Fear and Loathing in the Public Sector – Or Why I despise Oliver Letwin

Oliver Letwin, United Kingdom Conservative Par...

Image via Wikipedia

Yesterday I read this article about Oliver Letwin, who, according to the Guardian article

..warned that it was only through “some real discipline and some fear” of job losses that excellence would be achieved in the public sector.

Letwin added that some of those running schools and hospitals would not survive the process and that it was an “inevitable and intended” consequence of government policy.

A little background about Oliver Letwin. I’m always a little wary of using Wikipedia as a source but a few choice verifiable ‘quotes’  jump out.

He is the ‘architect of modern Conservative party policy’.

He would rather ‘beg than send his children to an inner city school’

Oh and earlier this year he said did not ‘want more families from Sheffield taking cheap foreign holidays’.

So do we have a picture of the man? The Eton-educated man who would not know the real effects of true fear in the workplace? That encompassing, sleep depriving fear of not knowing if you can afford your next mortgage payment or if your job will be there next week, next month or next year.

Does fear drive excellence?

Let me tell Mr Letwin exactly what it means in the working environment that I am based in.

I work in a Community Mental Health Team – our team has been decimated – actually to use that word literally, it is far worse than decimation – over the past two years. No, I don’t restrict the blame to the current government but include changes under the previous government in my criticism.

We have piles of unallocated ‘virtual’ files while we are pushed to the limits by increasing expectations regarding recording and inputting data which is supposed to ‘prove’ our efficiency.

We have had wards closed at the local hospital such that people who need emergency hospital admissions to psychiatric hospitals are placed away from their communities or on ‘inappropriate’ wards. I have police unable to provide assistance because their services have been cut.

Fear drives efficiency, he says? In our service we have been told there will be job cuts including possibilities of compulsory redundancies. Yes, I’m fearful.

The ‘consultation’ about what will actually be proposed for our jobs will probably be announced soon but we’ve known it has been coming for months. We’ve heard rumours. We’ve heard gossip. We’ve heard absolutely zero from our managers though. Nice. Way to generate lots of fear. All boxes ticked.

So what has this fear done for our efficiency? We are beyond demoralised. We have more people leaving and taking jobs elsewhere and  people are  taking longer periods of sick leave.

I know that Letwin wasn’t referring to the ‘front line’ staff in the public sector – oh no, he meant the managers because he is of a class and a mindset that probably finds it hard to hold a conversation on a human level with anyone who earns under £100,000 per year.

The distinction between ‘frontline’ and ‘backroom’ is a false one though as it is impossible that can operate without the other.

Hospital wards are closing. Cuts are being pushed through. We feel your ‘pressure’ Letwin. We feel your fear. But I could not possibly despise  you any more than I do for your ignorance and self-serving words that for me, epitomise what the Conservative Party and their ideology-driven cuts want to do to this country.

I would like to ask Letwin if he is happy to condone a country of Castlebecks. Well, you see, coming from someone who would ‘rather beg than send his child to an inner city school’ – he would never be in a position to actually know or understand the real concerns of people who are dependent on public services because he can always choose the private course for himself and his family.

I know he wants to ‘make a name for himself’. He likes to garner attention and oh, how clever he is to want to drive ‘fear’ into the public sector but that, to me, sounds close to cruelty.

Efficiency? I think we can do with  fewer MPs who feel the need to make claims for repairs to their tennis courts and to have their Agas serviced.

What kind of society have we become when we feel it is appropriate for a Government ‘Policy Minister’ to drive a disdain and almost bullying approach to a public sector that provides services he will never need?

Oh and the speech he made these remarks in?

It took place

at the London headquarters of KPMG, one of the biggest recipients of government cash, which won the first contract for NHS commissioning following the decision to scrap primary care trusts and further open the health service to private companies.

Nice work, Letwin. Roll on, executive consultancy. You are all in each others’ pockets.

Meanwhile I have work tomorrow.

You enjoy your private tennis court today.

Weekly Social Work Links 26

After my somewhat truncated break, I’m back (not that I ever went away but that’s another story for another day!).

Nectarine at Going Mental has to deal with too many consent forms. It’s an interesting take on the invasive nature of forms.

The Modern Social Worker has a piece religion and spirituality and their place in understanding cultural competence.

SocialJerk looks at dealing with the present rather than trying to fix the past. For me, that’s one of the keys of my work and the difference in the way I work and the way a psychologist might work with someone. I deal with the ‘now what?’.

Social Worker Mom is weighing up the pros and cons of her job – I really know that feeling – I do it quite frequently regarding career planning and looking at where I am versus where I want to be so can empathise wholeheartedly.

The Diary of a (Not So) Cheap Social Worker weighs up the pros and cons of moving out of her parents and finding an apartment of her own.

Here’s a great post that is from the week before last but it has some really useful links – as always from the Social Work Tech Blog – this post is about digital resources on the web.

And ever at the cutting edge,   Gamer Therapist looks at some specific uses for Google+.  I have to admit, I’m still finding my feet with Google+ – I am not wholly convinced by it yet but as always see potential and reserve a ‘wait and see’ policy – definitely worth reading the post if you want to find out more about it and a context in which it might be better used.

As a case in point, Dorlee publishes a post about evidence-based practice with information sourced from Google+.

And the Masked AMHP has posted a two part story – Part One here and Part Two here – subtitled Lenny : A Life and Death in the Mental Health System – as always with his posts, it is both poignant and valuable.  Very highly recommended and beautifully written.

How Not to Do Social Work looks at the new Advanced Social Work Professional role and whether it will do what is promised namely, keeping good practitioners on the front line.

A Case Manager’s Verse shares a story about the importance (and usefulness) of boundaries.

Peter at Child Protection Lessons draws on a report about links between mental health issues and child protection.

New BSW has been struggling with the heat – and finding it difficult to work. As for air conditioning, I’m glad it isn’t mandatory here! Sometimes I quite like Britain’s temperate climate..

The New Social Worker Blog also has talk of the heat in New York as well as the changes in state legislation which now recognises same sex marriage.

Congratulations to Doris at Hold My Hand who has just had her book – How Sweet Nursing Home –  about stories from working an a nursing home, published. It’s available via Amazon.com  but doesn’t seem to be available direct in the UK – still, quite an impressive achievement!

The last link and in the spirit of This Week in Mentalists ‘wild card’ is a non-social work post but a post from an ClaireOT about MOOC (Massive Open Online Course). I know some OTs are much more involved in this than social workers (judging from my ‘social media’ presence!) but I think it is a fantastic way to share resources and build information.

I am all for creating different kinds of social work/social care MOOCs. Maybe that’s another project for another day but do go and read Claire’s post if you have any interest in the possibilities of technology to create and grow learning collectively.

Castlebeck and CQC – Brief Thoughts

Paul Burstow MP addressing a Liberal Democrat ...

Image via Wikipedia

I don’t have time for a long post today, just a few brief thoughts that came to me as I considered the unsurprisingly critical report on Castlebeck by the CQC.

Of course it’s easy to be wise after the event but it leaves a bitter taste in the mouth when the CQC comes down hard on Castlebeck after it required a TV undercover programme to uncover the widespread abuse at Winterbourne View. Where is our faith in the CQC? Well, personally, I didn’t have any to begin with but this report is not a solution, it smacks of a desperation to gain any kind of public recognition of the CQC itself rather than a real attempt to improve any system of regulation.

Regulation costs. Good regulation costs. In the week that the Ofsted is planning two week, unannounced inspections of childrens’ services, I ask why services for adults have been allowed to be neglected?

Yesterday I heard Paul Burstow on the radio on my way home. Two things struck me, firstly that he didn’t seem to have any understanding of the difference between a hospital such as Winterbourne View and a care home. He  seemed to be happy to blame local commissioners for the quality of the placements that they commissioned in hospitals without an understanding of what had led to this situation – namely chasing the lowest prices.  He still is banging on about his so-called Excellence scheme which, if anything, will make things worse as I wrote here. The Excellence scheme is opt-in and it is for companies to pay to be a part of. That is not about excellence, that is about money-making.

The CQC should be demanding excellence from every single service it inspects. Every day. It doesn’t. It demands sufficient paperwork every couple of years, at most. That is how it inspects. Actually, the CQC doesn’t inspect any more. It does not have enough people to inspect, control and check.

We have allowed companies like Castlebeck to rake in millions of pounds of profits on the back of providing poor care to vulnerable residents and patients. We have allowed this because noone is calling the CQC and the government to account for destroying adult care services.

The CQC criticising Castlebeck – of course it will but remember this is on the back of one television programme with hidden cameras. What about the thousands of homes without hidden cameras? Where are the checks? Where is the scrutiny? Where is the excellence?

Sadness, Sympathy and Self

Sometimes, some days feel filled with sadness. I had one of those days this week. I don’t like to use the word ‘hardened’ but to put it this way, in over 10 years of frontline social work practice in some of the most deprived areas of the country and in the inner city, I’ve seen a fair bit of what society has to throw in terms of crumbs to those who are some of the most vulnerable members of it.

I look at the high rises that skirt around the cities and I see hundreds of lives being lived, families existing and stories being told. Some with hope and pride. Some with desperation and despair. All different, all a part of this community and society we live in. Poverty is real. Despair is real. The two don’t have to go hand in hand though.

I have a strong stomach and don’t bat an eyelid at all sorts of things when I walk into a house. I’ve probably seen worse.

In some ways, human misery is a part of my trade. Not always, of course, because there are the wonderfully reassuring smatterings of hope but difficult social circumstances and social deprivation run a theme through my career.

Although I often emphasis that mental ill-health is certainly no respecter of social class or financial assets, it is sometimes the level of deprivation and the difficulty and shame of poverty that I see that reminds me of the way that this political class intentionally ignores and isolates some members of the community.

Perhaps the most difficult part of  my job is wrapped up in the AMHP (Approved Mental Health Practitioner) role. It is a mirror into my ethical compass and while I enjoy the aspects that were involved in training and the support and development and even community feeling I have with other AMHPs, the process of making a decision about someone’s forced detention in hospital or a forced medication regime is never one that can be taken lightly and I don’t think it is one that should ever be ‘enjoyed’.  It is power, writ large. It is control.

Sometimes people thank you retrospectively for ‘making the right decision for me at the time’ but more likely that isn’t going to happen.

This week, I carried out a Mental Health Act Assessment in a hospital. That is very far from unusual. When I read the background and the circumstances, when I conducted the assessment and made the application for detention, which I did, I was overcome with a feeling of sadness for the action that I had taken and for the life that it predominantly affected.

For obvious reasons  I won’t go into details – anyway, even if I did they would possibly sound fanciful and unrealistic. To people who think that I have a ‘difficult’ job, I would say I  have had a walk-on part among some fine and very strong people who have had to contend with sickness, pain and family circumstances that have rolled all the dice against them in the lottery of life.

And when I sign the papers and write up the report, I don’t forget. I think, I reflect and I try to learn. What could we have done to prevent this situation from having occurred? Sometimes the answer is nothing but sometimes there might have been a different path, a different action or different guidance that might have led to a different outcome.

Sometimes, some days, I just feel overcome with sadness. Sadness at the injustices that are meted out by life, fate and circumstance. Sadness at the way that this society perpetuates and builds on those injustices of circumstance. Sadness at my role my own complacency in accepting that we have created such an unequal and unfair society.

In a community where people who live on state benefits are treated with an intention to humiliate and scorn and where the government not only condones and supports this, it tries to create further barriers between the ‘haves’ (with ‘have’ meaning working tax-payer) and the ‘have-nots’ (meaning those who depend on the state for income) it sickens me as I know that the rhetoric of ‘choice’ and  ‘community capacity building’  are empty words which mean nothing without the world of privilege. By privilege I don’t mean money, necessarily, but include the privilege of having family or friends around, the privilege of being well enough to build up networks of support, the privilege of being a part of a community. There is so much more to privilege that cash assets or income.

Sometimes I want to shout against the system that I am a part of. The social care system in this country is not ‘fair’ – it reeks desperately of unfairness and the pushing of ‘choice’ in very narrow terms onto a wide range of people who in reality have no choice whatsoever further marginalises and discriminates against poverty, incapacity and isolation.

But I continue in my job. I go into work and ‘buy into’ the system. In my own defence, I fight as hard as I can from the inside and I don’t forget the names, the faces and the stories of those whose lives touch mine.

I remember, I note and I learn and sometimes, that just fills me with sadness – but when I stop feeling that sadness, I stop learning, growing and trying to create a better world. One person at a time. In spite of the system I work in and with rather than because of it.

Why Deaf Awareness?

This is a guest post by Suzie  Jones@suziejones2010 . Many thanks to her – cb

Why deaf awareness?

When you think about the people you meet and talk to in your everyday life, I wonder if it crosses your mind that one in every six has a hearing loss? That’s 10 million people in the UK and this number is growing steadily with exposure to loud noises at an ever younger age. Over half of people who are 60 or older have a hearing loss. (and one in six has a vision loss, that equates to approximately 2 million who may be partially deafblind).

So, what’s a deaf person? Most of you will think that someone is a deaf person because they use sign language. But you may be mistaken. There are an estimated 50,000 to 75,000 deaf people who use British Sign Language (BSL), the rest will be using hearing aids, cochlear Implants, speech and lipreading.

How would you recognise a deaf person? The most obvious clues are they don’t respond to noises behind them and may be looking at you intently when communicating. They’re lipreading, and some of them probably don’t realise they are doing it. If you see someone wearing a hearing aid, don’t assume they are hearing like you are. The majority of deaf people have what is called a perceptive hearing loss, this is permanent, and it makes sounds not just quieter, but distorted too. Have a listen to this simulation :

Blindness cuts you off from things, but Deafness cuts you off from people says Helen Keller. How true this is. Communication is probably the most important thing to a person. If you can’t communicate you get frustrated, lose your confidence, withdraw from socialising with others and some people become suicidal and think life is over. Friends and colleagues think the person is being rude, ignoring them on purpose, or is simply not interested in them anymore. Yet communication is needed to tell people what you want or need, how you feel and to take and give instructions. It is no surprise, then that deafness is a major cause of mental health issues.

So how can deaf awareness help social workers? The best deaf awareness training will equip you with the knowledge to understand exactly how deafness affects an individual and an understanding of the diversity of people who are deaf and how they react to it.

From those who think being deaf is wonderful, to the point where they celebrate the birth of a deaf baby, to those who literally fall apart when they lose all of their hearing, sometimes overnight. It will also give you skills to speak clearly, know tactics you can use to make yourself understood and show you why deaf people make so many mistakes in lipreading and appear to not understand you.

It’s not just about what you see on the lips, lipreading is only 30% accurate, the rest is intelligent guesswork and can be extremely tiring. Deaf awareness will also teach you about the support that is available to aid communication and access, from registered communication professionals to technological equipment, like loop systems, TextRelay and other aids.

Deaf people really do blossom when they are treated with respect and given the opportunity to partake in things that other people take for granted. Such things are opportunities to go to the local leisure centre, to go to social events, to attend a subtitled screening at the local cinema, or even a tour of the local museum.

If you know how to make these accessible, you’re on a winner. After all deaf people are legally entitled to these things, it’s a fact though that most of them still a luxury or out of arms reach for many of us.

Don’t think that we can “make do” using family or having a sympathetic friend to be with us to do this communication support. It’s not independence, it makes us “needy” and reliant on people. We have a right to make our own choices in life and the freedom to say so without being influenced by the opinion of others. That’s the difference between providing professional communication support or not.

So next time you see an opportunity to go on a course to learn about deafness, do take it up. Don’t think that by learning BSL only is going to make you “deaf aware”. It won’t. You need to know who you’re learning it for before you start. If you would like a course run in your local area, do get in touch with us, we are here to make things better and raise this much needed awareness throughout the UK. The more people who are privy to this valuable knowledge, the better we can all make life for the 10 million people who are living with deafness every day in silence.

Suzie Jones

www.deafcomm.co.uk

Break

In the absence of a summer holiday, I am taking a break from the blog for about a week of so because I have a few more projects I’m working on that I need to devote a bit of concentrated time on!

There will be some guest posts and some posts I’ve been preparing and have written already but they won’t be as related to current events as usual!

(of course, I reserve the right to pop back up at any time.. and will try to get the round-up posts done if I can)

Meanwhile if you would be interested in contributing a guest post, please contact me via fightingmonstersblog@gmail.com  and I’ll be back in about ten days. I’m also around on Facebook here , on Twitter and on Google + 

Enjoy Smile

Selling the NHS – The Beginning

The National Health Service Norfolk and Norwic...

Image via Wikipedia

Yesterday, while most of the media, fixated self-referentially on the Murdoch hearings and Cameron was flying back into the country,  Lansley began to dismantle the National Health Service.

As The Guardian reports

In the first wave, beginning in April, eight NHS areas – including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children, and primary care psychological therapies for adults – will be open for “competition on quality not price”. If successful, the “any qualified provider” policy would from 2013 see non-NHS bodies allowed to deliver more complicated clinical services in maternity and “home chemotherapy”.

So we are led to believe that being open for ‘competition on quality not price’ will act to pat us on the head, reassure us, and direct us back to the ‘big media story’.

It worries me and it worries me for a number of reasons. Lansley’s words are couched in the words of ‘choice’ but I wonder exactly whose ‘choice’ it will be to make these commissioning decisions for which, no doubt, large amounts of money will change hands and profit-making publicly listed and private companies will be able to partake.

I admit to a bias having been exposed and having experience in the adult care sector which was subject to a similar rollout of competition which was supposed to increase choice and quality.

I’ve written many times about the end result and how it is one that has inherently favoured larger providers and companies that have been able to deliver on economies of scale rather than the poetic vision of small scale providers delivering local services. Those small scale providers were quickly priced out of the market and I fear this will happen again.

But wait, I hear, ‘quality not price’ Lansley says.. to which I reply, ‘nonsense’.

Why? Because there will probably be minimum standards of ‘quality’ that a service has to reach and beyond those, it will be a price competition. That’s what is supposed to happen in care – but who checks the standards? who will check the standards? How can we have confidence in a well-resourced and well-delivered service when regulators are so weak.

I do not want any private company to make a profit on my potential need for services for my back pain, my hearing or a child’s wheelchair.

Of course, making the publicly delivered service is clearly both too expensive and veering against the government doctrine of handing the healthcare to private companies.

I am sure the first few providers will intersperse local voluntary organisations with large multinational corporations in their delivery methods. Again, I point to the adult social care sector. We started along the path with the NHS and Community Care Act (1990) having a lot of local providers together with a few Southern Crosses and Care UKs. The local providers were eventually priced out.

Of course in the case of podiatry and hearing services as well as primary care psychological therapies, we can see these as almost discreet services. The ones that will potentially be easy to deliver and it will always be possible to find wonderfully successful outcomes for people choosing Boots rather than the local NHS for their podiatry appointments because it is more convenient. And I’m sure it seems to pave the way for Individual Health Budgets where people  are given the money to ‘spend’ on the services that they need. Choice you see. Choice is what it’s all about.

I turn back and look at what has happened in social care. Choice has been extended in wonderful ways to those with the loudest voices but in some ways those with the highest needs have been left behind. That is my main concern about the introduction of private into public.

For some people, the people in the comfortable middle classes of Chipping Norton, this is fantastic news – they can access their IAPT (or equivalent) by a local provider when they are feeling a bit down. They can have their feet checked in a local branch of Boots instead of having to travel into Oxford. All’s well.

Those will be the areas where both competition and choice are the highest.

My concern is that people who experience the degradation of poverty will have quieter voices and less choice because there may be higher multiples of health difficulties and choice is determined through power. I can’t help but think of people who are restricted in their choice by issues of capacity. Will they be given advocates to assist with the process or will they just be ignored? Will the choice by made by GPs who are courted by these private companies, just as they are currently courted by drugs companies?

How equitable will the ‘new’ system be?

If we are extending choice, we have to extend safeguards and checks.

If we are extending choice, we have to extend quality.

It hasn’t happened in social care – there is no reason to believe or trust that it will happen in healthcare.

It does make me wonder – Are we all in this together? Really? With the impact analysis projects that are carried out to ensure equality, I know there are provisions to look at ability and disability, gender etc but are social class and income level also considered?

And think – Lansley considers putting ‘quality’ in as a concession – he was happy to go ahead with the Bill and with a pure ‘cost’ factor. This is his so-called concession but it is no concession at all if we don’t have a definition of what ‘quality’ is. After all, the CQC – too look at the Health Care regulator – defines ‘quality’ on the basis of paper documents and paper inspections given to them by provider services.

If that doesn’t wave any red flags, I don’t know what will.

This is a government of interests rather than representatives. The shame is that the last government was too and likely all the future ones will be as long as we allow our heads to be turned more quickly by celebrity gossip than the tragedies unfolding in our adult care services.