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

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Will Fast-Track Training Improve Social Work?

Graduates

Yesterday, the Institute for Public Policy Research (IPPR) published a paper called ‘Frontline’ subtitled ‘Improving the children’s social work profession’.

The programme they call ‘Frontline’ is based on the ‘Teach First’ programme.  It’s interesting that the paper was written by Josh McAlister who was one of the drivers behind the Teach First programme.

In the proposed ‘Frontline’ programme, there would be a ‘fast track’ qualification route into social work (or ‘children’s social work’ which the paper seems to consider as a separate profession in itself!).

As the paper says in the introduction

‘This new programme – Frontline – would help attract the best people into one of Britain’s toughest professions, and in the long term create a movement of leaders to challenge social disadvantage’.

The methodology of the study seems ‘unusual’ to say the least. The focus group for a start was of participants in the Teach First programme where I’d have thought it would have been more useful to speak more broadly to practising social workers rather than only to social work academics. I think, as well there are significant differences between Teaching and Social Work and while ‘representatives of BASW and the College of Social Work’ were involved and ‘case studies’ were submitted by five local authorities, there is absolutely nothing written about discussions with those in practice or those who use social work services. Looking at the ‘focus group’ it seems the few who might once have been social workers, would have left frontline practice behind many many decades ago.

How can eight teachers really provide an idea of what might work for social work? I’m truly baffled this is presented as an acceptable ‘study’ of the profession when no practising professional is actually mentioned as having been spoken to in the methodology stated?

The study works on the basis of high vacancy rates and a need for ‘quality recruits’ which personally I find quite insulting as a proposition. The report states

‘Of the 2,765 people starting social work masters-level courses last year, only five completed their undergraduate degree at Oxford or Cambridge , among only 150 from any Russell Group university’

Excuse me while I rage for a moment. So the criteria for a ‘quality entrant’ is THAT? Seriously?? There are many reasons including those of familial expectations, type of school attended and social background which affect choice of university.  I got a good degree from a Russell Group university myself so I feel able to comment but having a degree from one of those specific universities is absolutely NO indication of quality. Honestly. If we start differentiating between an Oxford degree and a London Met degree we start moving into very difficult ground. Are we really saying ‘middle class’? Because that’s a little of what it feels like.

The other aspect that the report criticises is ‘quality of training’ – to which their response is to propose a ‘fast track’ scheme? Again, it doesn’t make sense to me. Surely the answer would be to extend rather than reduce the qualifying course? (I’m not in favour of extending the course beyond what it is currently, by the way, I’m just not sure I see the logic in reducing it if that’s an issue!).

So ‘Teach First’ uses an initial six week residential programme and then places ‘teachers’ in a ‘challenging school’ for two years while they do their PGCE in the first year.

Hm. So the PGCE is one year course anyway. I don’t see how that corresponds to a ‘summer school’ for social workers and then putting them into a ‘challenging’ situation for a couple of years. There’s a lot more study that will be missed along the way with this ‘fast track’ scheme in social work.

Not least, the issue that is completely overlooked in this paper that a social work training course and qualification is generic not specific to ‘children’s social work’ and that ‘children’s social work’ is not a profession apart.

This proposal seems to have completely ignored the idea that social work training is generic. Teacher training would be specific both to age group (secondary) and to subject so narrow in focus.

Someone who qualifies as a social worker needs to have broader experience outside children and families field because people don’t exist in silos attributed to age, because sound Mental Health and Community Care knowledge actually makes all social workers more effective and more skilled in their jobs.  This ‘Frontline’ programme proposes similarly to ‘Teach First’ that it is a two year commitment but that the ‘social worker’ qualifies after one year. I find it mind-boggling that anyone thinks this is a workable model – with the Teach First at least you have a PGCE which is one year but with this ‘Frontline’ the MA programme is two years anyway so that’s much more to ‘pack in’. Too much, I’d say.

What is obvious to me is that the person writing this report has no idea about social work – what it is, how it works and how it should work. He seems preoccupied with his ‘Teach First’ baby and is convinced that Teach First raised the profile and status of Teaching.

Personally, I can’t imagine ‘Frontline’ would have an equivalent role within social work. I think it is dangerous to separate off the profession and focus on the ‘children’s social work profession’ separately because I think learning and experience (through placements) across the life course is something that marks social work training out. I also think that there is a very facile definition of ‘good social work entrants’ that doesn’t seem to have had regard to any complexity I’d expect from a report.

I hope this programme goes nowhere because the experiences of Teaching and Social Work are very different but it’s ridiculous and elitist enough for this government to want to run with it.

I hope they don’t. I hope someone talks to social workers before anything close to this is implemented. Do I think that will happen? On previous record, unlikely and mores the shame for the social work profession as a whole.

photo by Quick, like a Mule @ Flickr

On starting a Social Work Course

As the universities start on their teaching paths and the summer fades into autumn, I turn to reflect on my own years since I arrived at the university on my social work course what advice I’d give to me if I were starting today.

Here’s what I would tell the younger me who entered the social work training, unsure what to expect.

I’ve indulged myself a little and hopefully some will find this useful and add to the list in the comment section.

1) Seek opportunities, don’t wait for them to arrive.

This goes for learning/reading/finding articles as well as opportunities at placement and eventually in job seeking. Sometimes it can be a real change of focus moving from further education to higher education as the focus needs to move to self-direction. Self motivation is crucial. In the words used by Stephen Hawking

“Remember to look up at the stars, not down at your feet. Try to make sense of what you see and wonder about what makes the universe exist. Be curious,”

Personally I combine the courses I’ve studied, both my qualification degree and my post-qualifying training with the motivation to seek out information, read related texts and ignite discussions around policies and politics outside work as parts of my professional development.

2) Build strong relationships with your peers.

I am still close to some of the people I trained on my social work course with and have been since we were students. We’ve travelled down very different professional paths and had very different personal experiences along the way but the support we’ve been able to give to each other through treading a common path at that point in our lives has been a valuable strength through the good, bad and wobbly periods. Peer support is crucial and those on the outside will find it hard to understand the pressure you are under while you are training.

3) Be the social worker you would want to have

This is quite a simple motto. Never see the user – whatever area you are working in as the ‘other’. It could be you, your child, your parent, your friend. You might not see that now. But imagine it if that’s too difficult and think about the interactions you have and how you would change them if you were receiving them. Sometimes you will be hated and resented. It’s the role and (usually) isn’t personal. You won’t often be thanked but you will be paid. Knowing you did your best and treated people as you would want to be treated or would want a close family member to be treated can be reward enough.

4) Reflect

This is a chestnut but it took me a while to get it.

In the words of Alexander Pope

Know then thyself, presume not God to scan
The proper study of Mankind is Man.

Know yourself. Know what makes you react the way you do. Know how you respond and what experiences in your life have led you to those responses. Know what you might have to do to change those reactions. Learn from them. If you have not been used to it reflection can be hard initially to ‘get’. It is a self-examination that tempers responses and allows them to be learnt from. When you do ‘get’ it, things will become easier. Reflection also builds resilience when you know what your own strengths and weaknesses are.

5) Remember the feeling of presumed powerlessness for when you are in a positions of power.

This is one I didn’t really get for a while either. When I was a student – particularly on placement, I felt meek and lacked confidence in my actions. I wasn’t a ‘real’ social worker and had (quite rightly) excellent supervision and guidance by the team around me. I didn’t feel like I was in a ‘powerful’ position however even as a student with those doubts, I went into the homes of others and carried out reviews, fed the information back to my team and helped make decisions about packages of care. I did have power in respect to the people I was allocated to work with.

In relation to my practice educator, I felt she held all the cards. She was wonderful and positive but it could have been different and I’ve heard many stories about oppressive practitioners with students. I’d say remember those feelings of powerlessness and think how the users who come into contact with you both as a social work student and eventually as a practitioner will feel. Power is something that can take a while to appreciate – particularly if you have it – but not acknowledging it can be dangerous.

6) Distractions

Sometimes distractions, hobbies, external interests can be vital. One of the things that kept me going through the very intense course and my career post qualification is having interests that are nothing at all related to the work that allow me to mix with and meet people from different backgrounds and attitudes that have allowed me to grow in different ways and ‘get away from it’ from time to time. Don’t neglect other interests/people/friends. You’ll likely need them later.

I wonder what advice other people would share with their younger selves?

Carers Week – More than Words

Building Blocks of Art
‘Carers Week’ begins today. While the ‘official theme’ of the week is ‘In Sickness and In Health’ with a focus on the health of carers, I would provide my own theme from my position of having worked in social care for a fair few years as ‘more than words’.

Carers’ need more than accolades in order to feel supported and be supported properly. We need to be able to provide resources and that needs money.

Over the last 15 or so years, there have been definite changes in the status of ‘carers’ in social care organisations.  We have rolled out ‘Carers Assessments’  and have been able to provide services for carers directly as a result of new legislation. While we  assess the needs of carers – what we don’t have and where the disconnect exists – is a duty to provide services and nor national criteria about where a service should be and must be delivered.

The problem I face all too often is revolves around carrying out Carers’ Assessments (of course there is a target for these) but not being able to actually provide anything as a result of them. To which the obvious question I am asked is ‘Why do them if they only provide information to the Local Authority?’.  My local authority, fortunately and for now, at least, is fairly generous with carer support and direct services but this is by no means universal.

Mother watches over

I have been fortunate to see and provide some excellent services through direct payments made to carers and in a lot of ways, the services I have been responsible for providing as direct payments to carers have been a lot  more successful than some of my experiences with direct payments more broadly. I am able to encourage assessments with the possibility of a direct service provision as a result but I know this is by no means universal.

Assessments in themselves can be useful if they are conducted well and sensitively. Sometimes allowing a carer to have the space to discuss their own needs and explain fully the care they are and do provide and the effects that this has on their own wellbeing/goals and lives can be valuable – however there comes a point when this has to be acknowledged in a more ‘real’ (and yes, that can mean costs) way than smiling and nodding. More than words.

I’ve also seen an increase in the ‘posting a carers assessment out’ style of assessing which can lose some of the subtleties gained in a conversation and a visit. Of course, not everyone wants an assessment because the language and the questions can be formalised and particularly we get the ‘I’m not a carer, I’m a spouse/child/parent’ response but I’d counter that’s something that can be addressed by a change in the way of ‘paper assessment’ and the language and discourse models that exist around social care. Why can’t we be more flexible regarding what an assessment actually is? Do we have to ask the questions on the form?

We give, others receive but that’s a tired model – particularly in relation to carers who give us, as a service and organisation – much much more than we can ever give them.

So why is it reduced to a paper assessment logged onto a computer database? Because that allows performance indicators to be met.

My ideal service would be more flexible about the ways that assessments are compiled and would allow much more for free text and less on box ticking. Box ticking can help some clarify but it by no means captures what role caring plays in all lives. ‘Caring’ is not uniform. There are a myriad of needs and a myriad of ways to both communicate this need and for support to be delivered – or there should be. If people want boxes to tick, by all means provide them but if they want open space to discuss or write or record what and how they feel about their role and what might help, then allow that too.

We also (in social care) need to work on our assumptions a lot. Families exist in different ways and have different histories. There may be many reasons that don’t need to be disclosed about caring may be more difficult in particular situations and assumptions can be very damaging.

The new Adult Social Care White Paper is imminent, apparently. There needs to be a commitment not just to assessments of carers but of delivery of services and support to carers. More than words.

While the government talks about ‘respite’ and the need for breaks, I’d argue that is essential but while the provision of services is being cut and there are fewer, more distant places to offer respite the realities will remain as far from the government planning as they are at present. Capital investment and investment in decent staffing in homes that offer respite consistently would help. Clear explanations about entitlements and potential costs would help. Services that speak to each other would help. Pooled budgets would help but the easy words come thick and fast. The solutions can’t be found by words alone.

The current system as it exists relies on carers significantly to ease the burden of cost of the social care system. This needs to be more transparent in terms of publishing details of how indicative personal budgets are arrived at and the amount that is ‘saved’ by a carer. If some of these ‘savings’ (not even a minute proportion – but some ) is ploughed back into effective and personalised support with professionals who are able to access and feedback good, local information and provide support and training to carers where they want it the savings over the long term would be much higher.

The cost of poor support for carers is much much higher than the cost of good support – but in these times of ‘belt-tightening’ it can be forgotten while we reach the goals of short term savings.

It’s a lesson that both the NHS and social care systems would be mindful to heed.

In order to support carers ‘In Sickness and In Health’ the government, the organisations such as the NHS and local authorities, employers and communities needs to provide ‘more than words’.

Images by W4nd3rl0st at Flickr and Sapphiren at Flickr

Reforming Care

There’s a good piece today in the Telegraph by Liz Kendall the Shadow Minister for Care and Older People about the need for the government to push through reforms to the system of funding (and provision) of social care in this country.

The timing is pertinent of course although the message seems to have been around for decades. Tomorrow will be the Queen’s Speech and the government will set out its legislative programme for the next year. With the Dilnot Commission reporting last year it seems that the need for changing the means of funding social care support would be something that may appear tomorrow. My own gut feeling is that it won’t but I’m happy to be wrong on this.

There are two connected but separate issues to the ‘care reform’ debate. One relates to the way that care is funded and that is the issue that Dilnot specifically refers to.

Currently, each Local Authority has it’s own ways and means of determining charges although there is a threshold capital limit of £23,500 above which a person may be liable for charges. There are various computations and methods that these levels and charges are managed but the fact is that means testing is by no means consistent across England – nor is quality and level of provision.

£5000 towards care in Manchester may buy something very different to the same in Chester or Westminster or Norfolk.

There is anger about the ‘working hard all their lives to buy a house and then needing to sell it instead of leaving it to the kids’ argument that I have less time for as I think the exponential rise in property values is less about working hard and more about luck, employment opportunities and an odd housing market but if you are going to deprive people of assets which by default is going to happen as social care won’t be fully funded, it should be done in a fair, equitable and transparent manner.

Currently, I find it almost impossible to explain to someone what charges they may be liable for and it shouldn’t be like that.

Dilnot proposes a cap (which may be changed according to the government) on the amount that would be charged to the individual needing care and I can appreciate that. It is a sum which could be insured against and it is a sum which can be planned for.  However, it would need increased capital funding from central government and there’s the rub.

As for the process of improving quality of care and choice in care. it’s separate but linked. The ‘system’ is starved of cash injection at the moment. Cost has overtaken quality in terms of contracts being meted out by local authorities and choice is a luxury for the few rather than an option for the majority.

The government has been ruthless in their decimation of budgets to local authorities and while we’d all like to think the NHS and local social care budgets are intrinsically linked – the reality is different and the shifting of cost and responsibility between health and social care ‘pots’ is damaging to those who need to use these services.

Work has to be done on the fundamental basis of the way that social care is delivered in terms of ensuring that rights and particularly the right of access to well funded care is open to all. While money will always buy more choice and better facilities (that’s the point of ‘working hard all your life’ if you want to follow that argument) – the provisions meted out to those who are unable to pay ‘top ups’ or arrange their care independently cannot lag behind.

There has to be a more cooperative flow of budgets between health and social care and they have a symbiotic partnership and while there is division, there will be increased costs.

Integration is seen as a ‘watch word’ but to date there has been little in terms of actually working on it in a practical and innovative manner from bottom up.

It becomes an easy word to through around and everyone around the table can nod and smile and say ‘yes, we need to do that’ but what is needed is solutions not a continual detailing of problems (although problems do need to be identified of course – but sometimes I feel that’s all that happens!).

So let’s watch and see if the government do pick up the challenge tomorrow – I suspect we won’t see any changes but I hope to be pleasantly surprised..

It is worth remembering though that the provision of Dilnot would appeal to the demographic the government wants to attract but it would be at a considerable cost.

I will watch with interest.

Changing Adult Social Care – The Select Committee Reports

Yesterday after collecting both written and verbal evidence, the House of Commons Health Select Committee published their report into Social Care.

It makes very interesting reading and is written accessibly so I would highly recommend that anyone with an interest in this area reads the original but I wanted to pick up on some of the themes myself as there were such crucial issues raised.

The main theme I picked out (and you don’t have to be very astute to click with this one!) is the need for continued work towards integration – not only between health and social care which has become a bit of an old chestnut, but also with social housing.

The figures the report pulls out are that 50% of GP visits and 70% of hospital days are required by older adults as well as half housing association tenancies.
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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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