Think Ahead – Why the Fast Track Mental Health Social Work Scheme is confused and poor


Last week, I read an article about the proposed government attempts to bolt a ‘Frontline’ scheme on to Mental Health Social Work. I was angry and I raged. Thanks to a comment (and I genuinely mean that) I wondered if I’d prejudged the process by some ill-considered quotes from the so-called ‘senior researcher’ and a government minister. Then I read the report itself and realised that while I hadn’t known all the detail, none of the concerns which I raised had been addressed.

People who have far more skill and knowledge than I do have written about this scheme – and people who actually know and understand the sector, unlike a think tank researcher who, on his own Twitter bio, claims to have expertise in education policy. I’d recommend the following pieces to learn more about the response to the scheme. This piece by Dr Martin Webber – a social work academic who has a particular interest in mental health social work (and more importantly, actually knows what it is) and this piece by Matt Graham, again, a social work academic who has worked in and knows mental health social work. Then there’s the sector commentary, from Community Care (an incredibly disingenuous interview with Norman Lamb which actually makes him into a bit of a laughing stock as he clearly demonstrates his lack of understanding of mental health social work – when he says, for example, that ‘only 8% of social work students choose a mental health placement’. Seriously – I feel a little sorry for him having been fed this by IPPR because anyone who knows social work and social work education will understand what that figure is really about and it isn’t about students not choosing mental health) and Mental Health Today.

 

I want to look at the report itself and while I don’t want to repeat some of the issues raised above, I am going to relate the cognitive dissonance between what the report says and my understanding and knowledge of mental health social work and why I think it’s based on flawed assumptions.

 

Starting with a solution and then ‘consulting’

This is something that is raised in the above pieces. It is blindingly obvious the government agenda was to take the ‘Teach First’ or ‘Frontline’ agenda and impose it on mental  health social work. Regardless of any consultation or discussion. This was a development that started with a solution and then went in search of a problem. Is the problem in mental health social work that there aren’t enough high calibre graduates coming into the profession? I’d say not but then, I’m biased and I know the excellence of my peers. I’m actually not opposed to new routes into social work for different groups of people. Our profession is strengthened by diversity. However, my worry is that this obsessive inferiority complex that social work, as a profession, has is going to stifle rather than extend diversity in social work. I see a professional voice that is growing and becoming more secure in itself and then we are told there’s a problem with image.

Having worked in and around mental health social work, I have never felt anything other than highly respected and valued as a member of a multidisciplinary team. Certainly, the consultant psychiatrists I’ve worked alongside have told me that they greatly value the social work profession and what it adds to multidisciplinary teams. So where is the problem? Not enough people who can’t get into clinical psychology considering social work as an option? Because that’s what seems to be presented in this document.  The document calls for an ‘improvement in the status of social work’ but certainly, within mental health (perhaps, unlike adult social work where professionals really have been deskilled and I’ll come back to that) I don’t see any concerns about the status within those who work in the profession. I was far more valued as a mental health social worker than as an adult social worker. But our job shouldn’t be about what status we have as professionals. It’s about doing a good job well, in a ethically sound context.

 

I’m going to look at the report in chunks – particularly where I feel the evidence is flawed and consider the report in detail.  I’m going to use the report headings themselves for ease of cross-referencing.

 

The challenges facing mental health social work

This is the place where we see how poor the research and consultation was, in the first chapter. We see evidence presented of the need for robust mental health services due to a rise in need. It’s hard to relate this to the destruction with which this government has unleashed on the health sector in general and mental health services in particular and not wonder what on earth the report is trying to prove. I hope the government didn’t pay a lot for this research as it’s pretty clear that the mental health sector is underfunded and working dangerously. However, the attempt to link this to a lack of the supply of good mental health social workers is flawed in the extreme as the problem isn’t a lack of supply or potential supply but a lack of actual posts available.  Here’s a nugget which evidences poor understanding

“Some local authorities have found it so difficult to implement integrated
working with the NHS that they are now choosing to bring their staff
and services back in house. It is important to find ways to deliver holistic
and integrated services in a more effective way”.

I’d say to the author that the reasons for pulling social workers out of mental health teams was related to Eric Pickles’ decimation of local government budgets rather than any decisions about ‘integration’ wasn’t working. Local authorities have different targets and sometimes social workers in mental health teams are pulled in different ways but I have spoken to many social workers who have been pulled out of mental health services and I’ve spoken with mental health teams who have had social workers pulled out.  The choices made were due to budgets not an ‘integration isn’t working’ agenda.

The integration agenda

The report then kindly explains to us what a ‘CMHT’ (Community Mental Health Team) is. I hope some of the directors of adult social services who are quoted in the article read this bit because my experience is that they rarely have a clue themselves.

The report says

Some {social workers] have reported benefitting from
greater levels of cooperation with other professionals, enabling them to
deliver a high-quality service to those with mental health needs. Those
that have reported negative experiences, however, have usually done so
due to a perception that they are unable to use their social work training
to deliver the social element of assessment and treatment. These mental
health social workers report either a situation in which their contributions
are undervalued and overridden by medical colleagues, or that their roles
as ‘care coordinators’ (see box 3.2) have caused the nature of their work
to become that of a generic health professional, requiring very little, if
any, social work expertise

So we can see what the researcher is doing by choosing the information that suits him. He discards the ‘some’ with positive experiences and picks up ‘those who have reported negative experiences’ and runs with it. He then goes on to pull apart ‘care coordination’ which he helpfully explains in a little box. This is my explanation of ‘care coordination’. Concerns about generic roles within CMHTs are not exclusive to social workers. I’ve heard nurses and CPNs describe the same. The issue isn’t solved by looking at social work in isolation. I have to say my experience was never one of disrespect or ‘being overridden’ by medical colleagues but maybe that says far more about a working culture and environment  and the leadership of the team than it does about social work specifically. If there is a problem, is it not one which is dependent on what profession you are but of general professional respect and hierarchies within teams. I would also absolutely refute that a generic role doesn’t require social work expertise. The point is that we, even when we work generically (and I did) contribute according to our professional backgrounds and work in multi-disciplinary teams to contribute our learning, values and positions.

I’ve found a bit I agree with

There are also significant concerns about the management of social
workers in integrated teams. Research suggests that social workers can
feel abandoned by the local authority

I certainly ‘felt abandoned by the local authority’ BUT why does the author then go on to completely confuse things by asking directors of adult social services for their input when they haven’t really proved that they know, understand or engage with mental health social work. I can live with feelings of abandonment from my employers to be honest, as long as I’m allowed to do the job I feel it is ethically right to pursue and a different training route does not solve this issue.  Then we get a really odd logical leap which evidences the need to find a solution and look for a problem. The author (I’m not going to call him a researcher anymore because he is using fiction), moves from a paper which talks about integration to a conclusion that we need

a cadre of highly trained social work
professionals with a commitment to integrated working will be required
to make multidisciplinary teams a success. A need therefore exists to
foster a new generation of mental health social workers, who have the
capabilities and confidence to work effectively with other professionals
in integrated teams.

So let’s get this unpicked a bit. He is blaming a lack of integrated working, entirely on the ‘cadre’ of social workers in integrated teams. Wow. We need a ‘new generation’ of mental health social workers. Need? Really? This is where we start seeing the arguments fall to pieces because what we actually need to make integration work are confident social workers who are able to challenge within teams. Sure, let’s bring some more in but this suggests we NEED new people in. Let’s have the new blood in because the current ones don’t have the skills. I see we move from fuzzy arguments to pre-defined solutions in a whirl. Funny that Lamb says this isn’t about denigrating current mental health social workers but it seems quite clear in that sentence.  You see, it’s OUR fault that integration isn’t and hasn’t worked. Our fault as mental health social workers. Not the local authorities who are desperate for money and need to bring their social workers back in house to pick up the local authority targets. No, it’s the fault of the social work profession.

And the conclusion

the first problem that a fast-track recruitment
programme in mental health social work will help to address – protecting
both the integration agenda in mental health and the role and status of
mental health social workers

And there we have it. This is going to ‘save’ the integration agenda. Unfortunately, the author has completely misunderstood (actually, I’ll give him some credit) or misinterpreted intentionally the reasons that integration has been struggling in mental health. Clue: It isn’t solely the fault of the social workers in the teams.

 

Recruitment

The next issue the ‘problem’ with recruitment. This is where the report gets very confused about the links and differences between adult social work and mental health social work. The author starts by saying

A situation has therefore arisen in which an increasing number of newly
qualified social workers are competing for a decreasing number of social
work positions. As a result, the vacancy rates in adult social work have
declined steadily from 9 per cent in 2011 to 6.7 per cent in 2013

Ok, what springs to mind immediately isn’t ‘What we need is a fast track scheme’. There are very different concerns and sensibilities than exist in childrens services. in fact the report talks about an ‘oversupply’ of newly qualified social workers.  There’s an odd little sentence about recruitment being a particular problem in adult mental health services. I travel around the country a fair bit in my current role and I speak to a lot of people in a lot of community mental health teams – both at work and outside of work – and problems recruiting to mental  health social work posts is never something I’ve come across. Of course, there may be parts of the country where that isn’t the case, but for London, where I am very well embedded, it’s not an issue I’ve ever heard raised. So where does the author go?

The most acute recruitment and retention problems concern
the role of approved mental health professionals (AMHPs). AMHPs
exercise functions provided for under the Mental Health Act 1983,
including making decisions about compulsory admissions to hospital.
Local authorities have a statutory duty to ensure that they have a
sufficient number of AMHPs to carry out the roles required of them
under the Act.

I sniggered at this. Yes, it is true there aren’t enough AMHPs but does he know the reason the change in the Mental Health Act 1983 – as amended 2007 – as made? It was to deal with this problem entirely. Now, it hasn’t been particularly successful but there are certainly a fair number of nurse AMHPs knocking around and the issue now isn’t so much the lack of availability of nurses (or social workers) to train as AMHPs so much as the lack of willingness for mental health trusts to pay for their training as the responsibility to provide AMHPs is the local authority’s. So having more social workers through a fast track route won’t ‘solve’ this problem. That’s the reason the number of social work AMHPs remains high – it’s due to the cost of training rather than the lack of supply of people who want to do the training. And then there’s a little box explaining why fast-track recruits can’t do AMHP training. Seriously what a clue has this author got about what the AMHP role is that he condescends to actually explain this. I would not want anyone without considerable work experience in a mental health setting (and 2 years training doesn’t come close) to take such a role and he insults our intelligence with  his little ‘explanation’ box. Mind, insulting the intelligence of social workers doesn’t seem to be a particular concern of his.

Then we have the little survey of directors of adult social services where no distinction is made in the questions between adult social work and mental health social work. So let’s look at some of the questions asked by the author and see if they are leading.

90 per cent of respondents either agreed or
strongly agreed with the statement that ‘more needs to be done to attract
the highest possible quality candidates in to the social work profession]

Firstly, this doesn’t specify adults, children or mental health social work and secondly, isn’t that about asking people if they like chocolate? Wouldn’t people say ‘yes’ to that question asked in relation to any profession? Should we do more to attract the highest possible quality candidates into teaching/nursing/law/journalism/banking – hard not to say ‘yes’ to any of this. And this is the ‘research evidence’ that this study is build on. A joke.

And he goes on

Our survey found that
47 per cent of respondents either agreed or strongly agreed with the
statement, ‘My local authority experiences a problem recruiting high
quality social workers in to adult settings’. While the response was
by no means unanimous, it does highlight ongoing concerns over the
quality of social workers.

47% is under half – there is no distinction between adult and mental health social work. This does not, to me, explain a specific concern about mental health social work and I’d ask the author why they put ‘adult social work’ in this question and not ‘mental health social work’. Remember, this is directors he is asking. Who probably haven’t got a clue about the quality of work done in the mental health trusts where they second their employees to. I’m not sure this is a fair reflection on the quality of social workers but what I’d say it is evidence of is asking questions and leading questions to evidence a solution which has already been proposed.

Let’s go on and please remember, these questions do not specify mental health social work.

Our survey of local
authorities found that the five skills deemed to be most lacking among
job applicants were:
• analytical ability/critical-thinking skills/intellectual capacity (56 per cent)
• awareness of evidence and its impact on practice (44 per cent)
• practical experience of social work (39 per cent)
• leadership skills (35 per cent)
• knowledge of integration and partnership working (32 per cent).
It is therefore clear that more needs to be done to attract talented
individuals into the profession, particularly those that can bring these
particular skills with them.

So remember how these questions are asked – they are not asking if applicants lack these skills but rather, if they have to choose skills which applicants lack, which would be their top five – so we are starting from a point of identifying deficits which are assumed to exist – and remember only 47% of respondents said they ‘agreed’ or ‘strongly agreed’ with their LA having difficulties recruiting high quality social workers. Surely it would have made more sense to ask these questions within mental health trusts where social workers actually work and where their job and the quality of their performance is known rather than directors of adult services who base their experiences on the far higher numbers of adult social workers that they would have contact with. This is why I say this evidence is flawed.

So what makes a ‘good’ graduate entrant into social work. Let’s see

Despite recent recruitment initiatives, social work is still not seen as a
career of choice for many graduates from highly selective universities.
In 2011/12, 2,840 people started social work master’s degree courses,
but of these only 270 had completed their undergraduate degree
at a Russell Group university, and only 10 had attended Oxford or
Cambridge. This means that only 9.7 per cent of people who started
training to be a social worker through the master’s route in 2011/12
came from a selective university

Now, before I get told off for hypocrisy myself, I have no issue with more graduate recruitment into social work from ‘selective’ universities but I don’t see the lack of recruits from ‘selective’ universities as a problem with social work recruitment. People want to join the profession – great – but why is which university you go to seen as a determiner of the quality or attractiveness of the profession. Is it a problem for social work that the profession doesn’t ‘compete’ with law, medicine and finance? Maybe we should rather, compare to nursing. Or better not compare with any other profession because, you know, we aren’t any other profession. I was lucky enough to get a grant when I went to university. I didn’t pay for my university fees (yes, that ages me!). I could choose any university that would take me – I was lucky to be able to choose a university with a good reputation. However, were I going to university and needing to pay for it without a grant, I would choose the cheapest, nearest one. That doesn’t make me less able than someone who happens to live in a town with a ‘selective’ university.  There is a route into social work for all graduates – which is the masters route – and it’s the route I took. It still exists.  Then he comes on to his great ‘let’s attract people who can’t make it onto clinical psychology courses’ argument. Um. I’d rather have people who actively choose social work to be honest. This is the argument for a specialist ‘mental health’ route but I don’t see any comparison (which makes far more sense to m e) with mental health nursing which is a different route to a mental health specific profession. I’ve often written of the need for generic training in social work because it preserves the integrity of social work – separating the routes out weakens the profession at a whole. If we have one ‘fast track’ route for ‘high flying’ graduates into childrens social work (Frontline) and one for Mental Health (Think Ahead) – where does that leave adult social work – working with people with physical disabilities, learning disabilities, older adults (which is my particular area of interest) – are we saying that doesn’t need ‘high flying’ graduates. I think we need one coherent path which allows for higher level specialism after qualifying and a more coherent post qualifying framework at a higher level – rather than fragmenting entry routes but that doesn’t exclude ‘high flying’ graduates. I’m very happy for them to join us. Delighted.

 

Education and practice learning

The author moves on to a critique of current training. I was a practice educator in a mental health team so was particularly interested in this. The author picks up general criticisms of social work education however Croisdale-Appleby and Nearey reports are considering these issues and will, hopefully, look at the whole education setting. It isn’t an argument for a completely new route in. He conducted a ‘focus group’ with students

All of the students felt
that the practical element of the course was important, particularly
for those who had come straight out of an undergraduate degree
that contained few practical elements

Did that need a focus group? I guess it did if you  have no idea about the sector but maybe it would be useful to take more students who have practical experience in social care settings rather than relying on the degree to do it all. I am not saying everyone needs years of experience of work in social care to enter the course but it seems like the solution could be ‘get the experience yourself’ rather than rely on a course to turf out a perfectly functioning social worker. I worked in social care for years before I did my social work training and it embedded a culture and understanding of the sector that could not have been replicated in a two year Masters degree. That’s my experience. Maybe the answer is to demand experience before admission to training courses rather than trying to ‘do it all’. It would display a commitment to the sector too –and I include experience as a user or carer of someone who uses social work services – it doesn’t have to be paid employment but it seems like the obvious answer.

We have Lamb rabbiting on about social work students not ‘choosing’ mental health placements but here’s the evidence he uses

A particular problem appears to be that fewer social work students are
qualifying with experience of mental health work. Placements in mental
health and other NHS services account for between 0 and 8 per cent of
all social work placements

So do we see the problem here? I don’t see the word ‘choice’ anywhere. As someone who offered a mental health NHS placement to students, we were massively oversubscribed in terms of students wanting placements. Mental Health placements in statutory services were seen as ‘gold dust’ in my experience. This is absolutely not about choice. My concern is that we are seeking the wrong solution. Think Ahead will deprive all students who come into social work from other routes from mental health placements as there are so few around and they will be able to ‘cherry pick’ for their own students and offer money to organisations for their own students to have placements. This means there will be fewer opportunities for those who use other routes into social work to have mental health placements with the risk that the diversity of students coming into mental health social work will decrease.

The author then goes on to waffle about bureaucracy in social work and how social workers should be able to ‘deliver effective interventions’ in mental health social work. I’m not going to waste my time on this simply because his paper doesn’t address a solution which is exclusive to graduates of a Think First type scheme. I think the idea is that these ‘effective interventions’ will be somehow ‘taught’ on the course but that replicates my concern about the Frontline scheme. Social work qualification courses aren’t about ‘teaching’ interventions – that comes with the job and the specific role as mental health social work varies and the tools you learn to use in a specialist dementia setting would be significantly different to those used in CAMHS – not least, the interventions change. The requirement of the job is not to train social workers to deliver specific interventions but to have an understanding of a framework to fit different interventions into different settings. So he shows no understanding of the needs of community mental health teams. Again.

 

Design Debates

Now the paper looks at how a course might actually look – The paper looks at Frontline as an exemplar – of course, because Frontline was developed by IPPR and has a similar type agenda as Think Ahead  which is quite open. And what of Frontline – remember, this is what Think Ahead is striving towards.

Frontline has completed recruitment for its first cohort of
participants, who will start the programme in the autumn of
2014. It received 2,684 applications, representing a ratio of 25
applicants for every one available place on the programme. Of
these, 1,272 applicants had completed an undergraduate degree
at a Russell Group university, and 184 were Oxbridge graduates.
This compares to the 270 Russell Group graduates who started
a master’s degree in social work in 2011/12, only 10 of whom
graduated from Oxbridge. Frontline has also attracted a larger
share of men than other to social work training routes

Russell Group/Oxbridge as determiners of quality, oh and more men. That’s good then. That’s always a plus. Seriously though, I don’t have any issue with Oxbridge/Russell group grads (or even men (!!)) choosing social work  but lets have some honesty with this debate. Yes, they had more applicants  but nowhere do they mention the £20,000 pay for people to take this qualification route. Now, who WOULDN’T choose to apply via that route rather than a Masters. Doesn’t matter if you want to work with children or not. If you have the option of choosing to apply for a bursary which is significantly lower or a course which pays decently and where you’ll be guaranteed placements – even if you weren’t bowled away with the programme, of course you’d choose the option with more money attached. So I think we have to take those figures with  pinch of salt. What I don’t understand and what’s written nowhere is how the outcomes of these students will be measured. There is no thought of seeing how Frontline cohorts perform BEFORE rolling out to other sectors or seeing if there is an evidence base to prove they are improving social work practice. No, that would take too long because the government has an agenda.

 

The little box about Frontline also doesn’t mention that the Frontline programme fell pretty steeply at the HCPC hurdle which monitored and regulated the quality of social work education. Oops.

 

The paper mentions recruiting for values but every single social work programme in the country should be doing this. This is not specific to a fast track scheme but they we get on to the real nub

The graduate recruitment market is extremely competitive, with many
corporations offering handsome rewards and training packages to
attract the most talented individuals. The programme must therefore be
designed to be attractive to graduates

AKA let’s pay people more to do social work courses. Actually, if they just stuck to that bit and threw away all the rest of the document, we’d probably recruit people into the profession but something that they should be aware of is that in some parts of the country, social workers won’t be early much more than the training salary when they qualify. This is not the equivalent of a medical degree where you train but in return get a higher salary on qualification. Or lawyers. It is much more akin to  nursing in terms of salary levels – except in nursing there are far more routes to management and leadership than there are in social work.  Funnily, this is their evidence that retention would not be an issue

Two-thirds of Teach First participants remain employed in teaching for
at least one year beyond their completion of the two-year programme

Er, guys, you know measuring retention after a two year programme and one year employment isn’t really much of an indication of long term retention rates.. guys.. guys. Seriously, one year out they have measured retention rates – oh and a 33% dropping off is seen as ‘good’. That’s even worse than social work. How about a comparison with regular retention rates in social work rather than pulling teaching in because you know, they are actually different professions. Oh, then the figures might not prove what the author wants them to prove (remember, starting from the solution and working backwards way of working). The paper then wiggles a bit and says, well, it doesn’t matter anyway because the programme actually isn’t about providing ‘frontline’ mental health social workers anyway, see —

What’s more, even if the proposed fast-track programme did have
a lower retention rate than existing, traditional training routes, there
is in any case considerable value in having a set of ‘high-calibre’
professionals who are trained in social work but who go on to forge
careers elsewhere in society

Which is completely counter to their argument about needing these high calibre graduates to embed and lead integration within social work settings and as social workers within mental health teams. And oh, the knowledge of interventions they will waste. No, this is about giving graduates a two year course in ‘leadership’ (what on earth.. ) and ‘mental health interventions’ (which they might need in some board rooms but probably not the way the programme was planned) as they flit through actually speaking to people with mental health needs really quickly on their route ‘to the top’.

If I were advising someone who wanted a leadership role in mental health, I would advise them to take mental health  nursing as a route to leadership and management as there are far more opportunities there. Every board of every trust is required to have a lead nurse. So where will these ‘leaders’ go? Oh, I shouldn’t say that, I’ll probably have one managing me in about five years time! So Lamb’s bleating about this programme improving the status of mental health social work is actually about this

Participants on the programme will develop an insight
into the problems that mental health social workers help to address,
and take that knowledge with them if they move into other leadership
positions in fields such as law, government and business

It’s a little game for a leadership class to play at mental health social work for a couple of years before passing on to private sector positions or better paying jobs. It isn’t even about leadership within the mental health sector. Is that what the government really wants to create a leadership ‘class’ and it is using social work as a tool. It has no interest in the profession itself. But we knew that, didn’t we?  There is a feel of ‘go, my bright young stars, try to see what ‘common people’ do for two years and then we’ll take you back into our law/govt/business embrace”.  This programme,in the words of the author “

it could help elite groups in society to gain a better understanding of the society that they serve

even if they don’t stick around for more than two years. I wonder if the author (I know nothing about him – wonder if he’s an elite) realises how incredibly insulting and patronising that sounds. It feels a bit like a person who is privileged staring into the lives of ‘poor people’ as if it’s some kind of sociological experiment without an understanding of the deep affect that relationships have in mental health social work. This is not an area to experiment. These are people’s lives and realities and it is not a testing ground for elite groups in society to play around with other people’s lives. I feel very strongly about that and was actually both shocked and sickened by these phrases. There is someone who doesn’t understand social work at all. I did ask the author if any service user groups had been consulted about this programme. I haven’t had a response. I hope he drops these phrases into the service user consultations – because there will be service user consultations, right? I mean I hope there already have been because as far as I’m concerned, that’s where I’d start.

So the course is a proposed two year programme but you know, the responsibility needs to come early because

In a national High Fliers survey, graduates ranked ‘having
responsibility from day one’ as one of the most important motivations
for applying for a job

I’m  confused as to whether this is a job or a training opportunity. Starting a masters course doesn’t sound like a ‘job’ to me but then, I stuck around for too long to fast track into govt, law or business so clearly I’m not as clear minded as the group that will be attracted by this route.  So what about a fast track then – well, let’s look at the evidence, says the author

While social work lecturers expressed concern about compressing
course length, those behind Step Up to Social Work and Frontline
believed that a carefully designed programme targeted at exceptional
candidates could be delivered in a shorter space of time

And let’s discard what the lecturers say and use the words of those who have no vested interest and are running condensed programmes say. Oh. Now, there’s choosing your evidence to suit your outcomes. We don’t have any clear outcome measures over the long term of the effectiveness of fast track routes. Frontline hasn’t even started running yet but the author thinks it is appropriate to take ‘what they say’ as evidence to show that fast tracking can work. That’s is the candidates are exceptional. Ah, maybe that’s the difference. It would be nice to have evidence though but that’s never troubled any politician or think tank. The programme will be located where the recruitment difficulties are. Ha ha. Good luck with developing that, Think Ahead. They say

The proposed programme must
be designed to address this issue by targeting areas and individual
NHS mental health trusts that have particular recruitment difficulties.

Do they know that few mental health trusts recruit social workers directly and those that do recruit them as ‘mental health professionals’ rather than as social workers? Why would a Trust choose to train a social worker rather than a nurse? Possibly because Think Ahead will pay them to take people on but this won’t develop models for sustained retention over the years – but then, that isn’t really Think Ahead’s purpose either. It’s about fast tracking people into professions that pay more and using this merely as a developmental tool along their journey – the cost being, people’s lives who are affected by short term relationships and people who have little interest in developing in practice. Again, we see evidence of a lack of understanding of the sector.  Their muddled thinking is evidenced by putting in the same sentence

Even so, the
programme should still aim to work with local authorities that are facing
particular problems in recruitment and retention as much as possible.

So wait, are they going to be working with mental health trusts or local authorities because they seem to be confused themselves. And I may not know everything (quite!) but I do know the mental health sector in London pretty well and wonder where they are going to find these vacancies. My suspicion is that the programme will bribe LAs and NHS trusts to provide placements so the scheme can get up and running – because honestly, the posts don’t exist anymore. The flit across the need for generic training but what hasn’t come across to me at all, is that there is any understanding that ‘mental health’ is not one speciality. Let me give my own experience. I worked in adult services in an older adults team and then moved into older adults mental health. My understanding from working in a social work team and doing care planning and care management was a key skill to take with me into older adults mental health services. If I’d done a generic ‘mental health’ social work course, I would have learnt different skills. I think we need a longer rather than a shorter course. My own solution would be to pick up on the AYSE and post-qualifying routes and firming up the routes into specialisms at that point – not at the entry level to the profession. That doesn’t exclude anyone and any ‘elites’ who want to join are more than welcome but it doesn’t create a separate route for ‘elites’.

And they argue that this training needs to be delivered by a social enterprise. And there’s the rub. This is a push to privatise social work recruitment and education. Remember, Frontline haven’t made it through the HCPC accreditation process yet but this is an attempt to split the profession and turn the training into a profit-making ‘social enterprise’ that will be a platform for division rather than unity. What will make social work stronger is unity rather than division. Fine, lets have new routes in but isn’t that what Narey and Croisdale-Appleby were looking at anyway. How about we stop, and assess the research and evidence before charging down a new path, especially when the evidence is based on so many fallacies.

 

How the programme will operate

If we need more evidence of the lack of understanding that this report is based on we need look no further than this section which explains in more detail how they propose to run the programme.

Let’s look at the avowed aims of the programme

The programme will be designed to attract high-calibre individuals
into employment as mental health social workers within integrated
community mental health teams. It will develop participants’ practice
capabilities and leadership skills, emphasising the inherent role of
leadership within social work practice (bringing together a range of
actors to solve complex problems). It will be designed to develop a
cadre of social workers who are able to lead the integration agenda,
as well as address issues concerning recruitment and progression of
social workers in the area of mental health.

FACT – integrated community mental health teams are rapidly disappearing because the government has driven enormous cuts to LA budgets.

FACT – if there’s one thing which is no missing in mental health social work it is professional leadership. In fact, mental health social workers are highly respected in the field and as AMHPs are often asked to contribute advise to the teams.

FACT – it isn’t a lack of the ability of social workers which is not pushing the integration agenda. To suggest this is frankly, laughable, and makes the whole document a joke.

FACT – there aren’t any issues around recruitment of mental health social workers. The document muddles adult and mental health social work in its survey and admits that there is an oversupply of social workers

FACT – The lack of progression of social workers in mental health is related to the way that NHS trusts operate and this is not going to reconfigure the entire NHS

So there we have it. The whole project is based on poor assumptions.

It’s even worse when it goes on to explain the problems it will solve, including the  lack of supply of AMHPs. Seriously, they just don’t get it. Especially if these elites are off being lawyers, politicians and businessmen because the one saving grace of being an AMHP is, you need actual, real experience. The issue about the lack of practice placements is not due to lack of choice but lack of supply. I suspect this programme will buy placements but that will affect supply of placements to those taking other routes which is a problem for the profession as a whole although it won’t be a problem for Think First ‘graduates’.

Ah ha, I see the first use of the word, service user to indicate involvement

As with all social
work courses, it is also important that service users and employers are
engaged in the design of the programme and in recruiting participants

I wonder how many service users were involved in the development of this paper. I asked that question.  It hasn’t been answered. And where will the placements be?

Community mental health teams are therefore strong contenders
to become the teams in which the Think Ahead programme is primarily
based. They are the ‘hub’ for the majority of mental health work carried
out in the community, and have strong links to other parts of the system
such as inpatient hospitals and children and adolescent mental health
services.

Oh, and they’ll dabble a bit in forensic mental health. I don’t see any attention paid to older adults services or dementia. Maybe they forgot that that falls into mental health services too. Oh, maybe they’ll be a problem with access to CMHTs which don’t have social workers in them anymore. But Think Ahead have a solution – they are going to be responsible for re-integrating mental health services personally – cos the programme is THAT attractive.

The NHS
mental health trusts that are selected to partner the programme and
provide the practice settings for participants will therefore need to be
committed to making integration work and promoting the role of social
workers within integrated mental health teams. In some cases, the
programme will have to actively rectify the structural and organisational
weaknesses that in the past have created difficulties for social workers
in integrated teams. This means that, in return for taking part in the
programme, trusts may have to improve their structures and systems
for supporting social worker

Er, I see a bit of delusional thinking here. Firstly, it wasn’t the Trusts that chose to remove social workers but the LAs who removed them due to financial costs so this just shows pure ignorance. And they really think that as a training programme they can demand integration of social workers into CMHTs? That’ll be interesting. I’m sure they’ll have money to do that but wow, the incredible lack of insight and arrogance is phenomenal. Do they think their programme will be so attractive that trusts will reconfigure to suit them? My experience of mental health trusts is they won’t deal with the hassle and will just employ more nurses instead. THis is just an incredible claim. Think Ahead is going to be able to demand integrated services.

As for the details, the graduates will have a DipSW after year one, and year two will see them employed in CMHTs on a year’s training contract to develop skills in the field. Seriously so despite them waffling about generic qualifications, they are condensing a two year social work programme into one. I have an idea. Why not extend the training to two years and call it a postgraduate programme – then, choose the very best social work graduates, from whatever route they choose and give them an extensive placement and support within a mental health setting. Oh, because that doesn’t ensure that only the elite can access this route. And it doesn’t allow a social enterprise to profit. Silly me.

After this two year programme

Given the amount that the NHS mental health trust and local authority
will have invested in the programme up to this point, it is likely that they
would offer participants a permanent job at the end of the programme
(although they would be under no obligation to do so). The programme
should therefore provide a more direct link between the supply and
demand for newly qualified social workers.

 

Invest? Do they understand the financial situation at the moment? Do they actually know what the demand is for mental health social workers at the moment? I can’t really see a geniune cohort existing. They are looking in the wrong places, at the wrong issues.

 

Conclusion

Well, I took the challenge and read the document. Much of it made me laugh but it also made me sad that this has been presented as an answer when the problems have not been clearly defined or identified. We, as a profession, have to consider what this will  mean as a whole if we allow these schemes to develop in the way that they have been presented. This isn’t about broadening entry. This is about removing social work education from the public sector. This shows incredible lack of insight and understanding into mental health social work.  As for the people who were consulted – they were as follows:-

 

Baroness Claire Tyler, chair, CAFCASS (chair)
Joan Beck, chair, Association of Directors of Adult
Social Services
Steve Bridge, social care workforce strategy manager,
Department of Health
Karen Dolton, head of care, Manchester City Council
Annie Hudson, chief executive, the College of Social Work
Dee Kemp, director, Topaz
Professor Julian Le Grand, professor of social policy, LSE
Doctor Glen Mason, director of communities and local
government, Department of Health
Josh MacAlister, chief executive, Frontline
Bridget Robb, chief executive, British Association of
Social Workers
Lyn Romeo, Chief Social Worker for Adults
Professor Hilary Tompsett, chair, Joint University Council
Social Work Education Committee
Frances Turner, social worker, Central and North West
London Mental Health Trust, Milton Keynes
Professor Aidan Worsley, chair, Association of Professors
of Social Work

I see one currently practising mental health social worker. I see no mental health trust management representation. Most tellingly, I see no service user representation at all. Is this the way we are allowing our profession to be defined. Read the report and weep. It is based on fallacy and factoids. It is based on leading questions and little knowledge.

We should look at where demand actually is, if there is demand and focus on that. We should develop stronger post-qualification frameworks and ensure that the social workers we have, stay and lead. We should fight for our profession as one and not look at mental health, adult and childrens and family social work as separate strands. Otherwise we don’t know what we’ve lost until it’s gone.

 

And I am waiting for the response about which service user groups were involved in this consultation still. Waiting.

4 thoughts on “Think Ahead – Why the Fast Track Mental Health Social Work Scheme is confused and poor

  1. Spot on. Solution first, then consultation: and selective quotations about issues of genuine concern which are only tangentially and tenuously related to the prescription. I often wonder what the wonk / politico dictionary entry for ‘consultation’ might say? Probably not ‘asked’, more like ‘told’. As you observe, few of the problems identified, which are real enough, are likely to be addressed by an infusion young graduates and in fact concentration on recruitment might seem in this context to be a positive distraction from some related issues, like the retention of staff and progressive undermining of the social work role in mental health.

  2. It strikes me that there is an underlying paternalism in Lamb’s ambitions for social work training. His ‘mission’ is to rescue emotionally disturbed individuals by improving the treatment available for all of them and extending the social work role. All very worthy – but there are so many people like this in society it is actually an impossible task.

    I think the profession needs to consider the philosophical question of whether we need more state intervention into personal life to make people more sane – or do we need less? I’m a libertarian and understand why people resist the state’s preconceived notions of what it is to be ‘normal’ (i.e. having an immature, addictive personality, being shopaholic, workaholic etc.). I think social workers should focus on their duties towards those who are at greatest risk and in greatest need. It’s about priorities.

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