiled in the way that they are.  It allowed me to reflect on some of the tasks I might ordinarily take for granted or complain about and step back with a realisation of what a well-completed and well undertaken assessment can mean.

We had lots of conversations about law. I think there was a law exam coming up. My particular joy was looking at the case study they had been given for their law test and being able to talk my way through it without barely catching  a breath. I clearly haven’t forgotten as much as I thought I had about Community Care Law (I’m fairly hot on Mental Health Law if I do say so myself – simply because I use the Acts (Mental Health and Mental Capacity) literally on a day by day basis in my job).

We also had a Mental Health Act Assessment come up while the student was around and I left her behind to read up on the codes of practice. I won’t take students to shadow Mental Health Act Assessments. I remember being pulled up on this while doing my Practice Assessor Course but I stand by my principle.

Firstly, Mental Health Act Assessments take place by their nature at a time when the person being assessed is in a high state of distress or illness and whether they would be able to give their consent to someone ‘observing’ is questionable. Personally, I believe strongly that the Assessment is about the person being assessed and not for me as a professional to control any more than I do through legal measures. So much control is taken from the individual that having students around reinforces the already massive power imbalance.

Finally, there’s no need for a student to attend. Of course AMHP trainees have to attend. They need to carry out observed assessments of Mental Health Act Assessments in order to complete the qualification but general social work students do not. Just as general medical students do not.

I explained to the student that I did not want her to come with me. She showed some disappointment but this is an area I feel very strongly about on an ethical basis and I promised when I returned that we would have a long discussion about the use of the Mental Health Act. Which we did.

I thought about how often the student/practice teacher relationship emphasises the student as the recipient of ‘knowledge’ but in practice, the teaching is a two-way process. I learn a lot from every student that comes. I learn about the impact of different lived experiences and different viewpoints. I learn about how my work is perceived by different cultures and communities. Things that I  might take for granted, I learn to challenge.

The teaching and learning relationship allows more considered reflection and while the nature of the role is that the experienced practitioner is placed in the position of ‘expert’, we can look at the same theoretical bases that we use in relation to students as the experts of their own learning and experiences.

As for the student, she seemed bright and enthusiastic. She wanted to do well and I have no doubt she will.  She had a background in a completely different area but she showed an empathy and understanding that will serve her well in the future. When she thanked me at the end of the day, I think I might have well forgotten to thank her.

I am sure I got as much, if not more, from the day as she did. She probably didn’t realise that.