Panels

Since I’ve been employed as a social worker one of the constants in my working week has been the presence and existence of ‘panels’ in many different forms. There was a brief stage when we were told not to refer to them as ‘panels’ but rather meetings but it’s all the same thing at least, in the setting in which I’ve been working. They are groups of managers and professionals of a variety of provenances making funding decisions on behalf of the local authority or health service.  Of course sometimes they say it is about joint decision making (which is why the word ‘panel’ is frowned upon now) but that’s really a facade. I make recommendations but I have little authority over funding decisions.

Different local authorities often have different mechanisms so my explanations of the panels that I might attend come with the proviso that things are arranged and organised in a variety of ways.

We have panels which primarily make decisions about packages of care that exceed a particular baseline cost. That baseline has changed a variety of times but generally managers in each team are given a certain ‘threshold’ to which they can approve funding requests but above that and any application for funding for residential or nursing respite or long term care have to navigate a ‘panel’.

We have separate panels for high cost personal budget packages which would be provided for care at home and those which approve residential and nursing care/respite and continuing health care (which authorise applications for long term payment for care by the NHS )

Going to panel generally involves the transfer of reams of paperwork. I’d probably say it’s the most obvious way though that I provide the function of advocating for a particular service user or family member when I ‘present’ the situation to those who make the ultimate funding decisions.

Contrary to what some people might think, I have absolutely no vested interest in the local authority or NHS ‘saving’ money by not agreeing to a particular package – indeed, I won’t tend to bring something to the panel if I don’t wholeheartedly agree with it myself. I am a great advocate of money being spent where it is needed.  I have a general wish to see public money well-spent of course and I understand the need to ration resources but if I bring something to the panel and authorise an assessment, it is because I believe that that is what is needed according to my professional  judgement and as far as that’s concerned, balancing the rest of the local authority’s budget is not an issue I consider (which is obviously why these panels exist!).

Similarly with the Continuing Health Care Panels  I cannot conceive of a situation where I would bring someone to that panel if I didn’t absolutely want and believe that they should get that funding.  If I attend and collate a report it is because I and the multi-disciplinary team behind the report, believe in it.  I absolutely want people to get what they are entitled to and have no ‘secret instructions’ to try and deny the funding. The rules though are not altogether clear but it suits the funding parties and the governments to keep the rules complicated and unclear. There’s a lot of money at stake.

The panels are open to service users and carers but for me, personally, it’s very rare that service users or carers attend with me.

I have more often  had family members attend Continuing Health Care Panels with me and found it is a much better way of working as it allows a lot more transparency and removes one of those bars between me trying to put the words of others in my mouth.

By now, I know the people who sit on the panels and they know me. That’s a massive advantage in being able to persuade and cajole. It makes me realise how useful it is to have built up links and a reputation among the more senior management. I like to think that a trust develops.

Panels used to scare me because I’d be questioned, often in detail about the proposals that would have a substantial monetary implication for the local authority. My paperwork and assessments are examined in great detail and a level of scrutiny applied. Now that I’m more confident, I tend to take pride in presenting my reports and welcome the questioning as I know what to prepare, what to highlight and what to expect.

I’ve had panels where paperwork alone is assessed and where we are not required to attend in person.  I prefer being there ‘in person’ especially when there are any question marks that I feel I can clarify.

One of my favourite tasks in my work is feeling that I am genuinely able to advocate and navigate a person or family through the muddy mired waters of local authority funding streams and decisions. I wouldn’t say I enjoy the panel process although there is a satisfaction in having something approved especially if it is something you feel might be hanging in the balance, but I don’t dread them as much as I used to.

As for now though, it’s just another part of the process of seeing a paper ‘plan’ through to fruition.  I know they work differently in different areas – indeed, I’ve seen them in different forms in the local authorities I’d work for – but that’s how they work – whether they are called meetings or panels, the effect is the same.

And that’s the explanation of what the panels are – the other side of each discussion I have and each decision that is made by the faceless ‘management’ that I sit in front are that they are desperately important decisions to each person who is reliant on the authorisation of that funding to allow them to life their lives more fully, to allow their family to have access to respite services. My job as I see it, is to bring the paperwork and paper assessments ‘to life’. I am not only writing about a person on a pro forma, but I’m able to flesh out the requested questions and documents with a person, with a family, with relationships.

That’s why I don’t mind attending  these panels as much as  I used to. I’m not frightened of them anymore. I see them as an opportunity to take a crucially important role in someone’s life and to speak for them and not  just about them.

Social Work Under Pressure – A Review

Jessica Kingsley Publishers sent m e a review copy of ‘Social Work Under Pressure – How to Overcome Stress, Fatigue and Burnout’ by Kate van Heugten  I interviewed the author and the interview is available on the Jessica Kingsley Blog here .  I know I’m biased but I highly recommend reading the interview to put the book into a context.

I was intrigued by ‘Social Work Under Pressure’ and what it might provide that is ‘different’ in the market of text books for social workers. While there are books covering the legalities, theories and policies, I haven’t come across a book that covers the emotional stresses and pressures of social work as a discrete issue.

van Heugten presents issues of workplace stress in social work (although there is no doubt that the issues and learning can be extrapolated into other areas of social care and health sectors) in the context of theories of ‘stress’ and stress management.

The first chapters are a great example of the importance of using theoretical approaches and research, in this case about models of workplace stress and stress management in practical situations.  van Heugten explains and expounds the relationships of vicarious trauma, compassion fatigue and burnout in more details as being issues for which the profession is particularly prone.

Her discussion of the increased stressors relating to bureaucratic tasks and a lack of control seem to have put a lot of my personal experiences of working as a frontline social worker into a context that made me able to understand better where my own reactions were ‘coming from’. As a ‘reflector’ by instinct, having a context within which to place the stresses and difficulties experienced at work helped me to explore how to build up my own resilience and recognise my own needs regarding self-care and support.

Van Heugten does address the issue of self-care and building resources and ‘toolkits’ to resist and overcome from the the stresses at work. Some of the ideas and plans are aimed squarely at managers and systems but there are also ideas there for individual practitioners without managerial control or authority.

Van Heugten looks at some of the specific issues which affect different areas of social work but her book is focussed internationally and she calls on a wide range of interviews and research data to back up her hypotheses about the reasons and solutions for workplace stress.

There are chapters about dealing with violence and aggressive service users and dealing with bullying in the workplace as well as ‘making mistakes’ and an appreciation that humans work in human services and we need to look after ourselves as well as each other in this trade because ultimately, stress and overload lead to poor practice and sick professionals.

I’d definitely recommend this book to managers, practitioners and social work students as it introduces a lot of elements that are fundamental to a successful and long career in social work and social care as well as health services and these elements are very seldom taught formally but rather learnt most frequently from decent managers, supervisors and colleagues.

It is easy to read and there is a good use of quotations and personal experiences, including the authors’ own experiences of personal stresses and combining this with work.  Each chapter concludes with references and it is a very well researched book that allows readers to discover more for themselves about specific issues that might affect them.

It is available from Jessica Kingsley Publishers and costs £19.99

Weekly Social Work Links 27

A slightly truncated version this week because the last week has been a little distracting and we have a foster child who is likely to appear at any moment!

So please add any other links or sites you’ve seen that have been useful in the comments section.

I’ll start with a post by Malcolm Payne which highlights a short article in the Economist about waste in the US health care system. Really sobering though as our government tries to privatise our own health service. Scary stuff.

I can definitely relate to some of the thoughts expressed at SocialJerk about cities, poverty and working through the summer and the little things, like monkeys, that can bring pleasure.

On Awake and Dreaming the author shares ten things she has learnt. It’s a good exercise.

Therapydoc at Everyone Needs Therapy shares some thoughts about confidentiality.

Doris, at ‘Hold my Hand’ remembers a colleague at the Nursing home where she works.

And A Case Manager’s Verse reflects on what it might be like to have a ‘secret shopping’ experience with users of the services we provide – and as someone who experiences the ‘client’ side of social work in my role as a foster carer – I’d say it definitely adds a very interesting perspective..

I have to admit to being faintly baffled by the ‘debt ceiling’ issues in the US despite my.. er.. A level economics but I did find this post by (Not So) Cheap Social Worker on ‘How the Debt Ceiling affects MSW (and other Graduate Students) to be interesting to give me some more insight into some of the issues.

At Do No Harm, Fareez writes about many changes that are happening in his life and with his work.

Dorlee has another interview up on her blog about Social Work V Psychology and an interview with a practitioner who is trained in both.

Finally, a mention for Community Care’s podcast which helps keep me up to date with social work/social care related news on a weekly basis. This week, they cover the strikes by social workers in Southampton.

Great work from them and good luck to all those in Southampton.

Definitely a great supporter.

As for me, my posts my be a little more sporadic while we have a child in placement but I’m not going anywhere.. in fact, I’m sure I’ll find many many more things to say about the dichotomy between practitioner and ‘client’.

Selling the NHS – The Beginning

The National Health Service Norfolk and Norwic...

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Yesterday, while most of the media, fixated self-referentially on the Murdoch hearings and Cameron was flying back into the country,  Lansley began to dismantle the National Health Service.

As The Guardian reports

In the first wave, beginning in April, eight NHS areas – including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children, and primary care psychological therapies for adults – will be open for “competition on quality not price”. If successful, the “any qualified provider” policy would from 2013 see non-NHS bodies allowed to deliver more complicated clinical services in maternity and “home chemotherapy”.

So we are led to believe that being open for ‘competition on quality not price’ will act to pat us on the head, reassure us, and direct us back to the ‘big media story’.

It worries me and it worries me for a number of reasons. Lansley’s words are couched in the words of ‘choice’ but I wonder exactly whose ‘choice’ it will be to make these commissioning decisions for which, no doubt, large amounts of money will change hands and profit-making publicly listed and private companies will be able to partake.

I admit to a bias having been exposed and having experience in the adult care sector which was subject to a similar rollout of competition which was supposed to increase choice and quality.

I’ve written many times about the end result and how it is one that has inherently favoured larger providers and companies that have been able to deliver on economies of scale rather than the poetic vision of small scale providers delivering local services. Those small scale providers were quickly priced out of the market and I fear this will happen again.

But wait, I hear, ‘quality not price’ Lansley says.. to which I reply, ‘nonsense’.

Why? Because there will probably be minimum standards of ‘quality’ that a service has to reach and beyond those, it will be a price competition. That’s what is supposed to happen in care – but who checks the standards? who will check the standards? How can we have confidence in a well-resourced and well-delivered service when regulators are so weak.

I do not want any private company to make a profit on my potential need for services for my back pain, my hearing or a child’s wheelchair.

Of course, making the publicly delivered service is clearly both too expensive and veering against the government doctrine of handing the healthcare to private companies.

I am sure the first few providers will intersperse local voluntary organisations with large multinational corporations in their delivery methods. Again, I point to the adult social care sector. We started along the path with the NHS and Community Care Act (1990) having a lot of local providers together with a few Southern Crosses and Care UKs. The local providers were eventually priced out.

Of course in the case of podiatry and hearing services as well as primary care psychological therapies, we can see these as almost discreet services. The ones that will potentially be easy to deliver and it will always be possible to find wonderfully successful outcomes for people choosing Boots rather than the local NHS for their podiatry appointments because it is more convenient. And I’m sure it seems to pave the way for Individual Health Budgets where people  are given the money to ‘spend’ on the services that they need. Choice you see. Choice is what it’s all about.

I turn back and look at what has happened in social care. Choice has been extended in wonderful ways to those with the loudest voices but in some ways those with the highest needs have been left behind. That is my main concern about the introduction of private into public.

For some people, the people in the comfortable middle classes of Chipping Norton, this is fantastic news – they can access their IAPT (or equivalent) by a local provider when they are feeling a bit down. They can have their feet checked in a local branch of Boots instead of having to travel into Oxford. All’s well.

Those will be the areas where both competition and choice are the highest.

My concern is that people who experience the degradation of poverty will have quieter voices and less choice because there may be higher multiples of health difficulties and choice is determined through power. I can’t help but think of people who are restricted in their choice by issues of capacity. Will they be given advocates to assist with the process or will they just be ignored? Will the choice by made by GPs who are courted by these private companies, just as they are currently courted by drugs companies?

How equitable will the ‘new’ system be?

If we are extending choice, we have to extend safeguards and checks.

If we are extending choice, we have to extend quality.

It hasn’t happened in social care – there is no reason to believe or trust that it will happen in healthcare.

It does make me wonder – Are we all in this together? Really? With the impact analysis projects that are carried out to ensure equality, I know there are provisions to look at ability and disability, gender etc but are social class and income level also considered?

And think – Lansley considers putting ‘quality’ in as a concession – he was happy to go ahead with the Bill and with a pure ‘cost’ factor. This is his so-called concession but it is no concession at all if we don’t have a definition of what ‘quality’ is. After all, the CQC – too look at the Health Care regulator – defines ‘quality’ on the basis of paper documents and paper inspections given to them by provider services.

If that doesn’t wave any red flags, I don’t know what will.

This is a government of interests rather than representatives. The shame is that the last government was too and likely all the future ones will be as long as we allow our heads to be turned more quickly by celebrity gossip than the tragedies unfolding in our adult care services.

Trouble at the CQC

A lot of people working within the social care sector have had misgivings about some of the changes that have been taking place at the CQC (care quality commission). The CQC is responsible for monitoring and registering care services (as well as health services,  but I’m going to concentrate on care services because it’s what I know best) since its inception when it pulled together various previous regulatory bodies and picked up their functions.

There are a lot of lessons to be learnt for the future within the CQC  as we draw to a point where lots of services across health and social care will be merging and we are pushed towards joint management. There is a lot to be wary of.

Private Eye has an expose’ piece in the current issue (dated 29/10-11/1, in the ‘In the Back’ Section p29). Unfortunately the piece doesn’t appear in full on their website so you will all have to go out and buy a copy (seriously, if you are concerned about the CQC it is definitely worth a read and to be honest, I can’t recommend Private Eye highly enough!).

I wanted to draw on some of the issues raised in the piece so forgive the lack of links for the time-being.

The investigation carried out by Private Eye was alongside ‘Compassion in Care’ which is a charity set up to counter abuse in care homes. The organisation was set up by Eileen Chubb, a former care worker who witnessed abuse and who lost her job because she was a ‘whistleblower’. The organisation campaigns for the vulnerable in care homes.

The report highlights a number of concerns related to the CQC particularly how they have either ignored and in one case ‘upgraded’ via the now defunct star-system homes in which proven maltreatment has occurred.

As the Eye says

‘Only last month we reported how – just two months before a hospital nurse described a care home resident as suffering ‘the worst care of neglect’ she had seen, the CQC had wrongly promoted what had been a failing home, run by care home giants Southern Cross, back up to a two-star ‘rating’.

I don’t have the time to relay all of the information and quite unbelievable lack of teeth of the CQC in the face of appalling care services as relayed by the Eye but it makes for frightening although worryingly not surprising reading to me.

Another part of the article refers to the leaked staff survey results published in Community Care and that backs up informal discussions I have with some good friends who currently work in the CQC.

The Eye states that

CQC Insiders were worried that attempts to push through registration for all homes and agencies ahead of the 1 October deadline was compromising safety in the homes themselves’.

This absolutely mirrors the conversations that I have had with CQC friends, including being told that they were told to concentrate on these registrations at the expense of visiting homes where issues may have been arising –much to their own chagrin.

The other concerning conversation I had with said friends was that the CQC seemed to be increasingly reliant on local authorities ‘quality assurance’ teams to check on the local residential, nursing and domiciliary services. We can only guess at what might happen to some of these teams as the local councils make massive cuts. I don’t know if they will be able to provide as strong a service as they might in less frugal times.

The Eye pulls up the report and interviews given by the head of the CQC last month stating that 34 homes and 8 agencies were closed after they took ‘enforcement’ action as a way to prove their ‘strong arm’ regulation as well as 51 other services which had closed after poor ratings.

This is an area that Private Eye has been investigating and has tried to push CQC to provide details of these ‘enforcements’ as there was nothing about them in the CQC’s annual report published in April 2010. Private Eye and Compassion in Care have tried to find details of the deregistered homes b ut the information  has ‘disappeared’ from the CQC website and they have been stalled in their attempts to investigate.

Cynthia Bower, the Chief Executive of the CQC in her previous incarnation was the West Midland Strategic Health Authority which was responsible for overseeing the Mid-Staffordshire Foundation Trust Hospital. It is quite staggering that the responsibility for protecting standard of care for those who are arguably some of the most vulnerable in society should be under her charge.

I’ve railed against ‘desk based’ assessments which were happening prior to the existence of the CQC where inspectors do not actually visit homes that have previously scored ‘well’ in inspectors but rather rely on ‘self-assessments’. It is a national scandal that we have no reliable and functioning way of monitoring care homes and that the CQC itself is relying on local authority quality assurance visits when it should be setting the gold standard itself.

The piece ends with the comment that while the CQC hasn’t responded to the piece, John McDonnell MP will be raising the issue in the House of Commons so hopefully they will respond to him.

I rail where I can but the difficulty I sometimes face is time and that often homes are able to ‘put on their best face’ for social workers when we visit. We have limited roles usually in reference to one particular resident.

I have to say that all the personal contact I have had with CQC inspectors has been exceptional – when I have picked up concerns at a care home and contacted them directly but it is clear that the time is not allowed in the same way that it had been previously.

We are back to penny pinching and cost-cutting.

Thank you to Private Eye and Compassion in Care for investigating these issues. They should be on the front page of every national newspaper rather than tucked away in the pages of Private Eye – but I have a lot of time and faith in Private Eye to be honest. They have some of the better investigative journalism in  my very simplistic terms. Go out and buy this edition, all the editions and subscribe!

We cannot let it lie.