New Year, Same Old Hogwash

Today, David Cameron issued his New Year message, and it’s every bit as vapid as you’d expect.

Yadda yadda Olympics boring boring Big Society boring boring our armed force boring boring excess in the City blah blah…

But here’s the bit that really got me livid.

I am determined to do the bold things it will take to sort out public services, too. Too often our schools aren’t up to scratch, our hospitals aren’t always clean enough and our police don’t catch criminals. Brilliant and committed people work in public services – but somehow the system stops them doing their job. So we’ll change it.

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The Truth About Adoption Is That There Are Many Truths

Last night’s Panorama documentary ‘The Truth About Adoption’ was a vivid, honest portrayal of the heartbreak and joy of fostering and adoption. As the adults, the social workers, carers, adopters, parents, the court, went about their business, it was impossible not to be profoundly moved as the stories of the children unfolded and their hopes and fears revealed.

Despite the setbacks they have faced in their short lives, all were remarkably optimistic about the future. Undeterred by delays and adoption breakdowns, they hoped for the love, care and security that we professionals call permanence. And why not: it’s the least our society should be able to offer.
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Crisis in Mental Health Care

Crisis Care in Mental Health – both community and inpatient –  is inconsistent and increasingly unable to deliver quality services.  Mind published a report today following an independent inquiry which they have carried out called ‘Listening to Experience’. This inquiry looked at evidence from 400 patients, professionals and providers and was intended to provide a qualitative shapshot of care in England.

While the press release points out that some outstandingly good levels of care were reported, it is useful to note some of the main points of criticism that were raised.

When looking at some of the examples cited in the statement from Mind, it’s hard to separate these issues from the agenda of cuts that is currently underway in public services and despite the government’s vehement denial that this is not going to lead to reductions in clinical staff, all I can say is that on the ground, I see it happening with my own eyes.

We have, and this is personal experience, wards closing, staff with redundancy hanging over them, downgrading of professionals and replacing qualified staff with unqualified staff. These are not management posts. These are all clinical posts. Staff remaining are pushed further and yes, eligibility is rising and service delivery is reaching a smaller group of people.
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Adoption Is Not Meant To Be Simple

Following National Adoption Week, the movement for change is gathering momentum. Yet following last week’s debate in parliament, I retain my doubts about the direction of travel.

Members from all sides praised the efforts of adopters and for that matter foster carers too. There was cross-party agreement that there were no straightforward answers because the system unavoidably meshes different organisations and professions, such as the court and social services, and to be fair there was little direct criticism of social workers themselves and acknowledgement that they themselves are frustrated with delays in the system.

Speakers from all parties took their cue from the Prime Minister’s comments during questions at the beginning of NAW:

“the Government pledge that we will make the process of adoption and fostering simpler. It has become too bureaucratic and difficult, and the result is that it is putting people off.”
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Little Hope In The Big Society

Although I’ve been to the centre once before, I’m lost in the maze of this industrial estate. Every unit looks the same, sharp angles and harsh functionality, and my satnav has given up. I think it’s shrugging in helplessness so I turn it off, park up and walk.

 

After a couple of aimless minutes, a low building down an alley catches my eye and I head towards it, the 60s brick, rusting metal rectangular windows and a couple of portacabins the clues I need. This must be an ex-council building. Inside, the faded paint, slightly stained carpet and chaotic noticeboards are welcoming and familiar. I’ve spent the majority of my working life in places like this and amongst the shabbiness I feel right at home.

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Retreat into the Medical Model

Like just about everywhere else in the public sector, Child and Adolscent Mental Health Services (CAMHS) are feeling the effects of the cuts. As in so many other areas right now, jobs are having a nasty habit of not getting re-advertised when people leave. We haven’t yet had actual redundancies in our neck of the woods, but the whispers are in the wind.

Particularly vulnerable to the cuts are the psychotherapists – psychodynamic therapists, family therapists, art therapists, play therapists. There aren’t many of them employed in CAMHS, but their influence extends beyond their numbers. I’ve had some fascinating conversations with our psychodynamic therapist who keeps “accidentally” leaving papers on attachment theory on my desk. The opportunity to co-work with systemic and family therapists has genuinely transformed the way I conduct my clinical practice. They don’t just change kids and families. They change their colleagues too.

We get a complex mix of cases coming through our doors. Kids with neurological disorders such as ADHD and autism. Kids who have been abused, neglected or traumatised. Young carers to physically or mentally ill parents. Families under enormous strain, or with tortuous family dynamics. Educational issues. Child in need/child protection issues. It can be a bewildering variety of problems. To navigate it requires an eclectic mix of clinical models in your toolbox – medical, psychosocial, cognitive-behavioural, systemic, psychodynamic.

In hard times, it seems to be the psychotherapists – with their specialist outlooks and long, arduous training – who are most likely to be for the chop. My worry is that as we retreat to a core of doctors, nurses, psychologists and social workers, we’ll also retreat into a more narrow view of what CAMHS is for and what it does. Possibly diminishing into simply a medication and CBT service.

Don’t get me wrong, I’m not anti-medical model. I’ve worked with plenty of kids who’ve genuinely benefited from a bit of methylphenidate or fluoxetine. I’m not anti-CBT either, though I don’t think it’s the panacea cure-all it’s sometimes touted as. But one of the reasons I chose to work in CAMHS is because of its wide mix of models to suit the equally wide mix of problems that we deal with. Seeing our toolbox get smaller before my eyes is something that worries me.

Social Care in a Time of Cuts

When I went into social work, and still from time to time, I come across more experienced colleagues who have been working in the field for far longer than I and they tell me about the ‘golden era’ of social work.

They tell me about the joys of real generic social work where they might start the day liaising with foster carers and end the day supporting an adult with a mental health need. Where they might have been involved in ‘real community work’ rather than the staid and procedural role that seems to have forced its way into the profession in recent decades.

It seemed to me, as an extension of the human propensity to reminiscence about times and experiences ‘in the past’ with a certain sugar coating. Just as ‘schooldays are your happiest days’ type memories.

As I move through the stages of my career, such as it is, I feel some mild thoughts of ‘how it used to be type nostalgia’ creeping into my own narratives.

I never thought we had particularly ‘good’ times but when I compare the types of care planning and support that was available and look at the bare bones of support provision now, I can’t help but thinking that perhaps we are moving backwards as opposed to forwards.

Social Work in a time of cuts presents a whole new world of ethical dilemmas that previously we might not have faced.

There are some improvements. The roll out of  ‘Direct Payments’ whereby people who  need services were ‘given’ the pot of funding available and were and are able to choose ways to spend it on different and more creative services has been a big step forward.

However this has led to the ‘personalisation’ agenda or the ‘transformation’ agenda or ‘any-kind-of-large-mostly-meaningless-word-you-want-to-add’ agenda which wants to use this model and extrapolate it out. While this certainly provides better systems for some groups of people, the agenda has left others behind, but I’ll come back to that another day.

Regardless of the detail the fact that choice is extended (however poorly in practice it is done – and it is done poorly) and that users are put at the heart of service provision is generally a good thing.

It’s a shame that the push towards ‘choice’ has come in an era of cuts or perhaps it is and always was wholly inevitable. We are seeing an attempt to push the responsibilities present in the NHS and Community Care Act (1990) and the National Assistance Act (1948) away from local authorities and towards individuals. For some individuals this is wholly appropriate and welcome but as we march towards another type of ‘one size fits all’ provision I do worry where it might lead.

We have fewer provisions to ‘hand out’ and eligibility criteria are rising so that fewer people fall into the ‘service user’ category. As a result, fewer carers will be entitled to what sparse support is available for them and the local authority responsibilities shrink accordingly.

My hope as a part of this blog and as a social worker who has and does work with adults is to monitor and process the ‘dying of the light’ or perhaps, on a very negative day what might be perceived as the ‘dying of the support’.

While less state involvement is exactly the right thing for a lot of people, we have to remember those for whom it remains necessary. The old tired ‘throwing the baby out with the bathwater’ phrase can be overused but I’m going to take the liberty of referring to it here because it explains to me what I see as happening to our social care and health services at the moment.

We, who see it from the ‘inside’ have a duty to report and share with those who might not be aware as it’s happening.

We need to fight.