Front Line Focus

Why mental health social workers can be particularly prone to stress

2012-01-04T08:25:09Z

Researchers at King's College London have recently launched a survey to measure stress among approved mental health professionals (AMHPs). This research is welcome because, although all social work can be stressful, there are some notable reasons why mental health social workers are particularly prone to stress.

In part, this is because of the intractable nature of the problems that they face. Invariably, these social workers are dealing with clients who are stressed or in a state of distress, who are often a risk to themselves, or to others, and who are unappreciative of interventions made in their interests.

AMHPs undertake assessments of people likely to require admission to hospital, sometimes under compulsion. This compulsory treatment, or the consideration of it, does little to foster trusting or therapeutic relationships with service users. Consequently, job satisfaction - a key factor in offsetting stress - is hard to come by.

Added expectation

Longstanding professional rivalries when working in partnership with professionals from health backgrounds further contribute to tension in the role. Then there is perhaps the added expectation that those working in mental health should be better at maintaining their own mental wellbeing; something that may dissuade them from admitting when they are feeling overwhelmed by work.

Previous studies by King's College researchers found that sickness rates were higher among approved social workers (ASWs, the predecessor to the AMHP role) than among non-ASW mental health social workers. They also found ASWs were less satisfied with their work.

Working in any field of social work is stressful at present. But mental health professionals are particularly troubled as local authorities, primary care trusts and mental health trusts are all looking to make huge savings. The combined effect is a sense that cuts are being made in a number of key areas that affect mental health provision.

A timely opportunity

How individuals cope with stress varies greatly and advice on how to deal with stress can sound trite, although ACAS and the HSE provide some valuable help in this area. Colleagues, too, are undoubtedly a useful source of support.

Over the years, advice, such as "choose your battles carefully", "always make time for a proper lunch break" and "leave work at work", has all been helpful. And I've found the support of family and friends invaluable, along with a set of interests that I look forward to outside of work.

The current King's College research project is a neat online survey. It is an important and timely opportunity for mental health social workers to contribute to the understanding of stress in the workplace.

More information

Approved mental health professionals polled over stress

Burnout: a social workers' survival guide

Mark Drinkwater is a community worker and Community Care's practice adviser.

Social work at Christmas: hope amid the gloom?

2011-12-20T12:40:23Z

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

'Tis the season to be cheerful, and for many children and families it will be. But such a sentiment does not always apply to the children and families social workers are involved with. They are having to pay the price for what the academic George Lambie calls the 'debacle of neoliberalism' (see 'From Recession to Renewal' edited by Joanna Richardson). They had no part in causing the economic and fiscal crisis facing the globalised, capitalist world, and yet are facing cuts in services and welfare benefits. There is also ever more job insecurity and anxiety, even if people manage to find increasingly scarce employment. Christmas will be a stressful time for many, though social workers and others will be doing their best to make a positive difference.

Skeleton staff

Although children and families are facing the brunt of austerity measures, social workers are not immune. Many local authority offices only open with 'skeleton' staff over the Xmas/New Year period. They will have to cope with increases in domestic abuse referrals, often related to the stress caused by the current economic and financial catastrophe. There will also be instances of family breakdown. For example, young people falling out with parents/carers and deciding (not a real 'choice' in the current jargon) to leave home. Because of austerity measures they will be unable to turn to local authorities or charities for assistance. Homelessness always becomes a more important issue over the festive period.

Twist in the tale

More positively perhaps, managers praise the fact that 'everyone' has worked hard over the preceding year - targets have been met, outcomes for children have been positive, and good inspection reports have been written. But there is a twist in the tale - next year is 'going to be challenging' with ever more resource constraints and efficiency savings needed. The need is to 'get more for less'.

The unspoken narrative is that there will be continued job losses and reductions in services. While social workers might feel secure, thinking that support and other staff are in the firing line, this should not be overstated or taken for granted.

An ideological problem

The key problem is ideological. The Conservative-led coalition is using the economic crisis as a front to reduce the role of the state in meeting citizens' needs unless they happen to be 'troubled' families needing 'trouble-shooters'. Other than this, people are expected to rely on themselves, family, friends and charity. If this project succeeds the danger is it will take us back to Victorian times.

But perhaps all is not lost. Ed Miliband has spoken about what comes after the neoliberalism, this echoed by academics who talk about the 'post-liberal world', one where notions of social justice and equality will be more to the fore. Then there is the Social Work Action Network conference in Spring of next year focussing in 'cuts, crisis and resistance', together with the need to build alliances in social work and social care. This is with a view to working towards a different world.

A season to be cheerful it may well be and, despite the doom and gloom, there may be hope on the horizon.

Online Community Care can focus the voices of social care

2011-11-17T15:25:50Z

by Nigel Leaney, manager of a mental health residential service

This is a hello, goodbye moment but I'll spare you a Beatles singsong. Next week is the last print edition of Community Care magazine, to make way for an exclusively online version. The fact there are now 300,000 online users of communitycare.co.uk is clear evidence of its success, as well as it being the largest specialist site for social work jobs in the UK.

Clearly the magazine will be missed. The aesthetic and practical experience of reading printed paper is different to looking at a screen. Until I was given a Kindle as a gift I was a luddite when it came to e-books. Now, much to some colleagues' amusement, I'm a fan. Not that I'm arguing for the demise of the printed book, more of a co-existence.

Moving with the times

In cash-strapped times, the like we've never seen in living memory, local authorities will inevitably question, and have a duty to do so, placing a printed advertisement in a magazine when the same outcome can be delivered through cyberspace for better value. Community Care has to move with the times, and as a respected brand there is every reason to be positive.

Apart from the squeezed readers' letters, magazines are pretty much autocracies having little to offer for encouraging a democratic, inclusive approach with their readership. An online Community Care has an opportunity to get the voices of social care professionals heard. And heard loudly. If this isn't an important time for this to happen then George Osborne doesn't need an abacus for Christmas.

Challenging the market forces

We need this website as an opportunity for all of us to challenge the market forces that are out to destroy social care. Not because they have to but because the government are cynical opportunists who are able to exploit the times to further their ideological taste for disaster capitalism as propounded by Milton Friedman et al.

When governments and their poodles start to exploit, devalue and rubbish the staff that are their responsibility, then we all sacrifice the care we purport to provide to vulnerable people in a supposedly civilised society, and then serve notice on the meaning of our professional identity and our ultimate existence.

An online Community Care with the contributions of its massed readership can hold central and local government to account, catch them in its web! It can give them a conscience, wanted or not.

Perhaps we need a minute's silence for the end of a wonderful publication then raise our glasses - okay cyber ones - to the new web future. Community Care is dead, long live Community Care!

When did performance management replace people skills in social work?

2011-11-14T12:00:22Z

by Sybil*, a children and families social worker

This autumn I found myself, like many others, watching the 16 year olds on Young Apprentice bossing their peers around and trying to impress Lord Sugar with their management and profit-making skills. The message is quite clear: only the personal qualities matter, not the background or education and, rather disturbingly, it's less important what strategy the project manager employs to achieve the goal, as long as they are successful.

I have also always thought that social work management has to be, by its nature, completely different to this type of corporate management. The purpose of our work is helping people change their lives, protecting vulnerable children and adults and, in some cases, taking part in life-changing decisions. Surely these delicate matters are less predictable than a business plan would require?

Yet, to my horror, I realised that many believe that it does not matter if you deal with people or potatoes, the workflow management is the same. It was the start of my acquaintance with the principles of corporate management in social work.

Timescales and budgets

In the past few years I've seen a strong shift towards performance management as the key part of the social care manager's role. The central government's obsession with statistics and reports has filtered down to all levels of social work management, creating a frenzy of targets and performance indicators. A good manager is seen as the manager who ensures that all paperwork is up to date, all statutory tasks are in timescale and the budget at the end of the year is not overspent. Poor quality of work might be forgivable, poor stats are not. And yet, we all know that bureaucracy does not keep children safe.

The best managers I have known stood out through their excellent people skills, their knowledge of their team's cases and their knowledge of their workers strengths and weaknesses. They were not afraid to disagree with the senior managers and they certainly would not have put a price on a child's life or welfare. They did not necessarily get on well with technology but they never started supervision with "Let's see where you are with your stats" but with "Tell me about this child". This made the workers trust them when they made a decision and their professional expertise was often consulted. Sadly, many of these managers were driven away from frontline practice as outdated, and replaced with others that seem content to spend all day at the computer looking at data, completely out of touch with the team that is crumbling under their excessive workloads.

Special person

I always thought that being a frontline team manager is the most difficult job in the whole local authority, requiring professional expertise and people management skills as well as a fully developed sense of leadership and personal accountability. It takes a very special person to fulfil this role successfully. Unfortunately what many managers seem to have forgotten is that while it might take a short course to learn performance management, it takes a whole career to become a good social work manager.

*name changed

How flexitime can tackle social work's long hours culture

2011-11-02T11:18:52Z

by John Grier, a team manager at Bradford Royal Infirmary

In these hard times of more for less we all need techniques to keep us going - to maintain that precious work-life balance. Perhaps the best stress-buster tool I've come across is flexitime, a humble unsung administrative procedure perhaps, but it can offer us a lot. If you already use it all I can say is make the most of it, if you don't, read on.

Still with me? Then you are probably working to some sort of time off in lieu system, the good old "TOIL". In my first qualified job the team leader had her own belief that social workers' pay included an unspoken allowance for overtime. To make a case for TOIL you had to confront her in her office, persuade her to take the TOIL book out of her desk on then argue for every hour you worked over. Needless to say not many people had the stomach to claim.

Horror stories

Since becoming a manager, however, I've seen the other side of TOIL, hearing horror stories of staff putting in claims for weeks worth of vaguely justified and recorded overtime, often at the most inconvenient times for team cover.

For both managers and staff TOIL can be a chore to record and monitor, so often genuine time owing is lost for the sheer hassle of writing it all down and totting it all up.

May I recommend flexitime as a handy off the peg system that is easy to use, tried and tested widely and has some inherent benefits? I've worked both systems and know which I prefer.

Getting the message

Log on in the morning and log off when you finish work, noting time taken for lunch - it healthily encourages you to take at least ½ hour - and you will see at the end of the month if you are in debit or credit - most of us will find it's the latter. The work/life balance it promotes is based on if you build up more than a day per month you lose it, so most people get the message and take their time back.

Flexitime mitigates against the worst of the "martyr" culture where people parade their dedication by working longer hours than their colleagues. I suspect it also mitigates against work-related stress by encouraging hard-working staff to take regular "breathers". It even makes your precious annual leave go further as you can add any flexitime hours when you want to book a longer break or family holiday. You can even "borrow" up to a days worth of flexitime - just so long as you pay it back!

It's not perfect or a total remedy for the intense demands many of us are under. Like any system it needs managing and monitoring. However, it's one example of computers working for us, not the organisation, as you see all your long hours being counted for you with the promise of a precious afternoon or whole day off. Just make sure you occasionally take it as "me" time, not just for family duties!

Social work in a time of cuts: if you didn't laugh you'd cry

2011-10-26T13:04:32Z

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

Frontline social workers have always used humour as a way of coping with their day-to-day work. It is a form of gallows humour, a type that still manages to be funny in the face of stressful situations. As Sigmund Freud once put it when writing about this subject, 'The ego refuses to be distressed by the provocations of reality, to let itself be compelled to suffer'.

Child protection social workers are particularly prone to such humour, but all social workers and social care staff face ever increasing pressure and resulting stress as public expenditure reductions bite home. Services to the most vulnerable are either being cut to the bone or are no longer available. As a colleague said 'many social workers develop quite a dark sense of humour to be able to cope with what can be extremely upsetting and difficult circumstances'.

Drawing the line

Some may frown upon the use of such humour because it minimising people's difficulties. Admittedly, there may be odd occasions where it is used inappropriately, thereby being disrespectful of users and amounting to oppressive practice. However, most practitioners know where to draw the line, only using humour as a way of 'release'. Having a joke about a situation relieves tension, and a less tense social worker can surely deliver a better service.

After all, the benefits to laughing are well known. These including relieving stress, even depression, and again this can only be beneficial to workers and users alike.
Furthermore, humour can actually be part and parcel of good practice. It can be used to develop rapport with difficult to reach users, for example. Similarly, it can be particularly helpful in building relationships with children and young people.

Not robots

It has to be remembered that social workers practise in social settings with real people. They are not robots working in a sterile environment. They do have a duty to uphold respect for the individuals they work with, but if using humour in appropriate ways helps in doing the job, it should not be called into question.

As another respected colleague said, 'Humour plays a part of daily social work life and interaction. We are committed professionals who strive to improve the life chances of the children and families we come in to contact with. However, there are clear pressures which, if not balanced with time out to talk about experiences and laugh at situations, would lead to more people leaving the profession through stress or simply being off sick.'

Returning to Freud, the ego 'insists that it cannot be affected by the traumas of the external world; it shows, in fact, that such traumas are no more than occasions for it to gain pleasure.' Perhaps the old master has it just about right.

The harsh reality of delivering social care in the voluntary sector

2011-10-26T11:30:38Z

A few weeks back I led a tour of voluntary sector organisations providing social care locally. With shrinking public services, these providers are central to the delivery of adult care and this excursion was a response to requests from statutory professionals - from the local authority, primary care and mental health trusts - who wanted to know what voluntary sector resources were available locally.

We stopped off at six projects for around 20 minutes each on a circular tour that took us no further than half a mile from the town hall (much to the chagrin of those who were hoping to journey farther afield). What we found was truly inspiring: voluntary sector organisations providing some great services with limited resources.

But much of what we discovered was disheartening. Our tour started at an advice centre where staff reported that enquiries had nearly doubled in recent years, with precious little increase in their resources. We also met with a learning disability provider who had lost a number of supported housing projects through competitive tendering processes. While they had picked up a few new contracts in their place, the unintended consequence of these changes in providers was that many service users had endured a protracted period of instability and insecurity.

The greatest challenges were perhaps faced by an older people's project. Earlier this year, they lost a large day-care contract with a neighbouring local authority. A further blow came when they failed to retain a home care service they provided; the contract was re-tendered and they were outbid by cut-price provider. Faced with a 65% drop in annual income they had just completed an agonising restructure which had made many of their highly-skilled staff redundant.

Like others on this tour, this provider saw little cause for optimism about the current climate in social care where brutal cuts are being introduced and commissioners favour ever-cheaper providers.

Social work has not lost its allure as a vocation

2011-10-25T12:46:04Z

By Helen Bonnick

The notion of social work as vocation is an old one; the idea of an occupation to which someone feels called and to which they are suited by skills or personality. The pioneers of social work often made great personal sacrifices in their service to the community, whether from a church or political background. Most of the social work codes of ethics or conduct speak of protecting the dignity and rights and interests of service users, as well as personal integrity and honesty. Student applications often refer to a sense of debt to society, or a deep, long held determination to serve others. The old reasons that individuals were drawn to social work hold good today.

And yet here social work stands, not with a sense of a lifetime calling, but with an average retention rate of eight years.

It often seems remarkable that people continue to stream to social work in the face of the much-publicised frustrations of those already in the field. What started out as a noble profession all-too-soon starts to feel like a technical task: driving a computer, the setting and measurement of targets, swamped by paperwork so that there is no time for face to face contact with service users. Within social care, we are familiar with the great pendulum swings: care or control, generic work or specialist teams, the alignment of children's services with adults or with education.

But while there are, sadly, plenty of unhappy social workers, as I travel around the country I also meet those whose teams are fully staffed and well-managed, where the work is calm and fulfilling and where a sense of purpose - and even of vocation - prevails. We need to be honest with those coming into the profession about what they face. But I am heartened, as I read the placement applications of prospective students, to see that the notion of calling and vocation remains.

Helen Bonnick is a social worker and practice educator

Conflict not always unwelcome in family court

2011-10-21T10:00:11Z

by Natalie Wyatt, a children and families social worker

With the Family Justice Review due to be published next month there is a renewed focus on the courts and the professionals working within them: solicitors, guardians, judges, expert witnesses and social workers. With so many different professionals with varying views, functions and levels of status it is easy to forget that we are all working to promote the best interests of the child. Conflicts can arise and professional egos can get hurt but is this always a bad thing? Thinking of it from the child's perspective would you rather your future be decided based on the evidence produced by one individual or would you rather your future had been rigorously debated and plans scrutinised to ensure you receive the best possible outcome?

Timely decision making

Of course delay is a huge issue within the family courts and the aforementioned rigour and scrutiny must be balanced by swift, timely decision making. Social workers can help this process along by ensuring the assessments completed prior to proceedings are as evidenced-based and thorough as possible, clearly reflecting the wishes and feelings of the child. Given the quality of some assessments making their way into the court arena and a common paucity of parallel planning it is understandable that guardians and solicitors can be critical of social workers.

Authorities' independence

What is less understandable however, is the widely held belief that local authorities somehow lack independence. The commissioning of expert assessments (in my experience the biggest cause of delay in public proceedings) often happen in response to claims that local authority assessments are not independent enough. This argument ignores the fact that local authorities have no vested interests in bringing children into care.

In fact it is the opposite, over the course of a child's lifetime, placement costs can run into hundreds of thousands of pounds. Bearing in mind this huge cost and more importantly the poor outcomes for looked after children it is clear local authorities do not enter into proceedings rubbing their hands together waiting to be lavished with some invisible reward. In my experience the feeling one gets when entering in to the court arena is never pleasurable but you do it in the belief it is the morally right thing to do.

Valued and respected

In the course of writing this piece I was asked if I feel my input at court is valued? Given that I've yet to be taken on in cross examination and that the requested order has always been obtained, yes I feel my statements are valued and respected. But when the day comes that I'm slaughtered on the stand or an 'independent' social worker is appointed to repeat the work I thought I'd already done maybe I will refer back to my opening paragraph and try to see it from the child's perspective.

Being mistaken for a social worker is a great compliment

2011-10-13T11:13:12Z

By Stuart Ayris

In 2009 I was given the opportunity to manage a community mental health team, having spent the previous 12 years of my career as a psychiatric nurse working on the wards.

Although I have been a nurse for 14 years, I have never defined myself by my profession. The first thing that struck me about my social work colleagues was how important being a social worker was to them; their passion for what they do, the oft expressed belief that all decisions should be considered within an ethical and moral framework. Phrases such as "in the spirit of the Act," and "the best interest of the client" echoed around the walls of my newly inhabited office. These people were proud of their profession.

The first time I was told, "you should have been a social worker," I was a little bemused. All I had done was remark that medication isn't always the answer. Did that imply nurses only consider pharmacological interventions and that social care has a monopoly over right and wrong? When a student nurse asked me what it was like being a social worker, I began to look deeper at what was going on. Me, being mistaken for a social worker? The cheek.

Working with my social work colleagues has been very much a learning experience. Not only have I had to learn the language but, in my role as team manager, I have had to negotiate the labyrinth that is the council HR and payroll policies. More importantly though I have also been obliged to let go of the years of pre-conceptions that had crept into my consciousness as I toiled away in the acute admission ward.

About a year into my new post, I began to see that what underpins our professions is nothing more complicated than values. The austere economic conditions have forced us, due to increased referrals and reduced budgets, to bridge those historical gaps between the professions. I am not talking about generic working but of one shared value - that of compassion.

If I were a client, I would not care if I were shown a name badge stating "social worker" or a name badge stating "community psychiatric nurse". What I would want to be shown is compassion. And compassion is not the proviso of any one profession. It is beholden upon all of us, social workers, nurses, psychologists, doctors and allied health professionals so show compassion for each other and for those whom we try so hard to help.

So I guess being mistaken for a social worker isn't such a bad thing after all. Not any more. Now that is one hell of a compliment.

Stuart Ayis is a community mental health team manager

The jargon and the reality of "flexible" social care

2011-10-06T09:23:47Z

(Does your manager use jargon? Pic posed by model: Image Source/Rex Features)

by John*, a care worker

Anyone who works in a care setting will be used to those higher up the pecking order talking in 'jargonese.' However a director's 'innovative and exciting' service may feel totally different to those working on the front line. So here's a guide to what those jargon words may actually mean to front line care workers.

An exciting period of transition: your job may be disappearing

Reviewing terms and conditions: the management are looking to save money by increasing 'flexibility' and making the organisation 'leaner' and more 'efficient' (see below). Often involves a cut in front line workers' wages.

Realigning terms and conditions: the management have done their review (see above) and now you will have to do more work for less money.

Flexible: You'll be expected to work any hour of the day and night but you won't be getting any extra money for working those anti-social hours

Efficiency savings: we're going to save money by cutting the pay of care workers or by making them work longer hours or by making them work more flexibly (see previous entry) or by sacking some workers and making the ones who are left work even harder or by a combination of all of these things.

A lean service: you're going to need the body and the stamina of a marathon runner because there won't be enough staff or allocated hours to do the job properly. Especially applicable to home help services for the elderly.

Competitive rates of pay: you'll be paid just as poorly for doing the job as other care workers in other organisations but we don't wan't to actually spell out the poverty wages in this advert.

Offering competitive rates of pay to attract the best candidates: this only applies to those in senior positions and it doesn't apply to front line care workers. Attracting and retaining the best candidates to do the job is obviously not that important when the job involves caring for the vulnerable in our society.

Downbanding: on a recent television programme this was said to be a new thing but anyone who works in social care will have been familiar with this concept. Jobs in social care are continually being 'rebranded', terms and conditions are being changed and wages are being cut. This has been going on for at least the last 20 years which has resulted in a relentless downward pressure on wages as well as on terms and conditions.

In due course: If something's going to happen 'in due course' it means it's either going to happen in the dim and distant future or never.

We're looking into it: you'll recieve an answer to your question or query 'in due course'(see above).

Work/life balance: you'll need to be an expert at juggling both your money and your time if you want to have any kind of life as you're likely to be working long, anti-social hours for low wages.

*Name changed

Social workers expect distress from service users but can they deal with it in themselves?

2011-09-29T10:05:21Z

by Sybil*, a children and families social worker

Imagine the following scenario: "Mary felt her heart racing as the meeting was progressing. She felt low and demoralised, and the woman on the other side of the table was constantly criticising her, making her look like she could not do anything right. Nobody present was doing anything to make this stop, and Mary eventually had to leave the meeting. As the door closed behind her, Mary broke down in tears".

It sounds like a typical scenario teaching social workers about power imbalance, anti-oppressive practice and how to be constructive in their relationship with their service users. Only that in this scenario, Mary is the social worker. She is a young social worker I once met as she was crying in the women's toilets after a difficult and badly managed meeting. She tried not to cry in the office, trying to avoid the inquisitive looks of the dozens of people present in the office at that time.

Anger distress and avoidance

Dealing with emotions is social work bread and butter. Anger, distress, avoidance - social workers know to expect them in their service users. Somehow, though, many social workers I meet appear surprised to find these feelings in themselves, as if it is something to be ashamed of. Unfortunately, crying is still often seen as a sign of weakness in the professional environment, although the same people acknowledge it as a part of emotional health for a service user.

There are many types of tears in social work. There are tears of sadness, tears of joy and tears of feeling overwhelmed and powerless. Social work does involve a huge human cost, which is very rarely acknowledged. Many managers see their duty as monitoring their workers' performance, but not their emotional health at work.

Like many others, I have found myself crying in the car on the way home after a difficult, exhausting piece of work that took place after hours, with nobody available for a debrief. I also could not hold back the tears when I heard that a young person with whom I once worked had passed away as a result of a very destructive lifestyle. Although I know the limits of my role and responsibilities, I am also human and I do care about the young people with whom I work.

Uncontained distress

Undoubtedly there is a difference between workers managing the emotions brought by their work and them feeling overwhelmed and showing distress in an uncontained manner. Service users expect the professionals involved with them to be trustworthy, reliable and stronger than they are themselves. They also make the distinction between the tears of a worker showing empathy and the tears of a worker who cries because of workload pressures. While the first can aid the healing process, the latter can undermine the whole organisation.

I don't think that workers should ever stop experiencing emotion at work; on the contrary I think that a worker who has shut down is a very dangerous one. But I also think that managers need to be more proactive in providing opportunities for their workers to offload and reflect in a safe environment and even provide specialist counselling services for workers involved in particularly complex or difficult cases. In the absence of that, whispered stories tell of social workers on anti depressants or binge drinking between four walls at home, a behaviour that they might have criticised earlier in the day in one of their service users.

*Name changed

(Pic model released: Eye Candy/Rex Features)

Message to providers: don't forget the service user consultation

2011-09-27T14:24:38Z

by Mark Drinkwater

Social care professionals are often afraid to admit their mistakes. This is understandable as errors can have long-lasting negative consequences for service users. But one recent conversation I've had with a social care commissioner from a neighbouring borough proved refreshing in this regard.

The commissioner confided that they had been going through a process of tendering out some reconfigured social care services. In accordance with good practice they had gone through consultations with various stakeholders.

Things had started well. They had held some useful discussions with potential independent providers and had incorporated their comments into the plans. With these amendments in place, they felt they had tweaked the service specification sufficiently.

Before inviting tenders for this service specification, one final consultation needed to be undertaken. It was with service users.

The users and their carers had a host of searching questions about the nature of the service and how it would be delivered. The commissioner quickly found that they were unable to answer a large number of these concerns and it dawned on them that service users should have been the first interest group that they consulted.

It might have come as little surprise if the commissioner had been tempted to ignore the concerns of service users. Most of us are, by now, familiar with faux-consultations (the recent government consultations on NHS and social care reforms spring to mind) where the act of consultation is more about informing people about predetermined decisions.

But thankfully, this commissioner publicly acknowledged that they had overlooked several factors. They then set about revamping the service specification to address the concerns of the service users.

The key issue was not that they had made a mistake; it was that they were prepared to admit it and make amends.

Mark Drinkwater is a community social worker in south London

There is no care in stopwatch social care

2011-09-26T11:20:49Z

by Jane* a home care worker

My local authority is about to start paying home care workers by the minute using an electronic call monitoring system (ECM). I use the service user's home phone to log in or out when entering and leaving their property.

The council claims that Actual Time Invoicing will save money by clawing back precious pennies from unscrupulous care workers who cut calls short. I offer no support to carers who reduce half-hour calls to 20 minutes by rushing. However, there are incidents when reducing visit times is necessary.

My priority on meeting a new service user is to gain their trust and make them feel comfortable with my presence in their home. Sometimes this is simple and they couldn¹t give two hoots about stripping down to their birthday suit to be washed.

It can take time, however, especially if the loss of their independence is still a shock. Recently I started visiting one gentleman who would only let me make his breakfast. After much coaxing he allowed me to wash his feet, then under his arms and now he has full body washes.

Building that relationship was intense work. Leaving when he wished me to and gradually increasing the length of the call was an incremental part of giving him the sense of control he needed. Under the new system I would not have been able to do this without my wages being penalised.

Logging in can be delayed simply because the client is using their phone when I arrive. Once, I walked into a woman's house to find her walking about with her knickers and skirt round her ankles I didn't stop to log in before helping her.

If I finish putting someone to bed in 20 minutes, am I supposed to plonk myself on the sofa with the main carer until the end of the half hour? How fair is that on someone who hasn't had a moment to herself since 6am? What if the family decide to cook tea? After meds and helping the service user to the toilet do I sit at the table with them until the time is up? And what if I feel unsafe in a call? Am I to lose 15 minutes' pay because I put my safety first?

My team leader has told me that if I need to leave a call early she would chase up extra pay for me. I do not know how she will find time for this when she is already struggling with rotas and covering staff sickness.

Although the system could deter carers from cutting calls short it does not address the reasons why they do. Also, an unprofessional carer is unlikely to perform extra duties when forced to stay at a call until the end of the allocated time.

To reward carers according to the length of time spent in one place and not by the quality of our care is to underestimate the complexity of our work and diminish its importance.

*Jane (name changed) is a home care worker who wishes to remain anonymous

(Pic: julianlimjl on flickr)

Efficiency drives and a paperwork frenzy: just another 12 months in social work

2011-09-14T15:30:59Z

by Sybil*, a children and families social worker

"She cared about you, you know... She did not make this decision lightly and she was always telling us in the office how bad she felt about it and how worried she was for you..." Tears were streaming down the young man's face as I was telling him, a year later, how his social worker felt when she left for another job. She had been his social worker for seven years. Fast forward three years and here I am, looking very embarrassed, trying to think how in the world will I explain to this young woman that her social worker had just left her job after a few days notice - she was her fourth social worker and had only met her a few weeks before.

High turnover

I wrote a year ago about the negative impact that the high turnover of social workers was having on the children and young people we are meant to support and protect, and also on the workers left behind to pick up the pieces. Fourteen social workers and one manager later, it feels like little has changed. Repeated changes in senior managers have added to the difficulties in retaining workers, who feel that the organisation is too unstable to be safe.

Our local authority is trying hard to change this situation. Additional resources have been created, the quality and frequency of supervision has improved and social workers are more involved in decision making than ever before. Somehow, though, these efforts still seem to miss the point and the grass continues to look greener on the other side. So where are we going wrong?

Top-down change

I don't think there are easy answers and at times when too much change is imposed top down and at a speed that feels too high, workers feel unsafe. Doing things right in social work does not always mean doing things quickly, and speed is a highly valued element in "efficient" organisations. For families, however, doing things at their pace is far more important than ticking a lot of boxes and social workers are placed in a situation where they have to cut corners and many refuse to do so.

Then there is the paperwork frenzy. The potential of bureaucracy to self reproduce is remarkable and I was amazed to discover that as our caseloads significantly reduced, the amount of paperwork to be completed increased. The reduced caseloads mean we are expected to review paperwork at least twice as frequently and update plans after every single meeting rather than after a significant change of circumstances. This leaves workers feeling that nothing has really changed and they are still expected to complete unrealistic amounts of documents, at times at home after hours.

I have not met a social worker who would refuse or complain to work late in case of an emergency or if the safety or welfare of a young person required it. Many of us have given up time at the weekend or in the evening to attend a special event for a young person on our caseload. However, giving up time with our families to feed the bureaucratic machine of unnecessary paperwork for newly invented internal protocols is where most of us draw the line.

* Name changed