Recently in Learning disabilities Category

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.

by Phil Collins, head of social work at Cedar House, a low-secure hospital near Canterbury for people with learning disabilities and mental health problems

One of the welcome changes in 2007 to the Mental Health Act was that all detained patients have a right to an independent mental health advocate. They act as an extra layer in standing up for a patient's interests and, in the worst cases, bringing to light any malpractice.

However, in March a report by the Mental Health Alliance found detained patients were not getting independent advocacy due to under-funding and inadequate commissioning.

At Cedar House we have advocates visiting twice a week. But, particularly when such advocates are not available, there is a real onus on social workers operating in such services to act as scrutinisers of care.

This is even more pressing when considering that such an in-house social worker will usually be the only non-medical professional on the multi-disciplinary team responsible for a patient's care and treatment. The psychiatrist (responsible clinician), nurse, psychologist and occupational therapist all have a medical training and background. Social workers come to the table with a different skill set. With their emphasis on social models of care and treatment they are - in effect - the only non-clinician in the clinical team.

Every member of every multi disciplinary team in the UK will say they take a patient-centred approach and uphold the highest standards of care. Usually they do. But it is the social worker in that team who is slanted to see a patient's care from a less clinical perspective. I won't tell a psychologist what psychological intervention to use, nor will I tell a psychiatrist which anti-psychotic to prescribe. But I will, for example, make sure a patient's family is kept in the loop on any significant changes to treatment.

One patient I used to work with who was diagnosed with autism was prone to aggression towards another patient. Rightly, the clinicians' proposed intervention was therapy-based -  about improving the interpersonal relationship between the two. My emphasis, however, was on doing our best to keep the two patients apart in the immediate future. It was in the best interests of the victimised patient, I argued.

In a high-standard secure unit, there should be many layers of scrutiny of patient care, as there are at Cedar House. But social workers are the ultimate scrutinisers of a social model of care.

I am not a shy and retiring person, and if something is not as it should then I mention it. I'm not always right and it can sometimes lead to a fierce exchange of views. But I see this as nothing but positive, and so does my team.

If it means being like a sergeant major, and banging our fist on the table to put across our point, then so be it. As the learning disability sector is still in a state of shock after the Winterbourne View scandal, this is what needed to be a social care scrutiniser in a secure clinical setting.

Sam Coates writes a blog for the Time on line. He is the Chief Political Correspondent for The Times, based in the Houses of Parliament.

His post yesterday 3rd December was: The Equality Bill for Dummies

For some of the best line drawings ever commissioned by HMG, click here

He linked it to the EasyRead version of the Equalities Bill for people with learning disabilities.