Social Work and Moving On

soraya nulliah goodbye perfect

In a couple of weeks I will be leaving social work. Or will I? I am moving into a job where my social work qualification is not an essential requirement. I am moving away from ‘frontline’ practice in the way that I have always understood and defined it.

Being diligent, I remain registered as a social worker by the HCPC (Health and Care Professions Council) and there is no doubt, therefore, that I can continue to  legally be entitled to call myself a ‘social worker’ but the job I will be doing is not ‘social work’.

I am incredibly proud of being a social worker so it is a shift for me. Of course, as I will be remaining in the sector, my experience will be crucial in the new role but I will no longer be building that same types of relationships on a personal level that I do (or at least I hope to) now. I will be working in a different way.

The next few weeks, then, will be filled with reflections. I am saying a lot of ‘goodbyes’. I have been in my current post for many years and the current council for even longer. I am saying goodbye to the people who are on my ‘caseload’ – some of  whom will be reallocated and some of whom will be discharged from the service. I am trying to get everything done but I know the way life works isn’t about neat closures.

I’m also saying goodbye to a local area I have worked in for many many years. Familiar streets, blocks of flats, estates which have so many faces and memories entrenched in them. There are roads and buildings I can’t walk past without remembering some of the people that lived within them and gave them the flavour and character of a neighbourhood.

I think of some of the people I worked with who had no one else to remember them. Isolated, detached from families by distance, ill-health or circumstance. Then I think of the families I saw, the warmth and kindness and hope within some of the depths of poverty and the tragedies that life can fling at people without recourse to ‘fairness’ or ‘equity’.

I’ve had the honour to work with some immense people who have opened up to me and allowed me to share some of their most difficult moments and I have worked alongside people who have struggled so long and hard with such dignity or pain.

I have put in services and tried to offer suggestions but – increasingly, I have also removed and denied services to those whom I felt would have an improved quality of life if they were provided.

I’ve learnt a lot about the value of good health and knowing ones limits. I’ve learnt enough about the effects of alcohol to turn me near enough teetotal (not entirely mind!). I have learnt enough that even the best planning can’t protect one from accidents or fate.

Ill health affects across all social classes, cultures and belief systems. I have walked into houses which have made my jaw drop, some through opulence and some through squalor. I have tried not to judge but to listen and respond – sometimes it can be predominantly about listening and hearing.

I have had good and not so good managers and feel so fortunate in my current role to work in a very supportive team and organisation so it is with sadness that I see how the cuts over the past couple of years have ripped the heart out of a service and professionals who really were, even if it didn’t always look like it from the outside, trying to do their best.

‘Doing our best’ will not be sufficient anymore. While a government talks of parity of esteem between mental and physical health and further integration or establishing the ‘dementia challenge’ which focuses on better diagnosis, it’s important that we do not allow those who spread the cheap and hopeful words around freely to believe that parity of esteem will not cost. Establishing good and supportive dementia services which focus on what happens AFTER diagnosis will cost and that integration has to involve more change that asking everyone to sit in a room together and do team building exercises.

When I look at adult social work and mental health social work, the two areas I have worked in and I see how things have changed, it is not only this government I look at with despair, it is the previous government too.

Ed Balls played political games with social workers and bought into the Sun criticism in the wake of the tragic death of Peter Connolly. All main political parties have backed the privatisation of care services without building in sufficient protection and until the personalisation agenda actually offers the same benefits to someone with dementia without a supportive family as it does to an independent adult with a physical disability I will see that it is not yet a success.

So I’ve seen a lot of changes but not all bad. I see a great hope in the profession as we can work harder on developing an independent voice that doesn’t need a battling professional organisation which can’t stop its bickering and pettiness or a ‘Chief Social Worker’ chosen by civil servants with no knowledge of what the heart of social work is to ‘speak for us’.

Let us speak for ourselves and find more ways of doing so. Social Work is a profession to be proud of – we just need to make sure more people know about it – and we need to put some more fight into it. Fight politically, fight against cuts which affect those whom we work with, challenge within the organisations in which we work and remember that we need to create and build a profession to be proud of for ourselves – because no one else will.

Not a ‘media officer’

Not a soap opera

Not a fly on the wall documentary

Not a professional organisation

Not a ‘college’

Not a Trade Union

Not a government-appointed ‘chief’

We have to claim the profession back from the narrow definitions that successive governments seem to be forcing us into. Social Work happens outside local government – something I am about to have a far better understanding of.

It’s going to be a weird few weeks for me as I grapple with my own professional and personal identity. I rather feel I won’t give up the fight wherever I go – I hope not. There’s still a lot more to be done.

pic by soraya nulliah @ flickr

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The ‘Red Tape Challenge’ does Health and Social Care

Red Tape

We all knew it would come in time. This wonderful government idea to slash all that awful ‘red tape’ that stops people doing what the government otherwise would stop them doing finally arrives at Health and Social Care.

I had a brief look at some of the provisions detailed as ‘red tape’ for which the government is asking for comment and quite frankly, I am horrified.

What I might see as essential protections, they are presenting as ‘red tape’ and asking for feedback about potential abolition.

This is a consultation so it’s really important that as many people as possible to contribute and in the joyful spirit of openness, the website allows up to see the live commenting on others. I wonder how those with less technological access or knowledge are able to comment quite so openly about some of the provisions up in the air.

But openness and accessibility only seems to go so far and for the government departments responsible they seem to be after whipping up public distaste of ‘red tape’ although actually, we really do need to move from the idea that bureaucracy is necessarily bad.

There is a separate website entirely to focus on ‘ regulatory enforcement’ and where it might be unnecessary.I feel robust regulation (and thus, enforcement which has to follow as a result) is essential. The big problem with social care and health regulation since the CQC was established was the ‘light touch’ type approach which had been taken and the ‘back office’ regulation and not enough enforcement.  I really really hope that it is not cut back further. I want to see more regulation and stronger enforcement, not less of it.

But back to the ‘red tape challenge’. I want to share some of the provisions ‘up for discussion’ that the government has classed as ‘red tape’.  I’m solely concentrating on what is up under ‘Quality of Care and Mental Health Regulations’ as I felt that was the area I knew best. The numbers refer to the list of these ever so demanding provisions in the Excel list here.

39 is that oh so burdensome (!!!) regulation that requires the Care Quality Commission ‘to monitor and access for monitoring purposes, people who are deprived of their liberty’ and necessity to report this to the Department of Health.

40 is a nice one about requiring people ‘who assess Deprivation of Liberty’ to have an enhanced CRB.  – clearly unnecessary because.. er.. people who lack capacity and may potentially be subject to DoLs aren’t likely to be vulnerable, right? I think there’s an issue about effectiveness of CRBs in general but a bit worrying that that’s considered ‘red tape’.

43 is much more worrying as it is the obvious ‘red tape’ which introduced IMCAs as a safeguard for ‘those who have noone to speak on their behalf’ making them mandatory in abuse and review situations. RED TAPE??

55 is another ‘good one’ which ensures that IMHAs are ‘of an adequate standard’ because clearly, that is unnecessary (!?!)

Obviously there are many many more – I’ve just, for reasons of time, picked out a few that interest me personally but do have a look at them and COMMENT.

I’m frankly insulted that some of these provisions are even considered to be ‘red tape’  but as there’s an open consultation, it’s important that as many people as possible who know and understand the implications of removing them, to contribute.

If the government want to know what ‘red tape’ is in terms of adding unnecessary burdens, I’ll gladly explain about how useful (or not) it is to spend time recording how much time I spend on ‘smoking cessation’ work or time spent ‘clustering’ people according to diagnosis into tiny little tick boxes which are, clinically, unhelpful in order to get the ‘Payment by Results’ systems which will never work well, up and running. THAT’S red tape.

But it seems to be red tape that potentially infringes on the rights of those who might be least able to protect their own that they are classing as ‘red tape’ here.

Contribute to the consultation and let’s tell them how important some of these provisions are.

Oh, and someone should tell the Department of Health that the GSCC doesn’t exist anymore as they seem to have forgotten on their Professional Standards page (published this week!) but we know how much interest the Department of Health has in social work and social care so shouldn’t really be surprised.

Pic by Martin Deutsch@Flickr

The Queen’s Speech and Adult Social Care

The Queen at the State Opening 2009

I was expecting little from the Queen’s Speech in relation to adult social care and I was exactly right in my assumption.

The one line

‘A draft bill will be published to modernise adult care and support in England’ made my heart sink from the outset.

‘Modernise’ is one of those words that could mean anything. Sure enough the details followed.

The Department of Health website expands on that sentence.

The main elements of the draft Bill are:

  • modernising the legal framework for care and support, to support the vision of the forthcoming White Paper on care and support
  • establishing Health Education England as a non-departmental public body
  • establishing the Health Research Authority as a non-departmental public body
  • creating a London Health Improvement Board
  • carrying out engagement and pre-legislative scrutiny on the draft Bill, as many in the social care sector have called for, to enable government to listen to people with experience and expertise, to make the most of this unique opportunity to reform the law

What is missing is more important that what is contained in that short statement from the Department of Health.

We knew already that the Law Commission report was likely to be incorporated into legislation. I feel confident that there will be a streamlining of legislation and systems around them which will be positive.

As well as improving (or ‘modernising’ as they like to call it) the hotchpotch of legislation into one Act, the recommendations, lest we forget, include strengthening safeguarding processes for adults and imposing duties on local authorities to provide services for carers.

Which brings me on to the part that is missing.

Funding.

There was no mention of tackling the immense funding gap in these proposals. There is talk about rolling out ‘choice and control’ but without knowing that this will be funded (which it won’t – we were always told this would be zero cost process of change) it leaves a bitter taste in the mouth.

The Department of Health talks about ‘building on progress’ of personal budgets and my hope that will mean plugging that gaps that were introduced in the first place. I have my doubts as plugging those gaps will lead to significant funding increases as it will mean investment in statutory advocacy to extend the same levels of choice to wider groups of users.

My concern is that what will actually happen is that we will be given more meaningless targets to reach that will be very beneficial to the few  but will leave a large swathe of people behind as the pot of money available for care simply runs out.

One of the ‘benefits’ the Department of Health elucidates is

simplifying the system and processes, to provide the freedom and flexibility needed by local authorities and social workers to allow them to innovate and achieve better results for people

Now, if anyone can translate this ‘policy speak’ into real language for me, I’d appreciate it.

I read it personally as a push towards ‘social enterprise’ type operations which push social workers away from local authorities but I could be totally wrong on that.

‘Innovate’ like ‘modernise’ is an easy word to throw around, especially by those who have no conception of the actual meaning of the word. Innovation needs a lot more than the proposals on the table. It needs much more inventive and open thinking from areas outside the Department of Health. I’d like to see more emphasis on co-production. We want users to have the flexibility to innovate rather than necessarily the social workers. And I say that as a social worker.

I will wait with interest to see the coming White Paper on Social Care. I set my expectations very low. But I do expect a lot of words like ‘choice’, ‘modern’, ‘innovative’ with no mention of funding at all.

photo via parliament_uk flickr

From Clicktivism to Activism

Reflections on Bevan’s Run

Yesterday, I went to the Department of Health to watch the end of Bevan’s Run. If you haven’t come across ‘Bevan’s Run’ it involved two hospital consultants, Clive Peedell and David Wilson – both cancer specialists in Middlesborough, running from Aneurin Bevan’s statue in Cardiff to the Department of Health based at Richmond House in London – 160 miles in six days. They did this to raise awareness of public (and professional) opposition to the Health and Social Care Bill.

My reasons for going to meet the runners (with a few hundred others) in London was to express my support for what they had done and my agreement in the agenda which they were promoting – namely that there is no mandate for this coalition government to dismantle and privatise the NHS – because that is what they are doing.

While I was there, I both chatted and listened to chatter of those around me – many with much more experience than me in the sector (there seemed to be a lot of doctors milling around) about the wish to demonstrate opposition again and again. The phrase ‘lions led by donkeys’ raised its heads in reference to professional leadership which had not (with some notable exceptions) provided  much leadership in opposing and disseminating the government’s plans.

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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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