Fast tracking Mental Health Social Work

First they came for the children and families social workers..

Last year, the government announced the shiny ‘Frontline’ scheme which was designed to fast-track ‘elite’ graduates into child protection jobs in ‘tough’ areas and push these sparkly bright graduates into ‘leadership’ roles. At the time, I moved this blog out of retirement specifically to challenge the processes, thinking and mostly the lack of consultation and involvement of children and families social workers – or indeed any social workers – when this scheme was developed. I’ve written about it here.

I spoke out and spoke up as best I could because I think these ‘fast track’ schemes are a folly and are attempts at solving the wrong problems. I lost that battle because it was the government doing what the government wanted to do. Yes, those in favour say, this is just about another route in to social work – perhaps I’m simple-minded, not being an Oxbridge graduate and all, but I thought we already  had the post-graduate route in to social work training (Masters qualification route). We even had a specialist child-focused route in to social work (Step Up to Social Work – which I’m also not a massive fan of, incidentally) but no, this would be different because this would fast-track even more and focus even more. So it would take all the worst parts and combine them.

This morning, the Independent reports that the IPPR (the same think tank of policy bods who haven’t got a clue about what social work actually looks like) are presenting a lovely report to Norman Lamb about encouraging graduates to move into mental health social work and this week ‘Think Ahead’ will be launched. Actually just typing that causes a deep nausea in my stomach and makes me shake with rage. ‘Think Ahead’ – that’s nice.

This is what the Independent says

Just 10 Oxbridge graduates studied for a social work master’s degree in 2011-12, compared with 10 per cent of the entire cohort applying for Teach First, the successful graduate teacher training programme. Despite the high skills required and difficulty of adult social work, very few top-flight students regard it as a prestigious job, the IPPR report says.

So that’s it, guys. Quality is judged by whether you are an Oxbridge graduate or not. Apart from the nausea, I have to say the tears are coming now. There are fantastic mental health social workers out there. There are fantastic mental health social workers coming through. This is a kick in the teeth of the highest degree. If we didn’t go to Oxbridge, clearly we aren’t good enough. Is there so little understanding that the issue is not about new entrants into mental health social work but the pulling apart of mental health social work so that there aren’t any jobs anymore. Surely we should be focussing on THAT. There is no shortage of newly qualified social workers who are very skilled who want to work in mental health. Maybe pushing some of the money and support into building strong post qualification frameworks to support them might be a better idea than pulling in people who don’t really have a clue what social work actually is.

 

Government endorsed ageism

I worked in an older adults mental health team. It is vital that I had a good understanding of adult social work as well as mental health social work. Lamb’s comment sticks in my stomach.

Mr Lamb said last night he was “very enthusiastic” about Think Ahead. “We are looking for people who can commit to do something to make a difference to young people with mental health problems, particularly people in their late teens and early twenties,” he said.

See, as far as Lamb is concerned, his focus is on making a different to YOUNG PEOPLE. Does he even know what mental health social work is or is he trying to develop a programme which is a mix between Frontline and Think First because, you know, Frontline blatantly isn’t focusing on anything other than child protection social work. This is evidence of the clear folly of building social work into specialist silos. This pot is where Mental Health goes. This pot is where Child Protection goes. We’ll train you as a ‘specialist’ social worker – whoops, what do we do if a child has mental health needs? Heaven forbid someone has dementia and that needs specialist social work input. Has there been ANY thought about it because it doesn’t look like it. I’d like to know from Lamb how many practising social workers they spoke to and where those people work – as well as their names – as they clearly don’t have a clue what happens in mental health social work nor what is happening now as local authorities pull their social workers out of mental health trusts. And that is happening all over the country.

What is social work?

According to the Independent article

The IPPR research shows that nearly 50 per cent of local authorities have problems recruiting high-quality adult social workers.

Well, I, for one, can’t wait to see the figures behind that research and there seems to be some confusion between adult social work and mental health social work which are not actually the same thing but I doubt the IPPR Oxbridge PPE graduates realise that. We are increasingly seeing a fragmentation of social work into discrete areas – you are a child protection social work or a mental health social worker etc. This is not helpful as the thing that makes the profession cohesive is our broad generic base. If we look at what social work is, it’s about a value base, an emphasis on reflection and social justice, a key understanding of how pieces fit together which are beyond labelling definitions and a focus on strengths-based models of working with people using specific approaches. This is beyond child protection processes or care management processes and it is what makes the profession one. I was disappointed to see one of the Chief Social Workers (for children and families) ask why genericism was important on twitter this morning when nurses had specialist training. What an utter heart-sink moment that was. If we have to explain why genericism is important to the fundamental definitions of social work to someone who defines themselves as a government appointment social work ‘leader’, I’m afraid we, as social workers are losing the battle. It is important that as social workers – social work practitioners, students, academics and social workers internationally, pull these definitions back from our government which is trying to define us by the processes that they ask us to do. We are far, far more than our tasks and that is why generic qualification is necessary and important. We need the space to understand beyond our specialisms and to grow and explore our values – because it is social work values that make social workers, not knowledge of specific child protection processes.

 

Choosing your team

Then the Independent goes on to say

The Think Ahead scheme will run as a social enterprise and operate rigorous two-year courses, starting in September 2015, for the “best and brightest” who could bring leadership to the profession. The board of the social enterprise will include Paul Farmer, the chief executive of Mind, and Dame Carol Black, the chairman of the Nuffield Trust and an adviser to the Government on health and social work. Mr Lamb also consulted Alastair Campbell, who has written extensively about his personal struggle with depression, on creating the programme.

And we get to the point. These are going to be the leaders and not the practitioners. They are not remotely interested in promoting good practice in mental health social work but producing a fast track leadership programme for privileged people who wouldn’t want to dirty their hands with actual social work. None of those people mentioned, the so-called ‘great and the good’ who are going to be on the board of this social enterprise are social workers. NONE OF THEM. Can we stop and think about that. Can we think about another profession that the government would treat with so little respect? We saw Ed Balls consult an agony aunt from the Sun to decide where social work should go after Peter Connolly’s tragic death. Now Lamb is no better in asking Campbell. This is a mess and it’s a government promoted mess. But he doesn’t need to bring social workers along with him because he is going to grow his own social work leaders who look like him, went to Oxbridge and don’t need to have any understanding of mental health social work. It makes me sick to my stomach and it’s difficult for me to even read but I’ll go on.

 

Kicking the profession while you’re at it

Now this bit made me laugh.

The new IPPR report says that “more than 90 per cent of directors of adult social services believe more needs to be done to attract the highest possible quality candidates into the social work profession”. Directors believe many job applicants lack analytical ability and intellectual capacity, awareness of evidence, practical experience of social work, and leadership skills.

The Director of Adult Services in the local authority I worked in didn’t actually realise that we, the mental health social workers which he had seconded into our mental health trust, were employed by him. He certainly wouldn’t have a clue what we did on a day to day basis or how skilled we were. And if he had said we lacked analytical ability and intellectual capacity, well, I’d have asked him (but he wasn’t remotely interested in what we did) to come out on a Mental Health Act Assessment with me. Does the government realise how insulting all this is? I think it does. They want to divide and rule and tell us how rubbish we are so we need to fling some Oxbridge graduates into the mix. Does Lamb or the IPPR even KNOW the difference between adult social work and mental health social work? Do they know that most Directors of Adult Social Services don’t know who their mental health social workers are because they are mostly seconded out? It sounds like pure ignorance of the sector to me. It seems like the government have built a solution without actually knowing or analysing the problem and certainly without an understanding of mental health social work.

And then the article says

Demand for adult social workers is high: a third of all families includes someone who is mentally ill, while one in four people will experience a mental health problem during their lifetime. In 2010, more than 1.25 million people used specialist NHS mental health services.

Ha ha. Ha ha. Seriously. Does the writer of this article actually know that these services have been slashed to pieces. Yes, more people need mental health social work  but there is less money and far, far fewer social workers delivering social work in Mental Health Trusts than there was in 2010. This makes a mockery of those of us who know how hard the cuts have hit.

 

Then we have the final kick in the teeth

Jonathan Clifton, senior research fellow at IPPR, said: “As the number of people diagnosed with mental ill-health increases, there is a moral imperative to develop effective services that can support each of them.

“Too many people can be let down when things go wrong, causing distress and putting vulnerable people at risk. A fast-track programme like Think Ahead could be one step on the journey towards changing this.”

Oh, dear, Jonathan Clifton, you really are a bit thick and haven’t done your research very well if you are the best they can do with a ‘senior research fellow’. The issue isn’t the quality of support and the fast track programmes. The issue is mental health services have been utterly decimated by this government and there isn’t money left to pay those who did the job well. I know because I left when we went through cuts which actively harmed people who used the service. Yes, vulnerable people are at risk but they are at risk because of people like Lamb cutting mental health services and support  – not because there aren’t people coming into the profession.

 

Rage, rage against the dying of the light

This scheme is ill-thought out, ignorant and insulting. It shows no understanding or insight into mental health services or social work services. The quotations are muddled, the thinking is illogical. As social workers who are committed to driving the profession and most importantly supporting and advocating for people who use social work services, we need to shout out and long about these destructive programmes and the lack of input that social workers have had into them.

If we want to look at what will ‘save’ mental health social work – I’ll  happily tell Lamb but then, as a social worker, I’m not the kind of person he’d want to consult with – especially as I guess he’d say I lack intellectual and critical rigour and analysis (although I’d like to see him say that to my face). You see, Lamb needs cleverer people than social workers to decide where social work needs to go – clearly. We are too thick and too many of us are plebs for us to be properly informed and consulted. No, it needs a think tank and other professionals to tell us. But if he were to ask me, this is what I’d tell him.

1. Fast track isn’t the answer. Longer, slower track is.

Keep the generic qualifying routes we have. We have postgraduate qualifying routes. What’s wrong with them? THEN, then, we have a robust, compulsory one year additional course supported by employers to get the specialist skills embedded but where this ‘let’s focus on young people’ thing comes from I don’t know. If we are going to build specialisms, please lets have an older adults one too which combines specialist mental health (particularly around dementia and late onset functional mental health needs) and physical disability which often affects older people.

We need more time not less time.

 

2. Consult social workers who are actually doing social work

I know, this is blue sky thinking. Who would think they could change the profession and actually ask the professionals working in the field. What would we know? But it would be nice, wouldn’t it.

3. Listen to people who rely on social work services.

Quick, let’s find ‘one of us’ who has had a mental health difficulty and shove them in the consultation. Ergo Alistair Campbell. No, Mr Lamb. Find someone who is currently using a mental health social workers’ services. Someone who has been detained by one of us. Find someone who is living in poverty and is being supported by a social worker because they don’t have any other support. Of course, have Mr Campbell as well but he may not be representative of all people who use social work services. Show a bit of respect to those who are reliant on these social workers coming through.

4. Drop the leadership strand.

You can’t train new graduates to be leaders without actually doing the job. We would be creating the wrong leaders. Look what the NHS graduate leadership programme does when leaders grow who haven’t had any clinical experience. The focus is on providing good quality social workers so why push them into leadership roles immediately. Leadership has to be earnt.

5. Genericism is important.

I won’t repeat myself but it is what makes social work, social work. We can’t allow others to define it for us. Let’s focus on post qualification training and make that more robust. Let’s push the focus into retaining and supporting good social workers. Let’s emphasis time to reflect and grow rather than jump on fast track scheme. That will improve mental health social work.

Parting Shots – Why I left my Social Work Post and What I’d change

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.

Change

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.

What does a Mental Health Social Worker do?

I think there’s a lot of misunderstandings about what I actually do at work. What do social workers who are in mental health services do? What do social workers who work in adult services do?

I hope by reading, some people get to learn a little of my day to day role but I also thought it might be useful to set it out more explicitly.

I’ve worked in adult services and I’ve worked, as I do now, in mental health services but I’ve never worked in childrens’ services so I can’t comment at all about the work that is done there. This is my attempt, not to explain social work as a whole, but to explain the bit of social work that I’m familiar with.

I work in a multidisciplinary Community Mental Health Team. We have a consultant psychiatrist attached to the team as well as a few (the amount fluctuates!) other doctors. We have occupational therapists, clinical psychologists, assistant psychologists, community psychiatric nurses and of course, social workers. We always seem to have students around, whether psychology trainees, OT students, nursing students or social work students (and even some medical students pop in occasionally).  I sit opposite a psychologist and between an OT and a nurse.

Although no week is typical, I’ll give a few examples both of the generic role and the way that social work fits into a mental health setting, in England, at least (because I’m not sure if there are differences in Scotland, Wales and Northern Ireland).

Work is allocated for ‘care co-ordination’. Care co-ordination is akin to what we would have called ‘care management’ in Adult Services although there are some differences and responsibilities under the Care Programme Approach.  It basically means we take responsibility as a kind of ‘key worker’ for individuals who are ‘taken on’ by our service.

Allocation should be done on the basis of appropriate professional expertise so for some issues that have a more ‘social work’ tilt about dynamics, organising personal budgets or residential placements might be preferred as allocated to social workers, some that are more rehabilitation orientated might be allocated to an Occupational Therapist and more medical or medication management might be allocated to a CPN but that is a very broad brush to paint and in practice – most people are a mixture of all the different needs and so are allocated generically. If I have need a of specific OT assessment for one of the people that I am care coordinating, I will ask one of our OTs and similarly, I care coordinate one person who receives a monthly depot injection from one of my nursing colleagues.

So what is care coordination/care management about? Well, we start by working with and on a care plan and this should be led by the user of the service. If there is a carer involved it would also involve them and we put together plans. In my service which works predominantly with older adults, there may well be care services needed and this is now all delivered through personal budgets so I would take someone through the supported self assessment questionnaire, the resource allocation system and develop with them and/or their carers, depending on capacity issues on a support plan and way that services would be delivered. This would be reviewed and implemented in partnership.

I will also arrange respite placements  and services when they are needed and review services as they are delivered.

Alongside this, I would also be responsible for monitoring any changes in mental state and might provide some brief therapeutic interventions mainly through basic CBT type models according to additional training which has been given in the NHS Trust I work in as they are trying to ‘skill up’ all care coordinators!  When I meet with someone, my discussion ranges for more broadly than about their care needs specifically. Sometimes it is about sourcing and finding ideas, services and people that might be able to help, namely through group work which is run across the service or through referrals to specific psychologists attached to the team. Sometimes it is much more difficulty to quantify – and log – and record.

I work with carers and work through carers’ assessments and services such as they are. Often I feel one of the most important aspects of my work is carer support as we rely so heavily on some carers. I might liaise with different organisations on peoples’ behalf if they can’t manage or need some assistance. Sometimes I help with Attendance Allowance or Disability Living Allowance claims but there are council teams that do that so it would only be in circumstances when I might know someone particularly well and be concerned that someone who doesn’t know them that well might ‘underplay’ some of their needs.

Sometimes it is about liaising with creditors, gas and electricity companies, housing etc with various degrees of success. I like to think of myself as an advocate at times.

Although at times, I am very far from an advocate. I am subject to specific ‘terms of reference’ of my job and have no control over things like budgets that can be assigned to various people with various needs. I would ‘present’ the needs of service users I work with to various internal funding panels so on that basis I need to advocate clearly.

We have to review the services that are in place regularly. I would attend meetings at day hospitals and on wards when I am allocated to people who currently attend or are inpatients.

I work to plan and organise discharges from hospitals both the psychiatric hospitals and the general hospitals when people whom I am allocated to are inpatients. There are some very obvious time limitations on these pieces of work and no-one wants anyone to be in hospital any longer than they have to – but equally no-one wants someone to be discharged from hospital before they are well enough to be – which is another very important consideration.

I conduct safeguarding investigations as well. Alerts come up with what can be surprising frequency and there are prescribed procedures through which we approach these investigations. It’s hard to generalise as they can be very different. Interestingly most of my recent ones have involved residential services in some way or another. I think I’ll come back to the process of investigating abuse in another post as it is altogether a subject in its own right. We tend to get more of these investigations in older adults services than occur in the working age adult services.

I am an Approved Mental Health Professional (AMHP). That means that I am on a rota to carry out Mental Health Act (MHA) Assessments . There is an important difference between a Mental Health Assessment which is a more generic term for an assessment of someone’s mental health and a specific ‘Mental Health Act Assessment’ which is a formal assessment under the 1983 Mental Health Act which can result in a compulsory admission to hospital without consent.

The role of the AMHP could be a post all of its own and it probably should be so I’ll condense here for clarity because it has increasingly become a part of my day to day role. I organise and arrange these assessments by arranging for ambulance service and doctors attendance (there have to be two medical recommendations written by doctors – one should know the patient (usually their own psychiatrist or GP along with an independent doctor who has had additional training). I also attend a magistrates’ court to obtain a warrant to enter if it is likely that we would not be allowed access to a property. I  arrange police support if necessary and would also organise a hospital bed if necessary.

There are legal forms to complete and I have an obligation to be mindful and respectful of legal rights and human rights when involved in these processes.  I am obliged to attend a specified amount of ‘legal updates’ every year to maintain my approval as an AMHP and every five years I have to be ‘reapproved’ which involved me taking a legal test and submitting some reflective pieces and examples of my work as well as carrying out a set number of assessments per year (no problem with the numbers – I’ve done the requisite annual number in the past week!).

I’m also a BIA (Best Interests Assessor). This means I have specific duties and responsibilities to carry out assessments under the ‘Deprivation of Liberty Safeguards’. Again, that probably demands a post or two of its own. Suffice to say that every so often I am called out to do a specific type of assessment on this basis.  I had to attend additional training to be able to do this and have to attend update workshops and training to retain my approval.

Apart from the things I’ve listed, my job involves other pieces of work. I write social circumstances reports for tribunals. I occasionally have been involved in assessments and writing reports for Guardianships and in taking part in the process of approving or extending a Community Treatment Orders. I frequently carry out Capacity Assessments for various reasons.

I’m a practice assessor too so when I have a student, well, I have a student to supervise. I tend to enjoy having students around. It does create more work though and there’s no recompense in terms of reduction of caseloads! And the universities and local authorities wonder why we can’t offer as many statutory placements!

My work is often one of juggling and trying to prioritise and reprioritise on the basis of risk management. What is more important for me to complete on any given day.

I haven’t even mentioned data input or writing case notes but takes a fair bit of time. We have regular audits of our ‘productivity’ – we have to input our ‘outcome measures’ and re-input them regularly so our management overlords accept that we are actually spending our time at work, working effectively and not just twiddling our thumbs and playing Facebook games.

The amount that we have to ‘report back’ is, of course, growing at an exponential rate.

So that is my job – as briefly as I could manage and I have missed out some of the million subtleties that might change on a day to day basis.

I generally enjoy it. I love the variety that is thrown my way on any given day. Some days it frustrates me and there are rarely enough hours in the day to get what I want done, done. This may explain some of my frustration with the bodies who all say they ‘speak for social work’.  Have they explained the role of social work outside child protection? Would you know, if you are not involved in the ‘system’ what a mental  health social worker actually does?

But really, that’s another fight for another day. For now, well, I need to go to work!

But I had over to you, dear reader. Is there anything that surprises you? What you expect? What have I left out – as I’m sure I have missed a lot of things!

The Joy of Targets

We operate to a system of targets. That should be no great surprise. It is how ‘value’ is determined and efficiency is maintained. Social Work is, for the most part in the UK, funded from the public purse and it’s quite right that we should be subject to a checking and controlling system than ensures we give the taxpayers value for money.

But (you could see the ‘but’ coming, I suspect) the types of data that we are expected to collect can provide a false sense of security in the systems. Some of this has clicked with the press over the weekend. Targets were met in Haringey. That does not mean a quality of service is maintained.

image tj scenes at flickr

I’m not against all targets, by the way. One which I think has improved the service is the one which is based on time from referral to contact. It means that noone can sit on a ‘waiting list’ not knowing what is happening to them. Even if it is just someone phoning to acknowledge receipt and give a contact telephone number until an assessment has been completed, at least that is better than hearing nothing.

Some though, are less than logical. There is a target relating to how many cases we close. By the way, I was taught never to refer to cases as case  but as people. So while I’m writing that in my head, I’m thinking ‘people’ but it just doesn’t seem to flow as well!

Back to the case-closing (I couldn’t really write people-closing..). To me, it is one of the more difficult targets to get my head around. I’ll close when I need to – not based on targets or pressure. It’s probably one of the more damaging targets, I think.

Then we have targets set by the NHS Trust and targets set by the Local Authority. The Trust, for example, sets guidance that we should each care coordinate 25 people and that we should register at least five ‘contacts’ per week. The five contacts is usually very easily achieved. Sometimes I might do that in a day.

Their views of contacts aren’t necessarily my view of contacts though. Going to visit someone in their home, ok, that’s an easy one, of course that’s a contact.

Going to visit someone when they are at home and they aren’t in/don’t answer the door. That’s also a contact (actually that doesn’t happen to me too much).

Visiting a carer or any kind of carer support. That’s not a contact.

A telephone call that is over 10 minutes and has some kind of therapeutic value (self-judged) is a contact.

The team I recently left was the worse in the Trust for the contacts. Or the worst at actually entering them on the database……

I think the older adults teams suffer slightly by having the same targets as the other CMHTs though. Our care coordination requires a lot more care management (putting together and monitoring care packages as older people tend to be more likely to need physical help) and our service users never come to our office to see us.

We are out and about a lot  more. I think, although this is gut instinct, that there is a lot more carer support work that possibly goes on in our teams. I know there are some weeks that I have done nothing else.

Then we have the Local Authority targets. I used to be really hot on these when I worked in a local authority office. Now.. possibly not so much. It is to make sure that reviews are regular and timely – but they also include things like monitoring work status without providing any way to put ‘retired’ on the forms they must have spent hours devising.

We have targets for carers support packages (actually providing services), direct payments and carers assessments. Apart from Direct Payments where the only situation where I was going to do this was in progress and was never seen through to completion due to other factors that changed the situation while I was working with it, I’ve been pretty good at the carers assessments and the carers services.

Not bad, actually, those targets. They remind us of the job we need to be doing.

But then there is the target that really rankles me. We have a target amount of Safeguarding Adult Investigations to complete. OK, it isn’t a high target but shouldn’t some things just be. . er.. done on the basis on which they are needed. Luckily, no manager I have ever worked with has ever done anything but be baffled by this as a target. It happens or it doesn’t.

The need to create a tick-box culture does more than anything else to remove the professionalism required.

Targets aren’t going anywhere. Some can encourage good working practice, even, but when they are imposed on a draconian basis, there is a danger that they will attract shoddy and half-hearted work on the basis of ‘completing a target’ or ticking a box. That is the real danger. So by all means, set targets – but make them realistic and relevant to individual services. What works for one agency or service may not work for another.

Indulgence

A completely self-serving and indulgent post if I can be forgiven, so I’ll keep it brief!

It’s Sunday, it’s a holiday weekend and I’m fairly busy but I did get a letter yesterday from the university confirming that the portfolio for my Approved Social Worker (ASW) training course has, quite literally, ticked all the boxes – and is being recommended for a pass.

It wasn’t easy but it possibly isn’t worthy of too much reflection as there won’t be any more ASW training. Next time round, it moves out of the exclusive domain of social workers and into the realms of Approved Mental Health Professionals….