The Social Care Experts Blog

If we are eating so badly, why are we living so long?

2010-08-26T11:47:43Z

by Dr Mike Fitzpatrick

The history of medicine reveals that doctors resort to recommending diets when they have no effective treatments - a state of affairs that prevailed from antiquity until the 1930s. Dietary protocols for numerous conditions, from insulin-dependent diabetes to pernicious anaemia, have disappeared with the development of new drugs or other forms of therapy.

The food issue: why food is at the heart of social care

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Dietary dogma

Things were bad enough when such dietary dogma was largely confined to the surgery. But now it has been elevated to become a central feature of government public health propaganda, in programmes such as the "five-a-day" fruit and vegetable promotion.

From any objective assessment of health trends in the industrialised world over the past half century, it is readily apparent that diet plays a marginal role in both the causation and the prevention of disease. There is a consensus that since the Second World War we have all been eating too much saturated fat, too much refined carbohydrates, too much salt, indeed too much of everything. Yet life expectancy has increased by about 10 years over this period - and it continues to increase.

Nightmare scenarios

While prophets of doom promote nightmare scenarios resulting from epidemics of obesity and diabetes, death rates from coronary heart disease continue to decline - and rival scaremongers raise the spectre of a demographic timebomb of the elderly.

Mike Fitzpatrick is a GP in Hackney, north east London

Big Thank A You - And Remembering What It's All Really About

2010-04-30T12:55:16Z

Two apparently unrelated stories struck me when I read last week's Community Care (29 April 2010). Both left me with strong feelings. Both deserve further comment. First there was the tribute, following his premature death, to David Morris, longstanding senior policy adviser on disability to the London Mayor.

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Dave had an important role. He was influential, he could make a difference. He had a massive track record. Yet he was one of those people who never came over important. As the old saying goes, he had no side to him. What I really valued about him was his commitment to inclusion. For people like me that meant really valuing his efforts to involve all disabled people, to address diversity and to include mental health service users/survivors equally alongside other disabled people. Some people work hard to do that. Others, including some disability leaders, don't. Dave came very firmly in the first category. I know that this was true about his efforts for other groups who faced particular barriers. Whenever I went to anything Dave was part of helping make happen, there was always the widest range of disabled people there. That's something to be proud of, a real achievement. I am really sad we won't be seeing more of Dave. Wishing you well Dave, wherever you are.

Second, there's the little item towards the back of Community Care where people talk about best and worst decisions they have made. Last week it was John Davies, a frontline social worker. What interested me was what he had to say about what he regarded as one of his worst decisions. It concerned his work with a long term mental health service user who also had a long history of alcohol problems. His 'diagnostic category' isn't what's important here. What's important is what John says of his practice with him. He writes 'His sister with great justification wrote a letter of complaint to my manager'. No ambiguity, no qualification, no get outs. He feels she was right to think he did badly by her brother. Yet there were many extenuating circumstances. He was young, inexperienced, put in a difficult position. But this experience clearly had a powerful and positive effect on John. And he is still in there. And while we can see how much more might have been involved than his own fallibility, he still wants to be clear about the part that might have played and be honest about it and take responsibility. If only social work, social services, senior managers and politicians more generally would take such a view, recognise their own limits, fallibility and shortcomings. Social work and social care would have to be better.

I think this is what brings these two stories together. Both are about putting service users and disabled people first. Both are about the important understandings that people from two very different positions and roles can give us. Let's hope they both can leave a lasting mark. Thanks Dave and thanks John.

Centre for Social Justice contradicts Cameron's 'broken Britain' slogan

2010-04-28T14:50:06Z

by Bob Holman

Unlike Margaret Thatcher, David Cameron does acknowledge the existence of
poverty. The credit rests with Iain Duncan Smith whose Centre for Social
Justice (CSJ) contains staff in contact with people in deprived areas.

]]> was not Abolishing Poverty but Mending Broken Britain. The unfortunate
title implies that a body of dysfunctional families are to blame for
unemployment, adverse child behaviour, teenage parents, crime and
violence which is a symptom of a broken society.

Of course, there are families who cannot cope but the Broken Britain
analysis is weak. First, it is too sweeping. The British Crime survey
reveals that crimes of violence are falling. The number of teenage
parents is dropping.

Second, it concentrates on the poor. Cameron said nothing about the
wealthy who avoid tax and the rich who gate themselves off from local
communities.

Third, Cameron blames state welfare. He overlooks the role of private
enterprise. Two million people did not choose unemployment. Their number
multiplied when wild bankers stimulated recession.

His solution is less state welfare, stronger communities, more voluntary
bodies and resources for youth projects.

One of the great contributions of the CSJ is the identification of small
voluntary bodies. As a member of its panel, I have visited agencies
which have transformed the lives of ex-offenders, struggling parents,
unemployed people and many more. For 25 years I worked with projects
which enabled deprived young people to thrive.

Yes, voluntary bodies do need more resources. But they can never cope
with the huge numbers in poverty. Meanwhile, Cameron's plan to cut
Britains deficit by slashing public services will make matters worse.

Above all, Cameron avoids the issue of inequality. The study 'The Spirit
Level' by Professors Wilkinson and Pickett shows that unequal societies
like Britain are much more liable to poor educational performances, low
social mobility, unemployment, imprisonment, poverty, unemployment and
other social evils than more equal societies. Those at the bottom feel
excluded and react with withdrawal, depression and anger. These are the
conditions which are the cause of most social disadvantages. Britain's
problem is not being broken, it is being unequal. A massive
redistribution of incomes and wealth will not solve all problems but
they can not be effectively tackled without it.

Cameron should meet Andy Stranack of the CSJ. He lives on a council
estate with a modest income. He is standing as a Conservative against
Labour's Harriet Harman who maintains her enormous wealth. Neither
Conservatives nor Labour take equality seriously. Social workers must
get it on the public agenda.

Bob Holman is the author of Keir Hardie. Labours Greatest Hero? Lion
Hudson

Road to social care funding reform lined by people with their heads in the sand

2010-04-06T14:23:44Z

by Richard Humphries

Many hope that White Paper 'Building the National Care Service' published last week will become a key staging post towards a reformed social care system.
If I had to choose a Beatles' song to describe the journey so far, it would be 'The Long and Winding Road' - and the destination still seems a long way in the distance.

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Despite frenetic activity, the publication of the White Paper days before the dissolution of parliament means that the government has run out of road for the time being.
The big idea of a national care service free at the point of need is certainly ambitious. It plucks at the emotional heartstrings connecting much of British society to the NHS. But it seems the earliest it could be fully implemented is 2016 - political light years away. This would make it 19 years since the Labour government first looked at the issue - the NHS was up and running in a fraction of that time.

The real underlying problem is that while everyone wants the benefits of a nationally consistent service that is free at the point of need, no-one is keen to pay for it. That politicians are reluctant to fight an election on a platform of compulsory contributions for care reflects a deeper public resistance to facing up to the costs of an ageing population - hence the political traction gained by the 'death tax' accusations - and why the tricky question of funding has been kicked into the long grass of a post-election commission.

The forthcoming general election will offer plenty of opportunities for social care to remain a key campaign issue. All parties should be pressed to set out clearly their own proposals. There needs to be honest dialogue with the public about how much good quality care would cost. Candidates should be quizzed about where they stand and what they would do, if elected, to promote change.

Richard Humphries is senior fellow at The King's Fund

Liking sex is not a disorder, but endlessly expanding psychological diagnoses might be

2010-03-10T11:22:15Z

by Dr Michael Fitzpatrick

Early commentary on the fifth edition of the Diagnostic and Statistical Manual (DSM V) of the American Psychiatric Association - due for publication in 2013 - has focused on the new range of sexual disorders. These include "absexuality" (the Mary Whitehouse syndrome of excitement at being appalled at displays of pornography), "hypersexuality" (the affliction of Tiger Woods, film stars and premiership footballers), and, so that nobody feels left out, "sexual arousal disorder" (experienced by people who are just not interested). ]]>
The need for a diagnosis
Yet there has been little questioning of the further expansion of the scope of psychiatric diagnosis. In his celebrated 1967 A Fortunate Man: A story of a country doctor, John Berger emphasised the therapeutic value to the patient of having a complaint "recognised" in the form of a diagnosis that was "defined, limited and depersonalised". The problem today is that we can no longer claim that giving patients the sort of labels offered in DSM V will make them stronger.

Whereas in the past mental illnesses were few and clearly defined, the new disorder labels are both more numerous and more diffuse. In 1952 the first edition of DSM (DSM I) recognised 106 categories of disorder; by 1994 and the publication of DSM IV, this number had expanded to 297. It is clear that DSM V will include many more disorders and they will apply to more people, stretching beyond the "one in four" currently deemed to be in need of psychiatric attention. The inclusion in the DSM V draft of new categories of being at risk of psychosis or dementia further extends the reach of psychiatry.

Blurring the boundaries
The popularity of the concept of a continuum of mental disorder results in a further blurring of the boundary between the normal and the abnormal.

Whereas diagnoses previously suggested the limited character of the condition, modern disease labels imply disorders that are unrestricted in the scope of the symptoms to which they give rise and in the duration of their effects. Post-traumatic stress disorder or recovered memory syndrome, for example, can be expressed in the widest variety of symptoms, which may arise long after the traumatic events believed to have triggered them. There is also a widespread conviction that these may continue indefinitely as people are "scarred for life" by past traumas. Today's sufferers from addictions or compulsions, expanded in the DSM V draft to include binge-eating and gambling, can never claim to have been cured; they live their lives "one day at a time" in an ongoing process of "recovery".

The depersonalised character of traditional diagnoses allowed the sufferer to objectify the condition as something "out there", perhaps a somewhat forced abstraction, but one with some pragmatic value. By contrast, a diagnosis like "negativistic personality disorder" is inescapably personal and subjective in character. Every sufferer exhibits a different range of symptoms, and there is no way of objectively confirming or monitoring the course of the illness.

Labels that prolong incapacity
The net effect of the dramatic expansion in the range of psychiatric diagnosis is that, instead of empowering the patient, these labels are more likely to intensify and prolong incapacity. It also reflects a profound demoralisation of society and a deep crisis of subjectivity.
In her fierce polemic against the influence of psychodynamic theories in social policy in the 1950s Barbara Wootton argued that when the boundary of psychiatric diagnosis changes, "the frontier of responsibility shifts". She was worried that "we are travelling steadily towards abandoning the concept of responsibility". I fear that if she had lived to read the DSM V draft she might have experienced an outburst of "intermittent explosive disorder".

Michael Fitzpatrick is a GP in Hackney and author of Defeating Autism: A Damaging Delusion, published by Routledge

Recent articles by Michael Fitzpatrick

Social pedagogy waffle

Swine flu morass

Forget the child pedagogy waffle; the solution is more obvious

2010-02-22T12:42:02Z

Do children in care really need social pedagogues, asks Michael Fitzpatrick, himself the parent of a looked-after child on the verge of transition to adult services

According to the draft guidance on "the physical and emotional health and well-being of looked after children and young people" produced by the National Institute for Health and Clinical Excellence (Nice) and the Social Care Institute for Excellence (Scie), social pedagogy is "an important development for all care provision". But what exactly is it?

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Barry Sheerman, Labour chair of the House of Commons' children, schools and families select committee, recently told Radio 4 listeners that 80% of Denmark's looked-after children progress to university thanks to social pedagogues (a rate some 10 times that of the UK). Perhaps in Denmark they do not also expect unqualified and transient social care staff to look after children with high levels of need.

Social pedagogy is an approach that can be traced back to the writings of Jean-Jacques Rousseau and is seen in the development of Froebel's kindergartens, and the more familiar nursery and residential schools associated with Montessori and Steiner. It attracts radical advocates who emphasise its commitment to social equality. However, it has also taken social pedagogy several decades to recover from its association with the Nazi regime. Then it was used to facilitate the extension of state authority into intimate spheres of family and personal life, just as these new Nice/Scie guidelines would incorporate the sort of intrusive and moralising therapeutic outlook that permeates public health policy into the education and social care of looked-after children.

It seems likely that the main appeal for New Labour is that a social pedagogue is not a social worker, that most disparaged and discredited professional of the past 10 years. A combination of managerialism, marketisation and scapegoating by politicians and the media has produced widespread demoralisation among social workers. The social pedagogue - new, glossy, Scandinavian, spouting platitudes about providing a "holistic package of support" and "integrated care and education" - emerges as the solution to a problem largely created by New Labour.

It is typical that this new Nice/Scie guidance fails to acknowledge the achievements of the current social care system, despite all its inadequacies. My son, like many others, has thrived in care through the dedicated efforts of high quality staff supported by high levels of professional expertise, efforts that generally receive little public recognition and inadequate remuneration.

The draft guidance is full of familiar jargon and waffle about "delivering excellent, world class, services". But there is no need to go in search of gimmicks to Denmark or Germany or even Pennsylvania, or to return to cultish and outmoded psychological theories of attachment and personal development to find out what children in care need.

It is straightforward. Children need care from well-trained and well-qualified staff. To attract and retain such staff, and prevent the rapid turnover that causes distressing disruptions to relationships and loss of continuity of care, they need to be well-paid and their activities need to be well-resourced. Politicians could help by ceasing to produce more policy guidance like this, by ceasing their bad-mouthing of social workers and by putting the pedagogues on their bicycles.

Michael Fitzpatrick is a GP in Hackney, east London

New remedies in respect of enhanced CRB disclosures

2009-11-18T08:42:11Z

by Allan Norman

One of the first decisions of the new UK Supreme Court L, R (on the application of) v Commissioner of Police of the Metropolis [2009] UKSC 3 (29 October 2009) will offer some welcome reprieve to social care workers and would-be social care workers who have discovered the devastating effects of "information disclosed at the Chief Police Officer's discretion" - on an enhanced CRB. There is now a way of fighting back.

The problem

The problem - because there most certainly is one - can be summarised as follows:

The use of enhanced CRBs is growing dramatically - nearly 275,000 were issued in 2008-09
The Police, if in doubt about the relevance of information, are likely to include it - saying, correctly, that it is for the organisation to whom it is disclosed to make decisions about suitability, not them
Employers and agencies are likely to err on the side of caution when an enhanced CRB raises concerns
All this has a devastating effect on the 10% or so of applicants in respect of whom enhanced information is disclosed.

]]> Guidance issued following an earlier court case gave precedence to child protection concerns over the rights of a would-be social care worker.

It was once held "that it is better that ninety-nine ... offenders shall escape than that one innocent man be condemned."*; our anxiety over the risks to children now seems to mean that we have reversed the ratio.

The court's decision

A clear majority of the court held that the earlier court case and guidance were wrong, erring too much in favour of disclosure in borderline cases. In future, greater weight must be given to the effect on the CRB applicant and on their career. Specifically, the court said that it was not unreasonable for the CRB applicant to be contacted and their views sought before disclosure, and even indicated this would be the norm, rather than the exception, in future. Thus, Lord Neuberger:

'I would have thought that, where the chief officer is not satisfied that the applicant has had a fair opportunity to answer any allegation involved in the material concerned, where he is doubtful as to its potential relevance to the post for which the applicant has applied, or where the information is historical or vague, it would often, indeed perhaps normally, be wrong to include it in an ECRC without first giving the applicant an opportunity to say why it should not be included.' (para 82)

Analysis

For the many people affected, this re-balancing exercise is welcome. However, it only addesses the tip of the iceberg of the original problem.

First, the exponential growth in the use of enhanced CRBs is itself questionable. Employers are legally bound by a Code of Practice, but many think that 'safe' practice means asking for an enhanced check even when they have no right to do so, and there is no effective remedy for illegal enhanced CRB checks.

Second, the 'soft' information included is generally untested. Untested allegations may be completely right, but they may be completely wrong. A person may be a wholly innocent suspect, the subject of a malicious allegation, the victim of mistaken identity. It remains to be seen how far representations that this is the case will affect police decisions on disclosure in future.

Finally, however, there needs to be a proper understanding of the system to ensure a robust and fair decision making process by employers and agencies. If those who receive such disclosures assume the disclosure of 'soft' information is proof of its veracity, or of a person's unsuitability, or if they abrogate responsibility for making such decisions at all, and in a risk-averse age simply say 'no, thank you', there will still not be justice.

Allan Norman is Principal Social Worker & Solicitor at Celtic Knot (www.celticknot.org.uk), an independent law firm and social work practice.

* Thomas Starkie, A Practical Treatise on the Law of Evidence, 1824

A tougher GSCC? No thanks!

2009-11-10T06:15:37Z

by Allan Norman

You might have thought from the media coverage of the GSCC between its discovery of a backlog of conduct cases and its sacking of its Chief Executive, that its problem was that it wasn't tough enough, and the solution was that in future it would need to be tougher. Neither is the case.

Dame Denise Platt has commented here on the prominence of public protection on the GMC's website, contrasting that with the GSCC's website. I should like to make a different comparison.
]]> searchable database of its regulatory decisions. If you analyse these, as I have, you will find the GMC far less trigger-happy with its suspension powers than the GSCC (see BASW Press Release, 'Arrogant regulators and their unfair treatment of social workers'). Doctors, unless they lack the ability or insight to practice safely, are frequently allowed the period while charges are pending to prove and to develop themselves. Equally, final outcomes may also be less draconian for a doctor than a social worker.

The CHRE report on the GSCC latches onto one of the key reasons why this might be so, and in recommending a similar approach for social workers, opens up the possibility that we may better protect the public by being less tough. It notes most healthcare regulators focus on fitness to practice rather than misconduct.

Within the GSCC regulatory regime, misconduct is central, and this is problematic. Why?

misconduct is defined with reference to the Codes of Practice, and they use broad phrases, like "working openly and co-operatively with colleagues", "maintaining clear and accurate records", "being reliable and dependable". The breadth of what might constitute misconduct means most of us are either guilty of it, or say, "there but for the grace of God..."
a finding of misconduct carries connotations of guilty misbehaviour, and so is more stigmatising than one of unfitness to practice. It is common for the GMC to pass straight over the primary allegations ("admitted and found proven") and go straight on to a discussion of the consequences for practice.
sanction is determined with reference to misconduct. In the GMC regime, it is possible - and frequently happens - that the facts having been proven, it is determined that fitness to practice is not impaired. It is easier to reach such a conclusion than that the facts do not constitute misconduct, so there is a different starting point for sanction.

I would therefore welcome a 'fitness to practice' regime as advocated in the recent report. But I do so for more than technical reasons. Primarily, it is because it is more in keeping with risk-based regulation. When I spoke out about the GSCC going through a lengthy and arduous conduct hearing for someone who had no intention to practice as a social worker and was content to receive the ultimate sanction of being struck off, Mike Wardle disagreed with me. More recently in contrast, another of my cases has highlighted the unwillingness of the Council to examine the conduct of students at all.

The common thread in what I would like the council to do is to take a risk-based approach to regulation. The focus on fitness to practise will - hopefully - be a move towards more risk-based regulation. At least, it allows practitioners to say, "yes, my practice fell short, let's explore how short, of perfection", and the regulator to say, "this much, so this is what is needed to improve your practice, we'll impose conditions and review and see how your practice improves."

Less tough, more realistic, better protection for the public, and social workers are treated more like the professionals we truly are.

Allan Norman is Principal Social Worker & Solicitor at Celtic Knot (www.celticknot.org.uk), an independent law firm and social work practice.

'Top social workers' needed to scrutinise child protection

2009-11-09T11:38:23Z

by Ray Jones, professor of social work, Kingston University and formerly director of social services in Wiltshire

Community Care has been ahead of the game. In a post I contributed in February it was recommended that following the 'Baby Peter' media frenzy which started a year ago this month there should be new performance indicators for children's services (and why not for adult social services as well) focussed on stability and continuity in front-line teams.
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Getting the basics right

It was an attempt to move the attention of senior managers, the inspectors and the government from distractedly focussing primarily on strategies and plans, cross-cutting service development and organisational change. If we do not get the basics right, and get stability in service delivery, the rest is just window dressing whilst the emperor still has no clothes!

And the argument has in part been won. New performance measures are to be introduced with the Department of Children, Schools and Families proposing workforce indicators on staff vacancy and turnover rates.

It is important that these measurements are applied to front-line managers as well as to practitioners. I have long held the view that it is front-line team managers, and not the service director and other senior managers, who determine the day-by-day quality of services and the experience for practitioners.

Top social worker

But in the February post there was another recommendation that "every council appoint a top child protection social worker with a responsibility to report in public to all councillors on the state of child protection services, and to report to the independently chaired safeguarding board on child protection services across all agencies".

This top social worker would not directly manage children's services, as more disruptive and distracting organisational change would just lead to further trauma and turmoil, but would be an independent expert voice monitoring, advising and reporting to politicians and to the community.

Credible scrutiny needed

With the increasing concern about child protection and care services in too many councils, and with the lack confidence in the competence of OFSTED, it becomes even more important that there is credible scrutiny and quality assurance in every council of children's social care services. But unlike the OFSTED model of inspections, there should also be the commitment to help the services to address weaknesses and build on strengths.

Children's services are now often led by a director with a background in teaching and schools. It is crucial that the experience and expertise in child protection and care is rebuilt at the top level, and the recent lesson from Doncaster is that there has to be an accountability to the full council and public reporting beyond mayors and one-party state political cabinets.

The GSCC needs reminding of whom it truly should serve

2009-11-09T11:30:58Z

by Denise Platt

Log onto the website of the General Medical Council (GMC). Pretty quickly you will read that "we protect patients by dealing firmly and fairly with serious concerns about doctors". The General Teaching Council says: "We work for children through teachers". Now look at the General Social Care Council website - you'll be hard pushed to find the words "protect the public" or any mention of people who use services on its home page or "about us" section.]]> The GSCC is now a quango in special measures. It has to restore the faith of the public and social workers that it does take the task of protecting the public seriously. It has six months to put right the serious failings identified by the Council for Healthcare Regulatory Excellence (CHRE) report.

Regulation of social workers is not an end in itself. It is there to ensure that the professionals who support individuals and families in the most vulnerable of circumstances work to the highest standards of competence and conduct. The regulator must be unequivocally clear that it has the people who rely on social work services as the focus of its attention, the core of all its activities.

A regulator must act firmly to take action when concerns about fitness to practice or conduct are raised. It is not only the public that demands this, social workers want it too. Professionals should be dealt with fairly, competently and with integrity.

A regulator needs to practice what it preaches and work to the highest ethical and regulatory standards in its own field. It should ensure that staff are properly trained and developed and that they are confident in their roles, properly equipped to do a difficult job.
Politicians need to take seriously the recommendations to move to a system of "fitness to practice". The GSCC needs a more sophisticated range of sanctions to intervene or support in a timely way when significant concerns about an individual's practice are raised.

And politicians should curb their reorganisation tendencies. Social workers support both individuals and families across age groups. Politicians should resolutely resist any temptation to create separate regulatory bodies for those who work in children's services and those who work in adult services.

This is not a good time for the social work regulator to be in trouble - the GSCC needs all the support we can give it at this time.

Dame Denise Platt is a member of the Committee on Standards in Public Life and the Audit Commission. She was previously chair of the Commission for Social Care Inspection

'Don't let professionals tell you they know about parenting'

2009-11-05T16:32:00Z

by Michael Fitzpatrick

I often think it is strange that parents ask me - as a GP - for advice on matters of child-rearing.
It is understandable that parents should seek medical advice about their children's coughs and fevers, even about teething and nappy rashes. But why turn to a doctor for help with sleeping and feeding problems, toilet-training, tantrums and bad behaviour?

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Why do parents watch Supernanny and read all these books, and even bring their family problems to their GPs? According to the government's former "Respect tsar" Louise Casey: "there's no shortage of people who want to be bossed around a bit". As journalist Jenny Bristow observes in her provocative new book, Standing Up To Supernanny, "the symbolic success of Supernanny is in cementing the idea that parents really want and need a 'third person' in their relationship to help with the allegedly hellish torment of raising their children."

Parental anxieties and insecurities have reached such a pitch that mothers and fathers are prepared to accept professional intrusion in intimate family relationships - even by people with no particular expertise (if indeed there is such as thing as expertise in parenting). Nevertheless, GPs, nurses, health visitors, social workers, generic "family support" workers are ready and willing to boss parents around in surgeries, children's centres, Sure Start schemes.

While respectable parents join internet forums and read Gina Ford and attend parenting classes, parents of "chaotic" families are invited to attend residential "family intervention projects".

According to the senior project worker at a pioneering unit in Dundee, who was quoted in The Guardian, a lot of residents find it "prison-like" and "quite intrusive" to begin with. Yet over the past three years some 2,600 families have voluntarily attended schemes in 170 centres.
Promoters of family intervention claim it is "incredibly cost effective" by keeping children out of the youth justice system and formal state care. But Jenny Bristow objects to the "wider coercive trends" towards "professionalising parenting", including the national vetting scheme that appears to represent every adult as a potential abuser.

Bristow upholds the privacy of family life against state-sponsored intrusions and respecting family relationships "based on spontaneous affection and authority". She criticises professional intervention for sapping parental confidence and undermining their ability to raise the next generation of adults.

The fact that parents turn to doctors for help with parenting confirms the extent to which they have come to accept the assumptions at the heart of government policy and media commentary - that they are incapable of rearing their children without professional monitoring, advice and support.

But, as Bristow suggests, it would be better if professionals stopped pretending they have any special wisdom about child-rearing. If parents stopped acting like children and put their trust in themselves - and other adults - when it comes to bringing up children then supernanny would soon become redundant, and GPs would have to restrict their practice to medical matters.

Michael Fitzpatrick is a GP in Hackney and the author of The Tyranny of Health: Doctors and the Regulation of Lifestyle

Neo-liberal values threaten the very existence of social work

2009-11-05T16:00:10Z

by Steve Rogowski, a social worker (children and families) with a local authority in NW England

The Social Work Taskforce is due to report later this year but I wonder if it will deal with one of the most fundamental issues. It will come up with (yet another) definition of social work, though whether this will cover why most people come into social work in the first place and thereafter often become so disillusioned is another matter.
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Moral police

The vast majority did not want to be care managers, rationers of services or, in many instances, simply the moral police. They also did not want to be form/computer exemplar fillers working at the behest of managers.

Importantly, all such views are consistent with the International Federation of Social Workers definition of social work which refers to the importance of adhering to human rights and social justice. This in turn points to working genuinely alongside people on the difficulties they face.

Problems for practitioners

However, given the current neo-liberal society we have, adhering to the aforementioned values poses considerable problems for individual practitioners and even challenges the very existence of social work as a profession.

Partly this is because how the work is set, carried out and controlled now lies in the managerialism imported from the private sector. Financial rationalisations and 'getting more for less' predominate this process.

As we all know this involves often meaningless, bureaucratic targets so as to process cases as quickly as possible, with the absolute minimum, if any, of services being provided.

Less time with clients

It can also mean that the 'meeting the targets' culture results in less time being spent with clients/service users with their needs, therefore, not being adequately addressed. An obvious example of when this can happen, and the dire consequences that can result, is when there are child care concerns.

All this goes hand in hand with a society where people at the bottom of the pile are often castigated and demonised by politicians and the media, rather than being seen as deserving respect and understanding.

Sociology of vindictiveness

The idea that change is possible in their lives and behaviours, for many the essence of social work, is often completely overlooked. Jock Young helpfully relates such developments to the emergence of the 'sociology of vindictiveness' whereby what can be seen as the casualties of society are essentially blamed for their predicament.

But surely when considering people's behaviour and problems, this necessitates understanding their lives and the social and economic context in which they live. From this social explanations rather than 'victim-blaming' accounts of our world are needed; another key value which relates to the very existence of social work itself.

The values outlined here are under severe pressure given the current ideological, political and economic climate. One hopes the task force seriously addresses these issues, but even if they do, and especially with a Tory government on the horizon, my advice is to not hold too deep a breath if you are wanting to see any real change in day-to-day practice.

Detention of asylum seeking children is abuse

2009-11-04T11:39:55Z

by Clare Sambrook, a co-ordinator of citizens' campaign End Child Detention Now

One key feature of government guidance issued this week on how UK Border Agency staff should care for the children they lock up, is 'safer recruitment'. Officers raiding family homes and searching children in their beds will be thoroughly checked, with 'references always taken up'.

That begs the question: just how low were standards until now?

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"State-sanctioned neglect"

Families fresh out of detention confirm in every detail the recent report (pdf) by paediatricians and psychologists in Child Abuse & Neglect who found that children detained at Yarl's Wood were 'clearly vulnerable, marginalized, and at risk of mental and physical harm as a result of state sanctioned neglect.'

The doctors recorded comments from parents about their children's 'sexualised behaviour', about older children's tendency to wet their beds and soil their pants, about the 'increased fear due to being suddenly placed in a facility resembling a prison', about the 'abrupt loss of home, school friends and all that was familiar to them.'

The doctors reported the photographing and the fingerprinting, the roll calls and the body searches, the ID cards that children must carry at all times, the ten locked doors between freedom and the family centre, the steep deterioration in parents' mental health and parenting abilities, the self-harm and the suicide attempts.

Human suffering

To speak, as the government did this week, of giving children the 'opportunity to thrive' in the context of this moral calamity would be laughable if it were not for the human suffering behind every statistic.

Last weekend, immigration minister Phil Woolas revealed in a letter to Pete Wishart MP that 889 children from 488 families had been detained for more than 28 days between April 2004 and September 2009.

No matter how good the guidance, nor how diligently some people may follow it, the fact is that innocent children, whatever their immigration status, do not belong in prison.

It harms them. There is no need for it. There is no evidence that families with children are likely to abscond. The detention of asylum seeking children is absolutely unacceptable. It is state-sponsored child-abuse and it must stop.

End Child Detention Now has launched a petition calling upon the government to stop detaining children.

Politicians should keep out of politics

2009-11-03T08:09:48Z

by Allan Norman

'Then the messenger who had gone to call Micaiah spoke to him, saying, "Now listen, the words of the prophets with one accord encourage the king. Please, let your word be like the word of one of them, and speak encouragement."'

A couple of weeks ago, Conservative MPs criticised the Director or Public Prosecutions, Kier Starmer QC for speaking out in opposition to Conservative proposals to repeal the Human Rights Act. It wasn't in their power to force his resignation, but that is what the home secretary did when Professor David Nutt spoke out in opposition to Labour policy on drugs last week.

It seems our political masters have a shared view that those in public office should keep out of politics. Indeed, faith leaders should keep out of politics too. So should the royal family. The list goes on.

Which begs the questions, what is there that is not political? And who other than politicians in public life is entitled to an opinion?

]]> Alan Johnson's argument is, "Professor Nutt was not sacked for his views... He was asked to go because he cannot be both a government adviser and a campaigner against government policy."

Whyever not? As government advisers, the ACMD makes recommendations based on its evaluation of the evidence. His 'campaigning against the government' is no more than a public official reiterating in public what his public position is. As soon as we reflect on the alternatives, we realise how much worse they would be. Should all government advisers advise in secret? Should they all take a government whip? Or is it that the government intends, by proferring its penny to those who might mount articulate opposition to it, to effectively silence them?

One might argue that politicians have a democratic mandate. That I accept. But populist democracy is not necessarily either right or just. It is surely right that as the populist majority gets the tough on drugs policy it wants, it also learns that it is getting it despite, and not because of, the evidence.

Kier Starmer, like David Nutt, was commenting in our area of expertise as social workers, as well as in his own. For, as I have commented before, universal human rights is a central objective of social work. And since it seems to me that localised human rights is something of a tautology - where you say, your human rights in this country are this, elsewhere they may be different - Kier Starmer is making a compelling case that social work might properly make out itself.

Micaiah, for telling his king the truth that he needed to hear instead of the lies that he wanted to hear, was put in prison and fed nothing but bread and water. His response was to reiterate his truth: "Take heed, all you people!" So should we take heed though our modern day prophets face only the loss of public office.

Allan Norman is Principal Social Worker & Solicitor at Celtic Knot (www.celticknot.org.uk), an independent law firm and social work practice.

The story of Micaiah is in The Bible, I Kings 22

National college of social work faces leadership challenge

2009-11-02T11:50:37Z

by Nigel Clarke

Two years ago, I was asked by the Royal Pharmaceutical Society of Great Britain (RPSGB) if I would chair an independent inquiry into a future professional body for pharmacists. The RPSGB's regulatory function had, arguably, swamped its professional body role, and when the government decided to create a new regulator, a review of what members wanted from their body was sensible.

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Core membership
Secondly, bodies like this should be for everyone essential to the work of that profession. Here, social workers will be the core membership, of course - but a professional body must be able to act as a forum within which ideas can be taken forward, standards considered, and policy debated. A narrow body will carry less weight in the wider world - so it is worth considering affiliation for those who work closely with the profession.

A professional body is clearly there to represent its members' interests. It is not a trade union, nor a regulator, nor a trade body for corporate interest - but it must be able to work closely with all these. At heart it must have a structure that allows it to provide members with the tools for continuous professional learning, for supporting career development, underpinned by the appropriate accreditation.

Leadership challenge
At the heart of all this is leadership. Such a professional body must have an authoritative voice - to the profession itself, but also on the national stage. That demands a governance structure that commands the support of members. Nothing is more destructive to the reputation of a body than the appearance of factionalism and excessive internal political manoeuvring; we can all name examples to illustrate that. These are usually the result of the council of a body becoming remote from its members. So when setting the body up in the first place, it is vital to ensure that its structure is focused on member services first and foremost, and that it stays that way. Good communications is not a luxury; without it, no success is possible.

Nigel Clarke chaired the inquiry into a professional body for pharmacy (The Clarke Inquiry)

➔ Website where pharmacists' comments about professional body