Reality check

It’s 9.45am when I arrive at Islington Council’s occupational therapy offices and Gwen Ovshinsky is already there, talking to two of the therapists (OTs) about the morning ahead. She is finding out what they have in store for her as this is the day that Gwen, Islington’s director of adult social services, will accompany one of them on a home visit.

The outing has been set up as part of Islington’s annual “front-line week” for senior managers. Since the scheme has been running, Gwen has helped to serve meals in a day centre, accompanied people with dementia on transport and spent time in an asylum seeker service.

The concept behind front-line week is to increase the visibility of those at the top of the organisation and show how they value the work carried out by those in daily contact with service users.

For Gwen it is a chance to publicly demonstrate her interest in the council’s services and prove that she is “not just sitting in head office thinking about budgets and performance indicators”.

It is also a chance for her to meet service users. “Nowadays I don’t have much contact with service users and their families, and this is a way for me to be reminded of the reality of the lives of people who need our services. It gives me a chance to talk to service users and for them to say what they want to me.”

Ingrid Clark is the OT tasked with taking Gwen out, so how does she feel about having the boss looking over her shoulder?

“If I were a new member of staff I would be much more nervous,” she says. After 15 years working for the service she is confident in her ability.

We pile into Ingrid’s well-worn Peugeot 305 for the short drive to the housing estate where John Craig-Smith, 65, lives. John has myelopathy – compression of the spinal cord – and as a result has mobility difficulties. He is in pain, and has problems using one of his arms.

As soon as we arrive, the reality and frustrations of front-line work hit home for Gwen; all the OT equipment is supposed to have been delivered, but one vital piece – a chair for her client – has not arrived. All Ingrid can do is apologise and explain that it should be on its way. She then demonstrates how to use the equipment that has been delivered.

First up is the bread and butter board, equipped with spikes to hold bread in place so that John can spread butter. Then comes the sock aid – a gadget that allows the user to put on their socks without bending. Last comes the bath board to help John get in and out of the tub.

While Ingrid demonstrates how to use the devices, Gwen talks to John about his condition. Is he in pain? Are there things he can still do? Is there anything else he can think of that would help? She explains to John’s wife, Pam, that she would be eligible for a carer’s assessment and advises the couple to appeal against a benefits decision. When she returns to the office Gwen will ask the welfare rights staff to send John a form to launch an appeal.

Gwen finds out from John that he felt the OT assessment form was too long – something that Ingrid had already complained about earlier in the day. You cannot help feeling that this is a victory for Ingrid – surely now Gwen will consider revising the form.

But spending time with a senior manager is not just about having a chance to whinge. Ingrid also wants to register her gratitude for the flexibility which allows her to work 17 and a half hours a week, term time, in school hours. She says that had this not been possible she would be at home, frustrated and claiming carer’s allowance herself, as her son has autism.

For Gwen the visit provided her with some pointers. She says: “It gave me a real-life flavour of service delivery issues and has brought home to me some of the issues for staff in delivering services and meeting targets.”

The experience has reminded her of why she went into social services, so does it make her want to swap her strategic role for more service user contact?

“It doesn’t, but it reminds me of the satisfaction you can have as a front-line worker when you feel you’ve made a differences to a service user’s life.”

While Gwen has been seeing at first hand how the OT service works, one of her assistant directors, Neal Murtagh, has been at the New Park Day Centre for disabled older people. When I arrive he is helping the service users have their lunch, an experience that reminds him of when he was 16 and worked in an older people’s home.

“One of the first jobs I had was in a dining room serving meals to people,” he says.

The day centre is one of the services that Neal manages and he is familiar with the staff through his occasional visits in a “management scrutiny” capacity. But this visit is more relaxed.
Before lunch, Neal sat in on a meeting of the drivers who bring the older people to the centre. They told him how the routes needed to be changed to cope with additional service users who will be using the centre while another service is temporarily closed.

Time out at the front line contrasts with his regular job, based in head office and often involving analysis of figures.

“As a manager your perspective changes because you manage through other people, but you still hope you’re making a difference,” he says.

This is not the first time that Neal has taken part in front-line week. In the past he has spent time with a hospital OT service, with district nurses and in a children’s home.

“I hope the staff get something out of it, meeting the senior management team and sharing their experiences. It’s good for us and them,” he says.

Indeed, Lloyd Coombes, manager of the New Park Day Centre, views front-line week as a positive thing for staff and says that every year he puts in a request for a senior manager to attend.

“For us it’s great,” he says. “Years ago a lot of senior managers did not understand the issues in the service they managed but people see that Neal understands the issues. It’s a humbling thing to go back and understand what things are like at the grass roots.”

Humbling it may be but, given senior managers’ accountability for services, those in the dark about the running of front-line services remain so at their peril.


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