by Peter BeresfordAfter much delay the publication date of the government's green paper on the future of adult social care was set for early July 2009. Given the difficult political and economic times we now live in, it is hard to imagine how this consultation document could ever match the enormous expectations that were originally placed on it when, little more than a year ago, the government committed itself to a radical new policy of personalisation and self-directed support.
Clearly the priority is to make the most of the consultation period
that is now available to us to work for the most progressive reform
possible. Our eyes must be focused on the future. But it is difficult
at such a time not to look to social care's past and wonder what
lessons this may still have to offer us.
This was very much my
feeling when I turned again to a book (right) which Suzy Croft and I wrote 23
years ago in 1986 when attention was first being focused on 'public
choice' and 'community care' in the new decentralisation policies that
were then being advocated and implemented (Beresford and Croft, 1986).
Patch decentralisation
We spoke to local people in one such area in Brighton where plans for patch decentralisation were particularly advanced and high profile - the individual budgets of their age. We asked some of the big questions about this major reform. Would it merely mean increased privatisation, relying on more unpaid and commercial care or make possible the more accessible and responsive services and support that had been promised. Would it exploit women? What were the ramifications for older people, disabled people, and black people and members of minority ethnic groups, some of the groups which had been least well served by social services and social care. Would these policies have something to offer in developing the provision that people actually wanted?
Significantly just such questions have again been asked with the major moves now underway to transform adult social care. There have again been many of the same ambiguities, uncertainties and doubts.
Rise of market ideology
Looking back it is difficult to realise how much energy, effort, controversy and commitment were invested in the decentralised and community social work approaches which we explored in our book. Our book was particularly concerned with user and local involvement, issues that are still very much on the social care agenda. What few could have realised was that patch and community social work would have such a short life, despite their many strengths and benefits.
By the early 1990s, we had moved on to a mechanistic consumerist system of community care based on the market ideology of Mrs Thatcher that had little place for the flexibility, innovation, radicalism and professional development that patch and community social work had promised. Instead it gave us 'care management' - something the present reforms are trying to put an end to.
Preserve positive aspirations
The big issue now is how are we to make sure that all the positive aspirations underpinning personalisation and self-directed support aren't similarly lost and come to be seen as just another short lived blip in a much more one-size-fits-all kind of approach that has typified social care over many years. The Green Paper may not provide a promising basis for ensuring such a positive future. Our determination, however, as practitioners, service users, carers and the rest, however, forming alliances and working together, are going to be key in countering the real risks of social care going backwards again rather than going forwards.
Reference
Peter Beresford and Suzy Croft, (1986), Whose Welfare?: Private care or public services, Brighton, The Lewis Cohen Urban Studies Centre.
This was very much my
feeling when I turned again to a book (right) which Suzy Croft and I wrote 23
years ago in 1986 when attention was first being focused on 'public
choice' and 'community care' in the new decentralisation policies that
were then being advocated and implemented (Beresford and Croft, 1986). Patch decentralisation
We spoke to local people in one such area in Brighton where plans for patch decentralisation were particularly advanced and high profile - the individual budgets of their age. We asked some of the big questions about this major reform. Would it merely mean increased privatisation, relying on more unpaid and commercial care or make possible the more accessible and responsive services and support that had been promised. Would it exploit women? What were the ramifications for older people, disabled people, and black people and members of minority ethnic groups, some of the groups which had been least well served by social services and social care. Would these policies have something to offer in developing the provision that people actually wanted?
Significantly just such questions have again been asked with the major moves now underway to transform adult social care. There have again been many of the same ambiguities, uncertainties and doubts.
Rise of market ideology
Looking back it is difficult to realise how much energy, effort, controversy and commitment were invested in the decentralised and community social work approaches which we explored in our book. Our book was particularly concerned with user and local involvement, issues that are still very much on the social care agenda. What few could have realised was that patch and community social work would have such a short life, despite their many strengths and benefits.
By the early 1990s, we had moved on to a mechanistic consumerist system of community care based on the market ideology of Mrs Thatcher that had little place for the flexibility, innovation, radicalism and professional development that patch and community social work had promised. Instead it gave us 'care management' - something the present reforms are trying to put an end to.
Preserve positive aspirationsThe big issue now is how are we to make sure that all the positive aspirations underpinning personalisation and self-directed support aren't similarly lost and come to be seen as just another short lived blip in a much more one-size-fits-all kind of approach that has typified social care over many years. The Green Paper may not provide a promising basis for ensuring such a positive future. Our determination, however, as practitioners, service users, carers and the rest, however, forming alliances and working together, are going to be key in countering the real risks of social care going backwards again rather than going forwards.
Reference
Peter Beresford and Suzy Croft, (1986), Whose Welfare?: Private care or public services, Brighton, The Lewis Cohen Urban Studies Centre.
Newspaper articles, Social Work Journals and BASW only acknowledge "Childrens' Social Work" and
although Mental Health is a statutory area of social work it is rarely highlighted (except in catastrophic terms in the media). Local Authority Legal Departments are more in tune with Childrens Services legislation and more often than not our own peer support on mental helath legislation is more effective.
We need a separate Professional Association to promote our area. BASW appears to be made up of ex Childrens Social Workers which would explain the constant focus on Childrens social work and legislation. Similarly Journals such as Community Care lack any coherent knowledge or focus on statutory mental health social work.
As a Duty AMHP last week I phoned the ambulance service to request an ambulance for a patient who was to be detained under Section of the MHA. I was told there would be a wait for 4 hours and I should phone again following the assessment and the time would only start ticking then. The ambulance Manager pointed out to me that ambulance personnel are specially trained to deal with cardiac arrest and accident trauma so transferring mental patients to hospital does not fit with their skills mix and they claim they are reduced to being taxi drivers. While we are sympathetic with their needs this leaves a vacuum for mental health patients who cannot wait for 4 hours to be taken to hospital.
The Duty AMHP has to wait with the patient and travel to hospital to hand over the Section papers long after the doctors and police have left. Lone Working ? What's that? Because we are a small group of professionals The Local Authority or the Trusts do not understand our role fully.
We have asked our management to pull the funding for the ambulance service and either give it to the police who are transferring detained patients regularly to hospital or to fund alternative transport. Police support is on a good will basis at present and when they realise they could be paid they may stop supporting us.
In arranging the assessment I also phoned the hospital (doctors should be doing this) for a bed to be told there are no beds. I told the Unit Manager I would go ahead with the MHA assessment making out my application (for detention) to their Trust placing the responsiblity with them to find a bed. I cannot cancel a MHA assessment because there are no beds.
The police will not always turn up and we need them more often these days. However, when they do attend they are very supportive. In some London Boroughs the police will only come out on Wednesdays ! !
Where can we AMHPs (Approved Mental Health Professionals) consult and with whom to get appropriate supports without which we will not be able to sustain our service.