… And they’re off! But it’s a disappointing start for the Mental Capacity Act

In the line-up for the 2007 legislation Grand National we see the return of some old favourites.  Waiting for the starters’ orders are the Mental Health Act alongside the NHS & Community Care Act. We also see the return of the Chronically Sick & Disabled Persons Act and … surely not … Yes it is, the National Assistance Act is back for another plod around the course, surely he should have retired by now.  We also welcome along one of the favourites this year, in his first year of entry, the Mental Capacity Act is confidently waiting for what must surely be a resounding victory for all those he represents.   They’re under starters’ orders, and they’re off …

… but it’s a rather lack-lustre performance from the Mental Capacity Act 2005 (MCA).  I’m probably not the only one slightly disappointed by the sluggish start; 5 years into the MCA I have to admit that things probably haven’t gone as some of us may have imagined.  I was prompted to write this blog having recalled a recent occasion concerning a gentleman with a learning disability. He asked his carers for support to obtain an application form for a driver’s license and then to complete the form. Instantly, the carers decided that it would be far too dangerous for the gentleman to be driving around and, quoting the MCA, in his ‘best interest’ decided that it would be better if they didn’t support the gentleman to obtain and complete a driver’s license application form. I think the only correct consideration of the MCA were the two words, ‘best interest’ and even they were out of context! On every level, they failed to apply the MCA correctly or even remotely well. If  they had, they would have approached the decision from the assumption that the gentleman had capacity (which, interestingly he did) and provided the support he was requesting in the first place.

This of course isn’t an isolated incident and only recently was also reported about on the Community Care website.  Poor application of the MCA is widespread, it crosses all levels of care professions and it has to be addressed for the sake of those it should be protecting. If I were the MCA, I would be suffering from a complex right about now. Being misrepresented, misquoted, ignored, it’s enough to make even the strongest legislation question themselves!

Some organisations see the importance of MCA training, but where I often see a glaring hole is in people’s ability to apply the principles and use the MCA as the framework it was intended to be. People can usually quote phrases, provide general themes or even list the 5 principles of the MCA but that is often where knowledge and application stop. Carers and professionals alike should be discussing it daily, in team meetings, formally in supervision and informally. They should be applying it to all decisions being made and actions being undertaken on behalf of someone who may lack capacity. They should be questioning everything and inquisitively discussing whether any action or decision being made is the least restrictive or whether a seemingly unimportant decision made by carers or professionals has just had a significant impact upon individual.

The MCA doesn’t have to be a complex piece of legislation unattainable to anyone who doesn’t have a law degree.  It even comes with a very user-friendly Code of Practice to which of course, anyone working with an individual who may lack capacity must have regard for.  But it does have to be a piece of legislation that is used well and frequently by all concerned to ensure that we really do act in peoples’ best interest.

Advertisements

Familiarity Breeds Contempt

Over the course of the past months, who could help but feel a plethora of emotion as the horrors of Winterbourne View have unfolded before our very eyes: Absolute disgust that an organisation could get to the point where such blatant institutional abuse becomes a part of daily life, anger at the systems in which we work as they are revealed as insufficient to protect the most vulnerable in our society or perhaps a heart-wrenching empathy towards the vulnerable and a passion that things have to change and something done… but what?

It will hopefully have challenged us all as a professionals.  Is it just possible that as we go about our business there is a very real danger of becoming complecent unless we keep on out toes and remain true to our professional standards and ethical practices?  I’ve been reminded how very important the role of those who commission services and the need for greater accountability when choosing services for individuals who can’t choose for themselves.   Are we pressured into choosing the cheaper option even when we know in our heart that it isn’t the most suitable?  Do we sigh a sigh of relief and accept without question when we find a service that will accommodate the individual with particularly challenging behaviour knowing that the option will be limited? Do unrealistic case-load sizes prevent us from spending time to think outside of the box and identify the very best service and then think how it might be achieved? Do we have a professional relationship with providers when a less formal relationship can be so much easier? If we become too familiar those so important boundaries can become distorted and increase the risk of poor practice or even abuse going unnoticed or being excused.

I started my social care career working in a residential home for children with autism and it must be said that in my experience the majority of carers are decent caring people who go the extra mile.  Most don’t get paid heaps, have to work shifts but still turn up at work asking how they can make the next 8 hours the best they possibly can for those they have come to work for.  However, there are some for whom that isn’t the case and over the past couple of weeks we have seen 11 photos that will probably remain imprinted on our minds long after the media frenzy has died down.

I’d really like to hear how recent events have perhaps challenged you as a health or social care worker as you strive to help deliver the very best services to those who need them. I also look forwards to hearing how the Department of Health is going to drive service commissioning, delivery and safeguarding forwards.  What is agreed upon is that there needs to be a radical overhaul of social care; what doesn’t see so clear is what that will look like.

 

A Culture of Care?

I can’t help it but I’m somewhat unimpressed and uninspired by claims that Castlebeck’s transformation is nearly complete (As reported by The Guardian).  I’m sure Mr Sullivan has done a sterling job in dragging the remains of homes such as Winterbourne View towards acceptable standards but the very fact that such poor standards of care are evident in contemporary care is a shameful indictment on our society.

It riles me not only that such abuse took place in the first instance, but that it wasn’t picked up by the care provider.  Would the abuse still be happening if it were down to Castlebeck to identify it and take action?  I shudder to think that the answer might be a resounding “Yes”.  Also to think what else may be happening within care homes across the UK where vulnerable adults don’t have the benefit of family involvement or carers with the insight to blow the whistle on abuse … or Panorama!

 Having worked with numerous residential and nursing homes, it is not hard to see how totally dependant some vulnerable members of our society are on those paid to provide good quality care:  Care that is monitored and regulated and where safeguarding policies are in place to ensure that those who can’t speak up for themselves are protected from abuse… Really?

I can’t help but recalling one particular home, the manager was sitting in a very well equipped, spacious office when I arrived congratulating herself at the marvel that were her new, glossy brochures. Showing prospective families just exactly how decent the home was with its ample garden blooming with flowers and general good cheer.  Carers smiled on the front cover in a manner that exuded quality, person-centred care from more carers than one could possibly need whilst care-free residents tucked into their gormet meals.

Sadly, the reality was very different:  Insufficiently trained carers that didn’t have the time to answer a call-bell that had been rung for the umpteenth time as the room’s occupant continued to lie in urine soaked sheets.  Then there was the missed opportunity after missed opportunity to spot pressure wounds that were silently getting progressively worse – out of sight, out of mind.  All the time, the owner continued to congratulate herself and confidently sell the homes’ services to prospective new residents and their families.  Oblivious to the reality that was unravelling the other side of her plush office door.

Of course, such business’ need to be well run but when business comes before quality of care something needs to change.  Whole cultures need to change because if the underlying ethos of a home’s manager is developing a thriving business, how can the ethos of carers within that home be anything different … such as caring perhaps.  Whilst I’m all for serious case reviews and learning from past mistakes, I’m not convinced my ministers’ exclamations that, “We must learn from this so that these things must never happen again!”   I fear that they will happen again … and again until the whole culture of care changes to one of … well, care.

I can recall perhaps just a handful of small care homes where the managers rota themselves on shift so they know what’s going on and can identify any training needs.  Where more money is spent on care than on prtraying a good image to prospective new residents.  They may not be glistening with a new coat of paint every 6 months or benefit from TV advertising but they are run with an underlying ethos of care and respect and reflect far more the brochures that are displayed elsewhere, but they don’t have their own glossy brochures.  All they have is a good reputation which gets them by more than adequately.

The Human Cost of Cuts in Social Care

Yesterday I was sent a link to this blogpost by Lucy at The Small Places. I highly recommend everyone involved in social care read this post. It is written by someone who uses and needs support that is provided by the local authority, however their services have been, are being cut significantly.

The narrowing of the eligibility criteria isn’t a ‘paper cut’ made in an office within accounting departments of local authorities, it has a harsh and detrimental effect on the day to day quality of life of another human being who is dependent on the way that provisions are allocated. These are the choices that have been and are being made in the context of cuts and these are the people, actually, we are all the people that Burstow has to justify himself to when he talks about no money being taken out of social care budgets.

The author of the blogpost explains

Yesterday, my care plan was reviewed, and despite the social worker agreeing that I have substantial ‘needs’, to every question that I answered regarding what my carers do for me, the reply was: ‘we don’t fund that any more’. So from now on, no one is allowed to do: laundry, from putting into the washer, putting on a ceiling clothes rail, ironing and putting away…

no shopping allowed or putting it away; paying bills or doing any post office visits; carers aren’t allowed to accompany you out any more either socially, or to hospital/doctors/dentist/opticians or other practical appointments where you need someone to propel your wheelchair; they can’t put the bins out; can’t stack or empty the dishwasher or do any kind of clearing up whatsoever: the list goes on and on. All of the things that I cannot do for myself.Just about anything you can think of that a healthy person would do in the home or outside the home on a day-to-day/week-to-week basis is no longer allowed.

I recognise this. From the ‘other side’ so to speak. I have been, I am, that social worker (well, not in literal terms) but I have to explain that we no longer provide hot meals delivery, we can’t count time for someone to be taken to medical appointments, we deprive people of assistance for some of the tasks we, ourselves, take for granted.

There has always been an issue of resourcing with some user groups benefiting more than others. In older adults services, for example, it was always rare to allow carers time to accompany service users to go to the shops – however, wasn’t the new and wonderful era of personalisation and choice supposed to change this?

We are now able to offer the choice between the hours (and money) spent on someone helping with a bath and use it instead to go out for an hour to the shops. Not necessarily a palatable choice we would expect for ourselves, is it?

The author of the post goes on

I am supposed to have everything delivered now, but they don’t understand the costs of that. Fresh food (and I say that in the loosest sense since they mostly send you stuff that’s about to go out of date), in terms of fruit for example does not last a whole week; you’re lucky if it’s a few days. I can’t eat processed food because I also have IBS. So I’ll have to do an internet shop twice a week which will cost £8 delivery and I will also have to spend a minimum of £25 per shop, that means my four weekly food bill would be £240: I cannot possibly afford that. And since no one is allowed to put it away, what do I do with it when it arrives?

Cost transfers from local authority to user and is the ‘personal budget’ supposed to allow for this? You’d think so.  This was one of the more baffling parts of the post

Ah, now the very helpful social worker had a suggestion for all of this: I can use my D.L.A. to employ someone to do all of the other things now and pay for any transport needs! That’s what D.L.A. is for isn’t it? As I replied however, I pay ALL of the care element and part of my severe disability element back to the local authority for my care, so how can I use that?

Well, exactly. Disability Living Allowance (or Attendance Allowance for over 65s) is non-means tested however it is counted in terms of assessments for charges so there is an expectation in the finance departments within Local Authorities.  This allowance is seen by the local authority as a legitimate  target for charges to be recouped back to the Local Authority for the costs of care – and to be honest, I can see the point. These benefits (at least, the care component) are paid because there are care needs specifically. However for the social worker to lack this information is no doubt rubbing salt into the wound of cuts.  The social worker sounds to have been put in a difficult position and I know the feeling. We are tasked to pass the news of cuts to those who can least afford it and who rely most heavily on the provision of services – but it’s a duty to give fair and honest advice at this point.

It does make it clear though that ‘better information’ and shiny web sites providing directories of services or new ‘Trip Advisor’ type sites rating services are all very well and good but the real thing that social care needs is funds to meet basic needs. The focus needs to be on quality of life not ‘how much can we slice off budgets’. There no easy answer but being disingenuous about the nature of ‘choice’ available and being honest about the realities of decisions being made is significant.

This post speaks the truth of many others who cannot speak up – and this is someone who has been able to use a direct payment positively. There are many many more who haven’t.

As a social worker this post spoke the realities I see every day and highlights the benefits of social media to improve my personal practice – it shows me how social workers are perceived with an honesty I rarely get in terms of feedback on a day to day basis due to the power differentials which exist.  I hope I don’t respond to people in the way that social worker did but I will be more aware of my responses and how they are interpreted when I am in people’s homes.

And I will continue to fight against the cuts agenda all the harder. We have a powerful collective voice as social workers and we have to use it to tell the stories that we say, to not passively accept some of the hardships and injustices we see on a daily basis.

We can and must do so much better.

A look at ‘Caring for our future : reforming care and support’

paper stack 1 SQ BW 500X

A rapid chase through the Care White Paper

The government published it’s long overdue Care White Paper yesterday. There’s been time for a significant amount of coverage to push through to the media and I don’t want to repeat information that’s out there but rather provide a response/analysis from where I am and where I see it. There is a good summary on Community Care though.

It’s a hotch potch of a document. The words are pretty but there’s an underlying tone of ‘saving taxpayers money’ which shines through from every good intentioned statement. Saving money isn’t a bad thing but I wonder how much the intention is to change the way the market in care is delivered in line with the NHS Bill and how much is to actually change the philosophy behind the process of care. I doubt the government’s good intentions.

The White Paper divides into eight chapters. So I’ll follow that pattern in my review of them.

Chap 1: The Case for Change

Here, the paper itself sets out the current difficulties in the system as it is at present which is reactive to crisis rather than focused on prevention. I can’t help feeling a little cynical in noting even the current system wasn’t intended to be this way, but has developed as such due to the pressures on funding.  The government line is to prove the point about crisis response but that’s not really been the agenda all the time.

Believe it or not, there was a time we met ‘low’ needs and while accepting there is a financial limit, the demonisation of the system is hardly a true reflection of what was envisaged and more should be learnt about the ways that systems imposed develop into a ‘race to the bottom’.

So the paper suggests that the answers will be found by providing more services sooner in the process of ageing or a disabling condition.  We will have more support for carers and will be promoting communities to provide support within themselves.

People need more information, without doubt, and that will be provided. That’s hardly revolutionary but too much has been down to local differences – the old ‘postcode lottery’ arguments. This will be clarified so people can move around the country and know what they will be able to expect.

Interesting that the ‘opportunities from reform’ all seem to revolve around financial benefits. It’s a valid benefit and opportunity but an interesting angle so

‘Promoting people’s wellbeing and independence’ will ‘limit future demand for care and support and help to ensure taxpayers’ money is used for effectively’.

Support for carers will enable them to ‘remain in the workplace’ which will ‘support economic growth’. So THAT’S why they are so keen to support carers – don’t want anyone to think that ‘caring’ without pay for a family member isn’t a valid and essential economic contributor.

and ‘Supporting businesses to grow’ – which is maybe what choice is all about.

I’m not against these agendas but I think the framing in economic terms is very very interesting.

Chap 2: Our vision for care and support

Understandably and quite rightly there is a high proportion of ‘control’ wanting to be distributed from top down to users in this section of the White Paper which is all well and good. It’s been (rightly) the movement of travel and needs to go further. As someone who works with people who have not been able to benefit fully from the ‘choice and control’ agenda, I was particularly looking for things that would help and support the people that I work with here.

There’s a lot of focus on promoting communities in being active and enabling to those living in them. There’s a need to promote better information streams – quite rightly – the system is enormously complex and I spot a little line on page 19 about ‘supporting the transformation of the social work profession’.

So the role and place of the local authority to provide care and support will be changing as it says

‘instead of purchasing and providing care and support, authorities will increasingly be expected to take a leadership role in a local area’. That should be interesting.

Chap 3 ‘I am supported to maintain my independence for as long as possible”

So in looking at prevention of isolation and needs the White Paper turns to communities to look for support, quite rightly. There’s a lot of potential here and social isolation is specifically targeted with some wonderful local models explained in terms of the way they work with isolated people to bring them into communities.

Not everyone wants to be a part of a community and there are some people communities tend to be less eager to support but it’s a great initiative for some people and there will be a lovely new Outcome Framework which will identify measures of loneliness for us to work on while local authorities managers and accountants look at ways they can meet targets at low or no cost.

Commissioners will be ‘encouraged’ (whatever that means) to draw on community support networks rather than moving people into ‘formal’ services. I read that along the lines of finding services that are provided at low or no cost but perhaps I’m a cynic.

There’s a line here too about social work pilot schemes which will  ‘liberate’ (I’m VERY suspicious of the word ‘liberate’) social workers from case management. It looks like a push towards more community based social work but I have some concerns. Firstly, case management is only bad if it is implemented badly as a process rather than as a collaboration. Poor case management can have an enormously detrimental effect on someone.

I’m not convinced by social work pilots but will wait for the outcomes of these pilots to see before I make a final judgement. I like the idea of more community work but am worried at what cost it may come in terms of privatising delivery of service and moving responsibilities for provision away from a democratic mandate.

I do like the idea of connecting care homes with their local areas. That is enormously positive and where I’ve seen it happen locally, it has made a big difference. It does seem like a lot of ‘use volunteers’ as the answer to problems but honestly, that’s not a bad thing where there are volunteers. I just wonder if all communities will be as engaged and where there is such a great reliance on community to provide support, what will be done in those areas that aren’t as supportive.

As regards housing, there will be significant investments in housing for older and disabled people. I hope this will encompass people in mental health services and is not limited to those with physical  health needs. There is a muddle over extra-care sheltered accommodation which is described as a way to meet low level needs but also as an alternative to residential care. Oh, I mean a ‘cost effective’ alternative to residential care. Missed the key point there.

Chap 4 ‘I understand how care and support works and what my entitlements and responsibilities are’

Information, information, information. It’s crucial in order to make choices and the government sets out ways, particularly websites, that will provide more information about services and facilities to all rather than just those eligible for them.

Interestingly the NHS 111 number will roll out support for social care. I wonder how this will work as a national helpline when provisioning is so different locally and there will be an extension of services like NHS Direct and NHS Choices into the social care sphere. Look forward to seeing that. I genuinely hope it works.

Local authorities will also be obliged to provide more information online but also in other formats, to those looking at services and providers but it looks like there is intended to be a default move online for many access points – including self assessments online as ‘they provide a better customer experience’. I wonder how this marries with the issues around the digital divide. There will be paper and telephone options available at least.

There will be a national eligibility framework and it seems (although this will only be confirmed later) that it may well be set at ‘substantial’ under current FACS guidelines although there will be a move to a new framework of assessment and eligibility.

People will also  have more options about who assesses them.

‘Our ambition is for many more providers to offer assessment services’. Good business opportunities there and a role for the social work pilot schemes.

Carers will have an entitlement to assessment (which exists) and to the provision of services (which doesn’t at present). I’m glad to see that.

Chapter 5 ‘I am happy with the quality of my care and support’

There’s an interesting diagram on this chapter on page 38 with circles of ‘roles and responsibilities in care and support’ around the ‘service users and carers’ at the centre, with Government, Commissioners, Providers and CQC around them. Interesting that there is no place for social workers. I expect we come into ‘commissioners’ but sad that the profession doesn’t seem to have a place around this diagram and is not even mentioned.

There is talk of better regulation by the CQC with inspections annually (scandalous that they were ever anything but in my view).

Looks like they’ll be a return to some kind of rating system too. Strange that just disappeared.

Statutory Safeguarding Adults Boards will be convened by local authorities with police and NHS organisations inputting to them. There will be further consultation on powers to access someone who might be at risk of abuse or neglect.  Personally, I’d like to have seen more on safeguarding.

Commissioning on quality is emphasised (good) and there seems to be a desire to look at some kind of outcome model to judge this. There’s also an acknolwedgement of the failing of some private care homes such as Southern Cross and

‘Local authorities have a duty to provide accommodation to anyone – publicly or self-funded – who has an urgent need for care which is not otherwise available’ and noone will be left homeless if a provider were to fail.

I don’t doubt that would be the case anyway but more public protection for private companies failing can only lead to additional costs.

Chapter 6 ‘I know that the person giving me care and support will treat me with dignity and respect’.

Here there’s an emphasis on building skills in the social care sector. I don’t believe people go into this field of work to be oppressive or uncaring but the system dictates it and a bullying workplace leads to poor and dangerous service delivery to people who have higher needs.

The government claims to be committed to the plans of the Social Work Reform Board and that the College of Social Work will play a heavy role in improving standards of education and training in social work in universities.

The White Paper supports the position of Principal Social Workers in Adult Services and part of that role will be coordinating feedback from frontline practitioners. I look forward to having one locally as I have a lot to feedback.

Chapter 7 ‘I am in control of my care and support’

Ah, personalisation, that bittersweet word which means everything and nothing. Everyone entitled to care and support will have a personal budget – I genuinely thought that was already on track and didn’t think it was anything new. And look

‘We will push further with our ambition to support as many people as possible to enjoy the benefits of a direct payment’.

I hope that support is extensive and looks beyond the current models which have served some exceptionally well but many others very very poorly.

I won’t mention the ignorant way that advocacy is included in the White Paper which evidences a lack of knowledge by those who wrote the paper but will merely reference Martin Coyle’s (from Action for Advocacy) blogpost which says it all.

There’s some more in this section about integration between health and social care which is becoming more distant in practice rather than more evident.  Use of the term ‘care coordination’ is confusing as it is a generally used term in mental health services and has different technical meaning to the way it is used in the White Paper in terms of physical health. That has already caused us many confusing conversations locally as to someone having two care coordinators – one for physical health and one for mental health – which kind of proves the point about duplicating work and having unfathomable systems. The terms should really be clarified and separated if necessary.

Chapter 8 ‘Making it Happen’

A draft bill was published alongside the White Paper. I haven’t read it yet. I wonder that some organisations seem to have thrown their lot in wholeheartedly with the government which makes me a little nervous. I want to support positive change but I don’t want to be blinded by good intentions and words that lead to little that changes the lives of those who have the most need for support.

Interestingly the ‘financial context’ is stuck at the back of the White Paper like a growing tumour. There are mealy mouthed words about the government putting money into social care but while taking away in the other hand, from local government, they have contributed directly to the ‘crisis management’ only model that they criticise.

Conclusion

I see little if anything revolutionary in this paper. I see nothing that explains a change in the direction of travel and means of delivering social care. I see some positive signs and some acknowledgement of difficulties but we were moving down the path of personalisation at a rate that it could only continue. While there was mention of personal budgets for residential care, I saw nothing about ISFs and developing ways of promoting choice for those who are excluded from communities and who may lack capacity. I saw nothing about changing legislative frameworks. I saw a lot of gaps, not least, the massive funding gap.

Nice words though, fluffy and helpful and a lot of the language of ‘choice’ (where possible), ‘community’ (where free) and ‘market’.

These things are always filled with the right words. I think a lot of opportunity to restructure and rethink adult social care has been lost although there are some springs of hope – there aren’t by any means enough.

Pic by wintersoul1 at Flickr

Integration, Conversation and Change

Some Random Thoughts about Making Things Better

I have spent a good deal of the last week thinking about the importance of building and making links across different parts of the ‘whole’ in terms of the way services are provided by agencies to us, the public. Some of the following thoughts may seem random but I’m trying to connect them in my head! Slowly but surely..

Conferences

Last week I attended the Digital Health Conference and Hack in Leeds (which I wrote about here).  Without repeating myself too much, there was a programme around changes and new thinking in both health and social care that stretched over two days and involved a lot of conversations with people from many different areas – both in terms of place of interest and work and in terms of geographical area and level of authority.

The main theme I took from those days was around the important of connections and conversations. Ideas and innovation is not a top down, nor a bottom up flow. The channels and flows need to be horizontal – and across sector and areas of interest – as well as vertical. We need to look at ideas from outside the sector rather than only talk to ourselves and rely on well-meaning civil services to devise policies in London, particularly when ‘social care’ is often seen as an afterthought in the ‘health and social care’ agenda. When I look at models and policies developed for ‘health and social care’ and see that social care is little more than an afterthought with processes developed clearly by people who probably would find it difficult to define social care, let alone understand the messy way it is structured locally, I start to despair and then remember that if I invite myself to the table, I can make those points directly which may, possibly, make a difference.

I left Leeds with some glimmers of hope that as long as social care does continue to place itself around tables like that, we would be able to contribute and even, perhaps, influence thinking in a little way.

‘Health’ is universal, social care is not. The narrowing restrictions on access to funded social care is a massive challenge as access unfortunately can play into the government agenda of stigmatising those who need the provision of service. There isn’t yet a more general perception that social care is something for everyone and in adults services, anyway, the charging policies cause a great deal of anger and resentment when we are trying to offer them to people.

Conversation

I had another conversation earlier this week too, with Mark Brown who is the editor of One in Four (highly recommended, I’ve been a subscriber for a while).  We come from different angles but want to find answers to the same problem of how t0 provide a better service to those who need it. While we haven’t (yet) found the answer, he’s a lot further ahead of me and I highly recommend looking at the keynote speech he recently delivered in Australia about new ways of delivering and providing mental health services.

Change

In the background as well, I heard about the closing of Social Work teaching at the Institute of Psychiatry and the move towards outcome measurements based on clusters and quantifying diagnosis and recovery, I wonder if Mental Health services are moving backwards rather than forwards in terms of promoting and developing different ways of thinking about services and different ways at delivering which move away from ‘medical models’ which have not proved to be useful generally.

Integration

‘Integration’ is only integration if it actually brings people together rather than driving them apart which is what it feels is happening at the moment. The pots of money are split and the silos are created. This currently is in the interests of those who are working across the sector as they have their own fiefdoms of interest and can’t see new ways of developing practice that is based on unquantifiable aims.

So what do we need to challenge and change from within?

The current systems promote wrong thinking in a number of ways.

If we can’t measure progress, progress doesn’t exist.

We are expected to aim towards mediocrity rather than strive for excellence.

There is an emphasis of the ‘us’ and ‘them’ dichotomy of professional and user with little understanding of the user as professional nor of the professional as user.

Thinking of the tenets of personalisation and how the poor implementation has been managed in England, I can see both some rays of hope and some shadows of despair.

What was supposed to be a user focused attempt to shift power in social care services has, instead, imposed an attempt at new ways of thinking onto old models. We were told we had to ‘make things work’ but as we have seen in practice, the tools we were given were old and rusty. Local authorities were not able to shift models of commissioning nor of power structures rapidly enough to make the system a reality. We should be studying and learning from what has gone wrong with this model and pulling up the examples of poor practice to learn rather than constantly dwelling on the models of good practice.

Despite and because of the conversations I’ve had over the past week, I am learning that there isn’t enough different thinking within the systems I work in. The knowledge and desire to change is being paid lip service because there is a demand on time and money. The truth is delivering better is not only potentially further savings in the long run in terms of cash, the amount that can be saved in terms of quality of life improvements are priceless.

Social Work has the possibility to be at the heart of these conversations. We occupy the space around the ‘social’ which strides across health and social care – and across the life course.  However the profession itself doesn’t seem to welcome innovation itself and hasn’t been able to define a specific role which leads to possibilities for much confusion. The way out is for practitioners to develop a voice. Personally, I’m holding out that the College of Social Work will do a better job of it than has happened previously – but the need for innovation and fresh thinking is the only thing that will improve the outcomes for those who rely on us.

We owe it.