Making Adult Social Care Better 1

I think I’m fairly good at griping and raising ‘problems’. For the next week, I want to try and take a positive approach and look at solutions as well as problems.

A few conversations I’ve had over the past week have focused on what is wrong with adult social work and mental health social work at the moment but more importantly what can be done to make things better.

My frustration is that for all the discussions that take place in the sector, so few seem to focus on those of us who have worked and are working at the so-called ‘front-line’. A home carer knows about the ways that contracts have been managed and awarded at the lowest cost and they will be able to tell you with far more insight than any contracting manager about the effects of 15 minute ‘spot’ visits and the lack of dignity present in the care for older people. They would also be able to give you an amalgam of ideas which branch from consideration, knowledge and experience of a wide range of service users.

Are employed home care workers ever invited to discussion forums and debates about the future of care? No. But you know, maybe the feedback would be the most valuable.

On a more personal level it feels as if the conversations about service design and delivery take place around and above us – with us being the people at the front line of support. Yes, there are discussions  with service users and carers but how much effort is made to seek out opinions that do not fit in the model that the consultants want them to express? How many of the people who attend these meetings, discussions and debates become self-selecting.

If you create a service user group, for example, in a particular borough, it seems to me obvious that you are most likely to engage will be those whose voices are already heard through different means.

I like to set myself up as some kind of advocate in terms of having an understanding of the needs of people who don’t often have their voices heard in these kinds of meetings and debates because the discussions I have are mostly with people who are at their lowest ebbs on the scale of health and need.

For me, it is crucially important that these people are not left behind by commissioners and service design but my experience and understanding of the sector suggests that they are.

I don’t want to keep harking back to the roll out of personal budgets on the back of the model of direct payments but I will. The voices of those without support and without advocates are understandably quieter and the way that the services have been designed focuses quite rightly on choice but what is not present is a way for an equitable service to be delivered to those who aren’t for some reason able to express choice.

So things that can make things better

– Use of advocates in a more formalised manner throughout the system. Volunteer advocates have a role but I see more mileage in professional advocacy with extensive investment in non-directed advocacy as that is potentially where the greatest need lies. If I weren’t so tied to my job in terms of needing a salary to pay the bills, I would, at a flash, try to establish some kind of enterprise to focus specifically on support planning and advocacy for adults with dementias. I hope there is a role for independent social work in this area in the future – in the meantime, if anyone wants to jump on my idea and run with it, I am happily ‘open sourcing’ it.

– involving front line practitioners in conversations, debates and discussions with the local authorities relinquishing some of the reins of power in respect to conversation. Recognise our professional vigour and competence. We see people and have discussions with people that will never attend forums collectively. We can signpost and support commissioners and contracting officers but we are never asked and never given the time to think more creatively outside our little boxes of control. We have ideas and a happier, more connected workforce is an engaged and interested one.

– speak to home care workers too – those with agencies and where in-house services still exist, with them. They will have good ideas about the ways that their services are failing.

– home visits to facilitate discussions – why have all meetings in a central hall when it can be limiting regarding those who have greater physical and mental health needs.

Technology can facilitate greater conversation and communication with two-way flows but face to face discussion is still very important as technology and keyboards can alienate some people – perhaps exactly those people whom it is most important to connect with.

-Practitioners have to be more engaged with developments in the sector and unfortunately I don’t see BASW or the embryonic College of Social Work being particularly engaged with social workers. Why have social workers become so disengaged from professional organisations and unions? Is it to do with a fear of employers? I think some more group action could really build the strength of social work but it is hard to shrug off the feeling that we are a disengaged and disenfranchised profession that like to feel sorry for our collective selves and wallow in our diminished status. I think if we took a stronger political stance and stood up to our employers and their political agendas and displayed more independence of thought, we would be able to demand more respect.

I have decided that while I can moan and groan with the best of ‘em, coming together with ideas for improvement is by far the best way of making our voices heard.

10 thoughts on “Making Adult Social Care Better 1

  1. I agree that there seems to be a culture within the profession (even at student level) of wallowing in self pity, myself included…people don’t generally say aw look poor social workers all beaten down and overworked lets give them a break…its up to us to take the profession by the scruff of its neck and show our professionalism and work by conducting our daily work with a passion, interest and level of knowledge and understanding which makes our critics sit up and take notice.

    I know this is idealistic and cuts, workloads etc etc reduce morale but its a cyclical argument….public opinion isn’t going to take pity on the profession without the profession first helps itself from within. I say become politicised, this can lead to motivation and passion for your work, build relations with colleagues (were all trying to face the same direction anyway), debate, discuss, educate and show service users that we are worth our salt in our day to day practice. Congruent listening and an attitude of trying to do all you can in difficult circumstances, even if this is only minimal progress towards the desired goal, could be a start.

    Thankyou for the positive post and the practical measures you suggest.

  2. What an amazing post! Every word written resonates with me and actually sent a shiver down my spine. Why are we such a disengaged and disenfranchised profession when our training is so political? We can seek empowerment and social justice for the service users we work with – but do not seem able to apply the same skills or focus when it comes to ourselves. If we believe that social work can make a positive contribution to people’s lives – and I do – then we need to stand up for social work.

  3. Thanks for the comments – Mark and Lisa. Unfortunately my positivity tends to come in patches.
    Lisa, I agree about needing to work on professional empowerment – I think the professional association and the union and the college could have been a lot more proactive but also the training needs to emphasis more professional collective responsibility.

    • That has been my general thought. I like to try and keep an open mind but I keep being proved wrong and feel very uncomfortable about profit being made in health and social care.

  4. Thanks for open-sourcing your ideal. I think this advocacy can still happen especially using the web as a platform. I was just discussing with another social workers that we need MORE human service workers blogging and advocating and sharing their stories. While I definitely understand professional and financial obligations your courage to write this blog brings us one step closer to sustainable change.

    My advice: Whatever ideal your thinking about in terms of advocacy. Throw it out to the twitter, facebook, and blog universe and start building an advisory team of folks that share your ideas and collaborate to publish and develop these ideas.

    Take a peek at Seth Godin’s Book Ideavirus around making ideas spread:

    free ebook

    • Thanks Mozart. I agree that the web gives us fine tools and platforms as communication moves into more post-modern type arenas. My cognitive dissonance lies around the fact that there is still a digital divide and it is still the case that those who shout the loudest will ‘be heard’ the most. The ‘internet advocacy’ also favours people of a certain age and cultural/social class. I work with a lot of people who have cognitive impairments and it is incredibly important that these groups of people aren’t left behind, as they have been in UK social care policy which is why I think non-directed advocacy support is so important.

  5. I found this a very interesting post and I agree that the challenge is to have a way of hearing every voice, not just those who know the “system” well or who have access to more sophisticated communication channels.
    I collect examples of personalisation in social care from different people’s perspectives – people who use services, carers, front-line staff (all roles), managers and leaders, care providers, commissioners… These messages are used in the Whose Shoes? learning and development tool to promote discussion and thus increase understanding in order to address the “real” issues. This approach provides a “safe” way of tackling the difficult questions as well as sharing good practice and celebrating the areas where everyone knows there are great success stories.

    I would be delighted if anyone would like to submit new scenarios for Whose Shoes?

    • Thanks for the comment. I don’t really know enough about the actual content of ‘Whose Shoes’ but I’ve love to know about solutions to the issues related to people who do not have the capacity to make decisions about care needs and don’t have advocates working with them and how choice exists beyond managed budgets within local authority block contract providers.

  6. your post really resonated with me – the “system” is too eager to take the quick option and just get a snapshot of clients and their support needs because “rolling out the programme of personalisation” tends to take precedence over really hearing the voices of those it is supposed to serve. I am at present writing a post on this very subject on my blog
    You are so right – there needs to be a some sort of enterprise that focuses on advocacy and support planning for people with dementia. I am six weeks into training to be a support planner with older people and I am seeing first hand for the first time that it takes time and patience to work with the client and their family/carers to facilitate a suitable personal budget package that meets their support needs.

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