Shoesmith, Balls and Appeals

Ed Balls, Member of Parliament of the United K...

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I was trying to steer away from discussion of the Shoesmith’s appeal against her dismissal by Haringey Council (via Ed Balls, the responsible Cabinet minister at the time) and her victory in the Court of Appeal – but having followed the case from the outset, I can’t quite resist coming back to it.

There are a few issues that have caught my attention in the press and blogs that I  have read over the past few days.

Firstly there is a confusion between the outcome (namely Shoesmith losing her job) and the process (being sacked via the Minister in a press conference on the basis – according to him, at least – of an OFSTED report, the findings of which she was not able to respond to).

I am biased although I have no time for Shoesmith. Like almost every Director of Services (Adults and Children) she is happy to take the pay without having an idea of how the services are, or aren’t being run ‘under her watch’. She doesn’t come across as a particularly sympathetic character and I think her lack of knowledge of social work  – as she comes from an education background – has come back to bite hard.

But, and this is the big but – that doesn’t mean she is suddenly an exception to employment law – and of course, that’s what the Court of Appeal found.

Secondly, Balls hung Shoesmith, and by extension the social work profession and professionals out to dry. It’s all very well saying responsibility should lie at the top  but if that is the case, why not the Children’s Minister himself? You see, the problem with the uproar following the tragic death of Peter Connolly, which led to the highly charged press conferences and shamefully manipulative exchanges in the Houses of Commons is that it was a manufactured outrage. Yes, of course it is beyond awful when a child dies following abuse and it is a failing when the systems that should protect that child break down but Peter Conn0lly isn’t the only child, unfortunately, to die under those circumstances and in the face of Ed Balls’ posturing and much as we would like it to be different, nor will he be the last one.

There was the awful tales of Alex Sutherland, Khyra Ishtaq, Baby B – and many others – so why was Peter Connolly thrust into the public consciousness such that the memories of a boy whose life was cut short are remembered by the details of his death and the photos released to the newspapers?

Well, that would probably be an interesting research project all in itself about media and the human psyche – but Balls admits that he succumbed to pressure regarding Shoesmith and the pressure was put on by the tabloid press. He even added insult to injury by throwing Deirdre Sanders, the agony aunt of the Sun newspaper onto the Social Work Taskforce which was to look at ways of improving social work practice. If anything demonstrates how he threw the profession to the baying wolves, it is that.

As for Shoesmith, however she may or may not have done her job, hers was not the hand that beat Connolly. She deserved better from her employers regarding advice although who knows if they gave her that media management advice and whether she chose not to take it or whether she was just thrown to the wolves by her employers.

The OFSTED report by which Balls condemned Shoesmith is faulty in the extreme and was altered. I wonder who might have put pressure on OFSTED to change this.

There is a lot of poor practice and poor knowledge of processes knocking around in this case. It wasn’t all to be laid at the feet of Shoesmith. It looks like the ex-minister had more to gain through his pandering to the press than anyone else and the shame is that it is on the back of a tragedy.

Shoesmith isn’t a social worker and never has been (although the Evening Standard headline seems to state it) but it’s easy for the press to make the leap because they have no idea about the actual facts nor do they check them. They want a hate figure. I am uncomfortable defending Shoesmith to a point because I am not sure exactly where the blame lies but the blame for processes should lie between the police service, the health service and children’s services.  Another Serious Case Review and more about the failings in communication between agencies. The profession really needs far more radical proposals than those set out in the Munro Report but it’s a start.

What Shoesmith was entitled to was the same process of natural justice that everyone else is- I don’t say she shouldn’t have been dismissed, that’s another argument entirely and to be honest, I think she should have been – but Balls was looking to the headlines rather than the law book when he acted to dismiss her.

For that, he should apologise rather than taking refuge in the baying crowds of populism – oh, but he’s a politician. However much I may hate the current government, and however much Osborne makes my skin crawl, I will never forget the shameless pandering to the tabloid press that Balls engaged in on the back of the death of a child.

Weekly Social Work Links 18

Maybe not quite so weekly but I was away last weekend and unable to put anything together. Back now and ready – very ready – for the long weekend.  Here are some of the posts I’ve come across over the last week that caught my eye.

A post on the Social Work Tech Blog is always a treat and I love the ideas in this post which show how a ‘self-care’ plan can be developed on the iPad – but don’t be fooled, the concept is transferable to pen and paper too (with attached PDF).

Jae Ran has a fantastic, thoughtful  post about research ethics. As I commented on the post, it shows the importance of understanding and knowing the methodology behind a research study – very relevant for promoting and using more evidence-based practice.

SocialJerk writes a beautiful and heartbreakingly moving post about sexual exploitation of girls and shares a story or two that cut deep and reminds us that of the importance of those strength-based approaches in practice.

I love the international perspective that social media and writing about social work has enabled me to have and in ‘A Social Worker’s View’, S.Wangene, based in Kenya, writes about a challenge which predominantly faces women in Africa and Asia and I had not been aware of – Obstetric Fistula and she follows up that post with another one about the challenges of Fistula treatment in Kenya

Staying with the international tilt, Dorlee at Social Work Career Development has another of her fascinating interviews – this time with a dramatherapist.

Hold my Hand is a blog written by a Social Worker who works in a nursing home and she relates the story of a woman she works with who has had a nightmare and how she is able to help.

On a slightly different tack, a couple of weeks ago, I discovered ‘Noone Sleeps Rough for a Free Sandwich’ which is a blog written by a support worker in a hostel in London (I think!). She shares the stories of her work and it really is an insightful read.  This is her most recent post about what she’s been up to on an overnight shift.

And In the Space of Reasons – not a social work blog but actually the blog of an academic who is involved in the study of the philosophy of mental health, writes about the recovery model in mental health services. It is worth reading for anyone who is involved in mental health.

Ladybird shares a story that her son wrote.

And a goodbye to ‘Diary of a Social Worker’ who is closing down his blog. Sorry to see it go.

In the face of the Sharon Shoesmith judgement yesterday, I will just link to the Guardian editorial which just about says exactly what I think about it but it is written with much more clarity and less ranting than I’d be able to muster.

Keeping Mum

I was sent information by a PR company about a book – Keeping Mum.

Keeping Mum: Caring for Someone with Dementia

I don’t usually respond to requests for information and advertising (and to be clear, this isn’t advertising as I haven’t been paid!) but I thought it might be a book that could be potentially interesting to people who might come across the site. I haven’t actually read the book yet and nor did I request a review copy – simply because I know I have such a backlog of books and lack of time at the moment but the information from the press release is as follows

“When Marianne Talbot’s mum was diagnosed with Alzheimer’s disease, Marianne found it impossible to put her mum into a care home. Instead Marianne cared for her mum in her own home for five years, whilst chronicling her experiences in a blog for three of those years.

The blog has now been published into a book called ‘Keeping Mum’. Heartwarmingly funny, frank and at times emotionally tearing, this book is a record of what it is like to care for a beloved parent whose mind is fragmenting. It is written for anyone, anywhere, who has anything to do with dementia or with caring.

The book also includes some great tips on daily living, managing others’ finances and the social care system. For more info please visit: http://www.keepingmum.org.uk/

Talbot’s blog can be found here and extracts from the book can be read here.

It has received excellent reviews on Amazon and I’m hoping that I will be able to find time to read it and review it properly but in the meantime, it seems to be worth checking out.

Personalisation and Professional Disillusionment

Yesterday, Community Care published the result of a survey they had undertaken about ‘personalisation’ among social care professionals.

The headline figures while wholly unsurprising, make for interesting reading where only 41% of respondents felt that service users would benefit from the implementation of personal budgets and 83% felt that cuts would impede the progress of the personalisation agenda.

To which my first thought was ‘only 83%’?

Anyone who has read some of my previous writing/ranting about personalisation will be pretty clear where I stand.

While the idea and the concept of introducing more person-centred support planning and opening up direct payments to a wider range of people is absolutely fantastic as a concept, the implementation has been dire.

There has been a complete side-lining of service user groups that don’t fit into the ‘easy’ mode – namely those with mental health problems, older adults and those who might not have capacity to involve themselves fully in the support planning process, the same figures and quotes that the government and her agencies roll out again and again about the man who pays for a PA to go with him to a football match instead of a day centre are so completely off the radar when the smaller pool of money available for care services exist that they are almost insulting to those for whom a) the thought of having enough money allocated to pay for two tickets to a football match would equal 7 showers a week – so it’s football or cleanliness and b) that group of people (because, yes, much as the government don’t want to accept it, they do exist) that actually WANT to go to day centres.

And so we plough on.

But even though I have had many criticisms of the way that personalisation and particularly personal budgets either managed centrally by the local authority (where the end effect is exactly the same for the service users in most situations) or delivered by direct payments (where someone has to have capacity and desire to take on the direct payment and employ assistants or have someone who is willing and able to do that for them) – there is more to the personalisation agenda and process which is in danger of being lost in the process.

Personalisation as a value base and an approach to work and social work in particular with people who need or who are eligible to receive services for care ties in perfectly with aims of re-addressing the power differential between provider and ‘receiver’ and the imbedded dichotomy between ‘giver’ and ‘taker’ in society.

That model of giver/taker which is bound within the welfare state system can create an imbalance and the potential to give back some of the ‘control’ and some of the decisions to the person who receives services may, in some way, redress elements of this balance. There is no way that my training and experience has taught me better than anyone else, what YOU as a recipient need. Yes, I learnt my theories and my models and understand that building social networks is important but if you prefer to do that at a coffee morning at the local museum instead of at a day centre that’s perfect. If you want your neighbour’s granddaughter to help with your personal care rather than an anonymous and frequently changing ‘carer’ from a local agency who is paid at mimimum wage and has a day full of appointments and who isn’t paid for travel time by her agency so she needs to cut short on some of the time – perfect.

But we already had that system with Direct Payments. Where is the difference?

Ideologically, the difference was that everyone would know how much money they were ‘getting’ – whether directly or managed and they would be able to be consumers. Our society tells us that money is power. Money creates consumers and the market will right itself.

Even, theoretically, when a personal budget is managed by a third party (and I include the local authority as a potential ‘manager’) you will know how much is ‘allocated’ to you so that you can ‘spend’ it in the way you want.

This doesn’t happen in practice though because local authorities need to save money and are still tied up into procurement contracts that make agencies unequal when ‘bidding’ for the funds that have been allotted via personal budgets.

I know this is getting a bit technical and complicated but it’s important to understand. I don’t think anyone can oppose ‘personalisation’ as an approach regarding empowerment and ideology.

The implementation, however, reeks of money-saving and penny pinching. It also has pushed the responsibility for services away from the local authorities and onto individuals and their carers.

You have £100 per week, find the care yourself – then we (the LA) aren’t responsible anymore.

I’m wholly in favour of contracting out assistance and advice on self-assessments and support planning to local voluntary sector organisations. My own LA tried that. We referred lots of people to them.  They withdrew because we were referring too  many people to them and the local organisations didn’t have the resources (or the contract) to undertake as many support plans as were being referred – but the idea is not one I have any problem with and in fact, I rather like it.

But this wasn’t offered to people who do not have the capacity to lead in their own self-assessment and support planning. The organisations couldn’t do that because they were not experienced in non-directed advocacy work – it takes longer.

It is hard to see through the budget cuts as well towards a future where, as Burstow as said he wants direct payments to be the ‘preferred method’ of delivery of personal budgets.  I don’t want to detract from the fact that this is and will be fantastic for some, perhaps most people, we move to a model where there is – again – a ‘one size fits all’ approach.

The true tragedy of the personalisation agenda is that is has and is coming to fruition during a period of cuts – the government (and the previous Labour government too) want to pull back the responsibilities of local authorities and with the criteria for accessing any support is rising rapidly it may well be that more and more personal budgets are delivered directly from peoples’ own savings or disability benefits (while they still exist).

I am fearful of the future for adult social care but I’m not necessarily unhopeful.

I think there is potential for change and development but unfortunately the ways I see of improving systems come at higher cost.  There has to be some major research and debate about the delivery of personal budgets and the way that personalisation encompasses people who lack capacity and lack advocates (family and friends) and how they can best benefit from this process – perhaps access to additional funds to pay for the trust fund type system of management we were assured would happen but in practice is not feasible for a relatively small sum of money as it costs more than it might deliver.

We need to see more about how support planning can work in the voluntary sector as, speaking personally, I genuinely don’t have time to do the process of support planning any justice as a part of my day to day job. It ends up being rushed because I can’t devote a couple of visits of a couple of hours to talk through and develop a truly person centred support plan.

The process of self-assessment needs to be reconsidered because while the idea is fantastic for some people – our self-assessment forms are biased towards physical disabilities and look scarily similar to a DLA form where people are asked to explain how they are on ‘their worst day’. That doesn’t really help with confident-building when you are working with someone who has very low self-esteem and depression/anxiety. The process of self-assessment in itself can and has been traumatic – let alone the person who is not able to engage with the assessment process due to a lack of mental capacity where questions about ‘dreams, hopes and wishes for the future’ while well-intentioned, can be hurtful and hard for families to listen to when they are asked to their parent who has advanced dementia.

I fear we have allowed a great conceit to be steamrollered into simply another ‘one size fits all’ approach to developing social care. It doesn’t have to be like this but that seems to be the government perception about what ‘personalisation and personal budgets’ are.

Choice is fantastic of course, but sometimes people want quality as well. It shouldn’t ever need to be an either/or. It does feel like it at the moment with the promotion of choice above all things.

So where are we going? Personalisation isn’t going away and nor should it. Personal budgets aren’t going away and nor should they.  Local authorities, however, might be going away – further and further away from social care and the responsibilities that they hold towards it.

We keep up with the advocacy and with the systems that are failing because we owe it to those who are reliant on these systems to make them work as best they can but we keep trying to pinpoint and pin down the flaws in the implementation with the hope that sometime, some day, someone will listen.

As professionals we don’t oppose personalisation. We have always been trying to use person-centred approaches. We just dislike injustice and inequity and that seems to be painted all over the current implementation and the frustration is that so few people (if any) in government seem to be aware.  Am I disillusioned? Yes, definitely. We were promised new ways of working in a more person centred way.

Desperate, no, not yet though as long as there’s some fight left in the belly to keep banging on and on and on about what personalisation SHOULD be and why it isn’t working yet. Not for everyone.

The Pilkingtons, Disability Hate Crime and Responses

Independent Police Complaints Commission

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Yesterday, the Independent Police Complaints Commission published it’s report into the case of Fiona and Francecca Pilkington which I wrote about first in September 2009.

The Guardian has an article which highlights some of the main points but to sum up, Fiona and her daughter, Francecca, who was 18 but had severe learning disabilities were being abused and targeted in their local community.  In 2007, Fiona killed herself and Francecca and this was seen as a response to the desperate situation that she found herself in with her family being constantly targeted and bullied in her local community. Fiona contacted the police on multiple occasions between 2004-2007  regarding anti-social behaviour and reading the report, it seems to show that as well as her and her daughter being targeted, her son was also subject to relentless abuse and bullying by an ‘identified group of youths’.

Reading through the report it is possible to note the range of persistent targeting, not just of the Pilkingtons, it seems,  but of others in the local area by the same ‘identified group of youths’ and the scope of the report from the IPCC was to determine why no substantial action was taken to protect and support the Pilkingtons.

In some of the background information in the report, the situation is described as being one where Fiona lived with her son and her daughter – as well as a daughter who had profound learning disabilities, her son (who is not named) had special educational needs. Fiona’s mother had moved into the home to help her out and it is reported that Francecca was also known to social services and was allocated within a ‘transitions’ team as she moved from children’s services to adults services.

It is noted that Fiona was finding it increasingly difficult to manage Francecca’s behaviours as well as being targeted by the ‘identified group of youths’. These were the key issues that drove her to the murder/suicide.

Reading through the details of each complaint made is a lesson in the lives some people have to live when they are targeted like this in the local community. Fiona’s son seems to have been suffering particularly from relentless abuse and physical assaults and bullying at home and at school. Francecca is called names and obscene gestures are made towards her. There are frequent references to stones being thrown at the house and windows broken.

The report contains extracts from letters that Fiona wrote to her MP and to the Leicestershire Constabulary. She wrote

„she (Francecca) does sign language at her school … so the yobs stick their fingers up at her‟.

„I cannot give my children the freedom of going up the street to the shops as I cannot be sure they‟ll be safe. I do my shopping at the weekend so I don‟t have to use the streets available shops when children are at home after school, during holidays‟.

One of the policemen responded in the inquiry that

he was never aware of the stress or anxiety the issues Fiona Pilkington raised in her letter were causing her. He says whenever he did see her he never got the impression she was a manic depressive, she was always bubbly and chatty and always had a little giggle and none of her behaviour rang any alarm bells with him. PC „A‟ said he got the impression Fiona Pilkington was quite feisty and if there were people outside, she wouldn’t have had a problem opening the doors and telling them to “do one”.

No action was taken when the incidents continued

One incident which did warrant a harassment order occurred when  Fiona’s son (who is referred to as being 13 in 2004) was pushed into a  shed at knifepoint and was locked in for a ‘few hours’.  She also states that her son had been (at this point) bullied at school for 8 years and mentions that the school were taking no action.

The report highlights that the pattern of abuse had built up significantly by this point and enough for the police to have established a pattern. The report goes on to detail every incident and response taken and how it could have taken place in a different way. It’s a long report.

What seems to be clear is that this anti-social behaviour in every sense of the word and that lack of protection or response towards the Pilkington’s has been seen to be inadequate.

I have been involved in a few different cases over the years where harassment and targeting have been problems in communities – although never at the level which is described in this report.

It happens. It does tend to happen more in areas where there is poverty and high unemployment. It happens when people do not perceive others as ‘the same’ or they see ‘easy targets’. Yes, educational programmes can take place which can help us all to learn about non-discrimination but I’m sure the people who are most option to the softer approaches would be those less likely to discriminate in the first place.

One of the points that the report makes is that the linking of this consistent abuse was not classified as  a ‘hate crime’ and the police have specific procedures when dealing with ‘hate crime’ including a referral to a specific department/officer who would have been able to assist in coordination of an approach.  Disability discrimination may well be forgotten as the perceptions of ‘benefit scroungers’ spreads through the media and government press releases.

A couple of other  points I picked up on, apart from the procedural errors in the way the police dealt with the series of complaints. I do wonder where social services fit into this. Not that they would be held responsible but in terms of providing support to Fiona as a carer and in providing some kind of network or advocacy in dealing with the police or pushing the police towards action. I don’t know the set up but I know I have chased (not literally!) up reports about anti-social behaviour when they have been discussed with me both with the local community police officers and the local housing office.

The local housing office, that’s the other agency that seems to be absent although the bounds of this report are limited and they may very well have been working hard behind the scenes but all the ‘identified group of youths’ were tenants of social housing. Pilkington was an owner occupier. I know that anti-social behaviour can potentially put a tenancy at risk and you might think in the list that is compiled this could have been considered. Maybe it was and we don’t know about it – to be fair.

While the ‘No Secrets’ guidance is referenced in the report, it is discounted from being the appropriate procedure to take as Francecca would have only turned 18 in 2006 and the scope of the guidance ‘would not have been relevant’.

I am curious about this – the age, of course, is a relevant issue but it seems to fall within the bounds of things that I would have considered as Safeguarding in the past – and currently.

There does seem to need to be firstly a shoring up of multi-agency working.

These incidents were not recognised as  a ‘hate crime’ which they should have been as a main reason for the initial targeting was disability-related.

I worry about a lot of things when I read this report though. I worry about the limits that we are bound to regarding what support we sometimes can and can’t provide. Fiona tried to be a strong advocate for her children and her voice was increasingly taken from her when she was not provided with the assistance and support she should have received from statutory agencies. I worry about the amount of support (or rather the lack of it) that is offered to carers who can come under increasing stress and I don’t see this getting any better in the ‘new world’ as local authorities increasingly take an even more ‘hands off’ approach to provision of care.

I hope the police will be able to implement stronger responses to hate crimes in all senses but particularly pick up on disability related hate crime as a separate and specific offence but also, I hope that those in the government and who rumble on about ‘big society’ and ‘importance of community’ learn to understand that not all communities are as supportive and helpful as they might be in Cameron’s dreams.

Volunteering one day a year might ease the conscience of Cabinet members and make them feel good about themselves but walking a day or two in the lives of people like Fiona Pilkington and reading through the IPPC report might teach them a lot more about what needs to be done to create a better and more cohesive society. It isn’t just about volunteering. It’s about creating hope, work and dignity for both those who need support in the community but also those who might otherwise grow up in poverty and seek to target those who are different because their own life experiences are so poor.

Will any Cabinet Minister volunteer their one day to work with the youths living on Bardon Road in Barwell where the Pilkingtons lived? No? That’s where they should be going.  That’s where the work needs to be done. On Bardon Road and on Bardon Roads throughout the country.

We need to learn from the deaths of Fiona and Francecca. We need to make a better societies and better communities and that can’t be done by brushing things that are less palatable under the proverbial carpet.

Sleep – Mental Health Awareness Week 2011

Yesterday, the Mental Health Foundation kicked off this year’s ‘Mental Health Awareness Week’ and the theme for this year is ‘Sleep’.

In conjunction with this, the Mental Health Foundation have produced a report about Sleep which is available to download free in PDF format here (it can also be bought in hard copy for £10).

I had a cursory glance through the report this morning and it really is quite fascinating because while I know the line about poor sleep both indicating and causing poor mental and physical health, I hadn’t really thought overly about the process of sleeping itself.

The first part of the report talks about sleep in general and what happens to the body when it is asleep in a physiological sense.  The second part concentrates on poor sleep and the different ways it can manifest, from insomnia to sleep apnoea, nightmares and snoring – and the final part of the report looks at sleeping well and various ways it might be achieved from ‘sleep hygiene’ to medication to CBT.

The survey in the report found that 30% of people asked had poor sleep patterns. I can definitely (like most people, I think) relate poor sleep to increased stresses and anxieties in my day to day life – unsurprising, to me, at least, that poor sleep leads to poor mental (and physical) health outcomes.

It can become cyclical so that stresses and poor mental health can lead to poor sleep which can lead to greater stresses and worsening mental health.

As well as the report, the Mental Health Foundation have produced some resources to use including a ‘Sleep Diary’. I can definitely see myself using this with people I work with.

There is  a free MP3 ‘Sleep Relaxation’  (on the same page) and while I haven’t listened to it yet, I have found audio resources useful in the past and will certainly be listening to it over the next few days.

And there’s a  free ‘Pocket Guide to Better Sleep’ in PDF form.

I think it’s an interesting theme for the week as sleep can be something that we take for granted if it doesn’t cause us problems (or just causes occasional problems) but I don’t think there are many people who can’t empathise with the distress that not being able to sleep well can cause as most people would have experienced at least occasional sleep difficulties and by highlighting it, this puts into a context that many people can understand, some of the difficulties faced by others.

Good set of resources too.

Sleeping

photo plod @ flickr

Guilt, Work and Switching Off

Over the weekend, I was reading Dorlee, from the ‘Social Work Career Development’’s guest post ‘The ABCs of Self-Care for Psychotherapists’ on ‘Private Practice From the  Inside Out’.

It is a useful and interesting list that can be extrapolated for many in the social work and social care sector – and probably many other sectors and areas where we work in stressful environments to be honest.
Libby's Guide to Total Relaxation

hewgriff @ flickr

It made me reflect on some of the ways in which our organisations work and are structured here in the UK and how unhealthy some of the ways we are forced to work are.

It is easy to blame poor management in the public sector (and that’s what I’m concentrating on, because honestly, that’s what I know) and in many cases it would be a fair place to apportion blame.

I have seen so many friends and colleagues ‘burn out’ by being almost criminally unsupported in the work place – ‘learning by doing’ through the false assumption that employers make that somehow social work graduates are immediately ‘ready for practice’ due to having one statutory placement.

Placements during the course are good arenas for training but they aren’t any more than a stepping stone to practice which is one of the reasons I am so strongly in favour of an assessed year of practice prior to registration as a social worker in the UK.

The real area for exploration though is the assumptions that are made at higher management levels about what work can and is safely carried out ‘on the front line’. I wonder sometimes what happens in the higher echelons of the Adult Services (and Childrens Services) directorates in the local authorities when they set some of the strangest and oddest targets and keep feeding the pressure on to the front line managers. It seems so very very distant.

So back to ‘self-care’ and ‘switching off’ from work.  It is something that, I think, for me anyway, takes practice.

I sometimes draw on my A level economics recollections of ‘Cost Benefit Analysis’ but instead of ‘costs’ and ‘benefits’ – I have the two ‘mental columns’ of ‘Things I can change’ and ‘Things I can’t change’ (without the financial implications!)

I can’t change whether Mrs M is going to have a fall this weekend. I felt that although she lacks capacity to make a decision as to her care and placement needs, it was in her best interests to stay at home in potentially risky environment as she had, prior to her dementia taking hold, indicated she never wanted to ‘go into a home’. She knows her way around her own home and while some ‘trip hazards’ may have been removed through an Occupational Therapy assessment and actions resulting from that, she remains a bit wobbly on her feet. Do I think about her when I go home on a Friday – sure, maybe a little – but I know I’ve done everything I could and I can’t stop her falling on a Friday evening or even on a Monday morning.

Am I worried about Mr Y who I assessed last week and made a decision not to admit to hospital under the Mental Health Act? Well, a little – after all, he wasn’t well and was disturbed – but I have to follow the criteria of the Act and I genuinely didn’t feel that he met them. Yet. I can’t ‘save the world’ or prevent all the accidents and incidents that might have adverse effects happening – so I try not to over-worry about them.

I am bound by the law of course and if someone doesn’t meet the criteria for compulsory admission to hospital under the Mental Health Act and they retain capacity – there’s nothing I can do. Quite rightly. Although sometimes, that instinct that drove me into this job – the ‘wanting to help’, the ‘wanting to make things ‘right’’ – it tries to pull me in another direction and those seeds of worry can be planted to blossom through the evenings and early mornings or over the weekend.

Sometimes I have to do this consciously and logically tell myself to evaluate situations.

Sometimes the worry comes because there are things that I haven’t done at work – telephone calls I haven’t made – reports I haven’t sent – visits I haven’t made.

Time is limited. As long as I can justify the time I do spend at work, I try to detach myself from these thoughts. I could always do more but the job is one of constant re-prioritising. Sometimes I forget to do things I’ve said I’d do or follow up on things I said I would. It happens. While it is my ‘fault’, I don’t necessarily see it as my ‘failing’. I know I can account for every single minute that I’m paid to be at work – even those minutes that I’m sitting chatting to colleagues about the weekends’ television or having a cup of coffee – because if we don’t have those minutes, we run the risk of further rushed, unreflected, unthoughtful pieces of work.

Colleagues have told me since my first social work job how important it is to look after ourselves in this profession.  The spur that often drives people into social care is a wish to make a difference and perhaps a desire for self-validation – the odd pat on the head of feeling that you made a positive difference to someone’s life. Unfortunately that same trait which is usually a force for good can be used and manipulated by managers to force people to work overlong hours, not take breaks throughout the day, push people to take work home because, you know, Mr K will suffer if you aren’t able to finish the paperwork this week. They know well how to pull on our ‘conscience’ because the same happened to them when they were mere practitioners.

It’s hard to say ‘no’ when you know the people involved. I’m drawn into some of the guilt because I promised to visit Mrs P last week. Well, I won’t say promise, because I don’t put things in those terms, but I said I would – then things happen and other things seem to take over and the telephone call about this or that suddenly has to take priority – and before I know it the week is over and I haven’t seen Mrs P or written up the report that I should have or telephoned a family member to confirm dates for respite.  It’s hard not to feel that I haven’t done my job.

But by weighing up what I did and how I prioritised, I can, at least switch off and learn to ease some of the personal responsibility by redrafting and reframing it as organisational guilt and responsibility.  That isn’t to say that I slack off or try and push the blame on others – to be clear, I never do that with a service user – and always take personal responsibility there as the last thing anyone ever wants to here if they are upset, disappointed or distressed is a social worker trying to fob them off on someone else – but mentally I try and differentiate between ‘things I can change’ and ‘things I can’t’.

For me, it works. But sometimes it’s something that has to be learnt each for themselves.

Are Beans more valuable than People? – Or A Day at Community Care Live 2011

Yesterday I went to the C0mmunity Care Live conference. It is an annual event put on by Community Care Magazine and runs across two days. Being one of the very few free events (and excellent – free isnt the ONLY reason I go but it does help!),  I’ve always made an effort to attend on one or other of the days and try and catch up on the workshop and debate programme that is put together about a very wide range of subjects relating to social care in the UK.

I went to a few workshops and my attempts at ‘live tweeting’ were scuppered initially when a colleague from work came to sit next to me in the first session.

It was a packed session run by the Mental Health Foundation about their Dementia Choices project and the title of the session was ‘Can personalisation and direct payment support work for people with dementia?’. There was an initial presentation about the research evidence and the project that the Mental Health Foundation had put together to pilot direct payments among adults with dementia  and then there was a talk from the daughter of a service user whose direct payments had changed her life.

I was a bit disappointed though. Not with the presentation and talks – they were very good and it was obviously something that was very deeply felt by those who have direct payments working for them but, in a sense, I felt that the speaker who first received direct payments for her mother in 2003 (I think – that’s from memory but it was a good few years ago) could have made the same speech about their use about 2 or 3 years ago before the move of the more widespread personalisation agenda. Her mother had been receiving direct payments for 8 years. What was ‘different’ then with this new push towards everyone receiving a direct payment?  I refer to my previous points about us knowing that direct payments can work incredibly well if there is an involved family to provide support for the person who may lack capacity but for the isolated older person who lacks capacity there is no ‘magic wand’ to make the systems that are over-complicated seem suddenly more empowering if there is no-one to take on the support planning role.

I’ve said this before and will again that I feel currently there is a two-tier service that we are providing where those with involved families and carers may receive the more individualised support plans simply because the additional time burdens of arranging support is placed on informal carers whereas those who do not have those networks receive exactly the same services as they always do – we just call it ‘managed personal budgets’.

The workshop instilled in me a kind of despair that this group of people that I work with a lot has again been sidelined in favour of the ‘easier’ groups. Where is the research with people who have greater cognitive impairments and who don’t have family members or carers who can or who are able to manage their support plans for them? Ah, a role for the voluntary sector perhaps? The problem is that the voluntary sector is also shrinking and someone needs to pay them so that a role for ‘support planning’ is likely to mean a lower personal budget.

Still, I know I should try and be more cheerful about it. It just seems that so much of the research time spent about personal budgets has been telling us things that we already knew about research that had taken place around marginalised groups regarding direct payments.

The second session I went to was about the need for media and social workers to work more closely together. Social Workers should not be afraid of the media and the media (and by that, the panel were referring particularly to main stream media – because that’s where the battles are to be won!) – should have a chance to engage more with social workers. The usual subjects of local authorities barring their employees from speaking to the press came up and hopefully the College of Social Work will be addressing this on a broader scale.

There are a lot of inaccuracies reported and it would be good to see more social workers able to contribute to debates about the work which we do to quell some of the misunderstandings.

I then went to session on Making Personalisation Work in an era of cuts. I almost didn’t go because I thought (wrongly, as it happened) that it would irritate me and that it would be people lecturing to us again how it is the intransigence of social workers which is holding up the forward march of social care.

It wasn’t that at all and for once, it really did sound like people were actually listening to what I wanted to say about the personalisation agenda and my fears for it. There is nothing at all I would like to do more than work in a person centred way regarding care and support planning. This is something I hope that I have always been doing since I qualified though. If it can be improved, it must be and I am more than willing to change every way I have of working in order to improve it but, and this was noted by the speakers, Peter Beresford and Miranda Wixon (of Think Local Act Personal) in some ways the government’s agenda of cuts has overtaken the meaning behind the ‘personalisation’ agenda.

Unfortunately, there has been a drive to try and deliver more for less and it is not only unrealistic, it can involve pushing people into making choices that they don’t necessarily want.

Beresford made the point that the government agenda is about pushing everyone onto direct payments as the ‘preferred method’ of delivering personal budgets but, he said, crucially – ‘preferred by whom’. Well, that would be the government.

There are more ways of delivering person centred planning and person centred support than providing the cash for someone to buy their own services and while it can work incredibly well for some people, there is the very real and often ignored or side-lined issue that it is not everyone’s choice to have that choice.

The excellent concept of personalisation and putting the primary role of designing support into the hands of the user of that support and the services is being lost to the marketisation agenda.

There was a speaker on the floor, in the question time who explained that the rate of pay for carers was lower than the rate of pay for employees in Tescos – asking, ‘Do we really value cans of beans over human life?’. It makes you ponder for a while – but there are vast issues about the undervaluing of care and support staff in our culture – not just through poor pay but through poor status. Surely the ‘heroes’ of our society should be the home carers and the support workers as much if not more than the professionals whom we traditionally hold in high esteem such as doctors – who, while performing fundamental roles are at least well-compensated for it.

Another speaker spoke about an issue that I am all too aware of where choice is actually reduced for service users as in-house local authority provided services are frozen out of the provider choice that has been given to users.

Can personalisation work then, in an era of cuts? We don’t have any choice. It will because the concept is a good one although the danger is that it has been completed hijacked by a government’s cost-cutting enterprise which will end up making social care delivery so restricted that it will barely exist in all but the most extreme situations.

It is not possible to detach ‘personalisation’ from ‘the era of cuts’ as local authorities have to divest themselves of many of their functions. I see a lot of third sector organisations and possibly private sector organisations moving into the support planning and assessment verifying and supporting roles. The money (when it comes) may come from the local authorities but they will not necessarily be involved in many of the intermediate processes. It may well be that some aspects of the work are far better done in other sectors. It will become far more usual for people to pay for their own care as the eligibility criteria rise – those who can afford it anyway – those who can’t afford it may well be waiting until they meet the critical bands of need before they receive support.

There will be a two-tier system of social care support. Those who can afford to meet their own ‘moderate/substantial’ care needs according to the Fair Access to Care Services and then shift to maybe receive some support from the local authorities as their needs increase – and those who can’t afford to meet their own moderate and/or substantial needs who will deteriorate more quickly and reach the ‘critical’ band which will qualify them for support quicker at the cost of their health and independence.

I am trying to think of a positive to end on. It was good to hear some of the concerns about the pushing out of the personalisation agenda are being heard. It was good to see groups of social workers who want to be engaged in the process of change.  I got a good supply of pens and although I wasn’t able to nab a mug, I did get a frisbee!

I almost forgot too, that the announcement of the memorandum of understanding between BASW and the College of Social Work – great news. Long overdue in my view!

Personally, I enjoyed being able to catch up with some people I’ve known a long time, others I’ve come across before and some I’d only ever met in a ‘virtual’ capacity – thanks to Shirley Ayres, the team at RiPfA and of course, the Community Care team as well as others who will remain nameless!

Embracing Social Media and Developing Guidance for Social Work

Image representing Twitter as depicted in Crun...

Image via CrunchBase

I’ve been engaged in an interesting conversation on Twitter over the past couple of days about guidance being developed or potentially being developed about  use of social media for social workers and more generally people who work in social care.

Our sector seems to be dragging its feet a little in this respect – certainly in comparison to some of the more sophisticated writing and communities that exist in other professional domains.

Can you imagine, for example, a social care blogging event taking place on the same scale that a legal blogging event is taking place today?

Or a weekly twitter chat about social care and social media strategies as happens with the NHS.

Even other local government employees seem to be talking about ways of using social media in their work that seems to be unbelievable for those who work in social work and social care.

Shirley Ayres on her site, posts an interesting video about the spread of social media and the need for engagement in all channels.

I wonder how long many of my colleagues and managers are going to be left ‘out of the loop’ and continue to let the world develop and grow around them.

The reasons that I am so strongly in favour of guidelines is that the bars are being moved regarding contact, discourse and discussion constantly and with many people testing out new ways of communicating and engaging, there are certain difficulties that lie ahead for the front line practitioner.

One is the anonymity vs named issue which I covered a couple of weeks ago. A part of me (the part where pride is based, I guess) would love to write under my own name but I worry about the impact that would have both on the service users I work with on a day to day basis and I am genuinely unsure if I am breaking any kind of contractual rules with my writing and can’t afford to risk my job.

Another is sheer openness of the debate and discussion. Just as I told one of our foster children not to put anything on Facebook that she would not want everyone in her school and family to see, the same applies for me but more so. With Twitter/Blogs/Facebook, privacy settings can be tightened but security is always an issue and even behind an anonymous persona, being a prig or prejudicial or just ‘having a moan about a visit’ might come across very differently to a service user who has just had an unpleasant and forced encounter with a social worker – does a search – and sees social workers complaining about seeing the ‘druggie’ or about people with ‘too many children’. Everyone likes a moan but having a moan about having a busy day is different from having a moan about some of the more particular things you might see on a day to day basis.

Then there is the illusionary barrier that is provided by a screen-name. Anyone can be a ‘social worker’ if they say they are. Anyone can be a ‘judge’ or a ‘professor of social work’ or a ‘psychologist’ if they say they are. While I have a healthy degree of scepticism generally, I tend to take people at face value  but I add a hefty pinch of salt as the ‘internet’ and by extension ‘social media’ can be a great way to invent less than useful ‘personalities’ if you are so minded to do.

I remember when I did some research back in the day into the use of social networks for self-help groups – and this is over 10 years ago when I was initially doing my MA – and came across lots of research examples of online confabulation. As I say, a healthy pinch of salt.

I hope that the baton is picked up by the social work profession because more than media guides and focus groups and the odd press release here and there, we, at the grass roots of the profession have an real opportunity to be heard by those who are able to make changes and help them get an understanding of what is happening beyond those focus groups but we can also change the perception of the profession and the sector and while I certainly don’t see ‘social media’ as a cure-all, I do see it as yet another tool to be added to our arsenal regarding communication.

Where previously a bad experience with a particular social worker might have shaped someones’ perception of the profession forever, now we have the chance to join in the discussion on blogs, give advice and thoughts in different forums, add support and information on twitter and show that social workers can do a lot more than just become mouthpieces of their employers.

But our employers and our College (whatever form that takes) need to take up the baton and run with it so that guidance can allow for safer practice and inform and education others in the profession about the opportunities that are now open to them.

Means Testing and Social Care Funding

Community Care reports that  Dilnot who is chairing the latest in a long, long line of consultations into care funding has heard overwhelming opposition to retaining the £23,000 savings threshold before people have to start paying towards their social care needs.

Charges for social care are a delicate political issue so not content with one report, each government seems to want to commission a dozen until they find one that says what they want to say politically.

As someone who doesn’t have any ideological issues with means-testing, I find the constant pushing of limits hard to understand.

If someone has money, surely they can and should pay for a service and if someone doesn’t have the money, the state should subsidise. Seems quite a good system.

That’s not to say there aren’t problems with the system as it is at the moment. There are lots. It is overcomplicated for a start. There is an element of the ‘postcode lottery’ about it.

The costs are increasing rapidly and, this is the rub, no-one wants to pay for social care. No-one. Whether they have £50 in the bank or £5000 or £5000000 – people have become used to receiving health care free and seem to make assumptions about the provision of social care on the same basis until they are actually made aware of the costs involved.

One of the most perfidious arguments I come across is the ‘I/my mother/my gran worked hard all her life so why should she pay when Mr Brown who has been on benefits all his life doesn’t?’.

Perhaps because you/your mother/your gran actually have the money to pay and Mr Brown doesn’t.

There is a lot of righteous indignation around in this country with people measuring what they have against what others have and what they get against what others get and seeing things as ‘unfair’. Unfair is a government that gives those who ‘have’ a free ride even if they have assets in the hundreds of thousands and restrict access to services for people who have the same and higher needs and fewer assets to pay for them.

Maybe you would prefer Mr Brown’s life of poverty on benefits or in a low paid job to your life where you’ve received a dignified wage and been able to save?

Or does it all come down to stamping ones’ foot and wanting to save your children’s inheritance?

I know this isn’t a popular view. Certainly Dilnot is going to reject it. The thought of – gasp – having to pay for social care if you have savings is such an anathema to the middle classes who have the loudest voices in the political process that it seems already to have been summarily dismissed out of hand.

The thought of having to sell the home to pay for care has been put up as the massive failing in the current system. Is it a failing? I’m not sure. The houses are are discounted from the sums if there is a partner who is disabled or over 60 living in them.

A charge can be put on the home by the local authority so the sale can be delayed until after the death of the person in question. Rental charges can be used to pay towards care fees if the family doesn’t want to sell the home.

Anyway, that’s likely to change because the home-owning electorate don’t like to pay for care for their parents when Mr Brown-on-benefits my be getting something for free.

One thing I am in favour of though, is the capping of care costs at a certain level if someone has very high needs. We used to have this in the local authority but as we’ve moved into more austere times, it has been abolished. While I think means testing is, by its nature, fairer, I don’t think anyone should be penalised if they have extremely high care needs.

The problem of course is that if people who have funds won’t and don’t pay – then who will? Why the state of course. Perhaps through the hideously conceived ‘insurance’ policies that the Conservatives dreamt-up pre-election which showed an ignorance of the details of care but could ‘insure’ someone with a lump sum payment (£8000 was suggested)  against care home costs in the future.  Another of Lansley’s gems. We really are seeing the measure of the man now.

I’ll be following Dilnot’s recommendations with interest. Just as I’ve tried to follow the very frequent and oft ignored proposals that have popped up again and again about the funding of long term care until the music stops and the government decides on the one that will win the most votes for them.

It’s a shame that so many games are being played in the name of ‘fairness’ where ‘fairness’ seems to only be referring to the wealthier, home-owning middle classes – but that’s where the votes are.

Cynical? Well, perhaps just a little bit!