Final post

Well, thank you for making it this far with me. I have decided after a fair bit of thought to officially ‘retire’ this blog and I won’t be updating it anymore. I’ve moved on  and am doing different things now. That isn’t to say I won’t be writing in other places and doing other things but not here.

I am going to leave the blog archives open and hope you find it useful. I started this blog back in 2008 and it’s helped me through a lot of difficult times, professionally and personally. Through foster caring, bereavement, moving houses, moving jobs and much growth and happiness.

I’ll still be around and pop in but I wanted to leave a final post to explain.

Whatever I end up doing, I’m incredibly proud of being a social worker and that’s not going to be changing any time soon.

Be good.

There and Back Again

I didn’t think I’d come back again but I’m pondering it now. I have a new job and a new role.  While I’m still a registered social worker, I’m no longer working in the local authority and am no longer a practising AMHP. It’s been quite a journey over the past two years.

While I’m pondering a return here, I have a low-key project I’ve just started running here.  Feel free to join me and.. well.. watch this space.

Thanks again for all the support and patience. It’s meant and means a lot to me.

Eligibility, Birmingham and Cuts

Birmingham was the first English town without ...

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While awaiting the details of the court judgement, there was an important ruling yesterday that Birmingham Council’s attempt to limit eligibility to social care services to those who have ‘critical’ care needs is unlawful.

Drawing out some of the definitions to what this actually means and could mean requires a look at the details of those who brought the case to court.

There were four defendents which the BBC explains include

a 65-year-old woman with severe learning difficulties who receives 24-hour care in a home paid for by the council

25-year-old man with a rare genetic disorder and severe learning disabilities who receives overnight respite care, also funded by the council

30-year-old deaf, autistic man with severe learning disabilities who is prone to self-harm. His specialist day care would also have gone under the plans

and

a 36-year-old woman with severe learning difficulties whose day care centre will close and who is also set to lose respite care

It’s useful to go back to the definitions of what ‘critical’ and ‘substantial’ needs are to understand fully the implications of councils moving the eligibility criteria from one stage to the next.

Critical needs exist where –

• life is, or will be, threatened; and/or
• significant health problems have developed or will develop; and/or
• there is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or
• serious abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out vital personal care or domestic routines; and/or
• vital involvement in work, education or learning cannot or will not be sustained; and/or
• vital social support systems and relationships cannot or will not be sustained; and/or
• vital family and other social roles and responsibilities cannot or will not be undertaken

Whereas Substantial needs (those that Birmingham are stating they are no longer able to meet) exist where –

• there is, or will be, only partial choice and control over the immediate environment; and/or
• abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out the majority of personal care or domestic routines;
and/or
• involvement in many aspects of work, education or learning cannot or will not be sustained;
and/or
• the majority of social support systems and relationships cannot or will not be sustained; and/or
• the majority of family and other social roles and responsibilities cannot or will not be undertaken

A couple of things to be noted here. A differentiation is made between ‘abuse’ and ‘serious abuse’ so that one will be covered and the other won’t. What kind of ‘legal’ test would there be to determine when abuse counts as ‘serious’ or not? Can we see children in similar cirumstances being subject to a differentiation of level of care available depending on whether abuse is ‘serious’ or ‘not serious’? And who is doing the judging? Well, I can answer that last question. It is the social worker involved as I am asked as a matter of course to ‘band’ people according to these criteria.

The obvious glaring point is the lack of thought of any kind of preventative work that sticking so closely to the criteria will create. Where is the hope of creating those very creative personal budgets when only the very bare minimum of essential needs are being met.

I can’t claim anything other than relief that Birmingham case was challenged in court. These criteria and these levels of need look at people as lists of what they cannot do. That goes against everything that we know and the ways in which we practice by looking at strengths and looking at people as individuals. However, the reason the criteria were brought in in the first place was to end some of the ‘postcode lottery’ of care provisions and to bring consistency to who was offered what nationally. Of course, the problem remained that interpretations of these criteria vary so the consistency which is objected by ticking boxes (the only way the officials seem to know to apply it) depends, as mentioned previously on the social worker who is doing the ‘judging’.

Back to this case though, it was brought under the Disability Discrimination Act and hopefully the judgement will be available soon. Hopefully too, local authorities around the country will be leafing through it and realising that the wholesale and slapdash cuts that they are imposing are not legal.

As for the government of millionaires, none of them will be reliant on social care support from the council. They can buy in any support that they might potentially need and cannot understand the distress of those who are totally reliant on the availability of services.  They cannot understand the implication of their gung-ho ideological cuts and the thought of Cameron, Clegg and Osborne claiming ‘We’re all in this together’ sticks painfully in the throat.

Although I fully expect Birmingham to challenge this ruling, I hope that the case is held and that some of the trigger happy cutting is stopped and the very real effect of the cuts agenda is shouted out more loudly and more clearly – not just for those of us who are personally losing services but to raise our voices with those who cannot always shout so loudly.

That is what social justice is about and that is what social working is about.

Housekeeping

Slightly dull post here but I needed more space than Twitter would allow! I’m in the process of trying to update my links and blogs on the sidebar.

If your blog has disappeared and you are still updating it and want people to visit – let me know, I’ll ‘unhide’ it.

If your blog has never appeared, it might be that I don’t know about it or have been caught up in a rush of ‘things to do’ and may have missed it so let me know in the comments.

If you know any other good sites/links that could help people (or just me!) then also add them here and I’ll try and update the ‘other links’ page as well.

I do try to check the blogs and sites I list and tend to list the ones I like to visit but if there’s something I’ve learnt over the last few years, it’s how quickly sites grow and shrink, come and go and there are thousands more than when I started out

Usually oversights are simply just to lack of awareness or lack of time on my part..

Thanks in advance for the help!

Risk, Capacity and Ethics

I know it gets a bit boring saying it but these last few weeks have been  busy. Ironically, bearing in mind what I have said about caseloads, the ramp-up in the disproportionate time available versus things to do ratio has been related to just one of my cases.

For obvious reasons, at this point, I can’t disclose too  many details but it will certainly be one of the ‘classic’ case studies that just about hits on all areas of practice including a hefty chunk of ‘ethical practice’ and what that may or may not mean.

This is a situation where I have worked from the basis of an assumption of capacity in regards to decisions being made, of course, in line with the context of the Mental Capacity Act. My judgement is not necessarily in line with other professionals and observers but ultimately, I am the ‘decision-maker’.

So, capacity is established. Even that is not clear-cut as I believe the individual has fluctuating capacity – as is not uncommon but the periods of lucidity allow the assumption to be made at those points.

And one of those ‘unwise’ decisions is being made. An unwise decision, we are told according to the Mental Capacity Act is central to our essence and choice as human beings with capacity and the making of an ‘unwise decision’ does not mean that someone does not have capacity.

So this is the perfectly acceptable and legally sound basis for the decision-making that I have taken.

We are given various examples of ‘unwise’ decisions on all the training we attend about the Mental Capacity Act. Often there is an element of humour in the training, you know, a man who might decide to spend his fortune on fast cars at the age of eighty rather than leave his money to his children and this is not a matter of capacity just because it is  not a ‘sensible’ decision. We all as an essence of our humanity take risks and make decisions that others might find ‘not very sensible’ but that doesn’t mean that we lack capacity.

It is a very important tenet.

The difficulty comes when firstly, there is not a necessarily clear-cut consensus that yes, this person is making a capacitous but unwise decision and secondly when there are risks attached.

Risk assessment is by it’s nature a tricky line to step. That’s the problem – if we knew all the facts, it would be simple.

I have been picking up lots of nervousness about this particular case because I think there was an expectation that the capacity assessment would go the other way – but the Act is clear about starting from an assumption of capacity.

I have spent an inordinate amount of non-work time worrying about the implications of the decisions being made. I went into work early one day after one of the ‘major’ decisions have been taken because this situation had been dwelling on my mind and I wanted to talk to someone about it.

I found my manager (who is always in early!) and ground her ear down a little about it. She was very good and patient with me as I explained my difficulties in separating the logical part of my brain where I am absolutely confident my practice is sound and I have acted in the way that is both in the best interests and respectful of the wishes of the service user – from the emotional part of my brain where I just want to be able to help more than we, as a service can offer or deliver in its current form.

I chuckled as I asked her, kind of jokingly, if she’d back me up in front of the GSCC if things didn’t go as we hope they will. She, of course, told me to stop being silly and that had I done anything more restrictive or authoritarian than she would have been truly upset with me. But in a way, that’s the ‘easy’ route – that’s the ‘safe’ route. When we talk about risk management and risk aversion, I can see the benefits and as a professional who does wield power to make decisions about peoples’ lives – that power unnerves me. I can see how easy it is to err on the side of caution.

A part of it is that I feel that although I can be clear that personally, I am taking the path which I am strong about, I feel that the service as a whole is not providing exactly what this person wants and needs and should have – because the needs are quite specialised and specific.

This should be exactly where ‘individual budgets’ can come into their own but the processes don’t always allow for people who are outside the ‘norm’. This is very far from a straightforward – ‘give a man a budget and let him plan’ that neatly fits the agenda of the individual budget. As I have discovered – although it isn’t really discovery as I knew this all along – it is hard to do anything quickly when you are wading through a swathe of largely unnecessary forms. It is hard to present some truly innovative systems and proposals when the system only permits choice to a certain degree.

As a practice assessor/teacher in the workplace, my last student often asked me about ‘ethical dilemmas’ as it was one of their competencies. I jokingly said that ethical dilemmas were a key part of the job as anything involving control had to be and when we cease seeing our power and influence as a part of that ‘ethics’ dichotomy, we take for granted the decisions we make and the power we have – we become dangerous practitioners.

We had a module on ‘ethics’ as a part of my Masters in Social Work but I also have a BA in Philosophy. I used to laugh about it and often do still. You know, the jokes about unemployed philosophy graduates and all that. To be honest, often they are fair.

But more than ever I am glad of the firm grounding I when I studied Philosophy as an undergraduate. Ethics – studied in far greater depth over the years of the initial degree, which seemed such a inately impractical course has bloomed into life.

Logic with it’s quasi-mathematical formulae has led me and directed my thinking in ways that I might not have been equipped to do otherwise.

I wonder, if, in retrospect, the first degree in Philosophy has aided my self-reflection and my skills as a social worker.

I remember when I applied for the Masters and the preference was for social sciences and I worried that people who had studied Social Policy would be better considered.

Now, I think Philosophy was the best grounding I could possibly have had. After all, doesn’t applied philosophy just about cover everything we do?

The Disgrace of Individual Budgets

I have a few words for Paul Burstow, the Minister responsible for Care Services, who is appalled, according to Community Care, about the low take up and roll out of personal budgets in Adult Services – the take up is so far only 13%.

He said to his party’s conference

“It’s disgraceful. We need to be far more critical of public services. Why are they not willing to let go of control?” He was speaking at a Liberal Democrat conference fringe session on social care and the government’s Big Society agenda.

Excuse me for a moment while I scream with frustration.

Back.

NOT WILLING TO LET GO OF CONTROL?

What does he think that the lack of roll-out is to do with a nefarious political plot to hold on to the control aspect?

No, it’s not. It’s all to do with poorly adapted and poorly administrated systems and piloted exclusively in teams and departments that were ‘easy’.

Where are those 13%? I can bet they are with adults with physical disabilities and adults with learning disabilities where a lot more resources and efforts had been pumped into direct payments so they had a sound base to start on.

That 13% is also likely to include older adults who have capacity and families to help advocate for them.

We have some quite rightly wonderful accessible easy read documentation for the forms with beautiful pictures that show who effective support planning can be in the learning disabilities field – but where is the real research for people who may lack capacity to make decisions due to dementia – for whom the same type of documentation is not relevant because in general, those who are support planning will have much less time and much less money to ‘be creative’.

Where the systems have not picked up is with those who do not have the families and friends who are able to invest a lot of time into creating personalised packages – of the people who do not have the capacity to manage and organise their own care – for whom the system of individual budgets will not change anything too dramatically.

I wish Mr Burstow would meet and talk with people who actually DO the job to understand the difficulties, rather than meeting and talking to people who manage people who do the job or people who write the policies or people who audit accounts.

I want to give up control. Believe me I do. It might mean some respite in the constant stream of care management duties that spring up incessently. Sometimes though, it isn’t all about retaining control but maintaining quality as well. Sure, if a capacitious decision is made, all is well and good and the right remains, as it should, with the end user, but where there is a decision that needs to be made on behalf of another person, the choices are already limited.

Why should someone have a potentially poorer service through a provider agency because they are not able to manage a bank account and do not have anyone who can assist them – sure, theoretically the local authority can hold the account but who makes the decisions about PAs and flexibility?

There is little doubt that high quality regular care provided by a small group of people or person is the favoured option for those that have successful care packages. People whose direct payments have been most successful have worked because of the people they have employed directly as often as not. However this is not a service which is offered through this system to people who lack the capacity to act as employers and who either don’t have families or don’t have people who can do this on their behalf – they still remain with agency providers which most people agree offer a poorer service.

This is my gripe and my main upset with this system. It is inherently discriminating and providing a poorer service to people who don’t understand the systems. If social workers had caseloads of 10, we might be able to do this on someone’s behalf but it is not possible with the workloads that are carried in older adults services.

So the people who ‘can’ get a gold star service and the people who ‘can’t’ get exactly the same as they always got.

That is both demoralising and unfair. It makes me cynical of the whole system and those who advocate it because perhaps if this could have been thought through at the time, we wouldn’t be lagging so far behind of targets.

Sure, I’ve been to the training, I know about the trust funds that can be created to manage care but how many people in older adults’ services are going to have packages that pay enough to establish and operate a trust fund as well as paying for it’s maintenance. The answer is not very many.

The way the  roll out has been managed, stinks. For people it works for, it works very well – but there are many people whose needs and wishes have not been able to be accounted for in the way the forms have been written and the way the processes work. That might be unique to the local authority I work in – it must work well somewhere.

But these lavish statements of Mr Burstow, they grate incessently and I say that as someone who would love this system to work but who is ground into dust by the ways it has been implemented.