Fear and Loathing in the Public Sector – Or Why I despise Oliver Letwin

Oliver Letwin, United Kingdom Conservative Par...

Image via Wikipedia

Yesterday I read this article about Oliver Letwin, who, according to the Guardian article

..warned that it was only through “some real discipline and some fear” of job losses that excellence would be achieved in the public sector.

Letwin added that some of those running schools and hospitals would not survive the process and that it was an “inevitable and intended” consequence of government policy.

A little background about Oliver Letwin. I’m always a little wary of using Wikipedia as a source but a few choice verifiable ‘quotes’  jump out.

He is the ‘architect of modern Conservative party policy’.

He would rather ‘beg than send his children to an inner city school’

Oh and earlier this year he said did not ‘want more families from Sheffield taking cheap foreign holidays’.

So do we have a picture of the man? The Eton-educated man who would not know the real effects of true fear in the workplace? That encompassing, sleep depriving fear of not knowing if you can afford your next mortgage payment or if your job will be there next week, next month or next year.

Does fear drive excellence?

Let me tell Mr Letwin exactly what it means in the working environment that I am based in.

I work in a Community Mental Health Team – our team has been decimated – actually to use that word literally, it is far worse than decimation – over the past two years. No, I don’t restrict the blame to the current government but include changes under the previous government in my criticism.

We have piles of unallocated ‘virtual’ files while we are pushed to the limits by increasing expectations regarding recording and inputting data which is supposed to ‘prove’ our efficiency.

We have had wards closed at the local hospital such that people who need emergency hospital admissions to psychiatric hospitals are placed away from their communities or on ‘inappropriate’ wards. I have police unable to provide assistance because their services have been cut.

Fear drives efficiency, he says? In our service we have been told there will be job cuts including possibilities of compulsory redundancies. Yes, I’m fearful.

The ‘consultation’ about what will actually be proposed for our jobs will probably be announced soon but we’ve known it has been coming for months. We’ve heard rumours. We’ve heard gossip. We’ve heard absolutely zero from our managers though. Nice. Way to generate lots of fear. All boxes ticked.

So what has this fear done for our efficiency? We are beyond demoralised. We have more people leaving and taking jobs elsewhere and  people are  taking longer periods of sick leave.

I know that Letwin wasn’t referring to the ‘front line’ staff in the public sector – oh no, he meant the managers because he is of a class and a mindset that probably finds it hard to hold a conversation on a human level with anyone who earns under £100,000 per year.

The distinction between ‘frontline’ and ‘backroom’ is a false one though as it is impossible that can operate without the other.

Hospital wards are closing. Cuts are being pushed through. We feel your ‘pressure’ Letwin. We feel your fear. But I could not possibly despise  you any more than I do for your ignorance and self-serving words that for me, epitomise what the Conservative Party and their ideology-driven cuts want to do to this country.

I would like to ask Letwin if he is happy to condone a country of Castlebecks. Well, you see, coming from someone who would ‘rather beg than send his child to an inner city school’ – he would never be in a position to actually know or understand the real concerns of people who are dependent on public services because he can always choose the private course for himself and his family.

I know he wants to ‘make a name for himself’. He likes to garner attention and oh, how clever he is to want to drive ‘fear’ into the public sector but that, to me, sounds close to cruelty.

Efficiency? I think we can do with  fewer MPs who feel the need to make claims for repairs to their tennis courts and to have their Agas serviced.

What kind of society have we become when we feel it is appropriate for a Government ‘Policy Minister’ to drive a disdain and almost bullying approach to a public sector that provides services he will never need?

Oh and the speech he made these remarks in?

It took place

at the London headquarters of KPMG, one of the biggest recipients of government cash, which won the first contract for NHS commissioning following the decision to scrap primary care trusts and further open the health service to private companies.

Nice work, Letwin. Roll on, executive consultancy. You are all in each others’ pockets.

Meanwhile I have work tomorrow.

You enjoy your private tennis court today.

Trade Unions and Strikes

I’ve written about my background and my somewhat ambivalent relationship with Unison in the past but today, as there is to be a widespread strike in the UK, I almost wish we had also been called out to strike alongside the teachers and the civil servants.
Marching through Piccadilly Circus

I’m very far from a ‘trigger happy’ union member. My default position has been to vote against any strikes called because I just want to get on with my job. Saying that, my attitude has changed over the last year or so since the election of this government and the dismantlement of the welfare state. The difference is that now, I’m angry.

Yes, I have a ‘public sector’ pension so the issue that today’s strike is about does affect me directly. I think the amount of jealousy and petty spirited hate that has been stirred up by the current government against public sector workers is distasteful in the extreme. We are portrayed as ‘fat cats’ milking the State while we depend on the poor private sector to prop us up. Oh, I might have a ‘get out’ because I could be regarded (although who knows on what definition that go) as a ‘front line worker’  but I don’t want to be patted on the head and distinguished from those who work incredibly hard to make sure that the work I do ‘at the front line’ can be carried out.

The administrative support, the IT support, the care workers (as we still have an in-house service) the emergency alarm cord operators, the library staff, the receptionists, the training department, the HR team and the accountants.

I want to know who these ‘paper pushers’ are supposed to be as most of the paper pushing happens in the executive offices or in the Houses of Parliament.

Over the last year, when we have had endless consultations about the cuts that are coming in our services and the changes that are coming to our jobs, I have seen the real value of union membership. As a member of Unison, I have attended regular meetings in our service and have gleaned a lot more information about the process than I would otherwise have had. We have been involved because the council has needed to involve us and yes, some of the shop stewards can be a bit bolshy, but that has been a very necessary characteristic in their dealing with the council.

I do wonder if BASW’s idea of a Union of Social Workers would have the same fire and resources to fight so strongly on our behalf as local authority employees. At the moment, I am very happy with Unison and the way they have supported and informed us through these difficult times.

As for today, good luck to those on strike. The issue they strike about today is also my issue but my anger is much broader than the pension issue – it is the destruction of support in society and the way that those who have least as being asked to pay.

I have learnt more in the last year about the importance of union  membership than I had in the previous ten. I don’t expect to ever follow blindly but I do value my membership much much more in these uncertain times.

Guilt, Work and Switching Off

Over the weekend, I was reading Dorlee, from the ‘Social Work Career Development’’s guest post ‘The ABCs of Self-Care for Psychotherapists’ on ‘Private Practice From the  Inside Out’.

It is a useful and interesting list that can be extrapolated for many in the social work and social care sector – and probably many other sectors and areas where we work in stressful environments to be honest.
Libby's Guide to Total Relaxation

hewgriff @ flickr

It made me reflect on some of the ways in which our organisations work and are structured here in the UK and how unhealthy some of the ways we are forced to work are.

It is easy to blame poor management in the public sector (and that’s what I’m concentrating on, because honestly, that’s what I know) and in many cases it would be a fair place to apportion blame.

I have seen so many friends and colleagues ‘burn out’ by being almost criminally unsupported in the work place – ‘learning by doing’ through the false assumption that employers make that somehow social work graduates are immediately ‘ready for practice’ due to having one statutory placement.

Placements during the course are good arenas for training but they aren’t any more than a stepping stone to practice which is one of the reasons I am so strongly in favour of an assessed year of practice prior to registration as a social worker in the UK.

The real area for exploration though is the assumptions that are made at higher management levels about what work can and is safely carried out ‘on the front line’. I wonder sometimes what happens in the higher echelons of the Adult Services (and Childrens Services) directorates in the local authorities when they set some of the strangest and oddest targets and keep feeding the pressure on to the front line managers. It seems so very very distant.

So back to ‘self-care’ and ‘switching off’ from work.  It is something that, I think, for me anyway, takes practice.

I sometimes draw on my A level economics recollections of ‘Cost Benefit Analysis’ but instead of ‘costs’ and ‘benefits’ – I have the two ‘mental columns’ of ‘Things I can change’ and ‘Things I can’t change’ (without the financial implications!)

I can’t change whether Mrs M is going to have a fall this weekend. I felt that although she lacks capacity to make a decision as to her care and placement needs, it was in her best interests to stay at home in potentially risky environment as she had, prior to her dementia taking hold, indicated she never wanted to ‘go into a home’. She knows her way around her own home and while some ‘trip hazards’ may have been removed through an Occupational Therapy assessment and actions resulting from that, she remains a bit wobbly on her feet. Do I think about her when I go home on a Friday – sure, maybe a little – but I know I’ve done everything I could and I can’t stop her falling on a Friday evening or even on a Monday morning.

Am I worried about Mr Y who I assessed last week and made a decision not to admit to hospital under the Mental Health Act? Well, a little – after all, he wasn’t well and was disturbed – but I have to follow the criteria of the Act and I genuinely didn’t feel that he met them. Yet. I can’t ‘save the world’ or prevent all the accidents and incidents that might have adverse effects happening – so I try not to over-worry about them.

I am bound by the law of course and if someone doesn’t meet the criteria for compulsory admission to hospital under the Mental Health Act and they retain capacity – there’s nothing I can do. Quite rightly. Although sometimes, that instinct that drove me into this job – the ‘wanting to help’, the ‘wanting to make things ‘right’’ – it tries to pull me in another direction and those seeds of worry can be planted to blossom through the evenings and early mornings or over the weekend.

Sometimes I have to do this consciously and logically tell myself to evaluate situations.

Sometimes the worry comes because there are things that I haven’t done at work – telephone calls I haven’t made – reports I haven’t sent – visits I haven’t made.

Time is limited. As long as I can justify the time I do spend at work, I try to detach myself from these thoughts. I could always do more but the job is one of constant re-prioritising. Sometimes I forget to do things I’ve said I’d do or follow up on things I said I would. It happens. While it is my ‘fault’, I don’t necessarily see it as my ‘failing’. I know I can account for every single minute that I’m paid to be at work – even those minutes that I’m sitting chatting to colleagues about the weekends’ television or having a cup of coffee – because if we don’t have those minutes, we run the risk of further rushed, unreflected, unthoughtful pieces of work.

Colleagues have told me since my first social work job how important it is to look after ourselves in this profession.  The spur that often drives people into social care is a wish to make a difference and perhaps a desire for self-validation – the odd pat on the head of feeling that you made a positive difference to someone’s life. Unfortunately that same trait which is usually a force for good can be used and manipulated by managers to force people to work overlong hours, not take breaks throughout the day, push people to take work home because, you know, Mr K will suffer if you aren’t able to finish the paperwork this week. They know well how to pull on our ‘conscience’ because the same happened to them when they were mere practitioners.

It’s hard to say ‘no’ when you know the people involved. I’m drawn into some of the guilt because I promised to visit Mrs P last week. Well, I won’t say promise, because I don’t put things in those terms, but I said I would – then things happen and other things seem to take over and the telephone call about this or that suddenly has to take priority – and before I know it the week is over and I haven’t seen Mrs P or written up the report that I should have or telephoned a family member to confirm dates for respite.  It’s hard not to feel that I haven’t done my job.

But by weighing up what I did and how I prioritised, I can, at least switch off and learn to ease some of the personal responsibility by redrafting and reframing it as organisational guilt and responsibility.  That isn’t to say that I slack off or try and push the blame on others – to be clear, I never do that with a service user – and always take personal responsibility there as the last thing anyone ever wants to here if they are upset, disappointed or distressed is a social worker trying to fob them off on someone else – but mentally I try and differentiate between ‘things I can change’ and ‘things I can’t’.

For me, it works. But sometimes it’s something that has to be learnt each for themselves.

Pre-CSR Rumblings

So the day of the statement on the Comprehensive Spending Review has arrived. It seems that this moment has almost been worked up into a frenzy by politicians and our own managers in extremis.

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‘We’ll know better what’s happening after the 20th’ has been muttered across corridors throughout the public sector as if all will be revealed. And perhaps it will be.

So much seems to have leaked out though that we have been well-insulated for an expectation for the worse. Personally, I don’t doubt that the final leak, Danny Alexander’s photographed document which speaks of up to 490,000 jobs going in the public sector was not a gaffe really but an intentional leak to prepare the public, through the media for some of the worst news. Perhaps I’m overly cynical and it was a genuine error but I think the way that this review and statement and worse, the military review was leakier than a colander, initiates a certain amount of cynicism.

Last week, I attended a training course with social workers from across a few different boroughs. While we were having lunch, someone was railing not on the usual line about how everyone hates social workers, but rather, with a new slant that everyone hates public sector workers. We nodded sympathetically. I think it’s an interesting leap out of some of the usual self-absorption and pity that follows groups of social workers like a mini-rain cloud over our collective heads that now we were able to look beyond that and identify with the public sector workforce as a whole.

I personally haven’t felt that. Possibly because about 90% of my friends work in the public sector so there isn’t much hatred to express but there is a general dichotomy growing within the country that wages spent on public services must be bad.

Of course, we know (because we’ve been brainwashed into the narrative) that debt is bad – national debt, that is because the 00s were all about telling us to borrow up to the max and beyond – so  must be repaid as quickly as possible.

Highest costs are in personnel of course so it makes sense on this logic that jobs will be cut but there is no doubt that the front-line will be absolutely affected.

The spending in the NHS has been protected and increased in real terms. I’m a little dubious about this to be honest. I work in a team and an organisation that is cutting back very real services and working with a fair few vacancies that will not be filled. Other teams around my borough have been told that posts will be eliminated and from what I hear this is fairly standard.

The money will probably be lost in meeting additional costs to cover a generally ageing and more depressed society who are becoming more obese and suffering from greater poverty. The additional money will be pushed into things like cancer treatments – and don’t get me wrong, having lost both of my parents prematurely to cancer, I have all the sympathy in the world for pushing cancer treatments but there is an element of ‘playing to the crowds’ about this. Funding cancer treatments is always going to be positive. Pushing money into acute mental health services, less likely.

Much has been made of the leak yesterday about the housing budgets being cut. This is scandalous in my opinion. Anyone who has spent a day in a social services department will know the impact that poor housing has on the well-being of a person and their family. I could write reams and reams solely about personal battles with particular housing departments – but it wouldn’t be terribly exciting and actually, I’ve come across some much more pleasant housing officers more recently (they still can’t help, they are just more polite about it).

Turning on housing to make cuts seems to be just building up problems and difficulties for future years and generations. I have seen some of the cruelty and greed of private landlords on a number of occasions when their tenants have needs related to disabilities – when they have stopped working and they think they can get higher prices by forcing people out by refusing all adaptations –  issues that have had to be picked up by social housing and have been. Perhaps it would be different if I worked in a area that did not command incredible rental costs due to the central London location but housing – and secure and stable housing – is so vitally important to mental and physical wellbeing that cuts, cuts, cuts may well lead to excessive future costs.

My concerns are not solely about cuts that have to be made. There’s an understanding that cuts would have happened in any case, that jobs would have been lost in the public sector regardless –  but this seems to be a government with a trigger happy glee about targetting some of the most vulnerable in society.

We know the welfare benefits will be slashed. I would keep an eye out for announcements on DLA (Disability Living Allowance) and AA (Attendance Allowance) – which the general narrative seems to be confusing fatally with ESA (Employment and Support Allowance) and Incapacity Benefit. DLA and AA are currently non-means tested. They absolutely need to remain non-means tested. I have a sinking feeling that may not be the case in the future but I really really really hope I’m wrong on that. That’s something I would march to parliament about.

My other concern remains and I know this is hopeless, about local authority budgets being slashed by capping council tax charges but more, by pushing more costs away from central government and onto local authorities. The ILF (Independent living fund) which assists in the funding of care packages for those adults of working age with the highest needs in matching the local authority support pound for pound, has already frozen new claims. This is going to place an enormous cost burden back onto local authorities.

Over at the Guardian, Patrick Butler has set up a new Cuts Blog set up which will follow future developments and their effects. I can’t say it’s likely to be cheery reading but as a document in social policy, it may well be interesting to see the changes emerge as they are happening.

Today, Community Care are also running live coverage from midday.

I’ll be following the announcements as closely as I can today – I’m not at work so will be watching  but at 6am I have a bitter taste in my mouth.

Politeness

The Economist in an attempt to draw some kind of ‘focus’ has a blog post from an NHS hospital administrator. I have to say, it made me squirm somewhat.

The author seems to be erring on the pernicious side to say the least. S/He is carrying out an important function but seems to have a chip on his/her shoulder about being caught up in the general perception of hatred directed at the public sector.

And the poor admin worker has developed a ‘persecution complex’.

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It’s hard not to be too mean about the author but the Economist obviously picked wisely for someone to say exactly what they wanted him/her to say.

Now, I know this is going to sound twee, but I have an incredible amount of respect for our admin workers. We have a very hard-working team and one of them in particular shows almost inhuman amounts of patience and kindness that I admire beyond anyone else in that office!

We could not work without them and every time an admin hour is cut, about three ‘front line’ hours are taken up by trying to combat systems we have no idea how to work efficiently.

So that aside, the chip on the shoulder of the admin worker that the Economist found, is the size of a Californian Redwood.

S/He seems to defend his/her rudeness to patients

Earlier this week, for example, I had a call from a very angry patient. It wasn’t clear why he was so enraged, but it was pretty clear very soon after picking up the phone that whatever the reason, I wasn’t to blame and probably couldn’t do anything about it. So, after trying to tell him this more than once, and warning him that if he didn’t stop shouting I was going to stop trying to talk to him, I put the phone down on him while he was in mid-rant.

Oh dear.

I attended my ‘customer care’ day as a part of my induction – yes, all social workers go through it. We saw it as a bit of a joke but actually, I took one of my most important lessons from it.

Firstly, if someone is angry, apologies are often useful – even if you are not personally responsible, you can diffuse a lot of anger by apologising for the way that person is feeling or by apologising for the way the organisation is treating them without accepting personal responsibilities.

The last thing in the world you want to hear if you are angry is someone saying ‘It’s nothing to do with me’. A quiet ‘I’m sorry you feel it’s been so difficult.’ goes a long way in diffusing some of the initial rant.

I say this both as an social worker and believe me, NHS administrator, if you have such a giant issue about the way your role is perceived, try a few hours in social services, at least everyone understands the importance of hospitals, but also as someone who has been known to phone up services with complaints and felt fobbed off.

Whatever Trust this employee works for has a job on their hands and clearly hasn’t thought about even the most basic customer fronting training. No, we don’t work in the private sector but that doesn’t mean we can’t learn about how to treat people as human beings and an awareness that just if we aren’t personally responsible for their distress and anger, we can take some kind of corporate front.

The sad thing is that firstly, the comments are full of people saying ‘oh, this is why we need a private healthcare system where employees know their places’! Hrmm.

And that this does a massive disservice to the excellent and thoughtful administrative staff who do fantastic jobs with kindness and politeness.

The cynic in me says the Economist found the perfect stooge to portray the public sector through whatever the opposite of ‘rose-tinted spectacles’ is!

(suggestions welcome!).

Closing Care Homes

Community Care reports that the CQC yesterday released figures stating that 42 adult care services (that would be care homes and home care agencies) have been closed over the last year following action taken by the registration authority.  A further 51 services were closed following ‘poor’ ratings.

The Guardian breaks down the figures a little more minutely. And the figures deserve examination.

Those 42 services comprised of 34 care homes and 8 agencies.

Of the ‘further 51’, that includes 39 care homes, 11 care agencies and 1 nursing agency.

The total amount of residents who have needed to move places of residence due to these closures is 1600.

How is this not a national scandal on the front page of every newspaper?

It may or may not be obvious (probably not, come to think of it) but I do haul around searches for care homes and poor practice in care homes including ones that have been forceably closed – that is active searching – and maybe 3 or 4 might have been on my radar. So that’s an awful lot of highly vulnerable people who have been subject to incredible disruption, often linked to abusive practices in these care homes that have completely slipped beneath the public radar.

The Guardian lists the reasons for these closures as being

• verbal and psychological abuse of residents;

• medicines not being managed safely, leaving people at risk of not receiving vital medication;

• lack of medical and nursing care;

• staff not legally able to work in the country;

• poor sanitary conditions;

• lack of staff training.

Unfortunately, verbal and psychological abuse of residents is always a potential danger in work with vulnerable people. Residential homes can be a rich ground for potential abuse and sometimes the ‘wrong’ people are attracted to the kinds of work which can allow for abusive power-plays. It is despicable, it should never happen, but it has and it will, unfortunately. The only way to stamp on it really is strong regulation and good management.

All the other issues though seem to point to potentially money-saving measures related to staffing –  illegal immigrants will invariably be paid a lot less than ‘legal’ employees. Poor medication management points to poor training. Training costs.

Lack of medical and nursing care? Medical and nursing care costs.

Poor sanitary conditions? Cleaning up costs.

Lack of staff training? Training costs.

Do we see a theme here?

It is a very pertinent theme as we move towards an NHS which will increasingly draw on private enterprise.

This announcement and these figures are in advance of a new regulation system that comes into place on Friday. I’m fortunate to have a very good friend working in CQC as an inspector.  We go back to when we worked together as care assistants in the same residential home. Now, that makes me feel old but I raise it only to show how strange it is where our careers take us – anyway, I use her as a sounding board about my day to day frustrations and equally have a neat little insight into some of the behind-the-scenes changes in the various regulatory bodies that have become the CQC. It sounds like a mess, to be frank.

I lost any faith in the regulatory system a while back – not because there aren’t good people working there – indeed, taking my friend as an example, I would be hard pushed to think of anyone with a higher moral compass as a practitioner and she couldn’t be more focussed on providing good outcomes but the constant flux in the system (and yes, retraction of staffing levels) does have an impact both on quality and on staff morale.

At the ‘sharp’ end we have abusive systems in residential homes which are able to rattle along without sufficient oversight and regulation because there aren’t the people to provide the level of supervision needed.

I don’t want to colour the past in roses unnecessarily. I know there were problems, certainly with the physical structures of homes but with private companies, the motivation to ‘get better’ and ‘improve’ is not sufficient to force their hands. It only occurs when the delivery is so very poor that they are actually losing money.

There was an interesting quote from Cynthia Bower, the Chief Executive of the CQC in the Guardian where she says .

“This is where we’ve been focusing our attention over the past year as we get the sector ready for a new registration system that will be even tougher when care is not up to scratch.

My ‘mole’ in the CQC would claim that this is a part of the problem – the focus on changing systems has taken people away from front line inspections and where I’d agree with her is that the desk-based inspection systems do not provide any protection to those the system is meant to protect.

I know the system is due to change but in my old fuddy-duddy way, I would say there is absolutely no replacement for spot inspections regularly, day and night, weekday and weekend, from inspectors.

A ‘good’ report one year is no more valid than a CRB check one day after it has been completed. Bad things can happen the day after an inspection takes place.

Yesterday I was talking to a family member about a problem that she raised regarding a residential home where her mother is currently placed. This is a ‘good’ residential home.

It isn’t an issue that could be termed to be ‘abusive’ but it shouts ‘poor staff training’ to me. One member of staff saying one thing can make a ‘good’ residential home ‘poor’.

I know it’s not fashionable and I can’t see it happening – not in the current climate – not ever, but when the staff were employed directly by the local authority, at least training, pay and conditions and supervision could be better enforced.

Of course, we can never roll back the privatisation of the care sector but it’s amazing how few lessons have been learnt from the difficulties faced. I suspect it’s because it is an aspect of people’s lives that no-one really wants to think about unless they are directly faced with it.

I suspect it is part of an ingrained fear of growing old and possibly internalised ageism which sees ‘the economically redundant’ elderly as being somehow peripheral to mainstream society and their needs, wishes, wants, desires and aspirations – even if those aspirations are about living out ones’ life with the necessary care given in a dignified and sensitive manner.

Older adults will never have the same voice as young families in drawing the attention of the exchequer.

Why aren’t we shouting about these residential homes that deliver so poorly? Why isn’t every single closure on the front page of the national newspapers? Why does no-one care about the ways we treat older adults in this society? How is this able to happen?

Money, guilt and fear, I suspect.

This is why I wanted to work with older adults initially and it remains the same ten years after qualifying. There is so much more work to be done. It can feel like swimming against a rising tide but if we don’t shout out and shout frequently, all will be lost for our futures.

Lean Years Ahead

I was talking to a friend of mine who does exactly the same job as me in a neighbouring local authority. Actually, we first met on our ASW (Approved Social Worker – as was) training…perhaps that’s another story for another day.

She was telling me about cuts in the services and the nervousness that is being expressed throughout the offices in the NHS and Social Services. She explained that there were a lot of jittery middle managers but that the following a ‘meeting’ a lot of additional work was being requested by the front line staff with no ‘give’ in the amount of allocations or expected emergencies to manage.

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We had a brief, fanciful jaunt through some of the fantasy ideas of ‘getting out of frontline work’ that comes up from time to time before chuckling those thoughts out of our systems.

The truth is that the culture of cuts did not begin with the new government and the general election. Our services were being cut away and savings being made for the last couple of years at least.

I am returning to work soon and there are more reconfigurations and changes to roles in progress. There are also job cuts coming. We like to think in terms of non-front line staff, of agency, bank staff but honestly, all those posts have already gone. We’ve already not been recruiting to vacant positions. No, I have a feeling there will be job cuts from those already in situ.

I’ve been fairly phlegmatic about it personally. I know there is a shortage of AMHPs  (Approved Mental Health Professionals)  and I have a hefty amount of experience at this point. I am also a bit complacent because I work in London and there are many many local authorities competing for the same supply of staff. There is no doubt though that quality of services will suffer and this is where my fears for personalisation agenda come in. Yes, it is a wonderful programme to increase choice but if the supply of funding narrows, the ILF (Independent Living Fund) closes down – there will be more calls on the budgets of local authorities and there may be more heading the way of Warwickshire, who, as reported in Community Care, are planning to ‘reduce or remove subsidies for services including home, day and respite care, direct payments and transport’.

Yes, this is a means-tested service but all so often, I’ve seen the possibility of high payments being a reason to refuse desperately needed services.

There are two problems with providing services at cost.

Firstly having grown up with a National Health Service, there is an ingrained sense of entitlement to state provision of services that relate to ‘health’. Of course, the wrangles between health and social services have a massive implication but to the lay user of services, if someone has a dementia, they have a health need, if someone has poor mobility following a hip replacement, that’s related to health – to the funding managers of the NHS and the Social Services the responsibility for finances falls differently  but logically and emotionally it comes as a shock to pay and there is an inherent sense of right to receive free care.

Secondly, there are a lot of people who refuse services that would be preventative on the basis of cost thereby leading to excessively costly future costs – usually to the health service. It’s hard to ‘sell’ direct payments when the payment received is barely more than the money paid. It makes little sense but still involves the same extreme levels of bureaucracy.

The new government talk a lot about consultation but I have to wonder how much consultation has taken place to those who actually rely on public services as opposed to the Daily Mail narrative of those who are interfering or ‘lazy’ public servants who have no interest in anything save their own ‘fat cat’ pension pots.

Take, for example, the axing of the Caring with Confidence scheme to provide support and training for informal carers. I wrote about it briefly last year It is a good resource and useful training materials and the reasons for the cutting short of the programme seem blurry to say the least. I hope at the very least that the website and the information remain operational however without anyone actually knowing about the project, it will be of little use.

I know there is discussion of the government taking suggestions from front-line workers about ways in which cuts can be made but it’s a well-travelled joke to make about turkeys voting for Christmas. The shame is that there are a lot of vital and important contributions that front line workers could provide in discussions about commissioning and the needs of people in the boroughs and areas in which they work but there isn’t the time or the space to make these contributions and to provide these insights at length because while the belts tighten so the workloads increase and the desires to take more ‘global’ views of the wider issues facing the services shrinks and so it remains with the professional policy writers to move things in directions and establish new think tanks and ignore the grass-roots services that exist.

But I don’t want to end on a negative theme, hard though it may be. There are many ‘flabby’ services and cuts that can be made – not least at the management levels. I wonder if a wider use of the voluntary sector may be a way forward. As far as adult social care goes though, until the latest (yawn) consultation on funding reaches a conclusion there is little to be done about the more global long-term shape that will be taken by services.

Cuts are not new in our services though. They have happened in the past and will again. Those whose services are cut are not the ones with the political will and strength to challenge them. Perhaps that is the real role of the social worker as advocate in the lean years ahead – to ensure that those for whom we work do not have the silent voices they have had in the past and to ensure that our own moral compasses over-ride those of the management agenda where necessary.