Category Archives: social work
(Note – I wrote this for something else where it was not used but thought, I’ve put the work in and might as well see if anyone else finds it useful/interesting! That’s why it’s a slightly different style from my usual rants and definitely drier#.. and why there’s a bibliography!)
Personalisation policy and the principles of developing person-centred care have promised a great deal in terms of increased choice and control for service users, and a change in focus towards greater user participation in services. While putting people at the heart of services is fundamental to a progressive and ethical social care culture, the gap between practice and policy in relation to the personalisation agenda can look like an insurmountable chasm to the practitioner. This is an area where promises have bounded ahead of practice experience.
What is personalisation?
Personalisation is a process which puts people who use services at the heart of decision-making about what is right for them and how their care and support needs will be met. The opaque jargon of social care can be a barrier to communicating key concepts, and defining ‘personalisation’ is crucial as the term is used in different ways and attracts meanings which can depend on the agenda of the speaker. Sometimes personalisation can be used as a synonym for person-centred practice and support. Gardner (2011) explains that ‘personalisation’ incorporates “different strands of ideology, theory, policy and practice”(p2). Not all definitions are inclusive of the groups of people who may lack capacity to make decisions for themselves about their care needs so it is easy to see how the rhetoric can overtake the reality.
The ‘personalisation’ agenda as it has been known is more than moving people to ‘personal budgets’ and the roll out of direct payments as a default mechanism for delivering social care. It is about moving the paradigm of ‘power’ away from the centre and towards the individual. The development of this personalisation agenda took place in the context of a great deal of excitement and promise. In the early stages where the Independent Living Fund (ILF) was created in 1988, allowing for the first time people who used services to directly commission and purchase their own services. This continued through the various configurations of direct payments (initially introduced through the Community Care (Direct Payments) 1996 Act) as they made their way through different user groups and the scope extended, leading to Putting People First (2007) which pushed through the ‘transformation agenda’ in adult social care to move towards personalisation for all.
It is important that we don’t confuse ‘personalisation’ with ‘direct payments’ nor ‘personal budgets’. Different models of providing people with more choice and autonomy over decisions which are made regarding their care can be done in many different ways and in some ways, the handing out of money and telling people to get on with it – with or without the requisite support – is a very narrow attitude to take in terms of allowing choice. Choice has to include a choice in the way that we can choose about what we receive, but there has been a political emphasis on direct payments as the gold standard of choice and that leaves some at a much greater disadvantage than others in terms of having control over their own support packages. The jargon and language attached to the change in adult social care creates a layer of professional knowledge so that in itself, it removes elements of knowledge and control from people who use services.
Gardner (2011) states that “Personalisation reinforces the idea that the individual is best placed to know what they need and how these needs can be best met. It assumes that people can be responsible and make their own decisions but people need information and support to do so” (p34).
Personalisation is about far more than ‘cash in pocket’. The system embraces models for establishing different routes to choose but in practice some of these are scarcely developed. For example, using individual service funds to buy support for older adults and people with mental health needs. This focus on the individual being at the heart of the process of choosing and having more control over the care that they are provided with and establishing a framework for person-centred practice lies at the heart of the ‘personalisation’ agenda. However, the path towards a goal that it is impossible not to support wholeheartedly has become muddied with the realities of spending cuts, local authority processes and challenges which have been continually ignored rather than addressed.
The policy has been driven by the wish to overpromise in terms of extending personal budgets (and hence the ‘personalisation’ agenda) to all within specific time frames where the reality has not been able to keep up. So we have seen the reinterpretation of ‘personalisation’ to represent care and support packages that in reality look no different at all to those which were delivered 5 or 10 years ago but with a different layer of language and bureaucracy layered on top of them. This creates further disillusion within the profession, especially as the social work profession is committed to increasing person-centred practice and empowerment of individuals in the face of the ‘system’ which can sometimes be oppressive and dictatorial.
The implementation challenges for the personalisation agenda have been extensive. While this is to be expected in any process involving widespread changes behind both the philosophy of a system and the systems themselves, the agenda of promoting user involvement, choice and co-production has moved at different rates for different user groups. For example, while the roots of the personalisation agenda lie in the Independent Living Fund and the processes built on driving forward choice and control for adults with physical disabilities and learning disabilities, SCIE report 40 (Newbronner et al , 2011) explains that “There is a risk that people in later life are being squeezed into a ‘one size fits all’ model of personalisation designed with and for younger people with physical and/or learning disabilities”.
Practitioners on the ground who are often the key to success of failure of these policies in practice perceive that there is little interest in addressing their experiences or hearing their feedback.
Personalisation is an important policy aim and it is important that it works. The idea of self-directed support (or personalisation) has been a process and direction through which policy has been travelling for decades. It touches on the fundamental aims of what social work is about and how it is used in practice. There have been many changes in the way adult social work has operated since the NHS and Community Care Act (1990) was rolled out and particularly as ‘social work’ developed into ‘care management’ through this period. So why was ‘personalisation’ needed? As local authorities disavowed themselves of delivering services directly, the logical step, as purchasers of services would be to ask people who used those services to have a greater input and role in making decisions about which services were commissioned. That, at the heart of it, is personalisation. One of the main criticisms within the care management model of services and care plans being written by social workers with services being defined by block contracts was that there was that this was very much a ‘one size fits all’ attitude which left people with little choice apart from accepting or declining the services which were on offer (Maclean, 2011).
The policy move to change this and to shift the ‘power’ from the provider to the user has been wholly positive. There is no professional expertise in deciding what meets the needs of individuals that cannot be trumped by the individual deciding for themselves. For this policy to move into practice, there have been accompanying bureaucratic and process-driven changes, such as the introduction of self-assessment processes and attempts at rationalising resources with some transparency (with mixed effects) around the amounts of money spent on care so that people can make their decisions about the services which best suit them. While the direct payment model is the most touted, there are also routes through local authority managed budgets and individual service funds (ISFs) where budgets are shifted to service providers to deliver as required by the service users.
How is personalisation?
The barriers to extending personalisation have been addressed in numerous research literature. There is much evidence which seems to repeat the same conclusions that the progress of different models of delivering care, because ‘personalisation’ is about more than direct payments. This leads to frustration among practitioners that the current barriers are exactly the same barriers which were identified to the same groups of people as those to direct payments five years ago with little progress in some areas.
SCIE carried out research (Newbronner et al , 2011) focusing on people with mental health needs and older people which were the groups of people where the take up of personal budgets has been slower to gain traction. They looked at the different ways that personal budgets were offered: namely those which were directly commissioned and managed by the local authority, third party managed accounts, direct payments or a mixture of these things. They found that there was a risk that inherent processes to assess and allocate resources such as the RAS (resource allocation system) and the assessment process which may be initially a self-assessment or a facilitated process of assessment depending on the local authority and the individuals’ needs, needed to be tailored more finely towards the relevant user group.
“Where a generic system [for RAS] was used it highlighted inequalities for resource allocation between client groups. Older people, especially those with high care needs, appeared to be the most disadvantaged.” (Newbronner et al , 2011) p9
This lack of equitable access through the ‘front-door’ leads to increased disillusionment with a process which is supposedly designed to be enabling and supportive.
Another barrier is that of attitude of social worker and organisation, which is mentioned in an Age UK report “Personalisation in practice” written in 2011.
“There was a concern among support providers and some LA/Trust staff that many PB (personal budget) holders, especially older ones, were being steered away from direct payments and towards managed accounts or services by the LA (local authority” p9.
This indicates that some of the ‘blockage’ on progress and implementation is within the systems which are meant to promote it.
The intransigence of social workers and the lack of desire to embrace new models of service provision which move the locus of ‘control’ away from the professional and towards the person who uses the service has often been argued as a reason for the poor take up of direct payments first ( (Littlechild, 2002) where they say, in relation to direct payments, the forebear of the current personal budgets “it is not disabled people making informed decisions to reject the idea of a direct payments package, but their social workers effectively depriving them of access to direct payments by failing to provide information and support” (p138). This is a harsh judgement to put at the feet of practitioners but it is one that is popular among policy drivers as it is easier to blame the attitudes of practitioners than to evolve methods to promote and simplify the methods of delivery of the personalisation agenda.
Unfortunately the ‘blame’ agenda took hold early in the development of policy making and has led to greater alienation of practitioners who do want to try and make things work. There is a sense of being blamed for not embracing personalisation when the system is flawed, not because they are negative but because the processes are inexorable and have been built to reflect the needs of particular service user groups whose needs, priorities, and abilities are not universal. Effectively, policies are designed to fit some service user groups at the expense of others. Glasby (2012) states “one danger [of the roll out of personalisation] may be that current policy rhetoric is so strong that it is difficult for people with legitimate concerns and questions to raise these in an open and safe environment. Speaking to front line practitioners, some feel as if expressing doubts can be seen as ‘heresy’ and they are reluctant to say what they are thinking. While this may not have been the intention of policy makers, it could be a significant barrier in change if people feel concerned about a policy but don’t feel comfortable exploring this further, and simply disagree in silence.” (p8)
In some of the legitimate concerns, (Newbronner et al , 2011) explains that there is an inherent biases present. Referring to resource allocation schemes (RAS) the study found that “Where a generic system was used it highlighted inequalities in resource allocation between client groups. Older people, especially those with high care needs, appeared to be the most disadvantaged.” (p6)
There are therefore, many legitimate concerns which have been evidenced through research into ways that personal budgets have been used with different user groups has shown. It is vital that the cautions voiced by less enthusiastic practitioners and service users are embraced by those who are guiding policy, rather than being written off as being ‘negative’ without having the chance for their voices to be heard and for lessons to be learnt as a result.
Another challenge that is faced in practice is one of time. Quality support planning needs the investment of time. In the ideal world, presented by those who ‘run with’ the agenda, everyone is able to take an active part in making decisions for themselves and choosing their own care to meet their needs, as defined by themselves. The reality is that some groups have not been able to engage in the process of taking an active role in their own support planning; they are effectively excluded. This may be because they lack the capacity to manage a direct payment or organise a personal budget themselves, or because they lack support systems around them, such as family to help them do this.
SCIE report 40 (Newbronner et al , 2011) emphasises the fact that older people are more likely to need care during a crisis. People undergoing a crisis are likely to be less able, at least initially, to engage in the process of planning and organising their own care. Intermediate care teams typically assess and set up a temporary interim care plan and budget. Support planning then takes place a second time once the person is in a more stable situation and able to take stock. The time taken to set up a more personalised care plan in terms of the administration hoops to jump through are a significant barrier to some people and some ways of providing support.
Where does Personalisation go?
The ideology behind personalisation is sound and needs to be embraced wholeheartedly.
As practitioners we want work to support, involve and include people who use our services. The future must involve a stronger focus on services and delivery of services in conjunction with people who use them, but in order to get there, we need there to be a realistic, no-blame space for discussion between those who make policy and those who implement policy, as well as those who use services who lie at the centre of the social care system. There is still a disparity in terms of those who are best served by current practice. People who have benefited most from personalisation are those with the best advocacy and loudest voices. For the policy to embed itself in practice, it needs to offer the same quality and opportunity for flexibility to all user groups including those who are not able to raise their voices and who don’t have family advocates to speak for them. That’s where the role of the social worker has scope to be established to a much greater extent. As practitioners on the ground they have some of the most acute understanding of the challenges faced by people they work with, particularly people who are not able to best articulate their own concerns. If personalisation is going to work for everyone, we need to hear the voices from practice.
Age UK. (2011). Personalisation in practice : lessons from experience. London: Age UK.
Netten et al (2012). Personalisation through Individual Budgets : Does it work and for Whom? . British Journal of Social Work , 1556-1573.
Gardner, A. (2011). Personalisation in Social Work . London : Sage.
Glasby, J. (2012). The controversies of choice and control – why some people might be hostile to English Social Care Reforms . British Journal of Social Work 1-15
Littlechild, J. G. (2002). Social Work and Direct Payments. Bristol : Policy Press.
Maclean, S. (2011). Personalisation and Person-Centred Care. London : City and Guilds.
Newbronner et al . (2011). SCIE report 40 : Keeping Personal Budgets personal : learning from the experiences of older people, people with mental health problems and their carers. London: SCIE .
Having been a Best Interests Assessor since the position came into being, I have a particular interest in how the deprivation of liberty safeguards (DoLS) work (or don’t) in practice. I am a fan of the Mental Capacity Act (2005) to the point of becoming quite defensive in the face of opposition to it. This is because having worked in older adults services (and more specifically in dementia services) since before the Act came into force, I’ve seen the big changes that it has made in codifying and protecting the rights of people who may lack capacity to make specific decisions at certain times in their lives.
What was a previous reliance on ‘common law’ principles of professionals/family members making decisions which were more often than not ‘in people’s best interests’ changed to become codified and provide protections to people who are in these situation where no specific legal reference existed before. While the ‘Daily Mail’ crowd grumble about decisions being made by ‘shady secret courts’ or even shadier ‘professionals’, the reality is that for decisions to be made on behalf of people, all those involved including family members and professionals where necessary, should decide together what is in someone’s best interest on the basis of previous wishes where they are not able to explain. The legislation and code of practice sets out, what was lacking before, in terms of expectations (nay, demands) of involvement and the responsibilities for decisions about capacity to be made by the most ‘appropriate person’.
Criticisms come, of the Mental Capacity Act (2005) through the Deprivation of Liberty Safeguards. I have written before about them here as I’ve been involved in making decisions and carrying out assessments. There is no doubt that the system in place is flawed. We identified some of the flaws when we did the training before the provisions came into force. Subsequent case law has not always been helpful. In the light of the CQC report published this week about the use of Deprivation of Liberty Safeguards, I thought it would be useful to reflect on some of my personal experiences of using them and observing others using (or not using them) rather than look through the report which others do far better than I would be able to.
The Deprivation of Liberty Safeguards (DoLS) were intended to provide a level of protection to people who lacked capacity to make decision about care and treatment either in hospitals or care homes, regarding situations when they were being deprived of their liberty and therefore had no recourse to any appeal process – unlike, for example, people who are detained under the Mental Health Act (1983) who have access to a tribunal system. Deprivation of Liberty Safeguards have their own Code of Practice (which is useful but got out of date rapidly in the face of changing case law). There are particular processes required for an authorisation to be made (by the supervisory body – which is the local authority) and it is based on assessments made by two people. One is a Best Interests Assessor (which was the role I took) and the other is the Mental Health Assessor (who is a doctor with special training although I wouldn’t lay too much confidence in the ‘special training’ as I’ve known it to be as little as a day). Having attended some joint training with Mental Health Assessors, I have to say, I wasn’t inspired with a great deal of confidence about some of the understanding of the processes but perhaps that’s changed in the year since I’ve practiced.
Problems with DoLS
One of the main problems I see with DoLS is that people are told ‘They are complicated’ and that seems to act as a disincentive for managing authorities (the care homes or the hospitals who may be depriving people of their liberty) to actually think about them too much. Or staff who work in these areas think they are ‘someone elses’ business. I’ve come across that before – hospitals who have one DoLS/MCA lead who is seen as the only person who needs to know about them. I would say that’s possibly not the most helpful way to think about it. As long as people think they are complicated, they will ignore them in the face of busy work environments.
I try to tell people, when and if they are interested, that everyone doesn’t need to know the intricacies of whether a particular practice is a deprivation or a restriction before making a referral – it is the job of the Best Interests Assessor to make that call as a part of the Best Interests Assessment and it is something that will depend, very much, on the individual circumstances of an individual person. What is important though, is that staff can identify some key issues that may come up that could trigger a referral at the very least. If staff are to be provided with such a list by their employers (which I’ve seen) then at least those employers should ensure that they update this checklist frequently in line with case law and they emphasise that it is not exhaustive. As frontline practitioners, we talk about hating check box lists. This is exactly an area where a check box list is supremely unhelpful unless it is changed frequently and concerns strong provisos – allowing some professional judgement.
The name is a bar too, of course. Deprivation of Liberty Safeguards – people seem to concentrate on the deprivation part and ignore the safeguards bit so they are seen negatively. Actually, it’s a way of protecting the person whose liberty is being deprived and without the safeguards they would not have the same level of protection. When I see the Mail/Express headlines like this we can see the danger of misinterpretation of the language. I don’t believe for a moment we have ‘more people subject to chemical cosh’ or ‘older people being tied up’ or ‘people denied from seeing their relatives’ than we did 10/20 years ago. We just have more understanding of when it’s happening and some of those people have had specific assessments to determine whether it’s in their best interests – where before it would just be a decision made without those safeguards. The language is troubling to tabloid news journalists who don’t look beyond the ‘deprivation’ word. Mind, it’s not just tabloid journalists – it’s care home managers who see it as a ‘bad thing’ if they make an application. Personally, I’d be delighted to see more referrals drip through as it means that there’s a possibility that some people will have access to the protections.
Some people want a list of things that are a ‘deprivation’ and what isn’t. The lack of such a list leads to an ‘it’s complicated’ charge. The reason there isn’t a list is what may be a deprivation of liberty to me, might not be to you. I’m generally quite a solitary person and am quite happy spending a day pottering around at home, doing not very much. My partner needs to go to the supermarket every day to get fresh fruit and vegetables. He will not buy fruit or veg a day in advance and doesn’t believe in weekly shopping (this is sometimes an issue between us!). Not allowing him out of the home (if we both lived in a care home) would have a far greater impact on his liberty than it would on mine because of our usual habitual behaviours. Whereas keeping me away from a television for more than a day would have a big impact on me but wouldn’t bother him in the slightest. Silly examples but it’s the reason we can’t make blanket decisions or say ‘locked doors = DoLS application”.
The interface between DoLS and the Mental Health Act (1983) is a particular bone of contention – in my experience. Having worked in older adults’ mental health services, I saw many situations on older adults inpatient wards where, if someone wasn’t battering down the door and actively attempting to leave at any opportunity, they were deemed to ‘comply’ with the detention without the need of any of those awkward legal-type powers. Unfortunately I haven’t seen a great deal of progress in this and some psychiatrists seem to dislike using the Mental Health Act (1983) to detain people who lack the capacity to consent to treatment/admission. DoLS does allow, potentially, another avenue although case law has been quite fluid in terms of where we stand. What I’ve seen FAR more of is a lack of use of either Mental Health Act or the Mental Capacity Act and somehow thinking that ‘informal admission’ is the ‘right’ answer if someone isn’t battering the door. Sometimes opposition to a detention can take other forms – increased levels of distress, lack of engagement with staff/family but I fear there is little flexibility in interpreting the ‘objecting’ patient when people are not actively saying ‘I want to go home’ every second – and even sometimes when they are ‘Oh, they are just like that’ or ‘that’s the dementia talking’. The thing is, this needs to be challenged and sometimes hierarchies within hospital systems don’t allow it. This is why I think the BIA role is crucial and that hospitals, in particular, should engage with genuine understanding of DoLS and what their actual purpose is rather than assuming they know.
I have a slight problem with the assumption that the Mental Capacity Act is ‘less restrictive’ than the Mental Health Act. To the person who lacks capacity to consent to treatment or a hospital admission – they are being kept in a place they don’t want to be and treated against their will regardless what legal framework (or none) they are subject to. The Mental Health Act offers more and better appeals processes (and more automatic checks – and of course, although this shouldn’t be an issue, the right to s117 aftercare) than the Mental Capacity Act so saying that DoLS offers a least restrictive alternative, is, I think, (whether judges agree with me or not) a false premise. One thing is for sure, there needs to be SOME legal framework and having none, certainly isn’t the least restrictive alternative.
What would work better?
I think there needs to be a streamlining of the DoLS process – perhaps more along the lines of the Mental Health Act which is better developed – certainly in terms of rights to advocacy for all and a similar type tribunal system. There needs to be much better understanding of the processes and what RIGHTS mean to people who lack capacity to make decisions. Local authorities need to provide better information and access to advocates all the way through the process – they are supposed to but it sometimes gets lost down the line.
CQC need to actually inspect and enforce when organisations are not telling them and they need to understand the processes better to judge organisations against what they should be doing.
Changing the name would help too, something about protecting rights not depriving of liberty – perhaps that’s a bit flippant but language is important.
Everyone within organisations needs a better understanding of them from care workers/health care assistants to consultant psychiatrists who seem to regard them as an optional extra if they can’t be bothered to use the Mental Health Act because ‘they don’t do that’ when people lack the capacity object in the only way that they can recognise.
These aren’t new now and they aren’t optional but too many organisations seem to write them off as ‘too complicated’. Too many supervisory bodies seem to ‘pre-screen’ referrals. There are too many discrepancies nationally to think that they are anywhere close to being embedded in our health and social care systems (despite CQC’s positivity on this).
We need access to clear information including current case law in a central space – perhaps the Department of Health can offer up some space – in easy to read language which explains rather than complicates.
I’m sure there’s far more than needs to be done. I don’t have all the answers – not by any means, but I do know we all, who have any interest in this sector, need to do a whole lot better and understand what the current law is. These safeguards aren’t an optional extra and just nice for people to understand a bit better. They are the current law and the current law is failing for as long as no one is actually checking or caring whether they are used properly or not.
A couple of ‘anniversaries’ have come up recently for me. It’s six years since I published my first post on this blog. It’s one year since I left my social work job. These milestones have caused me to reflect on the nature of the profession and the sector that I work in in a number of ways. I read my first post yesterday and it drew me back to why I started writing in the first place. I’d tried writing blogs before this one. I wrote a stupid little diary as an angst-ridden teen which was much more interesting when I looked back on it than while I was writing it. I made a conscious effort here though, to write about social work and social care.
Over the years, writing and publishing posts has helped me in ways I can’t begin to elucidate but I’m going to try. I’ve written about social work and social media many many times but in looking back over the six years and learning more as the conversations grow and develop, I’m going to indulge myself again and share some of the things I believe that writing here has changed and shaped my perception of the career I chose.
What I’ve learnt about social work by writing about it.
I never really ‘expected’ a career in social care when I started working in the sector. I didn’t know what I expected to be honest – possibly because I didn’t ‘expect’ very much. In all honesty, I was grateful to have a job that didn’t involve me having to work in a shop or an office. I was grateful that I could be paid to do something that I actually enjoyed doing. My expectations weren’t exactly stellar but I never really thought about ‘career’. That wasn’t for people like me. I’ve written a few times about how I moved from a support worker in residential care to a social work student and then a social worker. It wasn’t something I was planning or expecting but a happy coincidence. My first job after I qualified was busy and I constantly felt incompetent or that I should be doing something different or better – most of the times, I was probably right. My manager at that time ranks as one of the worst I’ve had. She was, quite frankly, a bully. I didn’t bear the brunt of it though. I kept my head down, did as I was told and relied a lot on the support from older and more experienced colleagues.
I went away, returned to social work and new legislation, procedures in a much better place. When I started writing this blog, I was finishing my ASW training. In the borough I worked in, we completed the training ‘full time’ with placements in other teams. I’d moved from adult social work into mental health social work for a few years and the ASW training was the logical next step. The service needed more ASWs. I wasn’t actually too keen. I remember a conversation I had with the service manager at the time when he told me that it would probably be the last opportunity I would get (I was on the last ASW training) before the rush of nurses and OTs and the shift towards AMHP training. Last chances. They can be quite a pull. I was struggling at work too for various reasons and to be brutally honest, welcomed the idea of taking some time out to do more training. I didn’t really think too much of the thought of what it would mean in the long run.
The course was the best I’ve ever done. Far surpassed my initial social work training in terms of quality of teaching, level of understanding, support and knowledge gained. I started writing here as my thoughts moved towards returning to work and a job I wasn’t sure I was even very good at. I’d had time out to study and I’d enjoyed it and I was worried about going back to the day to day ‘grind’ and becoming jaded. The ASW training lifted all the lingering inertia out of me. I wanted to do well. I wanted to learn. I was sad that the learning was coming to an end. So I started writing.
After the first few months, I forced myself to write something every day (giving myself weekends off). I wrote a post before work religiously for a number of years. Yes, the quality varies massively – but it forced me to find things of interest either in the news, from work or from my ‘outside work’ life to trigger. Some posts were longer than others, some more interesting than others. It was a good discipline, looking back and I don’t think I could return to it.
It taught me much more about the profession – I’d thought in terms of myself as a ‘adult social worker’ or a ‘mental health social worker’ but I hadn’t really thought about ‘social work’ per se because the work and the culture in childrens services, as I saw it, was so very different.
Then people seemed to be interested in what I was writing and I saw it was an opportunity to ‘sell’ social work. I explored for myself what being a social worker meant to me. I’ve been through the tunnel and out the other side with it to be honest. I’ve had, as we all do, those good and bad days. By writing I was able to share some of that. I was able to better reflect on what I was doing on a day to day basis and how it fit back in the profession as a whole more than my own little part of it.
As I wrote, I learnt how proud I was to be a social worker. That was something quite new for me. We joked about it but I didn’t realise, until I was writing for an ‘external’ audience, how important it was to me to represent the good work that is being done, by good people – often unnoticed – in the sector.
The blog also gave me a voice. I’ve made an issue of the fact that I’ve never been a manager. I was able to tell people who would never otherwise have listened, what it was like to work in the field and to have changes happening around you when there was no thought or consideration given to the experiences or voices from the ‘coal face’.
I was, and still am, amazed that people listened to me. Me. I’m not anything or anyone special. I don’t have any particular professional status. I haven’t written reams of peer-reviewed papers. But people seemed to read, listen and respond to me. That helped my confidence as an individual and as a practitioner enormously. So this blog and the other things I’ve written over the years, have given me confidence and have helped me to reflect on what it is to be a social worker, what it is to work in social care – and health services – and to realise that I could use my voice in different ways, even if I couldn’t always say things to my managers or in the Trust or local authority I worked in, someone, somewhere might listen and make things better in some ways.
I learnt a lot from blogs and comments from people who use social work and social care services particularly. I could never have the same interactions with people I worked with on a day to day basis because however pleasant and approachable I think I am, there is an undeniable power that I had in my statutory role. Reading about how people feel when they are detained under the Mental Health Act or have treatment forced on them, is an insight which – while hoping I was always sensitive – I could not get from other sources. Listening to how people felt when they experience crappy social workers or crappy carers or crappy systems, reinvigorated me to stop feeling so powerless in relation to the organisations which I worked in and realise the immense power I have in other people’s lives and to make sure I used it well. I may not be able to help those who have experienced the worst of statutory powers but my growing awareness of the impact would, I hope, help those who crossed my path.
Ultimately, and ironically, writing about social work, understanding its important and having more confidence in my own voice and opinions is what led to me having the confidence to leave it behind me. Isn’t life funny.
What I’ve learnt about social work since leaving it
I’ve written my ‘goodbye’ piece to my Trust and local authority so won’t go over that ground again. It’s been an interesting year as I’ve left behind a specific ‘social work’ job and moved into a job that doesn’t require a professional registration. In some ways, it’s solidified my determination to identify and pretend I’m still a ‘social worker’. It’s also though, allowed me to see the profession ‘from the outside’. When people meet me now, they don’t necessarily know what my professional background is so I have heard some interesting perceptions about social workers and can distance myself when I choose to.
A few weeks ago, I was at a meeting with various people from various places. When we drew to a close and had that brief chat before we headed off in our separate directions – we were talking about some of the difficult situations that had arisen. The person sitting opposite me said “You should try being a social worker”. In the skip of a heartbeat, I responded “I am… I mean, I was.. er.. I’m still registered”. Then I realised, coldly, that of course, no one in that room apart from me knew that. That was an odd feeling. I had, so long, identified as a social worker than having it not be either immediately obvious or relevant was another step away for me.
I get pangs of wanting to go back. Particularly, I miss some of the day to day work with people that I don’t get now. Then I try to remember what it was like, last summer, when the cuts bit hard and the stress levels were enormous. I’m happy where I am now, really I am but it’s not quite the same as sitting in someone’s front room – building a relationship with them and their family – and being ‘there’ to help see through some of the complications of ‘services’ to make things work out a bit better. Or meeting someone in hospital – or when you rock up to carry out an assessment and being able to follow it up through discharge to a better place. I have to admit i’ve occasionally glanced at social work jobs just to see if they tempt me back. I wouldn’t say ‘never’ but the longer I am away from the ‘coal face’ the harder, I think, it will be to go back. Maybe I’m kidding myself into thinking I will. I need to have that comfort blanket of believing that if I applied for my old job tomorrow, I’d be able to slot back into it.
I’ve learnt that social work is about so much more than local authority social work or social work within the NHS. I knew this, theoretically, of course – but now, as one of the ‘outsiders’ I see how important it is that social work doesn’t become pigeon-holed into only meeting statutory social work with a job title that includes ‘social worker’ in it.
I am using all the skills I gained through my training and my experience in my current job. Being a social worker, I believe, with my knowledge of assessment processes, experience, use of legislation and value base make me able to to what I do. Could someone without that do it as well? Yes, they can and they do – sometimes far better – but for me, it’s a good fit.
I now have a little distance from the profession which allows me to cast a more critical eye too. I was incredibly frustrated by the battles between BASW and the nascent College of Social Work back in the day. I see some kind of impasse has been reached now but I do wonder how sustainable it is to have two organisations – in a profession which has never particularly clung to representative organisations – battling for the same space.
With initiatives such as Frontline and the posts of the Chief Social Workers (who, it seems, have turned out to be mouthpieces for the govt – but I wait for them to prove otherwise to me) it has become really important for social workers to help define social work and not allow it to be defined for us by the Department of Health and the Department of Education. It isn’t only about child protection social work. It isn’t only about statutory social work. I am still as much of a social worker as I was last year, even though I don’t NEED to be a social worker for my post – perhaps I need to convince myself of that too but if we allow others to define the profession too narrowly, we will all lose out by it. In a world where I see the profession increasingly fragmenting, the real strength and voice can only come in unity. That’s what I’ve learnt.
In all, I remain incredibly proud to be a social worker. Although I was desperately sad to leave my last job and can’t help feeling tinges from time to time about whether I did the right thing, I can’t go back now. I have landed on my feet and the amount of learning I’ve done over the last year has been enormous. Mostly it’s about building on the skills, knowledge and values. You can’t be a social worker without all three of those. I’m still working on all of them and so very much locate myself within the profession. Will professional organisations, voices and representatives acknowledge that? I hope so.
Social work allowed me to create a ‘career’ when I never really thought I would have one. It’s allowed me to build confidence in myself so I can better represent and advocate others. It’s given me a great gift and I never expect to lose sight of that, forget the opportunities I have been given and stop fighting for the necessity of good social work. That’s done together though and we can build a better ‘social work’ with more voices.
That’s what I’ve learnt.
As I move on with both the writing and the career, I can’t help but feeling rather self-satisfied too. I am proud of what I have achieved so far but know there’s a long way to go. Pride isn’t particularly pretty but I’m hoping the confidence I’ve gained can be used to better represent, advocate and drive improvements for others as well as for me, rather than allow me to sit in a self-satisfied space and relax.
I left my job as a Mental Health Social Worker, AMHP, BIA, Practice Educator and all that I wrote about here last December. While I can’t be too specific about my current role, it’s (unsurprisingly really) in a related field but it’s moved me into the background and away from a direct role with people. It’s been nearly ten months now since I changed jobs and it has led me to reflect on what ‘being a social worker’ meant to my identity and how I viewed myself as well as how others viewed me. It hasn’t always been easy but every time I look back with a hint of regret, I see newspaper articles like this one today and remember what it was that led to me leaving behind what was, and what remains in many ways, my ‘perfect’ job. I loved working with older people, I loved working in Mental Health – and while I didn’t enjoy (you can’t ever enjoy) the detention and assessment part of the AMHP role, there was a unique camaradie with other AMHPs and the access to continued support through forums and legal updates was unrivalled.
I felt I could make a different to some people’s experiences of mental health services by explaining them and guiding them through what was a scary and difficult period of their or their family member’s life and if I could take them out the other end, well, there’s no better feeling in the world.
But it got harder. We know there were cuts in the service. Despite the government’s mealy mouthed promises about there not being cuts in frontline services – there were cuts in frontline services and significant cuts. I want to explain why I made the decision to leave – and it wasn’t a decision I made lightly.
In my six years in older adults’ mental health services we had been through three major reconfigurations. What had started as three teams covering localities within the borough I worked in, became two and then became one unified team. This was partly by design (the switch from three to two) and partly by circumstance (from two to one when managers didn’t actually have enough people to have two separate teams so had to merge them). We had some ‘almost’ reconfigurations when there were proposals to eliminate the ‘older adults mental health’ team as a separate strand and move everyone into ‘age blind’ services. This didn’t happen fortunately as I think it would have been disastrous for the client group we worked with. In our older adults teams we worked in different ways and had a particular expertise in working with people with cognitive impairments and against ageist services that are deeply embedded in the National Health Service. Suffice to say, I was used to change.
I don’t think my employers were bad or the worst, by any means, indeed, I have considerable warmth for them. My managers were decent people who were incredibly supportive and the organisation provided some excellent services. Then the changes came again. The internal consultation process was tough – not least because the executive team treated us, as staff members, as if we were stupid. I worked in the same office as the ‘executive team’ and there isn’t one of them that would have passed a greeting to those of us in the CMHT. We were clearly beneath them. I don’t mind that to an extent, except when we are trying to make particular points about the quality of service that we are able to deliver and there’s no value or credence given to our views. But enough of that – so the consultation was about more changes – this time even more radical. There had already been ward closures but more were proposed and this time, it was justified because the community services would be able to provide better support. The tiny little problem with this was that it would do so with fewer qualified members of staff. Who needs qualifications anyway, they’re overrated.
As a social worker seconded into the Trust, I was slightly protected. Our local authority confirmed it wouldn’t be cutting any of our posts and in any case (although this really was moot as they were clear that the social work posts were never in danger) the AMHPs were even more scarce so I’d never have been in danger. However, we’d be losing nurses and occupational therapists. Instead we’d be getting lots of new band 3 and 4 support workers. I’m all for support workers. We never had them before – but I’d thought they would be an addition rather than a replacement to the core team.
So this was the improved model. The thing was, that so many people were unhappy and miserable about having to reapply for their jobs after many years and through not being consulted even in a cursory fashion that they .. or rather we.. looked for other jobs. Actually, I didn’t look for a job at this point. It wasn’t until a bit further down the line. People who were eligible for early retirement took it. Some people took redundancy. Others took different jobs elsewhere. It was often those with most experience that left. The replacements didn’t come quickly.
There were days last summer when I was the only qualified member of staff covering my CMHT – no other social workers, nurses, OTs – sometimes even no doctors – that was mostly because some people worked part time so it wasn’t very regular but the fact that it happened at all was worrying. I was doing more Mental Health Act Assessments yet my caseload was expected to be up to date. ‘Duty’ became a bit of a fantasy because it felt like I was constantly on duty. I can deal with stress and manage it but when you worry that the work you are doing is not safe anymore, it becomes time to look away.
A message to the Executive Team
So in looking back I’d say this to those executive directors who never had time to stop and listen despite us collectively telling them how worried we were about the quality of services we were providing and how we felt we were being asked to work in ways which were increasingly risky. If you want to provide a really good quality service you have to listen to people other than those within your own echo chamber of management or leadership who are invested in agreeing with you. Staff want to work in ways which are fulfilling. We want to provide good care to people but the systems we work in are stripping that potential away and if we can’t do that, we can’t continue in it. We don’t want to be cramming people into wards which are further and further away because you’ve decommissioned local beds. We don’t’ want to be providing what we know are poor home care services because the council will only pay minimum wage and commissions on cost rather than quality. We don’t want to have to look further and further away for poorer and cheaper residential and nursing care. We want to be doing the creative support planning with personal budgets but then, it’s hard to be creative with 5 hours care when someone needs to use that for support with washing and dressing for the whole week. We want to be advocates and we want to drive and provide good care but have no access to good care. We want to support families and carers but we don’t have the time or the resources to.
And for you?
You need to listen. You need to listen because sometimes the people who are going out there and providing the services you, as executives are responsible for, know what they are doing and know the communities better than you do. You need to listen to people who access the services and their families and actually change things on the basis of what you are told – rather than just listening to MPs or local press as the people who contact MPs are not more valuable than those who are unable to – they just have different skills. You need to be honest – most of all. We know the cuts are coming but when you tell us this is about ‘service improvement’ we can’t ever trust you again.
On the outside
Since I’ve left, I have been pattering between sadness and frustration. The things that pushed me to my own limits were working in ways I didn’t feel were sustainable. I struggled with my place in this system which was built like a house of cards but I don’t want to leave this post in despair as I have hope. I needed to take a step back and having done so, I realised for the first time, how much stress I was under. I just thought that was the way things were but moving into another role has made me see how much of my life was wrapped in constant stress. It doesn’t have to be like that. I miss the job and the people. I worked with wonderful people and great colleagues. I know there are fantastic social workers, nurses, OTs, psychiatrists and psychologists out there who are making a difference to people’s lives every moment and whose hearts are fully concerned with how to work better. The sadness is that so often they are engaged in battles with the organisations that employ them too. I would very much recommend social work and mental health social work as a great career move. You have opportunities to walk alongside people through their most difficult moments and learn from them about how you can take them through an often complex system that sometimes feels like it is falling apart.
The sadness is that sometimes the most difficult challenges come from within the organisations that employ us – it doesn’t have to be that way though. I’m sure there are many other experiences. While I don’t regret leaving, not really, I do wish I’d been listened to more. That more than anything, would have led me to stay.
Frontline is a scheme dreamt up by the IPPR who published a report – which has since been embraced by the government and opposition – which builds on the Step Up to Social Work model of social work training and Teach First which has proved to be a popular want to pull graduates into teaching, focussing on ‘difficult’ schools.
The idea behind it, based on research done with a focus group made up of people who had been teachers on the Teach First programme saw that there was ‘something wrong with social work’. A part of me says ‘tell us something we didn’t know’. Seriously. There have been proposals to change in the way that social work is taught which have stemmed from the Social Work Taskforce and then the Social Work Reform Board.
So what is it that will make ‘Frontline’ different? The initial paper linked to above, makes reference to Oxbridge and Russell Group graduates who aren’t choosing to go into social work and seeing that as a ‘problem’ for the profession.
According to the Frontline website
The Frontline training programme will last two years. Specifically
- An intensive five-week residential summer institute;
- The first 12 months as intensive on-the-job training and education;
- At the end of the first year participants will be qualified to practice and then undertake a second year as a newly qualified social worker.
Participants will be paid over these two years and will be based with the same local authority. Participant will complete a Masters over the two years of the programme.
The 12 months will be when people go to local authorities to be trained by a ‘consultant social worker’ who is basically a glorified practice educators who have their salaries augmented by ‘Frontline’ – which, incidentally, is either a charity or a social enterprise – depending on what you are reading. The social worker trainees will be working in ‘tough’ environments.
The idea is that these people will be ‘qualified’ social workers after one year and the second year will be the AYSE year. One year (or 13 months, I believe cos these whizzy geniuses sure can count).
So who is Frontline looking for?
Frontline will look for two key features in recruits. The first is high academic ability required to be an effective social worker. Social work practice requires analytical thinking, assessment skills, critical reflection and excellent written and spoken communication, which is why applicants must have a 2:1 degree or higher.
The second feature is the attributes, skills and values to be a successful practitioner. These range from emotional resilience, respect, good judgement, inter-personal skills, and humility
I love the intense irony that humility is written right at the bottom. I’m not one to rubbish academic rigour. I’m all for it but I think it’s interesting that it is the first thing they emphasise. People develop intelligence in different ways and having a 2:1 degree from a Russell Group university is only one indication but that’s their standard so fair enough. Just interesting emphasis.
So that’s the scheme and what’s not to love? I have a number of issues that have concerned me, none of which have been addressed by Frontline PR machine. I’m concerned that while they have said they want to engage and talk to social workers about this, there has been no evidence of them speaking to anyone except on their own terms, without actually answering questions of substance. Meanwhile, the PR machine flounces around the press with the ‘they just don’t understaaaaaaaaaaaaand’ us referring to social workers who don’t ‘get’ their new model without actually addressing the very real criticisms.
So what are the criticisms?
1) It is based on an elitist model where some universities are ‘better’ than others. The initial document refers to lack of entrants to social work training from Oxbridge and Russell Group universities being evidence of its lack of appeal. I’m not sure about ‘evidence’ for this. I don’t think the university you go to defines your quality of potential for social work or your intelligence and ability to critically analyse and reflect. Sometimes it’s based on income and family circumstances. Sometimes we go to the university that is nearest home. Sometimes we go to the university that offers the best course which may not be a Russell Group. It shows an enormous amount of assumptions (which, incidentally, are very bad in social work) to take otherwise
2) Lack of involvement of social workers in developing the model. Now Josh MacAlister, the so-called ‘brains’ behind the scheme has recruited some social worker managers and academics to ‘support’ him but that doesn’t refute the lack of involvement in the initial research of social workers. Yes, spokespeople from the College of Social Work and BASW have involved themselves but they have shown no effort to engage views other than those that agree with them or work on the base of the Social Work Reform Board which particularly looked at social work education and build the new professional capability framework. This falls outside that. It also hasn’t built on the Step Up scheme which makes no sense.
3) Compressing social work education into a year, even if the practice days are similar to the amount they are now, ignores the process of learning that needs time. There is a great post which I highly recommend which covers this far better than I can. Social Work is not analogous to teaching and somehow I think the model of Teach First doesn’t ‘fit’ as nicely as the government ministers would like to think it is. It displays a lack of understanding of social work. Teach First replaces a PGCE which is a one year course in a specialist subject (which is taught).
Social Work is a generic qualification. One does not ‘train’ as a child protection social worker or even a children and families social worker – but as a social worker who then specialises in working in a particular sector. This model doesn’t allow space and time to gain an understanding of what social work is. The fear is, it will breed process-driven staff who are able to fulfil functions within a child protection team but without a deeper understanding of social work as a profession which touches the lives of adults and children in different ways and at different stages.
Moving initial social work training – not least in an organisation which doesn’t understand social work, clearly, is, I fear a mistake. One of the figures behind Frontline told me that this was a poor argument as ‘there had always been arguments about genericism’. In my view that doesn’t mean we can’t still have the discussion. We need to have an understanding of personhood and social work as a whole profession because if we don’t it becomes two, or three professions. Does that matter? I think it does because we can’t work in isolation. Mental Health, for example, covers all areas of social work. Families don’t exist in isolation. Is one year (13 months) enough time to do this alongside placements? Personally, i don’t think so. I’m consistent in this as I also don’t have a lot of time for the Step Up programme.
4) Evidence base – why wasn’t there a hold on developing a new scheme until there had been a few years running of the Step Up Scheme? I was a sceptic of Step Up and I’ll accept that the first evaluation of the first two cohorts was more positive than I was assuming but there were some issues raised and what we really need to understand is retention rates which will need a few more years of evaluation. I’m willing to change my mind in the face of evidence but developing a programme before we had some data seems foolhardy but entirely consistent with government policy making. The one issue which did arise from the Step Up scheme was access and success rates of people from minority ethic groups who were disadvantaged. The Frontline team looks very white and very male. I wonder how this will be addressed explicitly.
5) There is no mention at all of user voice in the development of the programme of education. This is a massive gap but I will wait for details of the programme. It’s all about developing leaders. Frontline’s website says
Since the start of 2012 we’ve undertaken extensive consultation with the profession to inform the Frontline proposal. Employers, universities and professional bodies were included in the process and much of their feedback is directly reflected in our plans.
No mention of people who use or have used social work services, children who have been or are involved with social work or their parents and carers. Nothing. That evidences a lack of understanding of social work education and ethos as, quite rightly, user involvement is crucial to all social work education programmes.
6) Leadership. There is a focus on this being about ‘leaders’ and developing leadership. I have a bit of a difficult relationship with the term and with some of the ‘leadership’ training. We all want and need to be ‘leaders’, don’t we? But who are we leading. Here are some of the statements made on the Frontline site.
Frontline is focused on transforming the life chances of vulnerable children by recruiting and developing outstanding individuals to be leaders in social work and broader society
So is this about fast-tracking people through the actual ‘frontline’ work as a stepping stone to management and management consultancy? I rather suspect it is. I want to know more about what they see as leadership? Ah, they heard me, look at their FAQs
18. WHY DO YOU CALL SOCIAL WORK A LEADERSHIP PROFESSION?
We describe social work as leadership because it needs people who are able to bring together a wide range of agencies, set out a vision for a family and convince them to act. The ability to adapt and deal with change, set clear priorities and deliver action for children under extreme pressure demands leadership qualities which we would like to see recognised more widely in society.
Note: There is no understanding or explanation of social work that happens which doesn’t involve working with children. It’s about ‘convincing’ a family to act? Really? Is that leadership or is that using statutory power to impose. There is nothing in this bumpf about power that a social worker has and the understanding of the use of power. No, they emphasis ‘leadership’ and ‘leading’ but as a statutory social worker in child protection, you have all the cards in your powerful little statutory hand and I’m not sure it takes much ‘leadership’ to ‘convince’ families. Again, it’s a complete misunderstanding of the social work role and selling an untruth to those who take on the role. So if Frontline ‘breeding’ leaders or are we all leaders? Bit fuzzy but then this is to sell social work to people who would otherwise consider Teach First.
7) The rhetoric of those involved with the PR has been very much ‘we need excellent/better social workers’ ‘social work education is failing’ and it’s interesting how many academics have jumped on this bandwagon. Er, guys, you’re the ones doing the training?!
Seriously though, it’s not exactly going to endear you to a profession by saying that current social workers and social work students aren’t adequate. I see that they’ve backed down a bit from that but that was definitely the initial thrust behind their PR campaign – we need ‘better’ social workers. What they are creating, I fear, are people able to work through processes in particular local authorities effectively. Is that social work at all? Does doing social work tasks make one a social worker? Unfortunately I suspect the answer is yes because that’s what employers want.
8) Local authorities should take a greater responsibility for the ‘failure’ of social work training. They want ‘cookie cutter’ ready-to-practice social workers immediately from university without investing in the process of training on-the-job. In my view, and I say this as an ex-practice educator, placements are training to be a social worker but should not be used to train for a particular position. Students need space around the placements to understand processes, power and to analyse their own changing roles as they move between being students to being practitioners with power. What local authorities want, and through this scheme they get, is more akin to apprenticeships where social workers will be trained in their own systems. There’s an advantage to that. There’s also a potential disadvantage as one of the things I found most valuable in moving from being a student to a practitioners was being exposed to different systems, different organisations and different people who had different views about the same statutory function.
9) This has shifted the focus away from post-qualification training and towards pre-qualification training without any evidence about retention. It seems to me that a better focus would be to invest in training and retaining social workers who are qualified already. I say this with a little bitterness as a social worker remained in local authority/NHS practice for 12 years before moving away. I think there needs to be more thought specifically for post-qualification training in child protection with perhaps, a course akin to the AMHP training in mental health with better pay and status – and a need for greater experience before going into these roles.
In my opinion, one of the failings of the social work system we have is that often newly qualified social workers go into child protection work. Surely it makes more sense for there to be career progression and more experienced workers to be in this field but no one wants to stay so there is a rapid turnover. Maybe that’s something that should be addressed with the money Frontline generated instead of making the problem worse.
10) Frontline seem obsessed with social work’s ‘professional status’. They want social workers to be one of the most respected professions blah blah. By focusing on ‘leadership’ and recruiting ‘top graduates’ this will happen. Right. I’m more sceptical. I think it will only happen when social workers don’t obsess about their/own status and when we speak up for people who use social work services – without our job role and outside and show how useful we are. We don’t need validation and we don’t need to be ‘loved’. We don’t need documentaries so people ‘understand’ us. We need to do our job well and not wait for others to find the respect for us. If we tell people what we do well, if we concentrate on developing a profession where we can respect ourselves, then we will be respected and some people will always hate us because we use state powers to control behaviours. That’s life.
I hope someone from Frontline will respond to these ten points in turn. I wait with interest.
In the bold move towards a transformation in adult social care, it feels from where I sit, that control has completely overtaken any pretence of ‘choice’ in the so-called move towards more idealised ‘person-centred’ care and support planning.
I hope I’ve been clear over the years in which I’ve expressed a remarkably consistent view that I love the idea of people being able to choose the support plan they like from a wide menu of options with ‘professionals’ taking less of a role. I am a massive fan of direct payments. I want people to have more personalised care and more creative care. Desperately. The options just aren’t there yet for people who lack capacity and that is a terrible disservice and inequity that is being served throughout the care system.
Removing care planning from my role doesn’t concern me – unlike those people on the training courses who bang the drums blindly about how wonderful and bright it looks when we allow people to choice whatever they like to put together packages of care, I don’t want ‘retain control’, I truly don’t believe that I, as a professional ‘know better’, but likewise I know that with the user group I work with, it is rare that I can just hand someone a support planning tool and a list of potential providers and tell them to ‘get on with it’.
That is as far from reality now as it was 20 years ago in my work. While I can say that everyone I care co-ordinate who has a ‘package of care’ is now officially on a ‘personal budget’ and some even have direct payments, it hasn’t really increased choice or control for any but a couple of those people.
If anyone for a moment wants to ponder the duplicitious nature of those in policy making ivory towers who dribble down policies which they want to couch in ‘soft’ language so they are difficult to challenge, one only has to read a fantastic piece of research conducted and published on The Small Places site.
It is worth reading through the piece in detail. Lucy, the author, made a number of requests to local authorities to ask about how their Resource Allocation Systems (the link between the ‘assessment’ and the ‘cash’ – basically) was calculated. She seemed to come up against a wall of obfuscation but it’s worth looking at her research in detail.
This reluctance for me, seems to relate to the lack and reduction in spending on care and support – the key ‘missing piece’ as to why a council can ‘reassess’ someone as needing less ‘cash’ than they did last year with a more traditional care package.
My personal experience is that the council I work in (and this is similar to things I’ve heard from people in other councils) probably doesn’t want to share it’s RAS because it’s ashamed of the utter dog’s dinner that it’s made of it. It doesn’t ‘work’. It doesn’t make sense. It is frequently changed. There is more emphasis on physical health needs as opposed to mental health needs and while there can be manual adjustments, some of the figures that are ‘spat out’ just seem nigh on ridiculous (and that works for sometimes calculating care ‘too high’ as much as a figure which is ‘too low’). It comes down to everything needing to be qualified and fitted onto a spreadsheet when actually the needs of two people who might fill out a self-assessment with the same ‘tick boxes’ might have very different needs in reality – no RAS can account for that. One person might under-score because they are embarrassed by the process and don’t want to admit to being incontinent on an initial visit from a social worker because they haven’t been able to tell anyone other than their GP – another person might be anxious and think they can manage less well than they can. Sometimes and this is what local authorities and health services seem to find hard to account for, you just have to treat people and their needs as individuals rather than the subject of outcome measures, tick box performance indicators or resource allocation systems.
Shouldn’t personalisation be about putting the user at the heart of the system? Every user should have a copy of the RAS and how the figure was determined. Which questions are weighted and which aren’t. Without that, there flow of money and the control rests solely with the local authority.
I’m fully against ‘traditional’ care packages. Having someone anonymous and constantly changing pop in for a 30 min welfare check once a day isn’t about improving the quality, control and choice in someone’s life, it’s about a local authority doing the absolute bare minimum that they can get away with to fulfil their statutory duties of care.
The lack of openness about the ways that the RAS shows the true colours of the reasons for these pushes towards the Eden of ‘Personalisation’.
While I have no doubt that for some people, as I keep saying, those with advocates, family or who are able to voice their own needs clearly, have and will continue to benefit enormously from having direct payments – it’s worth remembering that direct payments have been available and accessible for many years now.
Forcing everyone onto personal budgets has only discriminated against those with carers by reducing the amounts of money they are entitled to through the RAS (that’s my own experience of how our local RAS works) and has discriminated against those who lack capacity by promising all sorts of ‘creative’ ways of exploring third party management of support plans but without providing any real ways of accessing it (this is my current bugbear as I have been requesting assistance with this for months for service users I work with but have been told it is not possible for older adults yet as only those with learning disabilities have budgets large enough to make it cost effective – thereby clearing discriminating on the basis of age and type of disability).
I have changed from a fervent advocate of a system which was supposed to be so much better for everyone to a bitter opponent of a system which favours some kinds of disabilities over others, some kinds of service users over others, some kinds of carers (those who are willing to put a lot more time in to manage and support plan where necessary) than others and all to provide fewer services under the guise of choice.
No wonder Burstow is pushing everyone towards direct payments. He is pushing everyone towards a system which masks the way that payments are determined and discriminates openly against people who lack capacity or who have the ‘wrong’ kind of disability or family support.
Now we know that the local authorities can hide the way they make financial calculations, it becomes much more obvious to see behind the facade of the ‘Wonderful Wizard of Oz’ who promotes choice as the final goal to achieve at all costs.
I feel tricked and betrayed by the implementation of the personalisation agenda and the lack of any of the services around it to tackle directly with the problems at it’s heart.
I was deeply disappointed, for example, that the Mental Health Foundation’s ‘research’ and work with people specifically with dementia only focussed on people who either had capacity or had family. Their advice talks lovingly of setting up trust funds, appointing brokers – well, that is a fantasy rather than a reality and exists only on paper as a choice. They merely replicated a lot of work which was done when direct payments were rolled out around lack of take up for people with dementia and they hadn’t said anything new (I happened to write my dissertation about the lack of take up of direct payments for older adults so did actually do literature researches at the time..).
Anyway, I’m getting ahead of myself.
For now, I think it’s important that we who see through the cosy policy makers congratulating about a ‘job well done’ speak up and speak up loudly for those for whom the system is a further barrier for true individualised care because these self-same policy-makers see them as ‘too difficult’.
My title explains that the personalisation dream is dying but it isn’t dead yet. To be brought back to life, all those involved need to embrace the principles of honesty and openness and not blind themselves to their successes if they can’t see the continuing barriers.
Please forgive the blatant self-promotion in this post but it’s Friday and I’m feeling a like I have a bit of a cold coming so I’m less ‘perky’ than usual.
Dorlee from Social Work Career Development has published an interview which she did with me and it concentrates on what I do at work and some of the ways it differs from Social Work in the United States. Excellent work, if I do say so myself – but joking apart, it is a good way for us to learn about social work in other countries.
Shirley Ayres has written a fantastic post for PSW, the BASW magazine (yes, I know.. ) and it includes some gems from myself. It’s a piece about social media use for social work specifically and is definitely worth a look. The PDF is available here
As for my twittering on last week about wanting to work collaboratively on more online social work conferences/learning/interaction – well, it’s VERY rudimentary, but I’ve set up a ‘holding site’ here
Feel free to nose around as the whole point is to emphasise openness, conversation and working together on something that can be led by social work and improve social work without having a cost barrier to entry and that allows all who want to learn and contribute to do so. I’ve also added a very basic forum just to collect ideas.
I don’t have any great desire to ‘run’ this project and if anyone with greater technical skills wants to volunteer them then please please do but it’s a start and I hope someone will – even if it isn’t me – because I think something that adds value to our collective, international knowledge base and moves learning out of universities and into practice will be a real ‘hook’ in convincing more practicing social workers to engage with social media and new technologies.
Enough from me, the forum is here. Do join and share ideas.
(Don’t be scared that there isn’t much there yet.. everything needs to start somewhere!)
I am not going to add anything to this post. After I wrote a post explaining why I left BASW, I was sent this as a response and agreed to publish it. I’ll leave the questions and comments for others and I have asked that someone from BASW respond to any questions or comments that arise from this post but obviously they are very busy so here’s their post. – cb
I’m disappointed that you are leaving BASW and, as head of communications for the Association and editor of PSW, I’m equally disappointed about your assessment of this magazine.
BASW is fortunate that more members have been joining than leaving for some time now but retention is just as vital as recruitment so any loss is frustrating.
Most members leave because their circumstances have changed – they might have lost their job, left social work or retired. On those occasions when someone contacts us to cite a specific issue for why they no longer wish to remain a member, someone from within BASW will usually correspond with them to at least try to respond to their concerns. Whether it makes any difference isn’t really the point – the main thing is to secure a grasp of what we’re doing wrong and how to do it better.
Your departure, inevitably more vocal and more public, is no different except that it seems appropriate to respond equally publicly, given the platform you have employed to air your views.
You cite BASW’s launch of the Social Workers Union (SWU) as the reason for now deciding to leave the Association. Clearly, the odd gripe apart, you are happy with your union and with your local representative. Fine. Really, fine, BASW has no intention of encouraging social workers who are happy with their trade union to up-sticks and join SWU instead.
We hope members in this position will still reflect on the range of member benefits being part of BASW offers, and will want to be part of their professional association, but in no sense is it making a play to poach you and others like you from other unions.
There are two reasons why SWU can be a good thing for the social work profession generally without impacting on the social work membership levels of Unison or any other union.
Firstly, there are well over 40,000 social workers in the UK who are not a member of a trade union or a professional association, so have little of the security such membership affords a practitioner in need of support – from basic advice to prolonged representation. By no measure can this be a welcome fact.
To date, a standalone BASW, acting solely as a professional association and without a union arm, has not attracted these people into membership. Nor too has any trade union appealed sufficiently for them to consider subscribing. BASW’s launch of the Social Workers Union offers these people something else, another option which some of them, just some, might choose to take.
Secondly, and most pressingly, there is one significant factor in BASW deciding to establish SWU that shouldn’t be ignored. A number of local authorities were increasingly unwilling to allow our Advice & Representation officers to attend internal disciplinary or conduct hearings. Although in contravention of ACAS guidance, this was leaving some fee-paying BASW members without access to the sort of expert representation they were entitled to have.
The ACAS guidance, it would seem, is just that, and if you are not a trade union then you don’t have guaranteed access to represent members with employers in the way we would want. By launching SWU, for no extra cost to members, we ensure, among other things, proper protection for local authority staff. This has to be a good development for social workers.
And let’s be very clear about which social workers. You describe BASW as ‘less relevant to me as a local authority social worker’ and ‘focused on either students and newly qualified social workers or independent social workers’. Yet SWU is, more than anything else, about ensuring we can support local authority social workers fully and properly in the increasing number of cases we are sadly being presented with where members are being poorly supported by employers.
You do allude to something very interesting though on the issue of how BASW represents local authority social workers and where we can do better. You suggest that the one thing you would really welcome is the chance for informal social networks – ‘safe’ places, physically and virtually, where like-minded people can discuss the future of social work. It’s a very strong concept and one BASW has recognised but could do far more in developing.
In this instance it is fair to say that we have gone much further down this road with independent members than local authority workers, as illustrated by the number of very successful independent groups holding regular meetings around the country. These aren’t controlled propaganda exercises – BASW staff usually only attend the first meeting to help get things off the ground – but informal meetings of independent social workers which BASW helps facilitate and that participants themselves then take forward.
We have staged a host of ‘tours’ within all UK countries over the past three years, many of which proved to be useful two-way discussion sessions, but facilitating networking groups within local authorities would be a good step for our members and should be explored further, and soon.
One of the most notable aspects of your blog, and the one I felt most keenly, was your assessment of PSW magazine. In particular, you referred to ‘pages and pages of propaganda’ and that there is ‘no space at all for any kind of dissenting or alternate views’. I will respond to this at some length but in brief I do not feel this is an accurate assessment of this magazine or BASW’s approach to dissent.
I have worked for a trade union where the members’ magazine became solely a propaganda device, where every editorial item was utterly patronising and where opportunities for dissent gradually dissolved to the extent it was untenable for me to remain with that organisation. I don’t miss it and I wouldn’t go back into that same environment or remain in an organisation that developed such a mindset. BASW is not that kind of organisation. Not even close.
Look at page 11 of this month’s PSW and you can see that one of the three letters is a direct attack on the magazine for publishing an article the correspondent loathed about lessons to be learnt from the Baby P case. I might disagree with the contributor but his was a valid member’s view which we published without hesitation.
Go back to March when we published a double page spread of comments posted by members online after BASW launched its own College of Social Work (as you will know, the name has since been dropped as BASW and the SCIE-sponsored College work to establish a single organisation for 2012) and you will see two sharply critical views and one far from convinced about the move. As a proportion of the 200 or so responses we received online this wasn’t just a fair reflection of dissent, it actually represented a higher proportion of opposing opinions than were actually posted.
Go back even further to the fall-out from BASW’s decision in early 2010 to hold a referendum of members on the kind of college members wanted to see. We carried letters from one BASW Council member who had resigned and another from a member at the end of his term, both of which were sharply critical of any move away from the SCIE college. No censorship, just publication.
It may surprise you but we actually don’t get a massive postbag of alienated members wishing to air their ire. Far more correspondents focus on something specific they have read, respond to requests for comment on a particular topical issue or, to my inevitable frustration, highlight minor errors of fact or grammar.
As for ‘reams of pages about how important BASW’ is, this is a tougher one because to some extent you have a point – we didn’t used to highlight the Association’s work that much in PSW at all. And people would complain that they didn’t know what BASW did.
People used to wonder why they were paying their membership fees if BASW wasn’t more publicly prominent, more vocal about the issues that mattered to them. BASW is definitely more assertive, more opinionated and, sometimes, more bolshy and for a lot of members that is a good thing.
Now, should that entail using the magazine for endless self promotion? No, in my view it should mean members get to read what BASW’s position is on key issues, whether on the riots in England, adult protection laws in Scotland, funding cuts in Northern Ireland or a consultation document on the future of social work in Wales.
As a monthly title PSW can’t present you, in print at least, with the very latest news, but it can reflect on the past month’s developments by offering the facts and adding a BASW view. This doesn’t change the facts but it does enable members to see what BASW is lobbying for, using the membership subscription fees they pay each year.
News is only a small part of the magazine though, so too is The Chief, where the chief executive is free to write what he wants to the BASW membership. Elsewhere you can read content including features, book reviews, advice columns and interviews, none of which offers a BASW view or seeks to evangelise.
Incidentally, though not without relevance, 345 members replied to a survey on our communications output in early summer and 92% said PSW was either a welcome or very welcome member benefit. It’s not scientific and there are plenty of members who haven’t expressed a view but it’s not a bad statistic considering it is an anonymous poll and I haven’t stood behind anyone’s back twisting their arms.
And just to go back to the issue of self promotion, only a couple of days ago, after reading your blog, I noticed a comment within a Guardian story about research it was co-sponsoring into the causes of the riots, in which the editor-in-chief waxed lyrical about the ‘great strides in the field of data journalism’ The Guardian was continuing to make. Possibly true but certainly self promotional.
BASW is an active, growing organisation that is constantly developing new services. We need to talk about this if we are to sustain our growth as, to borrow from your blog, there is ‘strength in numbers’ and the more members we have the more we can represent the interests of the social work profession – whether you are a student, local authority worker, independent or anyone else.
As for those Annual General Meeting numbers you wanted. Around 230 people attended the Practice Symposium in the morning and 164 remained for the actual Annual General Meeting. Of these, 134 supported the launch of SWU, 21 opposed the motion and eight abstained. Proxy votes totaled just nine, with five opposed to the launch of SWU and four in favour.
Would we like more members to take part in the decision about the future of their organisation? Absolutely and we are trying to learn lessons from our attempts to promote the AGM in May. Several advertisements and e-bulletins actually attracted the biggest turn out at a BASW AGM in my time at the Association, around five years, but we must continue to try and up the numbers further as clearly those who attend the event are clearly a minority of our overall membership – though this isn’t particularly unusual for any union or association.
Considerable effort will be made to alert members to the next opportunity to shape the future of BASW on 1 November when an Additional General Meeting in Birmingham will be asked to determine whether BASW should transfer its assets into a new College of Social Work. This will commence in earnest once BASW Council meets on 21 September to consider the latest position ahead of the Additional General Meeting.
I felt a tinge of sadness when I finally decided to quit BASW (British Association of Social Workers). I’ve been an advocate and member for a good few years and I have a great deal of respect for a lot of people who work there. I advised colleagues to join over the years amid general waves of apathy. I wanted to ‘make a difference’. I wanted to contribute to the general good of the profession as a whole and I saw my membership and support as the best way.
I can understand some of their irritation with the way the College of Social Work has been established but what I couldn’t understand and believe me, I tried to, via their own forums and press releases, to get to the heart of what their anger about was about UNISON (the trade union that linked with the College of Social Work) , with the College, with SCIE – who were charged with setting up the College on behalf of the governmentwas all about.
I know it was partly about control. BASW had initially thought to propose the idea of a ‘College of Social Work’ and probably felt that they should have been charged with running it. The problem was and remains that BASW members remain a minority of social workers. I remained a member though. I enjoyed being a part of the professional association. I thought that it added ‘something’ to my arsenal and allowed me, theoretically at least, to hold a stake in the present and future ‘state’ of social work in the UK.
However, for me, BASW seemed to become less relevant to me as a local authority social worker. They run events but they seemed to be focused on either students and newly qualified social workers or independent social workers (I’ve been told that this is a faulty perception but it’s the perception that I have regardless).
I looked at their magazine and I saw what appeared to be page after page of propaganda for their own campaign to disassociate from the ‘official’ SCIE led College of Social Work. There was no space at all for any kind of dissenting or alternate views. It felt like some ‘official party’ magazine. Sure, there would be some interesting articles but it would be one or two amid the reams of pages about how important BASW was. This is a membership magazine going to people who are already members. The writing felt patronising in the extreme as if we were just being exposed to a propaganda machine and were incapable of independent thought.
I am a member of UNISON as well as BASW. I never saw the two as being mutually exclusive. I certainly haven’t had UNISON bad-mouthing my professional organisation in its literature but BASW seem to find the idea of UNISON so difficult that they have press release playing ‘number games’ with their figures – forgetting the obvious point that some people (like me) are members of both organisations so comparing numbers becomes less.. helpful.. when you consider that some are counted in both ‘fields’.
I think their move towards creating a Trade Union is wrong-footed. I was unable to attend their AGM and when I asked about proxy voting, I was told that they only count the postal votes if those present dissenting reach a certain threshold. With that I realised that my vote against the Union would be discounted as those who would attend would be much more likely to vote in favour. I felt genuinely disenfranchised because my vote would not be counted unless I was able to attend in person.
I am deeply disappointed by both BASW and the College and their lack of engagement and innovation as regards trying to find new ways to build social work links and make progress in an increasingly social world. The same people are being appointed to the same committees to discuss the same issues. It very much feels like that from my point of view.
I was willing to continue my membership to BASW through their gripes and through my increasing concerns with the way they were moving.
However when they pushed out to promote their new ‘Social Workers Union’, that’s when I decided to leave.
They seem to be pushing their union as ‘added value’ to their current members. It would add no value to me as I already have a Trade Union. In fact, in their membership booklet, it even says that they encourage social workers who join to also join a trade union – and so I did. I know my Shop Steward and I admire them greatly. We link very well with the Health members of Unison as a lot of the issues, for me at least, in a Community Mental Health Team, are very similar regarding employment issues.
I’ve had my gripes with UNISON in the past as well but knowing how the local authority is minded, I would rather ‘stick my oar in’ with my colleagues regardless of whether they are ‘social workers’ or not as opposed to being in a union which exists only to support social workers. Currently our jobs are at risk. UNISON is working very hard locally to establish links within the local council and NHS trust to consultation and they are created with being an established partner and union who has members across the council. With unions, however right or wrong it may be, I think there is strength in numbers and I dare not quit my union membership in these current times. If BASW are focussing on ‘being a union’ and I don’t want to be a member of ‘their’ union – why should I pay for it? Especially when I am content with the union representation I receive from UNISON?
I felt sad to pack in my BASW membership and may be back in the future if they steer towards a more conciliatory path. I would still recommend membership for students, I think, because the fees are lower and if they to incorporate the union membership it may well be a good ‘deal’ to assist through difficulties with placements. I would also recommend membership for Independent social Workers as they have good networks and frequent meetings and events for Independent Social Workers and have good insurance packages (so I’m told).
For me, though, I need to see more and mostly I need to see more positivity. The organisation increasingly feels very defensive and negative and that makes me sad.
Ultimately what I would like from a professional organisation/college is more local groups/social groups. Spaces both physically and virtually to discuss the future of social work and ‘safe’ places to bring together issues that affect social work as a whole. Not just a forum, online forums are ‘old hat’ but there are more ways to discuss and find space.
I think regional groups would definitely help build connections and membership.
I know there are good people in BASW and that they want the best for the profession but I couldn’t justify continuing to pay over £200 per year alongside my union membership as they move in a path I no longer agree with and in tough financial times, you have to ask ‘Is it worth it?’.
Personally, I felt it wasn’t.
My hope is that there is a move towards more collaboration with the College of Social Work but that those within the College will push away some of the apparently self-obsessed cobwebs from BASWs eyes and create and evolve an institution that can really work for Social Work rather that what appears to be their own ends because unfortunately that’s sometimes how it feels from the ‘front line’.
Committees arguing for their own continued existence. I’m sad to say that but that’s how I feel.
Just one aside, when playing their numbers games and trying to ‘outmanoeuvre’ Unison in claiming to have more ‘Social Work’ members, I commented that I would like to know two things
How many members attended the BASW AGM?
How many people voted in favour of the move towards a Trade Union (numbers not percentages)?
I haven’t been given these figures but if there is anyone from BASW reading, I’d really like to know.
I’m not saying at all that I’ve left forever. I really hope I will be back at some point but I have to see more effort and will towards promoting the profession rather than BASW itself.