Usually when I’ve mentioned workloads here, it’s because they are increasing or we are going through one of the ‘peaks’ in the general ‘peak or trough’ pattern of work balances.
I’m going to do it again because we are definitely in a ‘peak’. The problem is, the peak has been pretty much ongoing for a few months.
The freeze on recruitment is biting much harder now. I suppose it was sustainable when one person, two people left. When numbers five, six, seven left it became more obviously apparent to everyone left in the office.
Our office has an empty look to it and none of us are ‘smart working’ or ‘working from home’. Sure, we have visits in the community but even at the beginning and end of the day, there is office space in overabundance that makes the thought of hot-desking comical.
So we are each working on more cases and the cases we are working on have more urgency attached to them as the allocation to a care co-ordinator have come later than they might otherwise have come.
Paperwork is being left uncompleted. Oh, you may pat me on the back for prioritising visiting service users and carers at the expense of ‘filling in forms’ but each piece of paperwork I don’t complete in a timely fashion has a consequence for said service user or carer. It might be a delayed processing of an individual budget – it might be the delay to a respite admission or a carers assessment – it might be the delay of attendance at a Continuing Care Panel (lovely 55 page assessment form sitting on my desk that induces nervous twitches). I could bring the form home – but I don’t. At the moment, I honestly think it is the ability to leave things behind at work and walk out at 5pm (as much as is possible) which is preserving my sanity.
It does mean that things aren’t getting done though.
There have been a couple of recent consequences of this – not helped by a rush of Mental Health Act Assessments and Best Interests Assessments which had very time-specific periods in which to be completed. For reasons that may be obvious, I have to prioritise Mental Health Act Assessments above everything else when they come in and Best Interests Assessments usually are requested in my experience during the 7 day period that an urgent authorisation is ‘running’ so have to be completed within that seven day period (note – these seven days have no consideration for the distinction between ‘working’ days or not and they include the period that the paperwork needs to flit backwards and forwards between Managing Authority and Supervisory Body so realistically, it means the Best Interest Assessor will have 3/4 days to complete the assessment).
My desk is like the inside of a paper recycling depot with filing done in various piles of paper. One pile is ‘things to be filed’, One is ‘things to do’, One is ‘not sure where to put this piece of paper’. I have overflowed to the empty desk next to me.
Yesterday some things happened that caused me to reflect on the current work pressures.
Our service manager approached me at roughly 9.01am and asked me for the Self-Assessment Questionnaire for a service user (who has fairly advanced dementia and a distant and uninvolved family and therefore would need substantial assistance in completing it) I had taken on a few weeks ago. I hadn’t done it. She was very pleasant about it when I started listing all the other things that I had been doing. As I am wont to say when asked why I haven’t completed something ‘it isn’t like I’ve been sitting at my desk twiddling my thumbs instead of completing the work’.
The service user involved had a care package that had been set up as an emergency and it was actually working really well but we needed to create an individual budget for her. Ironically, I’ve visited her a few times to monitor the care package and ensure both that she is keeping well and to enable us to build up a relationship so she begins to both recognise and trust me. I didn’t get round to the SAQ as the format of questions was so alien to her. She didn’t want to answer questions about what she could or couldn’t do – indeed, she didn’t accept that she needed any support whatsoever and would say she didn’t understand what these nice ladies coming into her flat were doing (they were preparing meals for her!). What she wanted was to tell me stories about where she used to work (although they were framed in the present tense) and tell me about her friends (mostly moved away or died) and how they visited her regularly.
I hadn’t completed the SAQ and the Performance Indicator Monsters are chasing me down. But, service user is safe and receiving support.
For me, this makes a mockery of the process of individual budgets. Yes, she could have a wonderfully creative package of care in place. But where is the time to sit down and talk her through each stage when she is (understandably) completely disinterested in process. It can feel almost cruel to labour the point for the sake of the department completing forms and ticking boxes.
How is her service to be ‘personalised’ and where are the champions of personalisation? They are telling us about packages of care where young adults can choose driving lessons to get around. Where are the champions of the personalisation agenda in helping us with means to engage people who are frightened by the process and overwhelmed by self-assessment questionnaires?
Oh, wait, all the training is about people who take an active interest in being involved in the process of care planning and self-assessment.
I try. Believe me, I try. I have no interest in the process failing. Indeed, I held out a massive hope that personal budgets would serve older adults who lack capacity much better than the direct payments system did. I have been sorely disappointed.
Anyway having explained away my lack of action to the manager, she nodded, expressed sympathy and headed on her path.
Later in the day, I was confronted by an emergency situation. It wasn’t the nature of the emergency that caused me difficulties. I have dealt with many similar types of circumstances through my years of practice but what was different was my reaction.
I spoke to my manager and as we concluded that I needed to make an emergency visit, I asked for a colleague who was ‘on duty’ to accompany me.
The situation perhaps didn’t warrant it and there was an expectation that it was the kind of issue that I should be able to manage with my proverbial eyes closed but internally, I felt some of the panic rising. I suspect that was the combination of stress about workload issues and thinking about my next arranged visit.
My manager agreed for someone to go with me – possibly because I don’t think I have asked of assistance with a visit for about three years so she might have clocked on that something was up so we went together.
On arriving, I saw that the situation is one I could easily have managed alone. I felt almost embarrassed that my colleague had come with me but then I thought, I knew I had been right to ask. I can recognise my own reactions and needs better than anyone else.
Situation resolved successfully, I apologised profusely to my colleague for ‘wasting her time’ but she, of course, denied this and said she was happy to help.
The rest of the day, I was analysing why I had asked in the first place. Why did I suddenly feel phased by an issue that I have dealt with successfully many times before? I’m not sure I can answer that but I think I’ll put it down as a positive recognition that sometimes, we just need a little more help in the day to day work and we need to be able to recognise these moments to better serve those who rely on our services.
Even after ten years, I still have ‘wobbles’ of confidence. They happen less now as is to be expected but for a moment, it was as if I had been transported back to my early days in practice when I wondered if I would ever be like my more experienced colleagues and able to manage anything that was at the end of the telephone line.
It reminded me I’m not there yet and perhaps I never will become instinctively complacent about the work.
That’s not a bad thing as long as I’m in a team that is encouraging and supportive.
And I am.
- Personalisation in Mental Health and Older Adult Services (fightingmonsters.wordpress.com)