Making Adult Social Care Better 1

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

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

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

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

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

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

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

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

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

So things that can make things better

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

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

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

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

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

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

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

Contrary

I have not been in the most sanguine of moods at work recently.  A mild and basically inconsequential altercation has put me somewhat at odds with one of our countless managers and although in my head (and this might be one of the problems!) I know I am right (!) , in retrospect, I probably haven’t been exceptionally wise about voicing my concerns and might be treading a fine line between outspokenness and ‘trouble-making’.

So all in all, I have to consider whether I’ve reached my regular ‘two year itch’ stage of working where I have tended to move on to different jobs or roles every couple of years – pretty much since I qualified.

I did apply for a new job a few months ago and that is the cause of some of the general grumbliness because it was an internal position which I didn’t get because I was told there weren’t enough applicants (only me actually.. )  so it will be re-advertised at some random point in the future but at the moment, I’m not inclined to re-apply.

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I am restless though. I feel I should be doing ‘more’. There is a strange position where social workers in the team, being seconded and therefore unbanded in relation  to our Health Service colleagues – end up on placed at about Band 6 equivalent – so we have nurses and OTs with significantly less experience being given more substantial tasks and responsibilities on the basis of their Band 7 (actually, the salary is genuinely not an issue for me but they do get paid more as well!) and the sometime obtuse situation where I am often approached for advice and support on the basis of my AMHP status and training by someone who is actually more senior than me in those strange office pecking orders that emerge.

I don’t give it a second thought most of the time because I’m more than happy to help and I have so much to do that there’s no point pulling weight but when it is raised in the more general meetings, it doesn’t really hold water.

It is grating particularly at present because my local authority won’t fund any PQ training for me at Higher Specialist (Masters) level unless I am a Senior Practitioner and I have exhausted all the possible training at the Specialist level (as I have a full PQSW under the old system which is equivalent to a Specialist level Award).

I enjoy learning. I don’t like standing still. For years, I’ve wanted to take a student on placement and in fact, was told that I could only on condition that I completed the ASW (Approved Social Work) training first on the basis of a service need (I wasn’t at all keen to train as an ASW – for the record!). I have done exactly what was asked of me and postponed my more favoured training route (the practice teaching) .

Now though, I’m being told that unless I hold a more senior position, the training will not be funded and anyway, I can’t be released for training because I am such a precious (!) resource as an AMHP (ASW as was) that it would not be possible for me to miss so many days.

Generally I like my job. I have good, conscientious colleagues and work with some excellent consultants. I enjoy working in the service area too. I think there is so much work to be done in the field of care for older adults and I feel passionately that there is a strong advocacy and support role that I can fill. Since I qualified, I have worked exclusively with the over 65s age group too so I suppose there is an element of expertise there as well.

I enjoy working in mental health services too as it gives me more flexibility to provide the support that I went into social work to do.

I love that social work has a place in a multi-disciplinary team and am grateful that I can inject some of the social model of care into the team approach although to be honest, that is very much the ethos of the team as a whole.

What I don’t love is the politics of the management and management structures. I could ignore it for a good deal of time but as I have wriggled into the team, I  have become more aware of where the priorities and balances lie – and they are firmly fixed on ‘not rocking the boat’ and almost impossibly lean balance sheets.

Part of the reason I feel I can do this job is because I have no fear of voicing my thoughts, feelings and experiences. I genuinely believe that advocacy and giving a voice to disenfranchised is a great part of my role and that I would be doing myself an injustice if I didn’t reflect this in my own dealings too.

But last week, in conversation with a more senior colleague, I was  urged to be more cautious in my language. A little less confrontational, perhaps. While seeing my point, she said that my approach could mark me as a ‘trouble-maker’.  That would not, she said, be useful in the longer term.

And I can see her point too, after all, she’s been working in the service for decades. But a part of me doesn’t want to keep my head down. I might lay low for a while though – it isn’t as if I don’t have enough to be getting on with in the meantime…  but I am going to try and push for the practice teaching .

World Social Work Day

Happy World Social Work Day! A day to celebrate the joy of social work – I had an idea for a post planned but couldn’t let this occasion pass so my thoughts about the letter received by every registered social worker in the UK on Friday will have to hold for another day – oh the suspense!

Hilton Dawson, the incoming Chief Executive of the British Association of Social Workers, a former MP, writes a piece in the Guardian celebrating Social Work with much more eloquence than I would be able to muster pre-work but without doubt it convinced me that today should be for positive thoughts.

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I have said it before and I will again, just for effect – I’m incredibly proud to be a social worker. I might not shout out too loudly about in when out and about in public because I quite like my nose the shape it is already thank you very much, but when I look more globally at the work that is done and the work that I have been able to do, I’m very very proud.

It isn’t always easy – in fact, it rarely is. If it were easy, it would be boring. I have an opportunity and a window to walk with people through some of their most difficult moments and to convince, cajole and encourage them through it. Sometimes we make it out the other side, sometimes we don’t but at least by ensuring that there is a place to turn to, a number to ring, an ear to listen – it can make sense of some of the more troubling shots that fate plays with us.

Sometimes it isn’t about walking through scenarios with people, sometimes it is about making decisions for them or bursting into their flats with platoons of police officers to cuff them and assess their mental health. No, it isn’t fun. No, it isn’t rewarding. But thinking of the longer term – being years rather than weeks or months – it is something that is measured in degrees of the whole. Sometimes the decisions we make aren’t the ‘right’ ones. We work with risk. But we cannot afford to be afraid of risk.

I feel honoured to have the opportunity to share peoples’ lives. I see some of the pain that lingers behind the twitching net curtains. But I also see some of the hidden joys – some of the unexpected recoveries.

I qualified as a social worker in 2000. With about two years out where I had nothing whatsoever to do with anything related to social work, I have been working for almost 7 years in the post of a qualified social worker.

The most valuable things I have learned?

Clearly humility. You gain nothing by status and no-one goes into social work for the status, obviously. You cannot assume you know anyone better than the client and/or the carer who lives in that situation. Respect is a two-way street – you cannot and should never expect it unless you willingly give it. That obviously holds for users of services but it needs to hold equally for other professionals, care staff everyone with whom you have contact.

Advocacy – we learnt about the importance of advocacy and particularly self-advocacy as I was training. I have found myself most effective when I advocate for myself as well. We can dictate to our own managers what expectations should be made of us. What expectations we have for support and supervision. If we can’t advocate for ourselves we cannot effectively advocate for others.

Social justice underpins social work. When you are sitting under mounds of papers that need to be filed in front of a computer with a database programme that needs to be compiled, it is good to throw a thought back as to why the job is important and continues to be so important. We can’t escape the paper work or the database systems. We probably can’t truly learn to love them either. Unless we actively engage with those who are responsible for making these systems – at a national rather than local level – we can’t expect change.

And so I’m back to the letter we all received from Alan Johnson and Ed Balls – the content being too predictable, it did end with an invitation to discuss and engage with the Social Work Taskforce – with those who are deciding the future of social work in the UK (and an agony aunt from The Sun). I engaged. In pretty strong language – but not offensive language, I hasten to add.

I would encourage others who received their letters to engage – and if the requested conference date is full (as the one I wanted to go to is) – write directly because they do leave an email address (and I, for one, even got a fairly speedy response!).  It will not take long and it is important that we re-grasp the profession for what it is and not for what the media creates it to be.

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